Academic literature on the topic 'DIAGNOSTIC THINKING'

Abstract. Autistic thinking and its manifestations in Rorschach responses have long been of interest to students of psychopathology and practitioners of personality assessment. However, the precise nature of autistic thinking has not always been adequately grasped, nor have its diagnostic implications been fully appreciated. The present report clarifies the concept of autistic thinking and distinguishes it from current conceptions of autism; it elaborates the mental processes involved in autistic thinking; it considers linkages between the clinical conceptualization of autistic thinking and research findings from related fields; it delineates criteria for identifying and coding autistic thinking in Rorschach protocols; and it discusses the interpretive significance and diagnostic implications of autistic Rorschach responses.

When performing diagnostic actions in everyday life, the doctor does not think about why he does it so and not otherwise. The researcher is forced to think about his thinking style when the need arises to change it due to the objective processes of clinical diagnostic development. Among these we can mention the following: 1) intensification of examination (diagnosis is becoming more morphological); 2) increasing role of the functional component of clinical diagnosis, which plays a crucial role in the diagnosis of pre-disease and so-called borderline conditions; 3) formation of a new type of medical examination - screening; 4) use of the computer in diagnostics.

Introduction. This study aimed to investigate dental students’ clinical reasoning and diagnostic thinking ability by key feature test and “diagnostic thinking inventory” questionnaire. Methods. The present study was a descriptive cross-sectional study. The participants consisted of 61 senior dental students. Clinical reasoning and diagnostic thinking were assessed by key feature tests and the “diagnostic thinking inventory” “DTI” questionnaire, respectively. The “diagnostic thinking inventory” was developed by Bordage et al. in France and consisted of 41 questions on a 6-point Likert scale. The satisfaction of students was assessed through a 10-item questionnaire. Data were analyzed using SPSS 19 with descriptive tests (mean, SD, and percentage), student independent T-test, and Pearson correlation. The significance level was determined at p < 0.05 . Results. The mean scores of the key feature test were 56.55 ± 7.80. Diagnostic thinking scores of learners were reported in diagnostic thinking 136.47 ± 16.45, flexibility in thinking 72.22 ± 11.15, and structure of memory 64.24 ± 7.84. The difference in students’ scores in flexibility in thinking was significantly higher among male students than female students. ( p -value = 0.04). The students’ satisfaction scores were 3.53 ± 0.52, which showed relative satisfaction. Conclusion. The participants’ clinical reasoning and diagnostic thinking skills were reported at a low level. This issue emphasizes the need for training to enhance diagnostic thinking and clinical reasoning in dental education. Formative evaluation and reform of the educational programs of this course should be considered.

Aim: To study the psychopathological mechanisms of the development of the prodromal stage of psychosis in order to identify risk factors for the formation of psychosis. Materials and Methods: In this research 137 patients with newly diagnosed psychosis were examined: 65 patients with a diagnosis of paranoid schizophrenia; 72 patients - with a diagnosis of acute polymorphic psychotic disorder. Results: According to the analysis of symptoms using the PANSS, the absence of signs of an anxious state, conceptual disorganization of thinking, emotional withdrowal are reliable signs of PPP in PS, and unusual thought content, absence of signs of stereotyped thinking, tension, anxiety, and hallucinations are reliable signs of PPP in APPD. According to the analysis of symptoms using the SOPS, unusual thought content/delusional ideas, bizarre thinking, social anhedonia, suspiciousness/persecutory ideas, decrease in expressiveness of emotions are reliable signs of PPP in PS, and bizarre thinking, impaired tolerance to normal stress, sleep disturbance, perceptual abnormalities/hallucinations, trouble with focus and attention are reliable signs of PPP in APPD. Conclusions: In the process of studying the clinical-psychopathological and pathopsychological aspects of the development of the PPP, a number of risk factors for the formation of psychosis were identified. We found that he most important diagnostic signs of PPP in PS patients are: stereotyped thinking, social isolation, disorganizational thinking disorders, passive-apathetic social detachment, suspiciousness. The most informative prodromal symptoms of HP in PS patients are: conceptual disorganization of thinking, bizzare thinking, social isolation, suspiciousness/persecutory ideas, reduced expression of emotions.

The article presents a theoretical analysis of key concepts. The article proves that in the process of teaching students at the university it is necessary to apply innovative means and methods of developing visual thinking. One of the means to supplement and enhance the process of memorization, as well as the analysis of information using simple images that contribute to the effective development of visual thinking, is sketchnoting techniques. The article discusses the ways of using sketchnoting as a technology for developing students’ visual thinking. The study reflects the developed diagnostic tools for determining the level of development of visual thinking of first-year students. The article describes the main stages of experimental verification of the effectiveness of the methodology for the development of visual thinking of students based on the use of sketchnoting techniques: primary diagnostics, the stage of introducing the methodology into the scientific and educational process of the university, the stage of verifying the effectiveness of the methodology (through secondary (control) diagnostics). Based on the analysis of the results of diagnostic measurements, a positive dynamics of the level of development of visual thinking of students was revealed, which made it possible to prove the effectiveness of the applied techniques involving the use of sketchnoting techniques.

This research explores the neuro-pedagogical diagnostic mechanisms aimed at developing logical thinking skills in future educators. The study examines how the integration of neuroscience and pedagogy enhances the efficiency of educational processes, allowing for targeted observation, evaluation, and support of students’ cognitive development. The paper also presents diagnostic tools and strategies for identifying and improving logical reasoning through neuro-pedagogical approaches.

The purpose of this research was to investigate the application of design processes to the development of novel self-use molecular diagnostic devices for sexually transmitted infections. The argument proposed in this thesis is that the application of design methods at the earliest research stages into miniaturised, low cost, molecular diagnostic technologies will accelerate and improve the process of translating proof of concept diagnostic technologies into usable devices. Concept development requirements and potential issues and barriers to development were identified through interviews with expert stakeholders. These requirements were further refined through a survey of a multidisciplinary diagnostic medical device research group. An action research method was applied to develop a proof of concept prototype to the preclinical trial stage. Through these research studies, a design process model was formulated for use in a research environment. The application of design methods to the proof of concept prototype described in the thesis have resulted in a preclinical trial prototype that exhibits the necessary features for development into a self-use molecular diagnostic device. Issues and barriers were identified and discussed, design guidelines for further development beyond preclinical trial were defined and a generalised design process model for self-use molecular diagnostic devices for sexually transmitted infections was proposed. This research highlights the need for design methods to be applied at the earliest possible stages of the development of novel molecular diagnostic devices.

