Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

Diagnosis of Helicobacter pylori : What should be the gold standard?

Since the discovery of Helicobacter pylori (H. pylori) in 1983, numerous detection methods for the presence of the bacterium have been developed. Each one of them has been associated with advantages and disadvantages. Noninvasive tests such as serology, 13C urea breath test (UBT) and stool antigen tests are usually preferred by the clinicians. Serology has its own limitation especially in endemic areas while 13C UBT is technically very demanding. The stool antigen detection method, although specific, is usually associated with poor sensitivity. The 13C UBT is believed to be specific, but with present revelation of the fact that stomach is colonized by many other urease producing bacteria makes it questionable. Histology, culture, rapid urease test and polymerase chain reaction (PCR) are the tests which are carried out on antral biopsies collected by invasive means. Histology has been proposed to be very sensitive and specific but the question is how by simply looking the morphology of the bacteria in the microscope, one can claim that the curved bacterium is exclusively H. pylori. Rapid urease test (RUT), the doctor’s test, is also challenged because the presence of other urease producing bacteria in the stomach cannot be denied. Moreover, RUT has been reported with poor sensitivity specially, when density of the bacterium is low. Isolation of H. pylori is essential to investigate its growth requirements, antibiotic susceptibility testing, studying virulence factor to develop vaccine and many more explorations. It has also got several disadvantages i.e., special condition for transporting, media, incubation and few days waiting for the colonies to appear, apart from the speed essentially needed to process the specimens. Till date, majority of the microbiological laboratories in the world are not equipped and trained to isolate such fastidious bacterium. The option left is PCR methods to detect H. pylori’s DNA in gastric mucosa, gastric juice, saliva, dental plaques and environmental specimens. There are speculations for false positivity due to detection of non-pylori Helicobacters due to genetic sharing; and false negativity due to low bacterial counts and presence of PCR inhibitors. However, specimen collection, transportation and processing do not require speed and special conditions. PCR based diagnosis may be considered as gold standard by designing primers extremely specific to H. pylori and targeting at least more than one conserved genes. Similarly specificity of PCR may be improved by use of internal Primers. Further, nested PCR will take care of false negatives by countering the effect of PCR inhibitors and low bacterial counts. Therefore, nested PCR based methods if performed properly, may be proposed as gold standard test.

‘Outbreak Gold Standard’Selection to Provide Optimized Threshold for Infectious Diseases Early-alert Based on China Infectious Disease Automated-alert and Response System

The China Infectious Disease Automated-alert and Response System（CIDARS） was successfully implemented and became operational nationwide in 2008. The CIDARS plays an important role in and has been integrated into the routine outbreak monitoring efforts of the Center for Disease Control（CDC） at all levels in China. In the CIDARS, thresholds are determined using the ？Mean＋2SD？ in the early stage which have limitations. This study compared the performance of optimized thresholds defined using the ？Mean ＋2SD？ method to the performance of 5 novel algorithms to select optimal ？Outbreak Gold Standard（OGS）？ and corresponding thresholds for outbreak detection. Data for infectious disease were organized by calendar week and year. The ？Mean＋2 SD？, C1, C2, moving average（MA）, seasonal model（SM）, and cumulative sum（CUSUM） algorithms were applied. Outbreak signals for the predicted value（Px） were calculated using a percentile-based moving window. When the outbreak signals generated by an algorithm were in line with a Px generated outbreak signal for each week, this Px was then defined as the optimized threshold for that algorithm. In this study, six infectious diseases were selected and classified into TYPE A（chickenpox and mumps）, TYPE B（influenza and rubella） and TYPE C [hand foot and mouth disease（HFMD） and scarlet fever]. Optimized thresholds for chickenpox（P_（55））, mumps（P_（50））, influenza（P_（40）, P_（55）, and P_（75））, rubella（P_（45） and P_（75））, HFMD（P_（65） and P_（70））, and scarlet fever（P_（75） and P_（80）） were identified. The C1, C2, CUSUM, SM, and MA algorithms were appropriate for TYPE A. All 6 algorithms were appropriate for TYPE B. C1 and CUSUM algorithms were appropriate for TYPE C. It is critical to incorporate more flexible algorithms as OGS into the CIDRAS and to identify the proper OGS and corresponding recommended optimized threshold by different infectious disease types.

