Drugs & the Brain: Case-based Instruction for an Undergraduate Neuropharmacology Course.

PubMed

Nagel, Anastasia; Nicholas, Andrea

2017-01-01

In order to transform a traditional large non-majors general education (GE) neurobiology lecture (Drugs & the Brain) into an active learning course, we developed a series of directed mini-cases targeting major drug classes. Humorous and captivating case-based situations were used to better engage and motivate students to solve problems related to neuropharmacology and physiology. Here we provide directed cases, questions and learning outcomes for our opiates mini-cases. In addition, we describe how case studies were incorporated into our course and assessed using peer review and online quizzing. An in-depth analysis of the overall course transformation on student exam performance, opinions and instructor evaluations can be found in the JUNE article Don't Believe the Gripe! Increasing Course Structure in a Large Non-majors Neuroscience Course.

Case Studies Every Day. Using "The Dallas Morning News" in Law-Related Education.

ERIC Educational Resources Information Center

Garrett, Judith; Yarbro, Judy

Intended to help teachers of law-related education direct student's critical thinking by examining case studies in everyday newspapers, this booklet contains seven activities suitable for use with intermediate and secondary students. By examining daily newspapers and participating in the activities, students (1) determine ways in which the law…

Case studies of power and control related to tobacco use during pregnancy.

PubMed

Greaves, Lorraine; Kalaw, Cecilia; Bottorff, Joan L

2007-01-01

The objective was to identify and describe elements of power and control evident in couple tobacco-related interaction patterns during pregnancy. Using a case study approach, elements of the Duluth Abuse Intervention Project Power and Control Wheel were used to examine women's experiences of tobacco reduction during pregnancy and post partum. Three cases were selected from a larger qualitative sample, using a maximum variation sampling approach. Although no direct evidence of partner abuse or violence accompanying partner efforts to influence women's smoking was described, most of the elements of power and control were present in the case study, and appeared to cause an emotional toll and a negative impact on women's ability to freely express their views about their own tobacco use. Elements of power and control, however subtle, are potentially important and unrecognized dimensions of women's tobacco reduction experiences. Additional care and attention should be taken in designing tobacco reduction interventions and policies directed at pregnant and post partum women and their partners to reduce the possibility that these interventions may contribute to the use of power and control.

Assessing different measures of population-level vaccine protection using a case-control study.

PubMed

Ali, Mohammad; You, Young Ae; Kanungo, Suman; Manna, Byomkesh; Deen, Jacqueline L; Lopez, Anna Lena; Wierzba, Thomas F; Bhattacharya, Sujit K; Sur, Dipika; Clemens, John D

2015-11-27

Case-control studies have not been examined for their utility in assessing population-level vaccine protection in individually randomized trials. We used the data of a randomized, placebo-controlled trial of a cholera vaccine to compare the results of case-control analyses with those of cohort analyses. Cases of cholera were selected from the trial population followed for three years following dosing. For each case, we selected 4 age-matched controls who had not developed cholera. For each case and control, GIS was used to calculate vaccine coverage of individuals in a surrounding "virtual" cluster. Specific selection strategies were used to evaluate the vaccine protective effects. 66,900 out of 108,389 individuals received two doses of the assigned regimen. For direct protection among subjects in low vaccine coverage clusters, we observed 78% (95% CI: 47-91%) protection in a cohort analysis and 84% (95% CI: 60-94%) in case-control analysis after adjusting for confounding factors. Using our GIS-based approach, estimated indirect protection was 52% (95% CI: 10-74%) in cohort and 76% (95% CI: 47-89%) in case control analysis. Estimates of total and overall effectiveness were similar for cohort and case-control analyses. The findings show that case-control analyses of individually randomized vaccine trials may be used to evaluate direct as well as population-level vaccine protection. Copyright © 2015. Published by Elsevier Ltd.

Solar energy utilization in the direct photocarboxylation of 2,3-dihydrofuran using CO2.

PubMed

Aresta, Michele; Dibenedetto, Angela; Baran, Tomasz; Wojtyła, Szymon; Macyk, Wojciech

2015-01-01

The conversion of CO2 into high energy products (fuels) and the direct carboxylation of C-H bonds require a high energy input. Energy cannot be derived from fossil carbon, in this case. Solar energy can be used instead, with a low environmental impact and good profit. We have studied the use of white light or solar energy in the photoreduction of CO2 and in photocarboxylation reactions, using different semiconductors modified at their surface. Two examples of reduction of CO2 to methanol and CO will be shortly discussed, and two cases of carboxylation of organic substrates. The case of carboxylation of 2,3-dihydrofuran will be discussed in detail.

Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

PubMed

Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

2015-11-01

Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

Using Scenarios and Simulations to Plan Colleges

ERIC Educational Resources Information Center

McIntyre, Chuck

2004-01-01

Using a case study, this article describes a method by which higher education institutions construct and use multiple future scenarios and simulations to plan strategically: to create visions of their futures, chart broad directions (mission and goals), and select learning and delivery strategies so as to achieve those broad directions. The…

Applying Case-Based Method in Designing Self-Directed Online Instruction: A Formative Research Study

ERIC Educational Resources Information Center

Luo, Heng; Koszalka, Tiffany A.; Arnone, Marilyn P.; Choi, Ikseon

2018-01-01

This study investigated the case-based method (CBM) instructional-design theory and its application in designing self-directed online instruction. The purpose of this study was to validate and refine the theory for a self-directed online instruction context. Guided by formative research methodology, this study first developed an online tutorial…

Assessment of "Teenage Diaries" for Teaching Concepts in Adolescent Psychology

ERIC Educational Resources Information Center

McKee, Meredith L.; MacDonald, Pamelyn M.

2009-01-01

Student self-report measures have been reported in numerous studies to assert that the use of case studies in college psychology courses can help students to better understand the relevance of course topics; however, few studies have directly measured the impact of case studies on students' learning. The present study differs from previous studies…

Tax Increment Financing and Education Expenditures: The Case of Iowa

ERIC Educational Resources Information Center

Nguyen-Hoang, Phuong

2014-01-01

This is the first study to directly examine the relationship between tax increment financing (TIF) and education expenditures, using the state of Iowa as a case study. I find that greater use of TIF is associated with reduced education expenditures. I also find little evidence to support the commonly held proposition that school spending increases…

Viability of single balloon enteroscopy performed under endoscopist-directed sedation.

PubMed

López Rosés, Leopoldo; Álvarez, Beatriz; González Ramírez, Abel; López Baz, Alina; Fernández López, Alexia; Alonso, Sara; Dacal, Andrés; Martí, Eva; Albines, Gino; Fernández Molina, Julieta; Lancho, Ángel

2018-04-01

there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field.

Unresolved legal questions in cross-border health care in Europe: liability and data protection.

PubMed

van der Molen, I N; Commers, M J

2013-11-01

Directive 2011/24/EU was designed to clarify the rights of EU citizens in evaluating, accessing and obtaining reimbursement for cross-border care. Based on three regional case studies, the authors attempted to assess the added value of the Directive in helping clarify issues in to two key areas that have been identified as barriers to cross-border care: liability and data protection. Qualitative case study employing secondary data sources including research of jurisprudence, that set up a Legal framework as a base to investigate liability and data protection in the context of cross-border projects. By means of three case studies that have tackled liability and data protection hurdles in cross-border care implementation, this article attempts to provide insight into legal certainty and uncertainty regarding cross-border care in Europe. The case studies reveal that the Directive has not resolved core uncertainties related to liability and data protection issues within cross-border health care. Some issues related to the practice of cross-border health care in Europe have been further clarified by the Directive and some direction has been given to possible solutions for issues connected to liability and data protection. Directive 2011/24/EU is clearly a transposition of existing regulations on data protection and ECJ case law, plus a set of additional, mostly, voluntary rules that might enhance regional border cooperation. Therefore, as shown in the case studies, a practical and case by case approach is still necessary in designing and providing cross-border care. © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Case studies in pathophysiology: The development and evaluation of an interactive online learning environment to develop higher order thinking and argumentation

NASA Astrophysics Data System (ADS)

Titterington, Lynda C.

