Pros and Cons of the Acceleration Scheme (NF-IDS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bogacz, Alex; Bogacz, Slawomir

The overall goal of the acceleration systems: large acceptance acceleration to 25 GeV and beam shaping can be accomplished by various fixed field accelerators at different stages. They involve three superconducting linacs: a single pass linear Pre-accelerator followed by a pair of multi-pass Recirculating Linear Accelerators (RLA) and finally a nonâ scaling FFAG ring. The present baseline acceleration scenario has been optimized to take maximum advantage of appropriate acceleration scheme at a given stage. Pros and cons of various stages are discussed here in detail. The solenoid based Pre-accelerator offers very large acceptance and facilitates correction of energy gain acrossmore » the bunch and significant longitudinal compression trough induced synchrotron motion. However, far off-crest acceleration reduces the effective acceleration gradient and adds complexity through the requirement of individual RF phase control for each cavity. Close proximity of strong solenoids and superc« less

Dental care protocol based on visual supports for children with autism spectrum disorders

PubMed Central

Mastroberardino, Stefano; Campus, Guglielmo; Olivari, Benedetta; Faggioli, Raffaella; Lenti, Carlo; Strohmenger, Laura

2015-01-01

Background Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments. Material and Methods 83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in order to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate. Results Seventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency (p=0.02; p=0.04; p=0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate (p<0.01). Conclusions The use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting. Key words:Autism spectrum disorders, behaviour management, paediatric dentistry, visual learning methods. PMID:26241453

Size acceptance as a grief process: observations from psychotherapy with lesbian feminists.

PubMed

Courtney, Jeanne

2008-01-01

Based on observations from my psychotherapy practice, I apply Kubler-Ross' five stages of grief (denial, anger, bargaining, depression, and acceptance) to the process a woman goes through when she learns about size acceptance and lets go of the unrealistic wish to make her body size conform to fat-phobic societal ideals of female beauty. Clients' presentations, therapeutic interventions, and countertransference are discussed for each stage. Lesbian feminists are likely to embrace size acceptance politics but may retain negative feelings about their own body size. In the bargaining stage, they may confound health concerns with body image issues, and it is important in their therapy to provide a holding environment that can tolerate ambivalence. My own depression stage was marked by countertransference that caused me to avoid the topic of body image with my clients. Therapists can help women in the size acceptance grief process by exploring their own evolving feelings about body image, bringing up the topic, and providing a non-judgmental holding environment.

Development of a School-Wide Behavior Program in a Public Middle School: An Illustration of Deployment-Focused Intervention Development, Stage 1

ERIC Educational Resources Information Center

Molina, Brooke S. G.; Smith, Bradley H.; Pelham, William E., Jr.

2005-01-01

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The…

Re-Evaluation of 6th Edition of AJCC Staging System for Nasopharyngeal Carcinoma and Proposed Improvement Based on Magnetic Resonance Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mao Yanping; Xie Fangyun; Liu Lizhi

2009-04-01

Purpose: To use magnetic resonance imaging to re-evaluate and improve the 6th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma. Methods and Materials: We performed a retrospective review of the data from 924 biopsy-proven nonmetastatic nasopharyngeal carcinoma cases. All patients had undergone magnetic resonance imaging examinations and received radiotherapy as their primary treatment. Results: The T classification, N classification, and stage group were independent predictors. No significant differences in the local failure hazards between adjacent T categories were observed between Stage T2b and T1, Stage T2b and T2a, and Stage T2b andmore » T3. Although the disease failure hazards for Stage T1 were similar to those for Stage T2a, those for Stage T2b were similar to those for Stage T3. Survival curves of the different T/N subsets showed a better segregation when Stage T2a was downstaged to T1, T2b and T3 were incorporated into T2, and the nodal greatest dimension was rejected. The disease failure hazard for T3N0-N1 subsets were similar to those of the T1-T2N1 subsets belonging to Stage II; the same result was found for the T4N0-N2 subsets in the sixth American Joint Committee on Cancer staging system. However, the staging system we propose shows more consistent hazards within the same stage group and better survival discrimination among T categories, N categories, and overall stages. Conclusion: Using the 6th American Joint Committee on Cancer staging system produces an acceptable distribution of patient numbers and segregation of survival curves among the different stage groups. The prognostic accuracy of the staging system could be improved by recategorizing the T, N, and group stage criteria.« less

Evaluation of Sixth Edition of AJCC Staging System for Nasopharyngeal Carcinoma and Proposed Improvement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu Mengzhong; Tang Linglong; Zong Jingfeng

2008-03-15

Purpose: To evaluate the 6th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma and to search for ways to improve the system. Methods and Materials: We performed a retrospective review of data from 749 biopsy-proven nonmetastatic nasopharyngeal carcinoma patients. All patients had undergone contrast-enhanced computed tomography and had received radiotherapy as their primary treatment. Results: The T stage, N stage, and stage group were significant, independent predictors for disease-specific death. No significant differences were found between Stage T2a and T1 in local failure-free survival or between Stage N3a and N2 in distantmore » failure-free survival. Survival curves of the different T/N subsets showed a better segregation when T2a and N3a were downstaged to T1 and N2, respectively. The hazard ratio of disease-specific deaths for patients with T2N0 disease was similar to that of patients with T1N0 disease; the same result was found for the T3N0 and T4N0 subsets. Downstaging the T2N0 subset to Stage I, T3N0 to Stage II, and T4N0 to Stage III resulted in a more balanced patient distribution, better hazard consistency among subgroups, and improved hazard discrimination between overall stages. Conclusion: Using the 6th edition of the American Joint Committee on Cancer staging system produced an acceptable distribution of patient numbers and segregation of survival curves among the different stage groups. The prognostic accuracy of the staging system could be improved by recategorization of the T, N, and group stage criteria.« less

The NEEDS Data Base Management and Archival Mass Memory System

NASA Technical Reports Server (NTRS)

Bailey, G. A.; Bryant, S. B.; Thomas, D. T.; Wagnon, F. W.

1980-01-01

A Data Base Management System and an Archival Mass Memory System are being developed that will have a 10 to the 12th bit on-line and a 10 to the 13th off-line storage capacity. The integrated system will accept packetized data from the data staging area at 50 Mbps, create a comprehensive directory, provide for file management, record the data, perform error detection and correction, accept user requests, retrieve the requested data files and provide the data to multiple users at a combined rate of 50 Mbps. Stored and replicated data files will have a bit error rate of less than 10 to the -9th even after ten years of storage. The integrated system will be demonstrated to prove the technology late in 1981.

Primary invasive squamous carcinoma of the vagina

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pride, G.L.; Schultz, A.E.; Chuprevich, T.W.

1979-02-01

Forty-three cases of primary vaginal squamous cell cancer were treated at the University of Wisconsin Hospital between 1956 and 1971. These cases comprised of 1.2% of patients admitted to the University Hospital with female genital tract cancer. Evidence is presented to support a modification of the currently accepted FIGO staging system for vaginal carcinoma (Stage II disease). Radiation therapy using both external beam and brachyradium equivalents or interstitial implantation of suitable isotopes was an effective method for the treatment of patients having early and locally advanced invasive vaginal cancer. The 5-year absolute survival rate for the entire series was 37.2%.more » Absolute survival rate by modified FIGO clinical staging was 66% for Stages I and IIA, 31% for Stage IIB, 25% for Stage III, and 0% for Stage IV.« less

A Six‐Stage Workflow for Robust Application of Systems Pharmacology

PubMed Central

Gadkar, K; Kirouac, DC; Mager, DE; van der Graaf, PH

2016-01-01

Quantitative and systems pharmacology (QSP) is increasingly being applied in pharmaceutical research and development. One factor critical to the ultimate success of QSP is the establishment of commonly accepted language, technical criteria, and workflows. We propose an integrated workflow that bridges conceptual objectives with underlying technical detail to support the execution, communication, and evaluation of QSP projects. PMID:27299936

Boosting Quality Registries with Clinical Decision Support Functionality*. User Acceptance of a Prototype Applied to HIV/TB Drug Therapy.

PubMed

Wannheden, Carolina; Hvitfeldt-Forsberg, Helena; Eftimovska, Elena; Westling, Katarina; Ellenius, Johan

2017-08-11

The care of HIV-related tuberculosis (HIV/TB) is complex and challenging. Clinical decision support (CDS) systems can contribute to improve quality of care, but more knowledge is needed on factors determining user acceptance of CDS. To analyze physicians' and nurses' acceptance of a CDS prototype for evidence-based drug therapy recommendations for HIV/TB treatment. Physicians and nurses were involved in designing a CDS prototype intended for future integration with the Swedish national HIV quality registry. Focus group evaluation was performed with ten nurses and four physicians, respectively. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to analyze acceptance. We identified several potential benefits with the CDS prototype as well as some concerns that could be addressed by redesign. There was also concern about dependence on physician attitudes, as well as technical, organizational, and legal issues. Acceptance evaluation at a prototype stage provided rich data to improve the future design of a CDS prototype. Apart from design and development efforts, substantial organizational efforts are needed to enable the implementation and maintenance of a future CDS system.

Performance characteristics of a slagging gasifier for MHD combustor systems

NASA Technical Reports Server (NTRS)

Smith, K. O.

1979-01-01

The performance of a two stage, coal combustor concept for magnetohydrodynamic (MHD) systems was investigated analytically. The two stage MHD combustor is comprised of an entrained flow, slagging gasifier as the first stage, and a gas phase reactor as the second stage. The first stage was modeled by assuming instantaneous coal devolatilization, and volatiles combustion and char gasification by CO2 and H2O in plug flow. The second stage combustor was modeled assuming adiabatic instantaneous gas phase reactions. Of primary interest was the dependence of char gasification efficiency on first stage particle residence time. The influence of first stage stoichiometry, heat loss, coal moisture, coal size distribution, and degree of coal devolatilization on gasifier performance and second stage exhaust temperature was determined. Performance predictions indicate that particle residence times on the order of 500 msec would be required to achieve gasification efficiencies in the range of 90 to 95 percent. The use of a finer coal size distribution significantly reduces the required gasifier residence time for acceptable levels of fuel use efficiency. Residence time requirements are also decreased by increased levels of coal devolatilization. Combustor design efforts should maximize devolatilization by minimizing mixing times associated with coal injection.

Factors influencing acceptance of technology for aging in place: a systematic review.

PubMed

Peek, Sebastiaan T M; Wouters, Eveline J M; van Hoof, Joost; Luijkx, Katrien G; Boeije, Hennie R; Vrijhoef, Hubertus J M

2014-04-01

To provide an overview of factors influencing the acceptance of electronic technologies that support aging in place by community-dwelling older adults. Since technology acceptance factors fluctuate over time, a distinction was made between factors in the pre-implementation stage and factors in the post-implementation stage. A systematic review of mixed studies. Seven major scientific databases (including MEDLINE, Scopus and CINAHL) were searched. Inclusion criteria were as follows: (1) original and peer-reviewed research, (2) qualitative, quantitative or mixed methods research, (3) research in which participants are community-dwelling older adults aged 60 years or older, and (4) research aimed at investigating factors that influence the intention to use or the actual use of electronic technology for aging in place. Three researchers each read the articles and extracted factors. Sixteen out of 2841 articles were included. Most articles investigated acceptance of technology that enhances safety or provides social interaction. The majority of data was based on qualitative research investigating factors in the pre-implementation stage. Acceptance in this stage is influenced by 27 factors, divided into six themes: concerns regarding technology (e.g., high cost, privacy implications and usability factors); expected benefits of technology (e.g., increased safety and perceived usefulness); need for technology (e.g., perceived need and subjective health status); alternatives to technology (e.g., help by family or spouse), social influence (e.g., influence of family, friends and professional caregivers); and characteristics of older adults (e.g., desire to age in place). When comparing these results to qualitative results on post-implementation acceptance, our analysis showed that some factors are persistent while new factors also emerge. Quantitative results showed that a small number of variables have a significant influence in the pre-implementation stage. Fourteen out of the sixteen included articles did not use an existing technology acceptance framework or model. Acceptance of technology in the pre-implementation stage is influenced by multiple factors. However, post-implementation research on technology acceptance by community-dwelling older adults is scarce and most of the factors in this review have not been tested by using quantitative methods. Further research is needed to determine if and how the factors in this review are interrelated, and how they relate to existing models of technology acceptance. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Designing with Traffic Safety in Mind.

ERIC Educational Resources Information Center

Matthews, John

1998-01-01

Provides an example of how one county public school system was able to minimize traffic accidents and increase safety around its schools. Illustrations are provided of safer bus loading zones, pedestrian walkways and sidewalks, staff parking, and acceptable methods for staging buses. A checklist for school driveway design concludes the article.…

Payload/orbiter signal-processing and data-handling system evaluation

NASA Technical Reports Server (NTRS)

Teasdale, W. E.; Polydoros, A.

1980-01-01

Incompatibilities between orbiter subsystems and payload communication systems to assure that acceptable and to end system performamce will be achieved are identified. The potential incompatabilities are associated with either payloads in the cargo bay or detached payloads communicating with the orbiter via an RF link. The payload signal processing and data handling systems are assessed by investigating interface problems experienced between the inertial upper stage and the orbiter since similar problems are expected for other payloads.

A pilot study of dentists' assessment of caries detection and staging systems applied to early caries: PEARL Network findings.

PubMed

Thompson, Van P; Schenkel, Andrew B; Penugonda, Bapanaiah; Wolff, Mark S; Zeller, Gregory G; Wu, Hongyu; Vena, Don; Grill, Ashley C; Curro, Frederick A

2016-01-01

The International Caries Detection and Assessment System (ICDAS II) and the Caries Classification System (CCS) are caries stage description systems proposed for adoption into clinical practice. This pilot study investigated clinicians' training in and use of these systems for detection of early caries and recommendations for individual tooth treatment. Patient participants (N = 8) with a range of noncavitated lesions (CCS ranks 2 and 4 and ICDAS II ranks 2-4) identified by a team of calibrated examiners were recruited from the New York University College of Dentistry clinic. Eighteen dentists-8 from the Practitioners Engaged in Applied Research and Learning (PEARL) Network and 10 recruited from the Academy of General Dentistry-were randomly assigned to 1 of 3 groups: 5 dentists used only visual-tactile (VT) examination, 7 were trained in the ICDAS II, and 6 were trained in the CCS. Lesion stage for each tooth was determined by the ICDAS II and CCS groups, and recommended treatment was decided by all groups. Teeth were assessed both with and without radiographs. Caries was detected in 92.7% (95% CI, 88%-96%) of the teeth by dentists with CCS training, 88.8% (95% CI, 84%-92%) of the teeth by those with ICDAS II training, and 62.3% (95% CI, 55%-69%) of teeth by the VT group. Web-based training was acceptable to all dentists in the CCS group (6 of 6) but fewer of the dentists in the ICDAS II group (5 of 7). The modified CCS translated clinically to more accurate caries detection, particularly compared to detection by untrained dentists (VT group). Moreover, the CCS was more accepted than was the ICDAS II, but dentists in both groups were open to the application of these systems. Agreement on caries staging requires additional training prior to a larger validation study.

Detailed requirements document for the Interactive Financial Management System (IFMS), volume 1

NASA Technical Reports Server (NTRS)

Dodson, D. B.

1975-01-01

The detailed requirements for phase 1 (online fund control, subauthorization accounting, and accounts receivable functional capabilities) of the Interactive Financial Management System (IFMS) are described. This includes information on the following: systems requirements, performance requirements, test requirements, and production implementation. Most of the work is centered on systems requirements, and includes discussions on the following processes: resources authority, allotment, primary work authorization, reimbursable order acceptance, purchase request, obligation, cost accrual, cost distribution, disbursement, subauthorization performance, travel, accounts receivable, payroll, property, edit table maintenance, end-of-year, backup input. Other subjects covered include: external systems interfaces, general inquiries, general report requirements, communication requirements, and miscellaneous. Subjects covered under performance requirements include: response time, processing volumes, system reliability, and accuracy. Under test requirements come test data sources, general test approach, and acceptance criteria. Under production implementation come data base establishment, operational stages, and operational requirements.

PARENT DEVELOPMENT

PubMed Central

Friedman, David Belais

1957-01-01

Today's parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child's development; otherwise, his advice and counsel do not “take” and he becomes tired and frustrated and angry. Parents progress through definite stages of development: Stage 1: Learning the cues—the struggle of the parents to interpret the infant's needs. Stage 2: Learning to accept growth and development—the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate—the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting—the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one's teenager—the parent learning to live independently while the teenager struggles to develop his own identity. The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease. PMID:13383387

Evaluation of data quality, timeliness and acceptability of the tuberculosis surveillance system in Brazil's micro-regions.

PubMed

Silva, Gabriela Drummond Marques da; Bartholomay, Patrícia; Cruz, Oswaldo Gonçalves; Garcia, Leila Posenato

2017-10-01

This study aimed to evaluate quality, acceptability and timeliness of the data in the tuberculosis surveillance system in Brazilian micro-regions. An ecological cross-sectional study was carried out, after a qualitative stage for selecting indicators. All 558 Brazilian micro-regions were used as units of analysis. Data available in the National Notifiable Diseases Information System (SINAN), from 2012 to 2014, were used to calculate 14 indicators relating to four attributes: completeness, consistency, timeliness and acceptability. The study made use of cluster analysis to group micro-regions according to acceptability and timeliness. Three clusters were identified among the 473 micro-regions with optimal or regular completeness (70% to 100%) and with over five notifications. Cluster 1 (n = 109) presented mean timeliness of notification and treatment equal to 62.8% and 24.9%, respectively. Cluster 2 (n = 143) had a mean percentage of cases tested for HIV equal to 55.9%. Cluster 3 (n = 221) had the best performing tuberculosis indicators. Results suggest priority areas for improving surveillance of tuberculosis, predominantly in the central-north part of the country. They also point to the need to increase the timeliness of treatment and the percentage of cases tested for HIV.

Acceptance Probability (P a) Analysis for Process Validation Lifecycle Stages.

PubMed

Alsmeyer, Daniel; Pazhayattil, Ajay; Chen, Shu; Munaretto, Francesco; Hye, Maksuda; Sanghvi, Pradeep

2016-04-01

This paper introduces an innovative statistical approach towards understanding how variation impacts the acceptance criteria of quality attributes. Because of more complex stage-wise acceptance criteria, traditional process capability measures are inadequate for general application in the pharmaceutical industry. The probability of acceptance concept provides a clear measure, derived from specific acceptance criteria for each quality attribute. In line with the 2011 FDA Guidance, this approach systematically evaluates data and scientifically establishes evidence that a process is capable of consistently delivering quality product. The probability of acceptance provides a direct and readily understandable indication of product risk. As with traditional capability indices, the acceptance probability approach assumes that underlying data distributions are normal. The computational solutions for dosage uniformity and dissolution acceptance criteria are readily applicable. For dosage uniformity, the expected AV range may be determined using the s lo and s hi values along with the worst case estimates of the mean. This approach permits a risk-based assessment of future batch performance of the critical quality attributes. The concept is also readily applicable to sterile/non sterile liquid dose products. Quality attributes such as deliverable volume and assay per spray have stage-wise acceptance that can be converted into an acceptance probability. Accepted statistical guidelines indicate processes with C pk > 1.33 as performing well within statistical control and those with C pk < 1.0 as "incapable" (1). A C pk > 1.33 is associated with a centered process that will statistically produce less than 63 defective units per million. This is equivalent to an acceptance probability of >99.99%.

24 CFR 200.45 - Processing of applications.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Act. (c) Staged applications. Staged applications leading to an application for firm commitment shall... of the Commissioner, which shall not be changed to the detriment of an applicant, if the application... the application is not acceptable as submitted, but can be made acceptable by a change in the number...

24 CFR 200.45 - Processing of applications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Act. (c) Staged applications. Staged applications leading to an application for firm commitment shall... of the Commissioner, which shall not be changed to the detriment of an applicant, if the application... the application is not acceptable as submitted, but can be made acceptable by a change in the number...

A new computer-based counselling system for the promotion of physical activity in patients with chronic diseases--results from a pilot study.

PubMed

Becker, Annette; Herzberg, Dominikus; Marsden, Nicola; Thomanek, Sabine; Jung, Hartmut; Leonhardt, Corinna

2011-05-01

To develop a computer-based counselling system (CBCS) for the improvement of attitudes towards physical activity in chronically ill patients and to pilot its efficacy and acceptance in primary care. The system is tailored to patients' disease and motivational stage. During a pilot study in five German general practices, patients answered questions before, directly and 6 weeks after using the CBCS. Outcome criteria were attitudes and self-efficacy. Qualitative interviews were performed to identify acceptance indicators. Seventy-nine patients participated (mean age: 64.5 years, 53% males; 38% without previous computer experience). Patients' affective and cognitive attitudes changed significantly, self-efficacy showed only minor changes. Patients mentioned no difficulties in interacting with the CBCS. However, perception of the system's usefulness was inconsistent. Computer-based counselling for physical activity related attitudes in patients with chronic diseases is feasible, but the circumstances of use with respect to the target group and its integration into the management process have to be clarified in future studies. This study adds to the understanding of computer-based counselling in primary health care. Acceptance indicators identified in this study will be validated as part of a questionnaire on technology acceptability in a subsequent study. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Real-time detection of transients in OGLE-IV with application of machine learning

NASA Astrophysics Data System (ADS)

Klencki, Jakub; Wyrzykowski, Łukasz

2016-06-01

The current bottleneck of transient detection in most surveys is the problem of rejecting numerous artifacts from detected candidates. We present a triple-stage hierarchical machine learning system for automated artifact filtering in difference imaging, based on self-organizing maps. The classifier, when tested on the OGLE-IV Transient Detection System, accepts 97% of real transients while removing up to 97.5% of artifacts.

Integrated System Test Approaches for the NASA Ares I Crew Launch Vehicle

NASA Technical Reports Server (NTRS)

Cockrell, Charles E., Jr.; Askins, Bruce R.; Bland, Jeffrey; Davis, Stephan; Holladay, Jon B.; Taylor, James L.; Taylor, Terry L.; Robinson, Kimberly F.; Roberts, Ryan E.; Tuma, Margaret

2007-01-01

The Ares I Crew Launch Vehicle (CLV) is being developed by the U.S. National Aeronautics and Space Administration (NASA) to provide crew access to the International Space Station (ISS) and, together with the Ares V Cargo Launch Vehicle (CaLV), serves as one component of a future launch capability for human exploration of the Moon. During the system requirements definition process and early design cycles, NASA defined and began implementing plans for integrated ground and flight testing necessary to achieve the first human launch of Ares I. The individual Ares I flight hardware elements: the first stage five segment booster (FSB), upper stage, and J-2X upper stage engine, will undergo extensive development, qualification, and certification testing prior to flight. Key integrated system tests include the Main Propulsion Test Article (MPTA), acceptance tests of the integrated upper stage and upper stage engine assembly, a full-scale integrated vehicle dynamic test (IVDT), aerodynamic testing to characterize vehicle performance, and integrated testing of the avionics and software components. The Ares I-X development flight test will provide flight data to validate engineering models for aerodynamic performance, stage separation, structural dynamic performance, and control system functionality. The Ares I-Y flight test will validate ascent performance of the first stage, stage separation functionality, and a highaltitude actuation of the launch abort system (LAS) following separation. The Orion-1 flight test will be conducted as a full, un-crewed, operational flight test through the entire ascent flight profile prior to the first crewed launch.

Integrated Testing Approaches for the NASA Ares I Crew Launch Vehicle

NASA Technical Reports Server (NTRS)

Taylor, James L.; Cockrell, Charles E.; Tuma, Margaret L.; Askins, Bruce R.; Bland, Jeff D.; Davis, Stephan R.; Patterson, Alan F.; Taylor, Terry L.; Robinson, Kimberly L.

2008-01-01

The Ares I crew launch vehicle is being developed by the U.S. National Aeronautics and Space Administration (NASA) to provide crew and cargo access to the International Space Station (ISS) and, together with the Ares V cargo launch vehicle, serves as a critical component of NASA's future human exploration of the Moon. During the preliminary design phase, NASA defined and began implementing plans for integrated ground and flight testing necessary to achieve the first human launch of Ares I. The individual Ares I flight hardware elements - including the first stage five segment booster (FSB), upper stage, and J-2X upper stage engine - will undergo extensive development, qualification, and certification testing prior to flight. Key integrated system tests include the upper stage Main Propulsion Test Article (MPTA), acceptance tests of the integrated upper stage and upper stage engine assembly, a full-scale integrated vehicle ground vibration test (IVGVT), aerodynamic testing to characterize vehicle performance, and integrated testing of the avionics and software components. The Ares I-X development flight test will provide flight data to validate engineering models for aerodynamic performance, stage separation, structural dynamic performance, and control system functionality. The Ares I-Y flight test will validate ascent performance of the first stage, stage separation functionality, validate the ability of the upper stage to manage cryogenic propellants to achieve upper stage engine start conditions, and a high-altitude demonstration of the launch abort system (LAS) following stage separation. The Orion 1 flight test will be conducted as a full, un-crewed, operational flight test through the entire ascent flight profile prior to the first crewed launch.

Project Gel a Randomized Rectal Microbicide Safety and Acceptability Study in Young Men and Transgender Women

PubMed Central

Cranston, Ross D.; Mayer, Kenneth H.; Febo, Irma; Duffill, Kathryn; Siegel, Aaron; Engstrom, Jarret C.; Nikiforov, Alexyi; Park, Seo-Young; Brand, Rhonda M.; Jacobson, Cindy; Giguere, Rebecca; Dolezal, Curtis; Frasca, Timothy; Leu, Cheng-Shiun; Schwartz, Jill L.; Carballo-Diéguez, Alex

2016-01-01

Objectives The purpose of Project Gel was to determine the safety and acceptability of rectal microbicides in young men who have sex with men (MSM) and transgender women (TGW) at risk of HIV infection. Methods MSM and TGW aged 18–30 years were enrolled at three sites; Pittsburgh, PA; Boston, MA; and San Juan, PR. Stage 1A was a cross-sectional assessment of sexual health and behavior in MSM and TGW. A subset of participants from Stage 1A were then enrolled in Stage 1B, a 12-week evaluation of the safety and acceptability of a placebo rectal gel. This was followed by the final phase of the study (Stage 2) in which a subset of participants from Stage 1B were enrolled into a Phase 1 rectal safety and acceptability evaluation of tenofovir (TFV) 1% gel. Results 248 participants were enrolled into Stage 1A. Participants’ average age was 23.3 years. The most common sexually transmitted infection (STIs) at baseline were Herpes simplex (HSV)-2 (16.1% by serology) and rectal Chlamydia trachomatis (CT) (10.1% by NAAT). 134 participants were enrolled into Stage 1B. During the 12 week period of follow-up 2 HIV, 5 rectal CT, and 5 rectal Neisseria gonorrhea infections were detected. The majority of adverse events (AEs) were infections (N = 56) or gastrointestinal (N = 46) and were mild (69.6%) or moderate (28.0%). Of the participants who completed Stage 1B, 24 were enrolled into Stage 2 and randomized (1:1) to receive TFV or placebo gel. All participants completed Stage 2. The majority of AEs were gastrointestinal (N = 10) and of mild (87.2%) or moderate (10.3%) severity. Conclusions In this study we were able to enroll a sexually active population of young MSM and TGW who were willing to use rectal microbicides. TFV gel was safe and acceptable and should be further developed as an alternative HIV prevention intervention for this population. Trial Registration ClinicalTrials.gov NCT01283360 PMID:27362788

Testing of polyimide second-stage rod seals for single-state applications in advanced aircraft hydraulic systems

NASA Technical Reports Server (NTRS)

Waterman, A. W.

1977-01-01

Machined polyimide second-stage rod seals were evaluated to determine their suitability for single-stage applications where full system pressure acts on the upstream side of the seal. The 6.35-cm (2.5-in.) K-section seal was tested in impulse screening tests where peak pressure was increased in 3.448-MPa (500-psi) increments each 20,000 cycles. Seal failure occurred at 37.92 MPa (5,500 psi), indicating a potential for acceptability in a 27.58-MPa (4,000-psi) system. Static pressurization for 600 sec at pressures in excess of 10.34 MPa (1,500 psi) revealed structural inadequacy of the seal cross section to resist fracture and extrusion. Endurance testing showed the seals capable of at least 65,000 1.27-cm (0.5-in.) cycles at 450 K (350 F) without leakage. It was concluded that the second-stage seals were proven to be exceptional in the 1.379-MPa (200-psi) applications for which they were designed, but polyimide material properties are not adequate for use in this design at pressure loading equivalent to that present in single-stage applications.

Towards Requirements in Systems Engineering for Aerospace IVHM Design

NASA Technical Reports Server (NTRS)

Saxena, Abhinav; Roychoudhury, Indranil; Lin, Wei; Goebel, Kai

2013-01-01

Health management (HM) technologies have been employed for safety critical system for decades, but a coherent systematic process to integrate HM into the system design is not yet clear. Consequently, in most cases, health management resorts to be an after-thought or 'band-aid' solution. Moreover, limited guidance exists for carrying out systems engineering (SE) on the subject of writing requirements for designs with integrated vehicle health management (IVHM). It is well accepted that requirements are key to developing a successful IVHM system right from the concept stage to development, verification, utilization, and support. However, writing requirements for systems with IVHM capability have unique challenges that require the designers to look beyond their own domains and consider the constraints and specifications of other interlinked systems. In this paper we look at various stages in the SE process and identify activities specific to IVHM design and development. More importantly, several relevant questions are posed that system engineers must address at various design and development stages. Addressing these questions should provide some guidance to systems engineers towards writing IVHM related requirements to ensure that appropriate IVHM functions are built into the system design.

Impact of SciELO and MEDLINE indexing on submissions to Jornal de Pediatria.

PubMed

Blank, Danilo; Buchweitz, Claudia; Procianoy, Renato S

2005-01-01

To evaluate the impact of SciELO and MEDLINE indexing on the number of articles submitted to Jornal de Pediatria. Analysis of total article submission, submission of articles from foreign countries and acceptance figures in the following periods: stage I - pre-website (Jan 2000-Mar 2001); stage II - website (Apr 2001-Jul 2002); stage III - SciELO (Aug 2002-Aug 2003); stage IV - MEDLINE (Sep 2003-Dec 2004). There was a significant trend toward linear increase in the number of submissions along the study period (p = 0.009). The number of manuscripts submitted in stages I through IV was 184, 240, 297, and 482, respectively. The number of submissions was similar in stages I and II (p = 0.148), but statistically higher in Stage III (p < 0.001 vs. Stage I and p = 0.006 vs. Stage II) and Stage IV (p < 0.001 vs. stages I and II, and p < 0.05 vs. stage III). The rate of article acceptance decreased during the study period. The number of original articles published has been stable since the 2001 March/April issue (n = 10), when the journal reached a printed page limit, leading to stricter judgment criteria and a relative decrease in acceptance rate. The number of foreign submissions in stages I through IV was 1, 2, zero and 17, respectively, with p < 0.001 for the comparison of stage IV with previous stages. SciELO indexing was associated with an increase in Brazilian manuscript submissions to Jornal de Pediatria, whereas MEDLINE indexing led to an increase in both Brazilian and foreign submissions.

Cold Aero Performance of a Two-Dimensional Mixer Ejector Nozzle

NASA Technical Reports Server (NTRS)

Balan, C.

2005-01-01

Since 1986, NASA and the U.S. aerospace industry have been assessing the economic viability and environmental acceptability of a second-generation supersonic civil transport, or High Speed Civil Transport (HSCT). Environmental acceptability in terms of airport community noise and economic viability are critical elements in this endeavor. Development of a propulsion system that satisfies strict airport noise regulations (FAR36 Stage III levels), at acceptable performance and weight, is critical to the success of any HSCT program. Two-dimensional mixer-ejector (2DME) exhaust systems are one approach in achieving this goal. In support of HSCT development, GEAE (GE Aircraft Engines), under contract to the NASA Glenn Research Center, conducted this test program at the NASA Langley 16 ft transonic wind tunnel to evaluate the cold aerodynamic performance aspects of the 2DME exhaust system concept. The effects of SAR (SAR, suppressor area ratio, = mixed-flow area/primary nozzle throat area), MAR (MAR = overall exhaust system exit/mixing-plane area), flap length, CER (suppressor chute expansion ratio), chute alignment, and free stream Mach number were investigated on a 1/11th cold aerodynamic scale model of a 2DME exhaust system.

Radiometric ratio characterization for low-to-mid CPV modules operating in variable irradiance conditions

NASA Astrophysics Data System (ADS)

Vorndran, Shelby; Russo, Juan; Zhang, Deming; Gordon, Michael; Kostuk, Raymond

2012-10-01

In this work, a concentrating photovoltaic (CPV) design methodology is proposed which aims to maximize system efficiency for a given irradiance condition. In this technique, the acceptance angle of the system is radiometrically matched to the angular spread of the site's average irradiance conditions using a simple geometric ratio. The optical efficiency of CPV systems from flat-plate to high-concentration is plotted at all irradiance conditions. Concentrator systems are measured outdoors in various irradiance conditions to test the methodology. This modeling technique is valuable at the design stage to determine the ideal level of concentration for a CPV module. It requires only two inputs: the acceptance angle profile of the system and the site's average direct and diffuse irradiance fractions. Acceptance angle can be determined by raytracing or testing a fabricated prototype in the lab with a solar simulator. The average irradiance conditions can be found in the Typical Metrological Year (TMY3) database. Additionally, the information gained from this technique can be used to determine tracking tolerance, quantify power loss during an isolated weather event, and do more sophisticated analysis such as I-V curve simulation.

Cross-cultural adaptation of the Window to Hope: a psychological intervention to reduce hopelessness among U.S. veterans with traumatic brain injury.

PubMed

Matarazzo, Bridget B; Hoffberg, Adam S; Clemans, Tracy A; Signoracci, Gina M; Simpson, Grahame K; Brenner, Lisa A

2014-01-01

To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of U.S. Veterans. Three-stage mixed-methods approach. Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions. Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized. RESULTS of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.

Influence of lactation stage and some flock management practices on sensory characteristics of goat milk from Brazilian Saanen breed.

PubMed

de Cássia Ramos do Egypto Queiroga, Rita; Costa, Roberto Germano; Madruga, Marta Suely; de Medeiros, Ariosvaldo Nunes; Dos Santos Garruti, Deborah; Magnani, Marciane; de Souza, Evandro Leite

2016-04-01

This study evaluated the influence of lactation stage (early, middle, late) and management practices (milking hygiene and buck presence) on the sensory attributes of Saanen goat milk. Goats were randomly divided in four groups in respect of different milking sanitary procedures and the presence/absence of the buck in the barn. Milk samples were analyzed for sensory attributes including quantitative descriptive analysis (QDA) and acceptance. The milking hygiene practice caused no significant influence on microbiological parameters. Results of QDA revealed that the buck presence increased the characteristic odor of milk at the middle and late lactation stages. The off-odor and off-flavor descriptors showed a distinct response since a higher intensity of these sensory characteristics was noted in the samples obtained from goats maintained without the buck. Odor and flavor contributed most in characterizing the different samples regardless of the management practice and lactation stage. The acceptance of odor showed to be influenced only by the lactation stage, while the acceptance of flavor was only through the presence of the buck. Odor acceptance correlated negatively to off-odor and off-flavor, suggesting that these two sensory attributes impaired the preference for the aroma of the milk samples. © 2015 Japanese Society of Animal Science.

Performance Characterization of an xy-Stage Applied to Micrometric Laser Direct Writing Lithography.

PubMed

Jaramillo, Juan; Zarzycki, Artur; Galeano, July; Sandoz, Patrick

2017-01-31

This article concerns the characterization of the stability and performance of a motorized stage used in laser direct writing lithography. The system was built from commercial components and commanded by G-code. Measurements use a pseudo-periodic-pattern (PPP) observed by a camera and image processing is based on Fourier transform and phase measurement methods. The results report that the built system has a stability against vibrations determined by peak-valley deviations of 65 nm and 26 nm in the x and y directions, respectively, with a standard deviation of 10 nm in both directions. When the xy-stage is in movement, it works with a resolution of 0.36 μm, which is an acceptable value for most of research and development (R and D) microtechnology developments in which the typical feature size used is in the micrometer range.

Performance Characterization of an xy-Stage Applied to Micrometric Laser Direct Writing Lithography

PubMed Central

Jaramillo, Juan; Zarzycki, Artur; Galeano, July; Sandoz, Patrick

2017-01-01

This article concerns the characterization of the stability and performance of a motorized stage used in laser direct writing lithography. The system was built from commercial components and commanded by G-code. Measurements use a pseudo-periodic-pattern (PPP) observed by a camera and image processing is based on Fourier transform and phase measurement methods. The results report that the built system has a stability against vibrations determined by peak-valley deviations of 65 nm and 26 nm in the x and y directions, respectively, with a standard deviation of 10 nm in both directions. When the xy-stage is in movement, it works with a resolution of 0.36 µm, which is an acceptable value for most of research and development (R and D) microtechnology developments in which the typical feature size used is in the micrometer range. PMID:28146126

Development and feasibility study of very brief interventions for physical activity in primary care.

PubMed

Pears, Sally; Morton, Katie; Bijker, Maaike; Sutton, Stephen; Hardeman, Wendy

2015-04-08

There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which 'active ingredients' (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acceptability of the short-listed VBIs, using tape-recordings and interviews with practitioners (n = 4) and patients (n = 68), to decide which VBIs merited further evaluation in a pilot trial. Four VBIs were short-listed: Motivational intervention; Action Planning intervention; Pedometer intervention; and Physical Activity Diary intervention. All were deliverable in around five minutes and were feasible and acceptable to participants and practitioners. Based on the results of interviews with practitioners and patients, techniques from the VBIs were combined into three new VBIs for further evaluation in a pilot trial. Using a two-stage approach, in which we considered the practicability of VBIs (acceptability, feasibility and cost) alongside potential efficacy from the outset, we developed a short-list of four promising VBIs for physical activity and demonstrated that they were acceptable and feasible as part of a preventive health check in primary care. Current Controlled Trials ISRCTN02863077. Registered 5 October 2012.

A two-stage predictive model to simultaneous control of trihalomethanes in water treatment plants and distribution systems: adaptability to treatment processes.

PubMed

Domínguez-Tello, Antonio; Arias-Borrego, Ana; García-Barrera, Tamara; Gómez-Ariza, José Luis

2017-10-01

The trihalomethanes (TTHMs) and others disinfection by-products (DBPs) are formed in drinking water by the reaction of chlorine with organic precursors contained in the source water, in two consecutive and linked stages, that starts at the treatment plant and continues in second stage along the distribution system (DS) by reaction of residual chlorine with organic precursors not removed. Following this approach, this study aimed at developing a two-stage empirical model for predicting the formation of TTHMs in the water treatment plant and subsequently their evolution along the water distribution system (WDS). The aim of the two-stage model was to improve the predictive capability for a wide range of scenarios of water treatments and distribution systems. The two-stage model was developed using multiple regression analysis from a database (January 2007 to July 2012) using three different treatment processes (conventional and advanced) in the water supply system of Aljaraque area (southwest of Spain). Then, the new model was validated using a recent database from the same water supply system (January 2011 to May 2015). The validation results indicated no significant difference in the predictive and observed values of TTHM (R 2 0.874, analytical variance <17%). The new model was applied to three different supply systems with different treatment processes and different characteristics. Acceptable predictions were obtained in the three distribution systems studied, proving the adaptability of the new model to the boundary conditions. Finally the predictive capability of the new model was compared with 17 other models selected from the literature, showing satisfactory results prediction and excellent adaptability to treatment processes.

Northrop Grumman HEC flight coaxial cryocoolers performance

NASA Astrophysics Data System (ADS)

Nguyen, T.; Russo, J.; Basel, G.; Chi, D.; Abelson, L.

2018-05-01

The Northrop Grumman Aerospace Systems (NGAS) has expanded the cryocooler product line to include a single stage High Efficiency Cryocooler (HEC) cooler with a coaxial pulse tube cold head that operates at temperatures down to 45K. The HEC coaxial pulse tube cooler has been adopted by several customers, and has completed acceptance testing to meet program flight requirements. The NGAS TRL 9 HEC is a pulse tube cryocooler with a flexure bearing compressor which has been delivered for a number of flight payloads that are currently operating in space. To date, NGAS has delivered space cryocoolers in several configurations including single stage with a linear cold head and two stage with both linear and coaxial cold heads. The new HEC coaxial cooler uses the same TRL9 HEC compressor with a passive pulse tube cold head, to maintain the flight heritage of the HEC linear cooler. In this paper, we present the flight acceptance test data of the HEC coaxial cryocooler, which includes thermal performance, launch vibration and thermal cycling. The HEC coaxial cooler has demonstrated excellent performance in family with the flight qualified HEC linear cooler. The HEC coaxial cooler provides users with additional flexibility in selecting the cold head configuration to meet their particular applications.

A comment on the PCAST report: Skip the "match"/"non-match" stage.

PubMed

Morrison, Geoffrey Stewart; Kaye, David H; Balding, David J; Taylor, Duncan; Dawid, Philip; Aitken, Colin G G; Gittelson, Simone; Zadora, Grzegorz; Robertson, Bernard; Willis, Sheila; Pope, Susan; Neil, Martin; Martire, Kristy A; Hepler, Amanda; Gill, Richard D; Jamieson, Allan; de Zoete, Jacob; Ostrum, R Brent; Caliebe, Amke

2017-03-01

This letter comments on the report "Forensic science in criminal courts: Ensuring scientific validity of feature-comparison methods" recently released by the President's Council of Advisors on Science and Technology (PCAST). The report advocates a procedure for evaluation of forensic evidence that is a two-stage procedure in which the first stage is "match"/"non-match" and the second stage is empirical assessment of sensitivity (correct acceptance) and false alarm (false acceptance) rates. Almost always, quantitative data from feature-comparison methods are continuously-valued and have within-source variability. We explain why a two-stage procedure is not appropriate for this type of data, and recommend use of statistical procedures which are appropriate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Disposal of Spacecraft and Launch Vehicle Stages in Low Earth Orbit

NASA Technical Reports Server (NTRS)

Johnson, Nicholas L.

2007-01-01

Spacecraft and launch vehicle stages abandoned in Earth orbit have historically been a primary source of debris from accidental explosions. In the future, such satellites will become the principal cause of orbital debris via inadvertent collisions. To curtail both the near-term and far-term risks posed by derelict spacecraft and launch vehicle stages to operational space systems, numerous national and international orbital debris mitigation guidelines specifically recommend actions which could prevent or limit such future debris generation. Although considerable progress has been made in implementing these recommendations, some changes to existing vehicle designs can be difficult. Moreover, the nature of some missions also can present technological and budgetary challenges to be compliant with widely accepted orbital debris mitigation measures.

In situ fatigue loading stage inside scanning electron microscope

NASA Technical Reports Server (NTRS)

Telesman, Jack; Kantzos, Peter; Brewer, David

1988-01-01

A fatigue loading stage inside a scanning electron microscopy (SEM) was developed. The stage allows dynamic and static high-magnification and high-resolution viewing of the fatigue crack initiation and crack propagation processes. The loading stage is controlled by a closed-loop servohydraulic system. Maximum load is 1000 lb (4450 N) with test frequencies ranging up to 30 Hz. The stage accommodates specimens up to 2 inches (50 mm) in length and tolerates substantial specimen translation to view the propagating crack. At room temperature, acceptable working resolution is obtainable for magnifications ranging up to 10,000X. The system is equipped with a high-temperature setup designed for temperatures up to 2000 F (1100 C). The signal can be videotaped for further analysis of the pertinent fatigue damage mechanisms. The design allows for quick and easy interchange and conversion of the SEM from a loading stage configuration to its normal operational configuration and vice versa. Tests are performed entirely in the in-situ mode. In contrast to other designs, the NASA design has greatly extended the life of the loading stage by not exposing the bellows to cyclic loading. The loading stage was used to investigate the fatigue crack growth mechanisms in the (100)-oriented PWA 1480 single-crystal, nickel-based supperalloy. The high-magnification observations revealed the details of the crack growth processes.

Using evaluation to adapt health information outreach to the complex environments of community-based organizations.

PubMed

Olney, Cynthia A

2005-10-01

After arguing that most community-based organizations (CBOs) function as complex adaptive systems, this white paper describes the evaluation goals, questions, indicators, and methods most important at different stages of community-based health information outreach. This paper presents the basic characteristics of complex adaptive systems and argues that the typical CBO can be considered this type of system. It then presents evaluation as a tool for helping outreach teams adapt their outreach efforts to the CBO environment and thus maximize success. Finally, it describes the goals, questions, indicators, and methods most important or helpful at each stage of evaluation (community assessment, needs assessment and planning, process evaluation, and outcomes assessment). Literature from complex adaptive systems as applied to health care, business, and evaluation settings is presented. Evaluation models and applications, particularly those based on participatory approaches, are presented as methods for maximizing the effectiveness of evaluation in dynamic CBO environments. If one accepts that CBOs function as complex adaptive systems-characterized by dynamic relationships among many agents, influences, and forces-then effective evaluation at the stages of community assessment, needs assessment and planning, process evaluation, and outcomes assessment is critical to outreach success.

Ensemble Bayesian forecasting system Part I: Theory and algorithms

NASA Astrophysics Data System (ADS)

Herr, Henry D.; Krzysztofowicz, Roman

2015-05-01

The ensemble Bayesian forecasting system (EBFS), whose theory was published in 2001, is developed for the purpose of quantifying the total uncertainty about a discrete-time, continuous-state, non-stationary stochastic process such as a time series of stages, discharges, or volumes at a river gauge. The EBFS is built of three components: an input ensemble forecaster (IEF), which simulates the uncertainty associated with random inputs; a deterministic hydrologic model (of any complexity), which simulates physical processes within a river basin; and a hydrologic uncertainty processor (HUP), which simulates the hydrologic uncertainty (an aggregate of all uncertainties except input). It works as a Monte Carlo simulator: an ensemble of time series of inputs (e.g., precipitation amounts) generated by the IEF is transformed deterministically through a hydrologic model into an ensemble of time series of outputs, which is next transformed stochastically by the HUP into an ensemble of time series of predictands (e.g., river stages). Previous research indicated that in order to attain an acceptable sampling error, the ensemble size must be on the order of hundreds (for probabilistic river stage forecasts and probabilistic flood forecasts) or even thousands (for probabilistic stage transition forecasts). The computing time needed to run the hydrologic model this many times renders the straightforward simulations operationally infeasible. This motivates the development of the ensemble Bayesian forecasting system with randomization (EBFSR), which takes full advantage of the analytic meta-Gaussian HUP and generates multiple ensemble members after each run of the hydrologic model; this auxiliary randomization reduces the required size of the meteorological input ensemble and makes it operationally feasible to generate a Bayesian ensemble forecast of large size. Such a forecast quantifies the total uncertainty, is well calibrated against the prior (climatic) distribution of predictand, possesses a Bayesian coherence property, constitutes a random sample of the predictand, and has an acceptable sampling error-which makes it suitable for rational decision making under uncertainty.

A Qualitative Case Study to Investigate the Technology Acceptance Experience Outlined in the TAM Using the Kubler-Ross Stages of Grieving and Acceptance

ERIC Educational Resources Information Center

Sotelo, Benjamin Eladio

2015-01-01

The Technology Acceptance Model (TAM) has been an important model for the understanding of end user acceptance regarding technology and a framework used in thousands of researched scenarios since publication in 1986. Similarly, the Kubler-Ross model of death and dying has also been used as a model for the study of acceptance within the medical…

Toward an Ontological Approach in Goal-Oriented Language Courseware Design and Its Implications for Technology-Independent Content Structuring

ERIC Educational Resources Information Center

Colpaert, Jozef

2006-01-01

The term "design" is being understood more and more as a methodological process, together with its acceptance as the result of such a process. As a process, it is a stage in the courseware engineering life cycle which primarily focuses on rendering the development process more effective and on enhancing the qualities of the finished system,…

Clinical decision support systems at the Vienna General Hospital using Arden Syntax: Design, implementation, and integration.

PubMed

Schuh, Christian; de Bruin, Jeroen S; Seeling, Walter

2015-12-01

The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years. We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance. Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration. Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted. Copyright © 2015 Elsevier B.V. All rights reserved.

Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer.

PubMed

Wood, Maree; Fonseca, Amara; Sampson, David; Kovendy, Andrew; Westhuyzen, Justin; Shakespeare, Thomas; Turnbull, Kirsty

2016-01-01

The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA). Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner. Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit ( n  = 20); Stage 3, template review ( n  = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients. The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency. It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.

Toni Morrison's Beloved: a journey through the pain of grief.

PubMed

Pass, Olivia McNeely

2006-01-01

This paper elucidates the structure of Toni Morrison's novel, Beloved, using the framework of human emotions in response to grieving and death as developed by Elisabeth Kubler-Ross. Through her studies of terminally ill patients, Kubler-Ross identified five stages when approaching death: denial and isolation, anger, bargaining, depression and acceptance. These stages accurately fill the process that the character Sethe experiences in the novel as she learns to accept her daughter's death.

Why was Relativity Accepted?

NASA Astrophysics Data System (ADS)

Brush, S. G.

Historians of science have published many studies of the reception of Einstein's special and general theories of relativity. Based on a review of these studies, and my own research on the role of the light-bending prediction in the reception of general relativity, I discuss the role of three kinds of reasons for accepting relativity (1) empirical predictions and explanations; (2) social-psychological factors; and (3) aesthetic-mathematical factors. According to the historical studies, acceptance was a three-stage process. First, a few leading scientists adopted the special theory for aesthetic-mathematical reasons. In the second stage, their enthusiastic advocacy persuaded other scientists to work on the theory and apply it to problems currently of interest in atomic physics. The special theory was accepted by many German physicists by 1910 and had begun to attract some interest in other countries. In the third stage, the confirmation of Einstein's light-bending prediction attracted much public attention and forced all physicists to take the general theory of relativity seriously. In addition to light-bending, the explanation of the advance of Mercury's perihelion was considered strong evidence by theoretical physicists. The American astronomers who conducted successful tests of general relativity became defenders of the theory. There is little evidence that relativity was `socially constructed' but its initial acceptance was facilitated by the prestige and resources of its advocates.

UAS Air Traffic Controller Acceptability Study-2: Effects of Communications Delays and Winds in Simulation

NASA Technical Reports Server (NTRS)

Comstock, James R., Jr.; Ghatas, Rania W.; Consiglio, Maria C.; Chamberlain, James P.; Hoffler, Keith D.

2016-01-01

This study evaluated the effects of Communications Delays and Winds on Air Traffic Controller ratings of acceptability of horizontal miss distances (HMDs) for encounters between UAS and manned aircraft in a simulation of the Dallas-Ft. Worth East-side airspace. Fourteen encounters per hour were staged in the presence of moderate background traffic. Seven recently retired controllers with experience at DFW served as subjects. Guidance provided to the UAS pilots for maintaining a given HMD was provided by information from self-separation algorithms displayed on the Multi-Aircraft Simulation System. Winds tested did not affect the acceptability ratings. Communications delays tested included 0, 400, 1200, and 1800 msec. For longer communications delays, there were changes in strategy and communications flow that were observed and reported by the controllers. The aim of this work is to provide useful information for guiding future rules and regulations applicable to flying UAS in the NAS.

The History of UTAUT Model and Its Impact on ICT Acceptance and Usage by Academicians

ERIC Educational Resources Information Center

Oye, N. D.; Iahad, N. A.; Rahim, N. Ab.

2014-01-01

This paper started with the review of the history of technology acceptance model from TRA to UTAUT. The expected contribution is to bring to lime light the current development stage of the technology acceptance model. Based on this, the paper examined the impact of UTAUT model on ICT acceptance and usage in HEIs. The UTAUT model theory was…

Molecular adaptations of Herbaspirillum seropedicae during colonization of the maize rhizosphere.

PubMed

Balsanelli, Eduardo; Tadra-Sfeir, Michelle Z; Faoro, Helisson; Pankievicz, Vânia Cs; de Baura, Valter A; Pedrosa, Fábio O; de Souza, Emanuel M; Dixon, Ray; Monteiro, Rose A

2016-09-01

Molecular mechanisms of plant recognition and colonization by diazotrophic bacteria are barely understood. Herbaspirillum seropedicae is a Betaproteobacterium capable of colonizing epiphytically and endophytically commercial grasses, to promote plant growth. In this study, we utilized RNA-seq to compare the transcriptional profiles of planktonic and maize root-attached H. seropedicae SmR1 recovered 1 and 3 days after inoculation. The results indicated that nitrogen metabolism was strongly activated in the rhizosphere and polyhydroxybutyrate storage was mobilized in order to assist the survival of H. seropedicae during the early stages of colonization. Epiphytic cells showed altered transcription levels of several genes associated with polysaccharide biosynthesis, peptidoglycan turnover and outer membrane protein biosynthesis, suggesting reorganization of cell wall envelope components. Specific methyl-accepting chemotaxis proteins and two-component systems were differentially expressed between populations over time, suggesting deployment of an extensive bacterial sensory system for adaptation to the plant environment. An insertion mutation inactivating a methyl-accepting chemosensor induced in planktonic bacteria, decreased chemotaxis towards the plant and attachment to roots. In summary, analysis of mutant strains combined with transcript profiling revealed several molecular adaptations that enable H. seropedicae to sense the plant environment, attach to the root surface and survive during the early stages of maize colonization. © 2015 Society for Applied Microbiology and John Wiley & Sons Ltd.

Alcohol Brief Interventions (ABIs) for male remand prisoners: protocol for development of a complex intervention and feasibility study (PRISM-A)

PubMed Central

Holloway, Aisha; Landale, Sarah; Ferguson, Jennifer; Newbury-Birch, Dorothy; Parker, Richard; Smith, Pam; Sheikh, Aziz

2017-01-01

Introduction In the UK, a significant proportion of male remand prisoners have alcohol problems. Alcohol Brief Interventions (ABIs) are an effective component of a population-level approach to harmful and hazardous drinking. ABIs have been shown to reduce the aggregate level of alcohol consumed and therefore reduce harm to the individual and to others. However, in relation to remand prisoners, there is no evidence as to how effective ABIs could be. The aims of this study are therefore to explore the feasibility and acceptability of an ABI for adult male remand prisoners and to develop an ABI for this group to be piloted in a future trial. Methods and analysis The study will comprise three stages. Stage 1: a cross-sectional survey of adult male remand and convicted prisoners (n=500) at one Scottish prison and one English prison will be undertaken to assess acceptability and feasibility of delivering an ABI, as well as prevalence rates of harmful, hazardous and dependent drinking. Stage 2: in-depth interviews will be conducted with a sample of remand prisoners (n=24) who undertook the survey (n=12 in Scotland; n=12 in England). Two focus groups (one in Scotland and one in England) with six to eight key stakeholders associated with alcohol-related healthcare provision in prisons will be conducted to explore views on barriers, facilitators and levers to ABI delivery. Stage 3: through formal intervention mapping, the analysed data will inform the refinement of an acceptable ABI that is feasible to deliver to male remand prisoners. Ethics and dissemination The project has been approved by the National Research Ethics Committee (NRES), National Offender Management System, Health Board Research and Development, Scottish Prison Service and ethics committee at The University of Edinburgh. Results will be published in peer-reviewed journals and presented at local, national and international conferences. PMID:28473514

A pen-based system to support pre-operative data collection within an anaesthesia department.

PubMed Central

Sanz, M. F.; Gómez, E. J.; Trueba, I.; Cano, P.; Arredondo, M. T.; del Pozo, F.

1993-01-01

This paper describes the design and implementation of a pen-based computer system for remote preoperative data collection. The system is envisaged to be used by anaesthesia staff at different hospital scenarios where pre-operative data are generated. Pen-based technology offers important advantages in terms of portability and human-computer interaction, as direct manipulation interfaces by direct pointing, and "notebook user interfaces metaphors". Being the human factors analysis and user interface design a vital stage to achieve the appropriate user acceptability, a methodology that integrates the "usability" evaluation from the earlier development stages was used. Additionally, the selection of a pen-based computer system as a portable device to be used by health care personnel allows to evaluate the appropriateness of this new technology for remote data collection within the hospital environment. The work presented is currently being realised under the Research Project "TANIT: Telematics in Anaesthesia and Intensive Care", within the "A.I.M.--Telematics in Health CARE" European Research Program. PMID:8130488

Moses presages Kubler-Ross: five stages in accepting death, as seen in the midrash.

PubMed

Berkowitz, M C; Knight, L

2001-11-01

This paper elucidates and explains an ancient midrash (rabbinic interpretation of a biblical text) through the lens of modern psychological theory. The midrash describes Moses' reactions to his approaching death. The paper points out that these reactions anticipate the five classic stages, described by Elizabeth Kubler-Ross, of coming to accept terminal illness: denial, anger, bargaining, depression and acceptance. The article shows the ancient rabbis' sensitivity to human feeling and the universal nature of human reaction through the dialogue and reactions they attribute to Moses. Finally, it shows how using this midrash offers a constructive model for approaching death, for Jewish and non-Jewish patients alike, as well as their caregivers.

Microprocessor-based control systems application in nuclear power plant critical systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shah, M.R.; Nowak, J.B.

Microprocessor-based control systems have been used in fossil power plants and are receiving greater acceptance for application in nuclear plants. This technology is not new but it does require unique considerations when applied to nuclear power plants. Sargent and Lundy (S and L) has used a microprocessor-based component logic control system (interposing Logic System) for safety- and non-safety-related components in nuclear power plants under construction overseas. Currently, S and L is in the design stage to replace an existing analog control system with a microprocessor-based control system in the U.S. The trend in the industry is to replace systems inmore » existing plants or design new power plants with microprocessor-based control systems.« less

Naval Airborne ESM Systems Analysis

DTIC Science & Technology

1989-09-01

basically three different kinds of receivers available in a very mature technoiogical state: a.) Crystal Video Receivers (CVR), b.) Instantaneous...filtered out by the narrow bandwidth of the video stage. This is referred to sometimes as "Processing Gain", and it is proportional to the ratio of the...Acceptance Bandwidth (Ba) to the Video Bandwidth (By), where gamma is the integration efficiency. Brf Bn = (3-3) Brf gamma 2 Bv Gamma varies from 0.5

Development of Souvenir Production Transaction Processing System

NASA Astrophysics Data System (ADS)

Rumambi, H.; Kaparang, R.; Lintong, J.

2018-01-01

This research aims to design a souvenir production transaction processing system for the craftsmen in North Sulawesi. The craftsmen make very simple recordings about souvenir production transactions and use documents that are not in accordance with the generally accepted accounting practices. This research uses qualitative method. The data is collected through interviews, observations, documents and literatures studies. The research stages are conducted in preliminary studies, data collection, data analyzed and system design. The design of system is built from chart of account, accounting cycle and documents as input and get processed in accounting recording. The outputs are financial statements. The system design provides benefits for the craftsmen in assessing the financial performance and getting financing from bank.

