Standard Methodological Approaches Research Articles

Environmental control on larval stages of fish subject to specific salinity range in tropical estuaries

In this study, we used a comparative cross-system analysis and a standardized methodological approach to understand which abiotic parameters, in addition to salinity, can play an important role in determining larval fish assemblages in tropical estuaries. Surveys were performed by using surface trawls in the same water mass (salinity ranging from 15 to 25) in four Brazilian estuaries (Macaé, São João, Bracuí and Perequê-Açu) from May 2013 to March 2015. Water temperature, oxygen saturation, pH, chlorophyll-a, nitrate, nitrite, ammonia, phosphate and total particulate matter were obtained at each sampling area. Comparative analysis of structural attributes of larval fish assemblages, showed inter-estuarine differences in terms of total abundance and diversity. Perequê-Açu Estuary registered the highest abundance levels and was highly dominated by a typical anadromous species Anchoviella lepidentostole. Macaé Estuary presented the most diverse larval fish assemblage, which was comprised by several marine species. Temperature and precipitation, in addition to salinity, were the main environmental variables regulating the larval fish assemblages. Temperature has played an important role in determining anadromous species abundance, since the greatest abundances were associated with high water temperatures recorded mainly in Perequê-Açu Estuary. Precipitation was responsible for episodic events of runoff in Bracuí, São João and Perequê-Açu estuaries, where the high precipitation collaborated to carry anadromous larvae from the spawning habitat to the estuarine zone. Conversely, the low precipitation in Macaé Estuary favored the immigration of marine species due to the decrease of the river flow. Oxygen saturation and nutrient load could have operated in an indirect way, through their effect on food supply, but further studies are necessary to investigate this question. Our study highlighted that fish larvae are highly sensitive to environmental variations and emphasized that conservation of estuarine habitats is essential to ensure success in the fish recruitment.

Design, Challenges, and Implications of Quality Improvement Projects Using the Electronic Medical Record: Case Study: A Protocol to Reduce the Burden of Postoperative Atrial Fibrillation.

Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery, which results in increased morbidity, mortality, length of stay, and hospital costs. We developed and followed a process map to implement a protocol to decrease POAF: (1) identify stakeholders and form a working committee, (2) formal literature and guideline review, (3) retrospective analysis of current institutional data, (4) data modeling to determine expected effects of change, (4) protocol development and implementation into the electronic medical record, and (5) ongoing review of data and protocol adjustment. Retrospective analysis demonstrated that POAF occurred in 29.8% of all cardiovascular surgery cases. Median length of stay was 2 days longer (P<0.001), and median total variable costs $2495 higher (P<0.001) in POAF patients. Modeling predicted that up to 60 cases of POAF and >$200 000 annually could be saved. A clinically based electronic medical record tool was implemented into the electronic medical record to aid preoperative clinic providers in identifying patients eligible for prophylactic amiodarone. Initial results during the 9-month period after implementation demonstrated a reduction in POAF in patients using the protocol, compared with those who qualified but did not receive amiodarone and those not evaluated (11.1% versus 38.7% and 38.8%; P=0.022); however, only 17.3% of patients used the protocol. A standardized methodological approach to quality improvement and electronic medical record integration has potential to significantly decrease the incidence of POAF, length of stay, and total variable cost in patients undergoing elective coronary artery bypass graft and valve surgeries. This framework for quality improvement interventions may be adapted to similar clinical problems beyond POAF.

Part 4. Post-cardiac arrest care: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

High quality integrated post-cardiac arrest care can significantly influence the outcome of patients with cardiac arrest, especially neurological recovery, and numerous studies have been conducted on this topic. In the 2015 Korean cardiopulmonary resuscitation (CPR) guidelines, post-cardiac arrest care was emphasized with effective advanced life support as one of the essential chains for survival. Based on an in-depth scientific evidence review using a standardized methodological approach proposed by the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) working group, the guidelines either partially updated the recommendations or added new recommendations for each specific topic.

