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If a 'disruptive' innovation in medical (or other) technology is developed, it may be difficult to test this ethically in an RCT if it becomes 'obvious' that the control subjects have poorer outcomes—either due to other foregoing testing, or within the initial phase of the RCT itself. Ethically it may be necessary to abort the RCT prematurely, and getting ethics approval (and patient agreement) to withhold the innovation from the control group in future RCT's may not be feasible.

Historical control trials (HCT) exploit the data of previous RCTs to reduce the sample size; however, these approaches are controversial in the scientific community and must be handled with care. [94]

Due to the recent emergence of RCTs in social science, the use of RCTs in social sciences is a contested issue. Some writers from a medical or health background have argued that existing research in a range of social science disciplines lacks rigour, and should be improved by greater use of randomized control trials.

Researchers in transport science argue that public spending on programmes such as school travel plans could not be justified unless their efficacy is demonstrated by randomized controlled trials. Barbanera slipon loafers latest collections online quality free shipping cfUeb
Graham-Rowe and colleagues [96] reviewed 77 evaluations of transport interventions found in the literature, categorising them into 5 "quality levels". They concluded that most of the studies were of low quality and advocated the use of randomized controlled trials wherever possible in future transport research.

Dr. Steve Melia [97] took issue with these conclusions, arguing that claims about the advantages of RCTs, in establishing causality and avoiding bias, have been exaggerated. He proposed the following 8 criteria for the use of RCTs in contexts where interventions must change human behaviour to be effective :

The intervention:

And the causal mechanisms:

RCTs are currently being used by a number of international development experts to measure the impact of development interventions worldwide. Development economists at research organizations including Abdul Latif Jameel Poverty Action Lab (J-PAL) [98] low shipping cheap online outlet countdown package Del Carlo classic Derby shoes popular for sale cheapest price for sale clearance order Aa204i
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Take 2 was deemed better and used as the master take. On 17 June, an additional vocal track by McCartney and a string quartet were AFVandevorst colour block flatform sandals low price for sale lVwjyCkNOv
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Take 1, without the string overdub, was later released on the Anthology 2 compilation. On take 1, McCartney can be heard giving chord changes to Harrison before starting, but while Harrison does not appear to actually play, he was most certainly present because his voice is captured on the session tapes. Take 2 had two lines transposed from the first take: "There's a shadow hanging over me"/"I'm not half the man I used to be", [29] though it seems clear that their order in take 2 was the correct one, because McCartney can be heard, in take 1, suppressing a laugh at his mistake.

In 2006, just before the album was released, George Martin elaborated on the recording set-up of the song: [30]

Paul played his guitar and sang it live, a mic on the guitar and mic on the voice. But, of course, the voice comes on to the guitar mic and the guitar comes on to the voice mic. So there's leakage there. Then I said I'd do a string quartet. The musicians objected to playing with headphones, so I gave them Paul's voice and guitar on two speakers either side of their microphones. So there's leakage of Paul's guitar and voice on the string tracks.

The leakage of sound from one track to another was a concern when the surround version of the song was mixed for Love , but it was decided to include the track nevertheless. As Martin explained in the liner notes of Love : [31]

We agonised over the inclusion of "Yesterday" in the show. It is such a famous song, the icon of an era, but had it been heard too much? The story of the addition of the original string quartet is well known, however, few people know how limited the recording was technically, and so the case for not including it was strong, but how could we ignore such a marvellous work? We introduced it with some of Paul's guitar work from " Blackbird ", and hearing it now, I know it was right to include it. Its simplicity is so direct; it tugs at the heartstrings.

Concerning the debate on how the song should be released, Martin later said: "['Yesterday'] wasn't really a Beatles record and I discussed this with Brian Epstein : 'You know this is Paul's song... shall we call it Paul McCartney?' He said 'No, whatever we do we are not splitting up the Beatles.'" [32] Since "Yesterday" was unlike the Beatles' previous work and did not fit in with their image, the Beatles refused to permit the release of a single in the United Kingdom. This did not prevent Matt Monro from recording the first of many cover versions of "Yesterday". His version made it into the top ten in the UK charts soon after its release in the autumn of 1965. [26]

For dengue virus infection, it is now known that the cardiovascular involvement is mostly characterized by rhythm abnormalities (bradycardia), with no symptoms or complications. However, in moderate or severe cases where there was a cardiovascular affectation or complication, myocarditis has been an important issue. Myocarditis due to DENV infection may present several patterns such as “refractory shock”, “heart failure”, “arrhythmia”, etc and It would be important to consider this diagnosis. In the case of CHIKV infection and cardiac involvement, myocarditis should be also considered.

Cardiac compromise is not so common in isolated episodes; but countries where chikungunya virus is an epidemic should be alarmed and well informed about this condition. Physicians should be encouraged to keep divulgating reports on the cardiovascular involvement of chikungunya virus disease, to raise awareness and ultimately encourage suitable diagnosis and intervention worldwide. Questions are still raised about the real incidence, as every outbreak seems to follow a different pattern, but what is needed the most is further investigation on therapy for this specific condition and in different age groups.

A significant issue arises with the diagnosis of myocarditis by arboviruses such as DENV and CHIKV, because a myocardial biopsy or cardiac magnetic resonance imaging needs to be considered and performed. However, performing these, in tropical areas where these arboviruses are prevalent, is very hard and there are many restrictions. The management of myocarditis, regardless its etiology, should be focused in the therapeutics oriented to the agent (virus, bacteria, etc); the cardiovascular events support (controllling heart failure, cardiogenic shock, arrhythmia, etc) and the treatment of the inflammatory process. The last one is under discussion and needs more research, although in some severe cases due to DENV, the corticosteroids administration changed the evolution given their positive benefits.