Helping the Child and the Family Cope with Death

ERIC Educational Resources Information Center

Carey, Ann

1977-01-01

The family counselor's role in the family's and child's struggle to accept death and all the anger which accompanies the various stages can mean the difference between acceptance without guilt or possible total family disintegration. (Author)

Accuracy of recorded tumor, node, and metastasis stage in a comprehensive cancer center.

PubMed

Brierley, James D; Catton, Pamela A; O'Sullivan, Brian; Dancey, Janet E; Dowling, Anthony J; Irish, Jonathan C; McGowan, Thomas S; Sturgeon, Jeremy F G; Swallow, Carol J; Rodrigues, George B; Panzarella, Tony

2002-01-15

The benefits of recording the tumor, node, and metastasis (TNM) stages of cancer patients are well accepted, but little is known about how accurately this is performed. An audit was performed to determine the accuracy of recorded stage and to act as a baseline before the implementation of an education program. All new patient referrals to Princess Margaret Hospital between July 1 and August 31, 1997, were reviewed. An audit panel composed of five health record technicians (HRTs) and 10 doctors was assembled. Each auditor reviewed 10% of the health record. If there was a discrepancy between the stage in the health record and the auditor stage, then the final stage was determined by the audit committee. Analysis of the agreement between the health record, the physician auditor, the HRT auditor, and the final stage was performed. A total of 855 patients were referred with a new diagnosis of a malignancy for which there was a TNM stage system; 833 patients (97.4%) had a stage assigned. There was agreement between the health record stage and final stage in 80% (95% confidence interval [CI], 77% to 82%) of cases for clinical stage, compared with 90% (95% CI, 87% to 92%) for pathologic stage. Of the major site groups, lung was the least accurately recorded. The most common major discrepancies were due to the recording of X when a definite category could be assigned. This audit demonstrates the importance of staging and provides impetus to develop staging guidelines and education programs.

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study.

PubMed

Seguin, Maureen; Dodds, Catherine; Mugweni, Esther; McDaid, Lisa; Flowers, Paul; Wayal, Sonali; Zomer, Ella; Weatherburn, Peter; Fakoya, Ibidun; Hartney, Thomas; McDonagh, Lorraine; Hunter, Rachael; Young, Ingrid; Khan, Shabana; Freemantle, Nick; Chwaula, Jabulani; Sachikonye, Memory; Anderson, Jane; Singh, Surinder; Nastouli, Eleni; Rait, Greta; Burns, Fiona

2018-04-01

Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. Twelve general practices and three community settings in London. HIV SSK return rate. Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.

High GMS score hypospadias: Outcomes after one- and two-stage operations.

PubMed

Huang, Jonathan; Rayfield, Lael; Broecker, Bruce; Cerwinka, Wolfgang; Kirsch, Andrew; Scherz, Hal; Smith, Edwin; Elmore, James

2017-06-01

Established criteria to assist surgeons in deciding between a one- or two-stage operation for severe hypospadias are lacking. While anatomical features may preclude some surgical options, the decision to approach severe hypospadias in a one- or two-stage fashion is generally based on individual surgeon preference. This decision has been described as a dilemma as outcomes range widely and there is lack of evidence supporting the superiority of one approach over the other. The aim of this study is to determine whether the GMS hypospadias score may provide some guidance in choosing the surgical approach used for correction of severe hypospadias. GMS scores were preoperatively assigned to patients having primary surgery for hypospadias. Those patients having surgery for the most severe hypospadias were selected and formed the study cohort. The records of these patients were reviewed and pertinent data collected. Complications requiring further surgery were assessed and correlated with the GMS score and the surgical technique used for repair (one-stage vs. two-stage). Eighty-seven boys were identified with a GMS score (range 3-12) of 10 or higher. At a mean follow-up of 22 months the overall complication rate for the cohort after final planned surgery was 39%. For intended one-stage procedures (n = 48) an acceptable result was achieved with one surgery for 28 patients (58%), with two surgeries for 14 (29%), and with three to five surgeries for six (13%). For intended two-stage procedures (n = 39) an acceptable result was achieved with two surgeries for 26 patients (67%), three surgeries for eight (21%), and four surgeries for three (8%). Two other patients having two-stage surgery required seven surgeries to achieve an acceptable result. Complication rates are summarized in the Table. The complication rates for GMS 10 patients were similar (27% and 33%, p = 0.28) for one- and two-stage repairs, respectively. GMS 11 patients having a one-stage repair had a significantly higher complication rate (69%) than those having a two-stage repair (29%) (p = 0.04). GMS 12 patients had the highest complication rate with a one-stage repair (80%) compared with a complication rate of 37% when a two-stage repair was used (p = 0.12). Guidelines to help standardize the surgical approach to severe hypospadias are needed. Staged surgery for GMS 11 and 12 patients may result in a lower complication rate but may not reduce the number of surgeries required for an acceptable result. Although further study is needed, the GMS score may be helpful for establishing such criteria. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Epidemiology and treatment of hepatocellular carcinoma in Thailand.

PubMed

Chonprasertsuk, Soonthorn; Vilaichone, Ratha-Korn

2017-04-01

Hepatocellular carcinoma (HCC) is the most frequent type of malignant liver tumor in Thailand. The high incidence rate of HCC reflects from chronic HBV infection in this endemic area. Some patients are asymptomatic at presentation whereas many of them presented at advanced stage of HCC with limited treatment options and grave outcome. The Barcelona Clinic Liver Cancer (BCLC) staging system and management allocation for HCC is widely accepted and used in many international guidelines including Thailand. Curative treatment is expected in early stage of HCC while palliative treatment, combination treatment and best supportive care are offered to advanced stage of HCC. The most effective strategy to prevent the development of HCC is prevention of HBV vertical transmission and treatment HBV or HCV infection. The purpose of this article is to update information of HCC in Thailand including epidemiology, diagnosis, clinical manifestation, and treatment. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cachexia: clinical features when inflammation drives malnutrition.

PubMed

Laviano, Alessandro; Koverech, Angela; Mari, Alessia

2015-11-01

Cachexia is a clinically relevant syndrome which impacts on quality of life, morbidity and mortality of patients suffering from acute and chronic diseases. The hallmark of cachexia is muscle loss, which is triggered by disease-associated inflammatory response. Cachexia is a continuum and therefore a staging system is needed. Initially, a three-stage system (i.e. pre-cachexia, cachexia and refractory cachexia) was proposed. More recent evidence supports the use of a five-stage classification system, based on patient's BMI and severity of weight loss, to better predict clinical outcome. Also, large clinical trials in cancer patients demonstrated that cachexia emerging during chemotherapy has greater influence on survival than weight loss at baseline. Therefore, becoming widely accepted is the importance of routinely monitoring patients' nutritional status to detect early changes and diagnose cachexia in its early phases. Although cachexia is associated with the presence of anabolic resistance, it has been shown that sustained yet physiological hyperaminoacidaemia, as well as the use of specific nutrients, is able to overcome impaired protein synthesis and revert catabolism. More importantly, clinical evidence demonstrates that preservation of nutritional status during chemotherapy or improvement of body weight after weight loss is associated with longer survival in cancer patients.

The feasibility of a group stress management Liver SMART intervention for patients with end-stage liver disease: A pilot study.

PubMed

Jutagir, Devika R; Saracino, Rebecca M; Cunningham, Amy; Foran-Tuller, Kelly A; Driscoll, Mary A; Sledge, William H; Emre, Sukru H; Fehon, Dwain C

2018-06-04

Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation. Twenty-nine English-speaking United Network for Organ Sharing-registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.ResultAttendance rate was 69.40%. The intervention was rated as "good" to "excellent" by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.Significance of resultsThe liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.

A Two-Stage Composition Method for Danger-Aware Services Based on Context Similarity

NASA Astrophysics Data System (ADS)

Wang, Junbo; Cheng, Zixue; Jing, Lei; Ota, Kaoru; Kansen, Mizuo

Context-aware systems detect user's physical and social contexts based on sensor networks, and provide services that adapt to the user accordingly. Representing, detecting, and managing the contexts are important issues in context-aware systems. Composition of contexts is a useful method for these works, since it can detect a context by automatically composing small pieces of information to discover service. Danger-aware services are a kind of context-aware services which need description of relations between a user and his/her surrounding objects and between users. However when applying the existing composition methods to danger-aware services, they show the following shortcomings that (1) they have not provided an explicit method for representing composition of multi-user' contexts, (2) there is no flexible reasoning mechanism based on similarity of contexts, so that they can just provide services exactly following the predefined context reasoning rules. Therefore, in this paper, we propose a two-stage composition method based on context similarity to solve the above problems. The first stage is composition of the useful information to represent the context for a single user. The second stage is composition of multi-users' contexts to provide services by considering the relation of users. Finally the danger degree of the detected context is computed by using context similarity between the detected context and the predefined context. Context is dynamically represented based on two-stage composition rules and a Situation theory based Ontology, which combines the advantages of Ontology and Situation theory. We implement the system in an indoor ubiquitous environment, and evaluate the system through two experiments with the support of subjects. The experiment results show the method is effective, and the accuracy of danger detection is acceptable to a danger-aware system.

MRT fuel element inspection at Dounreay

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gibson, J.

1997-08-01

To ensure that their production and inspection processes are performed in an acceptable manner, ie. auditable and traceable, the MTR Fuel Element Fabrication Plant at Dounreay operates to a documented quality system. This quality system, together with the fuel element manufacturing and inspection operations, has been independently certified to ISO9002-1987, EN29002-1987 and BS5750:Pt2:1987 by Lloyd`s Register Quality Assurance Limited (LRQA). This certification also provides dual accreditation to the relevant German, Dutch and Australian certification bodies. This paper briefly describes the quality system, together with the various inspection stages involved in the manufacture of MTR fuel elements at Dounreay.

Nurses views on accepting the creation of a nurses’ health monitoring system

PubMed Central

Rasoulzadeh, Nasrin; Abbaszadeh, Abbas; Zaefarian, Reza; Khounraz, Fariba

2017-01-01

Background Nurses’ health is often accompanied by various dangers due to the nature of their career. Therefore, it is required to monitor their health. Based on designing any system, users’ views should be investigated relative to the usefulness, necessity and acceptance of the system. Then, a designing and implementing process is conducted. Objective To investigate nurses’ views on accepting the creation of a Nurses’ Health Monitoring System. Methods This cross-sectional study was conducted in 2015. Sample size was 586 nurses of Shahid Beheshti University of Medical Sciences. Sampling was conducted using multi-stage random sampling method. Research tool was a two-section researcher-made questionnaire. In the first section, demographic data were studied and in the second section, a twelve-item questionnaire was presented based on technology acceptance model. Five-item questions were regulated on perceived usefulness (PU) and perceived ease of use (PEU) and views towards creating this system. Validity of the questionnaire was approved by content validity and content validity index and its reliability was approved by Cronbach’s alpha. Data were analyzed using SPSS16 and descriptive statistics (frequency distribution, percentage, mean). Results The majority of participants (75.3%) were females between 25–35 years of age (44.4%) and (58.2%) were married. Mean work experience was 11.5±8.19. Mean perceived usefulness (PU) (17.36±2.66) and perceived ease of use (PEU) (16.75±2.65) and views towards using a Nurses’ Health Monitoring System was (16.220±3.05). Conclusion Over two-thirds of nurses demonstrated perceived usefulness and perceived ease of use as well as positive views towards creating a nurses’ health monitoring system. It is recommended to design and implement a nurses’ health monitoring system based on local culture of Iranian nurses using IT in the health sector. PMID:28713521

Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

PubMed

Hindia, M N; Rahman, T A; Ojukwu, H; Hanafi, E B; Fattouh, A

2016-01-01

As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness.

Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks

PubMed Central

Hindia, M. N.; Rahman, T. A.; Ojukwu, H.; Hanafi, E. B.; Fattouh, A.

2016-01-01

As the enterprise of the “Internet of Things” is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application’s priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness. PMID:27152423

Unmet needs in obesity management: From guidelines to clinic.

PubMed

Ritten, Angela; LaManna, Jacqueline

2017-10-01

Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

Development and validation of a disease-specific health-related quality of life measure, the LupusQol, for adults with systemic lupus erythematosus.

PubMed

McElhone, Kathleen; Abbott, Janice; Shelmerdine, Joanna; Bruce, Ian N; Ahmad, Yasmeen; Gordon, Caroline; Peers, Kate; Isenberg, David; Ferenkeh-Koroma, Ada; Griffiths, Bridget; Akil, Mohamed; Maddison, Peter; Teh, Lee-Suan

2007-08-15

To develop and validate a disease-specific health-related quality of life (HRQOL) instrument for adults with systemic lupus erythematosus (SLE). The work consisted of 6 stages. Stage 1 included item generation for questionnaire content from semistructured interviews with SLE patients. In stage 2 item selection for the draft questionnaire was performed by thematic analysis of the patient interview transcripts and expert panel agreement. In stage 3 the content validity of the draft questionnaire was assessed by patients completing the questionnaire and providing critical feedback. In stages 4 and 5 construct validity and internal reliability of the 3 versions of the LupusQoL were evaluated using principal component analysis with varimax rotation and Cronbach's alpha coefficients, respectively. In stage 6 discriminatory validity, concurrent validity, and test-retest reliability were evaluated. Stages 1, 2, and 3 resulted in a preliminary instrument containing 63 items. In stage 4, 8 domains were identified. This factor structure, accounting for 82% of the variance, was confirmed in stage 5. The domains and Cronbach's alpha coefficients were physical health (0.94), emotional health (0.94), body image (0.89), pain (0.92), planning (0.93), fatigue (0.88), intimate relationships (0.96), and burden to others (0.94). Discriminant validity was demonstrated for different levels of disease activity (British Isles Lupus Assessment Group Index) and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). High correlations (r = 0.71-0.79) between comparable domains of the Short Form 36 and the LupusQoL assured acceptable concurrent validity. Good test-retest reliability (r = 0.72-0.93) was demonstrated. The LupusQoL is a validated SLE-specific HRQOL instrument with 34 items across 8 domains defined by patients as being important.

Grief elaboration in families with handicapped member.

PubMed

Calandra, C; Finocchiaro, G; Raciti, L; Alberti, A

1992-01-01

Families with handicapped member seem to follow the same five stages (rejection and isolation, anger, dealing with the problem, depression, acceptance) of Kubler-Ross grief elaboration theory while dealing with the narcissistic wound of a handicapped child. Some of these families show a block in one of the stages. The effort of psychotherapy is to remove the block and let them reach the last stage. In this paper families under systemic psychotherapeutic treatment are analyzed, who had in common the birth of a child with low or modest invalidating signs and psychotic or autistic features. The families structure did not show the characteristics of a psychotic family. Nevertheless either one or both parents ignored the evidence of their child disease and they built a "disease-incongrous" wait around the child, trying to push away the painful reality. The authors explain the importance of this approach for the improvement of the autistic traits.

Predicting the Operational Acceptability of Route Advisories

NASA Technical Reports Server (NTRS)

Evans, Antony; Lee, Paul

2017-01-01

NASA envisions a future Air Traffic Management system that allows safe, efficient growth in global operations, enabled by increasing levels of automation and autonomy. In a safety-critical system, the introduction of increasing automation and autonomy has to be done in stages, making human-system integrated concepts critical in the foreseeable future. One example where this is relevant is for tools that generate more efficient flight routings or reroute advisories. If these routes are not operationally acceptable, they will be rejected by human operators, and the associated benefits will not be realized. Operational acceptance is therefore required to enable the increased efficiency and reduced workload benefits associated with these tools. In this paper, the authors develop a predictor of operational acceptability for reroute advisories. Such a capability has applications in tools that identify more efficient routings around weather and congestion and that better meet airline preferences. The capability is based on applying data mining techniques to flight plan amendment data reported by the Federal Aviation Administration and data on requested reroutes collected from a field trial of the NASA developed Dynamic Weather Routes tool, which advised efficient route changes to American Airlines dispatchers in 2014. 10-Fold cross validation was used for feature, model and parameter selection, while nested cross validation was used to validate the model. The model performed well in predicting controller acceptance or rejection of a route change as indicated by chosen performance metrics. Features identified as relevant to controller acceptance included the historical usage of the advised route, the location of the maneuver start point relative to the boundaries of the airspace sector containing the maneuver start (the maneuver start sector), the reroute deviation from the original flight plan, and the demand level in the maneuver start sector. A random forest with forty trees was the best performing of the five models evaluated in this paper.

Application of polyimide actuator rod seals

NASA Technical Reports Server (NTRS)

Watermann, A. W.; Gay, B. F.; Robinson, E. D.; Srinath, S. K.; Nelson, W. G.

1972-01-01

Development of polyimide two-stage hydraulic actuator rod seals for application in high-performance aircraft was accomplished. The significant portion of the effort was concentrated on optimization of the chevron and K-section second-stage seal geometries to satisfy the requirements for operation at 450 K (350 F) with dynamic pressure loads varying between 200 psig steady-state and 1500 psig impulse cycling. Particular significance was placed on reducing seal gland dimension by efficiently utilizing the fatigue allowables of polyimide materials. Other objectives included investigation of pressure balancing techniques for first-stage polyimide rod seals for 4000 psig 450 K(350 F) environment and fabrication of a modular retainer for the two-stage combination. Seals were fabricated in 0.0254 m (1.0in.) and 0.0635 m (2.5in.) sizes and tested for structural integrity, frictional resistance, and endurance life. Test results showed that carefully designed second stages using polyimides could be made to satisfy the dynamic return pressure requirements of applications in high-performance aircraft. High wear under full system pressure indicated that further research is necessary to obtain an acceptable first-stage design. The modular retainer was successfully tested and showed potential for new actuator applications.

Pollution reduction technology program for turboprop engines

NASA Technical Reports Server (NTRS)

Tomlinson, J. G.

1977-01-01

The reduction of CO, HC, and smoke emissions while maintaining acceptable NO(x) emissions without affecting fuel consumption, durability, maintainability, and safety was accomplished. Component combustor concept screening directed toward the demonstration of advanced combustor technology required to meet the EPA exhaust emissions standards for class P2 turboprop engines was covered. The combustion system for the Allison 501-D22A engine was used, and three combustor design concepts - reverse flow, prechamber, and staged fuel were evaluated.

Persuasion stage in adoption theory: a cognitive response-cognitive structure assessment of source credibility and tax-incentive effects on consumer decision making for residential solar systems. [Suburbs of Baltimore

DOE Office of Scientific and Technical Information (OSTI.GOV)

Batory, S.S.

1981-01-01

The research objective was to learn more about the consumer's acceptance or rejection process toward a major residential energy innovation, a solar-generated water heating system. An experiment was conducted that evaluated one aspect of solar's commercialization, the persuasion stage in new-product-adoption decision making. A test of source credibility and monetary incentive effects on the consumer's decision-making processes was carried out. The experiment contained two message sources: the Department of Energy (a high credibility source) and a homebuilder (a moderate credibility source), and three levels of incentives, a tax credit equal to 40% of the solar unit purchase price, a 20%more » tax credit, and no tax credit. Subjects were randomly assigned to either a control group or one of six experimental treatments in a 2 x 3 fixed-effects factorial design. Subjects were 226 adult homeowners drawn from the suburbs of Baltimore, Maryland. The research postulated and tested a process of acceptance or rejection of innovations which was based on a cognitive-response/cognitive-structure paradigm of decision making. This process is called the persuasion stage by adoption theorists. Cognitive responses, beliefs, attitudes, and behavioral measures were the dependent variables. Consumers were shown to confront or debate incoming information by comparing it to their existing cognitive structure. This comparison process generated cognitive responses which led to changes in beliefs, attitudes, and behavior toward the innovation. The findings confirm that the federal government's intervention in the marketplace is having a favorable effect on the adoption decision process toward solar-generated water heating.« less

The IJHPR publishes its 100th article, and other momentous milestones.

PubMed

Rosen, Bruce; Israeli, Avi

2013-12-19

The Israel Journal of Health Policy Research (IJHPR) was launched in January 2012 and it is now publishing its 100th article. It was accepted into PubMed after only six months of publication and it has now also been accepted by Thomson Reuters for inclusion in the Web of Science as well as the Social Science Citation Index. It is rare for a new journal to reach these milestones at such an early stage in its development.One of the key factors in the journal's acceptance into these prestigious databases has been its unique national/international approach - exploring both what Israel can learn from health systems in other countries and what other countries can learn from Israeli health care. Another key factor has been its ability to attract high quality contributions from virtually all of the Israeli universities and research centers involved in health policy. A third important factor has been the journal's ability to engage leading international scholars as contributors and/or editorial board members.

Second-stage labor: how long is too long?

PubMed

Leveno, Kenneth J; Nelson, David B; McIntire, Donald D

2016-04-01

The management of labor has come under increased scrutiny due to the rapid escalation of cesarean delivery in the United States. A workshop of the Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the American Congress of Obstetricians and Gynecologists was convened to address the rising cesarean delivery rates and one of their recommendations was that the accepted upper limit of the second stage of labor should be increased to ≥4 hours in nulliparous women with epidural analgesia and to ≥3 hours in parous women with epidural. This led to the inaugural Obstetric Care Consensus series document, "Safe Prevention of the Primary Cesarean Delivery," wherein the workshop recommendations on second-stage labor were promulgated nationally. The result is that the now acceptable maximum length of the second stage of labor exceeds the obstetric precepts that have been in use for >50 years. In this Clinical Opinion, we review the evidence on infant safety, vis-à-vis length of the second stage of labor. Our examination of the evidence begins at the outset of the 20th century and culminates in the very recent (2014) recommendation to abandon the long accepted obstetric paradigm that second-stage labor >3 hours in nulliparous women with labor epidural is unsafe for the unborn infant. We conclude that the currently available evidence fails to support the Obstetric Care Consensus position that longer second-stage labor is safe for the unborn infant. Indeed, the evidence suggests quite the opposite. We suggest that when infant safety is at stake the evidence should be robust before a new clinical road is taken. The evidence is not robust. Copyright © 2016 Elsevier Inc. All rights reserved.

Role of Chemotherapy and Targeted Therapy in Early-Stage Non-Small Cell Lung Cancer.

PubMed

Gadgeel, Shirish M

2017-01-01

On the basis of several randomized trials and meta-analyses, adjuvant chemotherapy is the accepted standard of care for certain patients with early-stage non-small cell lung cancer (NSCLC). Patients with stage II, IIIA, or large (≥ 4 cm) IB tumors are candidates for adjuvant chemotherapy. The survival improvement with adjuvant chemotherapy is approximately 5% at 5 years, though certain trials have suggested that it can be 8% to 10%. Neoadjuvant chemotherapy also has shown a survival advantage, though the volume of data with this approach is far less than that of adjuvant chemotherapy. The combination of cisplatin and vinorelbine is the most well-studied regimen, but current consensus is to use four cycles of any of the platinum-based chemotherapy regimens commonly used as front-line therapy for patients with advanced-stage NSCLC. Trials to define biomarkers that can predict benefit from adjuvant chemotherapy have not been successful, but results of other such trials are still awaited. On the basis of the benefit observed with targeted agents in patients with advanced-stage disease and driver genetic alterations in their tumors, ongoing trials are evaluating the utility of these targeted agents as adjuvant therapy. Similarly, clinical benefit observed with checkpoint inhibitors has prompted assessment of these drugs in patients with early-stage NSCLC. It is very likely, in the future, that factors other than the anatomy of the tumor will be used to select patients with early-stage NSCLC for systemic therapy and that the choice of systemic therapy will extend beyond platinum-based chemotherapy.

Structure, texture, and mechanical properties of an MA2-1hp magnesium alloy after two-stage equal-channel angular pressing and intermediate annealing

NASA Astrophysics Data System (ADS)

Serebryany, V. N.; Perezhogin, V. Yu.; Raab, G. I.; Kopylov, V. I.; Tabachkova, N. Yu.; Sirotinkin, V. P.; Dobatkin, S. V.

2015-01-01

The effect of two-stage equal-channel angular pressing (ECAP) on the microstructure, the texture, and the mechanical properties of an MA2-1hp magnesium alloy is analyzed. ECAP leads to the formation of a submicrocrystalline structure with an average grain size of 640 nm, which includes Mg17Al12 phase particles with an average grain size of 240 nm and a volume fracture of 5.5%. A scattered tilted basal texture forms after ECAP, and its experimental pole figures are used for calculating orientation distribution functions and determining the volume fractions of the main orientations and the Schmid factors for different deformation systems. An increased activation of basal slip is found after both the first and the second stages of ECAP. As a result of two-stage ECAP, the strength properties of the alloy that correspond to the minimum acceptable values achieved by direct compression are obtained. Ductility is 44 and 18% after the first stage of ECAP plus subsequent annealing and after the second stage, respectively, which is almost four and two times higher than the initial value. The resulting strength mechanical properties of the alloy after the first and the second ECAP stages are analyzed using the Hall-Petch relation.

Characterization of perineural invasion as a component of colorectal cancer staging.

PubMed

Ueno, Hideki; Shirouzu, Kazuo; Eishi, Yoshinobu; Yamada, Kazutaka; Kusumi, Takaya; Kushima, Ryoji; Ikegami, Masahiro; Murata, Akihiko; Okuno, Kiyotaka; Sato, Toshihiko; Ajioka, Yoichi; Ochiai, Atsushi; Shimazaki, Hideyuki; Nakamura, Takahiro; Kawachi, Hiroshi; Kojima, Motohiro; Akagi, Yoshito; Sugihara, Kenichi

2013-10-01

Perineural invasion (PN) in colorectal cancer (CRC) is a site-specific prognostic marker, as mentioned by the AJCC Cancer Staging Manual, but it remains to be clearly defined. We aimed to identify an optimal characterization of PN as a component of cancer staging. On the basis of the anatomic features of the nervous system of the large bowel, site-specific pathologic criteria were assigned to PN according to the location of PN. Multi-institutional pathologic review based on these criteria was performed for 962 patients with stage I to III CRC at 2 institutions (1999 to 2004, cohort 1) and 1883 patients from 8 other institutions (2000 to 2004, cohort 2). In cohort 1, intramural and extramural PN were observed in 152 and 101 patients, respectively, which had a different impact on disease-free survival (hazard ratio, 2.6 [1.9 to 3.5] vs. 4.7 [3.4 to 6.5], respectively). A 3-tiered grading system (Pn0; Pn1a, intramural PN; Pn1b, extramural PN) distinguished 5-year disease-free survival as 88%, 70%, and 48%, respectively; and multivariate analysis identified PN grade as a significant prognostic marker independent of T or N stage. These results were similar in cohort 2. Interinstitutional difference of the prognostic impact of PN grade was acceptably small among all institutions. Interobserver study among 6 gastrointestinal pathologists showed superior judgment reproducibility for PN compared with vascular invasion. The results of our study indicate that PN is an important prognostic marker in CRC. The value of cancer staging could be enhanced by PN assessment using site-specific criteria and a simple grading system based on PN location within the bowel.

Prediction of forces and moments for flight vehicle control effectors. Part 1: Validation of methods for predicting hypersonic vehicle controls forces and moments

NASA Technical Reports Server (NTRS)

Maughmer, Mark D.; Ozoroski, L.; Ozoroski, T.; Straussfogel, D.

1990-01-01

Many types of hypersonic aircraft configurations are currently being studied for feasibility of future development. Since the control of the hypersonic configurations throughout the speed range has a major impact on acceptable designs, it must be considered in the conceptual design stage. The ability of the aerodynamic analysis methods contained in an industry standard conceptual design system, APAS II, to estimate the forces and moments generated through control surface deflections from low subsonic to high hypersonic speeds is considered. Predicted control forces and moments generated by various control effectors are compared with previously published wind tunnel and flight test data for three configurations: the North American X-15, the Space Shuttle Orbiter, and a hypersonic research airplane concept. Qualitative summaries of the results are given for each longitudinal force and moment and each control derivative in the various speed ranges. Results show that all predictions of longitudinal stability and control derivatives are acceptable for use at the conceptual design stage. Results for most lateral/directional control derivatives are acceptable for conceptual design purposes; however, predictions at supersonic Mach numbers for the change in yawing moment due to aileron deflection and the change in rolling moment due to rudder deflection are found to be unacceptable. Including shielding effects in the analysis is shown to have little effect on lift and pitching moment predictions while improving drag predictions.

76 FR 82103 - Airworthiness Directives; General Electric Company (GE) GE90-110B1 and GE90-115B Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... of small pieces from the HPC stages 1-2 seal teeth and two shop findings of cracks in the seal teeth... stages 1-2 seal teeth of the HPC stages 2-5 spool for cracks. This AD only allows installation of either HPC stator stage 1 interstage seals that are pregrooved or previously worn seals with acceptable wear...

Prioritizing guideline topics: development and evaluation of a practical tool.

PubMed

Ketola, Eeva; Toropainen, Erja; Kaila, Minna; Luoto, Riitta; Mäkelä, Marjukka

2007-08-01

A clear process for selecting and adopting clinical practice guidelines in the new topic areas is needed. The aim of this study is to design and develop a practical tool to assess guideline topics that have been suggested to the organization responsible for producing guidelines. We carried out an iterative development, feasibility and validation study of a guideline topic prioritization tool. The setting included the guideline producer organization and the tax-funded health care system. In the first stage of the tool development, participants were researchers, members of the Current Care Board and experts from health care organizations. In the second stage, the evaluation was done internally within the project by three independent reviewers. The main outcome measures were responses to an evaluation questionnaire, qualitative process feedback and analysis of the performance of the instrument on a random set of guidelines. Evaluations by three independent reviewers revealed good agreement and face validity with respect to its feasibility as a planning tool at the guideline board level. Feedback from board members suggested that the instrument is useful in prioritizing guideline topics. This instrument was accepted for use by the Board. Further developments are needed to ensure feedback and acceptability of the instrument by those proposing topics.

A Decade of Stage Fright Research (1960-1969): A Synthesis.

ERIC Educational Resources Information Center

Munger, Daniel I.

The synthesis of stage fright research by Clevenger (1959) has been widely accepted and used by writers in the speech field. Since 1959, additional research has appeared which warrants an updating of Clevenger's synthesis. Such a followup synthesis is the purpose of this paper. It assumes familiarity with the first article. Measuring stage fright…

Facts and controversies in mixed connective tissue disease.

PubMed

Martínez-Barrio, Julia; Valor, Lara; López-Longo, F Javier

2018-01-12

Mixed connective tissue disease (MCTD) is a systemic autoimmune rheumatic disease (SARD) characterised by the combination of clinical manifestations of systemic lupus erythematosus (SLE), cutaneous systemic sclerosis (SSc) and polymyositis-dermatomyositis, in the presence of elevated titers of anti-U1-RNP antibodies. Main symptoms of the disease are polyarthritis, hand oedema, Raynaud's phenomenon, sclerodactyly, myositis and oesophageal hypomobility. Although widely discussed, most authors today accept MCTD as an independent entity. Others, however, suggest that these patients may belong to subgroups or early stages of certain definite connective diseases, such as SLE or SSc, or are, in fact, SARD overlap syndromes. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Energy storage devices for future hybrid electric vehicles

NASA Astrophysics Data System (ADS)

Karden, Eckhard; Ploumen, Servé; Fricke, Birger; Miller, Ted; Snyder, Kent

Powertrain hybridization as well as electrical energy management are imposing new requirements on electrical storage systems in vehicles. This paper characterizes the associated vehicle attributes and, in particular, the various levels of hybrids. New requirements for the electrical storage system are derived, including: shallow-cycle life, high dynamic charge acceptance particularly for regenerative braking and robust service life in sustained partial-state-of-charge usage. Lead/acid, either with liquid or absorptive glass-fibre mat electrolyte, is expected to remain the predominant battery technology for 14 V systems, including micro-hybrids, and with a cost-effective battery monitoring system for demanding applications. Advanced AGM batteries may be considered for mild or even medium hybrids once they have proven robustness under real-world conditions, particularly with respect to cycle life at partial-states-of-charge and dynamic charge acceptance. For the foreseeable future, NiMH and Li-ion are the dominating current and potential battery technologies for higher-functionality HEVs. Li-ion, currently at development and demonstration stages, offers attractive opportunities for improvements in performance and cost. Supercapacitors may be considered for pulse power applications. Aside from cell technologies, attention to the issue of system integration of the battery into the powertrain and vehicle is growing. Opportunities and challenges for potential "battery pack" system suppliers are discussed.

Health care needs in end-stage COPD: a structured literature review.

PubMed

Habraken, Jolanda M; Willems, Dick L; de Kort, Susanne J; Bindels, Patrick J E

2007-10-01

To give an overview of relevant literature regarding health care needs in end-stage COPD and to identify specific areas where knowledge about needs is still lacking. We conducted a structured literature review. We used Bradshaw's classification system. Seventy-seven publications were found. Ten publications were included in the review. The results reported cover a wide range of subjects, all regarded as health care needs. Most reported on 'felt need', i.e. needs that are mentioned by patients themselves. Results on 'normative need' (based on expert judgement) were lacking. The literature about the health care needs of patients in the end-stage of COPD is sparse, and there is no commonly accepted definition of health care needs. Looking at the increasing demand for end of life care for COPD patients, there is a clear need for further research on this subject. We especially need to focus on agreement between experts and professionals so that guidelines can be developed. To attend to the unfulfilled needs of end-stage COPD patients, the delivery of health care should be re-examined carefully.

An engineering approach to controlling indoor air quality.

PubMed

Woods, J E

1991-11-01

Evidence is accumulating that indicates air quality problems in residential and commercial buildings are nearly always associated with inadequacies in building design and methods of operation. Thus, the very systems depended on to control the indoor environment can become indirect sources of contamination if diligence is not exercised at each stage of a building's life: a) planning and design, b) construction and commissioning, c) operation, and d) demolition or renovation. In this paper, an engineering perspective is presented in which the existing building stock is characterized in terms of its environmental performance. Preliminary data indicate that 20 to 30% of the existing buildings have sufficient problems to manifest as sick-building syndrome or building-related illness, while another 10 to 20% may have undetected problems. Thus, only about 50 to 70% of the existing buildings qualify as healthy buildings. Two methods and three mechanisms of control are described to achieve "acceptable" indoor air quality: source control and exposure control. If sources cannot be removed, some level of occupant exposure will result. To control exposures with acceptable values, the primary sensory receptors of the occupants (i.e., thermal, ocular, auditory, and olfactory) cannot be excessively stimulated. The three exposure control mechanisms are conduction, radiation, and convection. To achieve acceptable occupant responses, it is often practical to integrate the mechanisms of radiation and convection in heating, ventilating, and air conditioning systems that are designed to provide acceptable thermal, acoustic, and air quality conditions within occupied spaces.(ABSTRACT TRUNCATED AT 250 WORDS)

An engineering approach to controlling indoor air quality.

PubMed Central

Woods, J E

1991-01-01

Evidence is accumulating that indicates air quality problems in residential and commercial buildings are nearly always associated with inadequacies in building design and methods of operation. Thus, the very systems depended on to control the indoor environment can become indirect sources of contamination if diligence is not exercised at each stage of a building's life: a) planning and design, b) construction and commissioning, c) operation, and d) demolition or renovation. In this paper, an engineering perspective is presented in which the existing building stock is characterized in terms of its environmental performance. Preliminary data indicate that 20 to 30% of the existing buildings have sufficient problems to manifest as sick-building syndrome or building-related illness, while another 10 to 20% may have undetected problems. Thus, only about 50 to 70% of the existing buildings qualify as healthy buildings. Two methods and three mechanisms of control are described to achieve "acceptable" indoor air quality: source control and exposure control. If sources cannot be removed, some level of occupant exposure will result. To control exposures with acceptable values, the primary sensory receptors of the occupants (i.e., thermal, ocular, auditory, and olfactory) cannot be excessively stimulated. The three exposure control mechanisms are conduction, radiation, and convection. To achieve acceptable occupant responses, it is often practical to integrate the mechanisms of radiation and convection in heating, ventilating, and air conditioning systems that are designed to provide acceptable thermal, acoustic, and air quality conditions within occupied spaces.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1821369

14 CFR 431.35 - Acceptable reusable launch vehicle mission risk.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Acceptable reusable launch vehicle mission risk. 431.35 Section 431.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... launch flight through orbital insertion of an RLV or vehicle stage or flight to outer space, whichever is...

14 CFR 431.35 - Acceptable reusable launch vehicle mission risk.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Acceptable reusable launch vehicle mission risk. 431.35 Section 431.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... launch flight through orbital insertion of an RLV or vehicle stage or flight to outer space, whichever is...

14 CFR 431.35 - Acceptable reusable launch vehicle mission risk.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Acceptable reusable launch vehicle mission risk. 431.35 Section 431.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... launch flight through orbital insertion of an RLV or vehicle stage or flight to outer space, whichever is...

14 CFR 431.35 - Acceptable reusable launch vehicle mission risk.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Acceptable reusable launch vehicle mission risk. 431.35 Section 431.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... launch flight through orbital insertion of an RLV or vehicle stage or flight to outer space, whichever is...

14 CFR 431.35 - Acceptable reusable launch vehicle mission risk.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Acceptable reusable launch vehicle mission risk. 431.35 Section 431.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... launch flight through orbital insertion of an RLV or vehicle stage or flight to outer space, whichever is...

Genetic testing for the risk of developing late effects among survivors of childhood cancer: Consumer understanding, acceptance, and willingness to pay.

PubMed

Georgiou, Gabrielle; Wakefield, Claire E; McGill, Brittany C; Fardell, Joanna E; Signorelli, Christina; Hanlon, Lucy; Tucker, Kathy; Patenaude, Andrea F; Cohn, Richard J

2016-09-15

Genetic testing to determine cancer survivors' risk of developing late effects from their cancer treatment will be increasingly used in survivorship care. This 2-stage study with 64 survivors of childhood cancer and their parents investigated the preferences and acceptability of testing among those who may be at risk of developing late effects. The first stage (Stage 1) identified the most commonly perceived benefits and concerns regarding genetic testing for the risk of late effects among 24 participants. In Stage 2, during interviews, 20 survivors (55% of whom were female; mean age, 26.0 years [range, 18-39 years]; standard deviation [SD], 0.80) and 20 parents (55% of whom were male; mean age of child survivor, 14.2 years [range, 10-19 years]; SD, 0.79) rated the 7 most common benefits and concerns from those identified in Stage 1. Interviews were transcribed verbatim and analyzed. Decisional balance ratios were calculated by dividing the participants' average concerns scores with the average benefits scores. Genetic testing for late effects was highly acceptable: 95% of participants leaned toward testing, and the majority (65.9%) would pay up to Australian $5000. The majority (97.2%) reported it was acceptable to wait for up to 6 months to receive results, and to be offered testing immediately after treatment or when the survivor reached adulthood (62.9%). Survivors and parents had a highly positive decisional balance (Mean (M), 0.5 [SD, 0.38] and M, 0.5 [SD, 0.39], respectively), indicating that perceived benefits outweighed concerns. Although to our knowledge clinical efficacy has yet to be clearly demonstrated, survivors and parents described positive interest in genetic testing for the risk of developing late effects. Perceived benefits outweighed harms, and the majority of participants would be willing to pay, and wait, for testing. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2876-2885. © 2016 American Cancer Society. © 2016 American Cancer Society.

Design of the ILC RTML Extraction Lines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seletskiy, S.; Tenenbaum, P.; Walz, D.

2011-10-17

The ILC [1] Damping Ring to the Main Linac beamline (RTML) contains three extraction lines (EL). Each EL can be used both for an emergency abort dumping of the beam and tune-up continual train-by-train extraction. Two of the extraction lines are located downstream of the first and second stages of the RTML bunch compressor, and must accept both compressed and uncompressed beam with energy spreads of 2.5% and 0.15%, respectively. In this paper we report on an optics design that allowed minimizing the length of the extraction lines while offsetting the beam dumps from the main line by the distancemore » required for acceptable radiation levels in the service tunnel. The proposed extraction lines can accommodate beams with different energy spreads while at the same time providing the beam size acceptable for the aluminum dump window. The RTML incorporates three extraction lines, which can be used for either an emergency beam abort or for a train-by-train extraction. The first EL is located downstream of the Damping Ring extraction arc. The other two extraction lines are located downstream of each stage of the two-stage bunch compressor. The first extraction line (EL1) receives 5GeV beam with an 0.15% energy spread. The extraction line located downstream of the first stage of bunch compressor (ELBC1) receives both compressed and uncompressed beam, and therefore must accept beam with both 5 and 4.88GeV energy, and 0.15% and 2.5% energy spread, respectively. The extraction line located after the second stage of the bunch compressor (ELBC2) receives 15GeV beam with either 0.15 or 1.8% energy spread. Each of the three extraction lines is equipped with the 220kW aluminum ball dump, which corresponds to the power of the continuously dumped beam with 5GeV energy, i.e., the beam trains must be delivered to the ELBC2 dump at reduced repetition rate.« less

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation.

PubMed

Scobbie, Lesley; McLean, Donald; Dixon, Diane; Duncan, Edward; Wyke, Sally

2013-05-24

Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke. G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation. G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process. G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Use of the ‘Accountability for Reasonableness’ Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country

PubMed Central

Maree, Jonathan David; Chirehwa, Maxwell T.; Benatar, Solomon R.

2016-01-01

Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the ‘Accountability for Reasonableness’ (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion. The guidelines were primarily premised on patients being transplantable. We examined whether the revised guidelines enhanced fairness of dialysis resource allocation. This is a descriptive study of 1101 end stage kidney failure patients presenting to a tertiary renal unit in a middle-income country, evaluated for dialysis treatment over a seven-year period. The Assessment Committee used the accountability for reasonableness-based guidelines to allocate patients to one of three assessment groups. Category 1 patients were guaranteed renal replacement therapy, Category 3 patients were palliated, and Category 2 were offered treatment if resources allowed. Only 25.2% of all end stage kidney disease patients assessed were accepted for renal replacement treatment. The majority of patients (48%) were allocated to Category 2. Of 134 Category 1 patients, 98% were accepted for treatment while 438 (99.5%) Category 3 patients were excluded. Compared with those palliated, patients accepted for dialysis treatment were almost 10 years younger, employed, married with children and not diabetic. Compared with our previous selection process our current method of priority setting based on procedural fairness arguably resulted in more equitable allocation of treatment but, more importantly, it is a model that is morally, legally and ethically more defensible. PMID:27701466

Developing a Game Interface to Assess Risk Perception with Respect to Two Key Dimensions of Risk (Frequency and Severity) in Contexts Where Risks Are Elevated from Their Accepted, "Typical" Values.

PubMed

Goodman, William M; Ma, Zhenfeng; Andrade, Angie

2015-06-01

This four-stage study culminated in a game interface designed to calibrate people's perceptions of net risk (combining frequency and severity), in contexts where risks are elevated from their accepted, "typical" values, as when avalanche threats elevate the risks of "skiing" above levels skiers normally accept. Risk prompts are displayed dynamically, in naturalistic language, and not, for example, as static displays of dollar amounts or probabilities. Individual differences are measured. In Stage 1 (pilot), focus groups (n=9) piloted procedures, visual prompts, and examples of contexts where risks elevated from the "usual," for use in upcoming stages. In Stage 2 (exploratory), participants (primarily students; n=119; mean age, 20.1 years; 64 percent male) were assigned to risk contexts, answered demographic and risk-history questions, and then matched risk-description prompts to perceived "appropriate" levels along an ordinal risk scale. Descriptive measures and graphs showed response distributions; chi-squared analyses compared responses for different demographics. In Stage 3 (manipulating "cards"), participants (n=80; mean age, 37 years; 60 percent male) matched naturalistic risk prompts with ordinal risk positions. Regressions compared cards' placements with their "expected" (per exploratory Stage 2) placements. In Stage 4, the interface was coded in the Unity(®) (implemented at Business and IT Capstone, University of Ontario Institute of Technology, Oshawa, ON, Canada) development environment. In Stage 1, ambiguities in draft wordings/displays for Stage 2 were identified and corrected. Three risk contexts emerged: traffic/hidden intersection; skiing/avalanche; and swimming/drowning. In Stage 2, for traffic and skiing contexts, responses relating ordinal risk categories to realistic examples were observed to cluster around values potentially usable as markers. No associations appeared with demographic variables. In Stage 3, actual and "expected" ordinal-risk-category assignments for naturalistic risk markers were well correlated. "Approximate mappings" between markers and categories appeared stable. In Stage 4, the interface design incorporated the "approximate mappings"-yet also incorporated a "tuning phase," for measuring and recording individual differences. The interface can capture individual differences in risk perception on two key dimensions (frequency and severity)-viewed in dynamic, naturalistic scenarios, where risk levels are increased.

A hybrid, coupled approach for modeling charged fluids from the nano to the mesoscale

DOE PAGES

Cheung, James; Frischknecht, Amalie L.; Perego, Mauro; ...

2017-07-20

Here, we develop and demonstrate a new, hybrid simulation approach for charged fluids, which combines the accuracy of the nonlocal, classical density functional theory (cDFT) with the efficiency of the Poisson–Nernst–Planck (PNP) equations. The approach is motivated by the fact that the more accurate description of the physics in the cDFT model is required only near the charged surfaces, while away from these regions the PNP equations provide an acceptable representation of the ionic system. We formulate the hybrid approach in two stages. The first stage defines a coupled hybrid model in which the PNP and cDFT equations act independentlymore » on two overlapping domains, subject to suitable interface coupling conditions. At the second stage we apply the principles of the alternating Schwarz method to the hybrid model by using the interface conditions to define the appropriate boundary conditions and volume constraints exchanged between the PNP and the cDFT subdomains. Numerical examples with two representative examples of ionic systems demonstrate the numerical properties of the method and its potential to reduce the computational cost of a full cDFT calculation, while retaining the accuracy of the latter near the charged surfaces.« less

A hybrid, coupled approach for modeling charged fluids from the nano to the mesoscale

NASA Astrophysics Data System (ADS)

Cheung, James; Frischknecht, Amalie L.; Perego, Mauro; Bochev, Pavel

2017-11-01

We develop and demonstrate a new, hybrid simulation approach for charged fluids, which combines the accuracy of the nonlocal, classical density functional theory (cDFT) with the efficiency of the Poisson-Nernst-Planck (PNP) equations. The approach is motivated by the fact that the more accurate description of the physics in the cDFT model is required only near the charged surfaces, while away from these regions the PNP equations provide an acceptable representation of the ionic system. We formulate the hybrid approach in two stages. The first stage defines a coupled hybrid model in which the PNP and cDFT equations act independently on two overlapping domains, subject to suitable interface coupling conditions. At the second stage we apply the principles of the alternating Schwarz method to the hybrid model by using the interface conditions to define the appropriate boundary conditions and volume constraints exchanged between the PNP and the cDFT subdomains. Numerical examples with two representative examples of ionic systems demonstrate the numerical properties of the method and its potential to reduce the computational cost of a full cDFT calculation, while retaining the accuracy of the latter near the charged surfaces.

A hybrid, coupled approach for modeling charged fluids from the nano to the mesoscale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheung, James; Frischknecht, Amalie L.; Perego, Mauro

Here, we develop and demonstrate a new, hybrid simulation approach for charged fluids, which combines the accuracy of the nonlocal, classical density functional theory (cDFT) with the efficiency of the Poisson–Nernst–Planck (PNP) equations. The approach is motivated by the fact that the more accurate description of the physics in the cDFT model is required only near the charged surfaces, while away from these regions the PNP equations provide an acceptable representation of the ionic system. We formulate the hybrid approach in two stages. The first stage defines a coupled hybrid model in which the PNP and cDFT equations act independentlymore » on two overlapping domains, subject to suitable interface coupling conditions. At the second stage we apply the principles of the alternating Schwarz method to the hybrid model by using the interface conditions to define the appropriate boundary conditions and volume constraints exchanged between the PNP and the cDFT subdomains. Numerical examples with two representative examples of ionic systems demonstrate the numerical properties of the method and its potential to reduce the computational cost of a full cDFT calculation, while retaining the accuracy of the latter near the charged surfaces.« less

Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching.

PubMed

Greif, Robert; Egger, Lars; Basciani, Reto M; Lockey, Andrew; Vogt, Andreas

2010-12-01

The "4-stage approach" has been widely accepted for practical skill training replacing the traditional 2 stages ("see one, do one"). However, the superior effectiveness of the 4-stage approach was never proved. To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy, and consequently in a reduced number of attempts needed to perform the skill in <60s compared to traditional teaching. Randomized controlled single-blinded parallel group study at the University Hospital Bern. With IRB approval and informed consent 128 undergraduate medical students were randomized in four groups: traditional teaching, no stage 2, no stage 3, and 4-stage approach for the training of cricothyroidotomy. Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group. Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes. Performance time was measured from skin palpation to trachea ventilation. Study participants filled out a self-rating on competency during the training. Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of <60 s. Self-rating revealed that all groups felt equally competent throughout. Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Optical fiber inspection system

DOEpatents

Moore, Francis W.

1987-01-01

A remote optical inspection system including an inspection head. The inspection head has a passageway through which pellets or other objects are passed. A window is provided along the passageway through which light is beamed against the objects being inspected. A plurality of lens assemblies are arranged about the window so that reflected light can be gathered and transferred to a plurality of coherent optical fiber light guides. The light guides transfer the light images to a television or other image transducer which converts the optical images into a representative electronic signal. The electronic signal can then be displayed on a signal viewer such as a television monitor for inspection by a person. A staging means can be used to support the objects for viewing through the window. Routing means can be used to direct inspected objects into appropriate exit passages for accepted or rejected objects. The inspected objects are advantageously fed in a singular manner to the staging means and routing means. The inspection system is advantageously used in an enclosure when toxic or hazardous materials are being inspected.

Optical fiber inspection system

DOEpatents

Moore, F.W.

1985-04-05

A remote optical inspection system including an inspection head. The inspection head has a passageway through which pellets or other objects are passed. A window is provided along the passageway through which light is beamed against the objects being inspected. A plurality of lens assemblies are arranged about the window so that reflected light can be gathered and transferred to a plurality of coherent optical fiber light guides. The light guides transfer the light images to a television or other image transducer which converts the optical images into a representative electronic signal. The electronic signal can then be displayed on a signal viewer such as a television monitor for inspection by a person. A staging means can be used to support the objects for viewing through the window. Routing means can be used to direct inspected objects into appropriate exit passages for accepted or rejected objects. The inspected objects are advantageously fed in a singular manner to the staging means and routing means. The inspection system is advantageously used in an enclosure when toxic or hazardous materials are being inspected. 10 figs.

Knee arthrodesis with the Vari-Wall nail for treatment of infected total knee arthroplasty.

PubMed

Garcia-Lopez, Ignacio; Aguayo, Miguel Anguel; Cuevas, Antonio; Navarro, Pablo; Prieto, Cristobal; Carpintero, Pedro

2008-12-01

We reviewed 20 patients who had undergone one-stage (7 cases) or two-stage (13 cases) knee arthrodesis using the Vari-Wall intramedullary nail, as a salvage operation following infection of a total knee arthroplasty. The procedure was followed by systemic antibiotic administration and early rehabilitation. Intraoperative microbiological cultures were taken. The average period of follow-up was 20 months. Solid union was achieved in 80%; mean time to fusion was 9 months. There was no recurrence of infection. The average limb length discrepancy was 2.45 cm. A walking aid was needed by 95% of the patients. The complication rate was 30% including 4 pseudarthroses, one intraoperative fracture and one peroneal nerve palsy. The Vari-Wall intramedullary nail is a good option when an arthrodesis is indicated for salvage of an infected total knee arthroplasty. It can be performed in one or two stages depending on several factors such as microbiologic culture results. It achieved good pain relief and acceptable functional results in this study.

Automated digital magnetofluidics

NASA Astrophysics Data System (ADS)

Schneider, J.; Garcia, A. A.; Marquez, M.

2008-08-01

Drops can be moved in complex patterns on superhydrophobic surfaces using a reconfigured computer-controlled x-y metrology stage with a high degree of accuracy, flexibility, and reconfigurability. The stage employs a DMC-4030 controller which has a RISC-based, clock multiplying processor with DSP functions, accepting encoder inputs up to 22 MHz, provides servo update rates as high as 32 kHz, and processes commands at rates as fast as 40 milliseconds. A 6.35 mm diameter cylindrical NdFeB magnet is translated by the stage causing water drops to move by the action of induced magnetization of coated iron microspheres that remain in the drop and are attracted to the rare earth magnet through digital magnetofluidics. Water drops are easily moved in complex patterns in automated digital magnetofluidics at an average speed of 2.8 cm/s over a superhydrophobic polyethylene surface created by solvent casting. With additional components, some potential uses for this automated microfluidic system include characterization of superhydrophobic surfaces, water quality analysis, and medical diagnostics.

The Five Stages of Deciding on a Purchase...or a Job.

ERIC Educational Resources Information Center

Summey, John H.; Anderson, Carol H.

1992-01-01

Describes five stages of deciding on purchase or job: recognition of employment need; career information search; evaluation of career alternatives; identification and acceptance of employment; and postchoice evaluation. Evaluated importance of freedom/significance, growth, and variety in career decisions of 362 college students. Concludes…

From Passive Acceptance to Active Commitment: A Model of Feminist Identity Development for Women.

ERIC Educational Resources Information Center

Downing, Nancy E.; Roush, Kristin L.

1985-01-01

Presents a model of feminist identity development for women, derived, in part, from Cross's (1971) theory of Black identity development. The stages in this process include passive acceptance, revelation, embeddedness-emanation, synthesis, and active commitment. Implications of the model are outlined for women, nonsexist and feminist…

Coal combustion system

DOEpatents

Wilkes, Colin; Mongia, Hukam C.; Tramm, Peter C.

1988-01-01

In a coal combustion system suitable for a gas turbine engine, pulverized coal is transported to a rich zone combustor and burned at an equivalence ratio exceeding 1 at a temperature above the slagging temperature of the coal so that combustible hot gas and molten slag issue from the rich zone combustor. A coolant screen of water stretches across a throat of a quench stage and cools the combustible gas and molten slag to below the slagging temperature of the coal so that the slag freezes and shatters into small pellets. The pelletized slag is separated from the combustible gas in a first inertia separator. Residual ash is separated from the combustible gas in a second inertia separator. The combustible gas is mixed with secondary air in a lean zone combustor and burned at an equivalence ratio of less than 1 to produce hot gas motive at temperature above the coal slagging temperature. The motive fluid is cooled in a dilution stage to an acceptable turbine inlet temperature before being transported to the turbine.

Moses meets Kübler-Ross: the five stages toward accepting death as seen in the Midrash.

PubMed

Berkowitz, M C

2001-01-01

Elucidates and explains an ancient Midrash (rabbinic interpretation of biblical text, @ 400-600 CE) through the lens of modern psychological theory. Describes Moses's reactions to his approaching death and points out that his reactions follow closely the five classic stages of coming to terms with terminal illness. Brings to light and analyzes a text previously inaccessible to the non-specialist and notes practical applications for pastoral caregivers in dealing with the terminally ill in general. Suggests reasons why Jewish patients may be particularly resistant to accepting death and how using this Midrash could offer a constructive model to approaching death.

Tablet-Based Well-Being Check for the Elderly: Development and Evaluation of Usability and Acceptability

PubMed Central

Ariani, Arni; Kapadia, Vasvi

2017-01-01

Background Many elderly people prefer to live at home independently. One of the major concerns raised by the family members is the safety and well-being of their elderly family members when living independently in a home environment. To address this issue, assistive technology solutions have been available in the market. Despite their availability and proliferation, these types of solutions are not popular with the elderly due to their intrusive nature, privacy-related issues, social stigma, and fear of losing human interaction. This study shares the experience in the development of a digital photo frame system that helps family members to check the well-being of the elderly, exploiting their desire to remain socially connected. Objectives The aim of this study was to iteratively design, implement, and assess the usability, user friendliness, and acceptability of a tablet-based system to check the well-being of the elderly. Methods Our study methodology comprises three separate stages: initial system development, contextual assessment, and comparative case study evaluation. Results In the first stage, requirements were elicited from the elderly to design a well-being check prototype. In the second stage, areas for improvements (eg, privacy features) were identified. Also, additional features (such as medication prompts or food reminders) were suggested to help aged and health care service providers with effective but subtle monitoring of the elderly. These would lower their operating cost by reducing visits by care providers to the homes of the elderly. In the third stage, the results highlighted the difference (between users in India and Australia) in the levels of familiarity of the elderly with this technology. Some elderly participants at the Kalyani Institute for Study, Planning and Action for Rural Change, India latched onto this technology quickly while a few refused to use the system. However, in all cases, the support of family members was crucial for their willingness to use the technology. Conclusions This project has three major outcomes. First, a picture frame prototype was tested with the elderly to leverage the benefits of social communication. Second, the project helped us test and implement the “Silvercare” model for supporting the elderly through young retired people residing in the area. Finally, the project helped formalize the agile three-stage design methodology to develop information technology solutions for the elderly. Also, the project contributed to an ongoing European Union Project called Victoryahome, which involves more than 50 sites across 5 countries (Norway, Sweden, Netherlands, Portugal, and Australia) to assess the use of telepresence robots, wearable fall detectors, and medication dispensers for the elderly living independently. PMID:28500017

Tablet-Based Well-Being Check for the Elderly: Development and Evaluation of Usability and Acceptability.

PubMed

Ray, Pradeep; Li, Junhua; Ariani, Arni; Kapadia, Vasvi

2017-05-12

Many elderly people prefer to live at home independently. One of the major concerns raised by the family members is the safety and well-being of their elderly family members when living independently in a home environment. To address this issue, assistive technology solutions have been available in the market. Despite their availability and proliferation, these types of solutions are not popular with the elderly due to their intrusive nature, privacy-related issues, social stigma, and fear of losing human interaction. This study shares the experience in the development of a digital photo frame system that helps family members to check the well-being of the elderly, exploiting their desire to remain socially connected. The aim of this study was to iteratively design, implement, and assess the usability, user friendliness, and acceptability of a tablet-based system to check the well-being of the elderly. Our study methodology comprises three separate stages: initial system development, contextual assessment, and comparative case study evaluation. In the first stage, requirements were elicited from the elderly to design a well-being check prototype. In the second stage, areas for improvements (eg, privacy features) were identified. Also, additional features (such as medication prompts or food reminders) were suggested to help aged and health care service providers with effective but subtle monitoring of the elderly. These would lower their operating cost by reducing visits by care providers to the homes of the elderly. In the third stage, the results highlighted the difference (between users in India and Australia) in the levels of familiarity of the elderly with this technology. Some elderly participants at the Kalyani Institute for Study, Planning and Action for Rural Change, India latched onto this technology quickly while a few refused to use the system. However, in all cases, the support of family members was crucial for their willingness to use the technology. This project has three major outcomes. First, a picture frame prototype was tested with the elderly to leverage the benefits of social communication. Second, the project helped us test and implement the "Silvercare" model for supporting the elderly through young retired people residing in the area. Finally, the project helped formalize the agile three-stage design methodology to develop information technology solutions for the elderly. Also, the project contributed to an ongoing European Union Project called Victoryahome, which involves more than 50 sites across 5 countries (Norway, Sweden, Netherlands, Portugal, and Australia) to assess the use of telepresence robots, wearable fall detectors, and medication dispensers for the elderly living independently. ©Pradeep Ray, Junhua Li, Arni Ariani, Vasvi Kapadia. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 12.05.2017.

