Rationale Statements Research Articles

Exploring the rationale for prescribing ankle–foot orthoses and supramalleolar orthoses in children with cerebral palsy: A narrative synthesis of rationale statements

Background: To help improve outcomes for children with cerebral palsy (CP), ankle–foot orthoses (AFOs) and supramalleolar orthoses (SMOs) are prescribed. However, it is not clear why one intervention is prescribed over the other. Objectives: To explore the rationale for prescribing AFOs and SMOs in children with CP and its link to the choice of outcome measure used. Study design: Narrative review. Methods: Six databases were searched (eg, Medline) and data extracted from articles that met the inclusion criteria. Data describing the participant demographics, type of orthosis, and outcome measures used were summarized to provide context for the different rationale for orthotic prescription that were thematically analyzed. Discussion: Forty-seven articles were included. Participants were aged 9 ± 2 years, 59% were male, 79% had diplegia, and 38% were classified as Gross Motor Function Classification System level I. All studies included a rationale for prescribing AFOs that, in most cases, reflected the outcome measures used. These rationale statements were synthesized into 5 specific themes (e.g., reduced energy expenditure and metabolic costs). By comparison, 5 of these studies described the rationale for providing SMOs, and of those that did, most of the rationale statements were nonspecific. Conclusions: A large and contemporary body of literature describes the rationale for prescribing AFOs for children with CP. There are opportunities for future research that clearly articulates the rationale for prescribing SMOs for children living with CP and to focus the rational for orthotic intervention on the real-world challenges that are most important to children living with CP, such as the ability to participate among peers.

Why go green? Comparing rationales and planning criteria for green infrastructure in U.S. city plans

Green infrastructure is an increasingly popular urban sustainability strategy, widely promoted for its ability to provide multiple benefits. We examined 120 planning documents from 19 U.S. cities to identify if and how the stated benefits that cities use within their rationales for green infrastructure programs (rationale statements) align with the criteria used to site green infrastructure at the neighborhood scale (siting statements). Our findings suggest that many of the desired benefits stated in the rationales for green infrastructure lack corresponding and specific siting criteria. This was particularly evident for rationale statements concerning social and cultural ecosystem services, seemingly because certain benefits, especially those related to stormwater management, are prioritized over other green infrastructure services. While multiple benefits remain a dominant rationale for green infrastructure in the cities analyzed, including stormwater management, social cohesion, and biodiversity benefits, siting criteria were dominated by stormwater management, available locations, and other logistical considerations. These findings indicate a large-scale misalignment between the multifunctional ideal of urban green infrastructure and the procedures used to implement green infrastructure programs. We conclude with a discussion of how siting criteria and processes can be elaborated to deliver the desired benefits of green infrastructure.

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care.

BackgroundChronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems.MethodsThe QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus.ResultsFour QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components.ConclusionThe CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.

Mississippi’s whole body donors: Analysis of donor pool demographics and their rationale for donation

BackgroundWhole body donation (WBD) is fundamental to anatomical education and research because human dissection provides an educational tool for training healthcare professionals. Investigation into the demographics and rationale of whole body donors can provide insight on who donates their bodies to science. Literature reports a typical donor who is a 60 to 70-year-old, white, married, educated man with the reason for donating to be altruism. Because there are no studies in the United States (US) about the rationale of WBD in correlation with the donor characteristics, this study seeks to accomplish two aims: (1) analyze the demographics of the University of Mississippi Medical Center’s (UMMC) current donor registrants and (2) analyze their reasons for donation. MethodsData from authorization forms from living preregistered donors were analyzed. A survey was sent to registrants who filled out these forms between 2017 and 2019 about their reasons for body donation. ResultsUMMC has an average donor registrant population consisting of 69-year-old white (95.2%), females (56.5%) who acquired a college degree (24.9%) and are in good health at the time of donation (50.8%). Males and females differed in their marital status (p = 0.001), with more married males (67.2%) than females (46.2%) donating their bodies to science. Seven hundred eighty-one registrants completed the survey (56.3% response rate, n = 1,387). Their primary and secondary reasons for donation were furthering medical education/research (57.4%) and giving their body purpose after life (49.2%), respectively. In addition, thematic analysis of 62 donor rationale statements revealed that the majority of registrants wanted to donate their bodies for the purpose of being useful. ConclusionsThese results indicate that UMMC’s current registrant demographic data deviates from what is presented in the literature. The study also found that the main reason for donation for this registrant population was altruism with the purpose of being useful. Information from this study adds current US data to the published literature on WBD.