Reaching for the Gold Standard: Metaphors and Good University Teachers

This article considers "good" teachers in the context of current developments in universities in China to reach a "gold standard" of considerably higher and more challenging levels of teaching and learning. We outline this context and consider concepts of good teachers in classical Chinese traditions and more recent Western thinking as a possible dialogue within and between cultures of learning. Using cognitive and cultural linguistic perspectives, we analyze metaphorical concepts of "gold" in "the gold standard" as related to teachers. We report our applied metaphor research which analyzes Chinese students’ expectations, values and beliefs about good university language teachers;this presents a rich picture beyond developing knowledge, skills and understanding to include strong social and moral characteristics. Other aspects which recognize the complexity of "good" teachers show a student appreciation of teachers’ tireless effort, devotion and selfless sacrifice: these aspects are absent in many discussions of good teachers. The participant-centered picture from elicited metaphor analysis is part of students’ "cultures of learning," but this should be developed culturally for the gold standard through further teacher development and student engagement. In line with interaction in cultures of learning, we indicate some classroom ways to extend students’ thinking through scaffolding teacher-student interaction based on textbook activities.

Deciding the Gold Standard for Oral Anticoagulation Therapy

Healthcare practitioners have many anticoagulant options for treating various disease states pertaining to blood clots and blood clot formation. Each anticoagulant has pros and cons and the decision of which pharmacological agent to use can be confusing and difficult. In years past, Vitamin K antagonists have been the standard of care when treating specific disease states such as atrial fibrillation and venous thromboembolism based on habit and cost of care. The emergence of newer anticoagulants should be considered the new standard of care based on the evidence presented over the last several years.

Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention.For decades,the preferred approach was the open repair.As laparoscopy became more popular and available and more surgeons became familiarized with this modality,laparoscopic inguinal hernia repair became an alternative.The aim of this study is to assess the effectiveness of laparoscopic inguinal repair,with a focus on bilateral inguinal hernias.Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias.However,there are only a few studies concerning laparoscopic repair of bilateral hernias.It is yet to be proven that laparoscopy is the“gold standard”in the treatment of bilateral inguinal hernias.So far,the choice of an inguinal hernia repair technique has been up to each surgeon,depending on their expertise and available resources after taking into consideration each patient’s needs.

The M2 Money Supply, the Economy, and the National Debt: A Mathematical Approach

The United States dollar was tied to a finite standard dating back to 1792. The dollar has survived multiple wars, armed conflicts short of war, economic recessions, and the Great Depression. At the end of World War II, the dollar, by international agreement, effectively became the world’s reserve currency. Other currencies were fixed to the dollar and the dollar was in turn fixed to the gold standard, that is, the value of a dollar was fixed at thirty-five dollars per ounce of gold. In 1971, the United States government severed the dollar from the gold standard leaving the size of the money supply free of any finite limit. Since that time, the United States money supply, national debt, and stock market indices have experienced exponential growth. The purpose of this paper is to investigate mathematically and model the relationship among these key economic indicators. Our work in this paper allows us to gain some insight into how each of these economic indicators can influence one another while giving us a better idea of how the economy functions. We were allowed to collect data for each of the indicators over a certain period which allowed us to demonstrate that a strong correlation exists among these three indicators. After collecting our data and making some logical assumptions, we modeled the money supply as a function of time. In turn, we modeled the Dow Jones stock market index as a function of the money supply. Finally, we produced a model of the National Debt as a function of the Dow Jones stock market index. From the data, we collected and our economic indicator models, we derived a series of differential equations that would help us observe the exponential growth trend of each graphically. By showing a comparison from our collection of raw data versus our results from our model, we conclude that, under prevailing circumstances, it is reasonable to expect growth in all three indicators and increasing market volatility for some time to come. We have answered the question of whether the monetary and fiscal policies of the past half-century have been of some benefit. However, we question whether this trend is good for all Americans and whether it is sustainable in perpetuity. This paper concludes with possible areas of interest warranting additional investigation to enable us to better understand the economy and develop effective financial strategies.