Differential and transferable modulatory effects of mesenchymal stromal cell-derived extracellular vesicles on T, B and NK cell functions

Mesenchymal stromal cells (MSCs) are multipotent cells, immunomodulatory stem cells that are currently used for regenerative medicine and treatment of a number of inflammatory diseases, thanks to their ability to significantly influence tissue microenvironments through the secretion of large variety of soluble factors. Recently, several groups have reported the presence of extracellular vesicles (EVs) within MSC secretoma, showing their beneficial effect in different animal models of disease. Here, we used a standardized methodological approach to dissect the immunomodulatory effects exerted by MSC-derived EVs on unfractionated peripheral blood mononuclear cells and purified T, B and NK cells. We describe here for the first time: i. direct correlation between the degree of EV-mediated immunosuppression and EV uptake by immune effector cells, a phenomenon further amplified following MSC priming with inflammatory cytokines; ii. induction in resting MSCs of immunosuppressive properties towards T cell proliferation through EVs obtained from primed MSCs, without any direct inhibitory effect towards T cell division. Our conclusion is that the use of reproducible and validated assays is not only useful to characterize the mechanisms of action of MSC-derived EVs, but is also capable of justifying EV potential use as alternative cell-free therapy for the treatment of human inflammatory diseases.

Characterization of a novel variant BCR–ABL1 fusion transcript in a patient with chronic myeloid leukemia: Implications for molecular monitoring

Molecular monitoring of BCR–ABL1 transcript levels using quantitative polymerase chain reaction is an essential part of the modern management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors. Establishing the diagnostic BCR–ABL1 fusion transcript is necessary in order to select appropriate primers and probes for such monitoring. A case is described in which quantitative polymerase chain reaction failed to detect the presence of BCR–ABL1 fusion transcript in a Philadelphia chromosome-positive chronic myeloid leukemia patient. Further investigation demonstrated a novel in-frame BCR–ABL1 fusion transcript with a breakpoint in BCR exon 13 and insertion of a sequence of ABL1 intron 1, therefore enabling subsequent molecular monitoring. This case highlights the requirement for characterization of the BCR–ABL1 transcript type at chronic myeloid leukemia diagnosis. Issues concerning standardized methodological approaches and interpretation of transcript levels in such rare cases are discussed.

Moscow Metropolis Labour Market Features: the Requirements of Employers and the Quality of Young Specialists

The subject-matter of the article is the study of the features of the youth labour market in such a specific region of Russia as the city of Moscow. The topic of the work is connected with the adaptation of training system for young specialists to the regional requirements of the employers of Moscow. The main hypothesis of the research suggests that the city of Moscow is an atypical region of Russia and it makes no sense to apply the standard criteria and methodological approaches, which are typical to our country, to its labour market. As the research method, the authors have used a sample survey of the key Moscow employers and the respondents aged from 14 to 30 years. On the basis of the data of the sociological survey conducted by the authors, it was succeeded to identify the following features of the region in question: a relatively low level of the youth unemployment for Russia; the employers’ focus on such target signs of personnel as good communication skills, learning ability, professional knowledge and competences. The Moscow employers pay insufficient attention to such characteristics of young specialists as foreign language and computer skills, and a diploma of a prestigious education institution. The principal barriers that cause dificulties to the employment of young specialists in Moscow are: their overestimated salary expectations, poor professional training level and disinclination for work in principle. As a result of the survey, some practical proposals were formulated. Their application area is differentiated in two ways: focused on the young people’s behavior at the learning stage and focused on the improvement of the practical component of the activity of the vocational education institutions. The authors have come to the conclusions on the expediency of a deep focus of education institutions on the applied nature of training specialists, a need for attracting practitioners to teaching special disciplines, a need for developing the future specialists’ ability to present themselves and their work results in the professional environment (self-presentation), and an objective assessment of their real employment opportunities.

Monetary valuation of forest ecosystem services in China: A literature review and identification of future research needs

We propose a review of empirical studies dealing with the monetary valuation of forest ecosystem services in China. The analysis focuses on: assessing methodological differences between studies; highlighting the variation of monetary values across different ecosystem service types; and identifying and discussing future research needs. Based on a systematic search, our data set consists of 12 studies published in peer-reviewed journals in English, dealing with 72 forest ecosystem services. Our results suggest that domestic literature is affected by elusive categorization of ecosystem services and methodological inconsistencies. The wide variation in monetary values of Chinese forest ecosystem services, a phenomenon also observed in global level reviews, can be partially explained by the methodological heterogeneity of the studies. Future research could benefit from a strengthened and more standardized methodological approach, drawing from relevant methods and indicators employed in the reviewed domestic articles, as well as from insights and solutions proposed in the international empirical and conceptual literature. The exceptional forest restoration policy landscape coupled with the increasing establishment of commercial plantations offer important research opportunities for monetary valuation in China. Efforts should be directed towards assessing marginal values of ecosystem services in land-use changes over time, and benefit flows among different stakeholders.

Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis.

Seasonal/perennial allergic conjunctivitis is the most common allergic conjunctivitis, usually with acute manifestations when a person is exposed to allergens and with typical signs and symptoms including itching, redness, and tearing. The clinical signs and symptoms of allergic conjunctivitis are mediated by the release of histamine by mast cells. Histamine antagonists (also called antihistamines) inhibit the action of histamine by blocking histamine H1 receptors, antagonising the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine. Mast cell stabilisers inhibit degranulation and consequently the release of histamine by interrupting the normal chain of intracellular signals. Topical treatments include eye drops with antihistamines, mast cell stabilisers, non-steroidal anti-inflammatory drugs, combinations of the previous treatments, and corticosteroids. Standard treatment is based on topical antihistamines alone or topical mast cell stabilisers alone or a combination of treatments. There is clinical uncertainty about the relative efficacy and safety of topical treatment. The objective of this review was to assess the effects of topical antihistamines and mast cell stabilisers, alone or in combination, for use in treating seasonal and perennial allergic conjunctivitis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2014, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 July 2014. We also searched the reference lists of review articles and relevant trial reports for details of further relevant publications. We included randomised controlled trials (RCTs) comparing topical antihistamine and mast cell stabilisers, alone or in combination, with placebo, no treatment or to any other antihistamine or mast cell stabiliser, or both, that examined people with seasonal or perennial allergic conjunctivitis, or both. The primary outcome was any participant-reported evaluation (by questionnaire) of severity of four main ocular symptoms: itching, irritation, watering eye (tearing), and photophobia (dislike of light), both separately and, if possible, by an overall symptom score. We considered any follow-up time between one week and one year. Two review authors independently extracted data and assessed risk of bias. Disagreements were resolved by discussion among review authors and the involvement of a third review author. We followed standard methodological approaches used by Cochrane. We identified 30 trials with a total of 4344 participants randomised, with 17 different drugs or treatment comparisons. The following antihistamines and mast cell stabilisers were evaluated in at least one RCT: nedocromil sodium or sodium cromoglycate, olopatadine, ketotifen, azelastine, emedastine, levocabastine (or levocabastine), mequitazine, bepotastine besilate, combination of antazoline and tetryzoline, combination of levocabastine and pemirolast potassium. The most common comparison was azelastine versus placebo (nine studies).We observed a large variability in reporting outcomes. The quality of the studies and reporting was variable, but overall the risk of bias was low. Trials evaluated only short-term effects, with a range of treatment of one to eight weeks. Meta-analysis was only possible in one comparison (olopatadine versus ketotifen). There was some evidence to support that topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo. There were no reported serious adverse events related to the use of topical antihistamine and mast cell stabilisers treatment. It seems that all reported topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo in the short term. However, there is no long-term data on their efficacy. Direct comparisons of different antihistamines and mast cell stabilisers need to be interpreted with caution. Overall, topical antihistamines and mast cell stabilisers appear to be safe and well tolerated. We observed a large variability in outcomes reported. Poor quality of reporting challenged the synthesis of evidence.