Working with multiple representations: preservice teachers’ decision-making to produce a digital explanation

ABSTRACT A “digital explanation” is a science learning task where learners explain science content to non-expert others, in this case, the learners are primary preservice teachers [PST] in a science methods class. In the task, PST are assigned a prompt based on science content from the New South Wales K-6 syllabus and generate or source multiple representations to design and produce this stand-alone digital artefact. In this study, PST were interviewed about their decision making in producing the digital explanation, which offers insight into the design process and what makes for a successful product. Data include the digital explanations, interviews with nine PST, marking rubrics and rationale statements generated as part of the task. Thematic coding shows PST make design decisions for four principal reasons: content, engagement, clarity and unconscious selection. Decisions around content and engagement prevail and their decisions reveal keys to success in creating a digital explanation. We also note a tension between emphasis on engagement over content, which may reflect that the intended audience is young children and PST have a strong desire to gain and keep children’s interest.

The quality of reporting in randomized controlled trials of acupuncture for knee osteoarthritis: A cross-sectional survey

ObjectiveTo assess the reporting quality of acupuncture trials for knee osteoarthritis (KOA), and explore the factors associated with the reporting.MethodThree English and four Chinese databases were searched from inception to December 2016 for randomized control trials testing effects of acupuncture for knee osteoarthritis. We used the standard CONSORT (2010 version), CONSORT Extension for Non-Pharmacological Treatments, and STRICTA for measuring the quality of reporting. Using pre-specified study characteristics, we undertook regression analyses to examine factors associated with the reporting quality.ResultsA total of 318 RCT reports were included. For the standard CONSORT, ten items were substantially under-reported (reported in less than 5% of RCTs), including specification of important changes to methods after trial commencement (0.6%), description of any changes to trial outcomes (0.0%), implementation of interim analyses and stopping guidelines (0.6%), statement about why the trial ended or was stopped (1.6%), statement about the registration status (4.4%), accessibility of full trial protocol (4.7%), implementation of randomization (4.7%), description of the similarity of interventions (3.5%), conduct of ancillary analyses (3.8%) and presentation of methods for additional analyses (4.4%). Four of the STRICTA items were under-reported (reported in less than 10% of RCTs), including description of acupuncture style (8.5%), presentation of extent to which treatment varied (1.3%), statement of practitioner background (7.2%) and rationale for the control (9.1%). For CONSORT Extension, the reporting was poor across all items (reported in less than 10% of trials). Trials including authors with expertise in epidemiology or statistics, published in English, or enrolling patients from multiple centers were more likely to have better reporting.ConclusionsThe reporting in RCTs of acupuncture for KOA was generally poor. To improve the reporting quality, journals should encourage strict adherence to the reporting guidelines.

Categories that should be removed from mental disorders classifications: perspectives and rationales of clinicians from eight countries.

To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.

The 50th Anniversary of the US Surgeon General's Report on Tobacco: What We've Accomplished and Where We Go From Here

January 11, 2014, marks the 50th anniversary of a significant milestone in our nation's public health. It was on this date in 1964 that US Surgeon General, Dr. Luther Terry, courageously released the first Surgeon General's Report on Smoking and Health.[1][1] This landmark report transformed the way

IT funding's race with obsolescence, innovation, diffusion, and planning

AbstractIn times of difficult funding, information technology managers must build new foundations, rationale statements, methods of operating, and measures of accountability to maintain a strong funding base to sustain information technology.

Why We Need to Teach the Evolution of Morality

I present the case that the topic of the evolution of human morality is essential to any complete introductory biology course. This statement of rationale is accompanied (in complementary contributions) by: (1) a textbook-styled survey of recent literature on the topic, suitable for classroom use or as background for any teacher (Allchin 2009c); (2) a survey of current textbooks and available resources, with a brief discussion of teaching strategies (Allchin 2009d); and (3) a set of online resources (images and presentations) for classroom instruction (Allchin 2009a).

Aging and Text Comprehension: Interpretation and Domain Knowledge Advantage

In this study, young, middle-aged, and elderly adults read two different history texts. In the knowledge advantage condition, readers read a history text about an event that was well-known to readers of all ages but most familiar to elderly adults. In the no advantage condition, readers read a history text about a political situation of a country that no age groups knew much about. After reading the text, readers recalled and interpreted the texts. Comparison of the recall and the interpretation performance showed that while recall was best in the young group and declined with age, interpretation did not. The middle-aged and elderly adults generated interpretations that were equally deep and more synthetic than those of the young adults. They also generated interpretations with more diverse rationale statements. As for the effect of knowledge advantage its effect on text recall was straightforward: although not significant, age-group differences in recall were smaller in the knowledge advantage condition than in the no advantage condition, suggesting that age-related decline in recall can be moderated by older adults' knowledge advantage. The effect of knowledge advantage on text interpretation was less clear-cut. While knowledge facilitated interpretations, the facilitation was not uniform across different measures of interpretations, suggesting a complex interaction between text interpretation and knowledge.

