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Electron Beam Melting (EBM) is typically used to produce high performance titanium parts, but it falls short in ensuring the high surface finishing always requested for aerospace applications, and this leads to the need of a post-building finishing resulting in additional resources and energy consumption. An optimization of the post-processing is necessary and the literature lacks guidelines in this regard. In this study, 18 cylindrical samples were produced by EBM and then postprocessed by wet and dry turning by using the same process parameters. Surface roughness, tool wear rate, specific cutting energy and energy consumption were investigated and compared to understand the best compromise to remove the same total depth of cut (2.4 mm). Results showed that dry turning can result in saving up 9% in total energy consumption. Also, feed rate and depth of cut can be varied by fixing the spindle speed without significantly affecting surface roughness by saving up to 73% in total energy consumption. [ABSTRACT FROM AUTHOR]

JAMAevidence is an online resource available through McGraw Hill Medical for the teaching, learning, and application of evidence-based medicine. JAMAevidence helps students and clinicians identify, appraise, and use the best available evidence to assess health problems and the outcomes of health care. It also features books, calculators, educational guides, a glossary, and learning tools. [ABSTRACT FROM AUTHOR]

Energy-environmental efficiency directly relates to global climate change and sustainable development. The research applies a staggered DiD design to estimate the effects of low-carbon governance on energy-environmental efficiency via panel data of 284 cities in China. Results show that low-carbon governance significantly improves both unified energy-environmental efficiency and pure energy-environmental efficiency. Heterogeneity analysis reveals that low-carbon governance in central cities has no significant effect on energy-environmental efficiency, while that in peripheral cities can improve energy-environmental efficiency, which indirectly confirms the law of decreasing returns to scale. At the same time, low-carbon governance in both resource-based and non-resource-based cities improves energyenvironmental efficiency. However, among resource-based cities, low-carbon governance in growth and mature cities facilitates energy-environmental efficiency, while this effect disappears in declining and regeneration cities. Mechanism tests suggest that low-carbon governance immediately improves energy-environmental efficiency through intensive energy use and carbon emission reduction channels. The intermediate effect channels are mainly driven by fiscal decentralization, industrial structure upgrading, industrial agglomeration, innovation, and marketization, where fiscal decentralization plays a dominant role. [ABSTRACT FROM AUTHOR]

Forming process control of powder bed fusion (PBF) additive manufacturing (AM) is the key to produce high-quality qualified parts. In this paper, spreading powder process and electron-beam melting (EBM) of Ti6Al4V powder were simulated based on simulation technology, and the state of powder bed powder and melting trajectory characteristics were characterized. Firstly, the particle size distribution of Ti6Al4V powder was tested, and the particle diameter of normal distribution for simulation was determined. Then, the simulation models of spreading powder and EBM model were established. Finally, based on the simulation results, the effect of processing parameters on the quality of powder laying is analyzed, and the morphology of EBM melting trajectory is characterized. [ABSTRACT FROM AUTHOR]

Commonly used conservative shoulder pain treatments include: advice/analgesia, exercise/manual therapy and, corticosteroid injection. Moderators, patient/clinical attributes influencing treatment effect, facilitate clinical decision-making by identifying which patients might respond best to specific treatments. This review summarises results of studies aiming to identify/test treatment effect moderators. Randomised controlled trials (RCTs) containing some form of, or suggested moderation/subgroup analysis (sample size >20, and >10 subjects in smallest subgroup), comparing above treatments against physical/functional/pain outcomes, in adults with shoulder pain were searched for in Medline, Embase, PsychInfo, CINAHL, AMED, Pedro, Cochrane Database. Cochrane Risk of Bias tool and Pincus criteria for moderation analysis were applied. Six RCTs aiming to identify/test moderators and 16 suggesting potential moderators were included and data narratively synthesised. One trial offered confirmatory level moderation (Pincus criteria). Graded exercise had smaller effect in those with painful arc at baseline, compared against without, although lacked statistical significance (mean difference −14.0 shoulder disability (0–100 scale), 95% CI's [−28.1, 0.1], p = 0.05). Twenty other factors with insufficient level moderation evidence were identified. Review highlights lack of high-quality evidence for moderators of treatment effect of shoulder pain treatments. Future research should address proposed candidate moderators, using robust moderation methodologies to inform clinical decision-making. [ABSTRACT FROM AUTHOR]