A critical analysis of Islamic equity funds

Purpose – The purpose of this paper is to highlight the inconsistencies between the methodologies of Islamic funds and indices. Design/methodology/approach – The paper has reviewed the methodologies of the most prominent funds and indices (5) to apply their apparent screening features to the asset universe. In the analysis conducted, qualitative and quantitative screens are derived from each selected fund and index methodological approach to asset selection subject to Shari’ah constraints. Qualitative screens are applied first followed by quantitative screens. Findings – Few inconsistencies are evident between the chosen funds and indices when the qualitative screens are applied. However, the major inconsistencies are highlighted after analysis of the quantitative screens. Research limitations/implications – A number of companies within the asset universe are investment trusts, and such financial statement line item data were not found. However, this posed no difficulty, as these companies were investment trusts and would have been excluded in the qualitative screening process. Social implications – This paper will assist in the construction of a framework which thus leads to the development of a standardized methodological approach, ultimately benefiting investors. Originality/value – This paper is believed to be the first which analyzes the impact of Shari’ah screens on the Financial Times Stock Exchange (FTSE). Additionally, this paper also analyzes the impact of Shari’ah screens pre and post the financial crisis. The findings of this research paper will also aid in the construction of a different research methodological approach capable of selecting halal securities listed in the FTSE 250.

Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

To assess the effect of an intensive care unit (ICU) diary versus no ICU diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU. Systematic review of randomized controlled trials (RCTs) and clinical controlled trials. CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, PILOT; Web of Science Conference Proceedings, clinical trial registries and reference lists of identified trials. Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria. We identified three eligible studies; two describing ICU patients (N=358), and one describing relatives of ICU patients (N=30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07-1.19) or depression (RR 0.38, 95% CI 0.12-1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84-1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14-28), in comparison to no diary (median 28; range 14-38). Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

Decision-Oriented Health Technology Assessment: One Step Forward in Supporting the Decision-Making Process in Hospitals

ObjectivesThis article outlines the Decision-Oriented Health Technology Assessment: a new implementation of the European network for Health Technology Assessment Core Model, integrating the multicriteria decision-making analysis by using the analytic hierarchy process to introduce a standardized methodological approach as a valued and shared tool to support health care decision making within a hospital. MethodsFollowing the Core Model as guidance (European network for Health Technology Assessment. HTA core model for medical and surgical interventions. Available from: http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r. [Accessed May 27, 2014]), it is possible to apply the analytic hierarchy process to break down a problem into its constituent parts and identify priorities (i.e., assigning a weight to each part) in a hierarchical structure. Thus, it quantitatively compares the importance of multiple criteria in assessing health technologies and how the alternative technologies perform in satisfying these criteria. The verbal ratings are translated into a quantitative form by using the Saaty scale (Saaty TL. Decision making with the analytic hierarchy process. Int J Serv Sci 2008;1:83–98). An eigenvectors analysis is used for deriving the weights’ systems (i.e., local and global weights’ system) that reflect the importance assigned to the criteria and the priorities related to the performance of the alternative technologies. ResultsCompared with the Core Model, this methodological approach supplies a more timely as well as contextualized evidence for a specific technology, making it possible to obtain data that are more relevant and easier to interpret, and therefore more useful for decision makers to make investment choices with greater awareness. ConclusionsWe reached the conclusion that although there may be scope for improvement, this implementation is a step forward toward the goal of building a “solid bridge” between the scientific evidence and the final decision maker’s choice.

Insufficient evidence of effect of periodontal treatment on prevention or management of cardiovascular disease.

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, OpenGrey, the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure and the VIP database, the US National Institutes of Health Trials Register, the World Health Organisation (WHO) Clinical Trials Registry Platform and Sciencepaper Online databases were searched with no restrictions on language or date. Two reviewers independently selected studies and only randomised controlled trials (RCTs) and quasi-RCTs with follow-up times ≥ one year were considered. Data extraction and risk of bias assessment were carried out independently and in duplicate. Standard Cochrane methodological approaches were used. Only one trial involving 303 patients that compared scaling and root andomiz (SRP) with community care was included. It was considered to be at high risk of bias. No data on deaths (all-cause or CVD-related) were reported. There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence). The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant. The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures. We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.