A multi-stage color model revisited: implications for a gene therapy cure for red-green colorblindness.

PubMed

Mancuso, Katherine; Mauck, Matthew C; Kuchenbecker, James A; Neitz, Maureen; Neitz, Jay

2010-01-01

In 1993, DeValois and DeValois proposed a 'multi-stage color model' to explain how the cortex is ultimately able to deconfound the responses of neurons receiving input from three cone types in order to produce separate red-green and blue-yellow systems, as well as segregate luminance percepts (black-white) from color. This model extended the biological implementation of Hurvich and Jameson's Opponent-Process Theory of color vision, a two-stage model encompassing the three cone types combined in a later opponent organization, which has been the accepted dogma in color vision. DeValois' model attempts to satisfy the long-remaining question of how the visual system separates luminance information from color, but what are the cellular mechanisms that establish the complicated neural wiring and higher-order operations required by the Multi-stage Model? During the last decade and a half, results from molecular biology have shed new light on the evolution of primate color vision, thus constraining the possibilities for the visual circuits. The evolutionary constraints allow for an extension of DeValois' model that is more explicit about the biology of color vision circuitry, and it predicts that human red-green colorblindness can be cured using a retinal gene therapy approach to add the missing photopigment, without any additional changes to the post-synaptic circuitry.

A "TNM" classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP).

PubMed

Fainsinger, Robin L; Nekolaichuk, Cheryl L

2008-06-01

The purpose of this paper is to provide an overview of the development of a "TNM" cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat. In response to this gap in clinical assessment, the Edmonton Staging System (ESS), a classification system for cancer pain, was developed. Difficulties in definitions and interpretation of some aspects of the ESS restricted acceptance and widespread use. Construct, inter-rater reliability, and predictive validity evidence have contributed to the development of the ECS-CP. The five features of the ECS-CP--Pain Mechanism, Incident Pain, Psychological Distress, Addictive Behavior and Cognitive Function--have demonstrated value in predicting pain management complexity. The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.

Variation and Commonality in Phenomenographic Research Methods

ERIC Educational Resources Information Center

Akerlind, Gerlese S.

2012-01-01

This paper focuses on the data analysis stage of phenomenographic research, elucidating what is involved in terms of both commonality and variation in accepted practice. The analysis stage of phenomenographic research is often not well understood. This paper helps to clarify the process, initially by collecting together in one location the more…

Management Of Optical Projects

NASA Astrophysics Data System (ADS)

Young, Peter S.; Olson, David R.

1981-03-01

This paper discusses the management of optical projects from the concept stage, beginning with system specifications, through design, optical fabrication and test tasks. Special emphasis is placed on effective coupling of design engineering with fabrication development and utilization of available technology. Contrasts are drawn between accepted formalized management techniques, the realities of dealing with fragile components and the necessity of an effective project team which integrates the special characteristics of highly skilled optical specialists including lens designers, optical engineers, opticians, and metrologists. Examples are drawn from the HEAO-2 X-Ray Telescope and Space Telescope projects.

Single-stage-to-orbit: Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C., Jr.; Talay, Theodore A.; Austin, Robert Eugene

1995-10-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, and X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

Single-stage-to-orbit — Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C.; Talay, Theodore A.; Austin, Robert Eugene

1996-02-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

First Stage Acceptance Test

NASA Technical Reports Server (NTRS)

1960-01-01

This photograph shows the intense smoke and fire created by the five F-1 engines from a test firing of the Saturn V first stage (S-1C) in the S-1C test stand at the Marshall Space Flight Center. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

An Optimized 2.4GHz RF Power Amplifier Performance for WLAN System

NASA Astrophysics Data System (ADS)

Ali, Mohammed H.; Chakrabarty, C. K.; Abdalla, Ahmed N.; Hock, Goh C.

2013-06-01

Recently, the design of RF power amplifiers (PAs) for modern wireless systems are faced with a difficult tradeoff for example, cellphone; battery lifetime is largely determined by the power efficiency of the PA and high spectral efficiency which have ability to transmit data at the highest possible rate for a given channel bandwidth. This paper presents the design a multi stage class AB power Amplifier with high power added efficiency (PAE) and acceptable linearity for the WLAN applications. The open-circuited third harmonic control circuit enhances the efficiency of the PA without deteriorating the linearity of class-AB mode of the PA. The voltage and current waveforms are simulated to evaluate the appropriate operation for the modes. The effectiveness of the proposed controller has been verified by comparing proposed method with another methods using simulation study under a variety of conditions. The proposed circuit operation for a WLAN signals delivers a power-added efficiency (PAE) of 37.6% is measured at 31.6-dBm output power while dissipating 34.61 mA from a 1.8V supply. Finally, the proposed PA is show a good and acceptable result for the WLAN system.

Automated Counting of Particles To Quantify Cleanliness

NASA Technical Reports Server (NTRS)

Rhode, James

2005-01-01

A machine vision system, similar to systems used in microbiological laboratories to count cultured microbes, has been proposed for quantifying the cleanliness of nominally precisely cleaned hardware by counting residual contaminant particles. The system would include a microscope equipped with an electronic camera and circuitry to digitize the camera output, a personal computer programmed with machine-vision and interface software, and digital storage media. A filter pad, through which had been aspirated solvent from rinsing the hardware in question, would be placed on the microscope stage. A high-resolution image of the filter pad would be recorded. The computer would analyze the image and present a histogram of sizes of particles on the filter. On the basis of the histogram and a measure of the desired level of cleanliness, the hardware would be accepted or rejected. If the hardware were accepted, the image would be saved, along with other information, as a quality record. If the hardware were rejected, the histogram and ancillary information would be recorded for analysis of trends. The software would perceive particles that are too large or too numerous to meet a specified particle-distribution profile. Anomalous particles or fibrous material would be flagged for inspection.

Stage-specific and culture-specific coping strategies used by mainland Chinese immigrants during resettlement in Hong Kong: a qualitative analysis.

PubMed

Wong, Daniel Fu Keung

2002-01-01

A qualitative study was undertaken to explore the stage-specific and culture-specific coping strategies used by Mainland Chinese immigrants in Hong Kong to handle psychosocial stressors experienced during the resettlement stage of the migration process. While direct action coping strategies of problem-solving and compromise were used by immigrants to deal with recurring, daily resettlement difficulties, cognitive strategies of positive comparisons and positive and optimistic thinking were utilized to change the meanings of these difficulties. Emotion-focused coping of acceptance and avoidance strategies were culture-specific, and were useful in reducing the stress associated with the resettlement difficulties encountered. It was also found that strategies such as acceptance, compromise and avoidance might have deleterious effects on the longer-term adjustment of immigrants. Implications for services and counseling for the immigrants were suggested.

Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit.

PubMed

Berg, Gina M; LoCurto, Jamie; Lippoldt, Diana

2017-09-01

The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

Stage fright: its experience as a problem and coping with it.

PubMed

Studer, Regina; Gomez, Patrick; Hildebrandt, Horst; Arial, Marc; Danuser, Brigitta

2011-10-01

This questionnaire survey of 190 university music students assessed negative feelings of music performance anxiety (MPA) before performing, the experience of stage fright as a problem, and how closely they are associated with each other. The study further investigated whether the experience of stage fright as a problem and negative feelings of MPA predict the coping behavior of the music students. Rarely addressed coping issues were assessed, i.e., self-perceived effectiveness of different coping strategies, knowledge of possible risks and acceptance of substance-based coping strategies, and need for more support. The results show that one-third of the students experienced stage fright as a problem and that this was only moderately correlated with negative feelings of MPA. The experience of stage fright as a problem significantly predicted the frequency of use and the acceptance of medication as a coping strategy. Breathing exercises and self-control techniques were rated as effective as medication. Finally, students expressed a strong need to receive more support (65%) and more information (84%) concerning stage fright. Stage fright was experienced as a problem and perceived as having negative career consequences by a considerable percentage of the surveyed students. In addition to a desire for more help and support, the students expressed an openness and willingness to seriously discuss and address the topic of stage fright. This provides a necessary and promising basis for optimal career preparation and, hence, an opportunity to prevent occupational problems in professional musicians.

A pilot study on the use of tracking technology: feasibility, acceptability, and benefits for people in early stages of dementia and their informal caregivers.

PubMed

Pot, Anne Margriet; Willemse, Bernadette M; Horjus, Sarah

2012-01-01

Caregivers and clinicians may be confronted with the dilemma whether to allow people in early stages of dementia to go outside independently with the risk of getting lost, or to limit their autonomy and mobility. Newly available technology may offer a solution. This pilot study is focused on the feasibility, acceptability, and effectiveness of a three-month use of Global Positioning System (GPS) by care receivers and caregivers. Numbers and percentages of participants with positive responses to self-report questions were calculated. Differences between the pre- and post-test scores of role-overload and worry were tested with paired t-tests and effect-sizes were calculated. Of the 33 dyads of care receivers and caregivers, 28 remained in the study (dropout rate 15%). The majority of the caregivers was able to use the technology and integrate the use into their daily routines and would recommend the use of GPS. Almost half of the participants with dementia experienced more freedom and were less worried when they were outside unaccompanied, a quarter mentioned that they were more outside independently and a fifth that they had less conflicts with their caregiver after three months. Caregivers showed a trend to feel less worried, especially caregivers who could reach their relative using the telephone connection. No changes in caregivers' feelings of role-overload were found. The GPS device used in this study seems to be promising for people in early stages of dementia and their informal caregivers. A next step is to carry out a randomized controlled trial.

When Failure Means Success: Accepting Risk in Aerospace Development

NASA Technical Reports Server (NTRS)

Dumbacher, Daniel L.; Singer, Christopher E.

2009-01-01

Over the last three decades, NASA has been diligent in qualifying systems for human space flight. As the Agency transitions from operating the Space Shuttle, its employees must learn to accept higher risk levels to generate the data needed to certify its next human space flight system. The Marshall Center s Engineering workforce is developing the Ares I crew launch vehicle and designing the Ares V cargo launch vehicle for safety, reliability, and cost-effective operations. This presentation will provide a risk retrospective, using first-hand examples from the Delta Clipper-Experimental Advanced (DC-XA) and the X-33 single-stage-to-orbit flight demonstrators, while looking ahead to the upcoming Ares I-X uncrewed test flight. The DC-XA was successfully flown twice in 26 hours, setting a new turnaround-time record. Later, one of its 3 landing gears did not deploy, it tipped over, and was destroyed. During structural testing, the X-33 s advanced composite tanks were unable to withstand the forces to which it was subjected and the project was later cancelled. These are examples of successful failures, as the data generated are captured in databases used by vehicle designers today. More recently, the Ares I-X flight readiness review process was streamlined in keeping with the mission's objectives, since human lives are not at stake, which reflects the beginning of a cultural change. Failures are acceptable during testing, as they provide the lessons that actually lead to mission success. These and other examples will stimulate the discussion of when to accept risk in aerospace projects.

Design of bearings for rotor systems based on stability

NASA Technical Reports Server (NTRS)

Dhar, D.; Barrett, L. E.; Knospe, C. R.

1992-01-01

Design of rotor systems incorporating stable behavior is of great importance to manufacturers of high speed centrifugal machinery since destabilizing mechanisms (from bearings, seals, aerodynamic cross coupling, noncolocation effects from magnetic bearings, etc.) increase with machine efficiency and power density. A new method of designing bearing parameters (stiffness and damping coefficients or coefficients of the controller transfer function) is proposed, based on a numerical search in the parameter space. The feedback control law is based on a decentralized low order controller structure, and the various design requirements are specified as constraints in the specification and parameter spaces. An algorithm is proposed for solving the problem as a sequence of constrained 'minimax' problems, with more and more eigenvalues into an acceptable region in the complex plane. The algorithm uses the method of feasible directions to solve the nonlinear constrained minimization problem at each stage. This methodology emphasizes the designer's interaction with the algorithm to generate acceptable designs by relaxing various constraints and changing initial guesses interactively. A design oriented user interface is proposed to facilitate the interaction.

Summary of the study of disposal of nuclear waste into space

NASA Technical Reports Server (NTRS)

Rom, F. E.

1973-01-01

NASA, at the request of the AEC, is conducting a preliminary study to determine the feasibility of disposing of nuclear waste material into space. The study has indicated that the Space Shuttle together with expendable and nonexpendable orbital stages such as the Space Tug or Centaur can safety dispose of waste material by ejecting it from the solar system. The safety problems associated with all phases of launching and operation (normal, emergency and accident) of such a system are being examined. From the preliminary study it appears that solutions can be found that should make the risks acceptable when compared to the benefits to be obtained from the disposal of the nuclear waste.

Energy Savings Potential and RD&D Opportunities for Commercial Building HVAC Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goetzler, William; Shandross, Richard; Young, Jim

The Building Technologies Office (BTO) commissioned this characterization and technology assessment of heating, ventilation, and air-conditioning (HVAC) systems for commercial buildings. The main objectives of this study: Identify a wide range of technology options in varying stages of development that could reduce commercial HVAC energy consumption; Characterize these technology options based on their technical energy-savings potential, development status, non-energy benefits, and other factors affecting end-user acceptance and the ability to compete with conventional HVAC technologies; Make specific recommendations to DOE and other stakeholders on potential research, development, and demonstration (RD&D) activities that would support further development of the most promisingmore » technology options.« less

Payload Performance Analysis for a Reusable Two-Stage-to-Orbit Vehicle

NASA Technical Reports Server (NTRS)

Tartabini, Paul V.; Beaty, James R.; Lepsch, Roger A.; Gilbert, Michael G.

2015-01-01

This paper investigates a unique approach in the development of a reusable launch vehicle where, instead of designing the vehicle to be reusable from its inception, as was done for the Space Shuttle, an expendable two stage launch vehicle is evolved over time into a reusable launch vehicle. To accomplish this objective, each stage is made reusable by adding the systems necessary to perform functions such as thermal protection and landing, without significantly altering the primary subsystems and outer mold line of the original expendable vehicle. In addition, some of the propellant normally used for ascent is used instead for additional propulsive maneuvers after staging in order to return both stages to the launch site, keep loads within acceptable limits and perform a soft landing. This paper presents a performance analysis that was performed to investigate the feasibility of this approach by quantifying the reduction in payload capability of the original expendable launch vehicle after accounting for the mass additions, trajectory changes and increased propellant requirements necessary for reusability. Results show that it is feasible to return both stages to the launch site with a positive payload capability equal to approximately 50 percent of an equivalent expendable launch vehicle. Further discussion examines the ability to return a crew/cargo capsule to the launch site and presents technical challenges that would have to be overcome.

Single-Stage Ear Reconstruction and Hearing Restoration Using Polyethylene Implant and Implantable Hearing Devices.

PubMed

Hempel, John Martin

2015-12-01

The use of porous polyethylene in reconstructive surgery of the auricle is becoming increasingly accepted. This is a single-stage procedure providing pleasing cosmetic rehabilitation. Further advantages are the possibility of early implantation and the lack of complications caused by harvesting costal cartilage. Additional hearing restoration using middle ear implants allows functional rehabilitation at an early stage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

PubMed Central

2013-01-01

Background Goal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke. Methods G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation. Results G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process. Conclusions G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings. PMID:23705824

Decreased gene expression of CD2AP in Chinese patients with sporadic Alzheimer's disease.

PubMed

Tao, Qing-Qing; Liu, Zhi-Jun; Sun, Yi-Min; Li, Hong-Lei; Yang, Ping; Liu, De-Shan; Jiang, Bin; Li, Xiao-Yan; Xu, Jian-Feng; Wu, Zhi-Ying

2017-08-01

Many sporadic Alzheimer's disease (SAD) risk genes have been identified in the last decades, but most of them have not been consistently accepted. Here, we sought to identify SAD-associated genes and their potential mechanisms involved in SAD pathogenesis. A 2-stage design was employed. In stage 1, 95 variants in 75 genes that were previously reported as SAD-risk genes in Caucasian populations were evaluated in 1857 subjects (422 SAD patients and 1435 controls). In stage 2, a subset of promising variants found in stage 1 were further evaluated in an independent cohort of 1001 subjects (254 SAD and 747 controls). Variants in CD2AP were significantly associated with SAD risk in our subjects. Furthermore, CD2AP gene expression in peripheral blood lymphocytes (PBL) from 209 SAD patients and 213 controls was determined. CD2AP gene expression in PBL was significantly decreased in patients with SAD as compared with controls. Our study suggests that CD2AP is an SAD-risk gene in Chinese Han population and CD2AP gene expression is decreased in the PBL of patients with SAD, indicating its possible systemic involvement in SAD. Copyright © 2017 Elsevier Inc. All rights reserved.

The ontogeny of allorecognition in a colonial hydroid and the fate of early established chimeras.

PubMed

Fuchs, Marc-Aurel; Mokady, Ofer; Frank, Uri

2002-08-01

Colonies of the marine hydroid, Hydractinia, are able to discriminate between their own tissues and those belonging to unrelated conspecifics. We have studied the ontogeny of this allorecognition system by a series of allogeneic transplantations along a developmental gradient, including two-cell-stage embryos, 8 h morulae, planula larvae and metamorphosed polyps. Allograft acceptance of incompatible tissue was observed in all embryonic and larval stages, whereas metamorphosed polyps rejected incompatible transplanted allografts. Most of the chimeras established at the two-cell-stage, although composed of two allogeneic, incompatible entities with mismatching allorecognition loci, developed normally and remained stable through metamorphosis. The results of post metamorphic transplantation assays among the chimeras and the naive ramets, suggested that both incompatible genotypes were still represented in the chimera despite the onset of alloimmune maturation. The naive colonies always rejected each other. Chimeras established from later embryonic and larval stages did not develop into adult chimeric entities, but rather separated immediately post metamorphosis. We thus show that (1) allorecognition in this species matures during metamorphosis and (2) genetically incompatible entities may coexist in one immunologically mature, chimeric soma, provided that they were grafted early enough in ontogeny.

A simple teaching tool for training the pelvic organ prolapse quantification system.

PubMed

Geiss, Ingrid M; Riss, Paul A; Hanzal, Engelbert; Dungl, Andrea

2007-09-01

The pelvic organ prolapse quantification (POPQ) system is currently the most common and specific system describing different prolapse stages. Nevertheless, its use is not yet accepted worldwide in routine care. Our aim was to develop a simple teaching tool for the POPQ system capable of simulating different stages of uterovaginal prolapse for use in medical education with hands on training. We constructed a moveable and flexible tool with an inverted Santa Claus' cap, which simulated the vaginal cuff and the tassel at the end representing the cervix. A wooden embroidery frame fixed the cap and served as the hymen, the reference point for all measurements. Inside the cap, we sewed buttons to define the anatomic landmark points Aa and Ap located 3 cm distal from the frame. After explaining the device to the students, we used the three-by-three grid for recording the quantitative description of the pelvic organ support. First, each student had to demonstrate a specific prolapse with his cap device. Then, a prolapse was simulated on the cap, and the student had to take the relevant measurements and record them in the POPQ grid. The main training effect to understand the POPQ system seems to be the possibility for each trainee to simulate a three-dimensional prolapse with this flexible vagina model.

Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy.

PubMed

Fegelman, Elliott; Knippenberg, Susan; Schwiers, Michael; Stefanidis, Dimitrios; Gersin, Keith S; Scott, John D; Fernandez, Adolfo Z

2017-05-01

Transection of gastric tissue during laparoscopic sleeve gastrectomy (LSG) can be challenging. Reinforcing the staple line may decrease the incidence of issues requiring intervention. The objective of this study was to compare the number of intraoperative surgical interventions for a surgical stapler and reload system with Gripping Surface Technology (GST) to standard reloads in patients who underwent LSG. Patients who underwent elective LSG were enrolled. The study was conducted in two stages. For Stage 1, procedures were performed using a powered stapler and standard reloads. For Stage 2, a reload system with GST was used. The primary endpoint was surgical interventions for bleeding and/or staple line issues during transection of the greater curvature of the stomach. Propensity score matching was applied to create two groups similar in baseline characteristics and risk factors. A total of 111 subjects were enrolled across four centers. Propensity-matched procedures were completed with the standard (n = 38) or GST reloads (n = 38). The mean number of interventions in the standard group was 1.9 (1.29) versus 1.1 (1.45) in the GST group. Nonparametric comparisons were statistically significant, indicating a reduction in the distribution of interventions for GST subjects (P = .0036 for matched pair data). Tissue slippage during transection was low for both groups. Intraoperative leak testing was negative in all procedures, and no procedures were converted to open. Use of the GST stapling system reduces the need for staple line interventions in LSG. Both stapling systems had an acceptable safety profile.

Long life reaction control system design

NASA Astrophysics Data System (ADS)

Fanciullo, Thomas J.; Judd, Craig

1993-02-01

Future single stage to orbit systems will utilize oxygen/hydrogen propellants in their main propulsion means due to the propellant's high energy content and environmental acceptability. Operational effectiveness studies and life cycle cost studies have indicated that minimizing the number of different commodities on a given vehicle not only reduces cost, but reduces the ground span times in both the pre- and postflight operations. Therefore, oxygen and hydrogen should be used for the reaction controls systems, eliminating the need to deal with toxic or corrosive fluids. When the hydrogen scramjet powered NASP design development began in 1985, new system design studies considered overall integration of subsystems; in the context of that approach, O2/H2 reaction controls system were more than competitive with storable propellant systems and had the additional benefits of lower life cycle cost, rapid turnaround times, and O2 and H2 commodities for use throughout the vehicle. Similar benefits were derived in rocket-powered SSTO vehicles.

A miniature Joule-Thomson cooler for optical detectors in space.

PubMed

Derking, J H; Holland, H J; Tirolien, T; ter Brake, H J M

2012-04-01

The utilization of single-stage micromachined Joule-Thomson (JT) coolers for cooling small optical detectors is investigated. A design of a micromachined JT cold stage-detector system is made that focuses on the interface between a JT cold stage and detector, and on the wiring of the detector. Among various techniques, adhesive bonding is selected as most suitable technique for integrating the detector with the JT cold stage. Also, the optimum wiring of the detector is discussed. In this respect, it is important to minimize the heat conduction through the wiring. Therefore, each wire should be optimized in terms of acceptable impedance and thermal heat load. It is shown that, given a certain impedance, the conductive heat load of electrically bad conducting materials is about twice as high as that of electrically good conducting materials. A micromachined JT cold stage is designed and integrated with a dummy detector. The JT cold stage is operated at 100 K with nitrogen as the working fluid and at 140 K with methane. Net cooling powers of 143 mW and 117 mW are measured, respectively. Taking into account a radiative heat load of 40 mW, these measured values make the JT cold stage suitable for cooling a photon detector with a power dissipation up to 50 mW, allowing for another 27 to 53 mW heat load arising from the electrical leads. © 2012 American Institute of Physics

Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

PubMed

Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

2016-11-01

To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Negotiation on the Assessment of Research Articles with Academic Reviewers: Application of Peer-Review Approach of Teaching

ERIC Educational Resources Information Center

Kumar, Prashant; Rafiq, Imran; Imam, Boulent

2011-01-01

This study provides an insight into the dominant negotiation processes that occur between the authors of research articles and academic reviewers at the peer reviewing stage. Data of reviewers comments and authors responses on 32 science and engineering based journal articles covering four decision categories (accept as is, accept with minor…

Improving Psychological Adjustment among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment

ERIC Educational Resources Information Center

Rost, Ann D.; Wilson, Kelly; Buchanan, Erin; Hildebrandt, Mikaela J.; Mutch, David

2012-01-01

Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented…

Acceptance and Usability of OER in Indian Higher Education: An Investigation Using UTAUT Model

ERIC Educational Resources Information Center

Padhi, Nayantara

2018-01-01

In the global movement towards open knowledge society, open educational resources (OER) have become a prominent contributor as a medium of education, research and training. In India, the phenomenon of OER is still in nascent stage. Although the country has been massively investing on growth and usage of ICT, it still requires acceptance of OER as…

Preferred and Minimum Acceptable Listening Levels for Musicians while Using Floor and In-Ear Monitors

ERIC Educational Resources Information Center

Federman, Jeremy; Ricketts, Todd

2008-01-01

Purpose: This study examined the impact that changing on-stage music and crowd noise levels during musical performance had on preferred listening levels (PLLs) and minimum acceptable listening levels (MALLs) across both floor and in-ear monitors. Method: Participants for this study were 23- to 48-year-old musicians, with and without hearing loss,…

Calculation of Pareto-optimal solutions to multiple-objective problems using threshold-of-acceptability constraints

NASA Technical Reports Server (NTRS)

Giesy, D. P.

1978-01-01

A technique is presented for the calculation of Pareto-optimal solutions to a multiple-objective constrained optimization problem by solving a series of single-objective problems. Threshold-of-acceptability constraints are placed on the objective functions at each stage to both limit the area of search and to mathematically guarantee convergence to a Pareto optimum.

How Do Idaho Post-Secondary T&I Instructors Feel about Time-Shortened Tech-Prep Articulation?

ERIC Educational Resources Information Center

Rogers, George E.; Wilson, Ruth D.

A study examined the acceptance of the time-shortened articulation (TSA) approach adopted to implement tech prep programs by Idaho postsecondary trade and industrial instructors. From a sample of 143 instructors, 46 usable responses were received. Hall's (1979) Stages of Concern (SoC) model was used to determine if they had accepted the process,…

Effect of pre-cooking methods on the chemical and sensory deterioration of ready-to-eat chicken patties during chilled storage and microwave reheating.

PubMed

Ferreira, Valquíria C S; Morcuende, David; Madruga, Marta S; Hernández-López, Silvia H; Silva, Fábio A P; Ventanas, Sonia; Estévez, Mario

2016-06-01

The effects of pre-cooking methods, namely, boiling (BL), roasting (RT) and grilling (GR), refrigerated storage (14 days/+4 °C) and microwave reheating on chicken patties were studied. Physical, chemical and sensory parameters were evaluated in order to correlate the chemical deterioration of ready-to-eat chicken patties with the acceptance of the odor. Chemical deterioration was evaluated through the chemical composition, Maillard compounds, Thiobarbituric acid-reactive substances (TBARS) and volatiles. Sensory deterioration (odor liking) was performed by an acceptance test with hedonic scale. According to the TBARS values and volatile compounds generated in the head space during the examined stages, the pre-cooking method and the storage time had a significant effect on lipid oxidation, whereas reheating in a microwave had a negligible impact. At each succeeding processing stage, panelists gave lower odor scores to all samples and no significant differences were found between treatments at any stage. RT and GR patties showed less intense chemical changes and presented higher acceptation scores by the sensory panel than BL patties. Thus, the choice of pre-cooking method and control of storage conditions plays a key role in the inhibition of oxidative changes in ready-to-eat chicken patties.

Relationship of stage mensuration data to the performance of new and used cascade impactors.

PubMed

Roberts, Daryl L; Romay, Francisco J

2005-01-01

Cascade impaction is a standard test method for characterizing the quality of inhalable drug products. The sizes of the nozzles on each stage of the impactor are the critical dimensions for the performance of the impactor. Compendial reference methods call for periodic measurement of the size of the nozzles on each stage, a procedure known as stage mensuration. There is however currently no guidance on acceptable mensuration criteria. We aim to remedy this situation by providing a sound basis for understanding and using mensuration data, be it for acceptance criteria for new impactors or for the setting of mensuration tolerances for in-use impactors. We first show that multi-nozzle impactor stages behave as if all of the nozzles are equal in size to an effective diameter, , that is composed of the area-mean and areamedian diameters, W* and , calculated directly from the individual nozzle diameters for all nozzles on a given stage (equation 1): W= (W*)(2/3) x (W)(1/3) (1). Hence, the effective diameter provides an intuitive and technically sound basis for setting acceptance criteria for new and in-use impactors. We tabulate these criteria for the Mark II eight-stage Andersen cascade impactor and the Next Generation Pharmaceutical Impactor in a manner similar to the tables of critical impactor dimensions published in EP Supplement 5.1 and in USP 28. For two different impactors or for one impactor measured at two different times (e.g., at manufacture and in use), we find that the D50 values of a given stage are related to the effective diameters by D(50,2)/D(50,1)= (W(2)/W(1))(3/2) (2). Using the stage mensuration data for new, as-manufactured NGIs, we compare the D(50 )values of the first 125 as-manufactured NGIs with those of the archivally calibrated NGI. We further establish that the archivally calibrated NGI has D(50) values within 0.3% of an entirely perfect, hypothetical NGI with all nozzles equal to the nominal nozzle diameters. We also apply the equations to a specific mensurated impactor to show that a used impactor with some nozzles outside of the original manufacturing specifications can have the same aerodynamic performance as a new impactor.

Infrared Sensor System for Mobile-Robot Positioning in Intelligent Spaces

PubMed Central

Gorostiza, Ernesto Martín; Galilea, José Luis Lázaro; Meca, Franciso Javier Meca; Monzú, David Salido; Zapata, Felipe Espinosa; Puerto, Luis Pallarés

2011-01-01

The aim of this work was to position a Mobile Robot in an Intelligent Space, and this paper presents a sensorial system for measuring differential phase-shifts in a sinusoidally modulated infrared signal transmitted from the robot. Differential distances were obtained from these phase-shifts, and the position of the robot was estimated by hyperbolic trilateration. Due to the extremely severe trade-off between SNR, angle (coverage) and real-time response, a very accurate design and device selection was required to achieve good precision with wide coverage and acceptable robot speed. An I/Q demodulator was used to measure phases with one-stage synchronous demodulation to DC. A complete set of results from real measurements, both for distance and position estimations, is provided to demonstrate the validity of the system proposed, comparing it with other similar indoor positioning systems. PMID:22163907

The exceptional sediment load of fine-grained dispersal systems: Example of the Yellow River, China.

PubMed

Ma, Hongbo; Nittrouer, Jeffrey A; Naito, Kensuke; Fu, Xudong; Zhang, Yuanfeng; Moodie, Andrew J; Wang, Yuanjian; Wu, Baosheng; Parker, Gary

2017-05-01

Sedimentary dispersal systems with fine-grained beds are common, yet the physics of sediment movement within them remains poorly constrained. We analyze sediment transport data for the best-documented, fine-grained river worldwide, the Huanghe (Yellow River) of China, where sediment flux is underpredicted by an order of magnitude according to well-accepted sediment transport relations. Our theoretical framework, bolstered by field observations, demonstrates that the Huanghe tends toward upper-stage plane bed, yielding minimal form drag, thus markedly enhancing sediment transport efficiency. We present a sediment transport formulation applicable to all river systems with silt to coarse-sand beds. This formulation demonstrates a remarkably sensitive dependence on grain size within a certain narrow range and therefore has special relevance to silt-sand fluvial systems, particularly those affected by dams.

[Introduction of hazard analysis and critical control points (HACCP) principles at the flight catering food production plant].

PubMed

Popova, A Yu; Trukhina, G M; Mikailova, O M

In the article there is considered the quality control and safety system implemented in the one of the largest flight catering food production plant for airline passengers and flying squad. The system for the control was based on the Hazard Analysis And Critical Control Points (HACCP) principles and developed hygienic and antiepidemic measures. There is considered the identification of hazard factors at stages of the technical process. There are presented results of the analysis data of monitoring for 6 critical control points over the five-year period. The quality control and safety system permit to decline food contamination risk during acceptance, preparation and supplying of in-flight meal. There was proved the efficiency of the implemented system. There are determined further ways of harmonization and implementation for HACCP principles in the plant.

The exceptional sediment load of fine-grained dispersal systems: Example of the Yellow River, China

PubMed Central

Ma, Hongbo; Nittrouer, Jeffrey A.; Naito, Kensuke; Fu, Xudong; Zhang, Yuanfeng; Moodie, Andrew J.; Wang, Yuanjian; Wu, Baosheng; Parker, Gary

2017-01-01

Sedimentary dispersal systems with fine-grained beds are common, yet the physics of sediment movement within them remains poorly constrained. We analyze sediment transport data for the best-documented, fine-grained river worldwide, the Huanghe (Yellow River) of China, where sediment flux is underpredicted by an order of magnitude according to well-accepted sediment transport relations. Our theoretical framework, bolstered by field observations, demonstrates that the Huanghe tends toward upper-stage plane bed, yielding minimal form drag, thus markedly enhancing sediment transport efficiency. We present a sediment transport formulation applicable to all river systems with silt to coarse-sand beds. This formulation demonstrates a remarkably sensitive dependence on grain size within a certain narrow range and therefore has special relevance to silt-sand fluvial systems, particularly those affected by dams. PMID:28508078

Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation.

PubMed

Miles, A; Chronakis, I; Fox, J; Mayer, A

2017-03-24

To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA. Mixed methods. Single outpatient oncology department in central London. Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14-56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy. Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA. PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone. Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

An assessment of separable fluid connector system parameters to perform a connector system design optimization study

NASA Technical Reports Server (NTRS)

Prasthofer, W. P.

1974-01-01

The key to optimization of design where there are a large number of variables, all of which may not be known precisely, lies in the mathematical tool of dynamic programming developed by Bellman. This methodology can lead to optimized solutions to the design of critical systems in a minimum amount of time, even when there are a great number of acceptable configurations to be considered. To demonstrate the usefulness of dynamic programming, an analytical method is developed for evaluating the relationship among existing numerous connector designs to find the optimum configuration. The data utilized in the study were generated from 900 flanges designed for six subsystems of the S-1B stage of the Saturn 1B space carrier vehicle.

Pollution reduction technology program small jet aircraft engines, phase 3

NASA Technical Reports Server (NTRS)

Bruce, T. W.; Davis, F. G.; Kuhn, T. E.; Mongia, H. C.

1981-01-01

A series of Model TFE731-2 engine tests were conducted with the Concept 2 variable geometry airblast fuel injector combustion system installed. The engine was tested to: (1) establish the emission levels over the selected points which comprise the Environmental Protection Agency Landing-Takeoff Cycle; (2) determine engine performance with the combustion system; and (3) evaulate the engine acceleration/deceleration characteristics. The hydrocarbon (HC), carbon monoxide (CO), and smoke goals were met. Oxides of nitrogen (NOx) were above the goal for the same configuration that met the other pollutant goals. The engine and combustor performance, as well as acceleration/deceleration characteristics, were acceptable. The Concept 3 staged combustor system was refined from earlier phase development and subjected to further rig refinement testing. The concept met all of the emissions goals.

Neural Responses to Partner Rejection Cues

PubMed Central

Zayas, Vivian; Shoda, Yuichi; Mischel, Walter; Osterhout, Lee; Takahashi, Melissa

2009-01-01

Little is known about neural responses in the early automatic-stage processing of rejection cues from a partner. Event-related potentials (ERPs) offer a window to study processes that may be difficult to detect via behavioral methods. We focused on the N400 ERP component, which reflects the amount of semantic processing prompted by a target. When participants were primed by attachment-related contexts (“If I need help from my partner, my partner will be …”), rejection-related words (e.g., dismissing) elicited greater N400 amplitudes than acceptance-related words (e.g., supporting). Analyses of results for nonattachment primes suggest that these findings were not simply caused by target valence; the brain responds differentially to cues of partner rejection versus acceptance in under 300 ms. Moreover, these early-stage neurophysiological responses were heightened or dampened as a function of individuals’ adult attachment; women characterized by high anxiety and low avoidance showed the greatest N400 responses to cues of partner rejection (vs. acceptance). PMID:19493321

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

PubMed Central

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C

2016-01-01

Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. PMID:27489143

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition.

PubMed

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C; Moynihan, Paula

2016-08-03

Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.

Design Optimization for the Measurement Accuracy Improvement of a Large Range Nanopositioning Stage

PubMed Central

Torralba, Marta; Yagüe-Fabra, José Antonio; Albajez, José Antonio; Aguilar, Juan José

2016-01-01

Both an accurate machine design and an adequate metrology loop definition are critical factors when precision positioning represents a key issue for the final system performance. This article discusses the error budget methodology as an advantageous technique to improve the measurement accuracy of a 2D-long range stage during its design phase. The nanopositioning platform NanoPla is here presented. Its specifications, e.g., XY-travel range of 50 mm × 50 mm and sub-micrometric accuracy; and some novel designed solutions, e.g., a three-layer and two-stage architecture are described. Once defined the prototype, an error analysis is performed to propose improvement design features. Then, the metrology loop of the system is mathematically modelled to define the propagation of the different sources. Several simplifications and design hypothesis are justified and validated, including the assumption of rigid body behavior, which is demonstrated after a finite element analysis verification. The different error sources and their estimated contributions are enumerated in order to conclude with the final error values obtained from the error budget. The measurement deviations obtained demonstrate the important influence of the working environmental conditions, the flatness error of the plane mirror reflectors and the accurate manufacture and assembly of the components forming the metrological loop. Thus, a temperature control of ±0.1 °C results in an acceptable maximum positioning error for the developed NanoPla stage, i.e., 41 nm, 36 nm and 48 nm in X-, Y- and Z-axis, respectively. PMID:26761014

A CONCEPTUAL FRAMEWORK FOR MANAGING RADIATION DOSE TO PATIENTS IN DIAGNOSTIC RADIOLOGY USING REFERENCE DOSE LEVELS.

PubMed

Almén, Anja; Båth, Magnus

2016-06-01

The overall aim of the present work was to develop a conceptual framework for managing radiation dose in diagnostic radiology with the intention to support optimisation. An optimisation process was first derived. The framework for managing radiation dose, based on the derived optimisation process, was then outlined. The outset of the optimisation process is four stages: providing equipment, establishing methodology, performing examinations and ensuring quality. The optimisation process comprises a series of activities and actions at these stages. The current system of diagnostic reference levels is an activity in the last stage, ensuring quality. The system becomes a reactive activity only to a certain extent engaging the core activity in the radiology department, performing examinations. Three reference dose levels-possible, expected and established-were assigned to the three stages in the optimisation process, excluding ensuring quality. A reasonably achievable dose range is also derived, indicating an acceptable deviation from the established dose level. A reasonable radiation dose for a single patient is within this range. The suggested framework for managing radiation dose should be regarded as one part of the optimisation process. The optimisation process constitutes a variety of complementary activities, where managing radiation dose is only one part. This emphasises the need to take a holistic approach integrating the optimisation process in different clinical activities. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women.

PubMed

Obeidat, Rana F

2015-01-01

To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

The Acceptance of Exceptionality: A Three Dimensional Model.

ERIC Educational Resources Information Center

Martin, Larry L.; Nivens, Maryruth K.

A model extrapolates from E. Kubler-Ross' conception of the stages of grief to apply to parent and family reactions when an exceptionality is identified. A chart lists possible parent feelings and reactions, possible school reactions to the parent in grief, and the child's reactions during each of five stages: denial, rage and anger, bargaining,…

Do Incarcerated Offenders Experience the Five Stages of Grief as Do Terminally Ill Patients?

ERIC Educational Resources Information Center

Pledger, Carolyn Brastow

1985-01-01

Examines Kubler-Ross' five stages of grief (denial, anger, bargaining, depression, acceptance) as they are experienced not by terminally ill persons, but by 20 criminal offenders and their families during incarceration. Concludes that shock of arrest and incarceration stimulates reactions similar to those of persons coping with terminal diagnosis.…

Development and validation of the BRIGHTLIGHT Survey, a patient-reported experience measure for young people with cancer.

PubMed

Taylor, Rachel M; Fern, Lorna A; Solanki, Anita; Hooker, Louise; Carluccio, Anna; Pye, Julia; Jeans, David; Frere-Smith, Tom; Gibson, Faith; Barber, Julie; Raine, Rosalind; Stark, Dan; Feltbower, Richard; Pearce, Susie; Whelan, Jeremy S

2015-07-28

Patient experience is increasingly used as an indicator of high quality care in addition to more traditional clinical end-points. Surveys are generally accepted as appropriate methodology to capture patient experience. No validated patient experience surveys exist specifically for adolescents and young adults (AYA) aged 13-24 years at diagnosis with cancer. This paper describes early work undertaken to develop and validate a descriptive patient experience survey for AYA with cancer that encompasses both their cancer experience and age-related issues. We aimed to develop, with young people, an experience survey meaningful and relevant to AYA to be used in a longitudinal cohort study (BRIGHTLIGHT), ensuring high levels of acceptability to maximise study retention. A three-stage approach was employed: Stage 1 involved developing a conceptual framework, conducting literature/Internet searches and establishing content validity of the survey; Stage 2 confirmed the acceptability of methods of administration and consisted of four focus groups involving 11 young people (14-25 years), three parents and two siblings; and Stage 3 established survey comprehension through telephone-administered cognitive interviews with a convenience sample of 23 young people aged 14-24 years. Stage 1: Two-hundred and thirty eight questions were developed from qualitative reports of young people's cancer and treatment-related experience. Stage 2: The focus groups identified three core themes: (i) issues directly affecting young people, e.g. impact of treatment-related fatigue on ability to complete survey; (ii) issues relevant to the actual survey, e.g. ability to answer questions anonymously; (iii) administration issues, e.g. confusing format in some supporting documents. Stage 3: Cognitive interviews indicated high levels of comprehension requiring minor survey amendments. Collaborating with young people with cancer has enabled a survey of to be developed that is both meaningful to young people but also examines patient experience and outcomes associated with specialist cancer care. Engagement of young people throughout the survey development has ensured the content appropriately reflects their experience and is easily understood. The BRIGHTLIGHT survey was developed for a specific research project but has the potential to be used as a TYA cancer survey to assess patient experience and the care they receive.

ONAV - An Expert System for the Space Shuttle Mission Control Center

NASA Technical Reports Server (NTRS)

Mills, Malise; Wang, Lui

1992-01-01

The ONAV (Onboard Navigation) Expert System is being developed as a real-time console assistant to the ONAV flight controller for use in the Mission Control Center at the Johnson Space Center. Currently, Oct. 1991, the entry and ascent systems have been certified for use on console as support tools, and were used for STS-48. The rendezvous system is in verification with the goal to have the system certified for STS-49, Intelsat retrieval. To arrive at this stage, from a prototype to real-world application, the ONAV project has had to deal with not only Al issues but operating environment issues. The Al issues included the maturity of Al languages and the debugging tools, verification, and availability, stability and size of the expert pool. The environmental issues included real time data acquisition, hardware suitability, and how to achieve acceptance by users and management.

The biogenetical revolution of the Council of Europe - twenty years of the Convention on Human Rights and Biomedicine (Oviedo Convention).

PubMed

Nawrot, Oktawian

2018-05-16

The Council of Europe's legal regulation concerning development of biology and medicine undoubtedly form the most interesting, but certainly not perfect, over-national system of protection of human beings in prenatal stages of development. The strength of the mentioned system is that it based on well-known and common acceptable values and rules such as human dignity and its protection. The aim of the paper is to present the reasons behind adopting such a system, as well as the consequences of the latter.The author argues that in such a way a revolution within the human rights system of the Council of Europe took place. This revolution caused a significant expansion of the Council of Europe's system of human rights' protection and changed the perspective of the protection from vertical to the horizontal.

A real-time navigation monitoring expert system for the Space Shuttle Mission Control Center

NASA Technical Reports Server (NTRS)

Wang, Lui; Fletcher, Malise

1993-01-01

The ONAV (Onboard Navigation) Expert System has been developed as a real time console assistant for use by ONAV flight controllers in the Mission Control Center at the Johnson Space Center. This expert knowledge based system is used to monitor the Space Shuttle onboard navigation system, detect faults, and advise flight operations personnel. This application is the first knowledge-based system to use both telemetry and trajectory data from the Mission Operations Computer (MOC). To arrive at this stage, from a prototype to real world application, the ONAV project has had to deal with not only AI issues but operating environment issues. The AI issues included the maturity of AI languages and the debugging tools, verification, and availability, stability and size of the expert pool. The environmental issues included real time data acquisition, hardware suitability, and how to achieve acceptance by users and management.

Pollution reduction technology program for small jet aircraft engines, phase 1

NASA Technical Reports Server (NTRS)

Bruce, T. W.; Davis, F. G.; Kuhn, T. E.; Mongia, H. C.

1977-01-01

A series of combustor pressure rig screening tests was conducted on three combustor concepts applied to the TFE731-2 turbofan engine combustion system for the purpose of evaluating their relative emissions reduction potential consistent with prescribed performance, durability, and envelope contraints. The three concepts and their modifications represented increasing potential for reducing emission levels with the penalty of increased hardware complexity and operational risk. Concept 1 entailed advanced modifications to the present production TFE731-2 combustion system. Concept 2 was based on the incorporation of an axial air-assisted airblast fuel injection system. Concept 3 was a staged premix/prevaporizing combustion system. Significant emissions reductions were achieved in all three concepts, consistent with acceptable combustion system performance. Concepts 2 and 3 were identified as having the greatest achievable emissions reduction potential, and were selected to undergo refinement to prepare for ultimate incorporation within an engine.

Experimental characterization of Fresnel-Köhler concentrators

NASA Astrophysics Data System (ADS)

Zamora, Pablo; Benítez, Pablo; Mohedano, Rubén; Cvetković, Aleksandra; Vilaplana, Juan; Li, Yang; Hernández, Maikel; Chaves, Julio; Miñano, Juan C.

2012-01-01

Most cost-effective concentrated photovoltaics (CPV) systems are based on an optical train comprising two stages, the first being a Fresnel lens. Among them, the Fresnel-Köhler (FK) concentrator stands out owing to both performance and practical reasons. We describe the experimental measurements procedure for FK concentrator modules. This procedure includes three main types of measurements: electrical efficiency, acceptance angle, and irradiance uniformity at the solar cell plane. We have collected here the performance features of two different FK prototypes (ranging different f-numbers, concentration ratios, and cell sizes). The electrical efficiencies measured in both prototypes are high and fit well with the models, achieving values up to 32.7% (temperature corrected, and with no antireflective coating on SOE or POE surfaces) in the best case. The measured angular transmission curves show large acceptance angles, again perfectly matching the expected values [measured concentration acceptance product (CAP) values over 0.56]. The irradiance pattern on the cell (obtained with a digital camera) shows an almost perfectly uniform distribution, as predicted by raytrace simulations. All these excellent on-sun results confirm the FK concentrator as a potentially cost-effective solution for the CPV market.

Adapting a computer-delivered brief alcohol intervention for veterans with Hepatitis C.

PubMed

Cucciare, Michael A; Jamison, Andrea L; Combs, Ann S; Joshi, Gauri; Cheung, Ramsey C; Rongey, Catherine; Huggins, Joe; Humphreys, Keith

2017-12-01

This study adapted an existing computer-delivered brief alcohol intervention (cBAI) for use in Veterans with the hepatitis C virus (HCV) and examined its acceptability and feasibility in this patient population. A four-stage model consisting of initial pilot testing, qualitative interviews with key stakeholders, development of a beta version of the cBAI, and usability testing was used to achieve the study objectives. In-depth interviews gathered feedback for modifying the cBAI, including adding HCV-related content such as the health effects of alcohol on liver functioning, immune system functioning, and management of HCV, a preference for concepts to be displayed through "newer looking" graphics, and limiting the use of text to convey key concepts. Results from usability testing indicated that the modified cBAI was acceptable and feasible for use in this patient population. The development model used in this study is effective for gathering actionable feedback that can inform the development of a cBAI and can result in the development of an acceptable and feasible intervention for use in this population. Findings also have implications for developing computer-delivered interventions targeting behavior change more broadly.

eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability.

PubMed

Girgis, Afaf; Durcinoska, Ivana; Levesque, Janelle V; Gerges, Martha; Sandell, Tiffany; Arnold, Anthony; Delaney, Geoff P

2017-10-02

Despite accumulating evidence indicating that collecting patient-reported outcomes (PROs) and transferring results to the treating health professional in real time has the potential to improve patient well-being and cancer outcomes, this practice is not widespread. The aim of this study was to test the feasibility and acceptability of PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care), a newly developed electronic health (eHealth) system that facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. We developed an eHealth system in consultation with content-specific expert advisory groups and tested it with patients receiving treatment or follow-up care in two hospitals in New South Wales, Australia, over a 3-month period. Participants were recruited in clinic and completed self-report Web-based assessments either just before their upcoming clinical consultation or every 4 weeks if in follow-up care. A mixed methods approach was used to evaluate feasibility and acceptability of PROMPT-Care; data collected throughout the study informed the accuracy and completeness of data transfer procedures, and extent of missing data was determined from participants' assessments. Patients participated in cognitive interviews while completing their first assessment and completed evaluation surveys and interviews at study-end to assess system acceptability and usefulness of patient self-management resources, and oncology staff were interviewed at study-end to determine the acceptability and perceived usefulness of real-time PRO reporting. A total of 42 patients consented to the study; 7 patients were withdrawn before starting the intervention primarily because of changes in eligibility. Overall, 35 patients (13 on treatment and 22 in follow-up) completed 67 assessments during the study period. Mean completeness of patient-reported data was 93%, with 100% accuracy of data transfer. Ten patients completed cognitive interviews, 28 completed evaluation surveys, and 14 completed evaluation interviews at study-end. PROMPT-Care patient acceptability was high-100% (28/28) reported the time to complete the Web-based assessments (average 15 min) as about right, most willing to answer more questions (79%, 22/28 yes), 96% (27/28) found the Web-based assessment easier or same as completing a paper copy, and they valued the self-management resources . Oncology staff (n=5) also reported high acceptability and potential feasibility of the system. Patients and oncology staff found the PROMPT-Care system to be highly acceptable, and the results suggest that it would be feasible to implement it into an oncology setting. Suggested modifications to the patient assessment survey, clinician access to the reports, and system requirements will be made as part of the next stage of large-scale testing and future implementation of the system as part of routine care. Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0). ©Afaf Girgis, Ivana Durcinoska, Janelle V Levesque, Martha Gerges, Tiffany Sandell, Anthony Arnold, Geoff P Delaney, The PROMPT-Care Program Group. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.10.2017.

Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help?

PubMed

Nerini, Erika; Bruno, Fulvio; Citterio, Franco; Schena, Francesco P

2016-10-01

End-stage kidney disease is a life-threatening condition that compels patients to accept either dialysis or transplant. Kidney transplantation is the best choice for patients with end-stage kidney disease because it ensures higher quality of life and longer survival rates than other choices, with less cost for the healthcare system. However, in order for renal recipients to maintain the functioning graft they must take lifelong immunosuppressive medications, with possible side effects and low medication adherence. It is known that low medication adherence in kidney transplant recipients may cause poor outcomes, chronic graft rejection, and graft failure. In this review, the authors give an overview of nonadherence in the transplant setting. In addition, they analyze the role of different technologies as an aid to improve adherence, with a focus on mobile-phone based solutions to monitor and enhance kidney transplant recipient compliance.

Blood Vessel Extraction in Color Retinal Fundus Images with Enhancement Filtering and Unsupervised Classification

PubMed Central

2017-01-01

Retinal blood vessels have a significant role in the diagnosis and treatment of various retinal diseases such as diabetic retinopathy, glaucoma, arteriosclerosis, and hypertension. For this reason, retinal vasculature extraction is important in order to help specialists for the diagnosis and treatment of systematic diseases. In this paper, a novel approach is developed to extract retinal blood vessel network. Our method comprises four stages: (1) preprocessing stage in order to prepare dataset for segmentation; (2) an enhancement procedure including Gabor, Frangi, and Gauss filters obtained separately before a top-hat transform; (3) a hard and soft clustering stage which includes K-means and Fuzzy C-means (FCM) in order to get binary vessel map; and (4) a postprocessing step which removes falsely segmented isolated regions. The method is tested on color retinal images obtained from STARE and DRIVE databases which are available online. As a result, Gabor filter followed by K-means clustering method achieves 95.94% and 95.71% of accuracy for STARE and DRIVE databases, respectively, which are acceptable for diagnosis systems. PMID:29065611

Space Station: The next iteration

NASA Astrophysics Data System (ADS)

Foley, Theresa M.

1995-01-01

NASA's international space station is nearing the completion stage of its troublesome 10-year design phase. With a revised design and new management team, NASA is tasked to deliver the station on time at a budget acceptable to both Congress and the White House. For the next three years, NASA is using tried-and-tested Russian hardware as the technical centerpiece of the station. The new station configuration consists of eight pressurized modules in which the crew can live and work; a long metal truss to connect the pieces; a robot arm for exterior jobs; a solar power system; and propelling the facility in space.

Toward a unifying taxonomy and definition for meditation

PubMed Central

Nash, Jonathan D.; Newberg, Andrew

2013-01-01

One of the well-documented concerns confronting scholarly discourse about meditation is the plethora of semantic constructs and the lack of a unified definition and taxonomy. In recent years there have been several notable attempts to formulate new lexicons in order to define and categorize meditation methods. While these constructs have been useful and have encountered varying degrees of acceptance, they have also been subject to misinterpretation and debate, leaving the field devoid of a consensual paradigm. This paper attempts to influence this ongoing discussion by proposing two new models which hold the potential for enhanced scientific reliability and acceptance. Regarding the quest for a universally acceptable taxonomy, we suggest a paradigm shift away from the norm of fabricatIng new terminology from a first-person perspective. As an alternative, we propose a new taxonomic system based on the historically well-established and commonly accepted third-person paradigm of Affect and Cognition, borrowed, in part, from the psychological and cognitive sciences. With regard to the elusive definitional problem, we propose a model of meditation which clearly distinguishes “method” from “state” and is conceptualized as a dynamic process which is inclusive of six related but distinct stages. The overall goal is to provide researchers with a reliable nomenclature with which to categorize and classify diverse meditation methods, and a conceptual framework which can provide direction for their research and a theoretical basis for their findings. PMID:24312060

Joint Contributions of Peer Acceptance and Peer Academic Reputation to Achievement in Academically At-Risk Children: Mediating Processes

ERIC Educational Resources Information Center

Chen, Qi; Hughes, Jan N.; Liew, Jeffrey; Kwok, Oi-Man

2010-01-01

The longitudinal relationships between two dimensions of peer relationships and subsequent academic adjustment were investigated in a sample of 543 relatively low achieving children (M = 6.57 years at Year 1, 1st grade). Latent variable SEM was used to test a four stage model positing indirect effects of peer acceptance and peer academic…

The Kubler-Ross model, physician distress, and performance reporting.

PubMed

Smaldone, Marc C; Uzzo, Robert G

2013-07-01

Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

Cognitive and Social Processes Predicting Partner Psychological Adaptation to Early Stage Breast Cancer

PubMed Central

Manne, Sharon; Ostroff, Jamie; Fox, Kevin; Grana, Generosa; Winkel, Gary

2009-01-01

Introduction The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners’ psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning-making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Materials and Methods Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner’s diagnosis (n= 253), nine (n = 167), and 18 months (n = 149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning-making, and general and cancer-specific distress at all time points. Results Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer-specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer-specific distress were found. Conclusions Results indicate several cognitive-social processes directly predict partner distress. However, moderator effect models in which the effects of partners’ processing depends upon whether these efforts result changes in perceptions of the cancer experience may add to the understanding of partners’ adaptation to cancer. PMID:18435865

Cognitive and social processes predicting partner psychological adaptation to early stage breast cancer.

PubMed

Manne, Sharon; Ostroff, Jamie; Fox, Kevin; Grana, Generosa; Winkel, Gary

2009-02-01

The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners' psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner's diagnosis (N=253), 9 (N=167), and 18 months (N=149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning making, and general and cancer-specific distress at all time points. Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer-specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer-specific distress were found. Results indicate several cognitive-social processes directly predict partner distress. However, moderator effect models in which the effects of partners' processing depends upon whether these efforts result in changes in perceptions of the cancer experience may add to the understanding of partners' adaptation to cancer.

A design study for a compact two stage in-flight separator with a high mass resolution and large acceptance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hwang, Ji-Gwang; Kim, Eun-San, E-mail: eskim1@knu.ac.kr; Hatanaka, Kichiji

2015-03-15

The rare isotope beam separator with a large angular acceptance and energy acceptance is essential for examining the characteristics of unstable nuclei and exotic nuclear reactions. Careful design, however, is required to compensate for the effects of high order aberrations induced by large aperture magnets, which are used to collect rare isotopes obtained from a high energy primary heavy-ion beam hitting a target. In order to minimize the effect of the high order aberration, the optics was based on the mirror symmetry optics, which provides smaller high order aberrations, for the separation of {sup 132}Sn produced by a fission reactionmore » between the primary beam of {sup 238}U and a relatively thick Pb target. The designed optics provides energy acceptance (full), horizontal angular acceptance, and vertical acceptance of approximately 8%, 60 mrad, and 130 mrad, respectively.« less

A design study for a compact two stage in-flight separator with a high mass resolution and large acceptance.

PubMed

Hwang, Ji-Gwang; Kim, Eun-San; Hatanaka, Kichiji

2015-03-01

The rare isotope beam separator with a large angular acceptance and energy acceptance is essential for examining the characteristics of unstable nuclei and exotic nuclear reactions. Careful design, however, is required to compensate for the effects of high order aberrations induced by large aperture magnets, which are used to collect rare isotopes obtained from a high energy primary heavy-ion beam hitting a target. In order to minimize the effect of the high order aberration, the optics was based on the mirror symmetry optics, which provides smaller high order aberrations, for the separation of (132)Sn produced by a fission reaction between the primary beam of (238)U and a relatively thick Pb target. The designed optics provides energy acceptance (full), horizontal angular acceptance, and vertical acceptance of approximately 8%, 60 mrad, and 130 mrad, respectively.

A design study for a compact two stage in-flight separator with a high mass resolution and large acceptance

NASA Astrophysics Data System (ADS)

Hwang, Ji-Gwang; Kim, Eun-San; Hatanaka, Kichiji

2015-03-01

The rare isotope beam separator with a large angular acceptance and energy acceptance is essential for examining the characteristics of unstable nuclei and exotic nuclear reactions. Careful design, however, is required to compensate for the effects of high order aberrations induced by large aperture magnets, which are used to collect rare isotopes obtained from a high energy primary heavy-ion beam hitting a target. In order to minimize the effect of the high order aberration, the optics was based on the mirror symmetry optics, which provides smaller high order aberrations, for the separation of 132Sn produced by a fission reaction between the primary beam of 238U and a relatively thick Pb target. The designed optics provides energy acceptance (full), horizontal angular acceptance, and vertical acceptance of approximately 8%, 60 mrad, and 130 mrad, respectively.