2007-12-01

This study presents a framework for examining the effects of higher order thinking on the achievement of allied health students enrolled in a pathophysiology course. A series of clinical case studies was developed and published in an enriched online environment that guided students through the process of developing a solution and supporting it through data analysis and interpretation. The series of case study modules scaffolded argumentation through question prompts. The modules began with a simple, direct problem and they became progressively more complex throughout the quarter. A control group was assigned a pencil-and-paper case study based upon recall. The case studies were scored for content accuracy and evidence of higher order thinking skills. Higher order thinking was measured using a rubric based upon the Toulmin argumentation pattern. The results indicated implementing a case study of either online or traditional format was associated with significant gains in achievement. The Web-enhanced case studies were associated with modest gains in knowledge acquisition. The argumentation scores across the series followed two trends: directed case studies were associated with higher levels of argumentation than ill-structured case studies, and there appeared to be an inverse relationship between the students' argumentation and content scores. The protocols developed for this study can serve as a template for a larger, extended investigation into student learning in the online environment.

Analyzing workplace exposures using direct reading instruments and video exposure monitoring techniques

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

Gressel, M.G.; Heitbrink, W.A.; Jensen, P.A.

1992-08-01

The techniques for conducting video exposure monitoring were described along with the equipment required to monitor and record worker breathing zone concentrations, the analysis of the real time exposure data using video recordings, and the use of real time concentration data from a direct reading instrument to determine the effective ventilation rate and the mixing factor of a given room at a specific time. Case studies which made use of video exposure monitoring techniques to provide information not available through integrated sampling were also discussed. The process being monitored and the methodology used to monitor the exposures were described formore » each of the case studies. The case studies included manual material weigh out, ceramic casting cleaning, dumping bags of powdered materials, furniture stripping, administration of nitrous-oxide during dental procedures, hand held sanding operation, methanol exposures in maintenance garages, brake servicing, bulk loading of railroad cars and trucks, and grinding operations.« less

Instructors' Experiences of Web Based Synchronous Communication using Two Way Audio and Direct Messaging

ERIC Educational Resources Information Center

Murphy, Elizabeth; Ciszewska-Carr, Justyna

2007-01-01

This paper reports on an exploratory case study designed to gain insight into instructors' experiences with web based synchronous communication using two way audio and direct messaging. We conducted semi-structured interviews with eight instructors who used "Elluminate Live" in their web based, asynchronous courses in Education, Nursing,…

Inside the Black Box--An Implementation Evaluation Case Study

ERIC Educational Resources Information Center

Rector, Patricia; Bakacs, Michele; Rowe, Amy; Barbour, Bruce

2016-01-01

The case study presented in this article is an example of an implementation evaluation. The evaluation investigated significant components of the implementation of a long-term environmental educational program. Direct observation, evaluation-specific survey data, and historical data were used to determine program integrity as identified by…

Nanomaterial Case Study: Nanoscale Silver in Disinfectant ...

EPA Pesticide Factsheets

EPA announced the release of the final report, Nanomaterial Case Study: Nanoscale Silver in Disinfectant Spray. This report represents a case study of engineered nanoscale silver (nano-Ag), focusing on the specific example of nano-Ag as possibly used in disinfectant sprays. This case study is organized around the comprehensive environmental assessment (CEA) framework, which structures available information pertaining to the product life cycle, environmental transport and fate, exposure-dose in receptors (i.e., humans, ecological populations, and the environment), and potential impacts in these receptors. The document does not draw conclusions about potential risks. Instead, it is intended to be used as part of a process to identify what is known and unknown about nano-Ag in a selected application. In turn, the external review draft of the document provided a starting point to identify and prioritize possible research directions to support future assessments of nanomaterials. The information presented in the case study and the questions raised in this document are a foundation for a process to determine priorities among various research topics and directions. After that process has been completed, a final chapter will be added to this document to summarize highlights from preceding chapters and the major research issues that have emerged.

Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

PubMed

Macyszyn, Luke; Attiah, Mark; Ma, Tracy S; Ali, Zarina; Faught, Ryan; Hossain, Alisha; Man, Karen; Patel, Hiren; Sobota, Rosanna; Zager, Eric L; Stein, Sherman C

