OBJECTIVE: To establish whether the Finnish diabetes risk score for predicting the incidence of diabetes (FINDRISK) is also valid in the Netherlands, and to choose cut-off points suitable for the Dutch situation. DESIGN: . Descriptive. METHOD: The FINDRISK was validated in 3 Dutch cohort studies by means of repeated glucose measurements: the Hoorn study (n=5434), the PREVEND study (n=2713) and part of the Maastricht cohort from the MORGEN study (n=863). The predictive value was evaluated using receiver operating characteristic (ROC) analyses. The risk categories were defined on the basis of sensitivity, specificity and positive predictive value. RESULTS: The predictive value of the FINDRISK was best in the PREVEND cohort (area under the ROC curve 0.77) and was lower for the Hoorn study and the Maastricht cohort (area under the ROC-curve 0.71 for both). The scores were divided into three risk categories: low risk (score lower than 7), slightly increased risk (score 7-9) and increased risk (score so or higher). The percentage of persons with incident diabetes within about 5 years was < 6 in the low risk category, 6-14 in the category with slightly increased risk and 12-26 in the category with increased risk. 16-28% of the Dutch population studied had a score of 10 or higher. CONCLUSION: The FINDRISK is a reasonably good predictor for incident diabetes in the Netherlands.
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(1900). X. On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. The London, Edinburgh, and Dublin Philosophical Magazine and Journal of Science: Vol. 50, No. 302, pp. 157-175.
OBJECTIVE: To provide guidance regarding appropriate use of outcomes-based incentives as part of a reasonably designed wellness program designed to improve health and lower cost while protecting employees from discrimination and unaffordable coverage. METHODS: The process included reviewing the literature, regulations, case studies, and other resources while developing consensus through numerous group discussions. RESULTS: We offer guidance on the elements of a reasonably designed wellness program that should be in place if outcomes-based incentives are deployed and identify strategies to help ensure that effective and fair programs are put in place and evaluated. CONCLUSIONS: We strongly encourage employers using outcomes-based incentives as part of wellness initiatives to incorporate these elements of a reasonably designed wellness program and consider this guidance for the design, implementation, and evaluation of such programs.
OBJECTIVE: To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs. METHODS: To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI. RESULTS: As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less. CONCLUSIONS: Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.
(1960). A Specific and Reasonably Accurate Method for Routine Determination of Plasma Triglyceride. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 12, No. 1, pp. 1-9.
The use of fluoroscopy has become commonplace in many orthopaedic surgery procedures. The benefits of fluoroscopy are not without risk of radiation to patient, surgeon, and operating room staff. There is a paucity of knowledge by the average orthopaedic resident in terms proper usage and safety. Personal protective equipment, proper positioning, effective communication with the radiology technician are just of few of the ways outlined in this article to decrease the amount of radiation exposure in the operating room. This knowledge ensures that the amount of radiation exposure is as low as reasonably achievable. Currently, in the United States, guidelines for teaching radiation safety in orthopaedic surgery residency training is non-existent. In Europe, studies have also exhibited a lack of standardized teaching on the basics of radiation safety in the operating room. This review article will outline the basics of fluoroscopy and educate the reader on how to safe fluoroscopic image utilization.
The “As Low As Reasonably Achievable” (ALARA) principle is largely followed in the radiology field. The current article provided a historical overview on the evolution and development of the ALARA principle and its related concepts. Meanwhile, the scientific impact of papers dealing with the ALARA principle was largely unknown. The current study aimed to identify the body of literature dealing with the ALARA principle, which of them were cited the most, and which of their references were cited the most. The Web of Science database hosted by Clarivate Analytics was accessed. Relevant papers were identified and analyzed. The search identified 979 relevant publications. Six journals ( Health Physics , Pediatric Radiology , Radiation Protection Dosimetry , Transactions of the American Nuclear Society , Fusion Engineering and Design , and American Journal of Roentgenology ) have accounted for nearly one-fifth of these publications. The most cited publications and references mainly related to two patient groups, children and pregnant women. It is important to adhere to the ALARA principle whenever a decision is made to irradiate a patient, because the exact effect of radiation on the patient health is not yet totally understood and predictable.
OBJECTIVE: To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. DESIGN: A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). SETTING: Six acute NHS hospital trusts in England. METHODS: Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. RESULTS: Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. CONCLUSIONS: The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and quantifies the most frequently needed reasonable adjustments within the hospital pathways of vulnerable patient groups, and the most effective organisational infrastructure required to guarantee their use, together with resource implications.