Active Space Debris Removal using European Modified Launch Vehicle Upper Stages Equipped with Electrodynamic Tethers

NASA Astrophysics Data System (ADS)

Nasseri, Ali S.; Emanuelli, Matteo; Raval, Siddharth; Turconi, Andrea; Becker, Cristoph

2013-08-01

During the past few years, several research programs have assessed the current state and future evolution of the Low Earth Orbit region. These studies indicate that space debris density could reach a critical level such that there will be a continuous increase in the number of debris objects, primarily driven by debris-debris collision activity known as the Kessler effect. This cascade effect can be even more significant when intact objects as dismissed rocket bodies are involved in the collision. The majority of the studies until now have highlighted the urgency for active debris removal in the next years. An Active Debris Removal System (ADRS) is a system capable of approaching the debris object through a close-range rendezvous, establishing physical connection, stabilizing its attitude and finally de-orbiting the debris object using a type of propulsion system in a controlled manoeuvre. In its previous work, this group showed that a modified Fregat (Soyuz FG's 4th stage) or Breeze-M upper stage (Proton-M) launched from Plesetsk (Russian Federation) and equipped with an electro-dynamic tether (EDT) system can be used, after an opportune inclination's change, to de-orbit a Kosmos-3M second stage rocket body while also delivering an acceptable payload to orbit. In this paper, we continue our work on the aforementioned concept, presented at the 2012 Beijing Space Sustainability Conference, by comparing its performance to ADR missions using only chemical propulsion from the upper stage for the far approach and the de-orbiting phase. We will also update the EDT model used in our previous work and highlight some of the methods for creating physical contact with the object. Moreover, we will assess this concept also with European launch vehicles (Vega and Soyuz 2-1A) to remove space debris from space. In addition, the paper will cover some economic aspects, like the cost for the launches' operator in term of payload mass' loss at the launch. The entire debris removal mission from launch to de-orbiting of the target debris object will be analysed using Analytical Graphic Inc.'s Systems Tool Kit (STK).

The Latest in Surgical Management of Stage IIIA Non-Small Cell Lung Cancer: Video-Assisted Thoracic Surgery and Tumor Molecular Profiling.

PubMed

Woodard, Gavitt A; Jablons, David M

2015-01-01

Stage IIIA non-small cell lung cancer (NSCLC) remains a treatment challenge and requires a multidisciplinary care team to optimize survival outcomes. Thoracic surgeons play an important role in selecting operative candidates and assisting with pathologic mediastinal staging via cervical mediastinoscopy, endobronchial ultrasound, or esophageal ultrasound with fine needle aspiration. The majority of patients with stage IIIA disease will receive induction therapy followed by repeat staging before undergoing lobectomy or pneumonectomy; occasionally, a patient with an incidentally found, single-station microscopic IIIA tumor will undergo resection as the primary initial therapy. Multiple large clinical trials, including SWOG-8805, EORTC-8941, INT-0139, and ANITA, have shown 5-year overall survival rates of up to 30% to 40% using triple-modality treatments, and the best outcomes repeatedly are seen among patients who respond to induction treatment or who have tumors amenable to lobectomy instead of pneumonectomy. The need for a pneumonectomy is not a reason to deny patients an operation, because current operative mortality and morbidity rates are acceptably low at 5% and 30%, respectively. In select patients with stage IIIA disease, video-assisted thoracic surgery and open resections have been shown to have comparable rates of local recurrence and long-term survival. New developments in genetic profiling and personalized medicine are exciting areas of research, and early data suggest that molecular profiling of stage IIIA NSCLC tumors can accurately stratify patients by risk within this stage and predict survival outcomes. Future advances in treating stage IIIA disease will involve developing better systemic therapies and customizing treatment plans on the basis of an individual tumor's genetic profile.

Use of Shuttle Heritage Hardware in Space Launch System (SLS) Application-Structural Assessment

NASA Technical Reports Server (NTRS)

Aggarwal, Pravin; Booker, James N.

2018-01-01

NASA is moving forward with the development of the next generation system of human spaceflight to meet the Nation's goals of human space exploration. To meet these goals, NASA is aggressively pursuing the development of an integrated architecture and capabilities for safe crewed and cargo missions beyond low-Earth orbit. Two important tenets critical to the achievement of NASA's strategic objectives are Affordability and Safety. The Space Launch System (SLS) is a heavy-lift launch vehicle being designed/developed to meet these goals. The SLS Block 1 configuration (Figure 1) will be used for the first Exploration Mission (EM-1). It utilizes existing hardware from the Space Shuttle inventory, as much as possible, to save cost and expedite the schedule. SLS Block 1 Elements include the Core Stage, "Heritage" Boosters, Heritage Engines, and the Integrated Spacecraft and Payload Element (ISPE) consisting of the Launch Vehicle Stage Adapter (LVSA), the Multi-Purpose Crew Vehicle (MPCV) Stage Adapter (MSA), and an Interim Cryogenic Propulsion Stage (ICPS) for Earth orbit escape and beyond-Earth orbit in-space propulsive maneuvers. When heritage hardware is used in a new application, it requires a systematic evaluation of its qualification. In addition, there are previously-documented Lessons Learned (Table -1) in this area cautioning the need of a rigorous evaluation in any new application. This paper will exemplify the systematic qualification/assessment efforts made to qualify the application of Heritage Solid Rocket Booster (SRB) hardware in SLS. This paper describes the testing and structural assessment performed to ensure the application is acceptable for intended use without having any adverse impact to Safety. It will further address elements such as Loads, Material Properties and Manufacturing, Testing, Analysis, Failure Criterion and Factor of Safety (FS) considerations made to reach the conclusion and recommendation.

Predictive factors of user acceptance on the primary educational mathematics aids product

NASA Astrophysics Data System (ADS)

Hidayah, I.; Margunani; Dwijanto

2018-03-01

Mathematics learning in primary schools requires instructional media. According to Piaget's theory, students are still in the concrete operational stage. For this reason, the development of the primary level mathematics aids is needed to support the development of successful mathematics learning. The stages of this research are the stages of commercialization with preparatory, marketing, and measurement analysis procedures. Promotion as part of marketing is done by doing a demonstration to the teacher. Measurements were performed to explore the predictive factors of user feasibility in adopting the product. Measurements were conducted using the concept of Technology Acceptance Model (TAM). Measurement variables include external variables, perceived usefulness, perceived ease of use, attitude, intention to use, and actual use. The result of this research shows that the contribution of predictive factors of mathematics teachers on the teaching aids product as follows: the external variable and perceived ease of use at 74%, perceived usefulness at 72%, intention to use (behavioral) at 58%, attitude at 52%, and the consequence factor (actual use) at 42%.

Looking beyond disfigurement: the experience of patients with head and neck cancer.

PubMed

Henry, Melissa; Ho, Angela; Lambert, Sylvie D; Carnevale, Franco A; Greenfield, Brian; MacDonald, Christina; Mlynarek, Alex; Zeitouni, Anthony; Rosberger, Zeev; Hier, Michael; Black, Martin; Kost, Karen; Frenkiel, Saul

2014-01-01

Despite the frequent occurrence of head and neck cancer (HNC) disfigurement, little is known about its psychosocial impact on patients. This study aimed to understand the lived experience of disfigurement in HNC and explore what patients considered to be its influences. Fourteen disfigured HNC patients participated in a 45-to-120-minute in-depth, semistructured interview, which was analyzed qualitatively using interpretive phenomenology. A majority of participants (64 percent) were considered to be at an advanced cancer stage (stage III or stage IV). Patients' experiences revolved around the concept of a ruptured self-image (a discontinuity in sense of self). Forces triggering this ruptured self-image created a sense of "embodied angst", in which disfigurement served as a constant reminder of the patient's cancer and associated foundational malaise. Other influences fostered a sense of normalcy, balance, and acceptance. Participants oscillated between these two states as they grew to accept their disfigurement. This study's findings could guide supportive interventions aimed at helping patients face head and neck surgery.

Metamorphoses of ONAV console operations: From prototype to real time application

NASA Technical Reports Server (NTRS)

Millis, Malise; Wang, Lui

1991-01-01

The ONAV (Onboard Navigation) Expert System is being developed as a real time console assistant to the ONAV flight controller for use in the Mission Control Center at the Johnson Space Center. Currently the entry and rendezvous systems are in verification, and the ascent is being prototyped. To arrive at this stage, from a prototype to real world application, the ONAV project has had to deal with not only AI issues but operating environment issues. The AI issues included the maturity of AI languages and the debugging tools, what is verification, and availability, stability, and the size of the expert pool. The environmental issues included real time data acquisition, hardware stability, and how to achieve acceptance by users and management.

Identical Origin for Halide and Sulfate Efflorescences on Meteorite Finds and Sulfate Veins in Orgueil

NASA Technical Reports Server (NTRS)

Zolensky, M. E.

2000-01-01

Halide and sulfate efflorescences are common on meteorite finds, especially those from cold deserts. Meanwhile, the late-stage sulfate veins in Orgueil are universally accepted as having originated by the action of late-stage high fO2 aqueous alteration on an asteroid. I suggest here that these phenomena have essentially the same origin.

Identical Origin for Halide and Sulfate Efflorescences On Meteorite Finds and Sulfate Veins In Orgueil

NASA Technical Reports Server (NTRS)

Zolensky, Michael E.

1999-01-01

Halide and sulfate efflorescences are common on meteorite finds, especially those from cold deserts. Meanwhile, the late-stage sulfate veins in Orgueil are universally accepted as having originated by the action of late-stage high fO2 aqueous alteration on an asteroid. I suggest here that these phenomena have essentially the same origin.

Relationship between identity and attitude toward death in Japanese senior citizens.

PubMed

Nakagi, Satomi; Tada, Toshiko

2014-01-01

This study aimed to clarify the relationship between identity development stages and attitudes towards death among Japanese senior citizens. The subjects were recruited from among approximately 500 students attending educational courses for senior citizens in Prefecture A. We collected the data by using the questionnaire and interview. The contents of questionnaire were Erikson Psychosocial Stage Inventory (EPSI) and Death Attitude Profile-Revised (DAP-R). In the interview, we represented the four developmental stages, and asked the questions from birth to the present. The collection rate was 85.4% (427 subjects). And 10 subjects participated in the interview. In relation to correlations between the EPSI sub-factors and the DAP-R subscales, there were moderately strong, negative correlations between "Integrity" and "Fear of death" and between "Integrity" and "Avoidance of death". In relation to the subjects' reflections on their lives, the following four categories were extracted: [Trust relationships with others], [Self-confidence regarding my own efforts], [Wanting to contribute to society], and [Let things be as they are]. These results suggested that the accomplishment of "Integrity", which is the developmental task in the maturity stage, leads to the attitude of accepting one's whole life. Further, we have clarified that "Integrity" promotes the acceptance of death.

Health-related quality of life with long-term retention of the PROSthesis of Antibiotic Loaded Acrylic Cement system following infection resolution in low demand patients.

PubMed

Beaupre, Lauren A; Stampe, Kyle; Masson, Edward; O'Connor, Gregory; Clark, Marcia; Joffe, A Mark; Boychuk, Lesia R; Lavoie, Guy

2017-01-01

The study purpose was to (1) evaluate health-related quality of life (HRQL) with the PROSthesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) in situ for infected total hip arthroplasty (THA), (2) determine infection resolution, and (3) compare subjects who underwent second stage surgery with those who retained the PROSTALAC on a longer term basis. Demographics, physical demand level, and comorbidities were recorded prospectively in 29 subjects followed to at least 24 months after initial PROSTALAC insertion. HRQL was evaluated using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and RAND 36-Item Health Survey. Infection resolution was determined using a pre-specified clinical definition. Twenty-five of 29 (86%) subjects' infections resolved. Three subjects died, of whom two had resolved infections. For survivors, 22/26 (85%) completed HRQL evaluations. After PROSTALAC insertion, pain and function improved within 3-6 months and was retained at 24 months. Of those followed to 24 months, 7/22 (32%) subjects underwent second stage surgery. They were higher physical demand subjects ( p = 0.03) than those not undergoing second stage surgery. We found no difference in WOMAC scores at 24 months between those who underwent second stage surgery and those who retained the PROSTALAC ( p > 0.32). The PROSTALAC system for THA appears to allow acceptable HRQL while in situ for at least 2 years in low physical demand patients. Subjects with higher physical demand levels are more likely to undergo second stage surgery. Further evaluation is required to determine whether longer term PROSTALAC retention may be appropriate for specific patient groups.

Validation of EORTC IN-PATSAT32 for Chinese cancer patients.

PubMed

Zhang, Lei; Dai, Zhenbo; Cheng, Siying; Xie, Shumin; Woo, Stephanie Mu-Lian; Luo, Zhiqin; Wu, Jinglian; Gao, Tianwen; Liu, Jiahao; Zhang, Kai; Zhang, Jing; Jia, Xinyu; Miller, Adam R; Wang, Changli

2015-09-01

The aim of this study is to test the psychometric properties and acceptability of the European Organization for Research and Treatment of Cancer (EORTC) inpatient satisfaction with care questionnaire 32 (IN-PATSAT32) for evaluating Chinese cancer patients and to analyze the influence of age, educational level, diagnostic time, and tumor stage on patient satisfaction. Three hundred two cancer inpatients in Tianjin Cancer Institution and Hospital from June 2013 to December 2013 were recruited for this study. All participants self-administered the EORTC IN-PATSAT32 and EORTC quality of life questionnaire-core 30 (QLQ-C30). Psychometric evaluation of the validity, reliability, acceptability, as well as the influence of age, educational level, diagnostic time, and tumor stage on patient satisfaction, was conducted. A favorable internal consistency reliability was confirmed, as the Cronbach's α coefficients were >0.80 for all scales in the EORTC IN-PATSAT32, ranging from 0.849 to 0.944. Multi-trait scaling analysis showed that all item-scale correlation coefficients met the standard of convergent validity, and 79.3 % met the standard of discriminant validity. Weak correlations were found between the scales and single items of the EORTC IN-PATSAT32 and EORTC QLQ-C30, proving the validity of EORTC IN-PATSAT32. None of the EORTC IN-PATSAT32 scales were able to discriminate between patients across age categories, while significant influences of educational level on doctors' and nurses' conduct, as well as influences of diagnostic time and tumor stage on nurses' conduct, and information provision scales were discovered. The questionnaire was easily understood with a satisfactory acceptability. The EORTC IN-PATSAT32 appears to be a reliable, valid, and acceptable instrument to use on cancer patients and is appropriate for measuring the patient satisfaction of Chinese patients.

Self-Confident Approach in Coping with Stress and Social Appearance Anxiety of Turkish University Students: The Mediating Role of Body Appreciation

ERIC Educational Resources Information Center

Bakalim, Orkide

2016-01-01

During adolescence, it can be very stressful for young men and women to accept their bodies. However, it is important during this stage of their development to accept their body as it is. If they cannot complete this task successfully, young people may experience stress and anxiety. This study aims to investigate the mediating effects of body…

Regulating low-NOx and high-burnout deep-air-staging combustion under real-furnace conditions in a 600 MWe down-fired supercritical boiler by strengthening the staged-air effect.

PubMed

Kuang, Min; Wang, Zhihua; Zhu, Yanqun; Ling, Zhongqian; Li, Zhengqi

2014-10-21

A 600 MW(e) down-fired pulverized-coal supercritical boiler, which was equipped with a deep-air-staging combustion system for reducing the particularly high NOx emissions, suffered from the well-accepted contradiction between low NOx emissions and high carbon in fly ash, in addition to excessively high gas temperatures in the hopper that jeopardized the boiler's safe operations. Previous results uncovered that under low-NOx conditions, strengthening the staged-air effect by decreasing the staged-air angle and simultaneously increasing the staged-air damper opening alleviated the aforementioned problems to some extent. To establish low-NOx and high-burnout circumstances and control the aforementioned hopper temperatures, a further staged-air retrofit with horizontally redirecting staged air through an enlarged staged-air slot area was performed to greatly strengthen the staged-air effect. Full-load industrial-size measurements were performed to confirm the availability of this retrofit. The present data were compared with those published results before the retrofit. High NOx emissions, low carbon in fly ah, and high hopper temperatures (i.e., levels of 1036 mg/m(3) at 6% O2, 3.72%, and about 1300 °C, respectively) appeared under the original conditions with the staged-air angle of 45° and without overfire air (OFA) application. Applying OFA and reducing the angle to 20° achieved an apparent NOx reduction and a moderate hopper temperature decrease while a sharp increase in carbon in fly ash (i.e., levels of 878 mg/m(3) at 6% O2, about 1200 °C, and 9.81%, respectively). Fortunately, the present staged-air retrofit was confirmed to be applicable in regulating low-NOx, high-burnout, and low hopper temperature circumstances (i.e., levels of 867 mg/m(3) at 6% O2, 5.40%, and about 1100 °C, respectively).

INPRO Assessment of an INS in the Area of Safety of Fuel Cycle Installations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raj, B.; Busurin, Y.; Depisch, F.

2006-07-01

INPRO has defined requirements organized in a hierarchy of Basic Principles, User Requirements and Criteria (consisting of an indicator and an acceptance limit) to be met by innovative nuclear reactor systems (INS) in six areas, namely: economics, safety, waste management, environment, proliferation resistance, and infrastructure. If an INS meets all requirements in all areas it represents a sustainable system for the supply of energy, capable of making a significant contribution to meeting the energy needs of the 21. century. Draft manuals have been developed, for each INPRO area, to provide guidance for performing an assessment of whether an INS meetsmore » the INPRO requirements in a given area. The manuals set out the information that needs to be assembled to perform an assessment and provide guidance on selecting the acceptance limits and, for a given INS, for determining the value of the indicators for comparison with the associated acceptance limits. Each manual also includes an example of a specific assessment to illustrate the guidance. This paper discusses the manual for performing an INPRO assessment in the area of safety of fuel cycle installations. The example, chosen solely for the purpose of illustrating the INPRO methodology, describes an assessment of an MOX fuel fabrication plant based on sol-gel technology and illustrates an assessment performed for an INS at an early stage of development. The safety issues and the assessment steps are presented in detail in the paper. (authors)« less

UAS Air Traffic Controller Acceptability Study. 2; Evaluating Detect and Avoid Technology and Communication Delays in Simulation

NASA Technical Reports Server (NTRS)

Comstock, James R., Jr.; Ghatas, Rania W.; Consiglio, Maria C.; Chamberlain, James P.; Hoffler, Keith D.

2015-01-01

This study evaluated the effects of communications delays and winds on air traffic controller ratings of acceptability of horizontal miss distances (HMDs) for encounters between Unmanned Aircraft Systems (UAS) and manned aircraft in a simulation of the Dallas-Ft. Worth (DFW) airspace. Fourteen encounters per hour were staged in the presence of moderate background traffic. Seven recently retired controllers with experience at DFW served as subjects. Guidance provided to the UAS pilots for maintaining a given HMD was provided by information from Detect and Avoid (DAA) self-separation algorithms (Stratway+) displayed on the Multi-Aircraft Control System. This guidance consisted of amber "bands" on the heading scale of the UAS navigation display indicating headings that would result in a loss of well clear between the UAS and nearby traffic. Winds tested were successfully handled by the DAA algorithms and did not affect the controller acceptability ratings of the HMDs. Voice communications delays for the UAS were also tested and included one-way delay times of 0, 400, 1200, and 1800 msec. For longer communications delays, there were changes in strategy and communications flow that were observed and reported by the controllers. The aim of this work is to provide useful information for guiding future rules and regulations applicable to flying UAS in the NAS. Information from this study will also be of value to the Radio Technical Commission for Aeronautics (RTCA) Special Committee 228 - Minimum Performance Standards for UAS.

Determination of Indonesian palm-oil-based bioenergy sustainability indicators using fuzzy inference system

NASA Astrophysics Data System (ADS)

Arkeman, Y.; Rizkyanti, R. A.; Hambali, E.

2017-05-01

Development of Indonesian palm-oil-based bioenergy faces an international challenge regarding to sustainability issue, indicated by the establishment of standards on sustainable bioenergy. Currently, Indonesia has sustainability standards limited to palm-oil cultivation, while other standards are lacking appropriateness for Indonesian palm-oil-based bioenergy sustainability regarding to real condition in Indonesia. Thus, Indonesia requires sustainability indicators for Indonesian palm-oil-based bioenergy to gain recognition and easiness in marketing it. Determination of sustainability indicators was accomplished through three stages, which were preliminary analysis, indicator assessment (using fuzzy inference system), and system validation. Global Bioenergy partnership (GBEP) was used as the standard for the assessment because of its general for use, internationally accepted, and it contained balanced proportion between environment, economic, and social aspects. Result showed that the number of sustainability indicators using FIS method are 21 indicators. The system developed has an accuracy of 85%.

Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project.

PubMed

Redding, Colleen A; Jones, Deborah; Zulu, Robert; Chitalu, Ndashi; Cook, Ryan; Weiss, Stephen M

2015-12-01

Dissemination and scale up of voluntary medical male circumcision (VMMC) programs is well supported by evidence that VMMC reduces HIV risk in populations with high HIV prevalence and low rates of circumcision, as is the case in Zambia. At both individual and population levels, it is important to understand what stages of change for VMMC are associated with, especially across cultures. This study evaluated VMMC knowledge, misinformation, and stages of change for VMMC of uncircumcised men and boys (over 18 years), as well as the concurrent relationship between VMMC stages of change and sexual risk behaviors. Uncircumcised (N = 800) adult men and boys (over 18) were screened and recruited from urban community health centers in Lusaka, Zambia, where they then completed baseline surveys assessing knowledge, attitudes, HIV risk behaviors, and stages of change for VMMC. A series of analyses explored cross-sectional relationships among these variables. VMMC was culturally acceptable in half of the sample; younger, unmarried, and more educated men were more ready to undergo VMMC. Stage of change for VMMC was also related to knowledge, and those at greater HIV risk reported greater readiness to undergo VMMC. Efforts to increase VMMC uptake should address the role of perceived HIV risk, risk behaviors, readiness, accurate knowledge, cultural acceptance, and understanding of the significant degree of HIV protection conferred as part of the VMMC decision making process. These results support incorporating comprehensive HIV risk reduction in VMMC promotion programs.

Knowledge Integration and Use-Case Analysis for a Customized Drug-Drug Interaction CDS Service

NASA Astrophysics Data System (ADS)

Kam, Hye Jin; Park, Man Young; Kim, Woojae; Yoon, Duk Yong; Ahn, Eun Kyoung; Park, Rae Woong

Clinical decision support systems (CDSSs) are thought to reduce adverse drug events (ADEs) by monitoring drug-drug interactions(DDIs). However, clinically improper or excessive alerts can result in high alert overrides. A tailored CDS service, which is appropriate for clinicians and their ordering situations, is required to increase alert acceptance. In this study, we conducted a 12-week pilot project adopting a tailed CDSS at an emergency department. The new CDSS was conducted via a stepwise integration of additional new rules. The alert status with changes in acceptance rate was analyzed. The most frequent DDI alerts were related to prescriptions of anti-inflammatory drugs. The percentages of alert overrides for each stage were 98.0%, 96.0%, 96.9%, and 98.1%, respectively. 91.5% of overridden alerts were related to discharge medications. To reduce the potential hazards of ADEs, the development of an effective customized DDI CDSS is required, via in-depth analysis on alert patterns and overridden reasons.

Education and dissemination strategies of photoactuation as a novel phenomenon

NASA Astrophysics Data System (ADS)

Campo, E. M.; Wenn, D.; Ramos, I.; Esteve, J.; Mamojka, B.; Terentjev, E. M.

2011-10-01

In the current information age, scientists and educators are urged to disseminate scientific findings in a prompt manner for increased public acceptance, later on, in the market place. Customer acceptance of highly novel technologies is an education-driven effort that requires attention early-on during the stage of technology development. Prompt attention is particularly needed in technologies where nanoparticles are employed, such as those being developed within the Nano- Optical Mechanical Systems (NOMS) project. Another driving force to disseminate photoactuation is to generate interest and curiosity amongst the K-12 population that could eventually lead to increased enrollment of students in the physical sciences. In this paper, we present a work plan for the dissemination of photoactuation to society at large; from K-12 to the general public. The work plan will be designed in accordance with the logic model, following indications of the National Academy of Sciences, and will include a proposal for evaluating translational research following a process marker model.

The rarity of "unusual" [corrected] dispositions of victim bodies: staging and posing.

PubMed

Keppel, Robert D; Weis, Joseph G

2004-11-01

The act of leaving a victim's body in an unusual position is a conscious criminal action by an offender to thwart an investigation, shock the finder and investigators of the crime scene, or give perverted pleasure to the killer. The unusual position concepts of posing and staging a murder victim have been documented thoroughly and have been accepted by the courts as a definable phenomenon. One staging case and one posing case are outlined and reveal characteristics of those homicides. From the Washington State Attorney General's Homicide Investigation and Tracking System's database on murder covering the years 1981-2000 (a total of 5,224 cases), the relative frequency of unusual body dispositions is revealed as a very rare occurrence. Only 1.3% of victims are left in an unusual position, with 0.3% being posed and 0.1% being staged. The characteristics of these types of murders also set them apart: compared to all other murders, in staged murders the victims and killers are, on average, older. All victims and offenders in the staged murders are white, with victims being disproportionately white in murders with any kind of unusual body disposition. Likewise, females stand out as victims when the body is posed, staged, or left in other unusual positions. Whereas posed bodies are more likely to include sexual assault, often in serial murders, there is no evidence of either in the staged cases. Lastly, when a body is left in an unusual position, binding is more likely, as well as the use of more "hands on" means of killing the victim, such as stabbing or cutting weapons, bludgeons, ligatures, or hands and feet.

Simulative Analysis of Inter-Satellite Optical Wireless Communication (IsOWC) Link with EDFA

NASA Astrophysics Data System (ADS)

Singh, Mehtab; Singh, Navpreet

2018-04-01

In this paper, simulative analysis and performance comparison of different EDFA (Erbium-doped fiber amplifier) configurations in a 10 Gbps inter-satellite optical wireless communication (IsOWC) link have been reported for a 5,000 km long link and 1,550 nm operating wavelength. The results show that system in which both pre-amplifier and booster amplifier stages are implemented simultaneously outperforms systems with only pre-amplifier and booster amplifier stage. From the results, it can be seen that by deploying a transmission power level of 15 dBm, a link distance of 9,600 km can be achieved with a quality factor of 6.01 dB and BER (Bit error rate) of 1.07×10-9. Also, in this paper, the performance of an 8×7 Gbps WDM-IsOWC link has been reported. The results show that by using both EDFA pre-amplifier and booster amplifier stages, a link distance of 8,000 km for each channel is achievable with desired performance levels (Q≥6 and BER≤10-9). Also, the effect of channel spacing on the performance of WDM-IsOWC link is investigated. The results show that the received signal has acceptable performance levels when the channel spacing is 100 GHz but when the channel spacing is reduced to 80 GHz, the quality of the received signal degrades and link distance decreases.

On theoretical and experimental modeling of metabolism forming in prebiotic systems

NASA Astrophysics Data System (ADS)

Bartsev, S. I.; Mezhevikin, V. V.

Recently searching for extraterrestrial life attracts more and more attention However the searching hardly can be effective without sufficiently universal concept of life origin which incidentally tackles a problem of origin of life on the Earth A concept of initial stages of life origin including origin of prebiotic metabolism is stated in the paper Suggested concept eliminates key difficulties in the problem of life origin and allows experimental verification of it According to the concept the predecessor of living beings has to be sufficiently simple to provide non-zero probability of self-assembling during short in geological or cosmic scale time In addition the predecessor has to be capable of autocatalysis and further complication evolution A possible scenario of initial stage of life origin which can be realized both on other planets and inside experimental facility is considered In the scope of the scenario a theoretical model of multivariate oligomeric autocatalyst coupled with phase-separated particle is presented Results of computer simulation of possible initial stage of chemical evolution are shown Conducted estimations show the origin of autocatalytic oligomeric phase-separated system is possible at reasonable values of kinetic parameters of involved chemical reactions in a small-scale flow reactor Accepted statements allowing to eliminate key problems of life origin imply important consequence -- organisms emerged out of the Earth or inside a reactor have to be based on another different from terrestrial biochemical

Adherence to AIOM (Italian Association of Medical Oncology) lung cancer guidelines in Italian clinical practice: Results from the RIGHT-3 (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) study.

PubMed

Barni, Sandro; Maiello, Evaristo; Di Maio, Massimo; Ardizzoni, Andrea; Cappuzzo, Federico; Maranzano, Ernesto; Novello, Silvia; Bennati, Chiara; Ori, Alessandra; Rizzoli, Sara; Crinò, Lucio

2015-11-01

Clinical practice guidelines represent a key tool to improve quality and reduce variability of cancer care. In 2004, Italian Association of Medical Oncology (AIOM) launched the RIGHT (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) program. The third step, RIGHT-3, evaluated the concordance between AIOM lung cancer guidelines and Italian clinical practice. RIGHT-3 was a retrospective observational study, conducted in 53 Italian centers treating lung cancer. Sampling from AIOM database of 230 centers was stratified by presence of thoracic surgery and geographic distribution. To describe the adherence to AIOM guidelines (2009 edition), 11 indicators regarding diagnostic and treatment procedures were identified. Patients with non-small-cell lung cancer (NSCLC) diagnosis who had first visit in 2010 were divided into 3 groups, based on TNM stage: I-II-IIIA (5 indicators), IIIB (3 indicators) and IV (3 indicators). 708 patients were enrolled; 680 were eligible: 225 patients in stage I-II-IIIA; 156 patients in stage IIIB; 299 patients in stage IV. Cyto-histological diagnosis was available in 96%, 97%, 96% of stage I-II-IIIA, IIIB, IV respectively. Positron-emission tomography was performed in 64% of stage I-II-IIIA and 46% of stage IIIB. 88% of stage I-II patients eligible for surgery underwent lobectomy; after surgery, 61% of stage II and 57% of stage IIIA patients received adjuvant chemotherapy. Among stage IIIB patients who received combined chemo- radiotherapy, sequential approach was more common than concomitant treatment (86% vs. 14%). Among stage IV patients, 87% received platinum-based first-line treatment, and 70% received second-line. The RIGHT-3 study showed that, in 2010, adherence to Italian NSCLC guidelines was high for many indicators (including those related to treatment of stage IV patients), but lower for some diagnostic procedures. Guidelines adherence monitoring can be useful to reduce variability in cancer care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women

PubMed Central

Obeidat, Rana F.

2015-01-01

To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers’ support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system. PMID:27981122

Evaluation of urology residents' perception of surgical theater educational environment.

PubMed

Binsaleh, Saleh; Babaeer, Abdulrahman; Rabah, Danny; Madbouly, Khaled

2015-01-01

To evaluate surgical theater learning environment perception in urology residents in Saudi Arabia and to investigate association of learning environment perception and stages of residency program, sectors of health care system, and regions of Saudi Arabia. A cross-sectional survey using the surgical theater educational environment measure (STEEM) inventory. The STEEM inventory was used to measure theater learning environment perception of urology residents in Saudi Arabia. Respondents' perception was compared regarding different residency stages, sectors of the health care system, and regions of Saudi Arabia. Internal reliability of the inventory was assessed using the Cronbach α coefficient. Correlation analysis was done using the Spearman ρ coefficient. Of 72 registered residents, 33 (45.8%) completed the questionnaire. The residents perceived their environment less than acceptable (135.9 ± 16.7, 67.95%). No significant differences in perception were found among residents of different program stages, different sectors of health care system, or different regions in Saudi Arabia. Residents from the eastern region perceived the training and teaching domain better (p = 0.025). The inventory showed a high internal consistency with a Cronbach α of 0.862. STEEM survey is an applicable and reliable instrument for assessing the learning environment and training skills of urology residency program in Saudi Arabia. Urology residents in Saudi Arabia perceived the theater learning environment as less than ideal. The perceptions of theater learning environment did not change significantly among different stages of the program, different sectors of health care system, or different training regions of Saudi Arabia assuring the uniformity of urology training all over Saudi Arabia. The training programs should address significant concerns and pay close attention to areas in surgical theater educational environment, which need development and enhancement, mainly planned fashion of training, supportive supervision and hospital environment, and proper coverage and management of workloads. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A treatment planning comparison between modulated tri-cobalt-60 teletherapy and linear accelerator-based stereotactic body radiotherapy for central early-stage non-small cell lung cancer.

PubMed

Merna, Catherine; Rwigema, Jean-Claude M; Cao, Minsong; Wang, Pin-Chieh; Kishan, Amar U; Michailian, Argin; Lamb, James; Sheng, Ke; Agazaryan, Nzhde; Low, Daniel A; Kupelian, Patrick; Steinberg, Michael L; Lee, Percy

2016-01-01

We evaluated the feasibility of planning stereotactic body radiotherapy (SBRT) for large central early-stage non-small cell lung cancer with a tri-cobalt-60 (tri-(60)Co) system equipped with real-time magnetic resonance imaging (MRI) guidance, as compared to linear accelerator (LINAC)-based SBRT. In all, 20 patients with large central early-stage non-small cell lung cancer who were treated between 2010 and 2015 with LINAC-based SBRT were replanned using a tri-(60)Co system for a prescription dose of 50Gy in 4 fractions. Doses to organs at risk were evaluated based on established MD Anderson constraints for central lung SBRT. R100 values were calculated as the total tissue volume receiving 100% of the dose (V100) divided by the planning target volume and compared to assess dose conformity. Dosimetric comparisons between LINAC-based and tri-(60)Co SBRT plans were performed using Student׳s t-test and Wilcoxon Ranks test. Blinded reviews by radiation oncologists were performed to assess the suitability of both plans for clinical delivery. The mean planning target volume was 48.3cc (range: 12.1 to 139.4cc). Of the tri-(60)Co SBRT plans, a mean 97.4% of dosimetric parameters per patient met MD Anderson dose constraints, whereas a mean 98.8% of dosimetric parameters per patient were met with LINAC-based SBRT planning (p = 0.056). R100 values were similar between both plans (1.20 vs 1.21, p = 0.79). Upon blinded review by 4 radiation oncologists, an average of 90% of the tri-(60)Co SBRT plans were considered acceptable for clinical delivery compared with 100% of the corresponding LINAC-based SBRT plans (p = 0.17). SBRT planning using the tri-(60)Co system with built-in MRI is feasible and achieves clinically acceptable plans for most central lung patients, with similar target dose conformity and organ at risk dosimetry. The added benefit of real-time MRI-guided therapy may further optimize tumor targeting while improving normal tissue sparing, which warrants further investigation in a prospective feasibility clinical trial. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

A treatment planning comparison between modulated tri-cobalt-60 teletherapy and linear accelerator–based stereotactic body radiotherapy for central early-stage non−small cell lung cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Merna, Catherine; Rwigema, Jean-Claude M.; Cao, Minsong

We evaluated the feasibility of planning stereotactic body radiotherapy (SBRT) for large central early-stage non−small cell lung cancer with a tri-cobalt-60 (tri-{sup 60}Co) system equipped with real-time magnetic resonance imaging (MRI) guidance, as compared to linear accelerator (LINAC)–based SBRT. In all, 20 patients with large central early-stage non−small cell lung cancer who were treated between 2010 and 2015 with LINAC-based SBRT were replanned using a tri-{sup 60}Co system for a prescription dose of 50 Gy in 4 fractions. Doses to organs at risk were evaluated based on established MD Anderson constraints for central lung SBRT. R{sub 100} values were calculatedmore » as the total tissue volume receiving 100% of the dose (V{sub 100}) divided by the planning target volume and compared to assess dose conformity. Dosimetric comparisons between LINAC-based and tri-{sup 60}Co SBRT plans were performed using Student's t-test and Wilcoxon Ranks test. Blinded reviews by radiation oncologists were performed to assess the suitability of both plans for clinical delivery. The mean planning target volume was 48.3 cc (range: 12.1 to 139.4 cc). Of the tri-{sup 60}Co SBRT plans, a mean 97.4% of dosimetric parameters per patient met MD Anderson dose constraints, whereas a mean 98.8% of dosimetric parameters per patient were met with LINAC-based SBRT planning (p = 0.056). R{sub 100} values were similar between both plans (1.20 vs 1.21, p = 0.79). Upon blinded review by 4 radiation oncologists, an average of 90% of the tri-{sup 60}Co SBRT plans were considered acceptable for clinical delivery compared with 100% of the corresponding LINAC-based SBRT plans (p = 0.17). SBRT planning using the tri-{sup 60}Co system with built-in MRI is feasible and achieves clinically acceptable plans for most central lung patients, with similar target dose conformity and organ at risk dosimetry. The added benefit of real-time MRI-guided therapy may further optimize tumor targeting while improving normal tissue sparing, which warrants further investigation in a prospective feasibility clinical trial.« less

Building a Successful Middle School Outreach Effort: Microscopy Camp

ERIC Educational Resources Information Center

Penn, Lee R.; Flynn, Leslie; Johnson, Page

2007-01-01

Microscopy Camp program is designed to introduce acceptable representations of crystalline particles and their atomic structure to twelve-year-old middle school students at a developmental and educational stage.

Associated phoria and the measuring and correcting methodology after H.-J. Haase (MKH).

PubMed

Brautaset, R L; Jennings, J A

2001-09-01

The test charts included in the Polatest, designed by H.-J. Haase and manufactured by Zeiss, are used in Germany, Switzerland and Scandinavia for prism correction of 'associated phoria.' From clinical experience with the Polatest Haase developed a motor and sensory theory of the different stages of decompensation of 'associated phoria ' and a strategy for its prismatic correction - the MKH (Measuring and Correcting Methodology after H.-J. Haase). The theory challenges many accepted ideas about the plasticity of the visual system and the use of prisms in the treatment of sensory abnormalities. This article, the first full description in English, describes and critically discusses the MKH.

Perceived naturalness and evoked disgust influence acceptance of cultured meat.

PubMed

Siegrist, Michael; Sütterlin, Bernadette; Hartmann, Christina

2018-05-01

Cultured meat could be a more environment- and animal-friendly alternative to conventional meat. However, in addition to the technological challenges, the lack of consumer acceptance could be a major barrier to the introduction of cultured meat. Therefore, it seems wise to take into account consumer concerns at an early stage of product development. In this regard, we conducted two experiments that examined the impact of perceived naturalness and disgust on consumer acceptance of cultured meat. The results of Experiment 1 suggest the participants' low level of acceptance of cultured meat because it is perceived as unnatural. Moreover, informing participants about the production of cultured meat and its benefits has the paradoxical effect of increasing the acceptance of traditional meat. Experiment 2 shows that how cultured meat is described influences the participants' perception. Thus, it is important to explain cultured meat in a nontechnical way that emphasizes the final product, not the production method, to increase acceptance of this novel food. Copyright © 2018 Elsevier Ltd. All rights reserved.

Midwifery 2030: a woman's pathway to health. What does this mean?

PubMed

ten Hoope-Bender, Petra; Lopes, Sofia Tavares Castro; Nove, Andrea; Michel-Schuldt, Michaela; Moyo, Nester T; Bokosi, Martha; Codjia, Laurence; Sharma, Sheetal; Homer, Caroline

2016-01-01

The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Dying or living?: The double bind.

PubMed

Longhofer, J

1980-06-01

Describing the behaviors of terminally ill patients, their families and those charged with their care has received considerable attention during the past decade. This study of comprehensive cancer treatment and research facility indicates that the prevailing theory is limited to explanation at the intra-psychic level. In her work with hundreds of terminal cases, Dr. Elizabeth Kubler-Ross found that patients typically progress through five stages: 1) denial, 2) anger, 3) bargaining, 4) depression, and 5) acceptance. She concludes that the majority of her patients die in a stage of acceptance--a state of equanimity. Recently, scholars have claimed that this five stage scheme has limited applicability and may in fact contribute to the formalization of a dying person's behavior. This preliminary report proposes that the stage theory, if it has any descriptive validity, becomes meaningful only when used to describe behaviors occurring among patients, families, and medical practitioners. A plausible explanation of these behaviors is accomplished by examination of communication patterns containing the structure of paradox or double bind. Patients are forced to perceive realities about their physical conditions not as they appear to them, but as they are defined by those in their environment. This paper explores these communication patterns in relation to the structure of social relationships and the specific contents of messages being transmitted and received.

Trust in smart systems: sharing driving goals and giving information to increase trustworthiness and acceptability of smart systems in cars.

PubMed

Verberne, Frank M F; Ham, Jaap; Midden, Cees J H

2012-10-01

We examine whether trust in smart systems is generated analogously to trust in humans and whether the automation level of smart systems affects trustworthiness and acceptability of those systems. Trust is an important factor when considering acceptability of automation technology. As shared goals lead to social trust, and intelligent machines tend to be treated like humans, the authors expected that shared driving goals would also lead to increased trustworthiness and acceptability of adaptive cruise control (ACC) systems. In an experiment, participants (N = 57) were presented with descriptions of three ACCs with different automation levels that were described as systems that either shared their driving goals or did not. Trustworthiness and acceptability of all the ACCs were measured. ACCs sharing the driving goals of the user were more trustworthy and acceptable than were ACCs not sharing the driving goals of the user. Furthermore, ACCs that took over driving tasks while providing information were more trustworthy and acceptable than were ACCs that took over driving tasks without providing information. Trustworthiness mediated the effects of both driving goals and automation level on acceptability of ACCs. As when trusting other humans, trusting smart systems depends on those systems sharing the user's goals. Furthermore, based on their description, smart systems that take over tasks are judged more trustworthy and acceptable when they also provide information. For optimal acceptability of smart systems, goals of the user should be shared by the smart systems, and smart systems should provide information to their user.

Cargo Movement Operations System (CMOS). System Segment Specification, Updated, Increment II

DTIC Science & Technology

1990-05-02

CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: ACCEPT [ ] REJECT [ 3 COMMENT STATUS: OPEN [ ] CLOSED...ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] ORIGINATOR CONTROL...the LAN. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED

On the integral manifold approach to a flame propagation problem

NASA Astrophysics Data System (ADS)

Bykov, Viatcheslav; Goldfarb, Igor; Gol'Dshtein, Vladimir

2004-08-01

The problem of a pressure-driven flame in an inert porous medium filled with a flammable gaseous mixture is considered. In the frame of reference attached to an advancing combustion wave and after a suitable non-dimensionalization the corresponding mathematical description of the problem includes three highly nonlinear ordinary differential equations. The system is rewritten in the form of a singularly perturbed system of ordinary differential equations and is analysed analytically by the geometrical version of the asymptotic method of integral manifolds (MIM). The paper focuses on an analysis of the fine structure of the flame and its velocity on the basis of an asymptotical consideration of an arbitrary trajectory of the considered system in the phase space. It is shown that two different stages of the trajectory correspond to the two various sub-zones of the flame: the first stage (fast motion from the initial point to the slow integral) is interpreted as a preheat sub-zone and the second stage of the path corresponds to a reaction sub-zone. It is shown that an inter-zone boundary plays an important role in a determination of the flame properties: characteristics of the gaseous mixture at that point determine the flame velocity. The accepted approach of the investigation allows us to gain an analytical expression for the flame velocity. It appears that the velocity formula represents a cubic-root dependence on the Arrhenius exponent, which in turn contains the parameters of the boundary point. The theoretical predictions are found to coincide rather well with the data of direct numerical simulations.

An inexact risk management model for agricultural land-use planning under water shortage

NASA Astrophysics Data System (ADS)

Li, Wei; Feng, Changchun; Dai, Chao; Li, Yongping; Li, Chunhui; Liu, Ming

2016-09-01

Water resources availability has a significant impact on agricultural land-use planning, especially in a water shortage area such as North China. The random nature of available water resources and other uncertainties in an agricultural system present risk for land-use planning and may lead to undesirable decisions or potential economic loss. In this study, an inexact risk management model (IRM) was developed for supporting agricultural land-use planning and risk analysis under water shortage. The IRM model was formulated through incorporating a conditional value-at-risk (CVaR) constraint into an inexact two-stage stochastic programming (ITSP) framework, and could be used to control uncertainties expressed as not only probability distributions but also as discrete intervals. The measure of risk about the second-stage penalty cost was incorporated into the model so that the trade-off between system benefit and extreme expected loss could be analyzed. The developed model was applied to a case study in the Zhangweinan River Basin, a typical agricultural region facing serious water shortage in North China. Solutions of the IRM model showed that the obtained first-stage land-use target values could be used to reflect decision-makers' opinions on the long-term development plan. The confidence level α and maximum acceptable risk loss β could be used to reflect decisionmakers' preference towards system benefit and risk control. The results indicated that the IRM model was useful for reflecting the decision-makers' attitudes toward risk aversion and could help seek cost-effective agricultural land-use planning strategies under complex uncertainties.

Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project

PubMed Central

Redding, Colleen A.; Jones, Deborah; Zulu, Robert; Chitalu, Ndashi; Cook, Ryan; Weiss, Stephen M

2015-01-01

Background Dissemination and scale up of voluntary medical male circumcision (VMMC) programs is well supported by evidence that VMMC reduces HIV risk in populations with high HIV prevalence and low rates of circumcision, as is the case in Zambia. Purpose At both individual and population levels, it is important to understand what stages of change for VMMC are associated with, especially across cultures. This study evaluated VMMC knowledge, misinformation and stages of change for VMMC of uncircumcised men and boys (over 18 years), as well as the concurrent relationship between VMMC stages of change and sexual risk behaviors. Method Uncircumcised (N = 800) adult men and boys (over 18) were screened and recruited from urban community health centers in Lusaka, Zambia, where they then completed baseline surveys assessing knowledge, attitudes, HIV risk behaviors and stages of change for VMMC. A series of analyses explored cross-sectional relationships among these variables. Results VMMC was culturally acceptable in half of the sample; younger, unmarried, and more educated men were more ready to undergo VMMC. Stage of change for VMMC was also related to knowledge, and those at greater HIV risk reported greater readiness to undergo VMMC. Conclusions Efforts to increase VMMC uptake should address the role of perceived HIV risk, risk behaviors, readiness, accurate knowledge, cultural acceptance and understanding of the significant degree of HIV protection conferred as part of the VMMC decision making process. These results support incorporating comprehensive HIV risk reduction in VMMC promotion programs. PMID:25896876

78 FR 36794 - Information Collection Request; Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-19

... sex domestic partner applicants will be given this form prior to staging. Title: Affidavit Declaring... sex domestic partners applying to be accepted and placed together as Peace Corps Volunteers meet the...

Eligibility and Funding for Visiting Scholars | FNLCR Staging

Cancer.gov

Expressions of Interest (EoI) will be accepted from investigators in the extramural research community including those that are in academia, foundations, pharmaceutical companies, etc. Applications are especially encouraged from established investiga

Saturn Apollo Program

NASA Image and Video Library

1968-01-01

This image depicts the Saturn V S-IVB (third) stage for the Apollo 10 mission being removed from the Beta Test Stand 1 after its acceptance test at the Douglas Aircraft Company's Sacramento Test Operations (SACTO) facility. After the S-II (second) stage dropped away, the S-IVB (third) stage was ignited and burned for about two minutes to place itself and the Apollo spacecraft into the desired Earth orbit. At the proper time during this Earth parking orbit, the S-IVB stage was re-ignited to speed the Apollo spacecraft to escape velocity injecting it and the astronauts into a moon trajectory. Developed and manufactured by the Douglas Aircraft Company in California, the S-IVB stage measures about 21.5 feet in diameter, about 58 feet in length, and powered by a single 200,000-pound-thrust J-2 engine with a re-start capability. The S-IVB stage was also used on the second stage of the Saturn IB launch vehicle.

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer.

PubMed

Obeidat, Rana F; Dickerson, Suzanne S; Homish, Gregory G; Alqaissi, Nesreen M; Lally, Robin M

2013-01-01

Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment. The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer. An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age). Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning. Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.

ATLAS FTK a - very complex - custom super computer

NASA Astrophysics Data System (ADS)

Kimura, N.; ATLAS Collaboration

2016-10-01

In the LHC environment for high interaction pile-up, advanced techniques of analysing the data in real time are required in order to maximize the rate of physics processes of interest with respect to background processes. The Fast TracKer (FTK) is a track finding implementation at the hardware level that is designed to deliver full-scan tracks with pT above 1 GeV to the ATLAS trigger system for events passing the Level-1 accept (at a maximum rate of 100 kHz). In order to achieve this performance, a highly parallel system was designed and currently it is being commissioned within in ATLAS. Starting in 2016 it will provide tracks for the trigger system in a region covering the central part of the ATLAS detector, and will be extended to the full detector coverage. The system relies on matching hits coming from the silicon tracking detectors against one billion patterns stored in custom ASIC chips (Associative memory chip - AM06). In a first stage, coarse resolution hits are matched against the patterns and the accepted hits undergo track fitting implemented in FPGAs. Tracks with pT > 1GeV are delivered to the High Level Trigger within about 100 ps. Resolution of the tracks coming from FTK is close to the offline tracking and it will allow for reliable detection of primary and secondary vertexes at trigger level and improved trigger performance for b-jets and tau leptons. This contribution will give an overview of the FTK system and present the status of commissioning of the system. Additionally, the expected FTK performance will be briefly described.

Thermal Control Subsystem Design for the Avionics of a Space Station Payload

NASA Technical Reports Server (NTRS)

Moran, Matthew E.

1996-01-01

A case study of the thermal control subsystem development for a space based payload is presented from the concept stage through preliminary design. This payload, the Space Acceleration Measurement System 2 (SAMS-2), will measure the acceleration environment at select locations within the International Space Station. Its thermal control subsystem must maintain component temperatures within an acceptable range over a 10 year life span, while restricting accessible surfaces to touch temperature limits and insuring fail safe conditions in the event of loss of cooling. In addition to these primary design objectives, system level requirements and constraints are imposed on the payload, many of which are driven by multidisciplinary issues. Blending these issues into the overall system design required concurrent design sessions with the project team, iterative conceptual design layouts, thermal analysis and modeling, and hardware testing. Multiple tradeoff studies were also performed to investigate the many options which surfaced during the development cycle.

Multispectral imaging for biometrics

NASA Astrophysics Data System (ADS)

Rowe, Robert K.; Corcoran, Stephen P.; Nixon, Kristin A.; Ostrom, Robert E.

2005-03-01

Automated identification systems based on fingerprint images are subject to two significant types of error: an incorrect decision about the identity of a person due to a poor quality fingerprint image and incorrectly accepting a fingerprint image generated from an artificial sample or altered finger. This paper discusses the use of multispectral sensing as a means to collect additional information about a finger that significantly augments the information collected using a conventional fingerprint imager based on total internal reflectance. In the context of this paper, "multispectral sensing" is used broadly to denote a collection of images taken under different polarization conditions and illumination configurations, as well as using multiple wavelengths. Background information is provided on conventional fingerprint imaging. A multispectral imager for fingerprint imaging is then described and a means to combine the two imaging systems into a single unit is discussed. Results from an early-stage prototype of such a system are shown.

Progress on alternative energy resources

NASA Astrophysics Data System (ADS)

Couch, H. T.

1982-03-01

Progress in the year 1981 toward the development of energy systems suitable for replacing petroleum products combustion and growing in use to fulfill a near term expansion in energy use is reviewed. Coal is noted to be a potentially heavy pollution source, and the presence of environmentally acceptable methods of use such as fluidized-bed combustion and gasification and liquefaction reached the prototype stage in 1981, MHD power generation was achieved in two U.S. plants, with severe corrosion problems remaining unsolved for the electrodes. Solar flat plate collectors sales amounted to 20 million sq ft in 1981, and solar thermal electric conversion systems with central receivers neared completion. Solar cells are progressing toward DOE goals of $.70/peak W by 1986, while wind energy conversion sales were 2000 machines in 1981, and the industry is regarded as maturing. Finally, geothermal, OTEC, and fusion systems are reviewed.

Development and comparison of user acceptance of advanced comprehensive triage PDA support system with a traditional terminal alternative system.

PubMed

Chang, Polun; Tzeng, Yuann-Meei; Wu, Shiao-Chi; Sang, Ying-Yang; Chen, Shih-Shin

2003-01-01

An advanced PDA support system for the triage was designed to evaluate users inverted exclamation mark | acceptance of this system compared with a traditional terminal system. Davis inverted exclamation mark | Technology Acceptance Model was used to evaluate users inverted exclamation mark | acceptance. All 72 ER nurses in a 2700-bed medical center were invited for the study. The results showed that the PDA system was easier to operate than the terminal one, but had worse interface. The subjects showed significantly greater willingness to accept the terminal system instead of the PDA system. The comparative acceptance of PDA, compared with that of the old system, might still be marginally too low if its interface couldn inverted exclamation mark |t be improved or no other unique practical benefits could be verified.

A proposed model of factors influencing hydrogen fuel cell vehicle acceptance

NASA Astrophysics Data System (ADS)

Imanina, N. H. Noor; Kwe Lu, Tan; Fadhilah, A. R.

2016-03-01

Issues such as environmental problem and energy insecurity keep worsening as a result of energy use from household to huge industries including automotive industry. Recently, a new type of zero emission vehicle, hydrogen fuel cell vehicle (HFCV) has received attention. Although there are argues on the feasibility of hydrogen as the future fuel, there is another important issue, which is the acceptance of HFCV. The study of technology acceptance in the early stage is a vital key for a successful introduction and penetration of a technology. This paper proposes a model of factors influencing green vehicle acceptance, specifically HFCV. This model is built base on two technology acceptance theories and other empirical studies of vehicle acceptance. It aims to provide a base for finding the key factors influencing new sustainable energy fuelled vehicle, HFCV acceptance which is achieved by explaining intention to accept HFCV. Intention is influenced by attitude, subjective norm and perceived behavioural control from Theory of Planned Behaviour and personal norm from Norm Activation Theory. In the framework, attitude is influenced by perceptions of benefits and risks, and social trust. Perceived behavioural control is influenced by government interventions. Personal norm is influenced by outcome efficacy and problem awareness.

48 CFR 46.502 - Responsibility for acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Responsibility for acceptance. 46.502 Section 46.502 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 46.502 Responsibility for acceptance. Acceptance of...

Advances in liver transplantation allocation systems.

PubMed

Schilsky, Michael L; Moini, Maryam

2016-03-14

With the growing number of patients in need of liver transplantation, there is a need for adopting new and modifying existing allocation policies that prioritize patients for liver transplantation. Policy should ensure fair allocation that is reproducible and strongly predictive of best pre and post transplant outcomes while taking into account the natural history of the potential recipients liver disease and its complications. There is wide acceptance for allocation policies based on urgency in which the sickest patients on the waiting list with the highest risk of mortality receive priority. Model for end-stage liver disease and Child-Turcotte-Pugh scoring system, the two most universally applicable systems are used in urgency-based prioritization. However, other factors must be considered to achieve optimal allocation. Factors affecting pre-transplant patient survival and the quality of the donor organ also affect outcome. The optimal system should have allocation prioritization that accounts for both urgency and transplant outcome. We reviewed past and current liver allocation systems with the aim of generating further discussion about improvement of current policies.

High speed true random number generator with a new structure of coarse-tuning PDL in FPGA

NASA Astrophysics Data System (ADS)

Fang, Hongzhen; Wang, Pengjun; Cheng, Xu; Zhou, Keji

2018-03-01

A metastability-based TRNG (true random number generator) is presented in this paper, and implemented in FPGA. The metastable state of a D flip-flop is tunable through a two-stage PDL (programmable delay line). With the proposed coarse-tuning PDL structure, the TRNG core does not require extra placement and routing to ensure its entropy. Furthermore, the core needs fewer stages of coarse-tuning PDL at higher operating frequency, and thus saves more resources in FPGA. The designed TRNG achieves 25 Mbps @ 100 MHz throughput after proper post-processing, which is several times higher than other previous TRNGs based on FPGA. Moreover, the robustness of the system is enhanced with the adoption of a feedback system. The quality of the designed TRNG is verified by NIST (National Institute of Standards and Technology) and also accepted by class P1 of the AIS-20/31 test suite. Project supported by the S&T Plan of Zhejiang Provincial Science and Technology Department (No. 2016C31078), the National Natural Science Foundation of China (Nos. 61574041, 61474068, 61234002), and the K.C. Wong Magna Fund in Ningbo University, China.

Quality of life of Greek patients with end stage renal disease undergoing haemodialysis.

PubMed

Kastrouni, Maria; Sarantopoulou, Eleni; Aperis, Georgios; Alivanis, Polichronis

2010-09-01

An evaluation of the quality of life of patients with end stage kidney disease undergoing haemodialysis in the Greek population was conducted to understand whether this quality could be improved. Comparisons were made with a similar study conducted in United States in regards to the effects of kidney disease in daily life, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, social support, physical functioning, role physical on daily routine, pain, general health perceptions, role emotional, emotional well being, social function and energy/fatigue. Any differences are discussed and analysed. Sexual problems were found to be more prominent in this study, but the emotional status has greater influence in quality of life in the US study. The results were more positive in Greece with respect to dialysis staff encouragement, patient satisfaction, as well as acceptance and the understanding of illness. The results from our study reflect the differences of the health care systems in various countries as well as population-related beliefs and values.

Should copyright be transferred before a manuscript is accepted?

PubMed

Teixeira da Silva, Jaime A

2017-10-01

Academic journals that undergo a process of academic scrutiny often pass a stage of peer review and subsequent editorial approval. In a process that can take weeks or months (in some cases, even years), an author aims to satisfy the requirements of peer reviewer and editorial scrutiny that would merit publication of their work. It is customary to, in traditional, non-open access journals, to then sign over copyright to the publisher, upon which the publisher then issues a proof, and the manuscript is then published. Even though it is obvious that an author would not submit to a journal with the objective of having it rejected, the issue of the timing of copyright transfer is one which does not appear to have been discussed in the literature, possibly because the order of transfer, i.e., after acceptance of a paper for publication, seems naturally logical. With the modernization of online submission systems, the transfer of copyright tends to occur online, after acceptance. However, on occasion, some journals request the transfer of copyright before peer review and editorial processing occurs, i.e., upon the act of submission. This letter examines three cases of Springer Nature plant science journals that demand the transfer of copyright to the journal's society upon submission, in direct violation of their instructions for authors. Authors have no right to challenge this discrepancy, nor can they complete submission in accordance with the instructions for authors because they are forced to submit copyright upon submission. Not only does transfer of copyright at such an early stage of the publishing process constitute a waste of authors' time-a precious commodity in a cut-throat field of science-in the three cases indicated in this paper, they may constitute a violation of authors' rights. The ethics of this request by the journals and publisher need to be debated.

Impact of Television on Children's Social Development

ERIC Educational Resources Information Center

Liebert, Robert M.; Sprafkin, Joyce N.

1977-01-01

Discusses the three-stage observational learning process of exposure (amount of contact and type of content), acquisition (what is learned), and acceptance (how much affects attitudes and actions) with emphasis on racial and sexual stereotypes. (JAB)

Understanding the 'four directions of travel': qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam.

PubMed

Witter, Sophie; Thi Thu Ha, Bui; Shengalia, Bakhuti; Vujicic, Marko

2011-08-17

Motivation and retention of health workers, particularly in rural areas, is a question of considerable interest to policy-makers internationally. Many countries, including Vietnam, are debating the right mix of interventions to motivate doctors in particular to work in remote areas. The objective of this study was to understand the dynamics of the health labour market in Vietnam, and what might encourage doctors to accept posts and remain in-post in rural areas. This study forms part of a labour market survey which was conducted in Vietnam in November 2009 to February 2010. The study had three stages. This article describes the findings of the first stage - the qualitative research and literature review, which fed into the design of a structured survey (second stage) and contingent valuation (third stage). For the qualitative research, three tools were used - key informant interviews at national and provincial level (6 respondents); in-depth interviews of doctors at district and commune levels (11 respondents); and focus group discussions with medical students (15 participants). The study reports on the perception of the problem by national level stakeholders; the motivation for joining the profession by doctors; their views on the different factors affecting their willingness to work in rural areas (including different income streams, working conditions, workload, equipment, support and supervision, relationships with colleagues, career development, training, and living conditions). It presents findings on their overall satisfaction, their ranking of different attributes, and willingness to accept different kinds of work. Finally, it discusses recent and possible policy interventions to address the distribution problem. Four typical 'directions of travel' are identified for Vietnamese doctors - from lower to higher levels of the system, from rural to urban areas, from preventive to curative health and from public to private practice. Substantial differences in income from formal and informal sources all reinforce these preferences. While non-financial attributes are also important for Vietnamese doctors, the scale of the difference of opportunities presents a considerable policy challenge. Significant salary increases for doctors in hard-to-staff areas are likely to have some impact. However, addressing the differentials is likely to require broader market reforms and regulatory measures.