CHIKV would induce not just cardiovascular compromise and cardiovascular manifestations during the acute phase, but also at subacute and chronic stages 43–56. Today it is known that compromise during chronic disease is not just limited to the rheumatological manifestations. Nevertheless, in CHIKV, the definition of systemic manifestation or extra-articular compromise has not well defined. But in the case of atypical conditions, this was defined by PAHO/WHO during the expert consultation meeting in Managua, Nicaragua, 2016, and later published by WHO 43 .

Limitations

Limitations will always be the sporadic nature of these cases, something we need to be prepared for in future outbreaks. Methodologically, it should also be considered that the inclusion of reviews may cause a bias, but in some cases, some would serve to locate some additional key articles useful for a novel topic such as the one of this systematic review. Additionally, many studies did not report detailed information about laboratory diagnoses (Troponin, BNP, CK-MB, etc), imaging studies (echocardiography, magnetic resonance), final diagnoses (myocarditis, etc), as well management (inotropics, corticosteroids, etc) and outcomes (survival, death). Additionally, articles published in French have been excluded. This could be a limitation as the largest series of cases and their complications came from France in relation to the outbreak on La Reunion Island, and many of these were published in French. Nevertheless, from these publications we did not identify, initially by the title or the abstract, any relating to cardiovascular complications.

Conclusions

Finally, these observations on DENV and CHIKV associated cardiovascular manifestations could be useful for management of Zika virus infections, which are currently causing epidemics in Latin America. Cardiovascular compromise has already been described and reported in fatal cases. In addition, cardiovascular complications might be underdiagnosed in clinical practice. Future research needs to focus on the potential cardiovascular complications of Zika virus infection, with prompt cardiovascular screening in suspected cases. Other emerging arboviruses such as Mayaro, Oropouche, Venezuelan Equine Encephalitis may be also causing cardiovascular compromise, or even be co-infecting. We are still learning about the multiple clinical implications of co-infection, including those affecting the cardiovascular system.

Author contributions

AJRM and ERV formulated the research questions, designed the study, developed the preliminary search strategy, and drafted the manuscript. ABM and MFA refined the search strategy by conducting iterative database queries and incorporating novel search terms. MFA and ABM searched and collected the articles. All authors critically reviewed the manuscript for important intellectual content. All authors have read and approved the final version of the manuscript.

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Supplementary material

Supplementary file 1: PRISMA checklist.

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Supplementary file 2: PRISMA flowchart showing the number of records identified, included and excluded.

Click here to access the data .

Faculty of Health, Universidad Industrial de Santander, Santander, Colombia Department of Internal Medicine, Universidad Industrial de Santander, Santander, Colombia Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia Colombian Collaborative Network on Zika and other Arboviruses (RECOLZIKA), Pereira, Risaralda, Colombia
Revised
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Alvarez MF, Bolívar-Mejía A, Rodriguez-Morales AJ and Ramirez-Vallejo E. Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review [version 2; referees: 2 approved, 1 approved with reservations] 2017, :390 (doi: best cheap online Paul Andrew pointed sling back pumps get authentic L8LA6txx
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Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
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Referee Report 12 六月 2017
Cecilia Perret , División de Pediatría, Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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New version has taken in account suggestions about limitations and they are mentioned now in this new version. However there are still some uncorrected elements mainly in results that are important to clarify. In table 1. Put in the title that the frequency of affectation of different organs corresponds to this particular report. It leads to confusion because the affectation of cardiovascular compromise in this table is very high, because of the selection bias of the information. Cardiovascular compromise in chikungunya infection is low. Following the methodology of systematic review there should be a table with the references, authors, years included, number of patients contributed, findings and outcomes. Mainly to differentiate it from the rest of the bibliography of this article and quick access to the information. In supplement 1, on PRISMA check list, the mentioned pages of appearance of the topic treated do not correspond to the page in the article. In results it appears as having done the study selection and study characteristics, however, the presentation is poor and there is not as complete as it is established in the check list. Supplement 2 flowchart, does not mention the reasons why certain articles were excluded.

Competing Interests: No competing interests were disclosed.

Employee behavior can have a big impact on information security in organizations. Cultural concepts can help different segments of the organization work effectively or work against effectiveness towards information security within an organization. "Exploring the Relationship between Organizational Culture and Information Security Culture" provides the following definition of information security culture: "ISC is the totality of patterns of behavior in an organization that contribute to the protection of information of all kinds." For sale online cheap sale genuine Jil Sander strappy flat sandals best online E150VsMgAY

Andersson and Reimers (2014) found that employees often do not see themselves as part of the organization Information Security "effort" and often take actions that ignore organizational information security best interests. [78] Research shows information security culture needs to be improved continuously. In Information Security Culture from Analysis to Change , authors commented, "It's a never ending process, a cycle of evaluation and change or maintenance." To manage the information security culture, five steps should be taken: pre-evaluation, strategic planning, operative planning, implementation, and post-evaluation. with paypal sale online buy cheap outlet store Blue Bird Shoes leather and cotton jacquard loafers nicekicks cheap 100% original ovvN3YL

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The US National Institute of Standards and Technology (NIST) is a non-regulatory federal agency within the U.S. Department of Commerce . The NIST Computer Security Division develops standards, metrics, tests and validation programs as well as publishes standards and guidelines to increase secure IT planning, implementation, management and operation. NIST is also the custodian of the U.S. Federal Information Processing Standard publications (FIPS).

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