To describe how patients with acute/subacute back pain and/or neck pain experienced a workplace intervention, conducted as a structured workplace dialogue (convergence dialogue meeting, CDM) within physiotherapy practice in primary care. Semi-structured interviews were performed with 10 patients who took part in the CDM. Qualitative content analysis was applied to the data. Three categories emerged from the analysis: physiotherapist (PT) as a facilitator, the employer as a key stakeholder and lack of transparency and concrete changes. This study describes patients' experiences of a workplace dialogue in physiotherapy practice. Even though few patients experienced concrete changes at the workplace, they were supportive for the intervention as well as how the PTs conducted the CDM. The patients expressed trust in the PTs who were seen as someone who could facilitate changes at the workplace, being proficient and supportive. The CDM could be a method to facilitate communication between stakeholders and support work ability. [ABSTRACT FROM AUTHOR]

In this experimental work, a mixture of Hydroxyapatite (HAp)+yttrium stabilized zirconia (YSZ) is deposited on a layer of Ti6Al7Nb alloy by electron-beam deposition method, which finds its application in bone and dental implants. Multi-criteria decision making method is adopted (TOPSIS) highlights the close to an ideal solution at the temperature of 160°C (Chamber), 950°C (Furnace), 30 mA (Energy), 90 min (Duration) for achieving the coated layer with optimal thickness. XRD revealed the heat treatment of the samples varying at 450°C and below, tend to shift the sample toward amorphous region due to the inherent nature of electron-beam deposition. To compensate for this, a post-heat treatment has been carried out. From SEM analysis, it is ascertained that coated specimen indicates minimal micro voids and pores, as seen in the cross-sectional area of the HAp/YSZ coated Ti6Al7Nb. The percentage increase from the stoichiometric YSZ and HAp (1.68) to 18.96% (1.99) and 19.20% (1.54) indicates the rise in elemental composition with rise in temperature, attributed to the dissolving nature of P, along with the boundaries of Zr and Ca. In the presence of HAp-YSZ, nano-coated specimen on the substrate would lead to a higher penetration depth along with increase in the strength of the bond formed (adhesive) in the specimen. In the presence of HAp/YSZ powder the corrosion rate falls by 49.34%, attributed to the presence of Zr in YSZ sample creating an addendum for osseointegration. [ABSTRACT FROM AUTHOR]

Background and Objectives:For Evidence Based Medicine (EBM) learning journal clubs are recommended, but these are not common practice. How participants discuss and learn about applying evidence in other group meetings is unknown. We examined different types of group meetings and explored the use of, and discussions about, clinical research evidence. Methods:A mixed-methods study design was adopted. After distribution and analysis of a questionnaire about types of group meetings, interviews were conducted to better understand the most frequently occurring type. Results:GPs have different types of meetings, but the most common group meetings where evidence wass discussed were so called quality circles, i.e. pharmacotherapy audit meetings in which GPs discuss drug prescription figures or preferred treatment together with pharmacists. Interviews showed that the source of evidence used mostly are the recommendations in the national GP guidelines. The underlying evidence or new research did not play an important role in the discussions. Conclusions:Quality circles seem to be more goal-oriented than learning oriented. Learning discussions about controversies in clinical research or about the integration of evidence, patient values and clinical expertise occurred infrequently. To harvest the potential value of group meetings for EBM learning, quality circles in their present design are not optimal. [ABSTRACT FROM PUBLISHER]

This article presents economic models for a new hybrid method where additive manufacturing (AM) and subtractive methods (SMs) are integrated through composite process planning. Although AM and SM offer several unique advantages, there are technological limitations such as tolerance and surface finish requirements; tooling and fixturing, etc. that cannot be met by a single type of manufacturing. The intent of this article is not to show a new manufacturing method, but rather to provide economic context to additive and subtractive methods as the best practice provides, and look at the corresponding economics of each of those methods as a function of production batch size, machinability, cost of the material, part geometry and tolerance requirements. Basic models of fixed and variable costs associated with additive, subtractive and hybrid methods to produce parts are also presented. An experimental design is used to study the influence of production volume, material and operating cost, batch size, machinability of the material and impact of reducing AM processing time. A composite response model for the unit cost is computed for the various levels associated with such engineering requirements. The developed models provide insight into how these variables affect the costs associated with engineering a mechanical product that will be produced using AM and SM methods. From the results, it appears that batch size, AM processing time and AM processing cost were the major cost factors. It was shown that the cost of producing ‘near-net’ shape through SM and AM was the decision criteria; which will be critical for tough-to-machine alloys and at multi-batch size. [ABSTRACT FROM AUTHOR]