Changes in blood flow during one stage lengthening of bone: an experimental study in rats.

PubMed

Kwon, S T; Chung, C Y

2000-06-01

Distraction osteogenesis is a well-accepted method of bone lengthening. Its disadvantages, however, are that it requires an external fixator and takes a long time. One-stage lengthening therefore offers certain advantages. A first point of reference for the safe limits of this procedure might be the changes of blood flow, and this is also the crucial factor in deciding on the appropriate method of lengthening, particularly where the hand or foot is involved. Using a laser Doppler flowmeter we measured blood flow in the dorsum of the foot after using bilateral minimonofixators to lengthen the tibias of 15 Sprague-Dawley rats. They were lengthened in four stages: stage 0 (before lengthening); stage I--12.5%; stage II--25%; and stage III--31.25% of lengthening. The blood flow during stage I decreased to 79% compared to that of stage 0; 16% during stage II; and 1% during stage III. This study suggests that the maximal permissible extent of lengthening might be less than a quarter according to the blood flow as suggested by this animal model.

Warm Disks from Giant Impacts

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2015-10-01

In the process of searching for exoplanetary systems, weve discovered tens of debris disks close around distant stars that are especially bright in infrared wavelengths. New research suggests that we might be looking at the late stages of terrestrial planet formation in these systems.Forming Terrestrial PlanetsAccording to the widely-accepted formation model for our solar-system, protoplanets the size of Mars formed within a protoplanetary disk around our Sun. Eventually, the depletion of the gas in the disk led the orbits of these protoplanets to become chaotically unstable. Finally, in the giant impact stage, many of the protoplanets collided with each other ultimately leading to the formation of the terrestrial planets and their moons as we know them today.If giant impact stages occur in exoplanetary systems, too leading to the formation of terrestrial exoplanets how would we detect this process? According to a study led by Hidenori Genda of the Tokyo Institute of Technology, we might be already be witnessing this stage in observations of warm debris disks around other stars. To test this, Genda and collaborators model giant impact stages and determine what we would expect to see from a system undergoing this violent evolution.Modeling CollisionsSnapshots of a giant impact in one of the authors simulations. The collision causes roughly 0.05 Earth masses of protoplanetary material to be ejected from the system. Click for a closer look! [Genda et al. 2015]The collaborators run a series of simulations evolving protoplanetary bodies in a solar system. The simulations begin 10 Myr into the lifetime of the solar system, i.e., after the gas from the protoplanetary disk has had time to be cleared and the protoplanetary orbits begin to destabilize. The simulations end when the protoplanets are done smashing into each other and have again settled into stable orbits, typically after ~100 Myr.The authors find that, over an average giant impact stage, the total amount of mass ejected from colliding protoplanets is typically around 0.4 Earth masses. This mass is ejected in the form of fragments that then spread into the terrestrial planet region around the star. The fragments undergo cascading collisions as they orbit, forming an infrared-emitting debris disk at ~1 AU from the star.The authors then calculate the infrared flux profile expected from these simulated disks. They show that the warm disks can exist and radiate for up to ~100 Myr before the fragments are smashed into micrometer-sized pieces small enough to be blown out of the solar system by radiation pressure.The Spitzer Space Telescope has, thus far, observed tens of warm-debris-disk signatures roughly consistent with the authors predictions, primarily located at roughly 1 AU around stars with ages of 10100 Myr. This region is near the habitable zone of these stars, which makes it especially interesting that these systems may currently be undergoing a giant impact stage perhaps on the way to forming terrestrial planets.CitationH. Genda et al 2015 ApJ 810 136. doi:10.1088/0004-637X/810/2/136

Development and Feasibility Testing of PROMPT-Care, an eHealth System for Collection and Use of Patient-Reported Outcome Measures for Personalized Treatment and Care: A Study Protocol.

PubMed

Girgis, Afaf; Delaney, Geoff P; Arnold, Anthony; Miller, Alexis Andrew; Levesque, Janelle V; Kaadan, Nasreen; Carolan, Martin G; Cook, Nicole; Masters, Kenneth; Tran, Thomas T; Sandell, Tiffany; Durcinoska, Ivana; Gerges, Martha; Avery, Sandra; Ng, Weng; Della-Fiorentina, Stephen; Dhillon, Haryana M; Maher, Ashley

2016-11-24

Patient-reported outcome (PRO) measures have been used widely to screen for depression, anxiety, and symptoms in cancer patients. Computer-based applications that collect patients' responses and transfer them to the treating health professional in real time have the potential to improve patient well-being and cancer outcomes. This study will test the feasibility and acceptability of a newly developed eHealth system which facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. The eHealth system is being developed in consultation with 3 overarching content-specific expert advisory groups convened for this project: the clinical advisory group, technical advisory group, and evaluation advisory group. The following work has already been completed during this phase of the study: the Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) eHealth system was developed, patient-reported outcomes were selected (distress, symptoms, unmet needs), algorithms to inform intervention thresholds for clinical and self-management were determined, clinician PRO feedback summary and longitudinal reports were designed, and patient self-management resources were collated. PROsaiq, a custom information technology system, will transfer PRO data in real time into the hospital-based oncology information system to support clinical decision making. The PROMPT-Care system feasibility and acceptability will be assessed through patients completing PROMPT-Care assessments, participating in face-to-face cognitive interviews, and completing evaluation surveys and telephone interviews and oncology staff participating in telephone interviews. Over the course of 3 months, the system will be pilot-tested with up to 50 patients receiving treatment or follow-up care and 6 oncology staff at 2 hospitals in New South Wales, Australia. Data will be collected to determine the accuracy and completeness of data transfer procedures, extent of missing data from participants' assessments, acceptability of the eHealth system and usefulness of the self-management resources (via patient evaluation surveys and interviews), and acceptability and perceived usefulness of real-time PRO reporting (via oncology staff interviews) at the completion of the pilot phase. This research investigates implementation of evidence into real world clinical practice through development of an efficient and user-friendly eHealth system. This study of feasibility and acceptability of the newly developed eHealth system will inform the next stage of larger scale testing and future implementation of the system as part of routine care. Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0). ©Afaf Girgis, Geoff P Delaney, Anthony Arnold, Alexis Andrew Miller, Janelle V Levesque, Nasreen Kaadan, Martin G Carolan, Nicole Cook, Kenneth Masters, Thomas T Tran, Tiffany Sandell, Ivana Durcinoska, Martha Gerges, Sandra Avery, Weng Ng, Stephen Della-Fiorentina, Haryana M Dhillon, Ashley Maher. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.11.2016.

Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD.

PubMed

Burkow, Tatjana M; Vognild, Lars K; Johnsen, Elin; Risberg, Marijke Jongsma; Bratvold, Astrid; Breivik, Elin; Krogstad, Trine; Hjalmarsen, Audhild

2015-12-10

Comprehensive multidisciplinary pulmonary rehabilitation is vital in the management of chronic obstructive pulmonary disease (COPD) and is considered for any stage of the disease. Rehabilitation programmes are often centre-based and organised in groups. However, the distance from the patient's home to the centre and lack of transportation may hinder participation. Rehabilitation at home can improve access to care for patients regardless of disease severity. We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The aims of this feasibility study were to assess patient acceptability of the delivery mode and components of a comprehensive pulmonary rehabilitation programme for any stage of COPD, as well as the technology usability, patient outcomes and economic aspects. Ten participants with COPD in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade I-IV were enrolled in a 9-week home programme and divided into two rehabilitation groups, with five patients in each group. The programme included exercise training and self-management education in online groups of patients, and individual online consultations. The patients also kept a digital health diary. To assess the acceptability of the programme, the patients were interviewed after the intervention using a semi-structured interview guide. In addition the number of sessions attended was observed. The usability of the technology was assessed using interviews and the System Usability Scale questionnaire. The St George's Respiratory Questionnaire (SGRQ) was used to measure health-related quality of life. The mode of delivery and the components of the programme were well accepted by the patients. The programme provided an environment for learning from both healthcare professionals and peers, for asking questions and discussing disease-related issues and for group exercising. The patients considered that it facilitated health-enhancing behaviours and social interactions with a social group formed among the participants. Even participants who were potentially less homebound appreciated the home group and social aspects of the programme. The participants found the technology easy to learn and use. The acceptability and usability results were consistent with those in our previous study of patients with very severe COPD. Only the mean change in the SGRQ total score of -6.53 (CI 95 % -0.38 to -12.68, p = 0.04) indicates a probable clinically significant effect. Economic calculations indicated that the cost of the programme was feasible. The results of this study indicate that comprehensive pulmonary rehabilitation delivered in home-based online groups may be feasible in COPD. The mode of delivery and components of the programme appeared to be acceptable across patients with different disease severity. The results in terms of patient outcomes are inconclusive, and further assessment is needed.

Strategies for the prevention of knee osteoarthritis.

PubMed

Roos, Ewa M; Arden, Nigel K

2016-02-01

Osteoarthritis (OA) has been thought of as a disease of cartilage that can be effectively treated surgically at severe stages with joint arthroplasty. Today, OA is considered a whole-organ disease that is amenable to prevention and treatment at early stages. OA develops slowly over 10-15 years, interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases. Joint injury, obesity and impaired muscle function are modifiable risk factors amenable to primary and secondary prevention strategies. The strategies that are most appropriate for each patient should be identified, by selecting interventions to correct--or at least attenuate--OA risk factors. We must also choose the interventions that are most likely to be acceptable to patients, to maximize adherence to--and persistence with--the regimes. Now is the time to begin the era of personalized prevention for knee OA.

Parental social cognitions: considerations in the acceptability of and engagement in behavioral parent training.

PubMed

Mah, Janet W T; Johnston, Charlotte

2008-12-01

Behavioral parent training (BPT) is a widely used, evidence-based treatment for externalizing child behaviors. However, the ability of BPT programs to be maximally effective remains limited by relatively low rates of acceptance, attendance, and adherence to treatment. Previous reviews have focused on a variety of demographic and mental health characteristics of parents and children that are predictive of poor outcomes in BPT. This paper focuses instead on consideration of parental social cognitions, and how incorporation of these cognitions may, or may not, be useful in advancing the effectiveness of BPT. We first review evidence suggesting limited incremental effects to incorporating parental cognitions within the context of BPT programs. Then, we examine the role of two particular types of parental social cognitions, attributions and parenting efficacy, in relation to the initial stages of accepting and engaging in BPT. We conclude by noting limitations in available research on the links between parental social cognitions and BPT, and we outline a number of potentially useful directions that may clarify whether or not parental social cognitions should be accorded greater attention either in the initial stages or throughout BPT programs.

Photovoltaic balance-of-system designs and costs at PVUSA

NASA Astrophysics Data System (ADS)

Reyes, A. B.; Jennings, C.

1995-05-01

This report is one in a series of 1994-1995 PVUSA reports that document PVUSA lessons learned at demonstration sites in California and Texas. During the last 7 years (1988 to 1994), 16 PV systems ranging from 20 kW to 500 kW have been installed. Six 20-kW emerging module technology (EMT) arrays and three turnkey (i.e., vendor designed and integrated) utility-scale systems were procured and installed at PVUSA's main test site in Davis, California. PVUSA host utilities have installed a total of seven EMT arrays and utility-scale systems in their service areas. Additional systems at Davis and host utility sites are planned. One of PVUSA's key objectives is to evaluate the performance, reliability, and cost of PV balance-of-system (BOS). In the procurement stage PVUSA encouraged innovative design to improve upon present practice by reducing maintenance, improving reliability, or lowering manufacturing or construction costs. The project team worked closely with suppliers during the design stage not only to ensure designs met functional and safety specifications, but to provide suggestions for improvement. This report, intended for the photovoltaic (PV) industry and for utility project managers and engineers considering PV plant construction and ownership, documents PVUSA utility-scale system design and cost lessons learned. Complementary PVUSA topical reports document: construction and safety experience; five-year assessment of EMTs; validation of the Kerman 500-kW grid-support PV plant benefits; PVUSA instrumentation and data analysis techniques; procurement, acceptance, and rating practices for PV power plants; experience with power conditioning units and power quality.

Maillard-reaction-induced modification and aggregation of proteins and hardening of texture in protein bar model systems.

PubMed

Zhou, Peng; Guo, Mufan; Liu, Dasong; Liu, Xiaoming; Labuza, Teodore P

2013-03-01

The hardening of high-protein bars causes problems in their acceptability to consumers. The objective of this study was to determine the progress of the Maillard reaction in model systems of high-protein nutritional bars containing reducing sugars, and to illustrate the influences of the Maillard reaction on the modification and aggregation of proteins and the hardening of bar matrices during storage. The progress of the Maillard reaction, glycation, and aggregation of proteins, and textural changes in bar matrices were investigated during storage at 25, 35, and 45 °C. The initial development of the Maillard reaction caused little changes in hardness; however, further storage resulted in dramatic modification of protein with formation of high-molecular-weight polymers, resulting in the hardening in texture. The replacement of reducing sugars with nonreducing ingredients such as sugar alcohols in the formula minimized the changes in texture. The hardening of high-protein bars causes problems in their acceptability to consumers. Maillard reaction is one of the mechanisms contributing to the hardening of bar matrix, particularly for the late stage of storage. The replacement of reducing sugars with nonreducing ingredients such as sugar alcohols in the formula will minimize the changes in texture. © 2013 Institute of Food Technologists®

Box-ticking and Olympic high jumping - Physicians' perceptions and acceptance of national physician validation systems.

PubMed

Sehlbach, Carolin; Govaerts, Marjan J B; Mitchell, Sharon; Rohde, Gernot G U; Smeenk, Frank W J M; Driessen, Erik W

2018-05-24

National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians' competence. Their effectiveness is determined by physicians' acceptance of and commitment to the system. This study, therefore, sought to explore physicians' perceptions and self-reported acceptance of validation across three different physician validation systems in Europe. Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians' perceptions and acceptance. Factors that influenced acceptance were the assessment's authenticity and alignment of its requirements with clinical practice, physicians' beliefs about learning, perceived autonomy, and organizational support. Users' acceptance levels determine any system's effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems' goals, thereby promoting acceptance.

[Actinic keratosis, Bowen's disease, keratoacanthoma and squamous cell carcinoma of the skin].

PubMed

Majores, M; Bierhoff, E

2015-02-01

Actinic (solar) keratosis is an intraepidermal squamous neoplasm of sun-damaged skin and by far the most frequent neoplastic skin lesion. A subdivison into three grades has been proposed with increasing acceptance not least because of the therapeutic consequences. The transition to invasive squamous cell carcinoma is reported in 5-10 % and with immunosuppression in 30 % of patients.Bowen's disease is a variant of squamous cell carcinoma in situ of the skin and the mucocutaneous junction. The differentiation from bowenoid papulosis as a lesion associated with human papillomavirus (HPV), actinic (solar) keratosis grade III, intraepidermal poroid lesions and in cases of clonal type from clonal seborrhoic keratosis and Paget's disease is very important.Keratoacanthoma is currently uniformly interpreted as a variant of highly differentiated squamous cell carcinoma of the skin with clinical and histomorphological characteristics. Clinically keratoacanthoma erupts rapidly and is capable of resolving spontaneously. Histologically, there is a characteristic growth pattern and various stages of regression. The final histomorphological diagnosis needs the entire specimen.Squamous cell carcinoma of the skin is the second most common type of skin cancer following basal cell carcinoma. With respect to reccurrencies and risk of metastases the subtyping of cutaneous squamous cell carcinoma is very important. The classification system of the Union Internationale Contra le Cancer (UICC) is based solely on the anatomical spread and the classification system of the American Joint Committee on Cancer (AJCC) also considers so-called high-risk features in the staging between stages I and II.

Fluvial geomorphology and river engineering: future roles utilizing a fluvial hydrosystems framework

NASA Astrophysics Data System (ADS)

Gilvear, David J.

1999-12-01

River engineering is coming under increasing public scrutiny given failures to prevent flood hazards and economic and environmental concerns. This paper reviews the contribution that fluvial geomorphology can make in the future to river engineering. In particular, it highlights the need for fluvial geomorphology to be an integral part in engineering projects, that is, to be integral to the planning, implementation, and post-project appraisal stages of engineering projects. It should be proactive rather than reactive. Areas in which geomorphologists will increasingly be able to complement engineers in river management include risk and environmental impact assessment, floodplain planning, river audits, determination of instream flow needs, river restoration, and design of ecologically acceptable channels and structures. There are four key contributions that fluvial geomorphology can make to the engineering profession with regard to river and floodplain management: to promote recognition of lateral, vertical, and downstream connectivity in the fluvial system and the inter-relationships between river planform, profile, and cross-section; to stress the importance of understanding fluvial history and chronology over a range of time scales, and recognizing the significance of both palaeo and active landforms and deposits as indicators of levels of landscape stability; to highlight the sensitivity of geomorphic systems to environmental disturbances and change, especially when close to geomorphic thresholds, and the dynamics of the natural systems; and to demonstrate the importance of landforms and processes in controlling and defining fluvial biotopes and to thus promote ecologically acceptable engineering. Challenges facing fluvial geomorphology include: gaining full acceptance by the engineering profession; widespread utilization of new technologies including GPS, GIS, image analysis of satellite and airborne remote sensing data, computer-based hydraulic modeling and geophysical techniques; dovetailing engineering approaches to the study of river channels which emphasize reach-scale flow resistance, shear stresses, and material strength with catchment scale geomorphic approaches, empirical predictions, bed and bank processes, landform evolution, and magnitude-frequency concepts; producing accepted river channel typologies; fundamental research aimed at producing more reliable deterministic equations for prediction of bed and bank stability and bedload transport; and collaboration with aquatic biologists to determine the role and importance of geomorphologically and hydraulically defined habitats.

Predictors of men's acceptance of modern contraceptive practice: study in rural Vietnam.

PubMed

Ha, Bui Thi Thu; Jayasuriya, Rohan; Owen, Neville

2005-12-01

Studies have shown family planning adoption is likely to be more effective for women when men are actively involved. The transtheoretical model of behavior change was used to examine men's involvement in general contraception and intrauterine device (IUD) use by their wives. The study was carried out in rural Vietnam with 651 eligible participants. Cons of IUD use for men in precontemplation and contemplation/preparation were significantly higher than those in the action/maintenance stages, whereas the reverse was true for pros of IUD. The self-efficacy for convincing wife to have IUD in precontemplation was significantly lower than for those in higher stages. Women's education and ages, spontaneous recall of modern contraceptive method, cons for IUD, and self-efficacy for contraception and for convincing wives to get IUD inserted (or continue use) were significant predictors of men's readiness to accept IUD. Interventions are targeted to reduce cons and increase self-efficacy for IUD use.

Semiconductor structural damage attendant to contact formation in III-V solar cells

NASA Technical Reports Server (NTRS)

Fatemi, Navid S.; Weizer, Victor G.

1991-01-01

In order to keep the resistive losses in solar cells to a minimum, it is often necessary for the ohmic contacts to be heat treated to lower the metal-semiconductor contact resistivity to acceptable values. Sintering of the contacts, however can result in extensive mechanical damage of the semiconductor surface under the metallization. An investigation of the detailed mechanisms involved in the process of contact formation during heat treatment may control the structural damage incurred by the semiconductor surface to acceptable levels, while achieving the desired values of contact resistivity for the ohmic contacts. The reaction kinetics of sintered gold contacts to InP were determined. It was found that the Au-InP interaction involves three consecutive stages marked by distinct color changes observed on the surface of the Au, and that each stage is governed by a different mechanism. A detailed description of these mechanisms and options to control them are presented.

Indonesia [Population education in countries of the region].

PubMed

Hardjosawarmono, S

1982-06-01

Indonesia currently faces 5 population problems: 1) large total population, estimated by 1980 census data at 147,383,075; 2) rapid population growth, increasing at the rate of 2.8 million annually by 1980; 3) a young population distribution, with 44% of the population under age 15; 4) uneven population distribution; and 5) rapid urbanization. The National Family Planning Coordinating Board (NFPCB), established in 1970 to plan and control family planning and population education, has set the goal of reducing the 1971 fertility rate by 50% by 1990. Population education is aimed at achieving voluntary acceptance of the small family idea. This is to be attained through awareness of the factors causing rapid population growth and the close interaction between such growth and development programs to enhance the standard of living. The population education program, which is administered by the Department of Education and Culture in cooperation with the NFPCB, underwent an orientation stage in 1970-72 and a pilot project stage in 1973-75. In the latter stage, teaching materials were developed and tested in 30 junior high schools. During the institutionalization stage, 1976-79, the program was systematically integrated into the educational system. Population topics are integrated with relevant subject areas from the 4th grade of elementary school to the 3rd grade of senior high school. A cell system is used to train teachers, who in turn train teachers in their respective schools. Population education has also been introduced into Indonesia's subsidiary schools under religious and Armed Forces jurisdiction. Current population education activities include the training of an additional 50,000 teachers and provision of teaching kits, slide projectors, and textbooks to all of the 160 nonformal learning centers. In addition, a number of government agencies, including the Ministries of Sports and Culture, Education, Health, Transmigration, Information, Religious Affairs, Home Affairs, and Defense, are involved in education programs aimed at those ages 10-45 who are outside of the educational system.

MECHANISMS INVOLVED IN THE ASSOCIATION BETWEEN PERIDONTAL DISEASES AND CARDIOVASCULAR DISEASE

PubMed Central

Teles, Ricardo; Wang, Cun-Yu

2012-01-01

It is now well accepted that besides the cholesterol associated mechanisms of atherogenesis, inflammation plays a crucial role in all stages of the development of the atherosclerotic lesion. This “inflammation hypothesis” raises the possibility that, through systemic elevations of pro-inflammatory cytokines, periodontal diseases might also contribute to systemic inflammation and, therefore, to atherogenesis. In fact, there is evidence that periodontal diseases are associated with higher systemic levels of high-sensitivity C-reactive protein and a low grade systemic inflammation. This phenomenon has been explained based on mechanisms associated with either the infectious or the inflammatory nature of periodontal diseases. The purposes of this article are to review (1) the evidence suggesting a role for oral bacterial species, particularly periodontal pathogens, in atherogenesis; (2) the potential mechanisms explaining an etiological role for oral bacteria in atherosclerosis; (3) the evidence suggesting that periodontal infections are accompanied by a heightened state of systemic inflammation; (4) the potential sources of systemic inflammatory biomarkers associated with periodontal diseases; and (5) the effects of periodontal therapy on systemic inflammatory biomarkers and cardiovascular risk. PMID:21223455

Self-Consistent Simulation of the Brownian Stage of Dust Growth

NASA Technical Reports Server (NTRS)

Kempf, S.; Pfalzner, S.; Henning, Th.

1996-01-01

It is a widely accepted view that in proto-planetary accretion disks the collision and following sticking of dust particles embedded in the gas eventually leads to the formation of planetesimals (coagulation). For the smallest dust grains, Brownian motion is assumed to be the dominant source of their relative velocities leading to collisions between these dust grains. As the dust grains grow they eventually couple to the turbulent motion of the gas which then drives the coagulation much more efficiently. Many numerical coagulation simulations have been carried out to calculate the fractal dimension of the aggregates, which determines the duration of the ineffective Brownian stage of growth. Predominantly on-lattice and off-lattice methods were used. However, both methods require simplification of the astrophysical conditions. The aggregates found by those methods had a fractal dimension of approximately 2 which is equivalent to a constant, mass-independent friction time. If this value were valid for the conditions in an accretion disk, this would mean that the coagulation process would finally 'freeze out' and the growth of a planetesimal would be impossible within the lifetime of an accretion disk. In order to investigate whether this fractal dimension is model independent, we simulate self-consistently the Brownian stage of the coagulation by an N-particle code. This method has the advantage that no further assumptions about homogeneity of the dust have to be made. In our model, the dust grains are considered as aggregates built up of spheres. The equation of motion of the dust grains is based on the probability density for the diffusive transport within the gas atmosphere. Because of the very low number density of the dust grains, only 2-body-collisions have to be considered. As the Brownian stage of growth is very inefficient, the system is to be simulated over long periods of time. In order to find close particle pairs of the system which are most likely to undergo a collision, we use a particle-in-cell (PIC) method for the early stages of the simulation where the system is still very homogeneous and a tree method later when the particles are more clustered.

A view from the AIAA: Introduction of new energy storage technology into orbital programs

NASA Technical Reports Server (NTRS)

Badcock, Charles

1987-01-01

The development of new energy storage technology must be heavily weighted toward the application. The requirements for transitioning low risk technology into operational space vehicles must remain the central theme even at the preliminary development stages by the development of efforts to define operational issues and verify the reliability of the system. Failure to follow a complete plan that results in a flight qualified unit may lead to an orphan technology. Development efforts must be directed toward a stable development where changes in design are evolutionary and end items are equivalent to flight units so that life and qualification testing can be used as a vehicle to demonstrate the acceptability of the technology.

Periodontal therapy.

PubMed

Niemiec, Brook A

2008-05-01

Periodontal disease is the most common disease in small animal patients. It not only creates severe localized infection, but it has been linked to numerous severe systemic maladies. Proper therapy of this disease process results in a significant increase in the overall health of the patient. The treatment of periodontal disease is currently evolving due to the acceptance of the specific plaque hypothesis of periodontal disease. These findings have led to the development of the "one-stage full-mouth disinfection" treatment as well as a vaccine against these organisms. However, the cornerstone of therapy is still meticulous plaque control. This control is achieved via a combination of regular dental prophylaxis and home care. With progressive disease, advanced periodontal surgery or extraction becomes necessary.

The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: A systematic review.

PubMed

Zimmermann, Fernanda F; Burrell, Beverley; Jordan, Jennifer

2018-02-01

In spite of supportive care for people affected by cancer being well recognized as a priority for research, there is little solid evidence of the effectiveness of psychological interventions using mindfulness for those with advanced cancer. This systematic review aims to describe, evaluate and synthesize the acceptability and potential benefits of mindfulness-based interventions (MBIs) for the psychological well-being of people with advanced cancers. Eight databases were searched and terms related to advanced stages of cancer and mindfulness were combined systematically to identify relevant published literature. Inclusion criteria were studies with adults only and all types of cancer at stages III and IV. There was considerable variety in the MBI treatment packages including in the extent and centrality of mindfulness in the interventions. Of 312 identified studies, only 8 included MBIs for people with advanced cancer rather than their families or carers. Results from these studies suggests that MBIs are acceptable and beneficial to the advanced cancer population, improving quality of life, use of mindfulness skills, acceptance of their cancer situation and reduction in depression and anxiety. Some adaptations were recommended however regarding delivery, simplified briefer MBIs, abbreviated session time, flexibility concerning locality of treatment and a minimized questionnaire burden for this group. MBI packages reviewed in this study had evidence of acceptability and of effectiveness, indicating potential benefit for this population. Individualized, including home-based interventions may be optimal to allow critically ill patients to participate in treatment. In future, MBIs adapted to the needs of various advanced cancer patients are recommended to address the gap in the field and improve health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

HPV-relatedness definitions for classifying HPV-related oropharyngeal cancer patient do impact on TNM classification and patients' survival.

PubMed

Taberna, Miren; Mena, Marisa; Tous, Sara; Pavón, Miquel Angel; Oliva, Marc; León, Xavier; Garcia, Jacinto; Guix, Marta; Hijano, Rafael; Bonfill, Teresa; Aguilà, Antón; Alemany, Laia; Mesía, Ricard

2018-01-01

Given the different nature and better outcomes of oropharyngeal carcinoma (OPC) associated with human papillomavirus (HPV) infection, a novel clinical stage classification for HPV-related OPC has been accepted for the 8th edition AJCC TNM (ICON-S model). However, it is still unclear the HPV-relatedness definition with best diagnostic accuracy and prognostic value. The aim of this study was to compare different staging system models proposed for HPV-related OPC patients: 7th edition AJCC TNM, RPA stage with non-anatomic factors (Princess Margaret), RPA with N categories for nasopharyngeal cancer (MD-Anderson) and AHR-new (ICON-S), according to different HPV-relatedness definitions: HPV-DNA detection plus an additional positive marker (p16INK4a or HPV-mRNA), p16INK4a positivity alone or the combination of HPV-DNA/p16INK4a positivity as diagnostic tests. A total of 788 consecutive OPC cases diagnosed from 1991 to 2013 were considered eligible for the analysis. Of these samples, 66 (8.4%) were positive for HPV-DNA and (p16INK4a or HPV-mRNA), 83 (10.5%) were p16INK4a positive and 58 (7.4%) were double positive for HPV-DNA/p16INK4a. ICON-S model was the staging system, which performed better in our series when using at least two biomarkers to define HPV-causality. When the same analysis was performed considering only p16INK4a-positivity, RPA stage with non-anatomic factors (Princess Margaret) has the best classification based on AIC criteria. HPV-relatedness definition for classifying HPV-related OPC patient do impact on TNM classification and patients' survival. Further studies assessing HPV-relatedness definitions are warranted to better classify HPV-related OPC patients in the era of de-escalation clinical trials.

HPV-relatedness definitions for classifying HPV-related oropharyngeal cancer patient do impact on TNM classification and patients’ survival

PubMed Central

Mena, Marisa; Tous, Sara; Pavón, Miquel Angel; Oliva, Marc; León, Xavier; Garcia, Jacinto; Guix, Marta; Hijano, Rafael; Bonfill, Teresa; Aguilà, Antón; Alemany, Laia; Mesía, Ricard

2018-01-01

Background Given the different nature and better outcomes of oropharyngeal carcinoma (OPC) associated with human papillomavirus (HPV) infection, a novel clinical stage classification for HPV-related OPC has been accepted for the 8th edition AJCC TNM (ICON-S model). However, it is still unclear the HPV-relatedness definition with best diagnostic accuracy and prognostic value. Material and methods The aim of this study was to compare different staging system models proposed for HPV-related OPC patients: 7th edition AJCC TNM, RPA stage with non-anatomic factors (Princess Margaret), RPA with N categories for nasopharyngeal cancer (MD-Anderson) and AHR-new (ICON-S), according to different HPV-relatedness definitions: HPV-DNA detection plus an additional positive marker (p16INK4a or HPV-mRNA), p16INK4a positivity alone or the combination of HPV-DNA/p16INK4a positivity as diagnostic tests. Results A total of 788 consecutive OPC cases diagnosed from 1991 to 2013 were considered eligible for the analysis. Of these samples, 66 (8.4%) were positive for HPV-DNA and (p16INK4a or HPV-mRNA), 83 (10.5%) were p16INK4a positive and 58 (7.4%) were double positive for HPV-DNA/p16INK4a. ICON-S model was the staging system, which performed better in our series when using at least two biomarkers to define HPV-causality. When the same analysis was performed considering only p16INK4a-positivity, RPA stage with non-anatomic factors (Princess Margaret) has the best classification based on AIC criteria. Conclusion HPV-relatedness definition for classifying HPV-related OPC patient do impact on TNM classification and patients’ survival. Further studies assessing HPV-relatedness definitions are warranted to better classify HPV-related OPC patients in the era of de-escalation clinical trials. PMID:29664911

Quality of care and economic considerations of active surveillance of men with prostate cancer

PubMed Central

2018-01-01

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted. PMID:29732278

Quality of care and economic considerations of active surveillance of men with prostate cancer.

PubMed

Filson, Christopher P

2018-04-01

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.

Cargo Movement Operations System (CMOS) System Segment Design Document. Revision. Increment 2

DTIC Science & Technology

1990-06-14

ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: ACCEPT [ ] REJECT [ ] COMMENT STATUS: OPEN [ J CLOSED [ ] Cmnt Page Paragraph No. No. Number...provided (SSDDII-0004). CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ 3 ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED...but not in paragraph 10.1. CMOS PMO ACCEPTS COMMENT: YES [ ) NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] * COMMENT DISPOSITION: COMMENT STATUS: OPEN

Difficulty accepting lifestyle limitations after the abrupt onset of end-stage renal disease.

PubMed

Wolfson, M; Strong, C; Hamel, K; Cummings-Cosgrove, M; Brown, R

1995-07-01

Adjustment to the lifestyle changes imposed by end-stage renal disease is particularly difficult when the onset is abrupt and unheralded. A case of atheroembolism is presented in which living situation, dietary compliance, and family involvement are particularly problematic for the dialysis staff. Discussion by team members focuses on the evolution of a reasonable disposition through diligence and persistence, recognizing the need to compromise medical indications with individual lifestyle and available family support.

Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy.

PubMed

Ager, B; Jansen, J; Porter, D; Phillips, K A; Glassey, R; Butow, P

2018-05-22

Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions. Copyright © 2018 Elsevier Ltd. All rights reserved.

V/STOLAND avionics system flight-test data on a UH-1H helicopter

NASA Technical Reports Server (NTRS)

Baker, F. A.; Jaynes, D. N.; Corliss, L. D.; Liden, S.; Merrick, R. B.; Dugan, D. C.

1980-01-01

The flight-acceptance test results obtained during the acceptance tests of the V/STOLAND (versatile simplex digital avionics system) digital avionics system on a Bell UH-1H helicopter in 1977 at Ames Research Center are presented. The system provides navigation, guidance, control, and display functions for NASA terminal area VTOL research programs and for the Army handling qualities research programs at Ames Research Center. The acceptance test verified system performance and contractual acceptability. The V/STOLAND hardware navigation, guidance, and control laws resident in the digital computers are described. Typical flight-test data are shown and discussed as documentation of the system performance at acceptance from the contractor.

National Decline in Donor Heart Utilization With Regional Variability: 1995–2010

PubMed Central

Khush, K. K.; Zaroff, J. G.; Nguyen, J.; Menza, R.; Goldstein, B. A.

2015-01-01

The severe shortage of donor hearts limits the availability of transplantation for the growing population of patients with end-stage heart disease. We examined national trends in donor heart acceptance for transplant. OPTN data were analyzed for all potential adult cardiac organ donors between 1995 and 2010. Donor heart disposition was categorized as transplanted, declined for transplant or other. We studied changes in the probability of donor heart acceptance according to demographic and clinical characteristics, nationwide and by UNOS region. Of 82 053 potential donor hearts, 34% were accepted and 48% were declined (18% used for other purposes). There was a significant decrease in donor heart acceptance from 44% in 1995 to 29% in 2006, and subsequent increase to 32% in 2010. Older donor age, female sex and medical co-morbidities predicted non-acceptance. Donor age and co-morbidities increased during the study period, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics. Overall, predictors of heart non-use were similar across UNOS regions, although utilization varied between regions. Regional variation suggests a potential to improve heart acceptance rates in under-performing regions, and supports research and policy efforts aimed at establishing evidence-based criteria for donor heart evaluation and acceptance for transplantation. PMID:25676093

Descriptive analysis and early-stage consumer acceptance of yogurts fermented with carrot juice.

PubMed

Cliff, M A; Fan, L; Sanford, K; Stanich, K; Doucette, C; Raymond, N

2013-07-01

This research explored the sensory characteristics and consumer acceptance of novel probiotic unsweetened yogurts. Yogurts were made with 4 carrot juice levels (8, 16, 24, and 32%), 2 firmness levels (regular, 45g/L milk solids; firm, 90g/L milk solids), and 2 starter cultures (C1, C2). The sensory profile characterized the color intensity (before and after stirring), carrot flavor, sourness, and 7 texture/mouth-feel attributes (astringency, chalkiness, mouth-coating, thickness, smoothness, creaminess, and graininess). The influence of carrot juice level and firmness level were evaluated using ANOVA, polynomial contrasts, and principal component analysis. Mean scores and standard errors were calculated. Consumer acceptance panels in Wolfville, Nova Scotia (n=56), and in Vancouver, British Columbia (Asian n=72, non-Asian n=72), evaluated the hedonic responses to the C1 and C2 formulations, respectively. We observed increases in color intensity, carrot flavor, creaminess, mouth-coating, and chalkiness with increasing carrot juice levels, as well as increases in color intensity, carrot flavor, creaminess, mouth-coating, thickness, and astringency with increasing milk solids concentrations of the C1 and C2 yogurts. Mean hedonic scores for color, appearance, and texture/mouth-feel were greater than hedonic scores for aroma, flavor/taste, and overall liking. This research identified the sensory qualities that need further development and demonstrated the importance of early-stage consumer acceptance research for directing new product development. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

OHI--Randomized Control Trial to Evaluate Efficacy, Acceptability, and Perception of Benefit of an Innovative Custom AFO

ClinicalTrials.gov

2018-05-25

Accidental Falls; Fall Due to Loss of Equilibrium; High Risk of Falls Due to Mobility Limitation; Diabetes; Arthritis; Cancer; Peripheral Arterial Disease; Parkinson's Disease; End Stage Renal Failure on Dialysis

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process.

PubMed

Smith, C F; Finn, G M; Stewart, J; McHanwell, S

2016-01-01

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel. © 2015 Anatomical Society.

Feasibility and Acceptability of Cryptococcal Antigen Screening and Prevalence of Cryptocococcemia in Patients Attending a Resource-Limited HIV/AIDS Clinic in Malawi.

PubMed

Chipungu, Chifundo; Veltman, Jennifer A; Jansen, Perry; Chiliko, Peter; Lossa, Christina; Namarika, Dan; Benner, Blake; Hoffman, Risa M; Bristow, Claire C; Klausner, Jeffrey D

2015-01-01

The World Health Organization (WHO) recommends screening patients living with AIDS to detect and treat early cryptococcal infection. The authors evaluated a cryptococcal antigen (CrAg) screening and treatment program at an HIV/AIDS clinic in Malawi. Eligible patients were of age >18 years, had a CD4 count <100 cells/µL or WHO clinical HIV/AIDS stage III or IV. Of 552 patients who presented for care, 113 were eligible, and all (100%) agreed to CrAg screening. Of them, 2 (1.8%; 95% confidence interval [CI]: 0-4.2%) patients were CrAg positive. Among those with CD4 count <100 cells/µL or WHO stage IV, the CrAg prevalence was 3.5% (95% CI: 0-8.4%) and 5.0% (95% CI: 0-15%), respectively. A CrAg screening program was acceptable to new patients in a Malawian HIV/AIDS clinic. The CrAg prevalence for patients with CD4 count < 100 cells/µL and WHO stage IV was consistent with cost-effectiveness estimates. CrAg screening and treatment programs for patients living with AIDS should be expanded. © The Author(s) 2015.

Measuring Shock Stage of ltokawa Regolith Grains by Electron Back-Scattered Diffraction and Synchrotron X-Ray Diffraction

NASA Technical Reports Server (NTRS)

Zolensky, Michael; Mikouchi, Takashi; Hagiya, Kenji; Ohsumi, Kazumasa; Martinez, James; Hagiya, Kenji; Sitzman, Scott; Terada, Yasuko; Yagi, Naoto; Komatsu, Mutsumi;

Rational design of the column of a heavy multipurpose machining center

NASA Astrophysics Data System (ADS)

Atapin, V. V.; Kurlaev, N. V.

2016-04-01

The main purpose in the design of supporting constructions of heavy multipurpose machining center is the reduction of mass at the given precision and productivity of machining. Accomplish these ends the technology of rational design of supporting constructions is offered. This technology is based on the decomposition method and the finite elements method in the combination with optimization methods. The technology has four stages: 1) calculation of external forces and loads, 2) as a result the boundary conditions (force, kinematics) for individual supporting constructions are formed, 3) a problem about final optimal distribution of a material by the individual supporting constructions with the real cross-section is solved; 4) dynamic analysis. By the example of design of the column of a heavy multipurpose machining center the main stages of rational design of the individual supporting constructions are shown. At a design stage of the carrying system consisting of load-bearing structures with simplified geometry, optimum overall dimensions of the column are identified. For the admitted system of preferences, it is necessary to accept the fact that the carrying system with the column with the sizes of cross section of 1.8 m (along x axis) and 2.6 m (along y axis) is the best. The analysis of the work of the column under the torsion condition with the use of method of mechanics shows that the column with square cross sections = 2.46·2.46 m which rigidity on torsion is 26 % higher in comparison with a production version is the best. The results of calculation show that a production-release design of the column with longitudinal and transverse edges of rigidity is 24 % heavier than the column with the edges located on a diagonally at equal rigidity.

48 CFR 2446.502 - Responsibility for acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Responsibility for acceptance. 2446.502 Section 2446.502 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 2446.502 Responsibility for acceptance. ...

A state comparison amplifier with feed forward state correction

NASA Astrophysics Data System (ADS)

Mazzarella, Luca; Donaldson, Ross; Collins, Robert; Zanforlin, Ugo; Buller, Gerald; Jeffers, John

2017-04-01

The Quantum State Comparison AMPlifier (SCAMP) is a probabilistic amplifier that works for known sets of coherent states. The input state is mixed with a guess state at a beam splitter and one of the output ports is coupled to a detector. The other output contains the amplified state, which is accepted on the condition that no counts are recorded. The system uses only classical resources and has been shown to achieve high gain and repetition rate. However the output fidelity is not high enough for most quantum communication purposes. Here we show how the success probability and fidelity are enhanced by repeated comparison stages, conditioning later state choices on the outcomes of earlier detections. A detector firing at an early stage means that a guess is wrong. This knowledge allows us to correct the state perfectly. The system requires fast-switching between different input states, but still requires only classical resources. Figures of merit compare favourably with other schemes, most notably the probability-fidelity product is higher than for unambiguous state discrimination. Due to its simplicity, the system is a candidate to counteract quantum signal degradation in a lossy fibre or as a quantum receiver to improve the key rate of continuous variable quantum communication. The work was supported by the QComm Project of the UK Engineering and Physical Sciences Research Council (EP/M013472/1).

Management of diabetic nephropathy: Recent progress and future perspective.

PubMed

Ahmad, Jamal

2015-01-01

Diabetic nephropathy (DN), a leading cause of end-stage renal disease (ESRD) affecting ∼20-30% diabetics, is associated with increased cardiovascular mortality. The progression of kidney disease in patients with diabetes can take many years. It occurs as a result of interaction between both genetic and environmental factors in individuals with both type 1 and type 2 diabetes. Hyperglycaemia, hypertension, and genetic pre-disposition are the main risk factors besides elevated serum lipids, smoking habits, and the amount of dietary proteins. Interventions such as glycaemic control, blood pressure control and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease remains high. The treatment of DN, therefore, has posed a formidable challenge besides optimization of renin-angiotensin-aldosterone system blockade in patients with DN; additional investigation has focused on the potential of novel therapies that target various pathways upregulated by hyperglycaemia or other targets believed to promote the progression of DN such as oxidative stress, inflammation, endothelin system and vitamin D receptors. This review article addresses the pathogenesis and some of the well established principles regarding the progression and accepted management of DN, and also includes the perspectives of novel anti-DN agents and the future directions for the prevention of DN. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Study of blade aspect ratio on a compressor front stage aerodynamic and mechanical design report

NASA Technical Reports Server (NTRS)

Burger, G. D.; Lee, D.; Snow, D. W.

1979-01-01

A single stage compressor was designed with the intent of demonstrating that, for a tip speed and hub-tip ratio typical of an advanced core compressor front stage, the use of low aspect ratio can permit high levels of blade loading to be achieved at an acceptable level of efficiency. The design pressure ratio is 1.8 at an adiabatic efficiency of 88.5 percent. Both rotor and stator have multiple-circular-arc airfoil sections. Variable IGV and stator vanes permit low speed matching adjustments. The design incorporates an inlet duct representative of an engine transition duct between fan and high pressure compressor.

Closing with Compassion.

ERIC Educational Resources Information Center

Willmer, Wesley K.; O'Connor, Marie J.

1979-01-01

A study on how people have responded to institutional termination and major elements of a humane process of closure are discussed. Kubler-Ross' five stages of human response to the prospect of death: denial, anger, bargaining, depression, and acceptance are applied to institutional termination. (MLW)

[Comparative effects of nebivolol and valsartan on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients].

PubMed

Altun, Burak; Acar, Gürkan; Akçay, Ahmet; Sökmen, Abdullah; Kaya, Hakan; Köroğlu, Sedat

2011-10-01

Hypertension is an important cardiovascular risk factor for the development of atrial fibrillation (AF). Increased atrial electromechanical coupling time interval measured by tissue Doppler is accepted as an important factor for prediction of AF development in hypertensive patients. The aim of this study was to compare the effects of valsartan, an angiotensin receptor blocker, and nebivolol, a beta-blocker, on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients. The study included 60 newly diagnosed stage 1 hypertensive patients with no other systemic disease. The patients were randomized to receive nebivolol 5 mg (30 patients; 21 women, 9 men; mean age 48.4 ± 11.4 years) and valsartan 160 mg (30 patients; 21 women, 9 men; mean age 49.8 ± 11.3 years). All the patients underwent tissue Doppler echocardiographic examination before and three months after treatment to compare the effects of the two drugs on atrial electromechanical coupling. Baseline blood pressures, electrocardiographic and echocardiographic findings, and atrial electromechanical coupling were similar in both groups (p>0.05). Both drugs significantly reduced blood pressure after treatment, with similar efficacy (p>0.05). Atrial electromechanical coupling time intervals showed significant decreases in both groups. Prolonged interatrial electromechanical time intervals in hypertensives are improved with antihypertensive treatment.

Agreement between oncology guidelines and clinical practice in Italy: the 'right' program. A project of the Italian Association of Medical Oncology (AIOM).

PubMed

Barni, S; Venturini, M; Beretta, G D; Gori, S; Molino, A; Carnaghi, C; Labianca, R; Sgarbi, S; Simoni, L; Maiello, E

2007-06-01

RIGHT (Research for the Identification of the most effective and hIGhly accepted clinical guidelines for the cancer Treatment) is a project promoted by the Italian Association of Medical Oncology (AIOM) to measure the concordance between oncology guidelines and clinical practice. The goal of this pilot phase was to develop and test a reliable process to measure this concordance nationwide. Twenty Italian centers participated to the survey. Breast cancer (BC) and colorectal cancer (CRC): guidelines issued by AIOM in 2003 were selected. A total of 29 indicators linked to the process of care were abstracted. Patients who had their first visit at the oncology center between February 2004 and June 2005, with a diagnosis of invasive BC (stage 1 or 2), colon cancer (stage 3), rectal cancer (stage T3-4 or N1-2) or advanced CRC were enclosed. One hundred and sixty-one patients (80%) were analyzed. On average, 93% of BC and 80.3% of colorectal patients received recommended care. These first results indicate that the RIGHT system provides a valid measurement of oncology care to assess agreement with guidelines. A second larger phase of this nationwide monitoring program will enable results to be generalized.

Flame tube parametric studies for control of fuel bound nitrogen using rich-lean two-stage combustion

NASA Technical Reports Server (NTRS)

Schultz, D. F.; Wolfbrandt, G.

1980-01-01

An experimental parametric study of rich-lean two-stage combustion in a flame tube is described and approaches for minimizing the conversion of fuel-bound nitrogen to nitrogen oxides in a premixed, homogeneous combustion system are evaluated. Air at 672 K and 0.48 MPa was premixed with fuel blends of propane, toluene, and pyridine at primary equivalence ratios ranging from 0.5 to 2.0 and secondary equivalence ratios of 0.5 to 0.7. Distillates of SRC-II, a coal syncrude, were also tested. The blended fuels were proportioned to vary fuel hydrogen composition from 9.0 to 18.3 weight percent and fuel nitrogen composition from zero to 1.5 weight percent. Rich-lean combustion proved effective in reducing fuel nitrogen to NO sub x conversion; conversion rates up to 10 times lower than those normally produced by single-stage combustion were achieved. The optimum primary equivalence ratio, where the least NO sub x was produced and combustion efficiency was acceptable, shifted between 1.4 and 1.7 with changes in fuel nitrogen content and fuel hydrogen content. Increasing levels of fuel nitrogen content lowered the conversion rate, but not enough to avoid higher NO sub x emissions as fuel nitrogen increased.

Money: a therapeutic tool for couples therapy.

PubMed

Shapiro, Margaret

2007-09-01

This article addresses the therapeutic importance of discussing money at every stage of a couple's relationship, both as a concrete reality and as a metaphor for security, adequacy, competence, commitment, acceptance, and acknowledgment in a relationship. I will present a developmental schema looking at financial issues that couples confront at various stages in the adult life cycle and how these affect and reflect relationship problems. The article also presents a money questionnaire as a useful tool for exploring family-of-origin financial history, affect, and behavior.

48 CFR 1346.503 - Place of acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Place of acceptance. 1346.503 Section 1346.503 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 1346.503 Place of acceptance. Insert a clause substantially similar to 1352...

Headquarters summary reports

NASA Technical Reports Server (NTRS)

1992-01-01

The status is summarized of the NASA sponsored involvement in high speed civil transport research and technology, including major cooperative efforts. That involvement is currently focussed on the High Speed Research Program. The program goals are an acceptable level of ozone depletion or sonic boom, the definition of which is a regulatory and political process. The HSRP goal is to provide technical bases for acceptability criteria. Community noise is currently regulated, and it seems clear that HSCT aircraft will have to comply with at least the spirit of the current subsonic constraint, FAR 36, Stage 3.

Pharmacy workers' perceptions and acceptance of bar-coded medication technology in a pediatric hospital.

PubMed

Holden, Richard J; Brown, Roger L; Scanlon, Matthew C; Karsh, Ben-Tzion

2012-01-01

The safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology. (1) To describe pharmacy workers' perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA. Pharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital's implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians' self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models. The BCMA system's perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA. To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians' acceptance and elucidating perceptions and other factors that shape acceptance. Copyright © 2012 Elsevier Inc. All rights reserved.

Results of Two-Stage Light-Gas Gun Development Efforts and Hypervelocity Impact Tests of Advanced Thermal Protection Materials

NASA Technical Reports Server (NTRS)

Cornelison, C. J.; Watts, Eric T.

1998-01-01

Gun development efforts to increase the launching capabilities of the NASA Ames 0.5-inch two-stage light-gas gun have been investigated. A gun performance simulation code was used to guide initial parametric variations and hardware modifications, in order to increase the projectile impact velocity capability to 8 km/s, while maintaining acceptable levels of gun barrel erosion and gun component stresses. Concurrent with this facility development effort, a hypervelocity impact testing series in support of the X-33/RLV program was performed in collaboration with Rockwell International. Specifically, advanced thermal protection system materials were impacted with aluminum spheres to simulate impacts with on-orbit space debris. Materials tested included AETB-8, AETB-12, AETB-20, and SIRCA-25 tiles, tailorable advanced blanket insulation (TABI), and high temperature AFRSI (HTA). The ballistic limit for several Thermal Protection System (TPS) configurations was investigated to determine particle sizes which cause threshold TPS/structure penetration. Crater depth in tiles was measured as a function of impact particle size. The relationship between coating type and crater morphology was also explored. Data obtained during this test series was used to perform a preliminary analysis of the risks to a typical orbital vehicle from the meteoroid and space debris environment.

Emerging Use of Early Health Technology Assessment in Medical Product Development: A Scoping Review of the Literature.

PubMed

IJzerman, Maarten J; Koffijberg, Hendrik; Fenwick, Elisabeth; Krahn, Murray

2017-07-01

Early health technology assessment is increasingly being used to support health economic evidence development during early stages of clinical research. Such early models can be used to inform research and development about the design and management of new medical technologies to mitigate the risks, perceived by industry and the public sector, associated with market access and reimbursement. Over the past 25 years it has been suggested that health economic evaluation in the early stages may benefit the development and diffusion of medical products. Early health technology assessment has been suggested in the context of iterative economic evaluation alongside phase I and II clinical research to inform clinical trial design, market access, and pricing. In addition, performing early health technology assessment was also proposed at an even earlier stage for managing technology portfolios. This scoping review suggests a generally accepted definition of early health technology assessment to be "all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty". The present review also aimed to identify recent published empirical studies employing an early-stage assessment of a medical product. With most included studies carried out to support a market launch, the dominant methodology was early health economic modeling. Further methodological development is required, in particular, by combining systems engineering and health economics to manage uncertainty in medical product portfolios.

Development and implementation of ultrasound picture archiving and communication system

NASA Astrophysics Data System (ADS)

Weinberg, Wolfram S.; Tessler, Franklin N.; Grant, Edward G.; Kangarloo, Hooshang; Huang, H. K.

1990-08-01

The Department of Radiological Sciences at the UCLA School of Medicine is developing an archiving and communication system (PACS) for digitized ultrasound images. In its final stage the system will involve the acquisition and archiving of ultrasound studies from four different locations including the Center for Health Sciences, the Department for Mental Health and the Outpatient Radiology and Endoscopy Departments with a total of 200-250 patient studies per week. The concept comprises two stages of image manipulation for each ultrasound work area. The first station is located close to the examination site and accomodates the acquisition of digital images from up to five ultrasound devices and provides for instantaneous display and primary viewing and image selection. Completed patient studies are transferred to a main workstation for secondary review, further analysis and comparison studies. The review station has an on-line storage capacity of 10,000 images with a resolution of 512x512 8 bit data to allow for immediate retrieval of active patient studies of up to two weeks. The main work stations are connected through the general network and use one central archive for long term storage and a film printer for hardcopy output. First phase development efforts concentrate on the implementation and testing of a system at one location consisting of a number of ultrasound units with video digitizer and network interfaces and a microcomputer workstation as host for the display station with two color monitors, each allowing simultaneous display of four 512x512 images. The discussion emphasizes functionality, performance and acceptance of the system in the clinical environment.

Cargo Movement Operations System (CMOS) System Segment Design Document (Draft) Increment II

DTIC Science & Technology

1990-05-02

and are arranged in page number order. RATIONALE: N/A CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION...NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] ORIGINATOR CONTROL NUMBER: SSDD-0003 PROGRAM...CMOS. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ 3 ORIGINATOR

Cargo Movement Operations System (CMOS). System Segment Design Document. Change 02

DTIC Science & Technology

1990-04-26

ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] ORIGINATOR CONTROL...ACCEPTS COMMENT: YES [ I NO [ ] COMMENT DISPOSITION: I COMMENT STATUS: OPEN [ ] CLOSED [1 I I i I I I I ORIGINATOR CONTROL NUMBER: SSDD-0006 PROGRAM...PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] i ORIGINATOR CONTROL

Cargo Movement Operations System (CMOS) Computer System Operator’s Manual. Draft

DTIC Science & Technology

1990-06-27

are arranged in page number order. RATIONALE: N/A CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION...ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMEN7 STATUS: OPEN [ ] CLOSED [ ] ORIGINATOR CONTROL NUMBER: CSOM-0003 PROGRAM OFFICE CONTROL...ACCEPTS COMMENT: YES [ ] NO ( 3 ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ 3 ORIGINATOR CONTROL NUMBER

Residential Cold Climate Heat Pump (CCHP) w/Variable Speed Technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Messmer, Craig S.

2016-09-30

This report summarizes the results of a three year program awarded to Unico, Inc. to commercialize a residential cold climate heat pump. Several designs were investigated. Compressors were selected using analysis from Oakridge National Laboratories followed by prototype construction and lab testing in a specially built environmental chamber capable of reaching -30°F. The initial design utilized two variable speed compressors in series with very good capacity results and acceptable efficiency at very cold temperatures. The design was then modified to reduce cost and complexity by redesigning the system using three dual-stage compressors: two in parallel followed by one in series.more » Extensive testing found significant challenge with oil management, reliability, weight and cost which prevented the system from being fully commercialized. Further analysis of other conceptual designs indicated that these challenges could be overcome in the future.« less

An artificial neural network improves prediction of observed survival in patients with laryngeal squamous carcinoma.

PubMed

Jones, Andrew S; Taktak, Azzam G F; Helliwell, Timothy R; Fenton, John E; Birchall, Martin A; Husband, David J; Fisher, Anthony C

2006-06-01

The accepted method of modelling and predicting failure/survival, Cox's proportional hazards model, is theoretically inferior to neural network derived models for analysing highly complex systems with large datasets. A blinded comparison of the neural network versus the Cox's model in predicting survival utilising data from 873 treated patients with laryngeal cancer. These were divided randomly and equally into a training set and a study set and Cox's and neural network models applied in turn. Data were then divided into seven sets of binary covariates and the analysis repeated. Overall survival was not significantly different on Kaplan-Meier plot, or with either test model. Although the network produced qualitatively similar results to Cox's model it was significantly more sensitive to differences in survival curves for age and N stage. We propose that neural networks are capable of prediction in systems involving complex interactions between variables and non-linearity.

Pedagogical Perception and Verbal Behavior.

ERIC Educational Resources Information Center

Hirblinger, Heiner

1989-01-01

Discusses researchers' emphasis upon prejudicial perceptions in pedagogics. Points out that prejudice is accepted as a normal feature of pedagogics and that elimination of the problem requires much effort. Demonstrates a way to release pedagogical perception from the stage of illusionary fixations and magical anticipations. (KO)

LIMS user acceptance testing.

PubMed

Klein, Corbett S

2003-01-01

Laboratory Information Management Systems (LIMS) play a key role in the pharmaceutical industry. Thorough and accurate validation of such systems is critical and is a regulatory requirement. LIMS user acceptance testing is one aspect of this testing and enables the user to make a decision to accept or reject implementation of the system. This paper discusses key elements in facilitating the development and execution of a LIMS User Acceptance Test Plan (UATP).

Assessing contextual factors that influence acceptance of pedestrian alerts by a night vision system.

PubMed

Källhammer, Jan-Erik; Smith, Kip

2012-08-01

We investigated five contextual variables that we hypothesized would influence driver acceptance of alerts to pedestrians issued by a night vision active safety system to inform the specification of the system's alerting strategies. Driver acceptance of automotive active safety systems is a key factor to promote their use and implies a need to assess factors influencing driver acceptance. In a field operational test, 10 drivers drove instrumented vehicles equipped with a preproduction night vision system with pedestrian detection software. In a follow-up experiment, the 10 drivers and 25 additional volunteers without experience with the system watched 57 clips with pedestrian encounters gathered during the field operational test. They rated the acceptance of an alert to each pedestrian encounter. Levels of rating concordance were significant between drivers who experienced the encounters and participants who did not. Two contextual variables, pedestrian location and motion, were found to influence ratings. Alerts were more accepted when pedestrians were close to or moving toward the vehicle's path. The study demonstrates the utility of using subjective driver acceptance ratings to inform the design of active safety systems and to leverage expensive field operational test data within the confines of the laboratory. The design of alerting strategies for active safety systems needs to heed the driver's contextual sensitivity to issued alerts.

Cross-sectional survey on the acceptability of suicide among rural residents, urban residents and college students from three locations in China

PubMed Central

Li, Xianyun; Phillips, Michael R.