Monetary Stability and Crisis Predictions Fallacies

In present days,our instable financial markets,characterized by heavier growing monetary responsibilities,are delivering and enlarging ever growing central banks’functions.The financial stability applied standards have been creating contradictory results in the recent Great Recessions since the year 1987 up to the central banks model,after the 2008 last financial crisis,with major central banks as the FED and the CEB(Diamond,2007,pp.189-200)conflicting main operative areas,monetary and financial goals with unexpected results.We have been living a very difficult and dramatic period,which suggests a lot of reconsiderations about what the monetary policy means and may pursue and in which area,with respect to the financial system restrictions,in particular,during the post-second World War,based initially on the pseudo gold dollar parity,things were relatively stable and major financial crises were happening in emerging peripheral markets only.Financial stability was ever relevant,but it was not something to which governments devoted institutional attention.Based on what happened during the recent crisis,it is now of capital responsibility connecting monetary and economic financial stability jointly.Central banks,on the contrary,seem not able to pursue both functions relying on classical market tools.Up to now,the only obligation,imposed to a central bank as a private agent,has been taking care of monetary stability,to contain inflation rates over upper limits,assumed in entering definitely in the legal tender monetary,regime almost everywhere over the planet.Originally,for specific monetary policy purposes alone,between central banks and possible financial entities,there were no guidelines or structural determined controls,only institutional and statutory single bank’s operational clauses.There were no legal constraints such as formal loan to-value,or loan to cash-flows,or formal capital level limits,based on actual constraints.Free repurchase agreements and sales or purchases of securities(the most relevant tools of monetary policy guidelines),generally based on private financial covenants,were the sole most recurrent tactical interferences in adjusting the economic free activity.The assuming statutory thresholds were casual in the incorporating state,central banks used to monitor the activities of agents through economic incentives,rather than mandating and monitoring specific legal prescriptions.The evolving inconsistency of both activities has become even more manifest;two conditions should be fulfilled simultaneously:To avoid dilemmas in which a central bank might be called to make the autonomous independent management choice between monetary price stability,pursuing at same time,generally incompatible,financial stability,two different policies should be rarely jointly assigned to same bodies,especially central banks.As regards the first issue,the IMF nevertheless,with Brunnermeier and Sannikov(Brunnermeier&Sannikov,2012),has argued that price stability and financial stability are interlinked Short-term debt financing played an important role in the run-up to the financial crisis,as increases in leverage helped boost growth but also made the economy more susceptible to a downturn.Since the recession,private agents have reduced their debt level while many governments have increased borrowing.This deleveraging process appears to be holding back the recovery,and the Japanese experience suggests that such deleveraging can continue over an extended period”,unless in the long run we are all broken at state level,as history seems now to prove.It is true indeed,as reminded by Lamfalussy(Lamfalussy et al.,2010,pp.7-9),and now widely proved by facts,that prices and the growth-employment objectives,run into each other because it is seldom the case that the pursuit of one is consistent with the pursuit of the second in global economies.

Cubic Spline Regression: An Application to Early Bipolar Disorder Dynamics

Owing to the fact that the major challenge of predicting the risk of having bipolar is the absence of a gold standard to distinguish between true cases and false positive;this study employed the extension of cubic spline function to the multinomial model to explore the risk tendency of unnoticed early bipolar across three different groups of mood disorder. The intermediate group was used to accommodate for false negative and false positive while mapping the true value of bipolar risk tendency across the three groups to a scale. Hence for all distributions of “yes” ticked in a mood disorder questionnaire, the study predicts the bipolar risk tendency while simultaneously accommodating for the patients response bias. The coefficients of the polynomial are obtained using the maximum likelihood method. The spline graph reveals how bipolar disorder build up slowly and lingers in the body for long without been noticed due to fluctuations in risk tendency of the mood scores.

What Happened to Jacques Rueff and Robert Triffin?

