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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]

The coastline of Qatar is a rich mosaic of productive and diverse ecosystems including mangrove forests, intertidal mudflats (sabkha), seagrass beds, and coral reefs. These ecologically interconnected ecosystems contain a substantial proportion of Qatar's total biodiversity, and support an estimated 97% of the >US$ 67 million in annual commercial fisheries, the highest value resource sector after petroleum. The extreme environmental conditions that characterize Qatar has led to fauna that are robust compared with other regions, but makes them highly sensitive to further pressure from anthropogenic stress. These vulnerable ecosystems have come under increasing pressure in recent decades as a result of dramatic expansion of coastal development, and threats to these ecosystems are likely to accelerate in the coming years as Qatar's economy and population continue to grow. Although environmental regulation had historically lagged behind the rapid pace of development, in recent years Qatar's leadership has aggressively expanded environmental management as a result of the growing awareness of the importance of coastal ecosystems. While these improvements are encouraging, management remains challenged by its current sectorial, project-driven focus. Ecosystem-based management (EBM) offers an opportunity to overcome these challenges by integrating impacts from across all major activities in multiple sectors and considering their cumulative effects on ecosystem services and products. While an EBM approach would require modest reprioritizing of existing processes and attention to addressing deficiencies in data needed to support decision making, it has the potential to greatly enhance the efficiency and effectiveness of coastal zone management. The article closes by summarizing a recently initiated research project on coral reefs and seagrass beds in Qatar which can serve as a model for development of the EBM approach for other coastal ecosystems in Qatar. [ABSTRACT FROM AUTHOR]

While Traditional Chinese medicine (TCM) does not lack well-conceived, empirically- and time-tested diagnostic and therapeutic treatment methodologies, these may be insufficient to support its fuller integration with the dominant Western health care system. Western medicine continues to discount, ignore, or even dismiss, many of the fundamental theories of TCM. Moreover, there continues to be widespread criticism of the the methods, and therefore the findings, of TCM-related research. Although questions increasingly arise as to the appropriateness of randomized controlled trials (RCTs) for studying certain types of medical research questions, including many pertaining to TCM, RCTs remain the gold standard for scientific research and strongly inf luence evidence-based medicine (EBM). Aspects of EBM have been an informal component of TCM dating back to the time of Zhang Zhong-Jing, and the Shang Han Lun certainly ref lects key elements of formal EBM. A deeper understanding and greater use of EBM among TCM professionals would improve the overall perception and credibility of TCM and contribute to its fuller integration with the conventional Western healthcare system, including among those who provide, pay for, and utilize TCM services. [ABSTRACT FROM AUTHOR]

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This paper aims to study the genesis of defects in titanium components made through two different additive manufacturing technologies: selective laser melting and electron beam melting. In particular, we focussed on the influence of the powders used on the formation of porosities and cavities in the manufactured components. A detailed experimental campaign was carried out to characterize the components made through the two additive manufacturing techniques aforementioned and the powders used in the process. It was found that some defects of the final components can be attributed to internal porosities of the powders used in the manufacturing process. These internal porosities are a consequence of the gas atomization process used for the production of the powders themselves. Therefore, the importance of using tailored powders, free from porosities, in order to manufacture components with high mechanical properties is highlighted. [ABSTRACT FROM AUTHOR]

Additive Manufacturing (AM) methods are generally used to produce an early sample or near net-shape elements based on three-dimensional geometrical modules. To date, publications on AM of metal implants have mainly focused on knee and hip replacements or bone scaffolds for tissue engineering. The direct fabrication of metallic implants can be achieved by methods, such as Selective Laser Melting (SLM) or Electron Beam Melting (EBM). This work compares the SLM and EBM methods used in the fabrication of titanium bone implants by analyzing the microstructure, mechanical properties and cytotoxicity. The SLM process was conducted in an environmental chamber using 0.4-0.6 vol % of oxygen to enhance the mechanical properties of a Ti-6Al-4V alloy. SLM processed material had high anisotropy of mechanical properties and superior UTS (1246-1421 MPa) when compared to the EBM (972-976 MPa) and the wrought material (933-942 MPa). The microstructure and phase composition depended on the used fabrication method. The AM methods caused the formation of long epitaxial grains of the prior β phase. The equilibrium phases (α + β) and non-equilibrium ά martensite was obtained after EBM and SLM, respectively. Although it was found that the heat transfer that occurs during the layer by layer generation of the component caused aluminum content deviations, neither methods generated any cytotoxic effects. Furthermore, in contrast to SLM, the EBM fabricated material met the ASTMF136 standard for surgical implant applications. [ABSTRACT FROM AUTHOR]

