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Tang W.,University of Tokyo | Tsutani K.,University of Tokyo | Kojimahara N.,Tokyo Women's Medical University | Kawai F.,Center for Education and Research
Japanese Pharmacology and Therapeutics | Year: 2014

The definition of clinical practice guidelines (CPGs) by Institute of Medicine (IOM, USA) was revised in 2011, and the term of "systematic review" (SR) was incorporated into this definition as the basis for CPGs development for the first time. In this review, we investigated the definitions and number of published SRs in the world. We also analyzed database records and the evidence used for answering clinical questions in Japanese CPGs that are selected by Minds (Medical Information Network Distribution Service), which works mainly as Japanese CPGs clearinghouse. We found 1) differences among the definitions or descriptions of SR published by different organizations (IOM, The Cochrane Library, PubMed) that may lead to differences in standards of CPGs development ; 2) publication by 31 Dec 2013 of approximately 5,500 SRs in the CDSR (Cochrane Database of Systematic Reviews) and 13,000 SRs in DARE (Database of Abstracts of Reviews of Effects), respectively ; 3) comparing the CPGs selected by Minds before and after 2011, an increase in the proportion of CPGs without any record of database searches from 21.5% to 29.1% ; 4) use of not only SRs, but also observational studies and case studies to answer clinical questions. We recommend that CPG development groups consider the number, quality, and freshness of existing SRs as well as the reviews of SRs for developing high-quality CPGs in the future.


Zhao H.,Technical University of Denmark | Zhao H.,Center for Education and Research | Wu Q.,Tsinghua University | Guo Q.,Tsinghua University | And 2 more authors.
IEEE Transactions on Sustainable Energy | Year: 2015

This paper presents a dynamic discrete-time piece-wise affine (PWA) model of a wind turbine for the optimal active power control of a wind farm. The control objectives include both the power reference tracking from the system operator and the wind turbine mechanical load minimization. Instead of partial linearization of the wind turbine model at selected operating points, the nonlinearities of the wind turbine model are represented by a piece-wise static function based on the wind turbine system inputs and state variables. The nonlinearity identification is based on the clustering-based algorithm, which combines the clustering, linear identification, and pattern recognition techniques. The developed model, consisting of 47 affine dynamics, is verified by the comparison with a widely used nonlinear wind turbine model. It can be used as a predictive model for the model predictive control (MPC) or other advanced optimal control applications of a wind farm. © 2010-2012 IEEE.


Goldszmidt M.,University of Western Ontario | Goldszmidt M.,Center for Education and Research | Aziz N.,University of Western Ontario | Lingard L.,Center for Education and Research | Lingard L.,University of Western Ontario
Academic Medicine | Year: 2012

Purpose: During admission case review, teams work to develop a shared understanding of the problems they need to address during the patient's hospitalization. However, research on the effects of the case review on patient care is limited. Informed by rhetorical genre theory, the authors explored the impact of team's communication practices on the comprehensiveness of the case review. Method: Using a multiple-case-study approach, the authors in 2010 observed in person, audio-recorded, and transcribed data from overnight and morning case review discussions for 19 patient cases in the internal medicine department of an academic medical center. They also extracted data from the corresponding admission notes. They used a constant-comparison approach to identify emerging themes within and across cases. Results: The authors identified detours, which typically arose from supervisors' interruptions, in all 19 cases. They identified five detour types: pausing the presentation, referring to a section later in the presentation, presenting sections out of sequence, skipping a section, and truncating the presentation. Although supervisors' interruptions during case review discussions allowed for teaching and patient care, they also created detours from the usual case presentation, which then could lead to the omission of relevant case details. Conclusions: Supervisors' interruptions during case review discussions can lead to detours, which simultaneously afford valuable opportunities for teaching and threaten comprehensive information sharing. Future research should explore detours in other teaching settings to better understand their positive, negative, and unintended consequences for patient care.


