AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty s...AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.展开更多
In order to consider the Wisdom of the Many, one has to reconsider Aristotle＇s statement about the source of a nation-state concerning political ＂gregarism＂--how it is called today, and why this belongs to the esse...In order to consider the Wisdom of the Many, one has to reconsider Aristotle＇s statement about the source of a nation-state concerning political ＂gregarism＂--how it is called today, and why this belongs to the essentials of political constitution. Beforehand, this concept should not provide an instance of theoretical indulgence for emotional concepts or alike. Then, this statement will have to be confronted with the core argument of the Wisdom of the Many, together with the interpretation of Waldron. It will be interpreted as the counterpart of gregarism： When several people find together a solution, which eventually overrules that of the （few） expert（s）, they rely upon a common focus or an instance of polar consciousness. This includes the final question if the shared consciousness-or the polarity condition-is not able to also dominate and manifest within a group of experts, of those sufficiently erudite. As a token of possible evidence, the answer is given with Fichte, his lecture of the Science of Knowledge of 1804 by reason of the succinct reliance upon the plural ＂We.＂展开更多
An earlier baseline study （Jellason et al. in preparation） has identified some of the key challenges faced by farmers and from that, appropriate Good Agricultural Practices （GAPs） have been selected for the enviro...An earlier baseline study （Jellason et al. in preparation） has identified some of the key challenges faced by farmers and from that, appropriate Good Agricultural Practices （GAPs） have been selected for the environment the farmers find themselves in and based on a review of available literature. Farmer action plans for enhancing smallholder resilience, GHGs emission mitigation and food security for these dry lands were developed. Expert opinions on the applicability of the selected GAPs to inform farmer co-learning and to validate the suitability of these practices in a dry land context were sought through the Delphi study. Experts were also invited to offer suggestions for improvement of the training action plan. Two rounds of a modified Delphi survey were carried out with experts from diverse backgrounds and locations across the globe to solicit their opinion. Results show that experts＇ agreement was reached on most of the action plan items. The results and opinions obtained from the survey were reviewed and adapted into the action plan leading to the development of GAPs for the co-learning exercise.展开更多
Objective Considering the importance of out-of-hospital services,the emergence of home care nursing,and the need for an ethical framework in nursing practice,the present study aimed to explore the nurses’experience o...Objective Considering the importance of out-of-hospital services,the emergence of home care nursing,and the need for an ethical framework in nursing practice,the present study aimed to explore the nurses’experience of ethical values of home care nursing.Methods The data of the study was collected using face-to-face individual interviews.Through purposive sampling,20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed.They shared their experiences of the ethical values of home care nursing.Then,the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method.Results In the present study,416 codes were extracted.Merging these codes based on the similarity,seven main themes,and 16 sub-themes were extracted.The themes included perception of the professional identity,respect for the client’s autonomy,respecting privacy,establishing human interaction,maintaining mutual safety,observance of justice,and cultural-religious competence.The sub-themes included responsibility,development of professional and inter-professional interactions,maintaining the professional status at home,providing the holistic artistic care,patient’s privacy,nurse’s privacy,and maintaining the confidentiality of information,respect for the client’s choice,honestly informing,empathetic interaction,adjusting the power positions,client's safety,nurse’s safety,establishing justice,respect for the religious beliefs at home and cultural sensitivity.Conclusion The participants stated that due to entering the patient’s privacy in the home care cases,the ethical values such as perception of the professional identity,privacy,family interactions’management,mutual security,and cultural-religious competence became doubly important compared to the hospital caring.展开更多
The main aim of this paper was to calculate soil organic carbon stock(SOCS) with consideration of the pedogenetic horizons using expert knowledge and GIS-based methods in northeastern China.A novel prediction process ...The main aim of this paper was to calculate soil organic carbon stock(SOCS) with consideration of the pedogenetic horizons using expert knowledge and GIS-based methods in northeastern China.A novel prediction process was presented and was referred to as model-then-calculate with respect to the variable thicknesses of soil horizons(MCV).The model-then-calculate with fixed-thickness(MCF),soil profile statistics(SPS),pedological professional knowledge-based(PKB) and vegetation type-based(Veg) methods were carried out for comparison.With respect to the similar pedological information,nine common layers from topsoil to bedrock were grouped in the MCV.Validation results suggested that the MCV method generated better performance than the other methods considered.For the comparison of polygon based approaches,the Veg method generated better accuracy than both SPS and PKB,as limited soil data were incorporated.Additional prediction of the pedogenetic horizons within MCV benefitted the regional SOCS estimation and provided information for future soil classification and understanding of soil functions.The intermediate product,that is,horizon thickness maps were fluctuant enough and reflected many details in space.The linear mixed model indicated that mean annual air temperature(MAAT) was the most important predictor for the SOCS simulation.The minimal residual of the linear mixed models was achieved in the vegetation type-based model,whereas the maximal residual was fitted in the soil type-based model.About 95% of SOCS could be found in Argosols,Cambosols and Isohumosols.The largest SOCS was found in the croplands with vegetation of Triticum aestivum L.,Sorghum bicolor(L.) Moench,Glycine max(L.) Merr.,Zea mays L.and Setaria italica(L.) P.Beauv.展开更多
文摘AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.