Winnicott’s (1968, 1993) play technique squiggling was piloted as a measure of creative thinking abilities and a potential diagnostic aid in the assessment of Asperger syndrome. The internal consistency and inter-rater reliability of squiggling was found to be acceptable. Mixed results were found between the six subscales in terms of concurrent validity with the Torrance Tests of Creative Thinking (TTCT: Torrance, Bal & Safter, 2008). Squiggling subscales Elaboration and Imagination showed signs of psychometric strength. However, Fluency and Originality require revision. Concurrent validity of the subscales Flexibility and Integration were not established. A matched-participants design enabled testing of hypothesised differences in creative thinking abilities with children with Asperger syndrome using the TTCT (Torrance et al., 2008): Abstractedness, Fluency, Originality, Integration, Elaboration, Resistance to Premature Foreclosure and Flexibility. Children with Asperger syndrome demonstrated a significantly higher level of elaboration and abstract imagination in their drawings relative to a comparison group of typically-developing children matched on age, visual motor integration ability and non-verbal IQ. Findings indicate partial support for the Weak Central Coherence Theory (Shah and Frith, 1983) and Leslie’s (1987) Meta-Representational Deficit hypothesis. Children with Asperger syndrome demonstrated understanding and expression of abstract concepts as graphical representations, thereby supporting their use in clinical assessments and interventions. No support was found for the Executive Dysfunction Theory (Pennington & Ozonoff, 1996) or for the Hyper-Systemising Theory (Baron-Cohen, 2006). Some limitations include the heterogeneity of the clinical group, and the possible confounding effects of verbal intellectual abilities, extrinsic rewards and performance anxiety. Major strengths of the study include a successful matching procedure and the finding of group differences with large effect sizes on particular creative thinking abilities.

Объектом исследования является профессиональное мышление студентов-психологов. Предметом исследования являлись предикторы развития диагностического мышления. Магистерская диссертация состоит из введения, трех глав, заключения, списка литературы (61 источник) и приложения, включающего в себя результаты методик (в баллах) и содержание теста. Объем магистерской диссертации 94 страниц, на которых размещены 1 рисунок и 5 таблиц. Во введении раскрывается актуальность проблемы исследования, разработанность проблематики, ставятся цель и задачи исследования, определяются объект и предмет исследования, формулируются гипотезы, указываются методы и эмпирическая база, а также этапы проведения исследования, теоретическая и практическая значимость работы. Первая глава включает в себя обзор иностранной и отечественной литературы по теме исследования профессионального мышления психологов и студентов-психологов. Представлены разделы, раскрывающие структуру феномена, его параметры и механизмы. Выводы по первой главе представляют собой итоги по изучению теоретического материала. Вторая глава посвящена практической деятельности психолога. В ней выделяется психодиагностика, как главная практическая деятельность психолога. Рассматривается структура, механизмы и особенности написания диагностического заключения психологом. Определяются психолингвистические параметры для оценки итоговых заключений студентов. Раскрывать особенности интеллектуальных и личностных характеристик письменной речи психолога. Выводы по главе 2 включают в себя основные результаты. Третья глава посвящена эмпирической части исследования и включает в себя: описание организации и методов проведенного исследования и результатов, полученных по всем использованным методикам (16-факторный личностный опросник Р.Б.Кеттела, опросник «Уровень субъективного контроля» и профориентационный тест на определение склонности и интереса к профессии психолог). Также представлен корреляционный и сравнительный анализ результатов исследования. В заключении в обобщенном виде изложены результаты теоретической и эмпирической частей работы, а также выводы по выдвинутым гипотезам, обоснована практическая значимость исследования и описаны возможные перспективы дальнейшей разработки данной проблематики.<br>The object of the study is the professional thinking of psychology students. The subject of the study was predictors of the development of diagnostic thinking. The master's thesis consists of an introduction, three chapters, a conclusion, a list of references (61 sources) and an appendix that includes the results of the methods (in points) and the content of the test. The volume of the master's thesis is 94 pages, which contain 1 figure and 5 tables. The introduction reveals the relevance of the research problem, the development of the problem, sets the goal and objectives of the research, defines the object and subject of the research, formulates hypotheses, specifies methods and empirical base, as well as the stages of the research, the theoretical and practical significance of the work. The first chapter includes a review of foreign and domestic literature on the topic of research of professional thinking of psychologists and psychology students. The sections that reveal the structure of the phenomenon, its parameters and mechanisms are presented. The conclusions of the first chapter are the results of the study of the theoretical material. The second chapter is devoted to the practical work of a psychologist. It highlights psychodiagnostics as the main practical activity of a psychologist. The structure, mechanisms and features of writing a diagnostic conclusion by a psychologist are considered. Psycholinguistic parameters are determined for evaluating the final conclusions of students. To reveal the features of the intellectual and personal characteristics of the written speech of the psychologist. The conclusions of chapter 2 include the main results. The third chapter is devoted to the empirical part of the study and includes: a description of the organization and methods of the study and the results obtained by all the methods used (the 16-factor personal questionnaire of R. B. Kettel, the questionnaire "The level of subjective control" and the career guidance test to determine the propensity and interest in the profession of psychologist). A correlation and comparative analysis of the results of the study is also presented. In conclusion, the results of the theoretical and empirical parts of the work, as well as conclusions on the hypotheses put forward, are summarized, the practical significance of the study is justified and possible prospects for further development of this problem are described.