JAMAevidence is a compilation of texts and tools that are dedicated to learning, teaching, and supporting evidence-based medicine (EBM). The subscription-based resource provides access to three EBM texts; podcasts; and complimentary learning resources such as education guides, calculators, and worksheets. This review will describe the sections of JAMAevidence so that the reader will be able to comfortably navigate and effectively use the resource. [ABSTRACT FROM AUTHOR]

Introduction. Surgical treatment for chronic subdural haematoma (CSH) has been analysed by applying evidence-based medicine (EBM) criteria earlier. Whether implementation of EBM-derived key factors into an optimised treatment algorithm would improve outcome, however, needs to be clarified.Material and methods. Symptomatic patients with CSH who fulfilled the inclusion criteria were either assigned to an optimised treatment algorithm (OA-EBM group) or to a control group treated by the standard departmental surgical technique (SDST group) in a prospective design. For the OA-EBM algorithm only one burr hole, extensive intraoperative irrigation and a closed system drainage with meticulous avoidance of entry of air was mandatory. A two-catheter technique was used to reduce intracavital air. Final endpoints were neurological outcome (Markwalder Score), recurrence and the amount of intracranial air.Results. A total of 93 out of 117 patients were evaluated accounting for 113 cases because 20 patients had bilateral haematomas. Demographic data of 68 cases in the SDST group did not differ from 45 cases in the OA-EBM group. The Markwalder Score showed greater improvement in the OA-EBM group (0.5 ± 0.6 vs. 1.0 ± 1.0, p = 0.003). The recurrence rate was 18% (12 patients) in the SDST group versus 2% (1 patient) in the OA-EBM group (p < 0.05). The amount of intracranial air was significantly lower in the OA-EBM group (3.3 ± 5.0 cm3vs. 5.2 ± 7.7 cm3) with p = 0.04. In the standard group computerised tomography scanning was performed slightly earlier (3 ± 1.7 days vs. 3.6 ± 1.4 days). When comparing only non-recurrent cases in both groups no significant difference was apparent.Conclusions. Implementation of EBM key factors into a treatment algorithm for CSH can improve neurological outcome in a typical neurosurgical department, reduce recurrence and minimise the amount of postoperative air within the haematoma cavity. [ABSTRACT FROM AUTHOR]

This article discusses the impact of the Norwegian government's administrative reform on the management of the Norwegian aquaculture industry and coastal areas. The 2010 reform of government administration strengthened the County Councils’ role in issues of aquaculture at the expense of the regional offices of the Directorate of Fisheries. The aim of the reform was to increase self-governance through decentralization. However, international trends in coastal zone and marine resource management are moving in the opposite direction, aiming at more integrated and ecosystem-based approaches involving the management of larger, rather than smaller, geographic regions. This article examines the possible effects of this reform in light of the move from government to governance, and in the context of a broad policy shift toward a more integrated, ecosystem-based management (EBM) of the coastal zone. Based on insights from multi-level and coastal zone governance debates, we argue that an unintended consequence of the Norwegian administrative reform could be increased fragmentation of the aquaculture governance system, as well as a reduced capacity to implement EBM-related measures. At the same time, the reform might improve coastal zone planning, although a further step toward integrated coastal zone management (ICZM) would require a greater delegation of authority to the County Councils. [ABSTRACT FROM AUTHOR]

In this work, a system of compatible blends based on two commercial grades of a thermoplastic elastomer, styrene-ethylene/butylene-styrene (SEBS), with extreme Shore A hardness values (5 and 90), was studied in order to obtain a range of different performance blends for orthopedic and childcare applications, where usually liquid silicone rubber is used. Mechanical properties of different blends were obtained, and Equivalent Box Model (EBM) was used for the prediction of the mechanical behavior. The results show good agreement between the theoretical model and experimental data of new blends of SEBS. [ABSTRACT FROM AUTHOR]