Randomized controlled trials (RCTs) are considered to produce the highest level of evidence in the original studies that informs the practice of evidence-based medicine (EBM). By manipulating an independent variable to study its impact on the outcome, RCTs establish causal relationships and provide valuable insights into clinical treatment. To improve patient outcomes and optimize the use of clinical resources, the practice of EBM plays a crucial role in designing and conducting RCTs to evaluate the effectiveness of clinical interventions. This review aims to explore the essential steps involved in conducting a rigorous and reliable RCT, ensuring the generation of high-quality evidence., (Copyright © 2024 by Daedalus Enterprises.)

Abstract non disponibile (Bioethics)

OBJECTIVE: The aim of this study was to explore applying the method of evidence-based medicine (EBM) to resolve common questions in the field of disability evaluation. METHODS: We used three clinical questions corresponding to problems encountered by insurance physicians in daily practice to explore opportunities for and barriers to the application of EBM. The questions fell under two topics: the prognosis of work ability and the effectiveness of interventions to enhance work participation. We used the four-step EBM strategy: (i) formulation of a clinical question, (ii) searching the literature, (iii) appraisal of the evidence, and (iv) implementation of the findings into clinical practice. We restricted the searches to PubMed (Medline). RESULTS: For rheumatoid arthritis, we found evidence on the prognosis of work disability over a long-term period. For remaining sciatica after lumbar discectomy, we found evidence for the stability of the limitations at this stage. For depression with co-morbid alcoholism, we found evidence that treatment of both conditions would enhance work participation. The searches were effective and efficient. The interpretation of the findings was hampered by a lack of consensus in the literature about outcomes such as the concept of a poor prognosis of work ability. CONCLUSIONS: The EBM strategy and methods can be used by social insurance physicians to find and apply evidence for common questions in disability evaluation. The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) model is instrumental in this, although more consensus on central outcome measures is needed. Further research is needed on the translation of evidence into practice. Development of valid specific search strategies for physicians in disability evaluation would improve the implementation of EBM.

Introduction: One of the most important changes in medical education programs in Iran has been designing and implementing course of Introduction to Clinical Medicine (ICM) in Isfahan University of Medical Sciences. This study determines the methods and results of process evaluation (from CIPP evaluation) used for ICM revision and evaluation program. This study aimed to provide evidences about its efficiency and extract its executive disadvantages and limitation. Method: This is an evaluation study conducted in Isfahan University of Medical Sciences. Data were collected through descriptive studies and in most cases, self-administrated questionnaire was used. In some cases, comparing the final MCQ scores was used. This evaluation was done during conducting new ICM program. Separate evaluation tools were prepared in several steps and used for each course at the end of that. These Steps are literature review, preparing draft questionnaire, getting feedback from, and consulting with main stakeholders of evaluation and preparing the final questionnaires. The content and face validity of the questionnaires were confirmed by experts of education after conducting a pilot study and the reliability were checked by Cronbach's Alpha coefficient. Results: The results showed that the students have more positive attitude toward EBM course. Students believed that ICM was an appropriate section for learning medical records. They were not satisfied with management of medical records course by nursing department, identifying learning objectives and the extent of accessing to them, time devoted to this lesson, teaching method, sources and evaluation method. Evaluation of communication skills course showed students’ positive attitude toward this course and their learning of this course. Overall students' satisfaction in most items of ICM course (volume of ICM course, resources, evaluation methods, exams intervals, content of tests, arrangement of packages, volume of lessons, arrangement of practical courses, giving information) was more in old ICM program than the new one. Clinical students agreed with all changes. Mean score of sign and symptom and pathophysiology of disease showed a slight increase in new ICM program (insignificant statistically). Frequency of the failed student decreased from 18 student-units in old ICM program to 10 student-units in new one. Conclusion: The results showed a relatively successful experience in reviewing and evaluating a medical education program. Regarding complexity of reviewing and evaluating medical education programs, this study can be used as a guide for designing other similar researches that are effective in future planning and decision-makings.