2017-05-01

OBJECTIVE Moyamoya disease (MMD) is a chronic cerebrovascular disease that can lead to devastating neurological outcomes. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. The optimal surgical approach, however, remains unclear. In this decision analysis, the authors compared the effectiveness of revascularization procedures in both adult and pediatric patients with MMD. METHODS A comprehensive literature search was performed for studies of MMD. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment using a direct and indirect revascularization technique. Utility values for the various outcomes and complications were extracted from the literature examining preferences in similar clinical conditions. Sensitivity analysis was performed. RESULTS A structured literature search yielded 33 studies involving 4197 cases. Cases were divided into adult and pediatric populations. These were further subdivided into 3 different treatment groups: indirect, direct, and combined revascularization procedures. In the pediatric population at 5- and 10-year follow-up, there was no significant difference between indirect and combination procedures, but both were superior to direct revascularization. In adults at 4-year follow-up, indirect was superior to direct revascularization. CONCLUSIONS In the absence of factors that dictate a specific approach, the present decision analysis suggests that direct revascularization procedures are inferior in terms of quality-adjusted life years in both adults at 4 years and children at 5 and 10 years postoperatively, respectively. These findings were statistically significant (p < 0.001 in all cases), suggesting that indirect and combination procedures may offer optimal results at long-term follow-up.

US hospital-based direct access with radiology referral: an administrative case report.

PubMed

Keil, Aaron; Brown, Suzanne Robben

2015-01-01

Legislative gains in the US allow physical therapists to function in expanded scopes of practice including direct access and referral to specialists. The combination of direct access with privileges to order imaging studies directly offers a desirable practice status for many physical therapists, especially in musculoskeletal focused settings. Although direct access is legal in all US jurisdictions, institutional-based physical therapy settings have not embraced these practices. Barriers cited to implementing direct access with advanced practice are concerns over medical and administrative opposition, institutional policies, provider qualifications and reimbursement. This administrative case report describes the process taken to allow therapists to see patients without a referral and to order diagnostic imaging studies at an academic medical center. Nine-month implementation results show 66 patients seen via direct access with 15% referred for imaging studies. Claims submitted to 20 different insurance providers were reimbursed at 100%. While institutional regulations and reimbursement are reported as barriers to direct access, this report highlights the process one academic medical center used to implement direct access and advanced practice radiology referral by updating policies and procedures, identifying advanced competencies and communicating with necessary stakeholder groups. Favorable reimbursement for services is documented.

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

PubMed

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations

PubMed Central

Gislason, Maya K; Andersen, Holly K

2016-01-01

We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects—like liquefied natural gas—on peoples, environments, and health. PMID:27763548

Developing a Disruptive Innovation in U.S. Higher Education: A Case Study of Competency-Based Education at College for America

ERIC Educational Resources Information Center

Hansen, Sarah Elizabeth Wilson

2016-01-01

Direct assessment competency-based education (CBE) is an online, self-directed learning innovation that is disrupting higher education. This study examined the development and early diffusion of direct assessment CBE at a private, nonprofit university. The purpose of this case study was to investigate the presence of organizational factors and the…

A study of the vibrational energies of two coupled beams by finite element and green function (receptance) methods

NASA Astrophysics Data System (ADS)

Shankar, K.; Keane, A. J.

1995-04-01

The behaviour of two hinged-hinged beams, point coupled by springs (translational, rotary and a combination of both) with weak to strong coupling is studied from the point of view of vibrational energies, input power and power transferred through the coupling. Two configurations are studied: in the first case the beams are placed parallel to each other and only the transverse, Euler-Bernoulli modes are considered; the second configuration is more complicated with the beams placed perpendicular to each other, executing axial as well as transverse vibrations. These models are studied by using a finite element analysis (FEA) package and, alternatively, via the modally derived Green functions of the uncoupled subsystems. In both cases the beams are given proportional damping and one of the beams is driven by a point harmonic force. The effects of coupling stiffness and modal summation bandwidth are studied. It is shown that there is good agreement between the FEA and the Green function approach over a range of coupling strengths, but that at higher strengths the number of uncoupled modes used significantly affects the accuracy of the Green function method used here. The beams in the second configuration are then further studied from the point of view of SEA coupling loss factors. The frequency averaged coupling loss factors are calculated for weak and strong coupling, first by using a power injection method, where the power balance equations are formed on the assumption of only direct coupling loss factors. Then, the entire matrix of direct and indirect coupling loss factors is derived by using a deterministic modal approach. These are compared and the indirect coupling loss factors are found to be significant in magnitude in respect to the direct coupling loss factors. Several cases are studied in which the coupling powers and energy levels are predicted by using only the direct coupling loss factors and compared with the exact results obtained by using both direct and indirect factors. These agree only under certain conditions for weak coupling and show rather poorer agreement in the case of strong coupling. This behaviour demonstrates the importance of taking into account indirect coupling loss factors in SEA models having several subsystems.