2011-01-01

Background Community attitudes about suicide and their relationship to suicidal behavior have not been adequately investigated in low- and middle-income countries. Aims Compare acceptability of suicide in different population cohorts in China, identify factors that affect the degree of acceptability, and assess the relationship of cohort-specific acceptability of suicide and suicide rates. Methods A multi-stage stratified random sample of 608 rural residents, 582 urban residents and 629 college students were administered a 25-item scale in which respondents stated the likelihood they would consider suicide (on a 5-point Likert scale) if they experienced a variety of stressors ranging from ‘being disciplined at work’ to ‘developing a chronic mental illness’. The internal consistency and test-retest reliability for the scale are excellent (Cronbach’s α =0.92, ICC=0.75). Results College students had the most permissive attitudes about suicide and urban residents were significantly more accepting of suicide as a response to serious life stressors than rural residents. Multivariate analysis found that the overall acceptability score was higher in women, decreased with age, and increased with years of education. Conclusions There was no clear relationship between cohort-specific acceptance of suicide and reported rates of suicide, highlighting the complexity of the relationship between attitudes about suicide (of which acceptability is only one component) and suicidal behavior. PMID:20801748

Social acceptability of Satellite Power Systems (SPS): the near-term outlook

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klineberg, S L

1980-05-01

It is important, at this early stage in the concept development and evaluation of Satellite Power Systems, to explore aspects of contemporary social change that may be expected to complicate the process of achieving the necessary support of the American public for this new technological venture. Current public attitudes make it appear unlikely that a consensus will evolve during the 1980s favoring costly efforts to develop vast new supplies of conventional energy. Opinion polls reveal a pervasive worry over inflation, a broadening of aspirations to encompass quality-of-life concerns, a growing distrust of central governments, large corporations, big science and technology,more » and a continuing commitment to environmental protection - all of which suggests a social environment that is likely to resist the development of a major new high-technology energy system such as the SPS. Opposition to satellite power will focus on the high front-end development costs, on environmental and technical uncertainties, and on a generalized distrust of large bureaucracies and esoteric technologies. The SPS concept is also likely to be viewed with skepticism by those with vested interests in the long-run uses of coal, shale, fission, fusion, or on-site solar technologies. The growing commitment to energy conservation and the spreading deployment of dispersed renewable-energy systems strongly suggest that the unmet US demand for centrally generated electricity is unlikely to grow sufficiently over the next twenty years to convince a reluctant public of the need for so large an investment of scarce resources in the SPS program. Satellite Power Systems will have a problem in the area of public acceptability.« less

Implementation of olfactory bulb glomerular-layer computations in a digital neurosynaptic core.

PubMed

Imam, Nabil; Cleland, Thomas A; Manohar, Rajit; Merolla, Paul A; Arthur, John V; Akopyan, Filipp; Modha, Dharmendra S

2012-01-01

We present a biomimetic system that captures essential functional properties of the glomerular layer of the mammalian olfactory bulb, specifically including its capacity to decorrelate similar odor representations without foreknowledge of the statistical distributions of analyte features. Our system is based on a digital neuromorphic chip consisting of 256 leaky-integrate-and-fire neurons, 1024 × 256 crossbar synapses, and address-event representation communication circuits. The neural circuits configured in the chip reflect established connections among mitral cells, periglomerular cells, external tufted cells, and superficial short-axon cells within the olfactory bulb, and accept input from convergent sets of sensors configured as olfactory sensory neurons. This configuration generates functional transformations comparable to those observed in the glomerular layer of the mammalian olfactory bulb. Our circuits, consuming only 45 pJ of active power per spike with a power supply of 0.85 V, can be used as the first stage of processing in low-power artificial chemical sensing devices inspired by natural olfactory systems.

Prediction based proactive thermal virtual machine scheduling in green clouds.

PubMed

Kinger, Supriya; Kumar, Rajesh; Sharma, Anju

2014-01-01

Cloud computing has rapidly emerged as a widely accepted computing paradigm, but the research on Cloud computing is still at an early stage. Cloud computing provides many advanced features but it still has some shortcomings such as relatively high operating cost and environmental hazards like increasing carbon footprints. These hazards can be reduced up to some extent by efficient scheduling of Cloud resources. Working temperature on which a machine is currently running can be taken as a criterion for Virtual Machine (VM) scheduling. This paper proposes a new proactive technique that considers current and maximum threshold temperature of Server Machines (SMs) before making scheduling decisions with the help of a temperature predictor, so that maximum temperature is never reached. Different workload scenarios have been taken into consideration. The results obtained show that the proposed system is better than existing systems of VM scheduling, which does not consider current temperature of nodes before making scheduling decisions. Thus, a reduction in need of cooling systems for a Cloud environment has been obtained and validated.

Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease.

PubMed

Winter, Lauren; Wong, Lydia A; Jerums, George; Seah, Jas-Mine; Clarke, Michele; Tan, Sih Min; Coughlan, Melinda T; MacIsaac, Richard J; Ekinci, Elif I

2018-01-01

Diabetic kidney disease is a common complication of type 1 and type 2 diabetes and is the primary cause of end-stage renal disease in developed countries. Early detection of diabetic kidney disease will facilitate early intervention aimed at reducing the rate of progression to end-stage renal disease. Diabetic kidney disease has been traditionally classified based on the presence of albuminuria. More recently estimated glomerular filtration rate has also been incorporated into the staging of diabetic kidney disease. While albuminuric diabetic kidney disease is well described, the phenotype of non-albuminuric diabetic kidney disease is now widely accepted. An association between markers of inflammation and diabetic kidney disease has previously been demonstrated. Effector molecules of the innate immune system including C-reactive protein, interleukin-6, and tumor necrosis factor-α are increased in patients with diabetic kidney disease. Furthermore, renal infiltration of neutrophils, macrophages, and lymphocytes are observed in renal biopsies of patients with diabetic kidney disease. Similarly high serum neutrophil and low serum lymphocyte counts have been shown to be associated with diabetic kidney disease. The neutrophil-lymphocyte ratio is considered a robust measure of systemic inflammation and is associated with the presence of inflammatory conditions including the metabolic syndrome and insulin resistance. Cross-sectional studies have demonstrated a link between high levels of the above inflammatory biomarkers and diabetic kidney disease. Further longitudinal studies will be required to determine if these readily available inflammatory biomarkers can accurately predict the presence and prognosis of diabetic kidney disease, above and beyond albuminuria, and estimated glomerular filtration rate.

[On the partition of acupuncture academic schools].

PubMed

Yang, Pengyan; Luo, Xi; Xia, Youbing

2016-05-01

Nowadays extensive attention has been paid on the research of acupuncture academic schools, however, a widely accepted method of partition of acupuncture academic schools is still in need. In this paper, the methods of partition of acupuncture academic schools in the history have been arranged, and three typical methods of"partition of five schools" "partition of eighteen schools" and "two-stage based partition" are summarized. After adeep analysis on the disadvantages and advantages of these three methods, a new method of partition of acupuncture academic schools that is called "three-stage based partition" is proposed. In this method, after the overall acupuncture academic schools are divided into an ancient stage, a modern stage and a contemporary stage, each schoolis divided into its sub-school category. It is believed that this method of partition can remedy the weaknesses ofcurrent methods, but also explore a new model of inheritance and development under a different aspect through thedifferentiation and interaction of acupuncture academic schools at three stages.

A Bayesian-frequentist two-stage single-arm phase II clinical trial design.

PubMed

Dong, Gaohong; Shih, Weichung Joe; Moore, Dirk; Quan, Hui; Marcella, Stephen

2012-08-30

It is well-known that both frequentist and Bayesian clinical trial designs have their own advantages and disadvantages. To have better properties inherited from these two types of designs, we developed a Bayesian-frequentist two-stage single-arm phase II clinical trial design. This design allows both early acceptance and rejection of the null hypothesis ( H(0) ). The measures (for example probability of trial early termination, expected sample size, etc.) of the design properties under both frequentist and Bayesian settings are derived. Moreover, under the Bayesian setting, the upper and lower boundaries are determined with predictive probability of trial success outcome. Given a beta prior and a sample size for stage I, based on the marginal distribution of the responses at stage I, we derived Bayesian Type I and Type II error rates. By controlling both frequentist and Bayesian error rates, the Bayesian-frequentist two-stage design has special features compared with other two-stage designs. Copyright © 2012 John Wiley & Sons, Ltd.

Low Noise Research Fan Stage Design

NASA Technical Reports Server (NTRS)

Hobbs, David E.; Neubert, Robert J.; Malmborg, Eric W.; Philbrick, Daniel H.; Spear, David A.

1995-01-01

This report describes the design of a Low Noise ADP Research Fan stage. The fan is a variable pitch design which is designed at the cruise pitch condition. Relative to the cruise setting, the blade is closed at takeoff and opened for reverse thrust operation. The fan stage is a split flow design with fan exit guide vanes and core stators. This fan stage design was combined with a nacelle and engine core duct to form a powered fan/nacelle, subscale model. This model is intended for use in aerodynamic performance, acoustic and structural testing in a wind tunnel. The model has a 22-inch outer fan diameter and a hub-to-top ratio of 0.426 which permits the use of existing NASA fan and cowl force balance designs and rig drive system. The design parameters were selected to permit valid acoustic and aerodynamic comparisons with the PW 17-inch rig previously tested under NASA contract. The fan stage design is described in detail. The results of the design axisymmetric analysis at aerodynamic design condition are included. The structural analysis of the fan rotor and attachment is described including the material selections and stress analysis. The blade and attachment are predicted to have adequate low cycle fatigue life, and an acceptable operating range without resonant stress or flutter. The stage was acoustically designed with airfoil counts in the fan exit guide vane and core stator to minimize noise. A fan-FEGV tone analysis developed separately under NASA contract was used to determine these airfoil counts. The fan stage design was matched to a nacelle design to form a fan/nacelle model for wind tunnel testing. The nacelle design was developed under a separate NASA contract. The nacelle was designed with an axisymmetric inlet, cowl and nozzle for convenience in testing and fabrication. Aerodynamic analysis of the nacelle confirmed the required performance at various aircraft operating conditions.

Advanced Low-Noise Research Fan Stage Design

NASA Technical Reports Server (NTRS)

Neubert, Robert; Bock, Larry; Malmborg, Eric; Owen-Peer, William

1997-01-01

This report describes the design of the Advanced Low-Noise Research Fan stage. The fan is a variable pitch design, which is designed at the cruise pitch condition. Relative to the cruise setting, the blade is closed at takeoff and opened for reverse thrust operation. The fan stage is a split flow design with fan exit guide vanes (FEGVs) and core stators. The fan stage design is combined with a nacelle and engine core duct to form a powered fan/nacelle subscale model. This model is intended for use in combined aerodynamic, acoustic, and structural testing in a wind tunnel. The fan has an outer diameter of 22 in. and a hub-to-tip of 0.426 in., which allows the use of existing NASA fan and cowl force balance and rig drive systems. The design parameters were selected to permit valid acoustic and aerodynamic comparisons with the Pratt & Whitney (P&W) 17- and 22-in. rigs previously tested under NASA contract. The fan stage design is described in detail. The results of the design axisymmetric and Navier-Stokes aerodynamic analysis are presented at the critical design conditions. The structural analysis of the fan rotor and attachment is included. The blade and attachment are predicted to have adequate low-cycle fatigue life and an acceptable operating range without resonant stress or flutter. The stage was acoustically designed with airfoil counts in the FEGV and core stator to minimize noise. A fan/FEGV tone analysis developed separately under NASA contract was used to determine the optimum airfoil counts. The fan stage was matched to the existing nacelle, designed under the previous P&W low-noise contract, to form a fan/nacelle model for wind tunnel testing. It is an axisymmetric nacelle for convenience in testing and analysis. Previous testing confirmed that the nacelle performed as required at various aircraft operating conditions.

Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient.

PubMed

Corvin, Stefan; Sturm, Wolfgang; Schlatter, Evelin; Anastasiadis, Aristotelis; Kuczyk, Markus; Stenzl, Arnulf

2005-09-01

The acceptance of open retroperitoneal lymph node dissection (RPLND) for stage I and II nonseminomatous testicular cancer has decreased because of the intraoperative and postoperative morbidity of the procedure. Laparoscopic RPLND is a minimally invasive and safe alternative for low-stage germ-cell tumors. It is, however, technically demanding and should therefore be performed only in experienced centers. The purpose of the present study was to evaluate the waterjet technique for laparoscopic RPLND. A series of 18 patients with clinical stage I testis cancer (group A) and 7 patients who had received chemotherapy for stage II disease (group B) underwent laparoscopic RPLND at our institution. The procedure was performed identically to the open approach using the modified template according to Weissbach and associates. The waterjet was used for removal of lymphatic tissue from the aorta and the vena cava, as well as from the sympathetic trunk. The operation was completed in all patients without conversion to open surgery. The mean operating time was 232 +/- 48 minutes. The waterjet was able to remove lymphatic tissue easily and atraumatically. At pressures of 20 bar, the lymph-node capsule remained completely intact, thus avoiding tumor-cell spread. Antegrade ejaculation could be preserved in all patients, who, to date, show no evidence of disease. The waterjet allows the safe and complete removal of lymphatic tissue, leaving vulnerable anatomic structures intact. It can decrease the learning curve of laparoscopic RPLND and contribute to better acceptance of this procedure.

Asian Women's Action for Resilience and Empowerment Intervention: Stage I Pilot Study.

PubMed

Hahm, Hyeouk Chris; Chang, Stephanie Tzu-Han; Lee, Gloria Yoonseung; Tagerman, Michelle D; Lee, Christina S; Trentadue, Mia Pamela; Hien, Denise A

2017-01-01

This study describes the development and pilot test of Asian Women's Action for Resilience and Empowerment (AWARE), a culturally informed group psychotherapy intervention designed to reduce depressive symptoms, suicidality, substance use, and HIV and sexual risk behaviors among 1.5 and second generation Asian American (AA) women. To participate, AA women had to meet the criteria for posttraumatic stress disorder (PTSD) or have a history of exposure to interpersonal violence (IPV) as determined using the Clinician-Administered PTSD Scale (CAPS) and Traumatic Life Events Questionnaire (TLEQ). This article also presents the preliminary feasibility and acceptability of AWARE from its Stage I pilot study of nine Chinese, Korean, and Vietnamese American women. To foster holistic treatment, AWARE was developed based on original research findings from Stage 0 and integrated theoretical models including fractured identity theory, empowerment theory, cognitive behavioral therapy (CBT), mindfulness-based techniques, and the AIDS Risk Reduction Model (ARRM). The development of AWARE was an iterative process informed by participant feedback, which led to frequent intervention modifications for a future randomized controlled trial (RCT) in Stage II. A qualitative analysis of participant feedback informed the following modifications: further exploration of feelings, improvements in technology delivery, learning and practicing coping skills, more specific cultural tailoring related to sexual health, decreased number of sessions and increased time per session. Findings provide support for the acceptability and feasibility of AWARE as "culturally informed" for AA young women with IPV histories, high-risk behaviors, and mental health issues.

Complex organic molecules and star formation

NASA Astrophysics Data System (ADS)

Bacmann, A.; Faure, A.

2014-12-01

Star forming regions are characterised by the presence of a wealth of chemical species. For the past two to three decades, ever more complex organic species have been detected in the hot cores of protostars. The evolution of these molecules in the course of the star forming process is still uncertain, but it is likely that they are partially incorporated into protoplanetary disks and then into planetesimals and the small bodies of planetary systems. The complex organic molecules seen in star forming regions are particularly interesting since they probably make up building blocks for prebiotic chemistry. Recently we showed that these species were also present in the cold gas in prestellar cores, which represent the very first stages of star formation. These detections question the models which were until now accepted to account for the presence of complex organic molecules in star forming regions. In this article, we shortly review our current understanding of complex organic molecule formation in the early stages of star formation, in hot and cold cores alike and present new results on the formation of their likely precursor radicals.

Unexpected Acceptance? Patients with Social Anxiety Disorder Manifest their Social Expectancy in ERPs During Social Feedback Processing.

PubMed

Cao, Jianqin; Gu, Ruolei; Bi, Xuejing; Zhu, Xiangru; Wu, Haiyan

2015-01-01

Previous studies on social anxiety have demonstrated negative-expectancy bias in social contexts. In this study, we used a paradigm that employed self-relevant positive or negative social feedback, in order to test whether this negative expectancy manifests in event-related potentials (ERPs) during social evaluation among socially anxious individuals. Behavioral data revealed that individuals with social anxiety disorder (SAD) showed more negative expectancy of peer acceptance both in the experiment and in daily life than did the healthy control participants. Regarding ERP results, we found a overally larger P2 for positive social feedback and also a group main effect, such that the P2 was smaller in SAD group. SAD participants demonstrated a larger feedback-related negativity (FRN) to positive feedback than to negative feedback. In addition, SAD participants showed a more positive ΔFRN (ΔFRN = negative - positive). Furthermore, acceptance expectancy in daily life correlated negatively with ΔFRN amplitude, while the Interaction Anxiousness Scale (IAS) score correlated positively with the ΔFRN amplitude. Finally, the acceptance expectancy in daily life fully mediated the relationship between the IAS and ΔFRN. These results indicated that both groups could differentiate between positive and negative social feedback in the early stage of social feedback processing (reflected on the P2). However, the SAD group exhibited a larger FRN to positive social feedback than to negative social feedback, demonstrating their dysfunction in the late stage of social feedback processing. In our opinion, such dysfunction is due to their greater negative social feedback expectancy.

Unexpected Acceptance? Patients with Social Anxiety Disorder Manifest their Social Expectancy in ERPs During Social Feedback Processing

PubMed Central

Cao, Jianqin; Gu, Ruolei; Bi, Xuejing; Zhu, Xiangru; Wu, Haiyan

2015-01-01

Previous studies on social anxiety have demonstrated negative-expectancy bias in social contexts. In this study, we used a paradigm that employed self-relevant positive or negative social feedback, in order to test whether this negative expectancy manifests in event-related potentials (ERPs) during social evaluation among socially anxious individuals. Behavioral data revealed that individuals with social anxiety disorder (SAD) showed more negative expectancy of peer acceptance both in the experiment and in daily life than did the healthy control participants. Regarding ERP results, we found a overally larger P2 for positive social feedback and also a group main effect, such that the P2 was smaller in SAD group. SAD participants demonstrated a larger feedback-related negativity (FRN) to positive feedback than to negative feedback. In addition, SAD participants showed a more positive ΔFRN (ΔFRN = negative – positive). Furthermore, acceptance expectancy in daily life correlated negatively with ΔFRN amplitude, while the Interaction Anxiousness Scale (IAS) score correlated positively with the ΔFRN amplitude. Finally, the acceptance expectancy in daily life fully mediated the relationship between the IAS and ΔFRN. These results indicated that both groups could differentiate between positive and negative social feedback in the early stage of social feedback processing (reflected on the P2). However, the SAD group exhibited a larger FRN to positive social feedback than to negative social feedback, demonstrating their dysfunction in the late stage of social feedback processing. In our opinion, such dysfunction is due to their greater negative social feedback expectancy. PMID:26635659

Study of solid rocket motor for space shuttle booster, volume 2, book 5, appendices E thru H

NASA Technical Reports Server (NTRS)

1972-01-01

Preliminary parametric studies were performed to establish size, weight and packaging arrangements for aerodynamic decelerator devices that could be used for recovery of the expended solid propellant rocket motors used in the launch phase of the Space Shuttle System. Computations were made using standard engineering analysis techniques. Terminal stage parachutes were sized to provide equilibrium descent velocities for water entry that are presently thought to be acceptable without developing loads that could exceed the boosters structural integrity. The performance characteristics of the aerodynamic parachute decelerator devices considered are based on analysis and prior test results for similar configurations and are assumed to be maintained at the scale requirements of the present problem.

The Impact of National Cultural Differences on Nurses' Acceptance of Hospital Information Systems.

PubMed

Lin, Hsien-Cheng

2015-06-01

This study aims to explore the influence of national cultural differences on nurses' perceptions of their acceptance of hospital information systems. This study uses the perspective of Technology Acceptance Model; national cultural differences in terms of masculinity/femininity, individualism/collectivism, power distance, and uncertainty avoidance are incorporated into the Technology Acceptance Model as moderators, whereas time orientation is a control variable on hospital information system acceptance. A quantitative research design was used in this study; 261 participants, US and Taiwan RNs, all had hospital information system experience. Data were collected from November 2013 to February 2014 and analyzed using a t test to compare the coefficients for each moderator. The results show that individualism/collectivism, power distance, and uncertainty avoidance all exhibit significant difference on hospital information system acceptance; however, both masculinity/femininity and time orientation factors did not show significance. This study verifies that national cultural differences have significant influence on nurses' behavioral intention to use hospital information systems. Therefore, hospital information system providers should emphasize the way in which to integrate different technological functions to meet the needs of nurses from various cultural backgrounds.

Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?

PubMed

Freeman, Michael A; Pleis, John R; Bornemann, Kellee R; Croswell, Emilee; Dew, Mary Amanda; Chang, Chung-Chou H; Switzer, Galen E; Langone, Anthony; Mittal-Henkle, Anuja; Saha, Somnath; Ramkumar, Mohan; Adams Flohr, Jareen; Thomas, Christie P; Myaskovsky, Larissa

2017-06-01

Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. However, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. We conducted a multicenter longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ = 1.04; P = 0.594]. Younger age (hazards ratio [HR], 0.98; 95% confidence interval [CI], 0.97-0.99), fewer comorbidities (HR, 0.89; 95% CI, 0.84-0.95), being married (HR, 0.81; 95% CI, 0.66-0.99), having private and public insurance (HR, 1.29; 95% CI, 1.03-1.51), and moderate or greater levels of depression (HR, 1.87; 95% CI, 1.03-3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.

ANSO study: evaluation in an indoor environment of a mobile assistance robotic grasping arm.

PubMed

Coignard, P; Departe, J P; Remy Neris, O; Baillet, A; Bar, A; Drean, D; Verier, A; Leroux, C; Belletante, P; Le Guiet, J L

2013-12-01

To evaluate the reliability and functional acceptability of the ‘‘Synthetic Autonomous Majordomo’’ (SAM) robotic aid system (a mobile Neobotix base equipped with a semi-automatic vision interface and a Manus robotic arm). An open, multicentre, controlled study. We included 29 tetraplegic patients (23 patients with spinal cord injuries, 3 with locked-in syndrome and 4 with other disorders; mean SD age: 37.83 13.3) and 34 control participants (mean SD age: 32.44 11.2). The reliability of the user interface was evaluated in three multi-step scenarios: selection of the room in which the object to be retrieved was located (in the presence or absence of visual control by the user), selection of the object to be retrieved, the grasping of the object itself and the robot’s return to the user with the object. A questionnaire was used to assess the robot’s user acceptability. The SAM system was stable and reliable: both patients and control participants experienced few failures when completing the various stages of the scenarios. The graphic interface was effective for selecting and grasping the object – even in the absence of visual control. Users and carers were generally satisfied with SAM, although only a quarter of patients said that they would consider using the robot in their activities of daily living. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The 140 GHZ, 1 MW Gyrotron - Status and Recent Results

NASA Astrophysics Data System (ADS)

Gantenbein, G.; Dammertz, G.; Illy, S.; Kern, S.; Leonhardt, W.; Piosczyk, B.; Schmid, M.; Thumm, M.; Braune, H.; Erckmann, V.; Laqua, H. P.; Michel, G.; Kasparek, W.; Lechte, C.; Legrand, F.; Lievin, C.; Prinz, O.

2009-04-01

A 10 MW ECRH system is currently under construction for the stellarator W7-X which will be built up and operated by IPP in Greifswald, Germany. The present status of the complete system is reported in [1]. The RF power will be provided by 10 gyrotrons. A European collaboration has been established to develop and build the 10 gyrotrons each with an output power of 1 MW for continuous wave (CW) operation [2]. Nine gyrotrons are being manufactured by Thales Electron Devices (TED), Vélizy, France, one gyrotron was produced by CPI, Palo Alto, CA and passed the acceptance tests at IPP. The acceptance tests of the TED gyrotrons are performed at the test stand at FZK and on site at IPP. The first series tube yielded a total output power of 0.98 MW, with an efficiency of 31 % (without a single stage depressed collector) in short pulse operation and of 0.92 MW in pulses of 1800 s (efficiency of almost 45 % at a depression voltage of 29 kV) [3], The Gaussian mode output power was 0.91 MW. The RF power, measured in a calorimetric load at the end of a 25 m long quasi-optical transmission line with seven mirrors, was 0.87 MW. In this contribution typical results of the next series gyrotrons will be reported.

Novel continuous authentication using biometrics

NASA Astrophysics Data System (ADS)

Dubey, Prakash; Patidar, Rinku; Mishra, Vikas; Norman, Jasmine; Mangayarkarasi, R.

2017-11-01

We explore whether a classifier can consistent1y verify c1ients and interact with the computer using camera and behavior of users. In this paper we propose a new way of authentication of user which wi1l capture many images of user in random time and ana1ysis of its touch biometric behavior. In this system experiment the touch conduct of a c1ient/user between an en1istment stage is stored in the database and it is checked its mean time behavior during equa1 partition of time. This touch behavior wi1l ab1e to accept or reject the user. This wi1l modify the use of biometric more accurate to use. In this system the work p1an going to perform is the user wi1l ask single time to a1low to take it picture before 1ogin. Then it wi1l take images of user without permission of user automatica1ly and store in the database. This images and existing image of user wi1l be compare and reject or accept wi1l depend on its comparison. The user touch behavior wi1l keep storing with number of touch make in equa1 amount of time of the user. This touch behavior and image wi1l fina1ly perform authentication of the user automatically.

48 CFR 828.203 - Acceptability of individual sureties.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Acceptability of individual sureties. 828.203 Section 828.203 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... Acceptability of individual sureties. ...

Early testing of new sanitation technology for urban slums: The case of the Blue Diversion Toilet.

PubMed

Tobias, Robert; O'Keefe, Mark; Künzle, Rahel; Gebauer, Heiko; Gründl, Harald; Morgenroth, Eberhard; Pronk, Wouter; Larsen, Tove A

2017-01-15

The toilets used most in informal urban settlements have detrimental consequences for the environment and human health due to the lack of proper collection and treatment of toilet waste. Concepts for safe, sustainable and affordable sanitation systems exist, but their feasibility and acceptance have to be investigated at an early stage of development, which is difficult due to the high costs of building working models. In this paper, we present an approach to estimate acceptance in a valid and representative form with only one working model, and apply it to test an innovative zero-emission toilet with recycling of wash water. Four basic principles were specified for investigation and nine hypotheses formulated to test the feasibility and acceptance of these principles: source separation of urine and feces with subsequent collection for resource recovery; provision of wash water in a separate cycle with on-site recovery through a membrane bioreactor; a convenient and attractive overall design; and a financially sustainable business plan. In Kampala (Uganda), in 2013, data was collected from 22 regular users, 308 one-time users and a representative sample of 1538 participants. Qualitative data was collected from the users, who evaluated their likes, perceived benefits, social norms and expected ease of use based on verbal and visual information. Most of the hypotheses were confirmed, indicating the feasibility and acceptance of the basic principles. Source separation and on-site water recovery were found to be feasible and accepted, provided users can be convinced that the emptying service and water recovery process work reliably. In the survey, the toilet was evaluated favorably and 51% of the participants agreed to be placed on a bogus waiting list. However, some design challenges were revealed, such as the size of the toilet, hiding feces from view and improving the separation of urine and water. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Pharmacy workers’ perceptions and acceptance of bar coded medication technology in a pediatric hospital

PubMed Central

Holden, Richard J.; Brown, Roger L.; Scanlon, Matthew C.; Karsh, Ben-Tzion

2012-01-01

Background The safety benefits of bar-coded medication dispensing and administration technology (BCMA) depend on its intended users favorably perceiving, accepting, and ultimately using the technology. Objectives (1) To describe pharmacy workers’ perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA. Methods Pharmacists and pharmacy technicians at a Midwest US pediatric hospital were surveyed following the hospital’s implementation of a BCMA system. Twenty-nine pharmacists and ten technicians’ self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models. Results The BCMA system’s perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA. Conclusions To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians’ acceptance and elucidating perceptions and other factors that shape acceptance. PMID:22417887

Selection criteria for forested natural areas in New England, USA

Treesearch

William B. Leak; Mariko Yamasaki; Marie-Louise Smith; David T. Funk

1994-01-01

The selection of forested natural areas for research and educational purposes is discussed. Five factors are important: sufficient size; representation of typical communities and sites; documented disturbance histories; acceptable current condition in terms of age, tree size, and successional stage; and administrative feasibility.

Fear of negative evaluation moderates effects of social exclusion on selective attention to social signs.

PubMed

Tanaka, Hiroaki; Ikegami, Tomoko

2015-01-01

Previous studies demonstrated that fear of negative evaluation (FNE) moderates responses to exclusion in late-stage social outcomes (e.g., social judgements and behaviours). People with low levels of FNE show affiliative responses, feeling compelled to recover their sense of belonging, whereas people with high levels of FNE do not. This study examined whether FNE also moderates responses to exclusion in early-stage interpersonal perception, manifested in selective attention. The experiment using a dot-probe task revealed that exclusion led participants with low levels of FNE to increase attention to signs of social acceptance (i.e., smiling faces). It also revealed that exclusion led those with high levels of FNE to pay more attention to signs of social threat (i.e., angry faces) relative to those of social acceptance. Thus, exclusion makes the motivation to protect oneself from social threats dominant over the motivation to reestablish social bonds among those who fear negative evaluation.

Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?

PubMed

Sholapurkar, S L

2010-01-01

Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable.

Effects of Support Groups for Individuals with Early-Stage Dementia and Mild Cognitive Impairment: An Integrative Review.

PubMed

Jao, Ying-Ling; Epps, Fayron; McDermott, Caroline; Rose, Karen M; Specht, Janet K

2017-01-01

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. A literature search was conducted in seven databases and 18 eligible research articles were retrieved. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners. Few studies included ethnic diversity, limiting the generalizability of findings. Further large-scale studies are needed to confirm the effects of support groups for individuals with MCI and ESD in all populations. [Res Gerontol Nurs. 2017; 10(1):35-51.]. Copyright 2016, SLACK Incorporated.

Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults

PubMed Central

Cameron, Linda D.; Durazo, Arturo; Ramirez, A. Susana; Corona, Roberto; Ultreras, Mayra; Piva, Sonia

2017-01-01

Hispanics represent a critical target for culturally-adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. Further, we used survey data to evaluate whether Self-Determination Theory factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants expressing substantial interest in using it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest and perceived efficacy, suggesting they could impede program use. In Stage 3, we implemented the mixed-methods findings to generate a revised HealthyYouTXT en Español. The emergent linguistic principles and multi-stage, multi-methods process can be applied beneficially in health communication adaptations. PMID:28248628

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy.

PubMed

Zhang, Shupeng; Wu, Liangliang; Wang, Xiaona; Ding, Xuewei; Liang, Han

2017-04-01

Though D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), the modified D2 (D1 + 7, 8a and 9) lymphadenectomy may be more suitable than D2 dissection for T2 stage GC. The purpose of this study is to elucidate whether the surgical outcome of modified D2 lymphadenectomy was comparable to that of standard D2 dissection in T2 stage GC patients. A retrospective cohort study with 77 cases and 77 controls matched for baseline characteristics was conducted. Patients were categorized into two groups according to the extent of lymphadenectomy: the modified D2 group (mD2) and the standard D2 group (D2). Surgical outcome and recurrence date were compared between the two groups. The 5-year overall survival (OS) rate was 71.4% for patients accepted mD2 lymphadenectomy and 70.1% for those accepted standard D2, respectively, and the difference was not statistically significant. Multivariate survival analysis revealed that curability, tumor size, TNM stage and postoperative complications were independently prognostic factors for T2 stage GC patients. Patients in the mD2 group tended to have less intraoperative blood loss (P=0.001) and shorter operation time (P<0.001) than those in the D2 group. While there were no significant differences in recurrence rate and types, especially lymph node recurrence, between the two groups. The surgical outcome of mD2 lymphadenectomy was equal to that of standard D2, and the use of mD2 instead of standard D2 can be a better option for T2 stage GC.

Staged lengthening arthroplasty for pediatric osteosarcoma around the knee.

PubMed

Kong, Chang-Bae; Lee, Soo-Yong; Jeon, Dae-Geun

2010-06-01

Orthopaedic oncologists often must address leg-length discrepancy after resection of tumors in growing patients with osteosarcoma. There are various alternatives to address this problem. We describe a three-stage procedure: (1) temporary arthrodesis, (2) lengthening by Ilizarov apparatus, and (3) tumor prosthesis. We asked (1) to what extent are affected limbs actually lengthened; (2) how many of the patients who undergo a lengthening procedure eventually achieve joint arthroplasty; and (3) can the three-stage procedure give patients a functioning joint with equalization of limb length? We reviewed 56 patients (younger than 14 years) with osteosarcoma who had staged lengthening arthroplasty between 1991 and 2004. Thirty-five of the 56 patients (63%) underwent soft tissue lengthening, and of these 35, 28 (50% of the original group of 56) had implantation of a mobile joint. Three of the 28 prostheses were later removed owing to infection after arthroplasty. The overall average length gained was 7.8 cm (range, 4-14 cm), and 25 (71%) of the 35 patients had a mobile joint at final followup. The average Musculoskeletal Tumor Society functional score was 23.2 (range, 15-28) and limb-length discrepancy at final followup was 2.6 cm (range, 0-6.5 cm). Although most mobile joints had an acceptable ROM (average, 74.2 degrees ; range, 35 degrees -110 degrees ), extension lag was frequent. Our approach is one option for skeletally immature patients, especially in situations where an expandable prosthesis is not available. However, this technique requires multiple stages and would be inappropriate for patients who cannot accept prolonged functional deficit owing to a limited lifespan or other reasons. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Development of a tripolar model of technology acceptance: Hospital-based physicians' perspective on EHR.

PubMed

Beglaryan, Mher; Petrosyan, Varduhi; Bunker, Edward

2017-06-01

In health care, information technologies (IT) hold a promise to harness an ever-increasing flow of health related information and bring significant benefits including improved quality of care, efficiency, and cost containment. One of the main tools for collecting and utilizing health data is the Electronic Health Record (EHR). EHRs implementation can face numerous barriers to acceptance including attitudes and perceptions of potential users, required effort attributed to their implementation and usage, and resistance to change. Various theories explicate different aspects of technology deployment, implementation, and acceptance. One of the common theories is the Technology Acceptance Model (TAM), which helps to study the implementation of different healthcare IT applications. The objectives of this study are: to understand the barriers of EHR implementation from the perspective of physicians; to identify major determinants of physicians' acceptance of technology; and develop a model that explains better how EHRs (and technologies in general) are accepted by physicians. The proposed model derives from a cross-sectional survey of physicians selected through multi-stage cluster sampling from the hospitals of Yerevan, Armenia. The study team designed the survey instrument based on a literature review on barriers of EHR implementation. The analysis employed exploratory structural equation modeling (ESEM) with a robust weighted least squares (WLSMV) estimator for categorical indicators. The analysis progressed in two steps: appraisal of the measurement model and testing of the structural model. The derived model identifies the following factors as direct determinants of behavioral intention to use a novel technology: projected collective usefulness; personal innovativeness; patient influence; and resistance to change. Other factors (e.g., organizational change, professional relationships, administrative monitoring, organizational support and computer anxiety) exert their effects through projected collective usefulness, perceived usefulness, and perceived ease of use. The model reconciles individual-oriented and environment-oriented theoretical approaches and proposes a Tripolar Model of Technology Acceptance (TMTA), bringing together three key pillars of the healthcare: patients, practitioners, and provider organizations. The proposed TMTA explains 85% of variance of behavioral intention to use technology. The current study draws from the barriers of EHR implementation and identifies major determinants of technology acceptance among physicians. The study proposes TMTA as affording stronger explanative and predictive abilities for the health care system. TMTA paves a long overlooked gap in TAM and its descendants, which, in organizational settings, might distort construal of technology acceptance. It also explicates with greater depth the interdependence of different participants of the healthcare and complex interactions between healthcare and technologies. Copyright © 2017 Elsevier B.V. All rights reserved.

Coping with change: a challenge for sponsors.

PubMed

McGuire, T P; McGowan, K

1987-04-01

In the past 25 years a trend away from lifetime commitment in religious institutes, a rising number of retired religious,, and the Second Vatican Council's call for greater lay involvement in all aspects of ministry have led to many changes in Catholic-sponsored health care facilities. The development process of religious institutes parallels that of individuals as they mature from infancy to late adulthood. After Vatican II, religious institutes underwent an "intimacy versus isolation" stage similar to that experienced by people in their twenties, in which interpersonal relationships became more important. Now institutes are in a stage of "ego integrity versus despair," where they must consider changes--closing facilities, mergers, affiliations,, or divestiture of sponsorship--and how they can keep their mission alive afterward. Religious leaders must be energetic in creating programs that allow laypersons who share the institute's mission, charism, and philosophy to carry out its ministry. But in the midst of these changes, religious members also will experience grief at the loss of their sponsorship or control over their facility. They pass through the same stages people experience after the death of a loved one: denial, anger, bargaining, depression, and acceptance. Only by confronting and accepting their grief can institute members go on to either new ministries or reaffirmed commitment to their current work.

The effects of message framing within the stages of change on smoking cessation intentions and behaviors.

PubMed

Cornacchione, Jennifer; Smith, Sandi W

2012-01-01

This study examines two commonly used and accepted theoretical models in health communication-the stages of change and message framing-to determine whether gain- or loss-framed messages are more effective at getting people to intend to quit smoking depending on their current stage of change (precontemplation, contemplation, or preparation). One hundred forty-eight current smokers were exposed to one of four gain- or loss-framed messages that emphasized the benefits of cessation or the costs of smoking. Message believability, message processing, and stage movement were measured to see if any differences existed as a function of the individual's base stage of change and message frame exposure. Overall, results indicated that all participants, regardless of stage and frame, engaged in more central than peripheral message processing. However, those in the precontemplation/loss frame and preparation/gain frame conditions engaged in significantly less cognitive processing than those in all other conditions. Additionally, gain-framed messages were most influential at getting individuals to progress from the contemplation to the preparation stage. Implications and future directions for research are also discussed.

Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients.

PubMed

Finkelstein, Joseph; Cha, Eun Me

2016-05-06

The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. After the mobile app use, mean KS increased from 27(3) to 31(3) ( P<0.0001). Proportion of patients who felt they "cannot quit smoking" reduced from 36% (20/55) to 18% (10/55) ( P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level ( P<0.02), employment status ( P<0.05), and high app acceptance ( P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.

Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients

PubMed Central

2016-01-01

Background The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. Objective This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. Methods Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. Results After the mobile app use, mean KS increased from 27(3) to 31(3) (P<0.0001). Proportion of patients who felt they “cannot quit smoking” reduced from 36% (20/55) to 18% (10/55) (P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level (P<0.02), employment status (P<0.05), and high app acceptance (P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. Conclusions Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted. PMID:27154792

A computer program for analyzing channel geometry

USGS Publications Warehouse

Regan, R.S.; Schaffranek, R.W.

1985-01-01

The Channel Geometry Analysis Program (CGAP) provides the capability to process, analyze, and format cross-sectional data for input to flow/transport simulation models or other computational programs. CGAP allows for a variety of cross-sectional data input formats through use of variable format specification. The program accepts data from various computer media and provides for modification of machine-stored parameter values. CGAP has been devised to provide a rapid and efficient means of computing and analyzing the physical properties of an open-channel reach defined by a sequence of cross sections. CGAP 's 16 options provide a wide range of methods by which to analyze and depict a channel reach and its individual cross-sectional properties. The primary function of the program is to compute the area, width, wetted perimeter, and hydraulic radius of cross sections at successive increments of water surface elevation (stage) from data that consist of coordinate pairs of cross-channel distances and land surface or channel bottom elevations. Longitudinal rates-of-change of cross-sectional properties are also computed, as are the mean properties of a channel reach. Output products include tabular lists of cross-sectional area, channel width, wetted perimeter, hydraulic radius, average depth, and cross-sectional symmetry computed as functions of stage; plots of cross sections; plots of cross-sectional area and (or) channel width as functions of stage; tabular lists of cross-sectional area and channel width computed as functions of stage for subdivisions of a cross section; plots of cross sections in isometric projection; and plots of cross-sectional area at a fixed stage as a function of longitudinal distance along an open-channel reach. A Command Procedure Language program and Job Control Language procedure exist to facilitate program execution on the U.S. Geological Survey Prime and Amdahl computer systems respectively. (Lantz-PTT)

Understanding product cost vs. performance through an in-depth system Monte Carlo analysis

NASA Astrophysics Data System (ADS)

Sanson, Mark C.

2017-08-01

The manner in which an optical system is toleranced and compensated greatly affects the cost to build it. By having a detailed understanding of different tolerance and compensation methods, the end user can decide on the balance of cost and performance. A detailed phased approach Monte Carlo analysis can be used to demonstrate the tradeoffs between cost and performance. In complex high performance optical systems, performance is fine-tuned by making adjustments to the optical systems after they are initially built. This process enables the overall best system performance, without the need for fabricating components to stringent tolerance levels that often can be outside of a fabricator's manufacturing capabilities. A good performance simulation of as built performance can interrogate different steps of the fabrication and build process. Such a simulation may aid the evaluation of whether the measured parameters are within the acceptable range of system performance at that stage of the build process. Finding errors before an optical system progresses further into the build process saves both time and money. Having the appropriate tolerances and compensation strategy tied to a specific performance level will optimize the overall product cost.

Entropy Measurement for Biometric Verification Systems.

PubMed

Lim, Meng-Hui; Yuen, Pong C

2016-05-01

Biometric verification systems are designed to accept multiple similar biometric measurements per user due to inherent intrauser variations in the biometric data. This is important to preserve reasonable acceptance rate of genuine queries and the overall feasibility of the recognition system. However, such acceptance of multiple similar measurements decreases the imposter's difficulty of obtaining a system-acceptable measurement, thus resulting in a degraded security level. This deteriorated security needs to be measurable to provide truthful security assurance to the users. Entropy is a standard measure of security. However, the entropy formula is applicable only when there is a single acceptable possibility. In this paper, we develop an entropy-measuring model for biometric systems that accepts multiple similar measurements per user. Based on the idea of guessing entropy, the proposed model quantifies biometric system security in terms of adversarial guessing effort for two practical attacks. Excellent agreement between analytic and experimental simulation-based measurement results on a synthetic and a benchmark face dataset justify the correctness of our model and thus the feasibility of the proposed entropy-measuring approach.

40 CFR 132.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Definitions. 132.2 Section 132.2... acceptable early life-stage tests. Stream design flow is the stream flow that represents critical conditions... used in operationally deriving criteria from experimental data to account for the quality or quantity...

Preliminary Performance of Lithium-ion Cell Designs for Ares I Upper Stage Applications

NASA Technical Reports Server (NTRS)

Miller, Thomas B.; Reid, Concha M.; Kussmaul, Michael T.

2011-01-01

NASA's Ares I Crew Launch Vehicle (CLV) baselined lithium-ion technology for the Upper Stage (US). Under this effort, the NASA Glenn Research Center investigated three different aerospace lithium-ion cell suppliers to assess the performance of the various lithium-ion cell designs under acceptance and characterization testing. This paper describes the overall testing approaches associated with lithium-ion cells, their ampere-hour capacity as a function of temperature and discharge rates, as well as their performance limitations for use on the Ares I US vehicle.

Cost analysis of adjuvant management strategies in early stage (stage I) testicular seminoma

PubMed Central

Cox, John A; Gajjar, Shefali R; Lanni, Thomas B; Swanson, Todd A

2015-01-01

Background Acceptable post-orchiectomy adjuvant therapy strategies for stage I seminoma patients include surveillance, para-aortic radiation therapy (RT), dog-leg RT, and a single cycle of carboplatin. The required follow-up recommendations were amended by the National Comprehensive Cancer Network (NCCN) in 2012. Given a cause-specific survival of nearly 100%, a closer analysis of the reimbursement for each treatment strategy is warranted. Methods NCCN guidelines were used to design treatment plans for each acceptable adjuvant treatment strategy. Follow-up charges were generated for 10 years based on 2012 (version 1.2012; unchanged in current version 1.2013) and 2011 NCCN (version 2.2011) surveillance recommendations. The 2012 Medicare reimbursement rates were used to calculate each treatment strategy and incremental cost-effectiveness ratios to compare the treatment options. Results Under the current NCCN follow-up recommendations, the total reimbursements generated over 10 years of surveillance, para-aortic RT, dog-leg RT, and carboplatin were $10,643, $11,678, $9,662, and $10,405, respectively. This is compared with the reimbursements as per the 2011 NCCN recommendations: $20,986, $11,517, $9,394, and $20,365 respectively. Factoring the rates of relapse into a salvage model, observation was found to be more costly and less effective ($–1,831, $−7,318, $–7,010) in the adjuvant management of stage I seminoma patients Conclusion Based on incremental cost-effectiveness ratios, para-aortic RT, dog-leg RT, and carboplatin are cost-effective options for the treatment of stage I seminoma when compared with observation; however, surveillance could potentially spare as many as 80%–85% of men diagnosed with stage I seminoma from additional therapy after radical inguinal orchiectomy. Such cost and reimbursement analyses are becoming increasingly relevant, but are not meant to usurp sound clinical judgment. Further studies are required to validate these findings. PMID:25610815

Dos and Donts for Conditional Acceptance of Nonconforming Supplies or Services

DTIC Science & Technology

2016-06-01

experience I had with conditional acceptance, and, second, to discuss some of the do’s and don’ts of conditionally accepting nonconforming items. Before...Division Chief, I discovered that our agency had been conditionally accepting this weapon system for several months. Only a few select people like the...Is conditionally accepting this weapon system in the best interest of the government? Finally, and most important, what am I going to do about it? My

Mockup design of personal health diary app for patients with chronic kidney disease.

PubMed

Lin, Hsiu-Wen; Wang, Yu-Jen; Jing, Ling-Fang; Chang, Polun

2014-01-01

Health self-management is important in the care of patients with chronic kidney disease. It is possible to improve the efficiency of patient self-management through the use of mobile technology and related software. This study is divided into three stages: 1. analysis of need: through observation, interview and content analysis of the chronic kidney disease health management manual; 2. design of system prototype: establish interface and system function; 3. prototype evaluation: evaluate whether the prototype designed by this study meets user needs. The system prototype includes: daily record, laboratory examination results, trend graphs, information search, sharing, communications and settings. Prototyping is done with Pencil Project for interface design and linking. The prototype is then exported in PDF format for mock-up simulation. Evaluation results: overall score was 4.01±0.60 leaning towards "agree", the highest score was ease of use (4.25±0.6), followed by easy to learn (4.15±0.68), acceptance (4.01±0.61), reliability (3.87±0.6) and functionality (3.83±0.49). The results show positive attitude towards the system.

Pathways to recovery: promoting change within a developmental-systemic framework.

PubMed

Bryant-Waugh, Rachel

2006-04-01

This article describes a format for the process of achieving therapeutic change through structured individual sessions with adolescents or adults with eating disorders. It is a model for change based on three separate existing theoretical or conceptual strands: Developmental theory; the application of systems theory and cybernetics to clinical practice; and feminist ideology. It was developed as a pragmatic, clinician-friendly model that could be successfully used by therapists from different disciplines, and is referred to here as developmental-systemic-feminist therapy or individual developmental-systemic therapy. Change in this context is defined as the overt and measurable alteration in feelings, thoughts and behaviours of the participant(s) over the course of treatment. The article provides an overview of the treatment model and outlines the five steps used to achieve change (explore; understand; accept; challenge; change). Essential components of the therapist's stance, skills and knowledge are described, followed by a discussion of the structure and content of sessions in different stages of the therapy. Finally, clinical examples are given to illustrate the clinical use of this model in young patients with eating disorders.

Report to the administrator by the NASA Aerospace Safety Advisory Panel on the Skylab program. Volume 1: Summary report. [systems management evaluation and design analysis

NASA Technical Reports Server (NTRS)

1973-01-01

Contractor and NASA technical management for the development and manufacture of the Skylab modules is reviewed with emphasis on the following management controls: configuration and interface management; vendor control; and quality control of workmanship. A review of the modified two-stage Saturn V launch vehicle which focused on modifications to accommodate the Skylab payload; resolution of prior flight anomalies; and changes in personnel and management systems is presented along with an evaluation of the possible age-life and storage problems for the Saturn 1-B launch vehicle. The NASA program management's visibility and control of contractor operations, systems engineering and integration, the review process for the evaluation of design and flight hardware, and the planning process for mission operations are investigated. It is concluded that the technical management system for development and fabrication of the modules, spacecraft, and launch vehicles, the process of design and hardware acceptance reviews, and the risk assessment activities are satisfactory. It is indicated that checkout activity, integrated testing, and preparations for and execution of mission operation require management attention.

Ambulatory polysomnography using a new programmable amplifier system with on-line digitization of data: technical and clinical findings.

PubMed

Drewes, A M; Nielsen, K D; Taagholt, S J; Svendsen, L; Bjerregård, K; Nielsson, L; Kristensen, L

1996-05-01

A new system for polysomnographic recording at home is presented. It consists of a 12 to 24-channel amplifier system with direct digitization of the polygraph signals using a portable computer. Sampling frequency, amplification and filter settings can be defined by the user, and the signals are evaluated at bedside. Technical testing proved a high signal/noise ratio, linear amplification and a good signal quality. Clinical testing of the first 100 recordings showed that they were acceptable for conventional sleep scoring in 98 cases. A comparison of two consecutive recordings was done in 9 healthy subjects and 11 patients with rheumatic disorders. Using conventional sleep staging, only a slight "first night effect" (FNE) was demonstrated in the sleep architecture. Power spectral analysis using autoregressive modeling demonstrated only a difference of power between the 2 nights in the beta (14.5-25 Hz) band. In conclusion, the usability and technical advantages make the system very suitable for ambulatory recordings and only a minimal FNE should be considered when results are evaluated.

[Health care access barriers and facilitators: a qualitative systematic review].

PubMed

Hirmas Adauy, Macarena; Poffald Angulo, Lucy; Jasmen Sepúlveda, Anita María; Aguilera Sanhueza, Ximena; Delgado Becerra, Iris; Vega Morales, Jeanette

2013-03-01

To determine whether health care access barriers and facilitators cut across different populations, countries, and pathologies, and if so, at which stages of health care access they occur most frequently. A qualitative systematic review of literature published between 2000 and 2010 was undertaken drawing on six international sources: Fuente Académica, MEDLINE (full-text), Academic Search Complete (a full-text multidisciplinary academic database), PubMed, SciELO, and LILACS. Scientific appraisal guidelines from the Critical Appraisal Skills Programme Español (CASPe) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were applied. Gray literature was also reviewed. From the review of scientific literature, 19 of 1 160 articles and 8 of 12 gray literature documents were selected. A total of 230 barriers and 35 facilitators were identified in countries with different contexts and degrees of development. The 230 barriers were classified according to the Tanahashi framework: 25 corresponded to availability, 67 to access, 87 to acceptability, and 51 to contact. Most of the barriers were related to acceptability and access. The facilitating elements that were identified had to do with personal factors, the provider-client relationship, social support, knowledge about diseases, and adaptation of the services to patients. The barriers and facilitators were seen mostly in people who initiated contact with the health systems, and they occurred at all stages of health care access. Only a few of the studies looked at people who did not initiate contact with the health services. The barriers and facilitators identified were socially determined and largely a reflection of existing social inequities in the countries. To reduce or eliminate them, joint action with other non-health sectors will be necessary.

Liver transplantation in Germany.

PubMed

Tacke, Frank; Kroy, Daniela C; Barreiros, Ana Paula; Neumann, Ulf P

2016-08-01

Liver transplantation (LT) is a well-accepted procedure for end-stage liver disease in Germany. In 2015, 1489 patients were admitted to the waiting list (including 1308 new admissions), with the leading etiologies being fibrosis and cirrhosis (n = 349), alcoholic liver disease (n = 302), and hepatobiliary malignancies (n = 220). Organ allocation in Germany is regulated within the Eurotransplant system based on urgency as expressed by the Model for End-Stage Liver Disease score. In 2015, only 894 LTs (n = 48 from living donors) were performed at 23 German transplant centers, reflecting a shortage of organs. Several factors may contribute to the low number of organ donations. The German transplant legislation only accepts donation after brain death (not cardiac death), whereas advances in neurosurgery and a more frequently requested "palliative care" approach render fewer patients suitable as potential donors. The legislation further requires the active consent of the donor or first-degree relatives before donation. Ongoing debates within the German transplant field address the optimal management of patients with alcoholic liver cirrhosis, hepatocellular carcinoma (HCC), and cholangiocarcinoma and measures to increase living donor transplantations. As a result of irregularities at mainly 4 German transplant centers that were exposed in 2012, guiding principles updated by the German authorities have since implemented strict rules (including internal and external auditing, the 8-eyes principle, mandatory repeated testing for alcohol consumption) to prohibit any manipulations in organ allocation. In conclusion, we will summarize important aspects on the management of LT in Germany, discuss legal and organizational aspects, and highlight challenges mainly related to the relative lack of organ donations, increasing numbers of extended criteria donors, and the peculiarities of the recipient patients. Liver Transplantation 22 1136-1142 2016 AASLD. © 2016 American Association for the Study of Liver Diseases.

Dr. med. – obsolete? A cross sectional survey to investigate the perception and acceptance of the German medical degree

PubMed Central

Heun, Xenia; Eisenlöffel, Christian; Barann, Bastian; Müller-Hilke, Brigitte

2014-01-01

Purpose: To obtain the German Medical Degree “Dr.med.” candidates are required to write a scientific thesis which is usually accomplished during Medical school education. This extra work load for the students amongst a lack of standardization and an M.D. awarded upon graduation in other European and Anglo-Saxon countries leads repeatedly to criticism of the German system. However, a systematic survey on the perception and acceptance of the German doctoral thesis among those affected is overdue. Methods: Using an online questionnaire, medical students as well as licensed doctors were asked for the status of their medical degree, their motivation, personal benefit, time and effort, scientific output, its meaningfulness and alternatives concerning their thesis. Patients were asked, how important they value their general practitioner’s title “Dr. med.”. The resulting data were evaluated performing basic statistic analyses. Results and Conclusions: The title “Dr. med.“ does not seem to be obsolete, but there is room for improvement. The scientific output is good and only a mere 15.1% of the candidates do not publish their results at all. Moreover, while at an early stage motivation, appreciation and recognition of personal benefits from the medical degree are considered as independent aspects, they merge to a general view at later stages. The current practice is considered most meaningful by the ones who have already finished their thesis. However, there are discrepancies between the expected and the actual length as well as the type of the thesis indicating that mentoring and educational advertising need improvement. As for the patients, their educational level seems to correlate with the significance attributed to the title “Dr. med.” held by their physician. PMID:25228932

Acceptability of potential rectal microbicide delivery systems for HIV prevention: a randomized crossover trial.

PubMed

Pines, Heather A; Gorbach, Pamina M; Weiss, Robert E; Hess, Kristen; Murphy, Ryan; Saunders, Terry; Brown, Joelle; Anton, Peter A; Cranston, Ross D

2013-03-01

We assessed the acceptability of three of over-the-counter products representative of potential rectal microbicide (RM) delivery systems. From 2009 to 2010, 117 HIV-uninfected males (79 %) and females (21 %) who engage in receptive anal intercourse participated in a 6-week randomized crossover acceptability trial. Participants received each of three products (enema, lubricant-filled applicator, suppository) every 2 weeks in a randomized sequence. CASI and T-ACASI scales assessed product acceptability via Likert responses. Factor analysis was used to identify underlying factors measured by each scale. Random effects models were fit to examine age and gender effects on product acceptability. Three underlying factors were identified: Satisfaction with Product Use, Sexual Pleasure, and Ease of Product Use. For acceptability, the applicator ranked highest; however, differences between product acceptability scores were greatest among females and younger participants. These findings indicate that RM delivery systems impact their acceptability and should be considered early in RM development to enhance potential use.

Acceptability of Potential Rectal Microbicide Delivery Systems for HIV Prevention: A Randomized Crossover Trial

PubMed Central

Gorbach, Pamina M.; Weiss, Robert E.; Hess, Kristen; Murphy, Ryan; Saunders, Terry; Brown, Joelle; Anton, Peter A.; Cranston, Ross D.

2012-01-01

We assessed the acceptability of three of over-the-counter products representative of potential rectal microbicide (RM) delivery systems. From 2009 to 2010, 117 HIV-uninfected males (79 %) and females (21 %) who engage in receptive anal intercourse participated in a 6-week randomized crossover acceptability trial. Participants received each of three products (enema, lubricant-filled applicator, suppository) every 2 weeks in a randomized sequence. CASI and T-ACASI scales assessed product acceptability via Likert responses. Factor analysis was used to identify underlying factors measured by each scale. Random effects models were fit to examine age and gender effects on product acceptability. Three underlying factors were identified: Satisfaction with Product Use, Sexual Pleasure, and Ease of Product Use. For acceptability, the applicator ranked highest; however, differences between product acceptability scores were greatest among females and younger participants. These findings indicate that RM delivery systems impact their acceptability and should be considered early in RM development to enhance potential use. PMID:23114512

Integration of Hospital Information and Clinical Decision Support Systems to Enable the Reuse of Electronic Health Record Data.

PubMed

Kopanitsa, Georgy

2017-05-18

The efficiency and acceptance of clinical decision support systems (CDSS) can increase if they reuse medical data captured during health care delivery. High heterogeneity of the existing legacy data formats has become the main barrier for the reuse of data. Thus, we need to apply data modeling mechanisms that provide standardization, transformation, accumulation and querying medical data to allow its reuse. In this paper, we focus on the interoperability issues of the hospital information systems (HIS) and CDSS data integration. Our study is based on the approach proposed by Marcos et al. where archetypes are used as a standardized mechanism for the interaction of a CDSS with an electronic health record (EHR). We build an integration tool to enable CDSSs collect data from various institutions without a need for modifications in the implementation. The approach implies development of a conceptual level as a set of archetypes representing concepts required by a CDSS. Treatment case data from Regional Clinical Hospital in Tomsk, Russia was extracted, transformed and loaded to the archetype database of a clinical decision support system. Test records' normalization has been performed by defining transformation and aggregation rules between the EHR data and the archetypes. These mapping rules were used to automatically generate openEHR compliant data. After the transformation, archetype data instances were loaded into the CDSS archetype based data storage. The performance times showed acceptable performance for the extraction stage with a mean of 17.428 s per year (3436 case records). The transformation times were also acceptable with 136.954 s per year (0.039 s per one instance). The accuracy evaluation showed the correctness and applicability of the method for the wide range of HISes. These operations were performed without interrupting the HIS workflow to prevent the HISes from disturbing the service provision to the users. The project results have proven that archetype based technologies are mature enough to be applied in routine operations that require extraction, transformation, loading and querying medical data from heterogeneous EHR systems. Inference models in clinical research and CDSS can benefit from this by defining queries to a valid data set with known structure and constraints. The standard based nature of the archetype approach allows an easy integration of CDSSs with existing EHR systems.

