Critical Appraisal

submissionThis essay will critically appraise a write up investigating the relationship in the midst of normalize intoxicantic beverage intake during pregnancy and risk of fetal death written by Andersen et al. (2012). This was a cohort consider that used the data from a sample of 91,843 Danish m new(prenominal)s. It was found that 55% of the cohort abstained all told during pregnancy, whilst the rest of the cohort reported consuming alcoholic beverageic drinks during this time. The authors reported that there was a substantially change magnitude risk of either spontaneous abortion or stillbirth in women who consumed even moderately broken in amounts of alcohol (2-3.5 drinks per week) before their 16th week of pregnancy. However, alcohol pulmonary tuberculosis after 16 weeks appeargond not to throw an effect.The introduction of this paper is extremely short, although it does manage to summarise why the get wind was conducted and the aim of the research is clear. The au thors bring out that earlier research into the effects of moderate alcohol outgo on foetal death shoot produced conflicting results and that there appear to be geographical trends in the outcome of such studies. Although a deficiency of conclusive evidence is a solid basis on which to conduct a new study, the authors do not explicitly detail why the accepted study will be any antithetical and how it will seek to overcome the limitations of previous research.The exact Appraisal Skills Progamme (CASP, www.casp-uk.net) recommends approaching critical appraisals using tercet steps. The get-go step is to task whether the study is valid by evaluating the methodological quality. The methodology of the current study is clformer(a) laid out and replicable. Despite this, one criticism of the methodology is the use of self-reported alcohol consumption data. Self-reported data is vulnerable to social desirability bias by which participants may withhold or pay certain behaviours in o rder to fit in to what separates expectations of them. genial desirability has been found to confound reports of different wellness related behaviours, such as diet (Klesges et al., 2004) and strong-arm activity (Adams et al., 2005). Using the levels of evidence hierarchy (Foster, 2011), cohort studies lay below systematic reviews and randomised control studies in their ability to avoid bias. Therefore, the studys design helps reduce the risk of other biases that could confound the results. The statistical analysis used was the luck ratio. This analysis calculates the ratio of the hazard rate corresponding to the two conditions of an explanatory variable (Spruance et al., 2004). In the current study, it was found that women who drank even just low levels of alcohol during pregnancy had higher hazard rates of former(a) foetal death than those women who abstained. This is a suitable statistical analysis that answers the research question at hand.The sulfur step in the CASP recomm endations for appraising evidence is to examine the results. It is important to consider how clinically important the results are and how much uncertainty surround them. Potentially, the current study has excellent clinical utility. Firstly, the sample size was full-size and as a result, the findings are homogeneously to be very representative of the population as a whole. There is some cultural bias to be aware of as the sample was collected exclusively from a Danish sample. Therefore, the results may not be generalisble to women in other countries. For example, in the UK, alcohol consumption has been found to be much higher, especially among females in their teen years (Mukherjee et al., 2005).The last step suggested by CASP is to assess whether the results are useful. The current results may certainly be useful in the area of health policy development. The knowledge that even low alcohol consumption within the first trimester of pregnancy basis increase the risk of foetal dea th strengthens current Government guidelines that recommend that women abstain completely from alcohol during pregnancy. In the United Kingdom, the Chief Medical Officer currently advises that women should avoid alcohol altogether however that if they must drink, to consume no more than 1-2 units once or twice a week. However, the current paper suggests that just two drinks per week could increase a womans risk of losing the baby. Nevertheless, the conclusions drawn by the study are based on the assumption that alcohol consumption contributed to the increased risk of foetal death and should be interpreted with caution. The study did not collect data on various other variables that may prepare contributed to the increased risk, such as illegal drug use during pregnancy has been associated with foetal death (Wolfe et al., 2005). Furthermore, consumption of large quantities of caffeine (Wisborg et al., 2003) has been found to be associated with a higher risk of early foetal death. Th e current study collected information on coffee consumption and it was found that 32.6% of women consumed between one and seven cups of