Medicina basada en la evidencia (MBE) es actualmente sinónimo de práctica médica moderna e innovadora. Sin embargo, poco se sabe de su real dimensión y principios. Su relación con la investigación y la "evidencia" es entendida como la interpretación de la literatura medica, la realización de mega ensayos clínicos o meta-análisis. MBE implica el uso juicioso de la mejor evidencia disponible, gracias a la evaluación rigurosa de la calidad metodológica de la información científica, así como de su aplicabilidad. La MBE rescata la experiencia y pericia clínica del médico. Adicionalmente, incorpora como tercer elemento fundamental las preferencias y valores de los pacientes acerca del cuidado de su salud. La intersección de estos tres aspectos constituye la esencia de la MBE. La práctica así entendida de la MBE ubica al paciente y sus circunstancias en el centro mismo del acto médico y lo revaloriza como "ciencia y arte". En esta revisión buscamos destacar como la práctica de la MBE guía hacia una toma de decisiones correcta y democrática. Así mismo, se revisa los diversos aportes en la práctica medica actual, las distorsiones creadas alrededor de ella y las limitaciones para su aplicación en nuestra realidad.(Rev Med Hered 2009;20:191-197).

Objective: To train and test a model predicting chronic kidney disease (CKD) using the Generalized Additive2 Model (GA2M), and compare it with other models being obtained with traditional or machine learning approaches., Materials: We adopted the Health Search Database (HSD) which is a representative longitudinal database containing electronic healthcare records of approximately 2 million adults., Methods: We selected all patients aged 15 years or older being active in HSD between January 1, 2018 and December 31, 2020 with no prior diagnosis of CKD. The following models were trained and tested using 20 candidate determinants for incident CKD: logistic regression, Random Forest, Gradient Boosting Machines (GBMs), GAM, and GA2M. Their prediction performances were compared by calculating Area Under Curve (AUC) and Average Precision (AP)., Results: Comparing the predictive performances of the 7 models, the AUC and AP for GBM and GA2M showed the highest values which were equal to 88.9%, 88.8% and 21.8%, 21.1%, respectively. These 2 models outperformed the others including logistic regression. In contrast to GBMs, GA2M kept the interpretability of variable combinations, including interactions and nonlinearities assessment., Discussion: Although GA2M is slightly less performant than light GBM, it is not "black-box" algorithm, so being simply interpretable using shape and heatmap functions. This evidence supports the fact machine learning techniques should be adopted in case of complex algorithms such as those predicting the risk of CKD., Conclusion: The GA2M was reliably performant in predicting CKD in primary care. A related decision support system might be therefore implemented., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Additive manufacturing ('3D printing') techniques provide engineers with unprecedented design freedoms, opening up the possibility for stronger and lighter component designs. In this paper 'layout optimization' is used to provide a reference volume and to identify potential design topologies for a given component, providing a useful alternative to continuum based topology optimization approaches (which normally require labour intensive post-processing in order to realise a practical component). Here simple rules are used to automatically transform a line structure layout into a 3D continuum. Two examples are considered: (i) a simple beam component subject to three-point bending; (ii) a more complex air-brake hinge component, designed for the Bloodhound supersonic car. These components were successfully additively manufactured using titanium Ti-6Al-4V, using the Electron Beam Melting (EBM) process. Also, to verify the efficacy of the process and the mechanical performance of the fabricated specimens, a total of 12 beam samples were load tested to failure, demonstrating that the target design load could successfully be met. [ABSTRACT FROM AUTHOR]

