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PubMedDate not supplied

"Reasonable efforts": toward implementation in permanency planning.

The "reasonable efforts" criterion for provision of services to the families of children in foster care and to the families of children at risk of entering foster care is designed to provide for external, and presumably more objective, monitoring by a court of the quantity and quality of these services. A standard of "reasonable effort" applicable to all cases in the two populations of concern is both impractical and probably unethical. Legally there must be a case-by-case determination of "reasonable efforts" that will weigh the unique elements of each case. It is hoped that the working guideline proposed here will provide a basis in child welfare practice for minimizing potentially great variations in court decisions. The guideline begins with a list of problems, verified via an adversarial review, as to why the child(ren) entered foster care or is at risk of doing so, followed by the establishment of the relevance of proffered services to those problems, followed by documentation of a sustained effort to facilitate the use of those services.

Child↗
PubMed1985

Reasons for patient referral to occupational therapy units by health care professionals.

This study sought to discover the main reasons four professional groups--physicians, nurses, physical therapists, and mental health professionals--referred patients to occupational therapy services. A total of 162 subjects completed a specially devised questionnaire listing various reasons for referral. Seven factors were uncovered representing reasons for referring patients. Significant differences were found among professional groups and among the type of institutional settings--psychiatric, geriatric, or physical care. Interpretation of the results revealed one main motivation for referring patients to occupational therapists involving the contributions in the psychological aspects of patient care. Another major motivation for referral was the medical contributions of occupational therapy in improving physical functions. Physical therapists differed considerably from the three other professional groups, tending to place greater emphasis on referral motives related to the latter approach.

Female↗
PubMed1985

[Reasons for inpatient admission to a psychiatric hospital and to a university clinic--a comparison].

The concrete reasons for a stationary admission in a psychiatric clinic and a psychiatric university hospital have been investigated. Evidential differences appeared at the age of the subjects and at the reasons for their admission: The psychiatric clinic admitted more agitated, desorientated, and intoxicated patients. More self-motivated addicts, calm persons suffering from delusions, and patients for diagnostic clarification, however, were admitted into the university clinic. Furthermore, the examination enabled to realize typical constellations between certain reasons for admission and the diagnoses. As to the duration of the treatment there were no important differences to ascertain between the two investigated clinics. Differences, however, were to realize when considering the duration of treatment according to the diagnoses.

Adult↗
PubMed2025

BiomedSQL: Text-to-SQL for Scientific Reasoning on Biomedical Knowledge Bases.

Biomedical researchers increasingly rely on large-scale structured databases for complex analytical tasks. However, current text-to-SQL systems often struggle to map qualitative scientific questions into executable SQL, particularly when implicit domain reasoning is required. We introduce BiomedSQL, the first benchmark explicitly designed to evaluate scientific reasoning in text-to-SQL generation over a real-world biomedical knowledge base. BiomedSQL comprises 68,000 question/SQL query/answer triples generated from templates and grounded in a harmonized BigQuery knowledge base that integrates gene-disease associations, causal inference from omics data, and drug approval records. Each question requires models to infer domain-specific criteria, such as genome-wide significance thresholds, effect directionality, or trial phase filtering, rather than rely on syntactic translation alone. We evaluate a range of open- and closed-source LLMs across prompting strategies and interaction paradigms. Our results reveal a substantial performance gap: GPT-o3-mini achieves 59.0% execution accuracy, while our custom multi-step agent, BMSQL, reaches 62.6%, both well below the expert baseline of 90.0%. BiomedSQL provides a new foundation for advancing text-to-SQL systems capable of supporting scientific discovery through robust reasoning over structured biomedical knowledge bases. Our dataset is publicly available at https://huggingface.co/datasets/NIH-CARD/BiomedSQL, and our code is open-source at https://github.com/NIH-CARD/biomedsql.

Journal Article↗
PubMed1978

Expressed reasons for the choice of a residency in family practice.

An analysis was conducted of expressed reasons for the choice of a family practice residency by prospective residents. The nature and frequency of reasons are presented. An attempt was also made to judge the importance of saliency of specific reasons expressed. The results are discussed in relation to past studies and future directions for the training of family physicians.

Career Choice↗
PubMed1981

Study of reasons for cessation of therapy with perhexiline maleate, sodium valproate and labetalol in the intensified adverse reaction reporting scheme.

