Use Of Alternative Strategies Research Articles

Fabrication and Characterization of Non-Conventional Starch Based Biofilms Employing Different Plasticizers

Increasing stress on environmental awareness has promoted the use of alternative strategies for common petrochemical based plastic sources to environmentally friendly biofilms and packaging materials. Food by products and underutilised indigenous plants sources are rich in biopolymers which can naturally decompose. The present study focusses on preparations of bioplastics from unconventional starch sources of litchi seed and churkha tuber as novel initiative to combat environmental pollution along with valorisation of undervalued plant sources and agrobased wastes. Ternary blend films of poly vinyl alcohol, starch, plasticizers like (glycerol, sorbitol, mannitol, propylene glycol, polyethylene glycol), citric acid prepared by casting technique produced best result. Comparative study of test samples (TH11, TH12, TH13, TH14 etc) with standardized thin films (TH1, TH2, TH3 etc.) showed variation in appearance, water activity, thickness, since the starch differ in their compositions, gelatinization and gelation time and temperature. High amylose containing litchi seed starch forms firm and more flexible films in comparison to low amylose containing churkha tuber starch. Maximum hygroscopicity was recorded in case of TH1 (77.4%) while thickness was maximum in case of TH12 (0.18 mm). Micro structural analysis clearly showed the nature of crosslinking between starch molecule and different plasticizers. The sensory analysis of food packed with the best among the formularized thin films showed mild change in taste while the other parameters remain same as normal. Better acceptability was in case of TH12 wrapped food rather than TH1. Thus, fabrication of biodegradable packaging is considered as the most sustainable alternative for food preservation. Int. J. Appl. Sci. Biotechnol. Vol 12(1): 29-38.

Enhanced Immunogenicity and Protective Effects against SARS-CoV-2 Following Immunization with a Recombinant RBD-IgG Chimeric Protein.

The unprecedented global impact caused by SARS-CoV-2 imposed huge health and economic challenges, highlighting the urgent need for safe and effective vaccines. The receptor-binding domain (RBD) of SARS-CoV-2 is the major target for neutralizing antibodies and for vaccine formulations. Nonetheless, the low immunogenicity of the RBD requires the use of alternative strategies to enhance its immunological properties. Here, we evaluated the use of a subunit vaccine antigen generated after the genetic fusing of the RBD with a mouse IgG antibody. Subcutaneous administration of RBD-IgG led to the extended presence of the protein in the blood of immunized animals and enhanced RBD-specific IgG titers. Furthermore, RBD-IgG immunized mice elicited increased virus neutralizing antibody titers, measured both with pseudoviruses and with live original (Wuhan) SARS-CoV-2. Immunized K18-hACE2 mice were fully resistant to the lethal challenge of the Wuhan SARS-CoV-2, demonstrated by the control of body-weight loss and virus loads in their lungs and brains. Thus, we conclude that the genetic fusion of the RBD with an IgG molecule enhanced the immunogenicity of the antigen and the generation of virus-neutralizing antibodies, supporting the use of IgG chimeric antigens as an approach to improve the performance of SARS-CoV-2 subunit vaccines.

Contaminant transport from solid waste dumps: Implications for environmental degradation with a focus on capital territory regions

Open dumping of Municipal solid waste is the main method of solid waste management in Pakistan. To investigate the impacts of leachate transportation from these waste dumps on groundwater quality, two sites were selected (I-12 in Islamabad and Lohsar in Rawalpindi), water samples were collected from existing wells during summer, winter, and rainy seasons and were analyzed for physiochemical parameters using standard methods. Most groundwater samples showed contamination and values of various parameters exceeded the desired limits set by the World Health Organization (WHO) and the National Standard for Drinking Water Quality (NSDWQ), especially during the rainy season, whereas the least contamination in groundwater samples was observed during the winter season. The results obtained were, pH: 5.75–7.87, Electrical Conductivity (EC): 103–3460 μS cm−1, Total Dissolved Solids (TDS): 436–4425 mg L−1, Total Alkalinity (TA): 190–1330 mg L−1, Total Hardness (TH): 128–676 mg L−1, Chlorides (Cl⁻): 56.7–893.3 mg L−1, Nitrates (NO₃⁻): 7.8–19.9 mg L−1, Dissolved Oxygen (DO): 6.1–20.8 mg L−1, Biological Oxygen Demand (BOD): 1.0–44.0 mg L−1 and Chemical Oxygen Demand (COD): 56–272 mg L−1. The findings suggest that the magnitude of groundwater contamination from leachate transportation is intricately influenced by factors such as leachate composition, seasonal variations and distance from the dumpsite. The contamination level reduced along the distance from the dumps. Except Copper (Cu) and Zinc (Zn), the concentration of all other heavy metals including, Iron (Fe), Chromium (Cr), Nickel (Ni), Lead (Pb), Cadmium (Cd) was found above standard appreciable limits. The t-test showed a significant difference in parameter concentrations for all seasons except for Cd and Zn. The calculation of water quality index through CCME (Canadian Council of Ministers of Environment) model revealed that all the groundwater samples around both the dump sites were of poor and marginal quality. In general, the groundwater quality of both study areas is not suitable for the drinking purpose. The study suggests regular testing and treating groundwater before use, use of engineered landfills, covering landfills with clay and vegetation and use of alternative strategies like composting and recycling for waste management.