A present monetary theory of the Great Depression has been explained as stemming from Milton Friedman,ignoring the previous Davanzati,a Florentine finding,in the 16th Century,an explanation solution to the increase of prices due to the arrival of Spanish silver from the New World.Designed to counter the Keynesian notion that the Depression resulted from instability theories,characterizing most modern capitalistic economies,Friedmans explanation identified lately the monetary trend as a disordered monetary policy,carried out by erroneous Federal Reserve Board interventions,possible after the Aldrich-Vreeland innovations,introducing Treasury money in the year 1908.More recent works about the Great Depression reconsider the attempts to restore the international gold standard,suppressed on the brink of World War I.We learnt that current views of the Depression,as analyzed in the 1920s by Ralph Hawtrey and Gustav Cassel,while recommending a gold standard reset,reflect that such standard risk deflations,unless the resulting increase in the international monetary demand linked to physical gold,could be satisfied.Although their early warnings of potential disaster became actual and their policy advice was consistently correct,their contributions were ignored and forgotten.The vanishing of their comments was firstly outlined not a long time ago,by Batchelder and Glasner What Ever Happened to Hawtrey and Cassel? (2013)This paper explores the possible reasons for the remarkable historical disregard of the Hawtrey-Cassel monetary explanation of the Great Depression,even by Nobel Prize winner Robert Mundell in his 2000 historical Nobel reconsideration of the monetary 20th century(Mundell,2000).The paper stresses the identical historical conditions surfacing after the Bretton Woods agreements.Robert Triffin and Jacques Rueff comment likely warnings as in the first Great Depression,under the monetary policy illusion and the Central Banks excessive disregard of the basics of the quantitative theory on the long run,mostly ignored.Robert Triffin started to address the problem in March and June of 1959,Italian Banca Nazionale del Lavoro Quarterly Review.The first of these articles(Part One:Diagnosis)explains in the simplest possible terms,the extraordinary success of the nineteenth century system of international gold based convertibility,and the calamitous collapse of the late 1920s attempts to bring it back to life.It may hold for us today an indication of the main efforts facing the similar attempt at reconstructing the past expressed some 64 years later,after the first of August 1914,by Triffin during the 1978 Christmas weekend.To deal with them in simple,commonsense terms would inevitably classify the author as an unrealistic whose views deserve no more than a raising of eyebrows.Jacques Rueff,with his The Monetary Sin of the West,a logical consequence of the Triffin previous notes of the 1960s,went straight to the consequences of the Camp David resolutions of President Nixon who just temporarily asked his Treasury Secretary,John Conally to suspend the gold convertibility.There were two changes in United States(U.S.)government policy toward the monetary role of gold in the last 100 years.The first was in 1933-1934;all holdings of gold were confiscated in March 1933.Then,the U.S.Treasury adopted a parity for the U.S.dollar of$35.00 an ounce at the end of January 1934.Gold production surged,the private demand for gold fell,and the U.S.experienced large increases in foreign demand for U.S.dollar securities.In those years there was a massive flow of gold to the U.S.The second historical change in U.S.gold policy followed the meeting at Camp David on August the 15th 1971,when the U.S.Treasury closed its gold window fearing a run on its gold holdings,declining towards$10 billion.Some U.S.officials sought to diminish the monetary role of gold.The anticipation of some U.S.officials attending Camp David was that the persistent U.S.payments problem would disappear,once foreign currencies had no parities in terms of the U.S.dollar.The prices of these foreign currencies would increase and the U.S.trade surplus would become larger.Instead,many foreign Central Banks became larger buyers of dollarssecurities,which led to a higher price of the U.S.dollar and a U.S.trade structural deficit.The U.S.international investment position morphed from the worlds largest creditor country,to the worlds present day largest debtor.

Diagnostic Value of tb-RNA in Pleural Effusion in Tuberculous Pleurisy

Objective:To explore the diagnostic value of tb-RNA in pleural effusion in tuberculous pleurisy.Methods:60 patients with tuberculous pleurisy treated from March 2018 to September 2019 were selected as the research object,and 60patients with non-tuberculous pleurisy treated at the same time were selected as the control group to analyze the diagnostic consistency of tuberculous pleurisy.Results:Through the consistency analysis of the gold standard and tb-RNA diagnosis,the diagnosis consistency of the two methods was strong.By comparing the tb-RNA level of the two groups,the tb-RNA level of the observation group was significantly higher than that of the control group(P<0.05);Through the analysis of diagnostic efficacy of tb-RNA,the diagnostic sensitivity and specificity of tb-RNA were 58.33%and 97.50%,respectively.Conclusion:tb-RNA detection of pleural effusion has a high positive diagnostic value and short detection cycle,which is of positive significance for the diagnosis of tuberculous pleural effusion.