A questionnaire was distributed to doctors requesting reasons for cessation of therapy in patients on three drugs being intensively monitored. Adverse events were given as the reason in 20 percent of patients stopping treatment with perhexiline, 15 percent with sodium valproate and 43 percent with labetalol. These adverse events are listed and compared with those reported spontaneously to the medical assessor for the same period. Deaths reported do not appear to be drug related. Enquiry concerning reasons for cessation of therapy would appear to be a useful adjunct to spontaneous reporting of adverse events for drugs being monitored intensively. The number of additional adverse events derived from the questionnaires approximately equalled those from spontaneous reporting.

Data Collection↗
PubMed1978

[Obligation to tolerance and reasonability of cataract extraction (author's transl)].

The reasonability of cataract extractions is mentioned with exposition of the interests of the insuring bodies and of the patient. We discuss individually the terms "medical treatment", "obligation to tolerance" and "reasonability". The surgical method and the general physical assessment of the patient earn special consideration for a "reasonable" cataract extraction. We also discuss the special situation of the surgeon.

Adult↗
PubMed1995

Children's gender-based reasoning about toys.

The goal of these studies was to investigate how preschool children use gender-based reasoning in making judgments about toy preferences for themselves and for others. In Studies 1 and 2, children (n = 22, n = 71) were shown unfamiliar, non-sex-typed toys and asked to rate how much they, other girls, and other boys would like each toy. As expected, children made gender-based inferences: "What I like, children of my sex will also like, and children of the other sex will not like." Study 3 was designed to assess how children use gender-based reasoning to make decisions about attractive and unattractive toys when they are given gender labels. Children (n = 91) were shown unfamiliar toys varying in attractiveness that were given explicit gender labels (e.g., "this is a toy girls really like") or no label. With a different experimenter (to avoid demand characteristics), children rated their own and others' liking of the toys. Children used gender labels to guide their own preferences and their expectations for others. Even with very attractive toys, children liked toys less if they were labeled as being for the other sex, and expected other girls and boys to do the same. The role of gender-based reasoning in cognitive theories of gender and on children's play preferences is discussed.

Child, Preschool↗
PubMedDate not supplied

Reasons why the dockers lost their fitness for work--a retrospective survey.

Evaluation of the reasons for loss of capability for performing heavy and very heavy loading operations was based on retrospective population examinations carried out in two loading sites in ports. Enrolled in the study were 701 people, their working period in port over 5 years (mean 18.9 +/- 6.1 years). The age of the examined averaged 42.4 +/- 11.3 years. In course of 6 years 32.4% of this group changed their work due to structural changes in port, 67.6% due to loss of health qualifications. In the evaluation of health reasons predominant were diseases of the peripheral nervous system, of musculoskeletal system and of connective tissue (22.4%). Second as to the incidence were chronic diseases of the respiratory system and upper respiratory tracts (17.8%), in that 6% of allergies and 1.3% tuberculosis. Next were diseases of the circulatory system (13.3%), out of 3.8% were hypertension and 4.7% heart ischaemic disease. Last position was occupied by diseases of the stomach and duodenum (7.1%) and posttraumatic states of the muscular and osseous system (4.3%). Changing of the working post for health reasons up to 30th year of age occurred in 6.8%, up to 40th year in 10.1% and to 50th year of life in 62.2% people examined. Change of the working post due to professional or educational promotion occurred chiefly below the age of 40.

Adult↗
PubMed1993

Protein secondary structure prediction using two-level case-based reasoning.

We have developed a two-level case-based reasoning architecture for predicting protein secondary structure. The central idea is to break the problem into two levels: first, reasoning at the object (protein) level, and using the global information from this level to focus on a more restricted problem space; second, decomposing objects into pieces (segments), and reasoning at the internal structures level; finally, synthesizing the pieces back to the objects. The architecture has been implemented and tested on a commonly used data set with 69.3% predictive accuracy. It was then tested on a new data set with 67.3% accuracy. Additional experiments were conducted to determine the effects of using different similarity matrices.

Amino Acid Sequence↗
PubMed1995

A psychiatric diagnostic system integrating probabilistic and categorical reasoning.