Os desperdícios e a necessidade de oferecer um atendimento de qualidade constituem um verdadeiro desafio para as empresas de saúde. Para tanto, a adoção da filosofia enxuta - particularmente do lean healthcare - pode contribuir para a redução dos desperdícios e melhoria da qualidade. Neste contexto, este trabalho teve como objetivo analisar os motivos e como ocorreu a implantação do lean thinking nos processos de atendimento em uma empresa de medicina diagnóstica, bem como identificar os resultados alcançados. MÉTODOS: Trata-se de uma pesquisa exploratória de abordagem qualitativa, em que foi realizado um estudo de caso incorporado. Para a construção das questões orientadoras das entrevistas realizou-se uma pesquisa bibliográfica que gerou seis temas: operações, cultura organizacional, apoio da alta administração, redução de custos e desperdícios, foco no cliente e comunicação e capacitação. A coleta de dados foi realizada com dez participantes, divididos em três grupos e por meio de observações diretas. RESULTADOS: O modelo lean thinking foi aplicado na empresa pela iniciativa de líderes que conheciam o modelo. No entanto, ocorreu de forma incompleta - os colaboradores operacionais não foram envolvidos na capacitação inicial; os princípios básicos e ferramentas que fundamentam o modelo lean não foram incorporados como modelo de trabalho da empresa; não houve a integração de toda a organização, da alta administração à operação; os clientes não participaram do mapeamento do fluxo dos processos do atendimento e não avaliaram o que agrega valor. Com isso, os resultados alcançados em relação à redução de desperdícios com geração de valor ao cliente e melhoria da qualidade com a implantação do lean foram pontuais, com pouca adesão das lideranças e equipe de colaboradores. CONCLUSÕES: A análise dos resultados sugere que a implantação parcial da metodologia do lean thinking e suas práticas seguindo a literatura, considerando o contexto da organização, pode ter contribuído para a obtenção de um desempenho aquém do esperado, em termos de qualidade e redução de desperdícios.<br>The waste and the need to offer a quality service are a real challenge for healthcare companies. To this end, the adoption of lean philosophy - particularly the lean healthcare - can contribute to reduce waste and improve quality. In this context, this study aimed to analyze the reasons and how the implementation of lean thinking occurred in the processes of care in a medical diagnostic company, as well as identify the results achieved. METHODS: This was an exploratory qualitative study, in which an embedded case study was conducted. For the construction of the guiding questions of the interviews we carried out a literature search that yielded six themes: operations, organizational culture, top management support, cost reduction and waste, customer focus and communication skills. The data collection was performed with ten participants, divided into three groups and through direct observations. RESULTS: The lean thinking model was applied in areas of the company by the initiative of leaders who knew the model. However, there was incomplete - operational employees were not involved in the initial training; the basic principles and tools that support the lean model were not incorporated as a working model of the company; there was not integration of the entire organization, from top management to the operation; customers did not take part on the flow mapping of the processes of care and did not evaluate what adds value in customer perception. Thus, the results achieved regarding wastes decrease with customer value development and quality improvements through lean deployment were punctual and presented poor uptake from leadership team and employees. CONCLUSIONS: The assay of achieved results suggests that the incomplete lean thinking methodology deployment and its best practices according to the literature, also taking into consideration the context among enterprise under study, may have contributed for achievements lower than expected, in relation to quality and wastes decrease.

Dissertation submitted in fulfilment of the requirements for the degree Master of Technology: Radiography in the Faculty of Health and Wellness Sciences, 2008<br>Introduction Research to date has not been able to agree whether spatial abilities can be developed by practice. According to some researchers spatial ability is an inherited cognitive ability, compared to spatial skills that are task specific and can be acquired through formal training. It is commonly assumed that radiographers require general cognitive spatial abilities to interpret complex radiographic images. This research was conducted to investigate second year radiography students’ three-dimensional thinking skills pertaining to film-viewing assessments. Materials and methods The experimental research strategy was mainly applied together with correlation research. Two trials were run (in 2005 and 2006). The sample group consisted of fifteen second year diagnostic radiography students in 2005 and twenty-three second year diagnostic radiography students, of the same institution, in 2006. Each year group was randomly divided into a control group and an intervention group. Two instruments were used, that is a film-viewing assessment and a three-dimensional test, Academic Aptitude Test (University) (AAT) nr. nine: Spatial Perception (3-D). The whole class completed this basic spatial aptitude test, as well as a base-line film viewing assessment, which focused on the evaluation of technique/anatomy of second year specialised radiographic projections. The marks that the students achieved in the fore-mentioned tests were compared, to determine if there was any correlation between their performances in the different tests. A curricular intervention, which was intended to improve applied three-dimensional skills, was subsequently applied. The students executed certain modified radiographic projections on parts of a human skeleton. For each radiographic projection, the students had to draw the relation of the X-ray beam to the specific anatomical structures, as well as the relation of these structures to the film. The related images of these projections were also drawn. With each of the following sessions, films including images of the previous session were discussed with each student. After the intervention, the whole class wrote a second film-viewing assessment. The marks achieved in this assessment were compared to the marks of the initial film-viewing assessment to determine the influence of the intervention on the performance of the intervention group. Following this assessment, for ethical reasons, the same intervention took place with the control group. A third film-viewing assessment was then written by all the diagnostic second year students to evaluate the overall impact of the intervention on the applied three-dimensional skills of the class. The marks of both the 2005 and 2006 classes (intervention classes) were compared to the marks achieved by former classes from 2000 to 2004 (control classes), in film-viewing assessments to evaluate the role of the curricular intervention over the years. The students again completed the three-dimensional test, Spatial Perception (3-D) to evaluate the impact of the intervention on students’ general three-dimensional cognitive abilities. These marks were also compared to the marks of the third filmviewing assessment, to determine if there was any correlation between the students’ performances in the different tests. Results The intervention groups did not perform significantly better in film-viewing assessments after the intervention, compared to the control groups, but reasonable differences, favouring the intervention group, were achieved. Statistical significance was achieved in film-viewing assessments with both year groups after the whole class had the intervention. The intervention year groups also performed significantly better than the previous year groups (without the intervention) in film-viewing assessments. The performance in general three-dimensional cognitive abilities of the group of 2006 improved significantly after the intervention, but on the contrary, the performance of the group of 2005 declined. There was a small intervention effect on the performance of the group of 2006. Only a weak to moderate correlation between the marks of the students achieved in the three-dimensional tests and the marks achieved in the film-viewing assessments, was found. Conclusion The contrasting evidence between the data of the two groups (2005 and 2006) in the three-dimensional tests and the small intervention effect on the performance of the group of 2006, makes the intervention not applicable for the increase of general spatial abilities. The results of this research show that the applied three-dimensional skills of radiography students in interpreting specialised and modified projections can be improved by intensive practice, independent of their inherited spatial abilities.

Sub-Saharan Africans (SSAs) are disproportionally affected by HIV in the UK. SSAs in the UK are also a group for whom religion is highly relevant, yet little is known about the possible associations between religion, spirituality and wellbeing or future thinking in this population. Previous studies have found associations between religion, spirituality and positive outcomes in the USA although much research to date has focused on levels of depression and depressive symptoms, to the neglect of positive aspects of wellbeing. Standardised self-report measures were used to measure wellbeing (psychological domain of the World Health Organisation Quality of Life HIV instrument), future thinking (The Future Thinking Task), HIV-related disability (overall function dimension of the HIV / AIDS targeted Quality of Life measure), Spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Wellbeing Scale), and Religion (Duke University Religion Index). A cross-sectional design was used to explore correlations between variables. The relationships between HIV-related disability and ( a) wellbeing and (b) future positive thinking were explored to establish whether spirituality or religion would mediate relationships between variables. 25 SSAs recently diagnosed with HIV (in the last 3-24 months) were recruited from 4 different sites. Spirituality was significantly associated with wellbeing and in multivariate analyses, HIV-related disability was significantly associated with both wellbeing and FPT. No aspect of religiosity was significantly associated with wellbeing or FPT. All other relationships were non-significant, however, due to the relatively small sample size the study is underpowered and therefore medium effect sizes have been reported between: wellbeing and future positive thinking; and spirituality and FPT. Spirituality did not mediate the relationships between HIV- 3 related disability and wellbeing. Additionally, neither spirituality nor any aspect of religiosity mediated the relationship between Hl'V-related disability and FPT. The results may support interventions which aim to decrease RIV-related disability and enhance spirituality in SSAs adjusting to RIV diagnoses in the UK. 4