Soil moisture trends in the Czech Republic between 1961 and 2012

ABSTRACTCentral Europe is generally not considered a drought‐prone region compared with, for example, the Mediterranean. However, Central Europe, including the Czech Republic, recently experienced a series of drought events with substantial impacts, especially on crop production. Because agriculture systems, and vegetation in general, have adapted to evenly distributed precipitation, the region is susceptible to even short‐term droughts. The recent drought events may be the result of multi‐decadal climate variability or a more general trend, with some studies showing a link to a more frequent occurrence of atmospheric circulation patterns that are conducive to drought. This study introduces an innovation to the standard methodological approaches in evaluating drought climatology by analysing soil moisture conditions over more than 50 years. This approach relies on state‐of‐the‐art observed weather data and state‐of‐the‐art soil moisture model data, and focuses on the dynamic simulation of soil moisture content with high temporal (daily) and spatial (500 m) resolution in a diverse landscape. Statistically significant trends of decreasing soil moisture content were found, notably during May and June between 1961 and 2012. In contrast, trends towards higher soil moisture content were noted during the October–March time period. When the periods of 2001–2012 and 1961–1980 were compared, the probability of drought between April and June was found to increase by 50%. This indicates a loading of the ‘climate dice’ towards drier conditions. The probability of extreme drought events has also been found to increase. These results support concerns about the potentially increased severity of drought events in Central Europe under projected climate change.

Diaries for recovery from critical illness.

During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient's recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient's ICU admission and an ongoing narrative outlining day-to-day activities. To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction. We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria. We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38). Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

Moderate quality evidence finds statistical benefit in oral health for powered over manual toothbrushes.

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. Reference lists of identified articles were also scanned for relevant papers. Identified manufacturers were contacted for additional information. Only randomised controlled trials comparing manual and powered toothbrushes were considered. Crossover trials were eligible for inclusion if the wash-out period length was more than two weeks. Study assessment and data extraction were carried out independently by at least two reviewers. The primary outcome measures were quantified levels of plaque or gingivitis. Risk of bias assessment was undertaken. Standard Cochrane methodological approaches were taken. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months). Fifty-six trials were included with 51 (4624 patients) providing data for meta-analysis. The majority (46) were at unclear risk of bias, five at high risk of bias and five at low risk. There was moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short and long-term. This corresponds to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and a 21% reduction in the long term. There was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups.There was also moderate quality evidence that powered toothbrushes again provide a statistically significant reduction in gingivitis when compared with manual toothbrushes both in the short and long term. This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness indices respectively. Again there was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups. The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points. Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses. Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.

Measures of outdoor play and independent mobility in children and youth: A methodological review.

Declines in children's outdoor play have been documented globally, which are partly due to heightened restrictions around children's independent mobility. Literature on outdoor play and children's independent mobility is increasing, yet no paper has summarized the various methodological approaches used. A methodological review could highlight most commonly used measures and comprehensive research designs that could result in more standardized methodological approaches. Methodological review. A standardized protocol guided a methodological review of published research on measures of outdoor play and children's independent mobility in children and youth (0-18 years). Online searches of 8 electronic databases were conducted and studies included if they contained a subjective/objective measure of outdoor play or children's independent mobility. References of included articles were scanned to identify additional articles. Twenty-four studies were included on outdoor play, and twenty-three on children's independent mobility. Study designs were diverse. Common objective measures included accelerometry, global positioning systems and direct observation; questionnaires, surveys and interviews were common subjective measures. Focus groups, activity logs, monitoring sheets, travel/activity diaries, behavioral maps and guided tours were also utilized. Questionnaires were used most frequently, yet few studies used the same questionnaire. Five studies employed comprehensive, mixed-methods designs. Outdoor play and children's independent mobility have been measured using a wide variety of techniques, with only a few studies using similar methodologies. A standardized methodological approach does not exist. Future researchers should consider including both objective measures (accelerometry and global positioning systems) and subjective measures (questionnaires, activity logs, interviews), as more comprehensive designs will enhance understanding of each multidimensional construct. Creating a standardized methodological approach would improve study comparisons.

Análise epistemológica das teses e dissertações sobre atendimento educacional especializado: 2000 a 2009