We describe a diagnostic support system for clinical psychiatry and its evaluation results. The system has two inter-related components: a rule-based reasoning part associated with uncertainty, and a deterministic part, that uses heuristics to perform categorical reasoning. The system includes the 30 groups of psychiatric diagnoses which are classified under the categories 290 to 319 of the DSM-III-R and the ICD-9. There are, in fact, 1508 rules relating 208 clinical findings with 257 diagnoses. The reasoning strategy is based on selecting and differentiating diagnostic categories in a hierarchical classification tree. The system is intended to be used for education of medical students, and to help non-specialist clinicians, residents in psychiatry, or experts with few years of experience in decision making. We tested the diagnostic performance of the system using case reports extracted from a specialized journal. In 52.8% of the cases, the correct diagnosis was ranked as the first hypothesis using only the rule-based part. In combination with the deterministic strategy, the correct diagnosis could be made for 73.6% of the analyzed cases.

Artificial Intelligence↗
PubMed1995

[Physiopathological reasoning in the clinical diagnosis].

It is generally acknowledged that the causal approach is used very seldom and only in the late stages of the diagnostic process, when hypotheses are refined and verified. The hypotheses generation is supposed to take place in the very first stage of the medical process, and the approach most frequently used is the probabilistic one. It is also believed that owing to its explanatory function, causal reasoning should be used only--and only sparingly--when solving intricate metabolic and endocrinological cases. The Authors refute this restrictive view of the causal approach's field of application, and examine the reasons that prevent its broader use, especially in the range of such pathologies. Amongst such reasons, the Authors highlight some present didactic trends: namely the fact that the basic teachings--which are also the necessary premise to the causal approach--are given too early, in the early years of the University syllabus, and remain therefore cut off from the actual medical teaching. On the basis of this analysis some alternative didactic methods are put forward.

Algorithms↗
PubMed1994

The influence of experience on community health nurses' use of the similarity heuristic in diagnostic reasoning.

This study explored the diagnostic reasoning of community health nurses, examining the association between nursing experience and use of the cognitive heuristic similarity. Two types of similarity reasoning were examined, similarity to a single prototype (SSP) and similarity to a population prototype (SPP). The hypothesis of the study, derived from heuristics theory and ACT theory predicted that experts would be more likely to make diagnoses by similarity assessment than less experienced nurses. A random sample of 214 community health nurses was studied. Each subject completed eight diagnostic problems included in the Clinical Inference Questionnaire (CIQ) that was developed for this study to measure judging by similarity. Most of the nurses in this study, regardless of experience, used similarity assessment as a basis for some diagnoses. Experts were more likely than less experienced nurses to judge by similarity in population prototype problems but not in single prototype problems. These findings suggest that the diagnostic process includes similarity reasoning and imply that this process cannot be well understood without further exploration of the role of cognitive heuristics.

Cognition↗
PubMed1994

The impact of a dental ethics curriculum on moral reasoning.

This study explored the effects of problem-oriented dental ethics curriculum, consisting of 39 contact hours distributed over four years on moral reasoning development and on attitudes about the value of instruction. Students (n = 720) in the classes of 1985 through 1992 participated in the required curriculum and completed, as freshman and seniors, the Defining Issues Test (DIT), a well-validated test of moral reasoning. In addition, students responded to open-ended questions about the value of ethics instruction. Cross-sectional comparison of the eight classes of entering freshman with two classes of third quarter juniors (n = 265) who completed the DIT prior to implementing the ethic curriculum indicated that the dental curriculum offered prior to 1981 had little influence on moral reasoning. Pre- to posttest DIT comparisons for seven of the eight classes of instructed students indicated statistically significant improvement. Comparison of the effect sizes (Cohen's d) of our intervention with the average effect size reported in a meta analysis of effective interventions indicates that results cannot be attributed to student maturation alone. Analysis of individual change patterns suggest that the success occurred despite a higher than average (17 percent vs. 6 percent) number of students who showed regression from pre- to posttest. Substantive explanations (gender, motivation, regression to the mean) did not appear to account for the change patterns, but theoretical explanations, based on observations in other settings, offer insights for further research and curriculum development. In conclusion, the results indicate that students not only benefit from ethics instruction, but value it.

Adult↗
PubMed1994

[Internal coherence of reasoning in a psychiatric patients group].