O processo diagnóstico em enfermagem é uma atividade complexa de competência do enfermeiro, desenvolvida por meio de etapas consecutivas e organizadas que resultam no diagnóstico de enfermagem. Para a sua operacionalização, o processo diagnóstico em enfermagem é mediado pelo pensamento crítico, compreendido pela expressão de habilidades cognitivas e hábitos da mente, necessários para determinar com acurácia o julgamento clínico. No ensino da enfermagem é destacada a importância do desenvolvimento do pensamento crítico pelo uso de estratégias de ensino, que orientem o processo diagnóstico em enfermagem e colaborem para o refinamento das habilidades de pensamento crítico dos alunos. O objetivo deste estudo foi validar o Modelo Teórico do Pensamento Crítico no Processo Diagnóstico em Enfermagem, proposto por Bittencourt em 2011. O estudo foi desenvolvido sob um paradigma qualitativo, com oito discentes concluintes do curso de Bacharelado em Enfermagem de uma Universidade localizada no Vale do Rio dos Sinos, RS e que estavam desenvolvendo as suas atividades de estágio curricular obrigatório, em um hospital público da mesma região. Além dos discentes, quatro pacientes adultos, clinicamente estáveis e internados no mesmo hospital foram sujeitos do estudo, representando os estudos de caso clínico reais, norteadores da aplicação do Modelo Teórico do Pensamento Crítico no Processo Diagnóstico em Enfermagem. O estudo recebeu aprovação do Comitê de Ética em Pesquisa da UFRGS e da universidade de origem dos discentes, atendeu aos pressupostos norteadores da pesquisa com seres humanos no Brasil. A coleta de dados ocorreu entre setembro e dezembro de 2014 e foi organizada em diferentes fases, iniciando pela capacitação dos discentes ao uso do software Cmap Tools,utilizado para elaboração de mapas conceituais,seguida pela aplicação do Modelo Teórico do Pensamento Crítico no Processo Diagnóstico em Enfermagem na prática clínica, durante a disciplina de Estágio Curricular IV. Após esta etapa, foram realizados três grupos focais, cujas sessões ocorreram no ambiente da Universidade, com o objetivo de discutir as habilidades de pensamento crítico elencadas pelos discentes na realização do processo diagnóstico em enfermagem. A análise dos dados utilizou estatística descritiva para identificar a frequência das habilidades de pensamento crítico escolhidas pelos discentes e, a seguir, pela análise de conteúdo proposta por Bardin, a partir dos relatos originados nos grupos focais. O referencial de avaliação de teorias de Meleis foi o norteador do processo de análise e discussão das características do modelo teórico na prática clínica e orientou a definição de duas categorias, em acordo com as etapas nominadas por Meleis, a saber: a descrição e o teste da utilidade. A descrição do Modelo Teórico do Pensamento Crítico no Processo Diagnóstico em Enfermagem identificou os componentes estruturais do modelo, a saber: proposições, descritas em duas afirmações da autora do modelo e conceitos, representados pelas habilidades de pensamento crítico e pelos conceitos centrais do processo diagnóstico em enfermagem. O teste da utilidade do Modelo Teórico do Pensamento Crítico no Processo Diagnóstico em Enfermagem foi realizado a partir da sua aplicação na prática clínica e, também, pela realização de três sessões de grupo focal, momentos em que as habilidades de pensamento crítico foram discutidas e elucidadas pelos discentes, que confirmaram estas habilidades como elementos estruturais do modelo teórico em análise. Em relação a estrutura do modelo teórico, três discentes sugeriram a inclusão da habilidade de raciocínio lógico na etapa de coleta de dados; houve o reconhecimento por todos os discentes em relação às demais habilidades de pensamento crítico que, no modelo em análise, apresentam elementos elucidativos do processo diagnóstico em enfermagem. O Modelo teórico do pensamento crítico no processo diagnóstico em enfermagem obteve a validação como um modelo teórico para uso no ensino teórico-prático de Enfermagem. Os discentes consideraram que a utilização deste modelo teórico contribuirá para minimizar a fragmentação do ensino do processo diagnóstico em enfermagem, percebida como uma dificuldade do processo de formação e que influencia no ensino-aprendizagem da acurácia dos diagnósticos de enfermagem.<br>Nurses are responsible for the process of diagnosis in nursing. This is a complex activity developed in consecutive and organized steps, which result in the nursing diagnosis. In order for it to be operationalized, the process of diagnosis in nursing is mediated by critical thinking, and expressed by cognitive skills and habits of the mind which are needed to accurately determine clinical judgment. Nursing education highlights the importance of developing critical thinking by teaching strategies that guide the process of diagnosis in nursing and help refine students’ critical thinking skills. The purpose of this qualitative study was to validate the Critical Thinking Model in Nursing Diagnosis developed by Bittencourt in 2011. Eight senior nursing students from universities located in Southern Brazil participated in the study. At the time of the study, they were developing mandatory internship activities at a public hospital located in the same region. In addition, four clinically stable adult patients admitted to the same hospital participated in the study, representing the real clinical cases where the Critical Thinking Model in Nursing Diagnosis was applied. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Sul and by the Ethics Committees from the students’ home universities, as it complied with rules governing research with human being in Brazil. Data was collected between September and December of 2014 and was then organized in different steps. First, students were trained on how to use Cmap Tools, which is used to create concept maps, and then they were trained on how to use the Critical Thinking Model in Nursing Diagnosis in clinical practice while attending Internship IV. Afterwards, three focus groups were conducted, with meetings taking place within the university. The main purpose of the meetings was to discuss critical thinking skills pointed out by the students while carrying out the process of diagnosis in nursing. For data analysis, descriptive analysis was used to identify the frequency of critical thinking skills chosen by the students, followed by Bardin’s Content Analysis for analysis of the reports and accounts given at the focus groups. Meleis’ Theory was used for analysis and discussion of the characteristics of the theory model in clinical practice and guided the shaping of two categories, according to the steps indicated by Meleis: description and usability test. The description of the Critical Thinking Model in Nursing Diagnosis identified the structural components of the model: propositions, described using two affirmations made by the model’s author and concepts, represented by critical thinking skills and main concepts of process of diagnosis in nursing. The usability test for the Critical Thinking Model in Nursing Diagnosis was carried out from its use in clinical practice as well as the three focus groups meetings. During these moments, critical thinking skills were discussed by students, who confirmed that these skills are structural elements of the theory model analyzed by the study. Regarding the structure of the theory model, three students suggested that logical reasoning skills be added to data collection. All students acknowledged further critical thinking skills that, regarding the model analyzed in the study, present elucidating elements of the process of diagnosis in nursing. The Critical Thinking Theory Model in Nursing Diagnosis was validated as a theory model to be used in theory-practice training in nursing. Students considered that this model would help minimizing the fragmentation of the process of diagnosis in nursing education, which is understood as a challenge in nursing education and which influences the accuracy of the teaching-learning process of nursing diagnosis.<br>El proceso diagnóstico em enfermería es una actividad compleja de competência del enfermero, desarrollada a través de pasos consecutivos y organizados que resultan en el diagnóstico de enfermería. Para su funcionamiento, El proceso diagnóstico en enfermería está mediado por el pensamiento crítico, entendido por la expresión de habilidades cognitivas y hábitos de la mente, necesarios para determinar con precisión el juicio clínico. Em la enseñanza de la enfermería está destacada la importância del desarrollo del pensamiento crítico por el uso de estrategias de enseñanza, que guién el proceso diagnóstico em enfermería y colaboren com el refinamiento de las habilidades de pensamiento crítico de los alumnos. El objetivo de este estúdio fue validar el Modelo Teórico del Pensamiento Crítico em el Proceso Diagnóstico de Enfermería propuesto por Bittencourt en 2011. El estúdio fue desarrollado bajo un paradigma cualitativo, con ocho discentes graduados del curso de Bachillerato en Enfermería de una Universidad ubicada en el Vale do Rio dos Sinos, RS y que estaban desarrollando sus actividades de pasantías curriculares obligatorias en un hospital público de la misma región. Además de los discentes, cuatro pacientes adultos, clinicamente estables y ingressados en el mismo hospital fueron sujetos del estudio, representando los estúdios reales de caso clínico, guías de la aplicación del Modelo Teórico del Pensamiento Crítico en el Proceso Diagnóstico de Enfermería. El estúdio fue aprobado por el Comité de Ética en Pesquisa de la UFRGS y de la universidad de origen de los discentes, atendió a los supuestos guías de la pesquisa con seres humanos en Brasil. La recolección de datos sucedió entre septiembre y diciembre de 2014 y fue organizada en diferentes fases, empezando por la formación de los discentes para el uso del software Cmap Tools, utilizado para la preparación de mapas conceptuales, seguida de la aplicación del Modelo Teórico del Pensamiento Crítico em el Proceso Diagnóstico en Enfermería en la práctica clínica, durante la disciplina de la pasantía curricular IV. Después de esta etapa fueron realizados tres grupos focales, cuyas sesiones se llevaron a cabo en el entorno de la Universidad, con el objeto de discutir las habilidades de pensamiento crítico enumerados por los discentes en la realización del proceso diagnóstico en enfermería. El análisis de los datos utilizo la estadística descriptiva para identificar las frecuencias de las habilidades de pensamiento crítico elegidas por los discentes y, luego, por el análisis de contenido propuesto por Bardin, a partir de los informes originados de los grupos focales. El referencial de evaluación de teorías de Meleis fue el guia del proceso de análisis y discusión de las características del modelo teórico em la práctica clínica y guió la definición de dos categorías, según los passos propuestos por Meleis, a saber: la descripción y la prueba de la utilidad. La descripción del Modelo Teórico del Pensamiento Crítico en el Proceso Diagnóstico en Enfermería identifico los componentes estructurales del modelo, a saber: proposiciones, descriptas en dos afirmaciones de la autora del modelo y conceptos, representados por las habilidades de pensamiento crítico y por los conceptos centrales del proceso diagnóstico enenfermería. La prueba de la utilidade del Modelo Teórico del Pensamiento Crítico en el Proceso de Diagnóstico en Enfermería se llevó a cabo a partir de su aplicación en la práctica clínica y, también, por la realización de três sesiones de grupo focal, momentos en que las habilidades de pensamiento crítico fueron discutidas y aclaradas por los discentes, quienes confirmaron estas habilidades como elementos estructurales del modelo teórico en análisis. Encuanto a la estrutura del modelo teórico, tres discentes sugirieron la inclusión de la habilidad de razonamiento lógico en la etapa de recolección de datos; hubo un reconocimiento desde todos los discentes en relación com las demás habilidades de pensamiento crítico que, en el modelo en análisis, presentan elementos explicativos del proceso diagnóstico en enfermería. El Modelo Teórico del Pensamiento Crítico en el Proceso Diagnóstico en Enfermería obtuvo la validación como un modelo teórico para uso en la enseñanza teórica y práctica de Enfermería. Los discentes consideraron que la utilización de este modelo teórico ayudará a minimizar la fragmentación de la enseñanza del proceso diagnóstico en enfermería, percibida como una dificultad del proceso de formación y que influye en la enseñanza y en el aprendizaje de la exactitud de los diagnósticos de enfermería.