Liberalism and the politics of identity seem incompatible. Liberalism starts from the capacity of reasonable individuals to order their lives. The politics of feminism and multiculturalism, however, argue that liberal individualism glosses over structural inequalities and relies on unjust normalizing pressures. Modern political philosophy must reconcile these two viewpoints if it is to move forward. Reasonably Radical synthesizes both approaches in a new form of liberal theory: deliberative liberalism.Anthony Simon Laden demonstrates that liberal theory can accommodate deep diversity once it recasts its understanding of the legitimization of just principles. Liberalism traditionally argues for the legitimacy of liberal political principles on the basis of citizens' consent, but derives that consent from what it regards as common human attributes. Laden, however, drawing on Rousseau and Hegel, two thinkers often ignored by contemporary liberals, claims that legitimacy cannot be so derived.According to deliberative liberalism, citizens' actual deliberation confers legitimacy on political principles in virtue of its being reasonable, regardless of whether it yields consensus. Laden argues that political deliberation can only be reasonable under certain social conditions, however. These include a reciprocal distribution of power and respect for deep diversity. Reasonable principles thus require radical politics, and both find a home in this clear theoretical articulation of identity politics which is at the same time a strong new vision of liberalism.
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In this article, I investigate how political dissent is linguistically constructed and mitigated in memes that are circulated nationally on WhatsApp in Oman. I do so by drawing upon insights from relational approaches to face, the theorization of communicative strategies as polysemous and ambiguous, and research pertaining to the Islamic practice of lamenting. The data consist of a representative set of memes collected in the summer and fall of 2015 as part of an ethnographic project on social media and Arab identity. I theorize memes as cultural tools that take the form of ‘reasonably hostile’ lament-narratives, which enable citizens in Oman to engage in democracy while saving face. To create lament-memes that voice dissent while mitigating face-attacks, Omanis draw upon various communicative strategies: They use repetition, code choice, hashtags, and different genres; they juxtapose emojis with text; and they manipulate the production and participation frameworks of texts. Collectively, these strategies, which function via intertextuality, allow the concerns to be aired, but indirectly and playfully. The article demonstrates how political dissent is negotiated and mitigated through memes, the agency of social media users, and the validity of conceptualizing memes as cultural tools.
David Silverman's second edition provides a refreshing introduction to doing and debating qualitative research. An antidote to the standard textbook, this new edition shows how research can be methodologically inventive, empirically rigorous, theoretically-alive and practically relevant. Using materials ranging from photographs to novels and newspaper stories, the book demonstrates that getting to grips with qualitative methods means asking ourselves fundamental questions about how we are influenced by contemporary culture. By drawing on examples from websites and social media in the new edition, Silverman's text acknowledges how our social worlds are changing and explores new arenas for data collection. A new Glossary of Received Ideas aims to challenge conventional understandings of terms central to qualitative research and will inform, amuse and stimulate readers. This book is perfect pre-course reading for those new to research as well as seasoned researchers who want to reflect on their practice.
Both in the component- and object-based contexts it is extremely important to derive as early as possible suitable test cases based on the UML specifications available during development. In this paper we focus on the integrated use of Sequence and State Diagrams for deriving a “reasonably” complete reference model, which will then be used for automatically deriving the test cases. The approach is meant to overcome some of the limitations of previously proposed model-based testing solutions, and is specifically conceived for industrial contexts, in which methodologies for producing effective test results soon, and even when the software is only partially modelled, are required.
The limitations of subgroup analyses are well established—false positives due to multiple comparisons, false negatives due to inadequate power, and limited ability to inform individual treatment decisions because patients have multiple characteristics that vary simultaneously. In this article, we apply Bayes’s rule to determine the probability that a positive subgroup analysis is a true positive. From this framework, we derive simple rules to determine when subgroup analyses can be performed as hypothesis testing analyses and thus inform when subgroup analyses should influence how we practice medicine.
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It is apparent that without extrapolation or animal experimentation, low-dose radiation has a small but statistically significant individual risk of excessive cancer over a child’s lifetime.1–3 This data was recently published as part of the ongoing, >50-year study of the survivors of the atomic bomb that cost $500 million. The kind of radiation and doses these individuals were exposed to is similar to that from computed tomography (CT) (Fig 1). The total body effect of the A-bomb versus the more localized effect of medical radiation makes little difference on the outcome. Figure 2 is an explanation of terminology of the radiation doses used. There is clearly an overlap between the CT doses currently used and the low doses that the atomic bomb survivors received. Fig 1. Relevant dose range for pediatric CT: 6 to 100 mSv (0.006–0.1 Sv). From Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the …
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A person with a reasonably stable sense of self-identity has a feeling of biographical continuity which she is able to grasp reflexively and, to a greater or lesser degree, communicate to other people. In conditions of late modernity, people live ‘in the world’ in a different sense from previous eras of history. Everyone still continues to live a local life, and the constraints of body ensure that all individuals, at every moment, are contextually situated in time and space. ‘Living in the world’, where the world is that of late modernity, involves various distinctive tensions and difficulties on the level of the self. People can analyse these most easily by understanding them as dilemmas which, on one level or another, have to be resolved in order to preserve a coherent narrative of self-identity. The first dilemma is that of unification versus fragmentation. A second dilemma is that of powerlessness versus appropriation. A third dilemma is that of authority versus uncertainty.