Contends that philosophers of science, technology, & society have failed to properly distinguish between the contexts of discovery & justification of scientific knowledge. Deconstruction of the ...discovery/justification distinction has historically been used in England to assert the intellectual dominance of universities over trade schools, by the Nazis to discredit scientific knowledge discovered by ethnic minorities, & most recently by the historicist strain of the philosophy of science, which measures scientific knowledge in part based on its origination within a certain research tradition. The consequence of the historicist view is an exclusive, independent view of knowledge that rejects interaction among disciplines, traditions or cultures. It is suggested that philosophers of science reconceptualize notions of discovery & justification to remove the exclusivity of use now granted to a research tradition for having made the discovery first in order to broaden communication & exchange of information across traditions, disciplines, & cultures. C. Ryan
PURPOSE:Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax are commonly performed, emerging evidence suggests that this ...practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. We hypothesize that a knowledge translation gap exists in this area. We aim to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared with chest radiography.
METHODS:We used a modified Dillman technique to conduct a brief web-based survey to Critical Care Medicine and Emergency Medicine physicians (targeted group of early adopters) evaluating the current practice related to CVC position confirmation and PTX exclusion via CXR or POCUS.
RESULTS:Of 200 post-training clinicians contacted, 136 (68%) responded to the survey. For routine CVC confirmation and PTX evaluation, 50.7% of Critical Care Medicine physicians and 65.4% of Emergency Medicine physicians reported using CXR alone while 49.3% and 33.1% respectively reported using CXR and ultrasound together. Though 84.6% of clinicians use ultrasound for CVC insertion “most of the time” or “always,” none use ultrasound alone for CVC position confirmation, and only 1% has used ultrasound alone for PTX exclusion.
CONCLUSIONS:Though data support its utility and advantages for POCUS as a sole modality for CVC position confirmation and PTX evaluation, POCUS is rarely used for this indication. We identified several perceived barriers toward widespread utilization suggesting areas for dissemination and implementation strategy development that will benefit patient care practices.
Ensuring equivalence of examiners' judgements across different groups of examiners is a priority for large scale performance assessments in clinical education, both to enhance fairness and reassure ...the public. This study extends insight into an innovation called Video-based Examiner Score Comparison and Adjustment (VESCA) which uses video scoring to link otherwise unlinked groups of examiners. This linkage enables comparison of the influence of different examiner-groups within a common frame of reference and provision of adjusted "fair" scores to students. Whilst this innovation promises substantial benefit to quality assurance of distributed Objective Structured Clinical Exams (OSCEs), questions remain about how the resulting score adjustments might be influenced by the specific parameters used to operationalise VESCA. Research questions, How similar are estimates of students' score adjustments when the model is run with either: fewer comparison videos per participating examiner?; reduced numbers of participating examiners?
Using secondary analysis of recent research which used VESCA to compare scoring tendencies of different examiner groups, we made numerous copies of the original data then selectively deleted video scores to reduce the number of 1/ linking videos per examiner (4 versus several permutations of 3,2,or 1 videos) or 2/examiner participation rates (all participating examiners (76%) versus several permutations of 70%, 60% or 50% participation). After analysing all resulting datasets with Many Facet Rasch Modelling (MFRM) we calculated students' score adjustments for each dataset and compared these with score adjustments in the original data using Spearman's correlations.
Students' score adjustments derived form 3 videos per examiner correlated highly with score adjustments derived from 4 linking videos (median Rho = 0.93,IQR0.90-0.95,p < 0.001), with 2 (median Rho 0.85,IQR0.81-0.87,p < 0.001) and 1 linking videos (median Rho = 0.52(IQR0.46-0.64,p < 0.001) producing progressively smaller correlations. Score adjustments were similar for 76% participating examiners and 70% (median Rho = 0.97,IQR0.95-0.98,p < 0.001), and 60% (median Rho = 0.95,IQR0.94-0.98,p < 0.001) participation, but were lower and more variable for 50% examiner participation (median Rho = 0.78,IQR0.65-0.83, some ns).