O Processo Diagnóstico em Enfermagem (PDE) consiste na coleta, interpretação e agrupamento de informações para levantar hipóteses diagnósticas. Tomar decisões quanto ao Diagnóstico de Enfermagem (DE) envolve habilidades de Pensamento Crítico (PC). O objetivo deste estudo foi propor um modelo teórico de PC no PDE cujos objetivos específicos foram identificar habilidades de PC no PDE; definir essas habilidades; relacioná-las ao PDE e construir um modelo teórico de PC no PDE. Tratou-se de estudo exploratório descritivo com abordagem qualitativa realizado na Universidade Federal da Paraíba campus João Pessoa. Foram selecionados sete discentes que aceitassem participar do estudo através da assinatura do Termo de Consentimento Livre e Esclarecido; estivessem cursando 9º semestre da Graduação em Enfermagem e realizando atividades teórico-práticas no Hospital Universitário Lauro Wanderley (HULW). Apresentou-se um caso clínico para identificação do DE prioritário e de habilidades de PC com justificativas. Realizou-se análise descritiva e de conteúdo desses dados para identificar categorias temáticas que orientaram três sessões de grupo focal que foram gravadas em áudio e transcritas para realizar análise de conteúdo. O projeto de pesquisa foi avaliado pelo Comitê de Ética em Pesquisa do HULW, recebendo parecer favorável. As habilidades de PC identificadas no PDE foram ANÁLISE, CONHECIMENTO TÉCNICO-CIENTÍFICO, RACIOCÍNIO LÓGICO, EXPERIÊNCIA CLÍNICA, CONHECIMENTO SOBRE O PACIENTE, DISCERNIMENTO, APLICAÇÃO DE PADRÕES e PERSPECTIVA CONTEXTUAL. Essas habilidades foram definidas assim: ANÁLISE é investigação e avaliação de aspectos biopsicossociais para compreensão de uma situação holisticamente; CONHECIMENTO TÉCNICO-CIENTÍFICO envolve conhecimento específico de enfermagem e da literatura; RACIOCÍNIO LÓGICO remete à percepção imediata de uma situação, agrupamento e relação entre dados; EXPERIÊNCIA CLÍNICA é a atuação do enfermeiro em casos clínicos semelhantes; CONHECIMENTO SOBRE O PACIENTE é o conhecimento de aspectos físicos, emocionais, sociais e espirituais do paciente; DISCERNIMENTO é a capacidade de julgamento de dados para tomada de decisão; APLICAÇÃO DE PADRÕES é a identificação, avaliação e agrupamento de dados com base em informações da literatura e PERSPECTIVA CONTEXTUAL é a visão de uma situação clínica como um todo. Assim, construiu-se um modelo teórico de PC no PDE. Nesse modelo, o CONHECIMENTO TÉCNICO-CIENTÍFICO é associado à EXPERIÊNCIA CLÍNICA dando sustenção teórico-prática ao PDE. A COLETA DE DADOS requer ANÁLISE, APLICAÇÃO DE PADRÕES, CONHECIMENTO SOBRE O PACIENTE e PERSPECTIVA CONTEXTUAL. A COLETA é seguida da INTERPRETAÇÃO e AGRUPAMENTO DE DADOS num processo contínuo de ANÁLISE e APLICAÇÃO DE PADRÕES associadas ao RACIOCÍNIO LÓGICO. Os problemas de saúde são conhecidos, gerando HIPÓTESES DIAGNÓSTICAS a serem julgadas com RACIOCÍNIO LÓGICO e DISCERNIMENTO. Nesse momento, toma-se a decisão quanto ao DE PRIORITÁRIO. O modelo teórico mostrou a complexidade do PDE com base nas habilidades de PC de discentes de enfermagem ao tomar decisões clínicas. Compreende-se que, ao utilizar essas habilidades, há possibilidade de tomar decisões adequadas quanto ao DE prioritário. Com base nesse modelo, é possível pensar em estratégias de PC a serem aplicadas, tanto no ensino como na prática clínica, para facilitar a operacionalização do PDE.<br>The Nursing Diagnostic Process (NDP) is the collection, collation and interpretation of information to raise diagnostic hypotheses. Make decisions regarding Nursing Diagnosis (ND) involves Critical Thinking skills (CT). The objective of this study was to propose a theoretical model of CT in NDP whose specific objectives were to identify CT skills in NDP; define these skills; relate them to the NDP and build a theoretical model of CT in NDP. It was descriptive exploratory study with qualitative approach held at the Universidad Federal of Paraíba campus João Pessoa. Seven students were selected that would participate in the study through the signing of the free and informed consent; they were attending the 9th semester of nursing graduate theoretical-practice activities and performing at the Hospital University Lauro Wanderley (HULW). Performed a clinical case identification ND priority and CT skills with justifications. Descriptive analysis was held and the content of these data to identify themes that have guided three focus group sessions that were recorded in audio and transcribed to perform content analysis. The research project was evaluated by the Committee of ethics in research of HULW, receiving a favorable opinion. CT skills identified in NDP were SCIENTIFIC and TECHNICAL KNOWLEDGE, ANALYSIS, LOGICAL REASONING, CLINICAL EXPERIENCE, KNOWLEDGE ON THE PATIENT, DISCERNMENT, APPLYING PATTERNS and CONTEXTUAL PERSPECTIVE. These skills have been defined thus: analysis is research and evaluation of biopsicossociais aspects for understanding of a situation holistically; Scientific-technical KNOWLEDGE involves specific knowledge of nursing and literature; LOGICAL REASONING refers to the immediate perception of a situation, grouping, and the relationship between data; CLINICAL EXPERIENCE is the role of the nurse in similar clinical cases; The KNOWLEDGE ON THE PATIENT is the knowledge of physical, emotional, social, and spiritual of the patient; Discernment is the judgment of data for decision-making; APPLICATION of STANDARDS is the identification, evaluation and data grouping based on literature information and CONTEXTUAL PERSPECTIVE is the vision of a clinical situation as a whole. Thus, built a theoretical model of CT in NDP. In this model, the scientific-technical KNOWLEDGE is associated with CLINICAL EXPERIENCE giving theoretical-practice to sustaining NDP. Data collection requires analysis, APPLICATION of standards, KNOWLEDGE ON THE PATIENT and CONTEXTUAL PERSPECTIVE. The collection is followed by INTERPRETATION and GROUPING DATA in a continuous process of analysis and APPLICATION of STANDARDS associated with the LOGICAL REASONING. Health problems are known, generating DIAGNOSTIC HYPOTHESES to be judged with LOGICAL REASONING and DISCERNMENT. At that time, the decision as ND priority. The theoretical model showed the complexity of the NDP based on the skills of nursing students CT to take clinical decisions. It is understood that, when using these abilities, there is possibility of taking appropriate decisions and priorities. Based on this template, you can think of CT strategies to be applied, both in teaching and clinical practice, to facilitate the operationalization of the NDP.<br>El proceso diagnóstico en enfermería (PDE) consiste en la recogida, interpretación y agrupamiento de informaciones para levantar las hipótesis diagnósticas. Tomar decisiones en cuanto al diagnóstico de enfermería (DE) envuelve habilidades de pensamiento crítico (PC). El objetivo de este estudio fue proponer un modelo teórico de PC en el PDE cuyos objetivos específicos fueron identificar habilidades de PC en el PDE; definir esas habilidades; relacionarlas al PDE y construir un modelo teórico de PC en el PDE. Se trató de un estudio exploratorio descriptivo con abordaje cualitativo realizado en la Universidade Federal da Paraíba, campus João Pessoa, Paraíba, Brasil. Fueron seleccionados siete discentes que aceptasen participar en el estudio por medio de la firma del Término de Consentimiento Libre y Esclarecido; estuviesen cursando el 9º semestre de la Graduación en Enfermería; y realizasen actividades teórico-prácticas en el Hospital Universitário Lauro Wanderley (HULW). Se presentó un caso clínico para identificación del DE prioritario y de habilidades de PC con justificativas. Se realizó análisis descriptiva y de contenido de eses datos para identificar categorías temáticas que orientaron tres sesiones del grupo focal, que fueron grabadas en audio y transcritas para realizar análisis de contenido. El proyecto de investigación fue evaluado por el Comité de Ética en Investigación del HULW y obtuvo su opinión favorable. Las habilidades de PC identificadas en el PDE fueron análisis, conocimiento técnico-científico, raciocinio lógico, experiencia clínica, conocimiento en el paciente, discernimiento, aplicación de patrones y perspectiva contextual. Esas habilidades fueron definidas así: análisis es investigación y evaluación de aspectos biopsicossociales para comprensión holística de una situación; conocimiento técnico-científico envuelve conocimiento específico de enfermería y de la literatura; raciocinio lógico remite a la percepción inmediata de una situación, agrupamiento y relación entre datos; experiencia clínica es la actuación del enfermero en casos clínicos semejantes; conocimiento en el paciente es el conocimiento de aspectos físicos, emocionales, sociales y espirituales del paciente; discernimiento es la capacidad de juzgamiento de datos para tomada de decisión; aplicación de patrones es la identificación, evaluación y agrupamiento de datos con base en informaciones de la literatura; y perspectiva contextual es la visión de una situación clínica como un todo. Así, se construyó un modelo teórico de PC en el PDE. En ese modelo, el conocimiento técnico-científico es asociado a la experiencia clínica, dando sustentación teórico-práctica al PDE. La recogida de datos requiere análisis, aplicación de patrones, conocimiento en el paciente y perspectiva contextual. La recogida es seguida de la interpretación y agrupamiento de datos en un proceso continuo de análisis y aplicación de patrones asociado al raciocinio lógico. Los problemas de salud son conocidos, generando hipótesis diagnósticas que serán juzgadas con raciocinio lógico y discernimiento. En ese momento, se toma la decisión en cuanto al DE prioritario. El modelo teórico mostró la complejidad del PDE con base en las habilidades de PC de discentes de Enfermería al tomar decisiones clínicas. Se comprende que, al utilizar esas habilidades, hay posibilidad de tomar decisiones adecuadas en cuanto al DE prioritario. Con base en ese modelo, es posible pensar en estrategias de PC que serán aplicadas, tanto en la enseñanza como en la práctica clínica, para facilitar la operacionalización del PDE.