Airway clearance therapy in the school environment: Retrospective analysis of a cohort of pediatric patients with cystic fibrosis

BackgroundAdherence to airway clearance therapy (ACT) in pediatric cystic fibrosis (CF) patients is reported to be below 50% and inability to sustain daily care is linked to poor health outcomes7,8,9. Through a collaboration between a CF care center and several schools, we hypothesized that ACT completed at school by pediatric CF patients will improve lung function while decreasing pulmonary exacerbations (PEx), days of antibiotics (abx) and hospitalizations. MethodsThis was a retrospective case-control study at a single CF care center consisting of 50 CF patients age < 18 at time when data was recorded (2012–2020). The case group used high-frequency chest wall oscillation or positive expiratory pressure devices at school for at least 1 year after self-reported or physician identified inadequate use at home. Lung function and measures of healthcare utilization were collected. ResultsIn the case group (n = 14), paired t-tests showed that after initiation of ACT at school, there were significant reductions in PEx requiring IV or PO abx (P = 0.010), total days of abx (P = 0.032), and visits to the CF care center (P = 0.037). There was no change in these outcomes in the matched control group (n = 36). ConclusionsThis is the first known study to highlight an initiative between a CF care center and schools which utilized airway clearance devices at school to ensure pediatric CF patients completed ACT. Through increased adherence, this relationship was associated with improved health outcomes. Use of alternative strategies may help patients with CF sustain adequate airway clearance.

Bacteriocin: A natural approach for food safety and food security.

The call to cater for the hungry is a worldwide problem in the 21st century. Food security is the utmost prime factor for the increasing demand for food. Awareness of human health when using chemical preservatives in food has increased, resulting in the use of alternative strategies for preserving food and enhancing its shelf-life. New preservatives along with novel preservation methods have been instigated, due to the intensified demand for extended shelf-life, along with prevention of food spoilage of dairy products. Bacteriocins are the group of ribosomally synthesized antimicrobial peptides; they possess a wide range of biological activities, having predominant antibacterial activity. The bacteriocins produced by the lactic acid bacteria (LAB) are considered to be of utmost importance, due to their association with the fermentation of food. In recent times among various groups of bacteriocins, leaderless and circular bacteriocins are gaining importance, due to their extensive application in industries. These groups of bacteriocins have been least studied as they possess peculiar structural and biosynthetic mechanisms. They chemically possess N-to-C terminal covalent bonds having a predominant peptide background. The stability of the bacteriocins is exhibited by the circular structure. Up till now, very few studies have been performed on the molecular mechanisms. The structural genes associated with the bacteriocins can be combined with the activity of various proteins which are association with secretion and maturation. Thus the stability of the bacteriocins can be used effectively in the preservation of food for a longer period of time. Bacteriocins are thermostable, pH-tolerant, and proteolytically active in nature, which make their usage convenient to the food industry. Several research studies are underway in the domain of biopreservation which can be implemented in food safety and food security.

Maximum Plantarflexion Lateral Ankle Radiograph for Pre-Operative Planning for the Arthroscopic Treatment of Osteochondral Lesions of the Talus