Whilst VESCA showed some sensitivity to the examined parameters, modest reductions in examiner participation rates or video numbers produced highly similar results. Employing VESCA in distributed or national exams could enhance quality assurance or exam fairness.
Antegrade colonic enemas (ACE) can be an effective management option for defecation disorders and improve quality of life. Best practice regarding channel placement is unclear and variation may exist ...around preferred initial type of channel, age at placement, and underlying diagnoses. We aimed to describe practice patterns and patient characteristics around ACE channel placement.
We conducted a multicenter retrospective study of children with an ACE channel cared for at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) from 2017 to 2022. Kruskal–Wallis test was utilized to test the age at surgery by site with significance level of 0.05.
500 patients with ACE channel were included. 293 (58.6%) patients had their ACE procedure at a PCPLC center. The median age at surgery was 7.6 IQR 5.3–11.0 years for the overall cohort and 8.1 IQR 5.3–11.5 years for placement at PCPLC centers. For PCPLC centers, median age at placement varied significantly across centers (p = 0.009). 371 (74.2%) patients received Malone appendicostomy, 116 (23.2%) received cecostomy, and 13 (2.6%) received Neo-Malone appendicostomy. Median age of patients by channel type was 7.7 IQR 5.3–11.0, 7.5 IQR 5.7–11.0, and 9.8 IQR 4.2–11.6 years, respectively. The most common indication for cecostomy was idiopathic/refractory constipation (52.6%), whereas anorectal malformation was the most common indication for Malone (47.2%) and Neo-Malone (61.5%). Among ACE channels placed at PCPLC centers, there was variation across institutions in preferred initial channel type. The 4 highest volume centers favored Malone appendicostomy over cecostomy.
There is variation in practice of ACE channel placement. At specialty pediatric colorectal centers, age at time of placement and type of channel placed varied across institutions. Further work is needed to better characterize diagnosis- and age-focused patient centered outcomes to clarify recommendations for our patients who benefit from these procedures.
Retrospective comparative study.
Level III.
Aim
We assessed the spatial distribution of four different types of avian specialization throughout Europe, identifying landscape features associated with specialization and quantifying where the ...Natura 2000 network intersects with areas of high avian specialization.
Location
Europe.
Time period
Present day.
Taxa studied
European breeding birds.
Methods
We used the European Atlas of breeding birds and four avian specialization measures (diet, foraging behaviour, foraging substrate and habitat). We calculated specialization richness and identified geographical hotspots for each of these ecological traits. We tested whether elevational gradient, landscape heterogeneity or dominant land use predicted each type of specialization richness. We determined which types of European protected areas are most associated with higher specialization richness.
Results
Diet and foraging substrate specialists increased with elevation, whereas richness of foraging behavioural specialists decreased. There was a greater richness of dietary and habitat specialists in forests than in other environments. The Natura 2000 areas declared under Bird and both directives (Birds and Habitats) intersected with a high dietary, foraging substrate and habitat specialist richness. The richness of foraging behaviour specialists was high in Birds directive areas. Single and multiple hotspots of specialization were greater in protected than non‐protected areas. However, almost 30% of specialization hotspots did not intersect with protected areas.
Main conclusions
Our findings suggest that higher levels of avian specialization in Europe are positively associated with elevation and forested land cover. Importantly, we found that the Natura 2000 network supports all types of avian ecological specialization, albeit mainly in areas declared under both directives.
