Essential aspects for the administration of blood components in hospitalized patients: A narrative literature review

Introduction Transfusion medicine develops and disseminates guidelines that govern the optimal conditions for transfusion. The purpose of this article is to review the current evidence on the use of blood components. Methods We searched PubMed, Scholar Google, ScienceDirect, SciELO and Cochrane web portals, as well as official documents published in the Chilean Society of Hematology. Articles from the last ten years were included, of which 42 were appropriate for this narrative literature review. Conclusion First of all, there is a controversy between two types of strategies regarding the practice of red blood cell transfusion: a liberal strategy and a restrictive strategy. Second, for the management of coagulopathies, clotting times do not reflect the true ability of patients to clot. Third, to reverse the effect of coumadin, the administration of vitamin K would suffice over the use of fresh frozen plasma. Fourth, the use of physiological triggers could help define the best time for a transfusion.

Comprehensive Assessment of Individuals With Significant Levels of Intellectual Disability: Challenges, Strategies, and Future Directions

The variety and extent of impairments in individuals with severe-profound levels of intellectual disability (ID) impact their ability to complete valid behavioral assessments. Although standardized assessment is crucial for objectively evaluating patients, many individuals with severe-profound levels of ID perform at the floor of most assessments designed for their chronological age. Additionally, the presence of language and motor impairments may influence the individual's ability to perform a task, even when that task is meant to measure an unrelated construct leading to an underestimation of their true ability. This article provides an overview of the assessment protocols used by multiple groups working with individuals with severe-profound levels of ID, discusses considerations for obtaining high-quality assessment results, and suggests guidelines for standardizing these protocols across the field.

Ideological Guidance Based on the Characteristics of Students in Higher Vocational Colleges in the New Era

To do a good job in ideological guidance of higher vocational students in the new era, we should first understand the position of the times and the characteristics of students; and then accurately grasp the essence of student ideological guidance; finally, use some pioneer and innovative leading concepts to improve the true ability of educating students.

Myanmar

This 2019 Article IV Consultation focuses on Myanmar’s near- and medium-term challenges and policy priorities and was prepared before COVID-19 became a global pandemic and resulted in unprecedented strains in global trade, commodity and financial markets. It, therefore, does not reflect the implications of these developments and related policy priorities. These developments have greatly amplified uncertainty and could heighten downside risks around the outlook. The IMF staff is closely monitoring the situation, including related policy responses from the authorities, and will continue to work on assessing its impact in the Myanmar economy. Although long-term prospects remain favorable, near-term growth is likely to remain below potential as the correction in real estate market and continued uncertainty weighs on investor sentiment in the runup to the 2020 elections. Starting FY2020/21, bank deleveraging will further slow credit and constrain gross domestic product growth as borrower’s true ability to repay is revealed with term loans coming due and banks restructure in earnest.

Investigating the Practical Consequences of Model Misfit in Unidimensional IRT Models

In this chapter, the practical consequences of violations of unidimensionality on selection decisions in the framework of unidimensional item response theory (IRT) models are investigated based on simulated data. The factors manipulated include the severity of violations, the proportion of misfitting items, and test length. The outcomes that were considered are the precision and accuracy of the estimated model parameters, the correlations of estimated ability (θ-hat) and number-correct (NC) scores with the true ability (θ), the ranks of the examinees and the overlap between sets of examinees selected based on either θ, θ-hat, or NC scores, and the bias in criterion-related validity estimates. Results show that the θ-hat values were unbiased by violations of unidimensionality, but their precision decreased as multidimensionality and the proportion of misfitting items increased; the estimated item parameters were robust to violations of un dimensionality. The correlations between θ, θ-hat, and NC scores, the agreement between the three selection criteria, and the accuracy of criterion-related validity estimates are all negatively affected, to some extent, by increasing levels of multidimensionality and the proportion of misfitting items. However, removing the misfitting items only improved the results in the case of severe multidimensionality and large proportion of misfitting items, and deteriorated them otherwise.

Reporting Valid and Reliable Overall Scores and Domain Scores Using Bi-Factor Model

Recently, large-scale testing programs have an increasing interest in providing examinees with more accurate diagnostic information by reporting overall and domain scores simultaneously. However, there are few studies focusing on how to report and interpret reliable total scores and domain scores based on bi-factor models. In this study, the authors introduced six methods of reporting overall and domain scores as weighted composite scores of the general and specific factors in a bi-factor model, and compared their performance with Yao’s MIRT (multidimensional item response theory) method using both simulated and empirical data. In the simulation study, four factors were considered: test length, number of dimensions, correlation between dimensions, and sample size. Major findings are that Bifactor-M4 and Bifactor-M6, the methods utilizing discrimination parameters of the specific dimensions to compute the weights, provided the most accurate and reliable overall and domain scores in most conditions, especially when the test was long, the correlation between dimensions was high and the number of dimensions was large; additionally, Bifactor-M4 recovered the relationship of true ability parameters the best of all the proposed methods; On the contrary, Bifactor-M2, the method with equal weights, performed poor on the overall score estimation; Bifactor-M3 and Bifactor-M5, the methods where weights were computed using the discrimination parameters of all the dimensions, performed poor on the domain score estimation; Bifactor-M1, the original factor method, obtained the worst estimations.