This experimental work was aimed at evaluating the internal coherence of reasoning. Several inferential structures of premises have been also typified so that the relationship likely to be established among these variables, and the specific characteristics of the samples involved could be assessed. Population included 50 psychiatric patients, and 50 sound control subjects. Both samples were administered Lopez-Alonso's Test of Reasoning Coherence. From such evaluations, total scores of logical incoherence mistakes as well as inferential structures of premises have been extracted. Results suggest that the psychiatric patients sample lacks a good control on the cognitive reversibility, hence adhering to more atypical structures based on reductionist criteria that give rise to a large number of mistakes coupled to a much more incoherent, and disorganized reasoning pattern.

Adult↗
PubMed1994

Postformal reasoning during adolescence and young adulthood: the influence of problem relevancy.

The effect of perception of problem relevancy on postformal reasoning performance of two groups of adolescents (13 to 16 years and 17 to 19 years) and one group of young adults (20 to 29 years) was examined. Problems known to reflect issues and situations relevant to adolescents, adults, and older adults were presented to 105 subjects. The three age groups did differ with respect to their perception of problem relevancy. Further, perceived relevancy appeared to disrupt postformal reasoning among the youngest group of adolescents while facilitating performance among the young adults. These results are discussed in relation to previous findings by Blanchard-Fields (1986) and theoretical positions postulating the development of postformal reasoning. Implications for effective counseling of adolescents are considered.

Adolescent↗
PubMedDate not supplied

HIV seroprevalence and reasons for refusing and accepting HIV testing.

BACKGROUND AND OBJECTIVES: We sought to evaluate the HIV seropositivity of patients who refused or accepted human immunodeficiency virus (HIV) testing in a South Carolina sexually transmitted diseases (STD) clinic, and the patients' reasons for refusing or accepting testing. STUDY DESIGN: A serologic and self-administered survey done Jan. 9 through June 1, 1989. For those who refused HIV testing, a routine syphilis serology sample was tested blindly for HIV. RESULTS: Of 1,929 patients in the study, 398 (21%) refused HIV testing. HIV test refusers were 2.2 times more likely to be HIV antibody positive than HIV test acceptors (3.0% versus 1.4%, prevalence ratio = 2.2, CI95 1.1-4.4), with this difference mainly occurring among males. Seven of eight patients reporting that they refused testing because they were HIV positive were found to be HIV negative. The principal reason indicated for test refusal was not feeling at risk for HIV infection. The principal reasons indicated for test acceptance were wanting to know the results for their own health status and wishing to prevent spread of the virus to partners. CONCLUSION: We conclude that: (1) a higher seropositivity exists among HIV test refusers than acceptors; (2) patient reporting HIV seropositivity should be viewed with caution; (3) many STD patients deny their risk for HIV; and (4) STD patients are concerned about transmission of HIV to their partners.

Adolescent↗
PubMed1996

Reasons that patients do not return for appointments in the initial phase of treatment of temporomandibular disorders.

Patients suffering form pain and dysfunction in the temporomandibular region sometimes ignore appointments after the initial examination. This from of noncompliance is well known and is often studied in patients suffering from recurrent headaches, arthritis, and lower back pain. Information on patients with temporomandibular disorders (TMD) who fail to attend the next visits and do not comply with the proposed treatment is scare. To 61 patients (aged 20 to 40 years) who did not attend the next visit after an initial examination and after discussing the treatment protocol, a questionnaire was mailed 6 months to 1 year after the first visit. The questions related to reasons for not attending and the possible treatment received. Some questions were also related to the present TMD state. The clinical profiles of the nonattenders were compared to those of a group of 400 TMD patients who did finish the proposed treatment (positive control). The nonattenders had more pain and dysfunction at initial examination than did the treated patients. The treated patients reported a shorter duration of symptoms before seeking treatment than did the nonattenders suggesting that the latter group had a more chronic pain state. The main reason for not returning was that symptoms improved enough or disappeared completely and spontaneously without the proposed treatment. Sixteen patients did not return for further treatment for reasons linked to the dentist-patient relationship. Fifty-seven percent of the nonattenders reported to be symptom free or sufficiently improved. One year after the initial examination and without the proposed treatment, most still had some symptoms such as clicking (59%) and reduced mouth opening (21%), but only 24% reported to be in need of treatment.

Chi-Square Distribution↗