Category: Arthroscopy; Ankle; Sports; Trauma Introduction/Purpose: Osteochondral Lesions of the Talus (OLT) are now a commonly encountered pathology resulting in ankle pain and disability. Because of growing interest and support for arthroscopic management, it has become increasingly important to develop pre-operative evaluation methods to determine which lesions are amenable to standard arthroscopic evaluation and treatment versus the use of alternative strategies including posterior ankle arthroscopy, open arthrotomy, or malleolar osteotomy. Recently a CT scan protocol has been developed with the maximum ankle plantarflexion to estimate which lesions are accessible by standard anterior ankle arthroscopy based on the location of the lesion relative to the anterior tibial plafond. We present a simplified alternative method using a clinic-based lateral ankle radiograph with maximal plantarflexion to attain similar information for surgical planning. Methods: A 25-year-old female presented to clinic approximately 3 years after an initial injury to the left ankle sustained while skiing, with prior conservative treatment. After examination and review of available imaging, discussion was held with the patient regarding continued conservative management of her left ankle OLT versus surgical intervention with ankle arthroscopy, OLT debridement, and microfracture due to the lesion size of less than 150 mm2 based on previously described treatment algorithms. To determine the best approach for ankle arthroscopy, anterior versus posterior, a left ankle non-weight-bearing maximal plantar flexion radiograph was performed in the clinic. This showed that with plantarflexion, the anterior margin of the medial based OLT was adjacent to the anterior lip of the tibial plafond. Based on the clinical experience of the treating surgeon, this serves as an indication that the lesion can be adequately accessed using standard anterior ankle arthroscopy with plantarflexion and/or non- invasive distraction. Results: The patient underwent standard ankle anterior tibiotalar arthroscopy with non-invasive distraction. Following diagnostic arthroscopy and limited debridement, with the ankle manually plantarflexed by an assistant, the OLT leading edge was easily identified. The remaining joint was intact without cartilage injury. There was moderate synovitis noted anterior and medial. An arthroscopic shaver and curette was used to debride the unstable articular cartilage back to sharp, stable borders, and all loose cartilage fragments were removed from the joint. This left approximately 8 x 15 mm of exposed subchondral bone. The subchondral plate was intact without bone loss or evidence of collapse. Using an arthroscopic microfracture awl, several microfracture holes were created through the subchondral plate and into the underlying metaphyseal bone until marrow fat was identified. Postoperatively, she was non weight bearing for six weeks with range of motion as tolerated, and advanced to full activity at three months without residual symptoms. Conclusion: In the management of OLTs, the limits of anterior arthroscopy have been pushed with time, due to the added complexity and possible morbidity associated with posterior arthroscopy and medial malleolus osteotomies for an open approach. Many factors have an impact on the intraarticular access using anterior ankle arthroscopy, with the posterior talus being the most challenging site to access. As seen in this case presentation, this simple and cost-effective radiographic technique can be employed by the clinician, among other clinical and imaging tools, to help guide appropriate surgical technique for lesions in the posterior half of the talar body.

Engineering E. coli to synthesize butanol.

Biobutanol is gaining much attention as a potential biofuel due to its superior properties over ethanol. Butanol has been naturally produced via acetone-butanol-ethanol (ABE) fermentation by many Clostridium species, which are not very user-friendly bacteria. Therefore, to improve butanol titers and yield, various butanol synthesis pathways have been engineered in Escherichia coli, a much more robust and convenient host than Clostridium species. This review mainly focuses on the biosynthesis of n-butanol in engineered E. coli with an emphasis on efficient enzymes for butanol production in E. coli, butanol competing pathways, and genome engineering of E. coli for butanol production. In addition, the use of alternate strategies for butanol biosynthesis/enhancement, alternate substrates for the low cost of butanol production, and genetic improvement for butanol tolerance in E. coli have also been discussed.

Rhizosphere Bacteria in Plant Growth Promotion, Biocontrol, and Bioremediation of Contaminated Sites: A Comprehensive Review of Effects and Mechanisms.

Agriculture in the 21st century is facing multiple challenges, such as those related to soil fertility, climatic fluctuations, environmental degradation, urbanization, and the increase in food demand for the increasing world population. In the meanwhile, the scientific community is facing key challenges in increasing crop production from the existing land base. In this regard, traditional farming has witnessed enhanced per acre crop yields due to irregular and injudicious use of agrochemicals, including pesticides and synthetic fertilizers, but at a substantial environmental cost. Another major concern in modern agriculture is that crop pests are developing pesticide resistance. Therefore, the future of sustainable crop production requires the use of alternative strategies that can enhance crop yields in an environmentally sound manner. The application of rhizobacteria, specifically, plant growth-promoting rhizobacteria (PGPR), as an alternative to chemical pesticides has gained much attention from the scientific community. These rhizobacteria harbor a number of mechanisms through which they promote plant growth, control plant pests, and induce resistance to various abiotic stresses. This review presents a comprehensive overview of the mechanisms of rhizobacteria involved in plant growth promotion, biocontrol of pests, and bioremediation of contaminated soils. It also focuses on the effects of PGPR inoculation on plant growth survival under environmental stress. Furthermore, the pros and cons of rhizobacterial application along with future directions for the sustainable use of rhizobacteria in agriculture are discussed in depth.