AimsCytogenetic abnormalities involving the IGH gene are seen in up to 55% of patients with multiple myeloma. Current testing is performed manually by fluorescence in situ hybridisation (FISH) on ...purified plasma cells. We aimed to assess whether an automated imaging flow cytometric method that uses immunophenotypic cell identification, and does not require cell isolation, can identify IGH abnormalities.MethodsAspirated bone marrow from 10 patients with multiple myeloma were studied. Plasma cells were identified by CD38 and CD138 coexpression and assessed with FISH probes for numerical or structural abnormalities of IGH. Thousands of cells were acquired on an imaging flow cytometer and numerical data and digital images were analysed.ResultsUp to 30 000 cells were acquired and IGH chromosomal abnormalities were detected in 5 of the 10 marrow samples. FISH signal patterns seen included fused IGH signals for IGH/FGFR3 and IGH/MYEOV, indicating t(4;14) and t(11;14), respectively. In addition, three IGH signals were identified, indicating trisomy 14 or translocation with an alternate chromosome. The lowest limit of detection of an IGH abnormality was in 0.05% of all cells.ConclusionsThis automated high-throughput immuno-flowFISH method was able to identify translocations and trisomy involving the IGH gene in plasma cells in multiple myeloma. Thousands of cells were analysed and without prior cell isolation. The inclusion of positive plasma cell identification based on immunophenotype led to a lowest detection level of 0.05% marrow cells. This imaging flow cytometric FISH method offers the prospect of increased precision of detection of critical genetic lesions involving IGH and other chromosomal defects in multiple myeloma.
Abstract Purpose We evaluated agreement among trained emergency physicians assessing the degree of B-line presence on bedside ultrasound in patients presenting to the emergency department (ED) with ...acute undifferentiated dyspnea. We also determined which thoracic zones offered the highest level of interobserver reliability for sonographic B-line assessment. Materials and methods We evaluated a prospective convenience sample of adult patients presenting with dyspnea to an academic ED. Two consecutive bedside lung ultrasounds were performed on 91 patients by a pair of physician-sonographers. The lung ultrasounds were structured 10-zone thoracic sonograms, documented as videos. Sonographer pairs were expert/expert (> 100 lung ultrasounds performed) or expert/novice pairs (novices performed 5 supervised examinations after structured training) and blinded to clinical data. Sonographers reported B-line concentration with 3 assessment methods: (1) normal (< 3 B-lines) or abnormal (≥ 3 B-lines); (2) ordinal (normal, mild, moderate, or severe), and (3) counting B-lines (0-10; > 10) in each zone. All statistical analyses were performed using SPSS version 18.0 (Chicago, IL) and Stata 12.1 (College Station, TX). We evaluated interrater and intrarater agreement using Intraclass correlation coefficients (ICCs). Results The right and left anterior/superior lung zones showed substantial agreement in all assessment methods and demonstrated best overall agreement (ICC for right: counting, ordinal, and normal/abnormal, 0.811 0.714-0.875, 0.875 0.810-0.917, and 0.729 0.590-0.821, respectively). Furthermore, both expert/expert pairs and expert/novice pairs showed substantial agreement in the right and left anterior/superior thoracic zones (expert/expert, 0.904 and 0.777, respectively; expert/novice, 0.862, and 0.834, respectively). Second best agreement was found for the lateral/superior lung zones (right: counting, ordinal, and normal/abnormal, 0.744 0.612-0.831, 0.686 0.524-0.792, and 0.639 0.453-0.761, respectively; and ICC left: counting, ordinal, and normal/abnormal, 0.671 0.501-0.782, 0.615 0.417-0.746, and 0.720 0.577-0.815, respectively). When comparing agreement to distinguish “normal vs abnormal” B-line findings, our results showed significant agreement in all zones with the exception of the right and left inferior/lateral lung fields and left posterior lung. Reinterpretation by 2 experts of all their own randomized video clips at a later date showed agreement of 0.697 (n = 733 zones) and 0.647 (n = 266) zones for ordinal assessment of B-line concentration. Conclusion Interrater agreement was best in the anterior/superior thoracic zones followed by the lateral/superior zones for both expert/expert and expert/novice pairs. Agreement in the lateral/inferior lung zones was overall inferior. Intrarater agreement was highest at extreme high or low numbers of B-lines.