Recent shifts towards ecosystem-based management and other holistic and participatory forms of oceans governance and management have come with demands for ways to better incorporate social data into decision-making processes such as integrated ecosystem assessments. This includes information related to a wide range of values associated with different aspects of marine social-ecological systems. This paper addresses that demand by first discussing various notions of value in the literature, and then presenting two case studies from British Columbia, Canada that illuminate some of the opportunities and complexities of using a mix of quantitative and qualitative approaches to bear on the challenge. Findings suggest that values are diverse and are contextually dependent, varying at small scales. Findings further suggest that values are hierarchically arranged and grouped differently by individuals into what might be called perspectives. Finally, the findings highlight that mixed-methods approaches featuring qualitative and quantitative elements may provide a step towards resolving tensions between, on one the one hand, a need to distil complex systems into observable, measurable indicators where the inevitable tradeoffs involved in resource management can be articulated, weighed, and on the other hand, a sense that characterizing the broad range of values that are relevant in shaping attitudes and conceptions of “what should be” in marine systems requires holistic thinking and attention to scale, context, relationality, subjectivity and rich detail. [ABSTRACT FROM AUTHOR]

Background. Hypertension is a civilization disease which currently affects about 10.5 m people in Poland. The number of patients with diagnosed, untreated hypertension amounts to 18%, and as many as 45% of patients are treated ineffectively, whereas only 26% are treated effectively. Impedance cardiography (IC) is an important tool both in diagnostics and the treatment of hypertensive patients, particularly in the case of antihypertensive treatment resistance. This method allows for the individualized treatment of each patient on the basis of hemodynamic parameters, monitoring of hypertensive patients in the outpatient care setting, and the assessment of cardiovascular risk factors. Objectives. The aim of the study was to evaluate the efficacy of hypotensive medications in patients with hypertension using impedance cardiography. Material and methods. The study involved 60 hypertensive patients, treated with antihypertensives, who failed to achieve the required blood pressure values. The modification of hypertension therapy was based on EBM (evidence-based medicine) and on hemodynamic parameters obtained using impedance cardiography. Results. It was found that high blood pressure therapy based on impedance cardiography parameters has a significant influence on blood pressure reduction compared to EM B-based therapy: below 140/90: 66.8 vs. 55.1% and below 130/80: 23.5 vs. 18.9%. Conclusions. On the basis of this study it was confirmed that impedance cardiography allows for a significant reduction of hypertension and the selection of the most effective therapeutic strategy, providing for the optimization and efficacy of hypertension treatment. [ABSTRACT FROM AUTHOR]

Introduction Modern medicine employs various approaches to analyzing data collected through clinical observation. The results of such analyses demonstrate general tendencies of the observations, yet they do not point to the dynamics of the therapeutic process. Aim The authors of the present study propose introducing the T 1 scale, thanks to which one can analyse the results and course of each patient's treatment in relation to normal distribution. The aim of this study is to prove that T 1 scale is functional in evaluating the effects of long-term therapy. Material and methods The study shows that T 1 scale, which is realized through the formula y = 10 z i + 50, is a universal scale. It has been concluded that the interval of T 1 scale determines effective dynamics of therapeutic procedures. The study encompasses 234 term infants born with normal weights who were diagnosed with neurodevelopmental disorders. The subjects were observed every 6 weeks. T 1 scale was applied in order to evaluate the dynamics of clinical change of the analysed features. Results and discussion The scale precisely differentiates the population, that is the number of patients for whom beneficial therapeutic effects were observed, the closer the values in T 1 scale are to the mean value of T 1 scale. T 1 scale makes it possible to evaluate clinical observations in the treatment process in a precise manner in line with evidence-based medicine (EBM). Conclusions T 1 scale makes it possible to evaluate clinical observations in the course of treatment in a precise manner in line with EBM. [ABSTRACT FROM AUTHOR]

Additive manufacturing is increasingly considered for production of high quality, metallic, aerospace parts. Despite the high potential of this manufacturing process to reduce weight and lead time, the fundamental understanding of additive manufactured Ti–6Al–4V material is still at an early stage, especially in the area of fatigue and damage tolerance. This paper covers the effects of inherent surface roughness on the fatigue life. In the as built condition, metallic parts have a poor surface texture, which is generally removed in fatigue critical areas. It is shown that the fatigue properties of Ti–6Al–4V samples, produced by direct metal laser sintering and electron beam melting, are dominated by surface roughness effects. A simple model based on an equivalent initial flaw size is formulated. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to "describe basic principles of EBM."Objective: We sought to identify the EBM skills of third- and fourth-year medical students.Methods: Our institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics.Results: Four hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%.Conclusions: As measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements. [ABSTRACT FROM AUTHOR]

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]