Doubts About the Role of Rehearsal in the Irrelevant Sound Effect.

. The irrelevant sound effect (ISE) describes the disruption of processes involved in maintaining information in working memory (WM) when irrelevant noise is present in the environment. While some posit that the ISE arises due to split obligation of attention to the irrelevant sound and the to-be-remembered information, others have argued that background noise corrupts the order of information within WM. Support for the latter position comes from research showing that the ISE appears to be most robust in tasks that emphasize ordered maintenance by a serial rehearsal strategy, and diminished when rehearsal is discouraged or precluded by task characteristics. This prior work confounds the demand for seriation with rehearsal. Thus, the present study aims to disentangle ordered maintenance from a rehearsal strategy by using a running memory span task that requires ordered output but obviates the utility of rehearsal. Across four experiments, we find a significant ISE that persists under conditions that should discourage the use of rehearsal and among individuals who self-report use of alternative strategies. These findings indicate that rehearsal is not necessary to produce an ISE in a serial recall task and thus fail to corroborate accounts of the ISE that emphasize the involvement of rehearsal.

Cultural Differences in the Use of Covert Coercion Among Mental Health Professionals of Latin Culture: A Focus Group Study

Coercion in Mental Health is related to sociocultural contexts. The purpose of this study is to examine whether the uses and perceptions of covert coercion on the part of professionals from four Latin-culture countries (Spain, Italy, Mexico, and Chile) differ between them and from those described in the literature. We conducted a qualitative research, using focus groups with professionals, with targeted sampling and an iterative process for thematic analysis. Several differentiating categories were found: the use of alternative strategies of covert coercion (deception, emotional blackmail, and directiveness); the role of family and socioeconomic differences; and cultural aspects such as the unique role religion plays in Mexico, a relatively greater toleration of threat as a means of coercion.

The Social Honesty game - A computational analysis of the impact of conformity and identity on honest behavior contagion in complex social systems

Abstract We consider a probabilistic-payoff social dilemma game and we analyze the impact of various social learning mechanisms - conformity, diversity generators, identity, on the dynamics of honest behavior in a virtual population. To capture the inherent variability and uncertainty of a complex social environment, the proposed model considers probabilistic payoffs as well as a variety of strategy updating rules and hybrid neighborhood topologies. The implicit underlying mechanisms are those of imitation and social influence. By simulating evolutionary spatial scenarios, we identify factors that favor contagion of honest behavior (i.e. social honesty) in the context of probabilistic payoff. Conformity and identity have a significant effect on the contagion of honest behavior. They slow down the dynamics, make it more stable, and help the formation and growth of clusters, favoring the emergence and spreading of honest behavior. However, their impact is topology dependent, nonlinear, exhibiting phase shifts. High conformity favors honest behavior in simple topologies, and does the opposite in complex topologies. Without a certain degree of diversity (use of alternative strategies) the system loses its adaptation capability. At the other end, strategy inconsistency leads to chaos, which favors the contagion of dishonest behavior. A structuring effect of leaders on chaotic behavior is also observed: their presence reduces the effects of random behavior, inducing alignment and reducing the necessity of a higher punishment probability. The key findings of this research can help predict trends and design public and organizational policies to nudge honest behavior, in the context of high complexity dynamics generated by the recent advances in information technology.

The Use of Alternative Strategies for Enhanced Nanoparticle Delivery to Solid Tumors.

Nanomaterial (NM) delivery to solid tumors has been the focus of intense research for over a decade. Classically, scientists have tried to improve NM delivery by employing passive or active targeting strategies, making use of the so-called enhanced permeability and retention (EPR) effect. This phenomenon is made possible due to the leaky tumor vasculature through which NMs can leave the bloodstream, traverse through the gaps in the endothelial lining of the vessels, and enter the tumor. Recent studies have shown that despite many efforts to employ the EPR effect, this process remains very poor. Furthermore, the role of the EPR effect has been called into question, where it has been suggested that NMs enter the tumor via active mechanisms and not through the endothelial gaps. In this review, we provide a short overview of the EPR and mechanisms to enhance it, after which we focus on alternative delivery strategies that do not solely rely on EPR in itself but can offer interesting pharmacological, physical, and biological solutions for enhanced delivery. We discuss the strengths and shortcomings of these different strategies and suggest combinatorial approaches as the ideal path forward.