AbstractTheories of medical diagnosis have been debated since at least the early eighteenth century. They were closely linked to different understandings of health and disease. In general, naturalistic and ontological understandings were confronted with nominalistic and constructivist interpretations of signs and symptoms. The foundations of today’s understanding of diagnosis were laid in the nineteenth century, which brought new ideas about the differentiation of individual diseases. The article reconstructs this development of concepts of medical diagnosis and discussions about the production of diagnostic signs. It then presents two approaches from the 1920s that attempted to reconcile nominalism and essentialism. The focus is on the approaches of the physicians Richard Koch and Francis Crookshank. Their concepts are compared and linked to Hans Vaihinger’s As-If philosophy, which was very prominent at the beginning of the twentieth century. The paper argues that Koch, in particular, sought to give an intentional and relational orientation to the idea of diagnosis, seeing nature and culture in diagnosis not as opposites but as interrelated elements, and that Koch’s and Vaihinger’s approaches still offer much insight into contemporary thinking about the theory of diagnosis.

Abstract The continuous improvements in the Oil&amp;Gas Industry to deal with reliability and maintainability objectives, higher operational reliability, improved safety, and emergency readiness for potential risk of unexpected events have led the Offshore Companies to be in the forefront of development of design and analysis methodology for integrity assessment and safety operation. The architecture of an integrated model targeting the major residual risks to the asset, new generations of internal and external inspection techniques, real-time monitoring sensors, material degradation prediction related to the actual and future operational conditions and machine learning methods are, as identified from the experiences of the authors, the new frontiers for the Pipeline Integrity Management. The advance in automation process to build pipeline digital twin, looking at new predictive and diagnosis tool by advanced FE models allows not only thinking defensively but also in taking an aggressive position toward safety and asset optimization. Plenty of attention was devoted to the 40 years of pipeline integrity assessment through which the engineering assessment takes advantage from inspection and operational data. Suite of services for an integrated solution including ad-hoc engineering and repair system readiness have been identified as the main pillars for best-in-class Operators. Case histories and integrated solution to ensure satisfactory performance and safety have been presented.

The article presents the content of the technology of development of positive thinking, optimism, which has a diagnostic, motivational, informational, educational, developmental, resource, regulatory, prognostic function. Keywords: positive thinking, optimism, technology.

Abstract Well operators often face various technical challenges when intervening and repairing older, mature field wells. The most common problem associated with aging wells are tubing and casing integrity. Uncertain sources of downhole leaks and data ambiguity often lead to incorrect diagnostics that can hinder repair work or even contribute to additional or worsened integrity issues. Operators continuously challenge service companies and technology providers to drive innovation. One such challenge is in finding efficient and comprehensive integrity diagnostics for dual-string wells. A basic and general diagnostic method to verify well integrity in dual-string wells involves setting plugs in the long and short strings and pressure testing the tubings. These operations are generally time consuming, and the test data does not usually pinpoint the location of the leak, if any. Since 2016 a new diagnostic solution for this challenge has been implemented using a slickline-deployed passive acoustic logging technique. Carefully designed intervention planning, combined with efficient data acquisition, led to significant time saving and improved data quality. A more complete assessment of the integrity of both strings is now more frequent and often necessary, while challenging the conventional thinking of having to assess the lower string only while assuming the upper string is in good condition. However, investigating dual-string integrity with uncertainty on the source of leak, restrictions on facilities and limitations on surveillance time will often waste more time and money if not approached carefully. This paper discusses two case studies, including a dual-string oil producer in the South China Sea that had sustained pressure in production casing annulus. The well operator initially considered that the long string had an integrity issue, while the short string did not, based on their surface-based annulus pressure diagnostics. Consequently, the operator decided to diagnose only the long string. The passive acoustic memory tool. combined with a fast-response temperature and spinner used for the diagnosis, identified a possible short string leak while logging through the long string. This result clearly demonstrated that surface analyses can be misleading, and a comprehensive downhole diagnostic should be the recommended method to identify leaks, especially in dual-string completions. This well operator has completed more than 100 integrity diagnostic runs in the last five years. The passive acoustic diagnostic interventions have resulted in an average 50-percent time saving compared to legacy methods, and data analysis results have led to significant improvements in well productivity.

While conventional interventions and evaluations address the symptoms of the learning crisis, there is growing acknowledgement that widespread and sustained learning improvements will require systems approaches that diagnose and address the root causes of low learning. This paper presents and applies three methods to evaluate education systems and inform how to improve system coherence for learning. First, we use learning trajectories to evaluate the dynamics of children’s learning in 22 low- and middle-income countries. Second, we present a set of principles called the ALIGNS principles and show how they can be used to evaluate and improve alignment of curricula, assessments, and teacher support and instruction. Finally, we present a systems diagnostic framework and apply it to a program in South Africa, showing how the program takes a systems approach to improve learning. These tools help concretize systems thinking and bring insights to bear on the design and evaluation of policies and programs intended to improve learning.