The microstructure and mechanical properties of SLM and EBM Ti–6Al–4V samples have been compared. The effect of part size and orientation on the defects, microstructure and their contribution to the tensile and fatigue properties were elucidated. As-fabricated SLM and EBM samples mainly consisted of α′ and α + β phases, respectively. Pores were the main defects in SLM and EBM samples, and closely related to scanning strategies and energy input. The porosity of SLM samples was higher compared to EBM samples. The part size had an obvious influence on the microstructure and mechanical properties of EBM samples but less so for SLM samples. Both SLM and EBM samples possessed higher strength and better ductility in the vertical orientation than those in the horizontal orientation. The tensile strength of SLM samples was significantly greater than that of EBM samples whereas the ductility was much lower. Due to the pores contained in samples, fatigue strength of both EBM and SLM samples was lower than those of cast and annealed alloys. However, hot isostatic pressing (HIP) significantly increased the fatigue limits of both SLM and EBM samples to above 550 MPa by closing of the pores. [ABSTRACT FROM AUTHOR]

Applying evidence based medicine (EBM) in our daily practice and health settings is a great challenge for residents due to the lack of time and experience. The following case scenario is an example of real life application of EBM.

Additive Manufacturing (AM) methods are generally used to produce an early sample or near net-shape elements based on three-dimensional geometrical modules. To date, publications on AM of metal implants have mainly focused on knee and hip replacements or bone scaffolds for tissue engineering. The direct fabrication of metallic implants can be achieved by methods, such as Selective Laser Melting (SLM) or Electron Beam Melting (EBM). This work compares the SLM and EBM methods used in the fabrication of titanium bone implants by analyzing the microstructure, mechanical properties and cytotoxicity. The SLM process was conducted in an environmental chamber using 0.4–0.6 vol % of oxygen to enhance the mechanical properties of a Ti-6Al-4V alloy. SLM processed material had high anisotropy of mechanical properties and superior UTS (1246–1421 MPa) when compared to the EBM (972–976 MPa) and the wrought material (933–942 MPa). The microstructure and phase composition depended on the used fabrication method. The AM methods caused the formation of long epitaxial grains of the prior β phase. The equilibrium phases (α + β) and non-equilibrium α’ martensite was obtained after EBM and SLM, respectively. Although it was found that the heat transfer that occurs during the layer by layer generation of the component caused aluminum content deviations, neither methods generated any cytotoxic effects. Furthermore, in contrast to SLM, the EBM fabricated material met the ASTMF136 standard for surgical implant applications.

The coastal zone is an area where a multitude of physical-natural, social and economic issues converge. The interactions among these elements are accentuated by the demographic concentration that characterises coastal areas all over the world. Coastal areas have the unique characteristic of being located in the connecting space between land and marine areas. The economic activities that take place on the coast require the services provided by terrestrial, intertidal and marine ecosystems for their proper functioning. In consequence, the main objective of this research is to identify and map ecosystem services provided by coastal ecosystems in the region of Andalusia (Spain) in order to move towards an Ecosystem-Based Management of this area. Ecosystem services are obtained from a literature review supported by a participatory process through expert consultation. The results obtained from the participatory process, together with the analysis and mapping of the ecosystems, make it possible to obtain those areas where the diversity of potential ecosystem services is greatest. The results of the research highlight certain ecosystems, such as the intertidal ecosystems, which, although they occupy the smallest surface area, are the ones that offer the greatest services to the population. Therefore, studying ecosystem services in coastal areas in order to move towards an Ecosystem-Based Management must be done from a broad perspective, considering the coastal zone as a complete socio-ecological system. [ABSTRACT FROM AUTHOR]