Telephone surveillance during the COVID-19 pandemic: Is it a helpful diagnostic tool for detecting acute pulmonary exacerbations in children with chronic lung disease?

Introduction The global burden of the 2019 novel coronavirus disease pandemic on the healthcare system, as well as the high transmission risk of coronavirus disease has led to the use of alternative strategies for evaluation of children with chronic conditions. In this context, telemedicine has become the effective and affordable choice. In this study we aimed to evaluate the efficiency of telephone visits to determine pulmonary exacerbations and hospitalization rates of children with cystic fibrosis and interstitial lung disease. Methods A total of 119 children with cystic fibrosis or interstitial lung disease were enrolled and provided cases in which telephone visits were applied during the peak time of the coronavirus disease pandemic in our country. The recordings of respiratory, gastrointestinal and other symptoms, nutrition status, rate of acute pulmonary exacerbation, treatments initiated by telephone visits, referral to hospital and hospitalization were established from the electronic health reports of the patients. Results Thirteen patients (10.9%) were symptomatic, 12 of them (10%) were diagnosed with acute pulmonary exacerbation. One patient was diagnosed with peripheral facial paralysis. Nine patients were recalled to the hospital and seven patients (5.8%) were hospitalised. Discussion Using telemedicine the health status of patients can be defined, and patients can be guided on proper healthcare that they need, especially during the times of pandemics which we are facing. Communication with patients while minimising the risk of exposure to coronavirus disease is an important advantage of telemedicine. Telemedicine will have to be implemented on our daily medical practice in the near future.

Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure

BackgroundBile duct injury rates for laparoscopic cholecystectomy (LC) remain higher than during open cholecystectomy. The “culture of safety” concept is based on demonstrating the critical view of safety (CVS) and/or correctly interpreting intraoperative cholangiography (IOC). However, the CVS may not always be achievable due to difficult anatomy or pathology. Safety may be enhanced if surgeons assess difficulties objectively, recognise instances where a CVS is unachievable and be familiar with recovery strategies.Aims and methodsA prospective study was conducted to evaluate the achievability of the CVS during all consecutive LC performed over four years. The primary aim was to study the association between the inability to obtain the CVS and an objective measure of operative difficulty. The secondary aim was to identify preoperative and operative predictors indicating the use of alternate strategies to complete the operation safely.ResultsThe study included 1060 consecutive LC. The median age was 53 years, male to female ratio was 1:2.1 and 54.9% were emergency admissions. CVS was obtained in 84.2%, the majority being difficulty grade I or II (70.7%). Displaying the CVS failed in 167 LC (15.8%): including 55.6% of all difficulty grade IV LC and 92.3% of difficulty grade V. There were no biliary injuries or conversions.ConclusionAll three components of the critical view of safety could not be demonstrated in one out of 6 consecutive laparoscopic cholecystectomies. Preoperative factors and operative difficulty grading can predict cases where the CVS may not be achievable. Adapting instrument selection and alternate dissection strategies would then need to be considered.

Rapid survey of bats (Chiroptera) in the Atlantic Forest in eastern Sergipe, Brazil: unexpected diversity in a fragmented landscape

Despite advances in recent decades, the Atlantic Forest of northeastern Brazil is still one of the least studied regions of the country, regarding, for instance, the bat fauna. The present study reports on the results of a rapid survey of the bat fauna of a fragmented landscape in the Atlantic Forest of eastern Sergipe, in the legal forest reserve of Fazenda Santana, a commercial sugarcane plantation located in the adjoining municipalities of Japoatã and Pacatuba. We recorded 272 bats belonging to 23 species and four families, from which 265 individuals from 18 species from two families (Phyllostomidae and Vespertilionidae) were captured in the mist-nets, and seven individuals of six species from four families (Emballonuridae, Molossidae, Phyllostomidae and Vespertilionidae) were recorded during the active searches. This species richness was higher than that found in previous studies in the Atlantic Forest of northeastern Brazil. Lasiurus blossevillii and Micronycteris minuta were recorded in Sergipe for the first time, increasing to 57 the number of bat species known to occur in this state. The use of alternative strategies (such as active search and sampling one night per point, seeking to areas with greater availability of resources) in rapid surveys may contribute to the compilation of a more robust sampling, reinforcing the usefulness of this approach for the inventory of the bat fauna of a given region.

Noninvasive strategies for surveillance of swine viral diseases: a review.

