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Search Results: 1 - 10 of 5690 matches for " Karen Burns "
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Partial Ventilatory Support Modalities in Acute Lung Injury and Acute Respiratory Distress Syndrome—A Systematic Review
Sarah M. McMullen,Maureen Meade,Louise Rose,Karen Burns,Sangeeta Mehta,Robert Doyle,Dietrich Henzler
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0040190
Abstract: The efficacy of partial ventilatory support modes that allow spontaneous breathing in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is unclear. The objective of this scoping review was to assess the effects of partial ventilatory support on mortality, duration of mechanical ventilation, and both hospital and intensive care unit (ICU) lengths of stay (LOS) for patients with ALI and ARDS; the secondary objective was to describe physiologic effects on hemodynamics, respiratory system and other organ function.
Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis
Jan O Friedrich, Ron Wald, Sean M Bagshaw, Karen EA Burns, Neill KJ Adhikari
Critical Care , 2012, DOI: 10.1186/cc11458
Abstract: MEDLINE, EMBASE and CENTRAL databases and conference abstracts were searched to June 2012 for parallel-group or crossover randomized and quasi-randomized controlled trials (RCTs) evaluating hemofiltration vs. hemodialysis in patients with AKI. Two authors independently selected studies and abstracted data on study quality and outcomes. Additional information was obtained from trial authors. We pooled data using random-effects models.Of 6,657 citations, 19 RCTs (10 parallel-group and 9 crossover) met inclusion criteria. Sixteen trials used continuous RRT. Study quality was variable. The primary analysis included three parallel-group trials comparing similar doses of hemofiltration and hemodialysis; sensitivity analyses included trials comparing combined hemofiltration-hemodialysis or dissimilar doses. We found no effect of hemofiltration on mortality (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.73 to 1.25, P = 0.76; three trials, n = 121 (primary analysis); RR 1.10, 95% CI 0.88 to 1.38, P = 0.38; eight trials, n = 540 (sensitivity analysis)) or other clinical outcomes (RRT dependence in survivors, vasopressor use, organ dysfunction) compared to hemodialysis. Hemofiltration appeared to shorten time to filter failure (mean difference (MD) -7 hours, 95% CI (-19,+5), P = 0.24; two trials, n = 50 (primary analysis); MD -5 hours, 95% CI (-10, -1), P = 0.01; three trials, n = 113 (including combined hemofiltration-hemodialysis trials comparing similar doses); MD -6 hours, 95% CI (-10, -1), P = 0.02; five trials, n = 383 (sensitivity analysis)). Data primarily from crossover RCTs suggested that hemofiltration increased clearance of medium to larger molecules, including inflammatory cytokines, compared to hemodialysis, although almost no studies measured changes in serum concentrations. Meta-analyses were based on very limited data.Data from small RCTs do not suggest beneficial clinical outcomes from hemofiltration, but confidence intervals were wide. Hemofiltration
Wean Earlier and Automatically with New technology (the WEAN study): a protocol of a multicentre, pilot randomized controlled trial
Karen EA Burns, Maureen O Meade, Martin R Lessard, Sean P Keenan, Francois Lellouche
Trials , 2009, DOI: 10.1186/1745-6215-10-81
Abstract: A pilot weaning randomized controlled trial (RCT) is underway in the ICUs of 8 Canadian hospitals. We will randomize 90 critically ill adults requiring invasive ventilation for at least 24 hours and identified at an early stage of the weaning process to either Automated Weaning (SmartCare?) or Protocolized Weaning. The results of a National Weaning Survey informed the design of the Protocolized Weaning arm. Both weaning protocols are operationalized in Pressure Support mode, include opportunities for Spontaneous Breathing Trials, and share a common sedation protocol, oxygen titration parameters, and extubation and reintubation criteria. The primary outcome of the WEAN study is to evaluate compliance with the proposed weaning and sedation protocols. A key secondary outcome of the pilot RCT is to evaluate clinician acceptance of the weaning and sedation protocols. Prior to initiating the WEAN Study, we conducted a run-in phase, involving two patients per centre (randomizing the first participant to either weaning strategy and assigning the second patient to the alternate strategy) to ensure that participating centres could implement the weaning and sedation protocols and complete the detailed case report forms.Mechanical ventilation studies are difficult to implement; requiring protocols to be operationalized continuously and entailing detailed daily data collection. As the first multicentre weaning RCT in Canada, the WEAN Study seeks to determine the feasibility of conducting a large scale future weaning trial and to establish a collaborative network of ICU clinicians dedicated to advancing the science of weaning.ISRCTN43760151Weaning is the process during which mechanical ventilation is gradually or abruptly withdrawn. In addition, it is the time during which work of breathing is transferred from the ventilator back to the patient until fully autonomous breathing is resumed. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation [1,
Gender Differences in the Validity of Career Interest Inventories  [PDF]
Stephanie T. Burns
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.58089
Abstract:

Predictive validity (including hit rates, kappa coefficients, and chance expectancy rates) between standard scoring and person matching was compared by gender based upon ex post facto data collected on 5143 medical students who had taken a career interest inventory and entered their medical residency. Hit rate accuracy for person matching with females and males in this study was lower than standard scoring. However, person matching demonstrated greater gender balancing in first match hit rates. Additionally, person matching increased career interest inventory validity over standard scoring as it has the greater ability to a) differentiate between and b) assign to specific occupational groups for females and males. Furthermore, person matching has the potential to offer female and male test takers the ability to receive narrative career data, which could improve the career decision making process over the scoring reports of career interest inventories using standard scoring.