coffee during their pregnancy. Therefore, coffee consumption and not just alcohol may have had an impact on the results. In the discussion, the authors acknowledge the large number of confounding variables that may have wedge upon the study. The discussion of the study does discuss the potential usefulness of the results. However, the authors state in the introduction that discrepancy amongst previous research was a driving force behind the study but fail to discuss why or how the current study may have alleviated this issue.In conclusion, this is a reasonably satisfying piece of research that could contribute considerably to health policy. However, it is flawed in some key areas and so the results should be interpreted with caution. For example, if the study is to be replicated, future researchers may consider additional outcome measures that cou ld mention participants at risk of social desirability bias. Nevertheless, the finding that even very low consumption of alcohol before the 16th week of pregnancy may contribute to early foetal death suggests that this should be further investigated as health policy may subsequently consider recommending women abstain completely from alcohol until after their 16th week.ReferencesAdams, S.A., Matthews, C.E., Ebbeling, C.B., Moore, C.G., Cunningham, J.E., Fulton, J. and Herbert, J.R. (2005) The effect of social desirability and social approval on self reports of physical activity. American journal of Epidemiology, 161(4), pp. 389-398.Andersen, A.N., Andersen, P.K., Olsen, J., Gronbaek, M. and Strandberg-Larsen, K. (2012) Moderate alcohol intake during pregnancy and risk of fetal death. International Journal of Epidemiology, 41, pp. 405-413.Foster, N. (2011) Making sense of the evidential hierarchy. In Carmen, A. (Ed), Assessing Evidence to Improve Population Health and Wellbeing. Exe ter Learning Matters Ltd.Klesges, L.M., Baranowski, T., Beech, B., Cullen, K., Murray, D.M., Rochon, J. and Pratt, C. (2004) Social desirability bias in self-reported dietary, physical activity and weight concerns measures in 8-to-10-year-old African-American girls results from the Girls health Enrichment Multisite Studies (GEMS). noise Medicine, 38, pp. 78-87.Mukherjee, R.A.S., Hollins, S., Abou-Saleh, M.T. and Turk, J. (2005) Low level alcohol consumption and the fetus. British Medical Journal, 330(7488), pp. 375-376.Spruance, L.S., Reid, J.E., Grace, M. and Samore, M. (2004) Hazard ratio in clinical trials. Antimicrobial Agents and Chemotherapy, 48(8), pp. 2787-2792.Wisborg, K., Kesmodel, U., Bech, B.H., Hedegaard, M. and Henriksen, T.B. (2003) Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life prospective study. British Medical Journal, 326, pp. 420.Wolfe, E.L., Davis, T., Guydish, J. and Delucchi, K.L. (2005) Mortality risk as sociated with perinatal drug and alcohol use in California. Journal of Perinatlogy, 25, pp. 93-100.Critical AppraisalCritical appraisal is the use of explicit, transparent methods to assess the data in published research, applying the rules of evidence to factors such as internal validity, adherence to reporting standards, conclusions and generalizability.12 Critical appraisal methods form a central part of the systematic review process.3 They are used in evidence-based health veneration training to assist clinical decision-making, and are increasingly used in evidence-based social care and education provision.when an entrepreneur is calculate about setting up in course it is important to think carefully about what is needed to make the idea a success, how the business will compete against other firms and how much money is needed to run it, these items would usually be included in a business plan. * The nature of the business it history and its legal structure* The product it offe rs, what make it different from anyone else, why customers would bribe it and how it is protected from the competition.* The nature of the market and the firms customer base .* The objectives of the business( set-out target that entrepreneur would like to achieve )* The strategy ( this set out how the objective is going to be achieved* Approach to marketing* The join and employee* The firms operations ( where it is based, the production facilities it requires, the capital it has)* A forecast of sale over a period in the future.Idea generation (ideation) is critical to the design and marketing of new products, to mar-keting strategy, and to the creation of potent advertising copy. In new product development, for example, idea generation is a key component of the preceding end of the process, often called the fuzzy front end and recognized as one of the highest leverage points for a firm (Dahan and Hauser 2001).Ideation is the creative process of generating, developing, and commun icating new ideas, where an idea is understood as a basal element of thought that can be either visual, concrete, or abstract.1 Ideation is all stages of a thought cycle, from innovation, to development, to actualization.2 As such, it is an essential part of the design process, both in education and practice.3