In view of the intensive development of the swine industry, monitoring and surveillance of infectious diseases require low-cost, effective, and representative population sampling methods. We present herein the state of knowledge, to date, in the use of alternative strategies in the monitoring of swine health. Blood sampling, the most commonly used method in veterinary medicine to obtain samples for monitoring swine health, is labor-intensive and expensive, which has resulted in a search for alternative sampling strategies. Oral fluid (OF) is a good alternative to serum for pooled sample analysis, especially for low-prevalence pathogens. Detection of viral nucleic acids or antiviral antibodies in OF is used to detect numerous viruses in the swine population. Meat juice is used as an alternative to serum in serologic testing. Processing fluid obtained during processing of piglets (castration and tail-docking) may also be used to detect viruses. These matrices are simple, safe, cost-effective, and allow testing of many individuals at the same time. The latest methods, such as snout swabs and udder skin wipes, are also promising. These alternative samples are easy to acquire, and do not affect animal welfare negatively.

The effects of the COVID-19 pandemic on oncological surgery

The COVID-19 global pandemic is changing the practice of oncologic surgery. Accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. Telemedicine is being widely employed. We present our thoughts on this topic and where we might be in the next several months.

Video-based assessment for laparoscopic fundoplication: initial development of a robust tool for operative performance assessment.

While better technical performance correlates with improved outcomes, there is a lack of procedure-specific tools to perform video-based assessment (VBA). SAGES is developing a series of VBA tools with enough validity evidence to allow reliable measurement of surgeon competence. A task force was established to develop a VBA tool for laparoscopic fundoplication using an evidence-based process that can be replicated for additional procedures. The first step in this process was to seek content validity evidence. Forty-two subject matter experts (SME) in laparoscopic fundoplication were interviewed to obtain consensus on procedural steps, identify potential variations in technique, and to generate an inventory of required skills and common errors. The results of these interviews were used to inform creation of a task inventory questionnaire (TIQ) that was delivered to a larger SME group (n = 188) to quantify the criticality and difficulty of the procedural steps, the impact of potential errors associated with each step, the technical skills required to complete the procedure, and the likelihood that future techniques or technologies may change the presence or importance of any of these factors. Results of the TIQ were used to generate a list of steps, skills, and errors with strong validity evidence. Initial SMEs interviewed included fellowship program directors (45%), recent fellows (24%), international surgeons (19%), and highly experienced super SMEs with quality outcomes data (12%). Qualitative analysis of interview data identified 6 main procedural steps (visualization, hiatal dissection, fundus mobilization, esophageal mobilization, hiatal repair, and wrap creation) each with 2-5 sub steps. Additionally, the TIQ identified 5-10 potential errors for each step and 11 key technical skills required to perform the procedure. Based on the TIQ, the mean criticality and difficulty scores for the 11/21 sub steps included in the final scoring rubric is 4.66/5 (5 = absolutely essential for patient outcomes) and 3.53/5 (5 = difficulty level requires significant experience and use of alternative strategies to accomplish consistently), respectively. The mean criticality and frequency scores for the 9/11 technical skills included is 4.51/5 and 4.51/5 (5 = constantly used ≥ 80% of the time), respectively. The mean impact score of the 42/47 errors incorporated into the final rubric is 3.85/5 (5 = significant error that is unrecoverable, or even if recovered, likely to have a negative impact on patient outcome). A rigorous, multi-method process has documented the content validity evidence for the SAGES video-based assessment tool for laparoscopic fundoplication. Work is ongoing to pilot the assessment tool on recorded fundoplication procedures to establish reliability and further validity evidence.

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient’s symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

Statistical analysis of democratization: a constructive critique

ABSTRACTWhile statistical analysis of the origins and stability of democracy has received a great deal of scholarly effort, and made major contributions to comparative politics, valid causal inference in this tradition remains exceptionally difficult and, perhaps, elusive. Three important challenges create difficulty for scholars who seek to assess the state of knowledge in this domain. First, most existing work on the origins of democracy starts (often without any explicit discussion) from the supposition that the key causes of democracy are largely randomly assigned. Second, much existing literature is far from specific about which of many methodological changes produces a new finding — making it hard for scholars to know how to interpret any resulting changes in the causal inference. Finally standards for credible statistical research have evolved and improved over time, requiring scholars to periodically decrement the credibility they attach to existing findings. This essay closes with ideas about how research in this domain might be improved by closer attention to detail and replication, by greater use of alternative strategies for causal inference including forward path analysis, and by a broader use of contemporary statistical tools for optimal multivariate description.