Background: Providing evidence-based care is recognized as a key skill for health care workers from diverse professions and cultures.Purpose: We aimed to assess the effectiveness of a short course in evidence-based medicine (EBM) to change the knowledge and skills of undergraduate medical students and point to possible incorporation of EBM in their curriculum.Methods: This is a before-and-after study that was evaluated by the Fresno questionnaire. A 2-week short course of lectures, seminars, online search, and answering worksheets was conducted on 54 fifth-year medical students rotating through the family medicine department at Jordan University Hospital from September 1 until mid-December 2011.Results: The students achieved a mean score of 26.7 out of 200 in the pretest and 119.5 in the posttest. The mean difference between the pre- and posttests was 92.8, a statistically significant result with a 95% confidence interval of 84.7, 101.0 (p< .0001) with an effect size of 4.2 standard deviation units.Conclusions: A short course in EBM will significantly improve the skills and knowledge of undergraduate medical students. [ABSTRACT FROM AUTHOR]

To achieve the desired outcomes of ecosystem-based or integrated coastal management, paradigm shifts must occur in all stages of the policy process. This article focuses on the evaluative stage following policy implementation, specifically on the use of coastal ecosystem condition indicators. A review of the recent literature suggests that coastal ecosystem condition indicators with too broad a scale or too narrow a scope lose utility and applicability. An analysis of these problems of scale and scope reveals that the process through which an index is designed and selected can hinder or heighten its validity. Local and diverse stakeholder input can help to ameliorate weaknesses, increasing the evaluative validity of coastal ecosystem condition indicators. [ABSTRACT FROM AUTHOR]

Introduction. There are few studies pertaining to asthma patients’ views on complementary and alternative medicine (CAM). The driving question behind the study is why some asthma patients choose noncompliance to conventional western medicine and resort to other modalities, often deemed as being ‘alternative,’ ‘complementary,’ or ‘integrated.’ Does the patients’ emancipation movement lead to greater awareness of the benefits of alternative medicine? Does the patients’ identity as asthma sufferers play a role in their decision? Method: Case studies based on semistructured interviews were conducted between June 2009 and January 2010 with 19 asthma patients in The Netherlands who have chosen complementary and alternative medicine (CAM). Patients were contacted through online forum of Dutch asthma patients’ organization Astma Fonds. Discussion. We have discovered that on the whole patients in the present study were well informed about risks and benefits of both prescribed and alternative medicines. We have argued that noncompliance to medical regime by some asthma patients can be explained by the rationality of their choice based on evidence of clinical trials of commonly assigned asthma medication as well as partial and anecdotal evidence of the benefits of CAM therapies. It is the patients themselves who, by invoking the same evidence-based dominant paradigm choose to address the conflict between protagonists of ‘conventional,’ western medicine and other modalities. Conclusion. The author argues that asthma patients’ noncompliance with (Western) medical regime and choice for alternative medical treatment of asthma is a matter of rational choice informed by evidence-based awareness. This evidence-based rationality particularly refers here to the patients’ awareness of the rather controversial results of clinical trials of commonly used asthma medicines, particularly those containing elements of budesonide (Pulmicort), an anti-inflammatory corticosteroid, and formoterol (Oxis, Foradil), a rapid-acting and long-lasting β2-agonist (bronchodilator). [ABSTRACT FROM AUTHOR]

This article elaborates on the opportunities and challenges that evidence-based medicine (EBM) has posed to the development of medical libraries and summarizes the research in the field of evidence-based medicine and achievements of EBM practice in Chinese medical libraries. Issues such as building collections of information resources, transformation of information services models, human resources management, and training of medical librarians, clinicians, and EBM users are addressed. In view of problems encountered in EBM research and practice, several suggestions are made about important roles medical libraries can play in the future development of EBM in China. [ABSTRACT FROM AUTHOR]

Academic health sciences libraries can take various approaches to support the problem-based learning component of the curriculum. This article presents one such approach taken to integrate information navigation skills into the small group discussion part of the Pathophysiology course in the second year of the Dental school curriculum. Along with presenting general resources for the course, the Library Toolkit introduced an algorithmic approach to finding answers to sample clinical case questions. While elements of Evidence-Based Practice were introduced, the emphasis was on teaching students to navigate relevant resources and apply various database search techniques to find answers to the clinical problems presented. [ABSTRACT FROM AUTHOR]