Abstract Introduction Numerous studies have demonstrated that many physicians lack fundamental skills in interpreting and using clinical care evidence. We hypothesized that building a foundation for evidence-based medicine (EBM) prior to the clinical years would provide an initial scaffold that could be integrated during clinical training. Many schools have interpreted LCME standard ED-17 as synonymous with instruction in EBM. Methods This was one of nine modules in EBM skills for first-year and second-year medical students, who were novices in EBM knowledge. The two-part module began with a 2-hour, in-class didactic covering the fundamental features of risk and harm studies, including internal study validity, and study results. Between 1 and 14 days later, students then participated in a 2-hour interactive large-group EBM exercise during which they applied their knowledge and practiced forming judgments for overall study validity. The large-group exercise is based on principles of team-based learning (TBL), but does not follow them exactly. Results We performed a pre-post assessment of alternative items (10 pre, 12 post) covering the same objectives. The preassessment scores were 175 correct and 215 incorrect (difficulty 44.87%). Postassessment scores were 421 correct and 47 incorrect (difficulty 89.96%). Discussion The mode of instruction is highly adaptable. In previous years, the module followed strict TBL pedagogy for the application exercise, and this EBM exercise can easily be converted back to a traditional TBL by having teams simultaneously report answers using whiteboards or flipcharts and then debating their choices. In addition, the initial didactic session can be prerecorded for students to review before class.

Professor Marlene Freeman of Massachusset General Hospital's answer to the question "How should I prescribe valproic acid (for psychiatric disorders) to women of childbearing age?" is "Don't do it at all.", (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Decision aids (DAs) are promising tools to foster evidence-based shared decision-making between practitioners and service users. Nevertheless, it is still obscure how an evidence-based DA for people with severe mental illness, especially psychosis, should look in an inpatient treatment setting to be useful and feasible. Therefore, we conducted focus groups with psychiatrists and service users to collect and assess their expectations and wishes regarding an evidence-based DA. From these findings, we derived immediate recommendations for the future development of DAs., Methods: We held two group interviews with service users (n = 8) and three group interviews with psychiatrists (n = 10). We used an open, large-scale topic guide. First, we presented data from a current meta-analysis on antipsychotics to the interviewees and, in a second step, asked for their expectations and wishes towards a DA that integrates these data., Results: Our thematic analysis revealed six key themes addressed by the respondents: (1) general considerations on the importance and usefulness of such a DA, (2) critical comments on psychiatry and psychopharmacotherapy, (3) communicative prerequisites for the use of a DA, (4) form and content of the DA, (5) data input, data processing and output as well as (6) application of the DA and possible obstacles., Conclusions: Participants identified several important features for the development of DAs for selecting antipsychotics in inpatient psychiatric treatment. The digital format was met with the greatest approval. Especially the adaptability to different needs, users and psychopathologies and the possibility to outsource information dissemination via app seemed to be a decisive convincing argument. Further research is required to test specific features of DAs to be developed in clinical settings., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objectives: The role of routine C4d staining in endomyocardial biopsy specimens is uncertain. The implications of a diagnosis of acute cellular rejection (ACR) with a positive C4d with or without any evidence of antibody-mediated rejection (AMR) are unclear. This study sought to evaluate a distinct phenotype of ACR+/C4d+ in AMR- patients.Methods: Data on C4d, ACR, and AMR were collected. Donor-specific antibody (DSA), panel-reactive antibody (PRA), flow crossmatch, and data on ACR and AMR episodes were also reviewed.Results: Thirty-five patients were followed. Group I with C4d+ biopsy specimens was compared with group II with C4d- biopsy specimens. ACR greater than 1R was higher in group I compared with group II (50% vs 7.4%; P = .01). Clinical suspicion of AMR, positive retrospective crossmatches, and detection of de novo DSA were also higher in group I.Conclusions: Our result indicate that C4d and ACR positivity in posttransplant patients may be a harbinger of a subclinical form of asymptomatic AMR. [ABSTRACT FROM AUTHOR]

Electron beam melting additive manufacturing (AM) process has been developed for the manufacture of Ti6Al4V parts for the aerospace industry. In the AM research team from Airbus Group, this technology is being evaluated with a view to production of flight hardware. During the evaluation of the process, the microstructure variation as a function of geometry was studied. A distinctive microstructure was observed up to 0.5 mm from of part surface (the skin layer) and the thickness of the α-plate spacing varied depending on the thickness of the parts being produced. With the purpose of quantifying the influence of the grain thickness and the mechanical performance of the material, cylinders with nine different diameters (6 up to 40 mm diameter) were manufactured with 80 mm height. The microstructure characterisation showed how the α-plate spacing changed from thin to thick structures and the influence of grain size on tensile strength was quantified. [ABSTRACT FROM PUBLISHER]