European National Society Cardiovascular Journals. Background, Rationale and Mission Statement of the “Editors´ Club”

Anesti Kondili MD, Djamaleddine Nibouche MD, Karlen Adamyan MD, Kurt Huber MD, Hugo Ector MD, Izet Masic MD, Rumiana Tarnovska MD, Mario Ivanusa MD, Vladimir Stane.k MD, Jorgen Videbak MD, Mohamed Hamed MD, Alexandras Laucevicius MD, Pirjo Mustonen MD, Jean-Yves Artigou MD, Ariel Cohen MD, Mamanti Rogava MD, Michael Bohm MD, Eckart Fleck MD, Gerd Heusch MD, Rainer Klawki MD, Panos Vardas MD, Christodoulos Stefanadis MD, Jozsef Tenczer MD, Massimo Chiariello MD, Joseph Elias MD, Halima Benjelloun MD, Olaf Rodevand MD, Piotr Kułakowski MD, Edvard Apetrei MD, Victor A. Lusov MD, Rafael G. Oganov MD, Velibor Obradovic MD, Gabriel Kamensky MD, Miran F. Kenda MD, Christer Hoglund MD, Patrizio Lancellotti MD, Thomas F. Luscher MD, Rene Lerch MD, Moufid Jokhadar MD, Habib Haouala MD, Vedat Sansoy MD, Valentin Shumakov MD, Adam Timmis MD.(European National Society Cardiovascular Journals Editors, see Appendix for complete affiliations).

European National Society Cardiovascular Journals. Background, Rationale, and Mission Statement of the “Editors' Club”

European National Society Cardiovascular Journals. Background, Rationale, and Mission Statement of the “Editors' Club”

Once More unto the Breach: Trying to Get Preservice Teachers to Link Historiographical Knowledge to Pedagogy

This essay describes the results of an experimental class co-taught by an historian and a social studies educator. The class was designed to accomplish two things: to narrow the gap in disciplinary thinking between preservice teachers and historians, and to overcome the preservice teachers' compartmentalized thinking about the nature of their newly acquired historical knowledge and the teaching of it. Through an analysis of the teacher candidates' final projects, which included an historiographic essay, rationale statement, and teaching unit, I demonstrate that the course was only marginally successful with the first objective, but considerably more successful in achieving the second. I suggest that disciplinary thinking may be more useful as a means of improving pedagogy than as an end in itself, and I conclude with a reflection on how the course could have been strengthened.

Consultation and referral guidelines citing the evidence: How the allergist-immunologist can help

Consultation and referral guidelines citing the evidence: How the allergist-immunologist can help

“Reading and math take so much of the time…”: An Overview of Social Studies Instruction in Elementary Classrooms in Indiana1

This study reports the results of a comprehensive survey (59 fixed and 3 open-ended response items) of a stratified (by grade) random sample of K-5 teachers in Indiana (n = 594; response rate = 49.5%). Results indicated that social studies is becoming increasingly marginalized in the K-5 curriculum relative to other core subject areas (e.g., math and reading). Evidence from the study suggests that three factors may play a role in this marginalization: (1) perceived level of administrative support for implementing state social studies standards; (2) lack of state-wide assessments for social studies at K-5 level; and (3) teachers' lack of a clear understanding of the goals and mission of the social studies at K-5 level. Respondents were asked to describe their rationale for social studies at their respective grade level and to describe the value of social studies instruction for their students. Data concerning these rationale statements were analyzed, and eight distinct categories emerged. Less than 30% of respondents offered rationales that incorporated the widely agreed-upon mission of social studies instruction—citizenship education. The report concludes with a call to revisit and rewrite the 1989 NCSS Position Statement on Social Studies for Early Childhood and Elementary School Children to address the continued marginalization of K-5 social studies in the post-‘No Child Left Behind’ climate.

Priorities in english language education Policy and classroom implementation

This report presents findings from the PPELE study of English language instruction in classrooms in five countries and discusses how those findings relate to stated governmental policies on language and education. Data from classroom lessons and teacher rationale statements show that teachers are aware of policy initiatives related to language education and to the potential longer-term needs of students for English. However, teachers focus on immediate classroom priorities that influence daily lessons and give emphasis to student learning. These findings support a multidirectional interpretation of language policy – derived not only out of structural priorities and classroom priorities, but also influenced by the social and personal dimensions of classroom teaching and by teachers’ goals and beliefs.

Screening for obesity in adults: recommendations and rationale.

This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for obesity in adults based on the USPSTF's examination of evidence specific to obesity and overweight in adults and updates the 1996 recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov), the National Guideline Clearinghouse (http://www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The summary of the evidence is also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse. *For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.

Screening for Colorectal Cancer: Recommendation and Rationale

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer and the supporting scientific evidence and updates the 1995 recommendations contained in the Guide to Clinical Preventive Services, 2nd edition. At that time, the USPSTF recommended screening for colorectal cancer with annual fecal occult blood testing, periodic sigmoidoscopy, or the combination of fecal occult blood testing and sigmoidoscopy but concluded that the evidence was insufficient to recommend for or against colonoscopy or barium enema. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov), the National Guideline Clearinghouse (http://www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The complete information on which this statement is based, including tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned.

Appendix II

Appendix II