Cultural Competemility: A Paradigm Shift in the Cultural Competence versus Cultural Humility Debate – Part I

For over 30 decades, cultural competence has commanded significant attention, being viewed as the cornerstone of fostering cross-cultural communication, reducing health disparities, improving access to better care, increasing health literacy and promoting health equity. However, a medley of definitions and conceptualizations has created intense debate, questioning its true ability to address cross-cultural problems in healthcare delivery. One ongoing debate centers around the relationship between cultural competence and cultural humility. Part I of this two-part series on cultural competemility will revisit this debate by discussing competing views of this relationship. A new paradigm of thought regarding the relationship between cultural competence and cultural humility will be proposed, one necessitating that cultural humility and cultural competence enter into a synergistic relationship. This synergistic relationship is embodied in a term coined "cultural competemility.” This article presents the debate regarding cultural competence verses cultural humility, defines the term cultural competemility, explains the relationship between cultural humility and cultural competence, describes the process of permeation and concludes by proposing a synergistic relationship between cultural competence and cultural humility to create the process of cultural competemility. Part II of this series will apply an intersectionality approach to the process of cultural competemility and offer strategies for nurses to actively challenge and address inequalities.

Carta al Editor Es erróneo hacer una asociación directa entre la detección de Helicobacter spp. y gastritis en caninos

It has been proposed that Helicobacter may play a significant role in the generation of gastritis and cancer in dogs. However, despite several independent efforts, there is still controversy regarding the true ability of Helicobacter to cause gastric lesions in these animals. The foregoing is due in part to the fact that gastritis is a multifactorial disease. Studies focused on naturally acquired infections have been unable to establish a positive correlation between Helicobacter colonization and gastritis. Establishing a clear association between the presence of Helicobacter and gastritis may be difficult due to the following reasons: (i) taxonomy of the genus Helicobacter remains unclear, (ii) virulence factors of Helicobacter species that colonize dogs are not well known, and (iii) simultaneous infections have been reported with several species of Helicobacter. Current knowledge in taxonomy and pathogenesis of Helicobacter species is insufficient to differentiate between pathogenic and non-pathogenic strains. Therefore, no direct association should be made between the detection of Helicobacter and gastritis.

Game-Theoretic Question Selection for Tests

Conventionally, the questions on a test are assumed to be kept secret from test takers until the test. However, for tests that are taken on a large scale, particularly asynchronously, this is very hard to achieve. For example, TOEFL iBT and driver's license test questions are easily found online. This also appears likely to become an issue for Massive Open Online Courses (MOOCs, as offered for example by Coursera, Udacity, and edX). Specifically, the test result may not reflect the true ability of a test taker if questions are leaked beforehand. In this paper, we take the loss of confidentiality as a fact. Even so, not all hope is lost as the test taker can memorize only a limited set of questions' answers, and the tester can randomize which questions to let appear on the test. We model this as a Stackelberg game, where the tester commits to a mixed strategy and the follower responds. Informally, the goal of the tester is to best reveal the true ability of a test taker, while the test taker tries to maximize the test result (pass probability or score). We provide an exponential-size linear program formulation that computes the optimal test strategy, prove several NP-hardness results on computing optimal test strategies in general, and give efficient algorithms for special cases (scored tests and single-question tests). Experiments are also provided for those proposed algorithms to show their scalability and the increase of the tester's utility relative to that of the uniform-at-random strategy. The increase is quite significant when questions have some correlation---for example, when a test taker who can solve a harder question can always solve easier questions.

Investigating the Practical Consequences of Model Misfit in Unidimensional IRT Models

In this article, the practical consequences of violations of unidimensionality on selection decisions in the framework of unidimensional item response theory (IRT) models are investigated based on simulated data. The factors manipulated include the severity of violations, the proportion of misfitting items, and test length. The outcomes that were considered are the precision and accuracy of the estimated model parameters, the correlations of estimated ability ([Formula: see text]) and number-correct ([Formula: see text]) scores with the true ability ([Formula: see text]), the ranks of the examinees and the overlap between sets of examinees selected based on either [Formula: see text], [Formula: see text], or [Formula: see text] scores, and the bias in criterion-related validity estimates. Results show that the [Formula: see text] values were unbiased by violations of unidimensionality, but their precision decreased as multidimensionality and the proportion of misfitting items increased; the estimated item parameters were robust to violations of unidimensionality. The correlations between [Formula: see text], [Formula: see text], and [Formula: see text] scores, the agreement between the three selection criteria, and the accuracy of criterion-related validity estimates are all negatively affected, to some extent, by increasing levels of multidimensionality and the proportion of misfitting items. However, removing the misfitting items only improved the results in the case of severe multidimensionality and large proportion of misfitting items, and deteriorated them otherwise.