Rational Choice Theory: Toward a Psychological, Social, and Material Contextualization of Human Choice Behavior  [PDF]
Tom Burns, Ewa Roszkowska
Theoretical Economics Letters (TEL) , 2016, DOI: 10.4236/tel.2016.62022
Abstract: The main purpose of this paper is to provide a brief overview of the rational choice approach, followed by an identification of several of the major criticisms of RCT and its conceptual and empirical limitations. It goes on to present a few key initiatives to develop alternative, more realistic approaches which transcend some of the limitations of Rational Choice Theory (RCT). Finally, the article presents a few concluding reflections and a table comparing similarities and differences between the mainstream RCT and some of the initial components of an emerging choice theory. Our method has been to conduct a brief selective review of rational choice theoretical formulations and applications as well as a review of diverse critical literature in the social sciences where rational choice has been systematically criticized. We have focused on a number of leading contributors (among others, several Nobel Prize Recipients in economics, who have addressed rational choice issues). So this article makes no claim for completeness. The review maps a few key concepts and assumptions underpinning the conceptual model and empirical applications of RCT. It reviews also a range of critical arguments and evidence of limitations. It identifies selected emerging concepts and theoretical revisions and adaptations to choice theory and what they entail. The results obtained, based on our literature reviews and analyses, are the identification of several major limitations of RCT as well as selected modifications and adaptations of choice theory which overcome or promise to overcome some of the RCT limitations. Thus, the article with Table 1 in hand provides a point of departure for follow-up systematic reviews and more precise questions for future theory development. The criticisms and adaptations of RCT have contributed to greater realism, empirical relevance, and increased moral considerations. The developments entail, among other things: the now well-known cognitive limitations (“bounded rationality”) and, for instance, the role of satisficing rather than maximizing in decision-making to deal with cognitive complexity and the uncertainties of multiple values; choice situations are re-contextualized with psychology, sociology, economic, and material conditions and factors which are taken into account explicitly and insightfully in empirical and theoretical work. Part of the contextualization concerns the place of multiple values, role and norm contradictions, and moral dilemmas in much choice behavior. In conclusion, the article suggests that the adaptations and
Boom and Bust Cycles in Financial Markets—Causes and Cures: Multiple Contradictory Functions of Money and Collective Action Problems  [PDF]
Tom R. Burns
Theoretical Economics Letters (TEL) , 2017, DOI: 10.4236/tel.2017.74062
Abstract: The aim of this conceptualization article is to formulate propositions about: (1) systemic faults in established money and financial systems, in particular the mechanisms that make for boom-and-bust cycles; and (2) the cognitive and action factors which limit the central banks capabilities to consistently and effectively to regulate or to limit these cycles. Drawing on earlier research (our own as well as that of others), this conceptualization is presented in Section 1. Section 2 identifies a new design and institutional arrangement, which would minimize the boom-and-bust predispositions in money and financial systems. This work builds on earlier research invested in the Chicago Plan (from the 1930s) in addition to our own research. Section 3 considers the expected political and ideological constraints on reforming financial systems. Previously operating constraints—including Neo-liberal erosion of New Deal banking arguments and reforms—make for formidable barriers. The paper concludes that reform is necessary—if boom-and-bust cycles on the scale of those since 1929 are to be effectively regulated; but it is suggested that such reform is politically and ideologically difficult if not impossible in the short-run.