http://dx.doi.org/10.5902/1984686X6986 O objetivo geral desta pesquisa foi realizar uma análise epistemológica de teses e dissertações sobre atendimento educacional especializado, produzidas no período de 2000 a 2009, a partir das dimensões técnica e teórica, analisadas através da adaptação do Esquema Paradigmático de Sánchez Gamboa (1987; 2007). Por meio de uma pesquisa qualitativa, foi realizada análise documental de 18 teses e dissertações. Os resultados indicam: 1. No Nível Técnico: Em 2009 foi o período que mais se produziu pesquisas sobre AEE; 72% do total foram produzidas em Universidades Públicas; 44% não especificaram as técnicas de registro; 50% não especificaram o tipo de análise de dados; 84% apresentaram procedimentos qualitativos; 2. Nível Teórico: Os principais temas tratados foram “Deficiência Auditiva/Surdez” (27,7%); 61% apresentaram abordagens metodológicas e tipos de mudança do tipo Inespecífica; 17% caracterizarem-se como crítico-dialéticas e 22% fenomenológico-hermenêuticas. A maioria das pesquisas não pode ser caracterizada ou classificada segundo um padrão de abordagem metodológica, devido ao seu aspecto hibrido e ao fato de não apresentar uma fronteira metodológica. É fundamental que sejam ampliadas as pesquisas sobre análise epistemológica, a fim de contribuírem de forma significativa e efetiva para a melhoria na qualidade das pesquisas e para sua aproximação com a práxis.

Tracheal intubation with a flexible intubation scope versus other intubation techniques for obese patients requiring general anaesthesia.

The prevalence of obesity (body mass index (BMI) > 30 kg/m(2)) is increasing in both developed and developing countries, leading to a rise in the numbers of obese patients requiring general anaesthesia. Obese patients are at increased risk of anaesthetic complications, and tracheal intubation can be more difficult. Flexible intubation scopes (FISs) are recommended as an alternative method of intubation in these patients. Intubation with an FIS is considered an advanced method, requiring training and experience; therefore it may be underused in clinical practice. Patient outcomes following intubation with these scopes compared with other devices have not been systematically reviewed. We wished to compare the safety and effectiveness of a flexible intubation scope (FIS) used for tracheal intubation in obese patients (BMI > 30 kg/m(2)) with other methods of intubation, including conventional direct laryngoscopy, non-standard laryngoscopy and the use of intubating supraglottic airway devices. We aimed to compare the frequency of complications, as well as process indicators, such as time taken for intubation and the proportion of first attempts that were successful, between groups using the different methods of intubation. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and two trial registers on 18 January 2013, and performed reference checking and citation searching and contacted study authors to identify additional studies. We included randomized controlled trials (RCTs) of participants aged 16 years and older with a BMI > 30 kg/m(2) that had compared the use of an FIS for tracheal intubation with any one of three comparison groups: direct laryngoscopy; non-standard laryngoscopy (including indirect laryngoscopy using a videolaryngoscope(VLS) or a rigid or semi-rigid stylet); or intubation of supraglottic airway devices (SADs). We used standard methodological approaches expected by The Cochrane Collaboration, including independent review of titles, data extraction and risk of bias assessment by two investigators. Three eligible studies were identified, all comparing the use of an FIS with a VLS. All studies were small, with only 131 participants in total across all trials. It was impossible for the intubators to be unaware of the device used, so all studies were at high risk of performance and detection bias for outcomes related to intubation. Because of substantial differences in design between the studies, we did not combine their results in meta-analyses. The results for all outcomes were inconclusive, with no differences noted between FIS and VLS. Two studies with experienced intubators reported first attempt success rates greater than 70% in both groups and less than 5% of participants requiring a change of intubation device. No evidence was found of any difference in difficulty or time taken between FIS and VLS intubation. No serious complications or airway trauma was reported, so we were unable to address these outcomes. Bleeding was uncommon, occurring in less than 5% of participants, and we found no evidence that it was more likely in the FIS group. One small study with a novice intubator reported no successful intubations using an FIS and compared with the use of an intubating SAD and stylet, as well as with a VLS. With only five participants in each group, no conclusions can be drawn from these additional comparisons. The evidence base is sparse, and the existing literature does not address the clinical questions of patient safety posed by this review. We are therefore unable to draw any conclusions on safety or effectiveness. More primary research is needed to investigate optimal intubation techniques in obese patients, and new studies should be powered to detect differences in complications and in success rates rather than process measures such as speed, which are of limited clinical importance.

Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia

The organization of elective surgical services has changed in recent years, with increasing use of day surgery, reduced hospital stay and preoperative assessment (POA) performed in an outpatient clinic rather than by a doctor in a hospital ward after admission. Nurse specialists often lead these clinic-based POA services and have responsibility for assessing a patient's fitness for anaesthesia and surgery and organizing any necessary investigations or referrals. These changes offer many potential benefits for patients, but it is important to demonstrate that standards of patient care are maintained as nurses take on these responsibilities. We wished to examine whether a nurse-led service rather than a doctor-led service affects the quality and outcome of preoperative assessment (POA) for elective surgical participants of all ages requiring regional or general anaesthesia. We considered the evidence that POA led by nurses is equivalent to that led by doctors for the following outcomes: cancellation of the operation for clinical reasons; cancellation of the operation by the participant; participant satisfaction with the POA; gain in participant knowledge or information; perioperative complications within 28 days of surgery, including mortality; and costs of POA. We planned to investigate whether there are differences in quality and outcome depending on the age of the participant, the training of staff or the type of surgery or anaesthesia provided. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and two trial registers on 13 February 2013, and performed reference checking and citation searching to identify additional studies. We included randomized controlled trials (RCTs) of participants (adults or children) scheduled for elective surgery requiring general, spinal or epidural anaesthesia that compared POA, including assessment of physical status and anaesthetic risk, undertaken or led by nursing staff with that undertaken or led by doctors. This assessment could have taken place in any setting, such as on a ward or in a clinic. We included studies in which the comparison assessment had taken place in a different setting. Because of the variation in service provision, we included two separate comparison groups: specialist doctors, such as anaesthetists; and non-specialist doctors, such as interns. We used standard methodological approaches as expected by The Cochrane Collaboration, including independent review of titles, data extraction and risk of bias assessment by two review authors. We identified two eligible studies, both comparing nurse-led POA with POA led by non-specialist doctors, with a total of 2469 participants. One study was randomized and the other quasi-randomized. Blinding of staff and participants to allocation was not possible. In both studies, all participants were additionally assessed by a specialist doctor (anaesthetist in training), who acted as the reference standard. In neither study did participants proceed from assessment by nurse or junior doctor to surgery. Neither study reported on cancellations of surgery, gain in participant information or knowledge or perioperative complications. Reported outcomes focused on the accuracy of the assessment. One study undertook qualitative assessment of participant satisfaction with the two forms of POA in a small number of non-randomly selected participants (42 participant interviews), and both groups of participants expressed high levels of satisfaction with the care received. This study also examined economic modelling of costs of the POA as performed by the nurse and by the non-specialist doctor based on the completeness of the assessment as noted in the study and found no difference in cost. Currently, no evidence is available from RCTs to allow assessment of whether nurse-led POA leads to an increase or a decrease in cancellations or perioperative complications or in knowledge or satisfaction among surgical participants. One study, which was set in the UK, reported equivalent costs from economic models. Nurse-led POA is now widespread, and it is not clear whether future RCTs of this POA strategy are feasible. A diagnostic test accuracy review may provide useful information.

Does Science Presuppose Naturalism (or Anything at All)?

Several scientists, scientific institutions, and philosophers have argued that science is committed to Methodological Naturalism (MN), the view that science, by virtue of its methods, is limited to studying ‘natural’ phenomena and cannot consider or evaluate hypotheses that refer to supernatural entities. While they may in fact exist, gods, ghosts, spirits, and extrasensory or psi phenomena are inherently outside the domain of scientific investigation. Recently, Mahner (Sci Educ 3:357–371, 2012) has taken this position one step further, proposing the more radical view that science presupposes an a priori commitment not just to MN, but also to ontological naturalism (ON), the metaphysical thesis that supernatural entities and phenomena do not exist. Here, we argue that science presupposes neither MN nor ON and that science can indeed investigate supernatural hypotheses via standard methodological approaches used to evaluate any ‘non-supernatural’ claim. Science, at least ideally, is committed to the pursuit of truth about the nature of reality, whatever it may be, and hence cannot exclude the existence of the supernatural a priori, be it on methodological or metaphysical grounds, without artificially limiting its scope and power. Hypotheses referring to the supernatural or paranormal should be rejected not because they violate alleged a priori methodological or metaphysical presuppositions of the scientific enterprise, but rather because they fail to satisfy basic explanatory criteria, such as explanatory power and parsimony, which are routinely considered when evaluating claims in science and everyday life. Implications of our view for science education are discussed.