21 CFR 820.86 - Acceptance status.

Code of Federal Regulations, 2010 CFR

2010-04-01

... QUALITY SYSTEM REGULATION Acceptance Activities § 820.86 Acceptance status. Each manufacturer shall... product which has passed the required acceptance activities is distributed, used, or installed. ...

A method for extending stage-discharge relationships using a hydrodynamic model and quantifying the associated uncertainty

NASA Astrophysics Data System (ADS)

Shao, Quanxi; Dutta, Dushmanta; Karim, Fazlul; Petheram, Cuan

2018-01-01

Streamflow discharge is a fundamental dataset required to effectively manage water and land resources. However, developing robust stage - discharge relationships called rating curves, from which streamflow discharge is derived, is time consuming and costly, particularly in remote areas and especially at high stage levels. As a result stage - discharge relationships are often heavily extrapolated. Hydrodynamic (HD) models are physically based models used to simulate the flow of water along river channels and over adjacent floodplains. In this paper we demonstrate a method by which a HD model can be used to generate a 'synthetic' stage - discharge relationship at high stages. The method uses a both-side Box-Cox transformation to calibrate the synthetic rating curve such that the regression residuals are as close to the normal distribution as possible. By doing this both-side transformation, the statistical uncertainty in the synthetically derived stage - discharge relationship can be calculated. This enables people trying to make decisions to determine whether the uncertainty in the synthetically generated rating curve at high stage levels is acceptable for their decision. The proposed method is demonstrated in two streamflow gauging stations in north Queensland, Australia.

'Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour.

PubMed

Dahlen, Hannah G; Homer, Caroline S E; Cooke, Margaret; Upton, Alexis M; Nunn, Rosalie A; Brodrick, Belinda S

2009-04-01

to determine women's and midwives' experiences of using perineal warm packs in the second stage of labour. as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births. two hospitals in Sydney, Australia. a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or standard care (n=357). Standard care was defined as any second stage practice carried out by midwives that did not include the application of warm packs to the perineum. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women. warm, moist packs were applied to the perineum in the late second stage of labour. warm packs were highly acceptable to both women and midwives as a means of relieving pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both midwives and women were positive about using warm packs in the future. The majority of women (85.7%) said that they would like to use perineal warm packs again for their next birth and would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of routine care in the second stage of labour. responses to questionnaires, eliciting experiences of women and midwives involved in the Warm Pack Trial, demonstrated that the practice of applying perineal warm packs in the late second stage of labour was highly acceptable and effective in helping to relieve perineal pain and increase comfort. perineal warm packs should be incorporated into second stage pain relief options available to women during childbirth.

Development of a peer-supported, self-management intervention for people following mental health crisis.

PubMed

Milton, Alyssa; Lloyd-Evans, Brynmor; Fullarton, Kate; Morant, Nicola; Paterson, Bethan; Hindle, David; Kelly, Kathleen; Mason, Oliver; Lambert, Marissa; Johnson, Sonia

2017-11-09

A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs' training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial. A manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context. Trial Registration ISRCTN01027104 date of registration: 11/10/2012.

Family support and acceptance, gay male identity formation, and psychological adjustment: a path model.

PubMed

Elizur, Y; Ziv, M

2001-01-01

While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

Global Acceptance of Biosimilars: Importance of Regulatory Consistency, Education, and Trust.

PubMed

Cazap, Eduardo; Jacobs, Ira; McBride, Ali; Popovian, Robert; Sikora, Karol

2018-05-16

Globally, biosimilars are expected to have a key role in improving patient access to biological therapies and addressing concerns regarding the escalating cost of health care. Indeed, in Europe, increased use of biologics and reduced drug prices have been observed after the introduction of biosimilars. Recently, several monoclonal antibody biosimilars of anticancer therapies have been approved, and numerous others are in various stages of clinical development. Biosimilars are authorized via a regulatory pathway separate from that used for generic drugs; they are also regulated separately from novel biologics. Biosimilar approval pathways in many major regulatory regions worldwide are, to a broad degree, scientifically aligned. However, owing to regional differences in health care priorities, policies, and resources, some important regulatory inconsistencies are evident. Acceptance of biosimilars by health care systems, health care professionals, and patients will be a key factor in the uptake of these therapies, and such regulatory variations could contribute to confusion and diminished confidence regarding the quality, efficacy, and reliability of these agents. Furthermore, the need for manufacturers to account for regulatory inconsistencies introduces inefficiencies and delays into biosimilar development programs. These issues should be addressed if biosimilars are to attain their maximal global potential. This review summarizes the evolution of the global biosimilar landscape and provides examples of inconsistencies between regulatory requirements in different regions. In addition, we review ongoing efforts to improve regulatory alignment and highlight the importance of education as a crucial factor in generating trust in, and acceptance of, biosimilars on a worldwide scale. Biosimilars of monoclonal antibody anticancer therapies are beginning to emerge, and more are likely to become available for clinical use in the near future. The extent to which biosimilars can contribute to cancer care will depend on their level of acceptance by health care systems, health care professionals, and patients. A better understanding of the regulatory basis for the approval of biosimilars may enhance confidence and trust in these agents. In order to have informed discussions about treatment choices with their patients, oncologists should familiarize themselves with the biosimilar paradigm. © AlphaMed Press 2018.

Exploring the Intrinsic Motivation of Hedonic Information Systems Acceptance: Integrating Hedonic Theory and Flow with TAM

NASA Astrophysics Data System (ADS)

Wang, Zhihuan

Research on Information Systems (IS) acceptance is substantially focused on extrinsic motivation in workplaces, little is known about the underlying intrinsic motivations of Hedonic IS (HIS) acceptance. This paper proposes a hybrid HIS acceptance model which takes the unique characteristics of HIS and multiple identities of a HIS user into consideration by interacting Hedonic theory, Flow theory with Technology Acceptance Model (TAM). The model was empirically tested by a field survey. The result indicates that emotional responses, imaginal responses, and flow experience are three main contributions of HIS acceptance.

The Use of a Mobile Learning Management System at an Online University and Its Effect on Learning Satisfaction and Achievement

ERIC Educational Resources Information Center

Shin, Won Sug; Kang, Minseok

2015-01-01

This study investigates online students' acceptance of mobile learning and its influence on learning achievement using an information system success and extended technology acceptance model (TAM). Structural equation modeling was used to test the structure of individual, social, and systemic factors influencing mobile learning's acceptance, and…

48 CFR 446.370 - Inspection and acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Inspection and acceptance. 446.370 Section 446.370 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 446.370 Inspection and acceptance. The Contracting Officer...

48 CFR 611.103 - Market acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Market acceptance. 611.103 Section 611.103 Federal Acquisition Regulations System DEPARTMENT OF STATE COMPETITION AND ACQUISITION PLANNING DESCRIBING AGENCY NEEDS Selecting and Developing Requirements Documents 611.103 Market acceptance...

Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia

PubMed Central

Mellor, Steve; Aryal, Siddhi; Sovannaroth, Siv; Roca-Feltrer, Arantxa

2017-01-01

Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination. PMID:28615155

User acceptance of a picture archiving and communication system (PACS) in a Saudi Arabian hospital radiology department

PubMed Central

2012-01-01

Background Compared with the increasingly widespread use of picture archiving and communication systems (PACSs), knowledge concerning users’ acceptance of such systems is limited. Knowledge of acceptance is needed given the large (and growing) financial investment associated with the implementation of PACSs, and because the level of user acceptance influences the degree to which the benefits of the systems for healthcare can be realized. Methods A Technology Acceptance Model (TAM) was used to assess the level of acceptance of the host PACS by staff in the radiology department at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. A questionnaire survey of 89 PACS users was employed to obtain data regarding user characteristics, perceived usefulness (PU) (6 items), perceived ease of use (PEU) (4 items), a change construct (4 items), and a behavior (acceptance) construct (9 items). Respondents graded each item in each construct using five-point likert scales. Results Surveyed users reported high levels of PU (4.33/5), PEU (4.15/5), change (4.26/5), and acceptance (3.86/5). The three constructs of PU, PEU, and change explained 41 % of the variation in PACS user acceptance. PU was the most important predictor, explaining 38 % of the variation on its own. The most important single item in the explanatory constructs was that users found PACS to have improved the quality of their work in providing better patient care. Technologists had lower acceptance ratings than did clinicians/radiologists, but no influence on acceptance level was found due to gender, age, or length of experience using the PACS. Although not directly measured, there appeared to be no cultural influence on either the level of acceptance or its determinants. Conclusions User acceptance must be considered when an organization implements a PACS, in order to enhance its successful adoption. Health organizations should adopt a PACS that offers all required functions and which is likely to generate high PU on the part of its users, rather than a system that is easy to use. Training/familiarization programs should aim at establishing high levels of PU in all users, particularly technologists. Health organizations are advised to measure all the factors that influence the acceptance of a PACS by their staff, in order to optimize the productivity of the system and realize the potential benefits to the greatest extent possible. PMID:22640490

Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease.

PubMed

Visser, Annemieke; Dijkstra, Geke J; Kuiper, Daphne; de Jong, Paul E; Franssen, Casper F M; Gansevoort, Ron T; Izaks, Gerbrand J; Jager, Kitty J; Reijneveld, Sijmen A

2009-01-01

Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life.

Knowledge sharing to facilitate regulatory decision-making in regard to alternatives to animal testing: Report of an EPAA workshop.

PubMed

Ramirez, Tzutzuy; Beken, Sonja; Chlebus, Magda; Ellis, Graham; Griesinger, Claudius; De Jonghe, Sandra; Manou, Irene; Mehling, Annette; Reisinger, Kerstin; Rossi, Laura H; van Benthem, Jan; van der Laan, Jan Willem; Weissenhorn, Renate; Sauer, Ursula G

2015-10-01

The European Partnership for Alternative Approaches to Animal Testing (EPAA) convened a workshop Knowledge sharing to facilitate regulatory decision-making. Fifty invited participants from the European Commission, national and European agencies and bodies, different industry sectors (chemicals, cosmetics, fragrances, pharmaceuticals, vaccines), and animal protection organizations attended the workshop. Four case studies exemplarily revealed which procedures are in place to obtain regulatory acceptance of new test methods in different sectors. Breakout groups discussed the status quo identifying the following facilitators for regulatory acceptance of alternatives to animal testing: Networking and communication (including cross-sector collaboration, international cooperation and harmonization); involvement of regulatory agencies from the initial stages of test method development on; certainty on prerequisites for test method acceptance including the establishment of specific criteria for regulatory acceptance. Data sharing and intellectual property issues affect many aspects of test method development, validation and regulatory acceptance. In principle, all activities should address replacement, reduction and refinement methods (albeit animal testing is generally prohibited in the cosmetics sector). Provision of financial resources and education support all activities aiming at facilitating the acceptance and use of alternatives to animal testing. Overall, workshop participants recommended building confidence in new methodologies by applying and gaining experience with them. Copyright © 2015 Elsevier Inc. All rights reserved.

What Residence Hall Staff Need to Know about Dealing with Death.

ERIC Educational Resources Information Center

Jacobs, Bonita; Towns, James E.

1984-01-01

Emphasizes the responsibility for residence hall staff to understand the grief process. An adaptation of Kubler-Ross's stages of death has produced helpful techniques for successfully accepting the death. Through understanding these principles, staff can become aware of the grief process and can assist residents. (JAC)

A Paradigm for the Telephonic Assessment of Suicidal Ideation

ERIC Educational Resources Information Center

Halderman, Brent L.; Eyman, James R.; Kerner, Lisa; Schlacks, Bill

2009-01-01

A three-stage paradigm for telephonically assessing suicidal risk and triaging suicidal callers as practiced in an Employee Assistance Program Call Center was investigated. The first hypothesis was that the use of the procedure would increase the probability that callers would accept the clinician's recommendations, evidenced by fewer police…

Letting Go with Love: The Grieving Process.

ERIC Educational Resources Information Center

O'Connor, Nancy

This book deals with death and the grieving process. The first three chapters cover several universal aspects of grieving. Four stages of grief are described and various feelings of grief (denial, anger, guilt, depression, acceptance) are examined. The next five chapters detail specific losses: death of a spouse, parent, child, friends and…

Exploring Cultural Rituals. Learning Page Lesson Plan.

ERIC Educational Resources Information Center

Douglas, Nanci; Ruddy, Mary

This two-week lesson plan exploring cultural rituals guides students to: improve their oral and written communication skills; write correct bibliographic citations for primary sources; and gain tolerance and acceptance of all cultures through the exploration and analysis of holiday and stages of life rituals. Aimed at students in grades 6 through…

Drawing Amish.

ERIC Educational Resources Information Center

Strauch-Nelson, Wendy

1999-01-01

Explores how the universal stages of graphic language development manifest themselves in children living in the Amish community and how the uniqueness of this subculture is reflected in their drawings. Explains that Amish children focus on an agrarian environment and use copying as a means to finding an accepted place in the community. (CMK)

Information Professionals for the Industrial Sector.

ERIC Educational Resources Information Center

Carrion-Rodriguez, Guadalupe; Quevedo-Procel, Jose

In today's information society, the greatest challenge for information professionals is to accept and understand the information world and to identify their own professional roles. These roles may vary according to the needs and stages of development of different countries, for not all countries are equally aware of the importance of information,…

Rational Emotive Education and the Developmental Stages of Jean Piaget.

ERIC Educational Resources Information Center

Lang, Janet M.

Rational-Emotive Therapy (RET) is predicated on a theory of causality. According to Ellis (1962), beliefs regarding an event, and not the event itself, cause emotional reactions. Mentally healthy persons practice this reational theory of causality. Neurotic persons accept an irrational theory of causality based on coincidental or correlational…

Enhancing user acceptance of mandated mobile health information systems: the ePOC (electronic point-of-care project) experience.

PubMed

Burgess, Lois; Sargent, Jason

2007-01-01

From a clinical perspective, the use of mobile technologies, such as Personal Digital Assistants (PDAs) within hospital environments is not new. A paradigm shift however is underway towards the acceptance and utility of these systems within mobile-based healthcare environments. Introducing new technologies and associated work practices has intrinsic risks which must be addressed. This paper contends that intervening to address user concerns as they arise throughout the system development lifecycle will lead to greater levels of user acceptance, while ultimately enhancing the deliverability of a system that provides a best fit with end user needs. It is envisaged this research will lead to the development of a formalised user acceptance framework based on an agile approach to user acceptance measurement. The results of an ongoing study of user perceptions towards a mandated electronic point-of-care information system in the Northern Illawarra Ambulatory Care Team (TACT) are presented.

STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis.

PubMed

O'Brien, Alanna; Redley, Bernice; Wood, Beverley; Botti, Mari; Hutchinson, Anastasia F

2018-03-01

To develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis. Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. A two-stage sequential multi-method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. This study identified a possible risk to patient safety related to under-recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period. © 2018 John Wiley & Sons Ltd.

Assessing the utility of TAM, TPB, and UTAUT for advanced driver assistance systems.

PubMed

Rahman, Md Mahmudur; Lesch, Mary F; Horrey, William J; Strawderman, Lesley

2017-11-01

Advanced Driver Assistance Systems (ADAS) are intended to enhance driver performance and improve transportation safety. The potential benefits of these technologies, such as reduction in number of crashes, enhancing driver comfort or convenience, decreasing environmental impact, etc., have been acknowledged by transportation safety researchers and federal transportation agencies. Although these systems afford safety advantages, they may also challenge the traditional role of drivers in operating vehicles. Driver acceptance, therefore, is essential for the implementation of these systems into the transportation system. Recognizing the need for research into the factors affecting driver acceptance, this study assessed the utility of the Technology Acceptance Model (TAM), the Theory of Planned Behavior (TPB), and the Unified Theory of Acceptance and Use of Technology (UTAUT) for modelling driver acceptance in terms of Behavioral Intention to use an ADAS. Each of these models propose a set of factors that influence acceptance of a technology. Data collection was done using two approaches: a driving simulator approach and an online survey approach. In both approaches, participants interacted with either a fatigue monitoring system or an adaptive cruise control system combined with a lane-keeping system. Based on their experience, participants responded to several survey questions to indicate their attitude toward using the ADAS and their perception of its usefulness, usability, etc. A sample of 430 surveys were collected for this study. Results found that all the models (TAM, TPB, and UTAUT) can explain driver acceptance with their proposed sets of factors, each explaining 71% or more of the variability in Behavioral Intention. Among the models, TAM was found to perform the best in modelling driver acceptance followed by TPB. The findings of this study confirm that these models can be applied to ADAS technologies and that they provide a basis for understanding driver acceptance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hunters' acceptability of the surveillance system and alternative surveillance strategies for classical swine fever in wild boar - a participatory approach.

PubMed

Schulz, Katja; Calba, Clémentine; Peyre, Marisa; Staubach, Christoph; Conraths, Franz J

2016-09-06

Surveillance measures can only be effective if key players in the system accept them. Acceptability, which describes the willingness of persons to contribute, is often analyzed using participatory methods. Participatory epidemiology enables the active involvement of key players in the assessment of epidemiological issues. In the present study, we used a participatory method recently developed by CIRAD (Centre de Coopération Internationale en Recherche Agronomique pour le Développement) to evaluate the functionality and acceptability of Classical Swine Fever (CSF) surveillance in wild boar in Germany, which is highly dependent on the participation of hunters. The acceptability of alternative surveillance strategies was also analyzed. By conducting focus group discussions, potential vulnerabilities in the system were detected and feasible alternative surveillance strategies identified. Trust in the current surveillance system is high, whereas the acceptability of the operation of the system is medium. Analysis of the acceptability of alternative surveillance strategies showed how risk-based surveillance approaches can be combined to develop strategies that have sufficient support and functionality. Furthermore, some surveillance strategies were clearly rejected by the hunters. Thus, the implementation of such strategies may be difficult. Participatory methods can be used to evaluate the functionality and acceptability of existing surveillance plans for CSF among hunters and to optimize plans regarding their chances of successful implementation.

Cargo Movement Operations System (CMOS) Final System Segment Design Document Increment II, (ChaNge 02)

DTIC Science & Technology

1990-11-07

present, the documents are in conflict with each other. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION...NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] p ORIGINATOR CONTROL NUMBER: SSDD-0003 PROGRAM...ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [1 ORIGINATOR CONTROL NUMBER: SSDD-0005 PROGRAM OFFICE

Specification for procurement of water-level sensing instrumentation, specification number HIF-I-1

USGS Publications Warehouse

Rapp, D.H.

1982-01-01

This specification is to communicate to instrument manufacturers the U.S. Geological Survey 's requirements. It covers systems for sensing the elevation of the water surface on open channels, rivers, lakes, reservoirs, storm-sewer pipes, and observation wells at Survey data-collection sites. The signal output (mechanical or electrical) must meet the signal input requirements of analog to digital and digital input recorders in use by the Survey. A classification of stage-sensing systems by common characteristics is used to aid Survey people making system selections. These characteristics are (1) system type (contact or noncontact), (2) sensor type and sensing distance, (3) accuracy, (4) range, (5) power requirements, (6) system size and weight, and (7) data output signal. Acceptable system requirements cover system configurations, signal outputs, materials, operation manuals, detailed environmental conditions, calibration procedures, system accuracy, power requirements, installation limitations, maintainability, safety, and workmanship. An outline of the qualification test procedures and failure criteria are also given. The Hydrologic Instrumentation Facility at NSTL Station, Mississippi will test available systems to determine if they meet the specification in this report for inclusion in the Survey 's 'Qualified Products List'. This list will be used for future procurement of water-level sensing systems by the Survey. (USGS)

48 CFR 3011.103 - Market acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Market acceptance. 3011.103 Section 3011.103 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY, HOMELAND... Developing Requirements Documents 3011.103 Market acceptance. (a) Contracting officers may act on behalf of...

Factors Potentially Influencing Student Acceptance of Biological Evolution

NASA Astrophysics Data System (ADS)

Wiles, Jason R.

This investigation explored scientific, religious, and otherwise nonscientific factors that may influence student acceptance of biological evolution and related concepts, how students perceived these factors to have influenced their levels of acceptance of evolution and changes therein, and what patterns arose among students' articulations of how their levels of acceptance of evolution may have changed. This exploration also measured the extent to which students' levels of acceptance changed following a treatment designed to address factors identified as potentially affecting student acceptance of evolution. Acceptance of evolution was measured using the MATE instrument (Rutledge and Warden, 1999; Rutledge and Sadler, 2007) among participants enrolled in a secondary-level academic program during the summer prior to their final year of high school and as they transitioned to the post-secondary level. Student acceptance of evolution was measured to be significantly higher than pre-treatment levels both immediately following and slightly over one year after treatment. Qualitative data from informal questionnaires, from formal course evaluations, and from semi-structured interviews of students engaged in secondary level education and former students at various stages of post-secondary education confirmed that the suspected factors were perceived by participants to have influenced their levels of acceptance of evolution. Furthermore, participant reports provided insight regarding the relative effects they perceived these factors to have had on their evolution acceptance levels. Additionally, many participants reported that their science teachers in public schools had avoided, omitted, or denigrated evolution during instruction, and several of these students expressed frustration regarding what they perceived to have been a lack of education of an important scientific principle. Finally, no students expressed feelings of being offended by having been taught about evolutionary science, and the overwhelming majority of the participants expressed enjoyment of the course and appreciation for having been taught about evolution.

Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

PubMed

Shafi, Salman Tahir; Saleem, Mohammad; Anjum, Roshina; Abdullah, Wajid; Shafi, Tahir

2018-01-01

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

Reasons for Chemotherapy Refusal or Acceptance in Older Adults With Cancer.

PubMed

Gopal, Naveen; Kozikowski, Andrzej; Barginear, Myra F; Fishbein, Joanna; Pekmezaris, Renee; Wolf-Klein, Gisele

2017-01-01

The majority of Americans diagnosed as having cancer are older than 65 years. They are, however, less likely than younger patients to receive chemotherapy. Our study aimed to better understand the specific reasons for acceptance or refusal of chemotherapy in older adults with cancer. An anonymous cross-sectional survey was distributed during a 6-month study period in a cancer center and an outpatient geriatric medicine faculty practice to patients at least 50 years old with cancer or to their family members. Data collected included reasons for refusal or acceptance, stage/type of cancer, and demographics. The association between chemotherapy refusal or initiation and these factors was assessed using the Fisher exact test. Among the 37 respondents meeting the inclusion criteria, 78.4% were patients and 21.6% were family members. The following factors were significantly associated with chemotherapy decision: perceived chemotherapy benefit ( P < 0.001), trust in the doctor's recommendation ( P = 0.013), social support ( P = 0.018), marital status ( P < 0.001), sex ( P = 0.037), race/ethnicity ( P = 0.021), and whether respondents had a family member or friend who had previously received chemotherapy ( P = 0.040). In contrast, none of the clinical variables, such as stage of cancer, previous receipt of chemotherapy, or interest in complementary/alternative medicine showed significant association with a patient's decision to accept or refuse chemotherapy treatment. Chemotherapy decisions made by older adults appear to be associated with demographic and social factors rather than with medical information. Recognizing the influence of these factors for older patients with cancer may help hematologists and oncologists to proactively address specific barriers and explore concerns regarding chemotherapy in older patients whose quality of life and longevity may be affected by treatment.

A critical look at persistent problems in the diagnosis, staging and treatment of temporal bone carcinoma.

PubMed

Zanoletti, Elisabetta; Lovato, Andrea; Stritoni, Paola; Martini, Alessandro; Mazzoni, Antonio; Marioni, Gino

2015-12-01

Temporal bone squamous cell carcinoma (TBSCC) is an uncommon malignancy with a distinctly poor prognosis in advanced cases. There is still much controversy surrounding the rational diagnostic/therapeutic approach to TBSCC. Diagnostic differences are due mainly to: the small number of cases reported (even in the largest available series); the inappropriate histological heterogeneity of several case series; the lack of an internationally-accepted staging system for TBSCC; the frequent absence of adequate radiological imaging to enable a malignancy's local, regional and distant extension to be studied in detail; and a non-standardized approach to final histological assessment of the surgical margins. As for the therapeutic approaches, several issues are still debated, including the choice between en bloc and piecemeal primary surgery for the tumor's removal, and the role of elective neck dissection. Although radiotherapy seems to be an effective adjuvant therapy in advanced cases, its role in low-stage tumors or as a primary treatment has yet to be established. The value of chemotherapy is also still unclear. The treatment strategy for TBSCC is often based on the combined experience of a given surgeon and institution, bearing the results reportedly achieved by other oncology centers in mind. To date, the optimal management of TBSCC is still elusive. We aimed to critically review the ongoing crucial issues concerning the management of TBSCC, analyzing how it is diagnosed, staged and treated, the management of recurrences, rational follow-up schedules, and prognostic factors for this disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology

PubMed Central

Buch, Maya H; Silva-Fernandez, Lucia; Carmona, Loreto; Aletaha, Daniel; Christensen, Robin; Combe, Bernard; Emery, Paul; Ferraccioli, Gianfranco; Guillemin, Francis; Kvien, Tore K; Landewe, Robert; Pavelka, Karel; Saag, Kenneth; Smolen, Josef S; Symmons, Deborah; van der Heijde, Désirée; Welling, Joep; Wells, George; Westhovens, Rene; Zink, Angela; Boers, Maarten

2015-01-01

Objectives Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. Methods We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A ‘0–10’ agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. Results Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. Conclusions This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes. PMID:24827533

Staging workers' use of hearing protection devices: application of the transtheoretical model.

PubMed

Raymond, Delbert M; Lusk, Sally L

2006-04-01

The threat of noise-induced hearing loss is a serious concern for many workers. This study explores use of the transtheoretical model as a framework for defining stages of workers' acceptance of hearing protection devices. A secondary analysis was performed using a cross-section of data from a randomized, controlled clinical trial of an intervention to increase use of hearing protection. Use of hearing protection devices was well distributed across the theorized stages of change. Chi-square analysis and analysis of variance revealed significant differences between stages for the variables studied. Discrete stages of hearing protection device use can be identified, laying the foundation for further work investigating use of the transtheoretical model for promoting hearing protection device use. The model can provide a framework for tailoring interventions and evaluating their effects. With further development of the transtheoretical model, nurses may be able to easily identify workers' readiness to use hearing protection devices and tailor training toward that goal.

Investigating User Identification in Remote Patient Monitoring Devices.

PubMed

Ondiege, Brian; Clarke, Malcolm

2017-09-13

With the increase in the number of people having a chronic disease, there is an increase in households having more than a single person suffering from the same chronic illness. One problem of monitoring such patients in their own home is that current devices have a limitation in the number of people who can use a single device. This study investigates the use of Near Field Communication (NFC) for identification in a multi-user environment. A mixed-method qualitative and quantitative approach was adopted, including focus groups, observations and a field trial. Data were collected in three phases. In Phase 1, five focus groups were conducted with patients to determine their beliefs, concerns and issues with using identification in remote patient monitoring devices. In Phase 2, participants were given a blood pressure monitor modified to include an NFC reader to enable identification. The modified device was given to patients living as a couple in the same household and both suffering from hypertension. Both patients used the device for a period of two weeks to observe their acceptance of the technology and determine their experience of usage. A total of 40 (20 couples) patients participated in the trial. Non-adherence to the full monitoring regimen was low and was mainly due to usability issues or commitments taking them away from the home and thus unable to take readings. After the trial period participants were invited to discuss their experiences with the technology in a focus group discussion (Phase 3), a total of five focus groups were conducted. Focus group discussions with the patients revealed that most participants liked using the system and were not apprehensive towards Healthcare Information Technology (HIT). The participants also had suggestions for improvements that could be made to the modified blood pressure monitor (such as, rechargeable in place batteries, integrate the components, easier to use cuff, and increased sensitivity of the NFC reader) that might improve the overall experience of the proposed technology and its acceptance. The study proposes a new framework, the Senior Patient Technology Acceptance Model (SPTAM) that offers an understanding of the needs of the elderly towards technology use and the factors that influence its acceptance. SPTAM emphasises that involving the patient in the early stages of development can lead to a more user-centred technology and help in identifying any underlying issues at an early stage, thus avoiding adding features which patients do not need. The findings from this empirical research can be used as recommendations to improve current RPM devices, save the NHS costs, inform standardization groups.

Investigating User Identification in Remote Patient Monitoring Devices

PubMed Central

Clarke, Malcolm

2017-01-01

With the increase in the number of people having a chronic disease, there is an increase in households having more than a single person suffering from the same chronic illness. One problem of monitoring such patients in their own home is that current devices have a limitation in the number of people who can use a single device. This study investigates the use of Near Field Communication (NFC) for identification in a multi-user environment. Methods: A mixed-method qualitative and quantitative approach was adopted, including focus groups, observations and a field trial. Data were collected in three phases. In Phase 1, five focus groups were conducted with patients to determine their beliefs, concerns and issues with using identification in remote patient monitoring devices. In Phase 2, participants were given a blood pressure monitor modified to include an NFC reader to enable identification. The modified device was given to patients living as a couple in the same household and both suffering from hypertension. Both patients used the device for a period of two weeks to observe their acceptance of the technology and determine their experience of usage. A total of 40 (20 couples) patients participated in the trial. Non-adherence to the full monitoring regimen was low and was mainly due to usability issues or commitments taking them away from the home and thus unable to take readings. After the trial period participants were invited to discuss their experiences with the technology in a focus group discussion (Phase 3), a total of five focus groups were conducted. Focus group discussions with the patients revealed that most participants liked using the system and were not apprehensive towards Healthcare Information Technology (HIT). The participants also had suggestions for improvements that could be made to the modified blood pressure monitor (such as, rechargeable in place batteries, integrate the components, easier to use cuff, and increased sensitivity of the NFC reader) that might improve the overall experience of the proposed technology and its acceptance. Conclusion: The study proposes a new framework, the Senior Patient Technology Acceptance Model (SPTAM) that offers an understanding of the needs of the elderly towards technology use and the factors that influence its acceptance. SPTAM emphasises that involving the patient in the early stages of development can lead to a more user-centred technology and help in identifying any underlying issues at an early stage, thus avoiding adding features which patients do not need. The findings from this empirical research can be used as recommendations to improve current RPM devices, save the NHS costs, inform standardization groups. PMID:28952556

A system justification view of sexual violence: legitimizing gender inequality and reduced moral outrage are connected to greater rape myth acceptance.

PubMed

Chapleau, Kristine M; Oswald, Debra L

2014-01-01

Rape is a pervasive social problem that causes serious physical and psychological repercussions. Rape victims' recovery is often complicated by the public's failure to believe the victim and restore justice. This study applied system justification theory to examine whether the justification of gender inequality is related to moral outrage (an emotional precursor to corrective action) and rape myth acceptance; we also examined whether rape myth acceptance is associated with moral outrage at injustice. Results showed that gender-specific system justification correlated with less moral outrage at human suffering as well as greater rape myth acceptance. The relationships between these variables were similar for men and for women, a finding that suggests that rape myths are system justifying for women. When we controlled for gender-specific system justification, rape myth acceptance correlated with less moral outrage. Results are discussed in the context of how legitimizing ideologies reduce moral outrage at injustice and perpetuate a system of sexual violence.

The effect of information about the benefits and harms of mammography on women's decision-making: study protocol for a randomized controlled trial.

PubMed

Carles, Misericòrdia; Martínez-Alonso, Montserrat; Pons, Anna; Pérez-Lacasta, Maria José; Perestelo-Pérez, Lilisbeth; Sala, Maria; Vidal, Carmen; Garcia, Montse; Toledo-Chávarri, Ana; Codern, Núria; Feijoo-Cid, Maria; Romero, Anabel; Pla, Roger; Soler-González, Jorge; Castells, Xavier; Rué, Montserrat

2017-09-12

The decision to participate or not in breast cancer screening is complex due to the trade-off between the expected benefit of breast cancer mortality reduction and the major harm of overdiagnosis. It seems ethically necessary to inform women so that they can actively participate in decision-making and make an informed choice based on their values and preferences. The objective of this study is to assess the effects of receiving information about the benefits and harms of screening on decision-making, in women approaching the age of invitation to mammography screening. A two-stage, randomized controlled trial (RCT). In the first stage, 40 Basic Health Areas (BHAs) will be selected and randomized to intervention or control. In the second stage, women within each BHA will be randomly selected (n = 400). Four breast cancer screening programs (BCSPs) of the Spanish public health system, three in Catalonia and one in the Canary Islands will participate in the study. Women in the intervention arm will receive a leaflet with detailed information on the benefits and harms of screening using mammography. Women in the control arm will receive a standard leaflet that does not mention harms and recommends accepting the invitation to participate in the biennial examinations of the BCSP. The primary outcome is informed choice, a dichotomous variable that combines knowledge, attitudes, and intentions. Secondary outcomes include decisional conflict; confidence in the decision made; anxiety about screening participation; worry about breast cancer; anticipated regret; time perspective; perceived importance of benefits/harms of screening; perceived risk of breast cancer; and leaflet acceptability. Primary and secondary outcomes are assessed 2-3 weeks after the intervention. This is the first RCT that assesses the effect of informing about the benefits and harms of breast cancer screening in Spain in women facing the decision to be screened using mammography. It aims to assess the impact of information on several decisional outcomes and to contribute to paving the road towards shared decision-making in breast cancer screening in our country. ClinicalTrials.gov registry, ID: NCT03046004 . Retrospectively registered on 4 February 2017. Trial name: InforMa study.

Implementing Connected Component Labeling as a User Defined Operator for SciDB

NASA Technical Reports Server (NTRS)

Oloso, Amidu; Kuo, Kwo-Sen; Clune, Thomas; Brown, Paul; Poliakov, Alex; Yu, Hongfeng

2016-01-01

We have implemented a flexible User Defined Operator (UDO) for labeling connected components of a binary mask expressed as an array in SciDB, a parallel distributed database management system based on the array data model. This UDO is able to process very large multidimensional arrays by exploiting SciDB's memory management mechanism that efficiently manipulates arrays whose memory requirements far exceed available physical memory. The UDO takes as primary inputs a binary mask array and a binary stencil array that specifies the connectivity of a given cell to its neighbors. The UDO returns an array of the same shape as the input mask array with each foreground cell containing the label of the component it belongs to. By default, dimensions are treated as non-periodic, but the UDO also accepts optional input parameters to specify periodicity in any of the array dimensions. The UDO requires four stages to completely label connected components. In the first stage, labels are computed for each subarray or chunk of the mask array in parallel across SciDB instances using the weighted quick union (WQU) with half-path compression algorithm. In the second stage, labels around chunk boundaries from the first stage are stored in a temporary SciDB array that is then replicated across all SciDB instances. Equivalences are resolved by again applying the WQU algorithm to these boundary labels. In the third stage, relabeling is done for each chunk using the resolved equivalences. In the fourth stage, the resolved labels, which so far are "flattened" coordinates of the original binary mask array, are renamed with sequential integers for legibility. The UDO is demonstrated on a 3-D mask of O(1011) elements, with O(108) foreground cells and O(106) connected components. The operator completes in 19 minutes using 84 SciDB instances.

Single-stage anterior high sacrectomy for locally recurrent rectal cancer.

PubMed

Fawaz, Khaled; Khaled, Fawaz; Smith, Myles J; Moises, Cukier; Smith, Andrew J; Yee, Albert J M

2014-03-01

A review of prospectively collected data on a consecutive series of patients undergoing single-stage anterior high sacrectomy for locally recurrent rectal carcinoma (LRRC). To determine the clinical outcome of patients who underwent anterior high sacrectomy for LRRC. High sacrectomy for oncological resection remains technically challenging. Surgery has the potential to achieve cure in carefully selected patients. Complete (R0) tumor excision in LRRC may require sacrectomy. High sacral resections (S3 and above) typically require a combined anterior/supine and posterior/prone procedure. We investigated our experience performing single-stage anterior high sacrectomy for LRRC. A consecutive series of patients with LRRC without systemic metastases who underwent resection with curative intent requiring high sacrectomy were identified. A review of a prospectively maintained colorectal and spine cancer database data was performed. An oblique dome high sacral osteotomy was performed during a single-stage anterior procedure. Outcome measures included surgical resection margin status, hospital length of stay, postoperative complications, physical functioning status, and overall survival. Nineteen consecutive patients were treated between 2002 and 2011. High sacrectomy was performed at sacral level S1-S2 in 4 patients, S2-S3 in 9 patients, and through S3 in 6 patients. An R0 resection margin was achieved histologically in all 19 cases. There was 1 early (<30 d) postoperative death (1/19, 5%). At median follow-up of 38 months, 13 patients had no evidence of residual disease, 1 was alive with disease, and 4 had died of disease. Morbidities occurred in 15 of the 19 patients (79%). Although high sacrectomy may require a combined anterior and posterior surgical approach, our series demonstrates the feasibility of performing single-stage anterior high sacrectomy in LRRC, with acceptable risks and outcomes compared with the literature. The procedure described by us for LRRC lessens the need for a simultaneous or staged prone posterior resection, with favorable R0 tumor resections, patient survival, and clinical outcomes. N/A.

[Acceptance and influence factor of central slaughtering of live poultry in residents of Guangzhou].

PubMed

Yuan, Jun; Xie, Chaojun; Liu, Yufei; Ma, Xiaowei; Cai, Wenfeng; Liu, Yanhui; Liu, Jianping; Su, Wenzhe; Ma, Yu; Yang, Zhicong; Lu, Jiahai; Wang, Ming

2015-03-01

To investigate a survey about acceptance of central slaughtering of live poultry in residents of Guangzhou. We conducted a telephone survey by sampling residents with fixed-line telephone and with normal hearing, whose age is more than 15 years, by Mitofsky-Waksberg two-stage method during Jan 6(th) to 8(th), 2014. 358 residents finished the telephone questionnaire by 12 320 health hot line. We investigated the acceptance rate of city-wide central slaughtering permanently. We compared the difference between the respondents and the 2010 Guangzhou census data by Cohen's effect sizes (w) and weighted by population age and sex. We used χ(2) test to compare the acceptance rate of central slaughtering in residents with different characteristic. We used multiple logistic regression analysis to analyze the factors. The difference in gender and age was small between respondents and the 2010 Guangzhou census data (w value was 0.13, 0.28, respectively), but that in education and marital status was large (w value was 0.52, 0.31, respectively). 49.0% (95% CI: 43.7%-54.3%) accept city-wide central slaughtering permanently. The acceptance rate of city-wide central slaughtering permanently in those who bought fresh, chilled and frozen poultry in their family in previous year was 54.3% (133/245), 60.0% (57/95) and 59.8% (49/82), respectively. It was more than those who didn't buy fresh, chilled and frozen poultry (38.1% (43/113), 44.9% (118/263) and 45.7% (126/276); χ(2) values were 8.15, 6.40 and 5.03; P values were 0.004, 0.011 and 0.025, respectively). The acceptance rate of city-wide central slaughtering permanently in those who deem fresh poultry taste better than live poultry was 64.9% (24/38). It more than those who deem not (47.0%, 151/320) (χ(2) = 4.22, 6.02, P = 0.040, 0.014, respectively). The acceptance rate of city-wide central slaughtering permanently in the male (OR = 2.68, 95% CI: 1.64-4.37) and those who deem getting sick due to buying live birds from LPM (OR = 1.72, 95% CI: 1.05-2.82), who can accept only fresh poultry carcass supply (OR = 2.39, 95% CI: 1.33-4.30), Who bought live poultry in their family in previous year (OR = 0.29, 95% CI: 0.11-0.74), who will decrease the consumption after ban on live poultry sale (OR = 0.50, 95% CI: 0.30-0.83) was 58.6% (109/186), 59.0% (92/156), 60.7% (139/230), 44.9% (132/295), 36.6% (68/186), respectively. In the early stage of avian influenza A(H7N9) epidemic in Guangzhou, the rate of acceptance of central slaughtering permanently in residents was not so high. Who deem getting sick due to buying live birds from LPM, who could accept only fresh poultry carcass supply and the male more accept city-wide central slaughtering permanently.

New treatments for stage I testicular cancer.

PubMed

Nappi, Lucia; Nichols, Craig R; Kollmannsberger, Christian K

2017-08-01

Clinical stage I represents the most frequent presentation of both seminoma and nonseminoma testicular cancer. Despite a survival rate of close to 100%, the management of patients with this disease stage is controversial. The recurrence rate is 10% to 20% for patients with stage I seminoma and 15% to 50% for those with stage I nonseminoma. A highly sensitive and specific biomarker of relapse that is applicable to both seminoma and nonseminoma, and able to drive a definitive risk-adapted management of the patients, still is not available. Lymphovascular invasion (LVI) in the orchiectomy specimen has been used as a risk factor in patients with stage I nonseminoma. However, with a risk of recurrence of 50% for LVI-positive patients and 15% for LVI-negative patients, the discriminative power of LVI is modest at best. Various management options exist. In the absence of a predictive biomarker for recurrence, active surveillance avoids overtreatment in 50% to 85% of patients, with no risk of long-term side effects in nonrelapsing patients and a preserved overall survival of almost 100% after specific treatment for recurrent disease. However, although active surveillance has been accepted as the preferred option for stage I seminoma and low-risk stage I nonseminoma, its role in high-risk stage I nonseminoma remains controversial.

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2013 CFR

2013-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2011 CFR

2011-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

Sex differences in moral reasoning: response to Walker's (1984) conclusion that there are none.

PubMed

Baumrind, D

1986-04-01

Data from the Family Socialization and Developmental Competence Project are used to probe Walker's conclusion that there are no sex differences in moral reasoning. Ordinal and nominal nonparametric statistics result in a complex but theoretically meaningful network of relationships among sex, educational level, and Kohlberg stage score level, with the presence and direction of sex differences in stage score level dependent on educational level. The effects on stage score level of educational level and working status are also shown to differ for men and women. Reasons are considered for not accepting Walker's dismissal of studies that use (a) a pre-1983 scoring manual, or (b) fail to control for education. The problems presented to Kohlberg's theory by the significant relationship between educational and stage score levels in the general population are discussed, particularly as these apply to the postconventional level of moral reasoning.

Validation of engineering methods for predicting hypersonic vehicle controls forces and moments

NASA Technical Reports Server (NTRS)

Maughmer, M.; Straussfogel, D.; Long, L.; Ozoroski, L.

1991-01-01

This work examines the ability of the aerodynamic analysis methods contained in an industry standard conceptual design code, the Aerodynamic Preliminary Analysis System (APAS II), to estimate the forces and moments generated through control surface deflections from low subsonic to high hypersonic speeds. Predicted control forces and moments generated by various control effectors are compared with previously published wind-tunnel and flight-test data for three vehicles: the North American X-15, a hypersonic research airplane concept, and the Space Shuttle Orbiter. Qualitative summaries of the results are given for each force and moment coefficient and each control derivative in the various speed ranges. Results show that all predictions of longitudinal stability and control derivatives are acceptable for use at the conceptual design stage.

Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? - From Chinese healthcare system perspective.

PubMed

Wang, Yu-ting; Huang, Gang

2012-08-01

The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China. Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis. Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B-A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B-A), and decrease of palliative therapy cost could reduce both the ICER and overall cost. The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Electronic Prescribing Decision Support System at a Tertiary Care Pediatric Hospital: The User Acceptance Perspective.

PubMed

Omar, Abdurahman; Ellenius, Johan; Lindemalm, Synnöve

2017-01-01

This study aims to evaluate pediatrician's acceptance, perception and use of Electronic Prescribing Decision Support Systems (EPDSS) at a tertiary care using Extended Technology Acceptance Model (TAM2). Qualitative research methodology was applied. Semi-structured questions were developed according to TAM2 model. Pediatricians perceived that the EPDSS is useful and they showed a favorable attitude. However, perceived ease of use and output quality appeared to affect use of EPDSS. Concerns were expressed about complicated screens, difficulty to read and view medication overview of the patient, the navigation requires many clicks and medication system don't meet their need. End users have difficulty of ordering drugs for ploy-clinical patients and they were unable to cancel or stop medications. Junior pediatricians were influenced by senior colleague since they can get better advice about medication order than the system. Applying TAM2 framework has revealed that pediatrician's attitude and acceptance of electronic prescribing system. This study has identified factors that are important for end user acceptance as well as suggestions for system improvement. Although pediatricians are positive to the usefulness of EPDSS, it appears there are some acceptance problems due to ease of use concern and usability issues of the system.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 4. Issues in Community Acceptance and IP Implementation.

DOT National Transportation Integrated Search

1979-09-01

The report describes various factors which influence community acceptance of integrated paratransit (IP) systems. In order to fully explore past events in those communities which have already accepted IP, a case study approach has been used. Seven we...

Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-year study.

PubMed

Ammenwerth, Elske; Mansmann, Ulrich; Iller, Carola; Eichstädter, Ronald

2003-01-01

The documentation of the nursing process is an important but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems such as low quality of documentation are reported. It is unclear whether computer-based documentation systems can reduce these problems and which factors influence their acceptance by users. We introduced a computer-based nursing documentation system on four wards of the University Hospitals of Heidelberg and systematically evaluated its preconditions and its effects in a pretest-posttest intervention study. For the analysis of user acceptance, we concentrated on subjective data drawn from questionnaires and interviews. A questionnaire was developed using items from published questionnaires and items that had to be developed for the special purpose of this study. The quantitative results point to two factors influencing the acceptance of a new computer-based documentation system: the previous acceptance of the nursing process and the previous amount of self-confidence when using computers. On one ward, the diverse acceptance scores heavily declined after the introduction of the nursing documentation system. Explorative qualitative analysis on this ward points to further success factors of computer-based nursing documentation systems. Our results can be used to assist the planning and introduction of computer-based nursing documentation systems. They demonstrate the importance of computer experience and acceptance of the nursing process on a ward but also point to other factors such as the fit between nursing workflow and the functionality of a nursing documentation system.

75 FR 68657 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-08

... LLC To Increase the Maximum Order Size Accepted by Floor Broker Systems From 25,000,000 Shares to 99... order size accepted by Floor broker systems from 25,000,000 shares to 99,000,000 shares. The text of the... systems shall accept a maximum order size of 99,000,000, an increase from the current 25,000,000 share...

MicroTCA-based Global Trigger Upgrade project for the CMS experiment at LHC

NASA Astrophysics Data System (ADS)

Rahbaran, B.; Arnold, B.; Bergauer, H.; Eichberger, M.; Rabady, D.

2011-12-01

The electronics of the first Level Global Trigger (GT) of CMS is the last stage of the Level-1 trigger system [1]. At LHC up to 40 million collisions of proton bunches occur every second, resulting in about 800 million proton collisions. The CMS Level-1 Global Trigger [1], a custom designed electronics system based on FPGA technology and the VMEbus system, performs a quick on-line analysis of each collision every 25 ns and decides whether to reject or to accept it for further analysis. The CMS trigger group of the Institute of High Energy Physics in Vienna (HEPHY) is involved in the Level-1 trigger of the CMS experiment at CERN. As part of the Trigger Upgrade, the Level-1 Global Trigger will be redesigned and implemented in MicroTCA based technology, which allows engineers to detect all possible faults on plug-in boards, in the power supply and in the cooling system. The upgraded Global Trigger will be designed to have the same basic categories of functions as the present GT, but will have more algorithms and more possibilities for combining trigger candidates. Additionally, reconfigurability and testability will be supported based on the next system generation.

Parts and Components Reliability Assessment: A Cost Effective Approach

NASA Technical Reports Server (NTRS)

Lee, Lydia

2009-01-01

System reliability assessment is a methodology which incorporates reliability analyses performed at parts and components level such as Reliability Prediction, Failure Modes and Effects Analysis (FMEA) and Fault Tree Analysis (FTA) to assess risks, perform design tradeoffs, and therefore, to ensure effective productivity and/or mission success. The system reliability is used to optimize the product design to accommodate today?s mandated budget, manpower, and schedule constraints. Stand ard based reliability assessment is an effective approach consisting of reliability predictions together with other reliability analyses for electronic, electrical, and electro-mechanical (EEE) complex parts and components of large systems based on failure rate estimates published by the United States (U.S.) military or commercial standards and handbooks. Many of these standards are globally accepted and recognized. The reliability assessment is especially useful during the initial stages when the system design is still in the development and hard failure data is not yet available or manufacturers are not contractually obliged by their customers to publish the reliability estimates/predictions for their parts and components. This paper presents a methodology to assess system reliability using parts and components reliability estimates to ensure effective productivity and/or mission success in an efficient manner, low cost, and tight schedule.

Passenger comfort technology for system decision making

NASA Technical Reports Server (NTRS)

Conner, D. W.

1980-01-01

Decisions requiring passenger comfort technology were shown to depend on: the relationship between comfort and other factors (e.g., cost, urgency, alternate modes) in traveler acceptance of the systems, serving a selected market require technology to quantify effects of comfort versus offsetting factors in system acceptance. Public predict the maximum percentage of travelers who willingly accept the overall comfort of any trip ride. One or the other of these technology requirements apply to decisions on system design, operation and maintenance.

Small, high pressure ratio compressor: Aerodynamic and mechanical design

NASA Technical Reports Server (NTRS)

Bryce, C. A.; Erwin, J. R.; Perrone, G. L.; Nelson, E. L.; Tu, R. K.; Bosco, A.

1973-01-01

The Small, High-Pressure-Ratio Compressor Program was directed toward the analysis, design, and fabrication of a centrifugal compressor providing a 6:1 pressure ratio and an airflow rate of 2.0 pounds per second. The program consists of preliminary design, detailed areodynamic design, mechanical design, and mechanical acceptance tests. The preliminary design evaluate radial- and backward-curved blades, tandem bladed impellers, impeller-and diffuser-passage boundary-layer control, and vane, pipe, and multiple-stage diffusers. Based on this evaluation, a configuration was selected for detailed aerodynamic and mechanical design. Mechanical acceptance test was performed to demonstrate that mechanical design objectives of the research package were met.

Contribution of the Multi Attribute Value Theory to conflict resolution in groundwater management. Application to the Mancha Oriental groundwater system, Spain

NASA Astrophysics Data System (ADS)

Apperl, B.; Andreu, J.; Karjalainen, T. P.; Pulido-Velazquez, M.

2014-09-01

The implementation of the EU Water Framework Directive demands participatory water resource management approaches. Decision making in groundwater quantity and quality management is complex because of the existence of many independent actors, heterogeneous stakeholder interests, multiple objectives, different potential policies, and uncertain outcomes. Conflicting stakeholder interests have been often identified as an impediment to the realization and success of water regulations and policies. The management of complex groundwater systems requires clarifying stakeholders' positions (identifying stakeholders preferences and values), improving transparency with respect to outcomes of alternatives, and moving the discussion from the selection of alternatives towards definition of fundamental objectives (value-thinking approach), what facilitates negotiation. The aims of the study are to analyse the potential of the multi attribute value theory for conflict resolution in groundwater management and to evaluate the benefit of stakeholder incorporation in the different stages of the planning process to find an overall satisfying solution for groundwater management. The research was conducted in the Mancha Oriental groundwater system (Spain), subject to an intensive use of groundwater for irrigation. A complex set of objectives and attributes were defined, and the management alternatives were created by a combination of different fundamental actions, considering different implementation stages and future changes in water resources availability. Interviews were conducted with representative stakeholder groups using an interactive platform, showing simultaneously the consequences of changes of preferences to the alternative ranking. Results show that the acceptation of alternatives depends strongly on the combination of measures and the implementation stages. Uncertainties of the results were notable but did not influence heavily on the alternative ranking. The expected reduction of future groundwater resources by climate change increases the conflict potential. The implementation of the method to a very complex case study, with many conflicting objectives and alternatives and uncertain outcomes, including future scenarios under water limiting conditions, illustrate the potential of the method for supporting management decisions.

Space Shuttle RTOS Bayesian Network

NASA Technical Reports Server (NTRS)

Morris, A. Terry; Beling, Peter A.

2001-01-01

With shrinking budgets and the requirements to increase reliability and operational life of the existing orbiter fleet, NASA has proposed various upgrades for the Space Shuttle that are consistent with national space policy. The cockpit avionics upgrade (CAU), a high priority item, has been selected as the next major upgrade. The primary functions of cockpit avionics include flight control, guidance and navigation, communication, and orbiter landing support. Secondary functions include the provision of operational services for non-avionics systems such as data handling for the payloads and caution and warning alerts to the crew. Recently, a process to selection the optimal commercial-off-the-shelf (COTS) real-time operating system (RTOS) for the CAU was conducted by United Space Alliance (USA) Corporation, which is a joint venture between Boeing and Lockheed Martin, the prime contractor for space shuttle operations. In order to independently assess the RTOS selection, NASA has used the Bayesian network-based scoring methodology described in this paper. Our two-stage methodology addresses the issue of RTOS acceptability by incorporating functional, performance and non-functional software measures related to reliability, interoperability, certifiability, efficiency, correctness, business, legal, product history, cost and life cycle. The first stage of the methodology involves obtaining scores for the various measures using a Bayesian network. The Bayesian network incorporates the causal relationships between the various and often competing measures of interest while also assisting the inherently complex decision analysis process with its ability to reason under uncertainty. The structure and selection of prior probabilities for the network is extracted from experts in the field of real-time operating systems. Scores for the various measures are computed using Bayesian probability. In the second stage, multi-criteria trade-off analyses are performed between the scores. Using a prioritization of measures from the decision-maker, trade-offs between the scores are used to rank order the available set of RTOS candidates.

48 CFR 15.101-2 - Lowest price technically acceptable source selection process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Lowest price technically acceptable source selection process. 15.101-2 Section 15.101-2 Federal Acquisition Regulations System FEDERAL... Processes and Techniques 15.101-2 Lowest price technically acceptable source selection process. (a) The...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Swamy, S.A.; Mandava, P.R.; Bhowmick, D.C.

The leak-before-break (LBB) methodology is accepted as a technically justifiable approach for eliminating postulation of Double-Ended Guillotine Breaks (DEGB) in high energy piping systems. This is the result of extensive research, development, and rigorous evaluations by the NRC and the commercial nuclear power industry since the early 1970s. The DEGB postulation is responsible for the many hundreds of pipe whip restraints and jet shields found in commercial nuclear plants. These restraints and jet shields not only cost many millions of dollars, but also cause plant congestion leading to reduced reliability in inservice inspection and increased man-rem exposure. While use ofmore » leak-before-break technology saved hundreds of millions of dollars in backfit costs to many operating Westinghouse plants, value-impacts resulting from the application of this technology for future plants are greater on a per plant basis. These benefits will be highlighted in this paper. The LBB technology has been applied extensively to high energy piping systems in operating plants. However, there are differences between the application of LBB technology to an operating plant and to a new plant design. In this paper an approach is proposed which is suitable for application of LBB to a new plant design such as the Westinghouse AP600. The approach is based on generating Bounding Analyses Curves (BAC) for the candidate piping systems. The general methodology and criteria used for developing the BACs are based on modified GDC-4 and Standard Review Plan (SRP) 3.6.3. The BAC allows advance evaluation of the piping system from the LBB standpoint thereby assuring LBB conformance for the piping system. The piping designer can use the results of the BACs to determine acceptability of design loads and make modifications (in terms of piping layout and support configurations) as necessary at the design stage to assure LBB for the, piping systems under consideration.« less

A continuous-discrete approach for evaluation of natural frequencies and mode shapes of high-rise buildings

NASA Astrophysics Data System (ADS)

Malekinejad, Mohsen; Rahgozar, Reza; Malekinejad, Ali; Rahgozar, Peyman

2016-09-01

In this paper, a continuous-discrete approach based on the concept of lumped mass and equivalent continuous approach is proposed for free vibration analysis of combined system of framed tube, shear core and outrigger-belt truss in high-rise buildings. This system is treated as a continuous system (i.e., discrete beams and columns are replaced with equivalent continuous membranes) and a discrete system (or lumped mass system) at different stages of dynamic analysis. The structure is discretized at each floor of the building as a series of lumped masses placed at the center of shear core. Each mass has two transitional degrees of freedom (lateral and axial( and one rotational. The effect of shear core and outrigger-belt truss on framed tube system is modeled as a rotational spring placed at the location of outrigger-belt truss system along structure's height. By solving the resulting eigen problem, natural frequencies and mode-shapes are obtained. Numerical examples are presented to show acceptable accuracy of the procedure in estimating the fundamental frequencies and corresponding mode shapes of the combined system as compared to finite element analysis of the complete structure. The simplified proposed method is much faster and should be more suitable for rapid interactive design.

Development and testing of study tools and methods to examine ethnic bias and clinical decision-making among medical students in New Zealand: The Bias and Decision-Making in Medicine (BDMM) study.

PubMed

Harris, Ricci; Cormack, Donna; Curtis, Elana; Jones, Rhys; Stanley, James; Lacey, Cameron

2016-07-11

Health provider racial/ethnic bias and its relationship to clinical decision-making is an emerging area of research focus in understanding and addressing ethnic health inequities. Examining potential racial/ethnic bias among medical students may provide important information to inform medical education and training. This paper describes the development, pretesting and piloting of study content, tools and processes for an online study of racial/ethnic bias (comparing Māori and New Zealand European) and clinical decision-making among final year medical students in New Zealand (NZ). The study was developed, pretested and piloted using a staged process (eight stages within five phases). Phase 1 included three stages: 1) scoping and conceptual framework development; 2) literature review and identification of potential measures and items; and, 3) development and adaptation of study content. Three main components were identified to assess different aspects of racial/ethnic bias: (1) implicit racial/ethnic bias using NZ-specific Implicit Association Tests (IATs); (2) explicit racial/ethnic bias using direct questions; and, (3) clinical decision-making, using chronic disease vignettes. Phase 2 (stage 4) comprised expert review and refinement. Formal pretesting (Phase 3) included construct testing using sorting and rating tasks (stage 5) and cognitive interviewing (stage 6). Phase 4 (stage 7) involved content revision and building of the web-based study, followed by pilot testing in Phase 5 (stage 8). Materials identified for potential inclusion performed well in construct testing among six participants. This assisted in the prioritisation and selection of measures that worked best in the New Zealand context and aligned with constructs of interest. Findings from the cognitive interviewing (nine participants) on the clarity, meaning, and acceptability of measures led to changes in the final wording of items and ordering of questions. Piloting (18 participants) confirmed the overall functionality of the web-based questionnaire, with a few minor revisions made to the final study. Robust processes are required in the development of study content to assess racial/ethnic bias in order to optimise the validity of specific measures, ensure acceptability and minimise potential problems. This paper has utility for other researchers in this area by informing potential development approaches and identifying possible measurement tools.

Lunar base heat pump, phase 1

NASA Technical Reports Server (NTRS)

Goldman, Jeffrey H.; Harvey, A.; Lovell, T.; Walker, David H.