Is There an Association between Social Connectedness, Social Identity, Alcohol Consumption and Mental Health among Young University Students?  [PDF]
Kristen Hunt, Sharyn Burns
Open Journal of Preventive Medicine (OJPM) , 2017, DOI: 10.4236/ojpm.2017.76009
Abstract: Social connectedness has been identified as a protective factor for a range of health issues however the literature is not conclusive. The high prevalence of hazardous alcohol consumption and mental health problems among university students along with the potential for the university as a setting for health promotion prompted this study. The study aims to explore the association between levels of alcohol consumption, mental health, social connectedness and social identity among university students. Online data were collected from a random sample of university undergraduate students (n = 2506) aged 18 - 24 years old. Outcomes were measured using the Alcohol Use Disorders Identification Test (AUDIT), the Kessler Psychological Distress Scale, Social Connectedness Scale, Social Identity Scale and measures of paid employment and study (hours), and participation in sports and other clubs. The majority of students had consumed alcohol in the last 12 months (87%). Of these students 38% reported to drink at hazardous levels (AUDIT ≥ 8). When all factors were considered: gender, living arrangements, being a domestic student, hours spent at work, participation in university and community sport, higher levels of psychological distress, higher levels of social connectedness, and lower levels of social identity were significant predictors of hazardous alcohol consumption. The finding highlights the need for the inclusion of integrated, multi-strategy health promotion interventions on campus. Further exploration of the associations between social connectedness and social identity as influences of health behaviors will better inform the development of targeted strategies for specific groups.
Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational study
Louise Rose, Sara Gray, Karen Burns, Clare Atzema, Alex Kiss, Andrew Worster, Damon C. Scales, Gordon Rubenfeld, Jacques Lee
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-30
Abstract: Prospective observational study of ED LOS for all patients receiving mechanical ventilation at four metropolitan EDs in Toronto, Canada over two six-month periods in 2009 and 2010.We identified 618 mechanically ventilated patients which represented 0.5% (95% CI 0.4%–0.5%) of all ED visits. Of these, 484 (78.3%) received invasive ventilation, 118 (19.1%) received NIV; 16 received both during the ED stay. Median Kaplan-Meier estimated duration of ED stay for all patients was 6.4?h (IQR 2.8–14.6). Patients with trauma diagnoses had a shorter median (IQR) LOS, 2.5?h (1.3–5.1), compared to ventilated patients with non-trauma diagnoses, 8.5?h (3.3–14.0) (p <0.001). Patients requiring NIV had a longer ED stay (16.6?h, 8.2–27.9) compared to those receiving invasive ventilation exclusively (4.6?h, 2.2–11.1) and patients receiving both (15.4?h, 6.4–32.6) (p <0.001). Longer ED LOS was associated with ED site and lower priority triage scores. Shorter ED LOS was associated with intubation at another ED prior to transfer.While patients requiring mechanical ventilation represent a small proportion of overall ED visits these critically ill patients frequently experienced prolonged ED stay especially those treated with NIV, assigned lower priority triage scores at ED presentation, and non-trauma patients.
Mental health services funding and development in KwaZulu-Natal: A tale of inequity and neglect
JK Burns
South African Medical Journal , 2010,
Abstract: Background. Globally, a significant ‘mental health gap’ exists between the major burden of mental and substance use disorders and the provision of psychiatric and mental health services. As a signatory to the UN Convention on the Rights of Persons with Disabilities, South Africa has committed itself to transformation aimed at ending the inequities that characterise mental health service provision and ‘closing the gap’. Methodology. Budget allocations over a 5-year period to 6 psychiatric and 7 general hospitals in KwaZulu-Natal (KZN) are compared and current numbers of psychiatric beds and psychiatric personnel in that province are contrasted with the numbers required to comply with national norms. Results. The mean increase in budget allocations to public psychiatric hospitals was 3.8% per annum, while that to general hospitals over the same period was 10.2% per annum. The median cumulative budget increase for psychiatric hospitals was significantly lower than that of general hospitals (Mann-Whitney U-test, p=0.001). No psychiatric hospitals received specific funding for tertiary services development. KZN has 25% of the acute psychiatric beds and 25% of the psychiatrists required to comply with national norms, with the most serious shortages experienced in northern KZN. There are 0.38 psychiatrists per 100 000 population in KZN. Conclusion. Inequitable funding, inadequate facilities and significant shortages of mental health professionals pervade the mental health and psychiatric services in KZN. There is little evidence of government abiding by its public commitments to redress the inequities that characterise mental health services.
Success, Failure or “No Significant Difference”? The Arguments For and Against Technology as a Learning Tool
Mary Burns
International Journal of Emerging Technologies in Learning (iJET) , 2013, DOI: 10.3991/ijet.v8i1.2376
Abstract: The question of whether computers have positively or negatively impacted student learning is still hotly contested in educational technology circles, particularly in the area of international development, by proponents and critics of technology in education. Overall, research still provides conflicting answers to this question. Nonetheless, the abundant research on effective school change and innovation implementation points to practices which those who promote technology in schools should tap. This paper outlines the long-term structural conditions that can lead to the deep change technology initiatives seek to promote.
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