Using a standardized data collection tool, two investigators independently collected the following data from included studies: patient characteristics including age, gender, substance use history, indication for buprenorphine; initiation regimen characteristics including the method used, setting, medication dosing details, duration of initiation period, use of ancillary medications; and information to assess risk of bias and our outcomes of interest.
Twenty-four unique patient cases met our inclusion criteria (Additional file 2: Table S1). Two cases within the 15 articles were excluded because they did not report the presence or absence of withdrawal symptoms during buprenorphine initiation, our primary outcome [4, 11]. Most reports came from the United States or Canada and represented both genders of adults ranging from 19 to 72 years. In most cases, buprenorphine was initiated for OUD alone or in combination with pain in both inpatient and outpatient settings. There was a range of initiation strategies represented amongst the 24 cases including micro-dosing, bridging with a transdermal opioid, or a combination of multiple strategies. The most utilized strategy was the Bernese method of micro-dosing [16], followed by bridging with a buprenorphine patch. Rapid micro-dosing, bridging with a fentanyl patch, and combination strategies compromised a small fraction of cases.
Callan Method Stage 12 Pdf 36
Despite a lack of current evidence, there are also practical challenges to implementation of alternative initiation strategies for buprenorphine. Insurance coverage for off-label use may be a barrier to successful implementation of certain strategies [26]. Traditional initiation typically occurs in the outpatient setting, whereas many of the included cases describe inpatient initiation which has direct implications to resources and costs of care. In general, many of the alternative initiation methods require manipulation of prescription products to achieve small enough doses to be consistent with published protocols. For example, manipulation of buprenorphine/naloxone to execute a microdosing protocol requires using scissors, razors, or folding and ripping buprenorphine/naloxone films to achieve the desired dose [27]. In the outpatient setting, patients are left to manipulate the dosage forms themselves. In the inpatient setting, some institutions may choose not to operationalize these practices based on the available evidence or may have policies and procedures that prohibit certain strategies [28, 29].
A literature survey typically employs a framework for structuring the evaluation of the works in the targeted area. This framework captures the potential properties of interest and enables a comparison of the surveyed works and drawing meaningful conclusions. The use of gamification in learning involves a number of aspects, including game elements, educational context, learning outcomes, learner profile and the gamified environment. Gamification is receiving attention, particularly for its potential to motivate learners. Accordingly, our objective involving evaluation of the level of understanding of the motivational impacts of gamification in educational contexts has shaped our decision of what categories of information to be included in the framework for evaluating the surveyed works. More specifically, we looked for information that can facilitate the process of identifying and analyzing the empirical evidence demonstrating the motivational effects of gamification. Motivation as a psychological process that gives behavior purpose and direction is contextual. Not only are individuals motivated in multiple ways, but also their motivation varies according to the situation or context of the task. To provide support for analyzing the contextual aspect, the information collected from the studies include the educational level, academic subject, and type of the gamified learning activity. We also included the used game elements, mechanics and dynamics since they are inherently related to the success of a gamification application. A number of motivation measures have been used in attempts to establish the effect of gamification on student motivation. In addition to appropriate measures, the verification of the validity of reported results requires availability of relevant statistical information about the studies. In order to provide support for our decision on how conclusive the reported results of a study are, we added the following categories: study sample, study duration, method of data collection, and outcome. Thus the final structure of information to be derived from the reviewed studies included the following categories: game elements, educational level, academic subject, learning activity, study sample, study duration, data collection, and outcome.
While it seems apparent that gamification has the potential to create enhanced learning environments, there is still insufficient evidence that it (1) produces reliable, valid and long-lasting educational outcomes, or (2) does so better than traditional educational models. There is still insufficient empirical work that investigates the educational potential of gamification in a rigorous manner. Increasing the number of studies that use randomized controlled trials or quasi-experimental designs will increase the scientific robustness. The continued (and coordinated) collection of evidence, that is, data that substantiate the successes and failures of gamification, remains crucial for building an empirical knowledge base and consolidating best practices, extracting guidelines and eventually developing predictive theories. It is necessary to strengthen the methodical base of gamified learning and systematically enlarge the body of evidence that explains what factors and conditions produce desirable outcomes. The empirical research should thereby not just be fixated on the pros of gamified learning, but also be open to the cons and the conditions when gamification for learning should be avoided (Linehan et al., 2011; Westera, 2015).
In addition to the gamification works with theoretical, conceptual or methodological orientation, five literature reviews (Borges, Durelli, Reis, & Isotani, 2014; Caponetto et al., 2014; Dicheva & Dichev, 2015; Faiella & Ricciardi, 2015; Gerber, 2014) have been published over the last two years. While these reviews synthesize the empirical research on gamification in education, neither of them provides a critical analysis of the strengths and weaknesses of the research findings of the reviewed studies. The present review addresses this gap by evaluating analytically the validity of the reported results.
Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.
Clinical and humanistic burden was consistently observed in European respondents with AD versus matched controls across severity levels, with burden also evident even in milder severity levels. This highlights the importance of improving disease management also in earlier stages of this disease. This is especially relevant given the broad set of comorbidities observed, including some that may be expected to lead to serious chronic conditions and the associated humanistic burdens that were observed.
Associated terms for pregnancy are gravid and parous. Gravidus and gravid come from the Latin word meaning "heavy" and a pregnant female is sometimes referred to as a gravida.[21] Gravidity refers to the number of times that a female has been pregnant. Similarly, the term parity is used for the number of times that a female carries a pregnancy to a viable stage.[22] Twins and other multiple births are counted as one pregnancy and birth.
A pregnancy is considered term at 37 weeks of gestation. It is preterm if less than 37 weeks and postterm at or beyond 42 weeks of gestation. American College of Obstetricians and Gynecologists have recommended further division with early term 37 weeks up to 39 weeks, full term 39 weeks up to 41 weeks, and late term 41 weeks up to 42 weeks.[26] The terms preterm and postterm have largely replaced earlier terms of premature and postmature. Preterm and postterm are defined above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.[27][28]
The chronology of pregnancy is, unless otherwise specified, generally given as gestational age, where the starting point is the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. This model means that the woman is counted as being "pregnant" two weeks before conception and three weeks before implantation. Sometimes, timing may also use the fertilization age, which is the age of the embryo since conception.
The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are established. By the end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.
Events after 42 weeks are considered postterm.[62] When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and the fetus increases significantly.[66][67] Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labour at some stage between 41 and 42 weeks.[68] 2ff7e9595c
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