1994-01-01

This report describes the Phase 1 process and analysis used to select a refrigerant and thermodynamic cycle as the basis of a vapor compression heat pump requiring a high temperature lift, then to perform a preliminary design to implement the selected concept, including major component selection. Use of a vapor compression heat pump versus other types was based on prior work performed for the Electric Power Research Institute. A high lift heat pump is needed to enable a thermal control system to remove heat down to 275 K from a habitable volume when the external thermal environment is severe. For example, a long-term lunar base habitat will reject heat from a space radiator to a 325 K environment. The first step in the selection process was to perform an optimization trade study, quantifying the effect of radiator operating temperature and heat pump efficiency on total system mass; then, select the radiator operating temperature corresponding to the lowest system mass. Total system mass included radiators, all heat pump components, and the power supply system. The study showed that lunar night operation, with no temperature lift, dictated the radiator size. To operate otherwise would require a high mass penalty to store power. With the defined radiation surface, and heat pump performances assumed to be from 40 percent to 60 percent of the Carnot ideal, the optimum heat rejection temperature ranged from 387 K to 377 K, as a function of heat pump performance. Refrigerant and thermodynamic cycles were then selected to best meet the previously determined design conditions. The system was then adapted as a ground-based prototype lifting temperature to 360 K (versus 385 K for flight unit) and using readily available commercial-grade components. Over 40 refrigerants, separated into wet and dry compression behavioral types, were considered in the selection process. Refrigerants were initially screened for acceptable critical temperature. The acceptable refrigerants were analyzed in ideal single and two-stage thermodynamic cycles. Top candidates were analyzed assuming realistic component limits and system pressure drops, and were evaluated for other considerations such as safety, environmental impact, and commercial availability. A maximum coefficient of performance (COP) of 56 percent of the Carnot ideal was achievable for a three-stage CFC-11 cycle operating under the flight conditions above. The program was completed by defining a control scheme and by researching and selecting the major components, compressor and heat exchangers, that could be used to implement the thermodynamic cycle selected. Special attention was paid to using similar technologies for the SIRF and flight heat pumps resulting in the commercially available equivalent of the flight unit. A package concept was generated for the components selected and mass and volume estimated.

[Advances in the research of scar stricture after esophageal burn].

PubMed

Zhao, Shi-lei; Gu, Chun-dong

2013-10-01

Caustic esophageal burn is a common ailment in clinical practice. In some patients, scar stricture was formed in the late stage of injury, and it seriously undermined quality of life of the patients. We adopted various clinical interventions at an early stage in order to relieve and alleviate the formation and development of corrosive esophageal stricture as a result of chemical injury as well as to avoid invasive operations to make it more acceptable for the patients. This article summarized the progress in etiology, pathological changes, identification, early prevention, and surgical management of corrosive esophageal stricture.

Cargo Movement Operations System (CMOS). Software Requirements Specification

DTIC Science & Technology

1990-03-12

was erroneously deleted. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN...previous SRS. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED...ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] 0 ORIGINATOR CONTROL NUMBER

Illness-related practices for the management of childhood malaria among the Bwatiye people of north-eastern Nigeria

PubMed Central

Akogun, Oladele B; John, Kauna K

2005-01-01

Background A wide range of childhood illnesses are accompanied by fever,, including malaria. Child mortality due to malaria has been attributed to poor health service delivery system and ignorance. An assessment of a mother's ability to recognize malaria in children under-five was carried out among the Bwatiye, a poorly-served minority ethnic group in north-eastern Nigeria. Methods A three-stage research design involving interviews, participatory observation and laboratory tests was used to seek information from 186 Bwatiye mothers about their illness-related experiences with childhood fevers. Results Mothers classified malaria into male (fever that persists for longer than three days) and female (fever that goes away within three days) and had a system of determining when febrile illness would not be regarded as malaria. Most often, malaria would be ignored in the first 2 days before seeking active treatment. Self-medication was the preferred option. Treatment practices and sources of help were influenced by local beliefs, the parity of the mother and previous experience with child mortality. Conclusion The need to educate mothers to suspect malaria in every case of febrile illness and take appropriate action in order to expose the underlying "evil" will be more acceptable than an insistence on replacing local knowledge with biological epidemiology of malaria. The challenge facing health workers is to identify and exploit local beliefs about aetiology in effecting management procedures among culturally different peoples, who may not accept the concept of biological epidemiology. PMID:15723706

Management Skills in Schools

ERIC Educational Resources Information Center

Jones, Jeff

2004-01-01

This book has been written at a time when the direct impact of leadership on the success of schools is increasingly widely accepted. Team leadership has always been important in schools, whether at the level of the department, the curriculum area, the key stage, the phase, or in relation to pastoral and leadership teams. This role has assumed…

Feasibility and Acceptability of the TALK Social Worker Intervention to Improve Live Kidney Transplantation

ERIC Educational Resources Information Center

DePasquale, Nicole; Hill-Briggs, Felicia; Darrell, Linda; Boyer, LaPricia Lewis; Ephraim, Patti; Boulware, L. Ebony

2012-01-01

Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with…

Bringing Imagination Back to Science

ERIC Educational Resources Information Center

Linfield, Rachel Sparks

2007-01-01

Albert Einstein once said, "Imagination is more important than knowledge." In order to develop his theories, he had to use his imagination and go beyond the facts generally accepted. He needed time to think and to imagine. Knowledge has a valuable part to play, but the current emphasis in England on end-of-key-stage assessments and…

Reinstatement of an Extinguished Fear Conditioned Response in Infant Rats

ERIC Educational Resources Information Center

Revillo, Damian A.; Trebucq, Gastón; Paglini, Maria G.; Arias, Carlos

2016-01-01

Although it is currently accepted that the extinction effect reflects new context-dependent learning, this is not so clear during infancy, because some studies did not find recovery of the extinguished conditioned response (CR) in rodents during this ontogenetic stage. However, recent studies have shown the return of an extinguished CR in infant…

Understanding Parental Grief as a Response to Mental Illness: Implications for Practice

ERIC Educational Resources Information Center

Penzo, Jeanine A.; Harvey, Pat

2008-01-01

Parents who are raising children with mental illness struggle with feelings of grief and loss. Kubler-Ross' (1969) stages of grieving (denial, anger, bargaining, depression, and acceptance) are examined as experienced by parents raising children with chronic mental illness. Practice implications for social workers who are working with children and…

Shakespeare in School and College.

ERIC Educational Resources Information Center

National Council of Teachers of English, Champaign, IL.

The teaching and understanding of Shakespeare are the subjects of these essays by (1) Louis B. Wright, who is concerned with the elements of Shakespearean plays which give them world-wide acceptance and timelessness, (2) Richard Hosley, who explores the use of stage curtains both today and when Shakespeare's plays were first produced, (3) G. L.…

Feminist Identity Development: The Current State of Theory, Research, and Practice

ERIC Educational Resources Information Center

Hyde, Janet Shibley

2002-01-01

A review of the three articles on feminist identity development in this issue indicates that (a) the Feminist Identity Development Scale (FIDS) and the Feminist Identity Composite (FIC) perform similarly and acceptably in psychometric analyses, (b) no research has properly tested whether there are true stages of feminist identity development, and…

Grief Counseling Groups for Adolescents Based on Re-Membering Practices

ERIC Educational Resources Information Center

Granados, Stephanie; Winslade, John; De Witt, Megan; Hedtke, Lorraine

2009-01-01

Focusing on "re-membering" practices is new to grief counseling. Traditional approaches to grief counseling are guided by the concepts of stages or tasks, usually to move the person toward accepting the reality of loss and to "say goodbye" to their deceased loved one. This alternative approach to grief counseling, driven by…

THE COMMUNITY PLANNING PROCESS. KANSAS STATE UNIVERSITY SHORT COURSE SERIES ON COMMUNITY PLANNING AND DEVELOPMENT, 6.

ERIC Educational Resources Information Center

WEISENBURGER, RAY B.

PART OF A KANSAS STATE UNIVERSITY SERIES ON COMMUNITY PLANNING AND DEVELOPMENT, THIS MONOGRAPH DISCUSSES THE STAGES IN THE PREPARATION AND IMPLEMENTATION OF COMPREHENSIVE URBAN SCHEMES. FIRST OF ALL, SOCIAL ACCEPTANCE, ECONOMIC, FEASIBILITY, POLITICAL RESPONSIBILITY, AND ENVIRONMENTAL SATISFACTION ARE VITAL TO SUCCESSFUL PLANNING. ORGANIZATION FOR…

Michael Howard: Military Historian and Strategic Analyst.

DTIC Science & Technology

1983-06-10

eighties it became obvious that "the growing acceptability of mili- tary studies" was a consequence of a careful nurturing during the embryo stage by...would decide the destiny of the nation. If the machine gun and the artillery piece meant the "battle went on for longer than expected; the casualties

The dying child and surviving family members.

PubMed

Shrier, D K

1980-12-01

This overview of death and dying focuses on the dying child and surviving family members. Children's concepts of death at different developmental stages are reviewed. These range from an inability to distinguish death from other forms of separation prior to age 3, through partial concepts of death until, by age 10 to 15 years, children are able to conceptualize death as universal, inevitable and final. The importance of adults assisting in the child's growing comprehension of death is stressed. The stages of grief and mourning, as outlined by Kubler-Ross, are reviewed from the perspective of the child and family: denial, anger, bargaining, depression and acceptance. Recognition is given to the variations in coping styles among different family members. The special circumstances related to the death of an infant and the impact of the death of a child on the surviving siblings are discussed. Specific helpful interventions to assist families in coping with mourning are described. The death of a child remains one of the most painful and difficult events for a family and its physician to accept.

Exploring user experience and technology acceptance for a fall prevention system: results from a randomized clinical trial and a living lab.

PubMed

Vaziri, Daryoush D; Aal, Konstantin; Ogonowski, Corinna; Von Rekowski, Thomas; Kroll, Michael; Marston, Hannah R; Poveda, Rakel; Gschwind, Yves J; Delbaere, Kim; Wieching, Rainer; Wulf, Volker

2016-01-01

Falls are common in older adults and can result in serious injuries. Due to demographic changes, falls and related healthcare costs are likely to increase over the next years. Participation and motivation of older adults in fall prevention measures remain a challenge. The iStoppFalls project developed an information and communication technology (ICT)-based system for older adults to use at home in order to reduce common fall risk factors such as impaired balance and muscle weakness. The system aims at increasing older adults' motivation to participate in ICT-based fall prevention measures. This article reports on usability, user-experience and user-acceptance aspects affecting the use of the iStoppFalls system by older adults. In the course of a 16-week international multicenter study, 153 community-dwelling older adults aged 65+ participated in the iStoppFalls randomized controlled trial, of which half used the system in their home to exercise and assess their risk of falling. During the study, 60 participants completed questionnaires regarding the usability, user experience and user acceptance of the iStoppFalls system. Usability was measured with the System Usability Scale (SUS). For user experience the Physical Activity Enjoyment Scale (PACES) was applied. User acceptance was assessed with the Dynamic Acceptance Model for the Re-evaluation of Technologies (DART). To collect more detailed data on usability, user experience and user acceptance, additional qualitative interviews and observations were conducted with participants. Participants evaluated the usability of the system with an overall score of 62 (Standard Deviation, SD 15.58) out of 100, which suggests good usability. Most users enjoyed the iStoppFalls games and assessments, as shown by the overall PACES score of 31 (SD 8.03). With a score of 0.87 (SD 0.26), user acceptance results showed that participants accepted the iStoppFalls system for use in their own home. Interview data suggested that certain factors such as motivation, complexity or graphical design were different for gender and age. The results suggest that the iStoppFalls system has good usability, user experience and user acceptance. It will be important to take these along with factors such as motivation, gender and age into consideration when designing and further developing ICT-based fall prevention systems.

The risk of river pollution due to washout from contaminated floodplain water bodies during high floods

NASA Astrophysics Data System (ADS)

Lyubimova, Tatyana; Lepikhin, Anatoly; Parshakova, Yanina; Tiunov, Alexey

2016-04-01

Today, the potential impact of extremely high floods, which in the last years have become a rather frequent weather-related disaster, is the problem of primary concern. In studies of the potential impact of floods the emphasis is placed first of all on the estimation of possible flood zones and the analysis of the flow regimes in these zones. However, in some cases the hydrochemical parameters related to changes in the chemical composition of water are more important than the hydraulic parameters. It is generally believed that the higher is the flow rate, the more intensive is the process of dissolution, i.e. the lower is the concentration of limiting contaminants in water. However, this statement is valid provided that flooding does not activate new sources of water pollution such as contaminated floodplain water bodies located in the vicinity of water supply systems. Being quite reliable and safe at small and moderate discharges, in the case of extremely high level of river waters they become intensive sources of water pollution, essentially limiting the water consumption schedule for downstream water consumers. It should be noted that compared to the well-studied mechanisms of waste discharge due to failure of hydraulic engineering structures by flood waves, the mechanisms of pollutant washout from the contaminated floodplain water bodies by the flood waves is still poorly understood. We analyze the impacts of such weather-related events on the quality of water in the water intake system, taking as an example, the section of the Vyatka River located in the Prikamskaya lowland of the Russian Federation. The risk of river pollution due to washout from the contaminated floodplain water bodies during high floods is studied by hydrodynamical modeling in the framework of combined approach using one-, two- and three-dimensional hydrodynamic models are implemented and by in situ measurements. It is shown that during high floods the removal of pollutants from the contaminated floodplain water bodies takes place. The washout process includes two stages. The first rapid stage lasts about two hours, during this stage the upper layer is washed out. During the second, longer stage, the concentration of contaminant in the floodplain water body remains nearly constant. The maximal concentration of contaminant in the river in the vicinity of water intake located 21 kilometers downstream is attained in 9 hours from the beginning of the flood; it can become several times larger than acceptable concentration. The calculations and in-situ measurements have also shown that the primary peak of contaminant concentration near the water intake is followed by a smaller second peak related to the contaminant propagation through inundated floodplain. After the second peak the concentration slowly decreases and reaches acceptable values in 30-40 hours. Thus, during high floods, contaminated floodplain water bodies located near drinking water supply systems can become new sources of water pollution which has to be taken into account in downstream water consumption schedule. This work was supported by Russian Science Foundation (grant 14-21-00090).

Navy Controls for Invoice, Receipt, Acceptance, and Property Transfer System Need Improvement

DTIC Science & Technology

2016-02-25

iR APT as a web-based system to electronically invoice, receipt, and accept ser vices and product s from its contractors and vendors. The iR APT system...electronically shares document s bet ween DoD and it s contractors and vendors to eliminate redundant data entr y, increase data accuracy, and reduce...The iR APT system allows contractors to submit and track invoices and receipt and acceptance documents over the web and allows government personnel to

48 CFR 552.270-29 - Acceptance of Space.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Acceptance of Space. 552... Acceptance of Space. As prescribed in 570.703, insert the following clause: Acceptance of Space (JUN 2011) (a... designated representative shall promptly inspect the space. (b) The Government will accept the space and the...

48 CFR 552.270-29 - Acceptance of Space.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Acceptance of Space. 552... Acceptance of Space. As prescribed in 570.703, insert the following clause: Acceptance of Space (JUN 2011) (a... designated representative shall promptly inspect the space. (b) The Government will accept the space and the...

48 CFR 552.270-29 - Acceptance of Space.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Acceptance of Space. 552... Acceptance of Space. As prescribed in 570.703, insert the following clause: Acceptance of Space (JUN 2011) (a... designated representative shall promptly inspect the space. (b) The Government will accept the space and the...

48 CFR 552.270-29 - Acceptance of Space.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Acceptance of Space. 552... Acceptance of Space. As prescribed in 570.603, insert the following clause: Acceptance of Space (SEP 1999) (a... designated representative shall promptly inspect the space. (b) The Government will accept the space and the...

48 CFR 552.270-29 - Acceptance of Space.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Acceptance of Space. 552... Acceptance of Space. As prescribed in 570.703, insert the following clause: Acceptance of Space (JUN 2011) (a... designated representative shall promptly inspect the space. (b) The Government will accept the space and the...

Ant system: optimization by a colony of cooperating agents.

PubMed

Dorigo, M; Maniezzo, V; Colorni, A

1996-01-01

An analogy with the way ant colonies function has suggested the definition of a new computational paradigm, which we call ant system (AS). We propose it as a viable new approach to stochastic combinatorial optimization. The main characteristics of this model are positive feedback, distributed computation, and the use of a constructive greedy heuristic. Positive feedback accounts for rapid discovery of good solutions, distributed computation avoids premature convergence, and the greedy heuristic helps find acceptable solutions in the early stages of the search process. We apply the proposed methodology to the classical traveling salesman problem (TSP), and report simulation results. We also discuss parameter selection and the early setups of the model, and compare it with tabu search and simulated annealing using TSP. To demonstrate the robustness of the approach, we show how the ant system (AS) can be applied to other optimization problems like the asymmetric traveling salesman, the quadratic assignment and the job-shop scheduling. Finally we discuss the salient characteristics-global data structure revision, distributed communication and probabilistic transitions of the AS.

Prediction Based Proactive Thermal Virtual Machine Scheduling in Green Clouds

PubMed Central

Kinger, Supriya; Kumar, Rajesh; Sharma, Anju

2014-01-01

Cloud computing has rapidly emerged as a widely accepted computing paradigm, but the research on Cloud computing is still at an early stage. Cloud computing provides many advanced features but it still has some shortcomings such as relatively high operating cost and environmental hazards like increasing carbon footprints. These hazards can be reduced up to some extent by efficient scheduling of Cloud resources. Working temperature on which a machine is currently running can be taken as a criterion for Virtual Machine (VM) scheduling. This paper proposes a new proactive technique that considers current and maximum threshold temperature of Server Machines (SMs) before making scheduling decisions with the help of a temperature predictor, so that maximum temperature is never reached. Different workload scenarios have been taken into consideration. The results obtained show that the proposed system is better than existing systems of VM scheduling, which does not consider current temperature of nodes before making scheduling decisions. Thus, a reduction in need of cooling systems for a Cloud environment has been obtained and validated. PMID:24737962

Factors influencing nurses' acceptance of hospital information systems in Iran: application of the Unified Theory of Acceptance and Use of Technology.

PubMed

Sharifian, Roxana; Askarian, Fatemeh; Nematolahi, Mohtaram; Farhadi, Payam

User acceptance is a precondition for successful implementation of hospital information systems (HISs). Increasing investment in information technology by healthcare organisations internationally has made user acceptance an important issue in technology implementation and management. Despite the increased focus on hospital information systems, there continues to be user resistance. The present study aimed to investigate the factors affecting hospital information systems nurse-user acceptance of HISs, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), in the Shiraz University of Medical Sciences teaching hospitals. A descriptive-analytical research design was employed to study nurses' adoption and use of HISs. Data collection was undertaken using a cross-sectional survey of nurses (n=303). The research model was examined using the LISREL path confirmatory modeling. The results demonstrated that the nurses' behavioural intention (BI) to use hospital information systems was predicted by Performance Expectancy (PE) (β= 2.34, p<0.01), Effort Expectancy (EE) (β= 2.21, p<0.01), Social Influence (SI) (β= 2.63, p<0.01) and Facilitating Conditions (FC) (β= 2.84, p<0.01). The effects of these antecedents of BI explained 72.8% of the variance in nurses' intention to use hospital information systems (R2 = 0.728). Application of the research model suggested that nurses' acceptance of HISs was influenced by performance expectancy, effort expectancy, social influence and facilitating conditions, with performance expectancy having the strongest effect on user intention.

Hypotheses on the appearance of life on Earth (review).

PubMed

Dose, K

1986-01-01

It is generally accepted within the natural sciences that life emerged on Earth by a kind of proto-Darwinian evolution from molecular assemblies that were predominantly formed from the various constituents of the primitive atmosphere and hydrosphere. Evolutionary stages under discussion are: the self-organization of spontaneously formed biomolecules into early precursors of life (protobionts), their stepwise evolution via (postulated) protocells to (postulated) progenotes and the Darwinian evolution from progenotes to the three kingdoms of contemporary organisms (archaebacteria, eubacteria and eukaryotes). Considerable discrepancies between scientists have arisen because all evolutionary stages from prebiotic molecules to progenotes are entirely hypothetical and so are the postulated environmental conditions. We can only theorize that all those environmental conditions that allow the existence of the various forms of contemporary life might have allowed also the development of their precursors. Because of all these difficulties the hypothesis that life came to our planet from a remote place of our universe (panspermia) has been revived. But experimental evidence only supports the view that spores can--under favorable circumstances--survive a relatively short journey within our solar system (interplanetary transfer of life). It is extremely unlikely that spores can survive a journey of hundreds or thousands of years through interstellar space.

[Anterior craniofacial resection: oncologic outcome and complications in a series of 111 cases].

PubMed

Suárez, C; Llorente, J L; Fernández de León, R; Cabanillas, R; Suárez, V; López, A

2004-01-01

Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion. A retrospective review of 111 patients with sinonasal tumors involving the anterior skull base who underwent combined craniofacial surgery. The most frequent pathological entity was adenocarcinoma (54 cases) and other epithelial tumors (29 cases). Five year actuarial survival according to the Kaplan-Meier method was 40%. Survival was affected by the histology of the tumor, brain involvement, and deep soft tissue involvement of the orbit. The UICC staging system did not show statistical prognostic significance. Complications occurred in 39 (35.1%) patients, resulting in 4 (3.6%) postoperative deaths. Major complications included cerebrospinal fluid leak in 18 patients, meningitis in 10, infection in 9, stroke in 4, and pneumocephalus in 4. The extent of the craniofacial resection was the most important factor associated with major complications. Despite the advanced stage of most of the patients, anterior craniofacial resection succeeded in terms of an acceptable survival rate. Nevertheless, significant complications were observed although in most patients were not life-threatening and had no negative impact on the quality of life.

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Acceptance criteria for reactor coolant system venting... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with high point vents for the reactor coolant system, for the reactor vessel head, and for other systems required...

10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Acceptance criteria for reactor coolant system venting... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with high point vents for the reactor coolant system, for the reactor vessel head, and for other systems required...

Application of gamma irradiation for aging control and improvement of shelf-life of kimchi, korean salted and fermented vegetables

NASA Astrophysics Data System (ADS)

Song, Hyun-Pa; Kim, Dong-Ho; Yook, Hong-Sun; Kim, Kyung-Soo; Kwon, Joong-Ho; Byun, Myung-Woo

2004-09-01

This study was carried out to evaluate the application of food irradiation as a method for extending shelf life of Kimchi. Gamma irradiation up to 10 kGy in the early stage of Kimchi fermentation had a dose-dependent effect on the inactivation of fermentative microbes, lowering the lactate dehydrogenase (LDH) activity and delaying acidification. Although gamma irradiation on the mid-fermentation stage of Kimchi inactivated the fermentative microbes effectively, LDH activity remained high and acidification continued. Kimchi irradiated at 10 kGy had lower scores in acceptability than those of control, 2.5 and 5 kGy irradiated. Therefore, gamma irradiation upto 5 kGy in the early fermentation stage is recommended for aging control and the improvement of shelf life of Kimchi.

Proposal of a novel system for the staging of thymic epithelial tumors.

PubMed

Bedini, Amedeo Vittorio; Andreani, Stefano Michele; Tavecchio, Luca; Fabbri, Alessandra; Giardini, Roberto; Camerini, Tiziana; Bufalino, Rosaria; Morabito, Alberto; Rosai, Juan

2005-12-01

We designed and assessed a new TNM staging system (herein called the INT [Istituto Nazionale Tumori] system) for thymic epithelial tumors in order to overcome the perceived drawbacks of Masaoka's system, which represents the current standard. In all, 123 cases were evaluated. The histologic types according to the World Health Organization (WHO) classification were as follows: subtype A: 5 cases; AB: 40; B1: 16; B2: 29; B3: 16; and C: 17 cases. There were 45 Masaoka's stage I, 33 stage II, 26 stage III, and 19 stage IV cases. A total of 11 INT definitions were grouped into three stages: locally restricted disease (75 cases), which included Masaoka's stage I and selected stage II cases (no pleural invasion); locally advanced disease (37 cases), which included Masaoka's stage III cases plus those staged II owing to pleural invasion and those staged IV owing to intrathoracic nodal or limited pleuropericardial involvement; and systemic disease (11 cases), which included the remaining Masaoka's stage IV cases. Completeness of resection, WHO types, and both staging systems were significant prognostic factors (p < 0.0001) on univariate analysis. The 95-month progression-free survival rates according to Masaoka's system were stage I: 100%; II: 93.6%; III: 46.3%; and IV: 23.2%. The INT system corresponding figures were as follows: locally restricted disease: 98.6%; locally advanced disease: 46.9%; and systemic disease: 11.7%. The INT system was the prognostic factor with the greatest impact (p = 0.0218) on multivariate analysis (Masaoka's system: p = 0.2012; completeness of resection: p = 0.6855; histology: p = 0.9386). The INT system allows finer disease descriptions than Masaoka's system, resulting in a stage grouping with higher prognostic distinctiveness.

Pressure letdown method and device for coal conversion systems

NASA Technical Reports Server (NTRS)

Kendal, J. M.; Walsh, J. V. (Inventor)

1983-01-01

In combination with a reactor for a coal utilization system, a pressure letdown device accepts from a reactor, a polyphase fluid at an entrance pressure and an entrance velocity, and discharges the fluid from the device at a discharge pressure substantially lower than the entrance pressure and at a discharge temperature and a discharge velocity substantially equal to the entrance temperature and entrance velocity. The device is characterized by a series of pressure letdown stages including several symmetrical baffles, disposed in coaxially nested alignment. In each baffle several ports or apertures of uniform dimensions are defined. The number of ports or apertures for each baffle plate is unique with respect to the number of ports or apertures defined in each of the other baffles. The mass rate of flow for each port is a function of the area of the port, the pressure of the fluid as applied to the port, and a common pressure ratio established across the ports.

Gran Telescopio Canarias Commissioning Instrument Optomechanics

NASA Astrophysics Data System (ADS)

Espejo, Carlos; Cuevas, Salvador; Sanchez, Beatriz; Flores, Ruben; Lara, Gerardo; Farah, Alejandro; Godoy, Javier; Bringas, Vicente; Chavoya, Armando; Dorantes, Ariel; Manuel Montoya, Juan; Rangel, Juan Carlos; Devaney, Nicholas; Castro, Javier; Cavaller, Luis

2003-02-01

Under a contract with the GRANTECAN, the Commissioning Instrument is a project developed by a team of Mexican scientists and engineers from the Instrumentation Department of the Astronomy Institute at the UNAM and the CIDESI Engineering Center. This paper will discuss in some detail the final Commissioning Instrument (CI) mechanical design and fabrication. We will also explain the error budget and the barrels design as well as their thermal compensation. The optical design and the control system are discussed in other papers. The CI will just act as a diagnostic tool for image quality verification during the GTC Commissioning Phase. This phase is a quality control process for achieving, verifying, and documenting the performance of each GTC sub-systems. This is a very important step for the telescope life. It will begin on starting day and will last for a year. The CI project started in December 2000. The critical design phase was reviewed in July 2001. The CI manufacturing is currently in progress and most parts are finished. We are now approaching the factory acceptance stage.

Oxygen tension in embryo culture: does a shift to 2% O2 in extended culture represent the most physiologic system?

PubMed

Morin, Scott J

2017-03-01

There has been much debate regarding the optimal oxygen tension in clinical embryo culture. The majority of the literature to date has compared 5% oxygen to atmospheric levels (20-21%). While the majority of modern IVF labs have accepted the superiority of 5% oxygen tension, a new debate has emerged regarding whether a further reduction after day 3 of development represents the most physiologic system. This new avenue of research is based on the premise that oxygen tension is in fact lower in the uterus than in the oviduct and that the embryo crosses the uterotubal junction sometime on day 3. While data are currently limited, recent experience with ultra-low oxygen (2%) after day 3 of development suggests that the optimal oxygen tension in embryo culture may depend on the stage of development. This review article will consider the current state of the literature and discuss ongoing efforts at studying ultra-low oxygen tension in extended culture.

Cell Partition in Two Polymer Aqueous Phases

NASA Technical Reports Server (NTRS)

Brooks, D. E.

1985-01-01

In a reduced gravity environment the two polymer phases will not separate via density driven settling in an acceptably short length of time. It is to be expected that a certain amount of phase separation will take place, however, driven by the reduction in free energy gained when the interfacial area is reduced. This stage of separation process will therefore depend directly on the magnitude of the interfacial tension between the phases. In order to induce complete phase separation in a short time, electric field-induced separation which occurs because the droplets of one phase in the other have high electrophoretic mobilities which increase with droplet size was investigated. These mobilities are significant only in the presence of certain salts, particularly phosphates. The presence of such salts, in turn has a strong effect on the cell partition behavior in dextran-poly (ethylene glycol) (PEG) systems. The addition of the salts necessary to produce phase drop mobilities has a large effect on the interfacial tensions in the systems.

Freshwater Clams (Pilsbryoconcha Exilis) as an Potential Local Mineral Sources in Weaning Food to Overcome Stunting in Grobogan, Central Java, Indonesia

NASA Astrophysics Data System (ADS)

Putri, S. R.; Anjani, Gemala; Wijayanti, Hartanti Sandi; Nuryanto

2018-02-01

Based on a preliminary survey in Grobogan Central Java, one of the local food that has a prospective nutrient content developed is freshwater clams. Results of PSG report in 2015, especially in Grobogan district with stunting problem of 31.5% consisting of 7.2% very short and 24.1% short. From the stunting event factor, the role of weaning food in the form of baby porridge is the most important component in the fulfillment of infant nutrition. The research is divided into two stages of the research is the initial stage to make the formulation process by way of freshwater clams, nutrient analysis, and formula calculation. The second stage is the process of formulation weaning food by way of formula making, nutrient analysis, and acceptance test of weaning food on the baby slurry is substituted by the freshwater clams. The influence statistically different substitution of freshwater clams on protein content (p=0.014), fat (p=0,041), carbohydrate (p=0,039), water (p=0,0001), ash (p=0.0001), iron (p=0.0001), and zinc (p=0.0001). There is no influence substitution of freshwater clams on energy content (p=0,129) and fiber (p=0,225). The percentage of favorite level on the acceptance test of color (p=0,005) and taste (p=0,006) was statistically different, but there was no difference flavour (p=0,913) and texture (p=0,198). freshwater clams flour is rich in iron and zinc content, so it can serve as local food, especially in Grobogan Central Java as a stunting handling. Obtained from the results of several formulations substituted of freshwater clams in formulation 2 is a formula that can meet the standards of KEPMENKES except on the content of protein and moisture content. Formula 2 acceptable to the panelists, except for the assessment of taste.

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

PubMed Central

Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

2016-01-01

Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible. PMID:26839014

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

Cargo Movement Operations System (CMOS). Software Test Description

DTIC Science & Technology

1990-10-28

resulting in errors in paragraph numbers and titles. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION...location to test the update of the truck manifest. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION...CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [

Cargo Movement Operations System (CMOS). Software User’s Manual

DTIC Science & Technology

1990-06-27

RATIONALE: N/A CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: ACCEPT [ ] REJECT [ ] COMMENT STATUS...NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ 3 ORIGINATOR CONTROL NUMBER: SUM-0003 PROGRAM...3.1.11. RATIONALE: Clarity. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN

An Investigation of Employees' Use of E-Learning Systems: Applying the Technology Acceptance Model

ERIC Educational Resources Information Center

Lee, Yi-Hsuan; Hsieh, Yi-Chuan; Chen, Yen-Hsun

2013-01-01

The purpose of this study is to apply the technology acceptance model to examine the employees' attitudes and acceptance of electronic learning (e-learning) systems in organisations. This study examines four factors (organisational support, computer self-efficacy, prior experience and task equivocality) that are believed to influence employees'…

Cargo Movement Operations System (CMOS) Final System Segment Specification (Change 04), Increment II

DTIC Science & Technology

1991-11-14

ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [ ] ORIGINATOR CONTROL NUMBER: SSS-002 PROGRAM OFFICE...only used for air cargo, does not alter the requirement for a surface cargo checklist. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [

An Example of an INPRO Assessment of an INS in the Area of Waste Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Allan, C.; Busurin, Y.; Depisch, F.

2006-07-01

Following a resolution of the General Conference of the IAEA in the year 2000 the International Project on Innovative Nuclear Reactors and Fuel Cycles, referred to as INPRO, was initiated. INPRO has defined requirements organized in a hierarchy of Basic Principles, User Requirements and Criteria (consisting of an indicator and an acceptance limit) to be met by innovative nuclear reactor systems (INS) in six areas, namely: economics, safety, waste management, environment, proliferation resistance, and infrastructure. If an INS meets all requirements in all areas it represents a sustainable system for the supply of energy, capable of making a significant contributionmore » to meeting the energy needs of the 21. century. Draft manuals have been developed, for each INPRO area, to provide guidance for performing an assessment of whether an INS meets the INPRO requirements in a given area. The manuals set out the information that needs to be assembled to perform an assessment and provide guidance on selecting the acceptance limits and, for a given INS, for determining the value of the indicators for comparison with the associated acceptance limits. Each manual also includes an example of a specific assessment to illustrate the guidance. This paper discusses the example presented in the manual for performing an INPRO assessment in the area of waste management. The example, chosen solely for the purpose of illustrating the INPRO methodology, describes an assessment of an INS based on the DUPIC fuel cycle. It is assumed that uranium is mined, milled, converted, enriched, and fabricated into LWR fuel in Canada. The LWR fuel is assumed to be leased to a utility in the USA. The spent LWR fuel is assumed to be returned to Canada where it is processed into CANDU DUPIC fuel, which is then burned in CANDU reactors. The assessment steps and the results are presented in detail in the paper. The example illustrates an assessment performed for an INS at an early stage of development. (authors)« less

Children's acceptance of a peer who is overweight: relations among gender, age and blame for weight status.

PubMed

Iobst, E A; Ritchey, P N; Nabors, L A; Stutz, R; Ghee, K; Smith, D T

2009-07-01

To examine the role of blame as a mediator of the relationships between perceiver age and gender and children's acceptance of an overweight peer. Cross-sectional study of children's perceptions of their overweight peers using structural equation modeling. Two hundred and ninety-one children between the ages of 3 and 11 years. Children viewed a videotape of a same-sex peer, dressed to appear overweight, interacting with an adult. After viewing the videotape, children responded to items assessing their perceptions of the child's social and emotional traits and how much the child was to blame for being overweight.Results:Confirmatory factor analysis indicated that the traits loaded on a single factor, acceptance. of analyses for our structural equation model indicated that as blame increased, acceptance of the peer decreased. The relationships between gender and blame and gender and acceptance were not significant. Children were categorized into three age groups (3-4, 5-8 and 9-11 years) to examine the influence of age. Children between 5 and 8 years of age were less likely to blame the model compared with younger and older children. Preschoolers reported the lowest acceptance, indicating a need for intervention for children in this age range. Furthermore, it will be important to conduct longitudinal studies to determine the influence of interventions as the child passes through different developmental stages.

Time perception and illness acceptance among remitting-relapsing multiple sclerosis patients under treatment.

PubMed

Król, Joanna; Szcześniak, Małgorzata; Koziarska, Dorota; Rzepa, Teresa

2015-01-01

The aim of the study was to determine temporal orientation in patients diagnosed with RR-MS as compared with that of healthy individuals; to analyse self-evaluated acceptance levels in terms of physical and psychological condition and self-reliance; an attempt to identify factors of illness acceptance in patients with RR-MS including temporal perspective. Acceptance of Illness Scale (AIS, adapted into Polish by Z. Juczyński), Zimbardo Time Perspective Inventory (ZTPI, adapted into Polish by M. Mażewski), and original interview aimed to assess socio-demographic data and self-evaluated physical as well as psychological condition and self-reliance of patients with MS (referred to the neurological testing according to the EDSS). Patients with RR-MS focus on fatalistic and hedonistic present more than healthy individuals. They also tend to reflect on their negative past experience. Acceptance of illness correlated positively with subjective assessment of physical and psychological condition as well as self-reliance, and negatively with objective disability score (measured with the use of EDSS) and a factor considering time of disease duration. Avoiding contemplation of negative past and concentrating on hedonistic future constitute significant predictors of illness acceptance. These results may be of importance in terms of holistic approach to treatment of RR-MS patients. In the initial stage of the disease progression, patients might benefit from psychological support due to change in temporal orientation.

Complex regional pain syndrome (CRPS) type I: historical perspective and critical issues.

PubMed

Iolascon, Giovanni; de Sire, Alessandro; Moretti, Antimo; Gimigliano, Francesca

2015-01-01

The history of algodystrophy is controversial and its denomination has changed significantly over time. Silas Weir Mitchell described several cases of causalgia due to gunshot wounds that occurred during the American Civil War, increasing knowledge about this clinical condition. A later key milestone in the history of CRPS is tied to the name of Paul Sudeck that, using X-ray examinations, described findings of bone atrophy following a traumatic event or infection of the upper limb. The most widely accepted pathogenic hypothesis, proposed by Rene Leriche, supported a key role of the sympathetic nervous system in the onset of the typical clinical picture of the disease, which was thus defined as "reflex sympathetic dystrophy". In the 50s John J. Bonica proposed a staging of CRPS. In a consensus conference held in Budapest in 2003, it was proposed a new classification system that included the presence of at least two clinical signs included in the four categories and at least three symptoms in its four categories. There have been other classification systems proposed for the diagnosis of CRPS, such as Veldman diagnostic criteria based on the presence of at least 4 signs and symptoms of the disease associated with a worsening of the same following the use of the limb and their location in the same area distal to the one that suffered the injury. On the other hand, the Atkins diagnostic criteria are much more objective than those proposed by IASP and are specifically applicable to an orthopaedic context. However, current classification systems and related criteria proposed to make a diagnosis of CRPS, do not include instrumental evaluations and imaging, but rely solely on clinical findings. This approach does not allow an optimal disease staging especially in orthopaedics.

Complex regional pain syndrome (CRPS) type I: historical perspective and critical issues

PubMed Central

Iolascon, Giovanni; de Sire, Alessandro; Moretti, Antimo; Gimigliano, Francesca

2015-01-01

Summary The history of algodystrophy is controversial and its denomination has changed significantly over time. Silas Weir Mitchell described several cases of causalgia due to gunshot wounds that occurred during the American Civil War, increasing knowledge about this clinical condition. A later key milestone in the history of CRPS is tied to the name of Paul Sudeck that, using X-ray examinations, described findings of bone atrophy following a traumatic event or infection of the upper limb. The most widely accepted pathogenic hypothesis, proposed by Rene Leriche, supported a key role of the sympathetic nervous system in the onset of the typical clinical picture of the disease, which was thus defined as “reflex sympathetic dystrophy”. In the 50s John J. Bonica proposed a staging of CRPS. In a consensus conference held in Budapest in 2003, it was proposed a new classification system that included the presence of at least two clinical signs included in the four categories and at least three symptoms in its four categories. There have been other classification systems proposed for the diagnosis of CRPS, such as Veldman diagnostic criteria based on the presence of at least 4 signs and symptoms of the disease associated with a worsening of the same following the use of the limb and their location in the same area distal to the one that suffered the injury. On the other hand, the Atkins diagnostic criteria are much more objective than those proposed by IASP and are specifically applicable to an orthopaedic context. However, current classification systems and related criteria proposed to make a diagnosis of CRPS, do not include instrumental evaluations and imaging, but rely solely on clinical findings. This approach does not allow an optimal disease staging especially in orthopaedics. PMID:27134625

User Acceptance of Picture Archiving and Communication System in the Emergency Department.

PubMed

Goodarzi, Hassan; Khatami, Seyed-Masoud; Javadzadeh, Hammidreza; Mahmoudi, Sadrollah; Khajehpour, Hojjatollah; Heidari, Soleiman; Khodaparast, Morteza; Ebrahimi, Ali; Rasouli, Hamidreza; Ghane, Mohammadreza; Faraji, Mehrdad; Hassanpour, Kasra

2016-04-01

Picture archiving and communication system (PACS) has allowed the medical images to be transmitted, stored, retrieved, and displayed in different locations of a hospital or health system. Using PACS in the emergency department will eventually result in improved efficiency and patient care. In spite of the abundant benefits of employing PACS, there are some challenges in implementing this technology like users' resistance to accept the technology, which has a critical role in PACS success. In this study, we will assess and compare user acceptance of PACS in the emergency departments of three different hospitals and investigate the effect of socio-demographic factors on this acceptance. A variant of technology acceptance model (TAM) has been used in order to measure the acceptance level of PACS in the emergency department of three educational hospitals in Iran. A previously used questionnaire was validated and utilized to collect the study data. A stepwise multiple regression model was used to predict factors influencing acceptance score as the dependent variable. Mean age of participants was 32.9 years (standard deviation [SD] = 6.08). Participants with the specialty degree got a higher acceptance score than the three other groups (Mean ± SD = 4.17 ± 0.20). Age, gender, degree of PACS usage and participant's occupation (profession) did not influence the acceptance score. In our multiple regression model, all three variables of perceived usefulness (PU), perceived ease of use (PEU) and the effect of PACS (change) had a significant effect in the prediction of acceptance. The most influencing factor was change with the beta of 0.22 (P value < 0.001). PACS is highly accepted in all three emergency departments especially among specialists. PU, PEU and change are factors influencing PACS acceptance. Our study can be used as an evidence of PACS acceptance in emergency wards.

Sharing Malaysian experience with the development of biotechnology-derived food crops.

PubMed

Abu Bakar, Umi K; Pillai, Vilasini; Hashim, Marzukhi; Daud, Hassan Mat

2005-12-01

Biotechnology-derived food crops are currently being developed in Malaysia mainly for disease resistance and improved post harvest quality. The modern biotechnology approach is adopted because of its potential to overcome constraints faced by conventional breeding techniques. Research on the development of biotechnology-derived papaya, pineapple, chili, passion fruit, and citrus is currently under way. Biotechnology-derived papaya developed for resistance to papaya ringspot virus (PRSV) and improved postharvest qualities is at the field evaluation stage. Pineapple developed for resistance to fruit black heart disorder is also being evaluated for proof-of-concept. Other biotechnology-derived food crops are at early stages of gene cloning and transformation. Activities and products involving biotechnology-derived crops will be fully regulated in the near future under the Malaysian Biosafety Law. At present they are governed only by guidelines formulated by the Genetic Modification Advisory Committee (GMAC), Malaysia. Commercialization of biotechnology-derived crops involves steps that require GMAC approval for all field evaluations and food-safety assessments before the products are placed on the market. Public acceptance of the biotechnology product is another important factor for successful commercialization. Understanding of biotechnology is generally low among Malaysians, which may lead to low acceptance of biotechnology-derived products. Initiatives are being taken by local organizations to improve public awareness and acceptance of biotechnology. Future research on plant biotechnology will focus on the development of nutritionally enhanced biotechnology-derived food crops that can provide more benefits to consumers.

Applying the technology acceptance model to explore public health nurses' intentions towards web-based learning: a cross-sectional questionnaire survey.

PubMed

Chen, I Ju; Yang, Kuei-Feng; Tang, Fu-In; Huang, Chun-Hsia; Yu, Shu

2008-06-01

In the era of the knowledge economy, public health nurses (PHNs) need to update their knowledge to ensure quality of care. In pre-implementation stage, policy makers and educators should understand PHNs' behavioural intentions (BI) toward web-based learning because it is the most important determinant of actual behaviour. To understand PHNs' BI toward web-based learning and further to identify the factors influencing PHNs' BI based on the technology acceptance model (TAM) in pre-implementation stage. A nationwide-based cross-sectional research design was used in this study. Three hundred and sixty-nine health centres in Taiwan. A randomly selected sample, 202 PHNs participated in this study. Data were collected by mailing in a questionnaire. The majority of PHNs (91.6%, n=185) showed an affirmative BI toward web-based learning. PHNs rated moderate values of perceived usefulness (U), perceived ease of use (EOU) and attitude toward web-based learning (A). Multiple regression analyses indicated that only U revealed a significantly direct influence on BI. U and EOU had significantly direct relationships with A; however, no significant relationship existed between A and BI. Additionally, EOU and an individual's computer competence revealed significant relationships with U; Internet access at the workplace revealed a significant relationship with EOU. In the pre-implementation stage, PHNs perceived a high likelihood of adopting web-based learning as their way of continuing education. In pre-implementation stage, perceived usefulness is the most important factor for BI instead of the attitude. Perceived EOU, an individual's computer competency, and Internet access at workplaces revealed indirect effects on BI. Therefore, increasing U, EOU, computer competence, and Internet access at workplace will be helpful in increasing PHNs' BI. Moreover, we suggest that future studies should focus on clarifying problems in different stages of implementation to build a more complete understanding of implementing web-based learning.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanquist, Thomas F.; Mahy, Heidi A.; Morris, Fred A.

Understanding the issues surrounding public acceptance of homeland security systems is important for balancing security needs and potential civil liberties infringements. A psychometric survey was used to measure attitudes regarding homeland security systems. Psychometric rating data were obtained from 182 respondents on psychological attributes associated with 12 distinct types of homeland security systems. An inverse relationship was observed for the overall rating attributes of acceptability and risk of civil liberties infringement. Principal components analysis yielded a two factor solution, with the rating scale loading pattern suggesting factors of Perceived Effectiveness and Perceived Intrusiveness. These factors also showed an inverse relationship.more » The 12 different homeland security systems showed significantly different scores on the rating scales and PCA factors, which were used to rank the systems in terms of overall acceptability. Difference scores for the rating scales and PCA factors were used to compute a single acceptability value reflecting the relative weight of risks and benefits. Of the 12 systems studied, airport screening, canine detectors and radiation monitoring at borders were found to be relatively acceptable, i.e., the perceived benefits for homeland security outweighed the perceived risks to civil liberties. Students rated several systems as more effective than professionals, but the overall pattern of results for both types of subjects was similar. The data suggest that risk perception research and the psychometric paradigm are useful approaches for quantifying attitudes regarding homeland security systems and policies, and can be used to anticipate potentially significant public acceptance issues.« less

Cargo Movement Operations System (CMOS) Final Software User’s Manual

DTIC Science & Technology

1990-12-20

CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: ACCEPT [ ] REJECT [ I COMMENT STATUS: OPEN...is correct. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ] ERCI ACCEPTS CO1MENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED...RATIONALE: .."DA001041" is in the SUM but not in the SDD. CMOS PMO ACCEPTS COMMENT: YES [ ] NO [ ERCI ACCEPTS COMMENT: YES [ ] NO [ ] COMMENT DISPOSITION: COMMENT STATUS: OPEN [ ] CLOSED [

Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults Living in the United States.

PubMed

Cameron, Linda D; Durazo, Arturo; Ramírez, A Susana; Corona, Roberto; Ultreras, Mayra; Piva, Sonia

2017-03-01

Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.

Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology.

PubMed

Buch, Maya H; Silva-Fernandez, Lucia; Carmona, Loreto; Aletaha, Daniel; Christensen, Robin; Combe, Bernard; Emery, Paul; Ferraccioli, Gianfranco; Guillemin, Francis; Kvien, Tore K; Landewe, Robert; Pavelka, Karel; Saag, Kenneth; Smolen, Josef S; Symmons, Deborah; van der Heijde, Désirée; Welling, Joep; Wells, George; Westhovens, Rene; Zink, Angela; Boers, Maarten

2015-06-01

Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A '0-10' agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A two-stage cognitive theory of the positive symptoms of psychosis. Highlighting the role of lowered decision thresholds.

PubMed

Moritz, Steffen; Pfuhl, Gerit; Lüdtke, Thies; Menon, Mahesh; Balzan, Ryan P; Andreou, Christina

2017-09-01

We outline a two-stage heuristic account for the pathogenesis of the positive symptoms of psychosis. A narrative review on the empirical evidence of the liberal acceptance (LA) account of positive symptoms is presented. At the heart of our theory is the idea that psychosis is characterized by a lowered decision threshold, which results in the premature acceptance of hypotheses that a nonpsychotic individual would reject. Once the hypothesis is judged as valid, counterevidence is not sought anymore due to a bias against disconfirmatory evidence as well as confirmation biases, consolidating the false hypothesis. As a result of LA, confidence in errors is enhanced relative to controls. Subjective probabilities are initially low for hypotheses in individuals with delusions, and delusional ideas at stage 1 (belief formation) are often fragile. In the course of the second stage (belief maintenance), fleeting delusional ideas evolve into fixed false beliefs, particularly if the delusional idea is congruent with the emotional state and provides "meaning". LA may also contribute to hallucinations through a misattribution of (partially) normal sensory phenomena. Interventions such as metacognitive training that aim to "plant the seeds of doubt" decrease positive symptoms by encouraging individuals to seek more information and to attenuate confidence. The effect of antipsychotic medication is explained by its doubt-inducing properties. The model needs to be confirmed by longitudinal designs that allow an examination of causal relationships. Evidence is currently weak for hallucinations. The theory may account for positive symptoms in a subgroup of patients. Future directions are outlined. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Thinking ahead--the need for early Advance Care Planning for people on haemodialysis: A qualitative interview study.

PubMed

Bristowe, Katherine; Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O'Donoghue, Donal; Vinen, Katie; Murtagh, Felicity E M

2015-05-01

There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the 'conveyor belt' culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential - one size does not fit all. © The Author(s) 2014.

Thinking ahead – the need for early Advance Care Planning for people on haemodialysis: A qualitative interview study

PubMed Central

Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O’Donoghue, Donal; Vinen, Katie; Murtagh, Felicity EM

2015-01-01

Background: There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. Aim: To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Study design: Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. Setting/participants: A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Results: Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the ‘conveyor belt’ culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Conclusion: Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential – one size does not fit all. PMID:25527527

Weight Gain in Advanced Non-Small-Cell Lung Cancer Patients During Treatment With Split-Course Concurrent Chemoradiotherapy Is Associated With Superior Survival

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gielda, Benjamin T., E-mail: Benjamin_gielda@rush.edu; Mehta, Par; Khan, Atif

Background: Preoperative concurrent chemoradiotherapy (CRT) is an accepted treatment for potentially resectable, locally advanced, non-small-cell lung cancer (NSCLC). We reviewed a decade of single institution experience with preoperative split-course CRT followed by surgical resection to evaluate survival and identify factors that may be helpful in predicting outcome. Methods and Materials: All patients treated with preoperative split-course CRT and resection at Rush University Medical Center (RUMC) between January 1999 and December 2008 were retrospectively analyzed. Endpoints included overall survival (OS), progression-free survival (PFS), local-regional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS). Patient and treatment related variables were assessed for correlationmore » with outcomes. Results: A total of 54 patients were analyzed, 76% Stage IIIA, 18% Stage IIIB, and 6% oligometastatic. The pathologic complete response (pCR) rate was 31.5%, and the absence of nodal metastases (pN0) was 64.8%. Median OS and 3-year actuarial survival were 44.6 months and 50%, respectively. Univariate analysis revealed initial stage (p < 0.01) and percent weight change during CRT (p < 0.01) significantly correlated with PFS/OS. On multivariate analysis initial stage (HR, 2.4; 95% CI, 1.18-4.90; p = 0.02) and percent weight change (HR, 0.79; 95% CI, 0.67-0.93; p < 0.01) maintained significance with respect to OS. There were no cases of Grade 3+ esophagitis, and there was a single case of Grade 3 febrile neutropenia. Conclusions: The strong correlation between weight change during CRT and OS/PFS suggests that this clinical parameter may be useful as a complementary source of predictive information in addition to accepted factors such as pathological response.« less

Systems Integration Processes for NASA Ares I Crew Launch Vehicle

NASA Technical Reports Server (NTRS)

Taylor, James L.; Reuter, James L.; Sexton, Jeffrey D.

2006-01-01

NASA's Exploration Initiative will require development of many new elements to constitute a robust system of systems. New launch vehicles are needed to place cargo and crew in stable Low Earth Orbit (LEO). This paper examines the systems integration processes NASA is utilizing to ensure integration and control of propulsion and nonpropulsion elements within NASA's Crew Launch Vehicle (CLV), now known as the Ares I. The objective of the Ares I is to provide the transportation capabilities to meet the Constellation Program requirements for delivering a Crew Exploration Vehicle (CEV) or other payload to LEO in support of the lunar and Mars missions. The Ares I must successfully provide this capability within cost and schedule, and with an acceptable risk approach. This paper will describe the systems engineering management processes that will be applied to assure Ares I Project success through complete and efficient technical integration. Discussion of technical review and management processes for requirements development and verification, integrated design and analysis, integrated simulation and testing, and the integration of reliability, maintainability and supportability (RMS) into the design will also be included. The Ares I Project is logically divided into elements by the major hardware groupings, and associated management, system engineering, and integration functions. The processes to be described herein are designed to integrate within these Ares I elements and among the other Constellation projects. Also discussed is launch vehicle stack integration (Ares I to CEV, and Ground and Flight Operations integration) throughout the life cycle, including integrated vehicle performance through orbital insertion, recovery of the first stage, and reentry of the upper stage. The processes for decomposing requirements to the elements and ensuring that requirements have been correctly validated, decomposed, and allocated, and that the verification requirements are properly defined to ensure that the system design meets requirements, will be discussed.

Administration of adjuvant chemotherapy for stage II-III colon cancer patients: An European population-based study.

PubMed

Babaei, Masoud; Balavarca, Yesilda; Jansen, Lina; Lemmens, Valery; van Erning, Felice N; van Eycken, Liesbet; Vaes, Evelien; Sjövall, Annika; Glimelius, Bengt; Ulrich, Cornelia M; Schrotz-King, Petra; Brenner, Hermann

2018-04-01

The advantage of adjuvant chemotherapy (ACT) for treating Stage III colon cancer patients is well established and widely accepted. However, many patients with Stage III colon cancer do not receive ACT. Moreover, there are controversies around the effectiveness of ACT for Stage II patients. We investigated the administration of ACT and its association with overall survival in resected Stage II (overall and stratified by low-/high-risk) and Stage III colon cancer patients in three European countries including The Netherlands (2009-2014), Belgium (2009-2013) and Sweden (2009-2014). Hazard ratios (HR) for death were obtained by Cox regression models adjusted for potential confounders. A total of 60244 resected colon cancer patients with pathological Stages II and III were analyzed. A small proportion (range 9-24%) of Stage II and over half (range 55-68%) of Stage III patients received ACT. Administration of ACT in Stages II and III tumors decreased with higher age of patients. Administration of ACT was significantly associated with higher overall survival in high-risk Stage II patients (in The Netherlands (HR; 95%CI = 0.82 (0.67-0.99), Belgium (0.73; 0.59-0.90) and Sweden (0.58; 0.44-0.75)), and in Stage III patients (in The Netherlands (0.47; 0.43-0.50), Belgium (0.46; 0.41-0.50) and Sweden (0.48; 0.43-0.54)). In Stage III, results were consistent across subgroups including elderly patients. Our results show an association of ACT with higher survival among Stage III and high-risk Stage II colon cancer patients. Further investigations are needed on the selection criteria of Stages II and III colon cancer patients for ACT. © 2017 UICC.

Dealing with colon cancer: one woman's emotional journey.

PubMed

Wilson, Candice T; Fletcher, Paula C

2002-11-01

Although death is inevitable, it continues to remain a taboo issue for society. A failure to discuss the unavoidable may represent a safeguard to avoid dealing with mortality and related fears. Many patients who are terminally ill spend their days feeling alone, misunderstood, and afraid. Kubler-Ross attempted to strip death of its negative connotations and to provide a venue for the terminally ill to have a voice. Using information from more than 200 clinical interviews, Kubler-Ross revealed a trend in emotions over time in most, but not all, of her patients, which enabled her to formulate a model of coping with death that included 5 interdependent emotional stages: denial, anger, bargaining, depression, and acceptance. This model has become the most widely accepted and popularized model on death and dying, often cited as the Five Stages of Grief." However, given the lack of research concerning Kubler-Ross's model, completing work in this area seems warranted. The purpose of this case study was to examine one individual's emotional journey after being diagnosed with terminal colon cancer. More specifically, the goals were twofold: (1) to provide the participant with a voice and to allow her story to be told by examining the major external events (ie,surgery, chemotherapy) occurring since the diagnosis that affected her emotional and physical well-being and (2) to determine whether the participant's emotional journey paralleled Kubler-Ross's model, to what extent, and whether new emotions or stages occurred. The participant, a 50-year-old female, was diagnosed with stage 4 Duke Stage D colon cancer. Qualitative information was collected in face-to-face interviews, newspaper articles about the participant, and e-mail correspondence (as form letters to a group of friends and supporters) and subsequently analyzed for trends. The overall results revealed clear existence of the 5 stages of grief as outlined in the Kubler-Ross model. Analyses also revealed that the stages often overlapped or occurred simultaneously. Additionally, the participant regressed to earlier stages when subjected to negative external factors. Four other highly salient emotions were also prevalent throughout the participant's experience with colon cancer, namely joy, fear, hope, and numbness. The findings from this case study help to validate Kubler-Ross's stages. Further, the importance of the voice of the participant cannot be overemphasized. This case study clearly depicts the unique thoughts and emotions during one woman's struggle with colon cancer, sentiments that are often overlooked in quantitative analysis.

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda

PubMed Central

Mendenhall, Emily; De Silva, Mary J.; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-01-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. PMID:25089962

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.

PubMed

Mendenhall, Emily; De Silva, Mary J; Hanlon, Charlotte; Petersen, Inge; Shidhaye, Rahul; Jordans, Mark; Luitel, Nagendra; Ssebunnya, Joshua; Fekadu, Abebaw; Patel, Vikram; Tomlinson, Mark; Lund, Crick

2014-10-01

Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence.

PubMed

Reilly, Rachel; Evans, Katharine; Gomersall, Judith; Gorham, Gillian; Peters, Micah D J; Warren, Steven; O'Shea, Rebekah; Cass, Alan; Brown, Alex

2016-04-06

Indigenous peoples in Australia, New Zealand and Canada carry a greater burden of chronic kidney disease (CKD) than the general populations in each country, and this burden is predicted to increase. Given the human and economic cost of dialysis, understanding how to better manage CKD at earlier stages of disease progression is an important priority for practitioners and policy-makers. A systematic review of mixed evidence was undertaken to examine the evidence relating to the effectivness, cost-effectiveness and acceptability of chronic kidney disease management programs designed for Indigenous people, as well as barriers and enablers of implementation of such programs. Published and unpublished studies reporting quantitative and qualitative data on health sector-led management programs and models of care explicitly designed to manage, slow progression or otherwise improve the lives of Indigenous people with CKD published between 2000 and 2014 were considered for inclusion. Data on clinical effectiveness, ability to self-manage, quality of life, acceptability, cost and cost-benefit, barriers and enablers of implementation were of interest. Quantitative data was summarized in narrative and tabular form and qualitative data was synthesized using the Joanna Briggs Institute meta-aggregation approach. Ten studies were included. Six studies provided evidence of clinical effectiveness of CKD programs designed for Indigenous people, two provided evidence of cost and cost-effectiveness of a CKD program, and two provided qualitative evidence of barriers and enablers of implementation of effective and/or acceptable CKD management programs. Common features of effective and acceptable programs were integration within existing services, nurse-led care, intensive follow-up, provision of culturally-appropriate education, governance structures supporting community ownership, robust clinical systems supporting communication and a central role for Indigenous Health Workers. Given the human cost of dialysis and the growing population of people living with CKD, there is an urgent need to draw lessons from the available evidence from this and other sources, including studies in the broader population, to better serve this population with programs that address the barriers to receiving high-quality care and improve quality of life.