This study aims to identify the main critical misalignments and inconsistencies nested in the Ecuadorian education system, which inhibit and limit its capacity to transform efforts, resources, and reforms into better learning outcomes for all students. To do so, it uses an innovative methodology developed by the RISE (Research on Improving Systems of Education) programme based on a 'Systems Thinking' perspective. This approach allows the analysis of key actors, their incentives, and interactions, to assess the overall alignment of the system and the existence of barriers that might prevent the system transitioning towards better learning outcomes. This study is based mainly on qualitative methods and information collected in the field through interviews, focus groups and surveys held in the first semester of 2022 in three cities in Ecuador: Quito, Tena, and Guayaquil. In total, more than 50 stakeholders from different regions and levels of the education system actively participated in this effort, targeted towards the identification and discussion of the inconsistencies and critical issues described in this study. The report has five sections that offer a detailed account of the implementation of the RISE diagnostic framework in the Ecuadorian educational system.

The scientific article deals with the analysis of peculiarities of the use of innovative AR/VR technologies in the process of developing future special- ists’ stress resistance. Based on the analysis of the introduction of AR/VR tech- nologies in the context of the implementation of a competency-based approach to higher education; modern studies on the impact of augmented reality on the emotional states and physiological features of a person in a stressful situation, the experience of cooperation of students and teachers at the Laboratory of Psy- chophysiological Research and STEAM-Laboratory has been described. Within the framework of the corresponding concept of cooperation, an integrative ap- proach to the process of personality’s stress resistance development has been designed and implemented. It is based on the complex combination of tradition- al psycho-diagnostic and training technologies with innovative AR/VR technol- ogies. According to the results it has been revealed that the implementation of a psycho-correction program with elements of AR technologies has promoted an increase of the level of personality’s emotional stability and stress resistance. The level of future specialists’ situational and personal anxiety has decreased; the level of insecurity, inferiority, anxiety about work, sensitivity to failures has also decreased; the level of flexibility of thinking and behavior, ability to switch from one type of activity to another one has increased; general level of person- ality’s adaptive abilities has also increased. The perspectives of further research include the analysis of the impact of AR/VR technologies on the future profes- sionals’ psychological characteristics in order to optimize the process of im- plementing a learner-centered approach into the system of higher education.

A “systems thinking” (ST) approach generally recognises that international development processes are complex, inter-related, non-linear, and constantly changing. They involve many different types of actors, all with different levels of power. ST change methods try to mirror these qualities, and move away from more conventional project design and implementation that use simple linear input-output-impact project logic. Thus, this rapid literature review seeks to find out what are some examples of ‘systems thinking’ projects in international development. The aim of this rapid review is to provide concrete examples of how ST shows up in the project design and management processes that are typically used by people working in the international development sector. These include project management arrangements, evaluation indicators, results frameworks, budget allocations and procurement, country diagnostics, and the foundational analysis that informs project design. The examples found were mostly extracted from donor project documents. Different definitions of ST may emphasise different elements. An attempt was made to find a range of projects from different sectors, and to go beyond projects that exemplified “Market Systems Development” and “Adaptive Management,” for which there are already repositories of project examples (see Further Resources).The inclusion of the projects in this review does not imply that they were successful, only that they contain some evidence of ST in them. Most of the projects identified have a further library of documents, including evaluations, that give more detailed information about their successes and failures.

This paper reviews the 2011 Sector Strategy on Institutions for Growth and Social Welfare (SIGS) of the Inter-American Development Bank (IDB, or Bank). The Strategy was produced as a requirement of the IDB-9 agreement. The review finds that the Strategy replicates a number of patterns observed in prior sector strategies. SIGS represents the first time that the Bank uses a modern definition of institutions; however, the concept of institutions is not incorporated as a guiding principle for setting priorities. Like other strategies, SIGS largely reflects the current work of the Bank, and also reflects the most common ideas and thinking of the time. This said, SIGS also emphasizes areas of work that had not been central to the Bank before, such as work with transparency and work in formalizing firms. The Strategy document itself has strengths but also a number of deficiencies. SIGS is more specific than prior strategies, although it still proposes quite a broad spectrum of activities. It contains a good diagnostic of the needs facing small and medium-sized enterprises and of innovation, although diagnostics in most other areas are relatively weak. Although SIGS maintains the IDB-9's focus on the Bank's comparative advantage, it does not analytically assess that comparative advantage, and it presents no evidence that the sectors prioritized reflect any particular operational or structural advantage of the Bank--except that they mostly represent sectors in which the Bank already works. SIGS's results framework is very poor, largely reflecting the inadequacies of the IDB-9 results framework, as applied to institutions. SIGS was not designed as an operational strategy, so it does not assess the Bank's operational capabilities to respond to the Region's needs in priority areas. SIGS has had little impact on the way the Bank works. Bank staff is generally unaware of the Strategy, and those who are aware of it do not report using it as a main input in country dialogue or project preparation. The Institutions for Development Department (IFD) is an exception: its staff do report using SIGS. However, the review of IFD's portfolio does not show clear evidence that project selection has changed in favor of SIGS priorities. IFD has produced a significant body of analytical work, which in some cases addresses institutional issues. Nonetheless, IFD's approach to implementing 'intersector alliances' has not included directly working across Bank departments to strengthen institutions broadly in the Bank's work. However, SIGS has served a useful purpose as a mechanism to reemphasize the importance of the issue of institutions for the IDB, and, to some degree, to consolidate and demarcate the areas of work within IFD.

Our thinking around neurodevelopmental disorders is undergoing a period of rapid change. The traditional approach, endorsed by classification systems such as the Diagnostic Statistical Manual, defines neurodevelopmental disorders such as autism and attention-deficit hyperactivity disorder (ADHD) as distinct categories.

In clinical practice, there is mounting concern about the burden of SCAR in relation to novel biologics as well as the increasing cost of diagnosis and management. This consensus report provides unique insights and the latest thinking from renowned experts on this important topic. The skin is among the parts of the body most commonly affected by adverse drug reactions (ADRs). Cutaneous ADRs affect 2% to 3% of all hospitalized patients and have a wide spectrum of clinical manifestations, are caused by various medicinal products, and result from different pathophysiologic mechanisms. Hence, their diagnosis and management are challenging. However, approximately 0.1% to 1% of patients with medicinal product eruptions have serious ADRs which can lead to disabling sequelae and in some cases, fatalities. Although Severe Cutaneous Adverse Reactions (SCAR) are rare, they are a significant health challenge and hinder the safe and effective use of medicines. In short, they pose substantial hurdles to drug developers, medicines regulators and health professionals. SCAR include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and generalized bullous fixed drug eruptions (GBFDE). Premarketing randomized clinical trials have limited power to detect SCAR. There is also a lack of specific diagnostic tests for SCAR, which today, depend on subjective causality assessment methods. These factors highlight the urgent need for guidelines, including how to predict, prevent, detect and diagnose SCAR either during drug development or in the post-marketing phase.