Wao H.,University of South Florida | Beckstead J.W.,University of South Florida | Beal J.,Center for Education and Research | Aluoch M.,University of South Florida | And 2 more authors.
Journal of the International Association of Providers of AIDS Care | Year: 2015

Health care providers (HCPs) serving HIV-infected patients, especially in rural and underserved areas, have limited access to continuing medical education. © The Author(s) 2013.


Senju A.,Birkbeck, University of London | Kikuchi Y.,University of Tokyo | Akechi H.,University of Tokyo | Hasegawa T.,University of Tokyo | And 3 more authors.
Research in Autism Spectrum Disorders | Year: 2011

Atypical development of face processing is a major characteristic in autism spectrum disorder (ASD), which could be due to atypical interactions between subcortical and cortical face processing. The current study investigated the saccade planning towards faces in ASD. Seventeen children with ASD and 17 typically developing (TD) children observed a pair of upright or inverted face configurations flashed sequentially in two different spatial positions. The reactive saccades of participants were recorded by eye-tracking. The results did not provide evidence of overall impairment of subcortical route in ASD, However, the upright, but not the inverted, face configuration modulated the frequency of vector sum saccades (an index of subcortical control) in TD, but not in ASD. The current results suggest that children with ASD do not have overall impairment of the subcortical route, but the subcortical route may not be specialized to face processing. © 2011 Elsevier Ltd. All rights reserved.


Wao H.,University of South Florida | Aluoch M.,University of South Florida | Odondi G.O.,University of Nairobi | Tenge E.,Moi University | Iznaga T.,Center for Education and Research
International Journal of Sexual Health | Year: 2016

ABSTRACT: To compare the perceptions of men who have sex with men (MSM) and health care providers (HCPs) on barriers to uptake of HIV/AIDS-related interventions using existing quantitative and qualitative data. Systematic review and meta-synthesis was employed to combine data from both groups. Based on studies focusing on MSM and HCPs, knowledge about the intervention and intervention's cost emerged as major barriers to uptake whereas HIV- or homosexuality-related stigma/discrimination was a barrier in studies focusing on MSM alone. Lack of practice guidelines was barrier among HCPs only. Few studies exist that focus on perceptions of barriers by HCPs. © 2016 Taylor & Francis.


Lloyd A.,University of Edinburgh | Lloyd A.,Center for Education and Research | Kendall M.,University of Edinburgh | Starr J.M.,University of Edinburgh | Murray S.A.,University of Edinburgh
BMC Geriatrics | Year: 2016

Background: The experiences of people with cancer and organ disease have been described across different dimensions of need as they approach death. Such information is lacking for frail older people approaching death, but could highlight how a palliative approach might be relevant for this population. Methods: Cognitively intact, community dwelling adults considered to be moderately or severely frail were recruited from a medical day hospital. Those recruited nominated an informal carer and case-linked professional. Qualitative in-depth serial interviews with older people and their informal carers were conducted over an 18 month period, and single interviews with case-linked healthcare professionals. Interviews were recorded, transcribed and narrative analytical techniques were used to compile case studies. Results: Thirty-four participants (13 patients, 13 informal carers and 8 healthcare professionals) completed 40 individual, 14 joint and 8 professional interviews. Five patients died during the study. The analysis highlighted a dynamic balance between losses and adaptations. Three typical patterns of multi-dimensional change emerged. 1) Maintenance of psychological and existential well-being with a gradual social decline mirroring the physical deterioration. 2) a gradual reduction in both psychological and existential well-being. 3) a marked downturn in social, psychological and existential well-being before death. Frail older people sustained their well-being through maintaining a sense-of-self, garnering support from carers and community structures, and focusing on living from day to day. Their well-being lessened when they lost their sense-of-self, feeling alienated from the world, and confused over the cause of their circumstances. Death remained distant and 'undiagnosed'. Social and community frameworks were essential for supporting their well-being. Conclusions: Multidimensional end-of-life trajectories for frail older people differed from those with other conditions. Alleviating psychological, social and existential distress should be a priority of care as frail older people reach the end of life. The current palliative care model is problematic for this group. Care should address future concerns and not necessarily involve a focus on death or place of death. © 2016 The Author(s).

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