The chemical species composition of a vitiated oxidizer stream can significantly affect the combustion processes that occur in many propulsion and power generation systems. Experiments were performed ...to investigate the chemical kinetic effects of vitiation on ignition and flame propagation of hydrocarbon fuels using propane. Atmospheric-pressure flow reactor experiments were performed to investigate the effect of NOx on propane ignition delay time at varying O2 levels (14–21mol%) and varying equivalence ratios (0.5–1.5) with reactor temperatures of 875K and 917K. Laminar flame speed measurements were obtained using a Bunsen burner facility to investigate the effect of CO2 dilution on flame propagation at an inlet temperature of 650K. Experimental and modeling results show that small amounts of NO can significantly reduce the ignition delay time of propane in the low- and intermediate-temperature regimes. For example, 755ppmv NOx in the vitiated stream reduced the ignition delay time of a stoichiometric propane/air mixture by 75% at 875K. Chemical kinetic modeling shows that H-atom abstraction reaction of the fuel molecule by NO2 plays a critical role in promoting ignition in conjunction with reactions between NO and less reactive radicals such as HO2 and CH3O2 at low and intermediate temperatures. Experimental results show that the presence of 10mol% CO2 in the vitiated air reduces the peak laminar flame speed by up to a factor of two. Chemical kinetic effects of CO2 contribute to the reduction in flame speed by suppressing the formation of OH radicals in addition to the lower flame temperature caused by dilution. Overall, the detailed chemical kinetic mechanism developed in the current work predicts the chemical kinetic effects of vitiated species, namely NOx and CO2, on propane combustion reasonably well. Moreover, the reaction kinetic scheme also predicts the negative temperature coefficient (NTC) behavior of propane during low-temperature oxidation.
Abstract
Purpose
Ensuring equivalence of examiners’ judgements within distributed objective structured clinical exams (OSCEs) is key to both fairness and validity but is hampered by lack of ...cross-over in the performances which different groups of examiners observe. This study develops a novel method called Video-based Examiner Score Comparison and Adjustment (VESCA) using it to compare examiners scoring from different OSCE sites for the first time.
Materials/ methods
Within a summative 16 station OSCE, volunteer students were videoed on each station and all examiners invited to score station-specific comparator videos in addition to usual student scoring. Linkage provided through the video-scores enabled use of Many Facet Rasch Modelling (MFRM) to compare 1/ examiner-cohort and 2/ site effects on students’ scores.
Results
Examiner-cohorts varied by 6.9% in the overall score allocated to students of the same ability. Whilst only a tiny difference was apparent between sites, examiner-cohort variability was greater in one site than the other. Adjusting student scores produced a median change in rank position of 6 places (0.48 deciles), however 26.9% of students changed their rank position by at least 1 decile. By contrast, only 1 student’s pass/fail classification was altered by score adjustment.
Conclusions
Whilst comparatively limited examiner participation rates may limit interpretation of score adjustment in this instance, this study demonstrates the feasibility of using VESCA for quality assurance purposes in large scale distributed OSCEs.
Identifying links between breeding and non-breeding sites in migratory animals is an important step in understanding their ecology. Recognising the relative importance of foraging areas and ...ascertaining site-specific levels of recruitment can provide fundamental and applied insights. Here, satellite telemetry and the stable isotope ratios (δ13C, δ15N and δ34S) of 230 green turtles Chelonia mydas from a regionally important rookery in northern Cyprus were employed to evaluate the relative importance of 4 foraging areas. A preliminary analysis of stable isotope ratios suggested that a major foraging area had been missed through satellite telemetry as a large proportion of turtles had isotope ratios that did not correspond to sites previously identified. Stable isotope ratios were then employed to select 5 turtles to be fitted with platform terminal transmitters in 2015. All 5 turtles were subsequently tracked to the same location, Lake Bardawil in Egypt. Serially collected tissue samples from 45 females, ranging over 2 to 4 breeding seasons, suggested that foraging site fidelity was very common, with 82% of females exhibiting extremely high temporal consistency in isotope ratios. Quantifying fidelity allowed an evaluation of foraging area-specific contributions to each breeding cohort over the past 2 decades and demonstrated that recruitment was unequal among sites, and dynamic over time, with Egypt now currently the major contributor to the nesting aggregation. This work demonstrates the utility of stable isotope analysis to elucidate the spatial ecology of cryptic taxa and illustrates how more robust baselines can be assembled against which to measure the success of future marine conservation initiatives.
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