文摘In order to consider the Wisdom of the Many, one has to reconsider Aristotle＇s statement about the source of a nation-state concerning political ＂gregarism＂--how it is called today, and why this belongs to the essentials of political constitution. Beforehand, this concept should not provide an instance of theoretical indulgence for emotional concepts or alike. Then, this statement will have to be confronted with the core argument of the Wisdom of the Many, together with the interpretation of Waldron. It will be interpreted as the counterpart of gregarism： When several people find together a solution, which eventually overrules that of the （few） expert（s）, they rely upon a common focus or an instance of polar consciousness. This includes the final question if the shared consciousness-or the polarity condition-is not able to also dominate and manifest within a group of experts, of those sufficiently erudite. As a token of possible evidence, the answer is given with Fichte, his lecture of the Science of Knowledge of 1804 by reason of the succinct reliance upon the plural ＂We.＂
文摘An earlier baseline study （Jellason et al. in preparation） has identified some of the key challenges faced by farmers and from that, appropriate Good Agricultural Practices （GAPs） have been selected for the environment the farmers find themselves in and based on a review of available literature. Farmer action plans for enhancing smallholder resilience, GHGs emission mitigation and food security for these dry lands were developed. Expert opinions on the applicability of the selected GAPs to inform farmer co-learning and to validate the suitability of these practices in a dry land context were sought through the Delphi study. Experts were also invited to offer suggestions for improvement of the training action plan. Two rounds of a modified Delphi survey were carried out with experts from diverse backgrounds and locations across the globe to solicit their opinion. Results show that experts＇ agreement was reached on most of the action plan items. The results and opinions obtained from the survey were reviewed and adapted into the action plan leading to the development of GAPs for the co-learning exercise.
基金This research was extracted from PhD thesis and was reviewed by Research Council of Isfahan University of Medical Sciences,Isfahan,Iran and approved with Grant No:398,547.
文摘Objective Considering the importance of out-of-hospital services,the emergence of home care nursing,and the need for an ethical framework in nursing practice,the present study aimed to explore the nurses’experience of ethical values of home care nursing.Methods The data of the study was collected using face-to-face individual interviews.Through purposive sampling,20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed.They shared their experiences of the ethical values of home care nursing.Then,the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method.Results In the present study,416 codes were extracted.Merging these codes based on the similarity,seven main themes,and 16 sub-themes were extracted.The themes included perception of the professional identity,respect for the client’s autonomy,respecting privacy,establishing human interaction,maintaining mutual safety,observance of justice,and cultural-religious competence.The sub-themes included responsibility,development of professional and inter-professional interactions,maintaining the professional status at home,providing the holistic artistic care,patient’s privacy,nurse’s privacy,and maintaining the confidentiality of information,respect for the client’s choice,honestly informing,empathetic interaction,adjusting the power positions,client's safety,nurse’s safety,establishing justice,respect for the religious beliefs at home and cultural sensitivity.Conclusion The participants stated that due to entering the patient’s privacy in the home care cases,the ethical values such as perception of the professional identity,privacy,family interactions’management,mutual security,and cultural-religious competence became doubly important compared to the hospital caring.
基金Under the auspices of Basic Project of State Commission of Science Technology of China(No.2008FY110600)National Natural Science Foundation of China(No.91325301,41401237,41571212,41371224)Field Frontier Program of Institute of Soil Science,Chinese Academy of Sciences(No.ISSASIP1624)
文摘The main aim of this paper was to calculate soil organic carbon stock(SOCS) with consideration of the pedogenetic horizons using expert knowledge and GIS-based methods in northeastern China.A novel prediction process was presented and was referred to as model-then-calculate with respect to the variable thicknesses of soil horizons(MCV).The model-then-calculate with fixed-thickness(MCF),soil profile statistics(SPS),pedological professional knowledge-based(PKB) and vegetation type-based(Veg) methods were carried out for comparison.With respect to the similar pedological information,nine common layers from topsoil to bedrock were grouped in the MCV.Validation results suggested that the MCV method generated better performance than the other methods considered.For the comparison of polygon based approaches,the Veg method generated better accuracy than both SPS and PKB,as limited soil data were incorporated.Additional prediction of the pedogenetic horizons within MCV benefitted the regional SOCS estimation and provided information for future soil classification and understanding of soil functions.The intermediate product,that is,horizon thickness maps were fluctuant enough and reflected many details in space.The linear mixed model indicated that mean annual air temperature(MAAT) was the most important predictor for the SOCS simulation.The minimal residual of the linear mixed models was achieved in the vegetation type-based model,whereas the maximal residual was fitted in the soil type-based model.About 95% of SOCS could be found in Argosols,Cambosols and Isohumosols.The largest SOCS was found in the croplands with vegetation of Triticum aestivum L.,Sorghum bicolor(L.) Moench,Glycine max(L.) Merr.,Zea mays L.and Setaria italica(L.) P.Beauv.