Formative Assessment Using Direct Behavior Ratings: Evaluating Intervention Effects of Daily Behavior Report Cards

ERIC Educational Resources Information Center

Sims, Wesley A.; Riley-Tillman, Chris; Cohen, Daniel R.

2017-01-01

This study examined the treatment sensitivity of "Direct Behavior Rating-Single Item Scales" (DBR-SIS) in response to an evidence-based intervention delivered in a single-case, multiple-baseline design. DBR-SIS was used as a formative assessment in conjunction with a frequently used intervention in schools, a Daily Behavior Report Card…

An Active Learning Activity for an IT Ethics Course

ERIC Educational Resources Information Center

Woods, David M.; Howard, Elizabeth V.

2014-01-01

Courses in Information Technology Ethics are often designed as discussion-intensive courses where case studies are introduced and evaluated using ethical theories. Although many of the case studies directly apply to our students' online lives, the stories can sometimes seem too far removed from their own experiences. While we read the news…

A Case Study Approach to Ethics in Career Development, Second Edition. Monograph Series

ERIC Educational Resources Information Center

Makela, Julia Panke; Perlus, Jessamyn G.

2017-01-01

This second edition tackles some of the most vexing questions that career development professionals encounter today. Using a case study design, it offers a hands-on experience with ethical terminology, resources, and issues. Each dilemma presented includes detailed, guided discussion of key issues and recommendations, with direct connections to…

Case study: use of problem-based learning to develop students' technical and professional skills

NASA Astrophysics Data System (ADS)

Warnock, James N.; Mohammadi-Aragh, M. Jean

2016-03-01

Problem-based learning (PBL) is a pedagogy that has attracted attention for many biomedical engineering curricula. The aim of the current study was to address the research question, 'Does PBL enable students to develop desirable professional engineering skills?' The desirable skills identified were communication, teamwork, problem solving and self-directed learning. Forty-seven students enrolled in a biomedical materials course participated in the case study. Students worked in teams to complete a series of problems throughout the semester. The results showed that students made significant improvements in their problem-solving skills, written communication and self-directed learning. Students also demonstrated an ability to work in teams and communicate orally. In conclusion, this case study provides empirical evidence of the efficacy of PBL on student learning. We discuss findings from our study and provide observations of student performance and perceptions that could be useful for faculty and researchers interested in PBL for biomedical engineering education.

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Accuracy of palpation-directed intra-articular glenohumeral injection confirmed by magnetic resonance arthrography.

PubMed

Powell, Scott E; Davis, Shane M; Lee, Emily H; Lee, Robert K; Sung, Ryan M; McGroder, Claire; Kouk, Shalen; Lee, Christopher S

2015-02-01

The aim of this study was to determine the accuracy of anatomic palpation-directed injections in the office setting. Two hundred twenty-six shoulders in 208 patients were studied using a 0.2-Tesla extremity scanner after the injection of gadolinium-diethylene triamine pentaacetic acid-saline. All patients were injected in a sterile fashion by a single board-certified shoulder surgeon using an anterior approach by palpating the rotator interval anterior to the acromioclavicular joint and angling the needle 45° lateral and 45° caudad. All injections, successful or otherwise, were single injections. Magnetic resonance (MR) arthrograms were retrospectively read by 2 musculoskeletal fellowship-trained, board certified radiologists to determine whether the injection was in the glenohumeral joint. Two hundred one of the 226 injections were successful (88.9%). Of the 25 unsuccessful injections, the contrast material extravasated out of the capsule in 5 cases and into the subscapularis tendon in 10 cases. The contrast material was injected into the subacromial space in 9 cases, into the rotator interval fat in 9 cases, and into extracapsular tissue in 6 cases. There was insufficient volume of contrast material in 10 cases. The accuracy rate was 88.9%. There were no complications. The palpation-directed rotator interval anterior approach technique for intra-articular glenohumeral MR arthrogram injections performed by a single surgeon was 88.9% accurate. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Closed-loop assisted versus manual goal-directed fluid therapy during high-risk abdominal surgery: a case-control study with propensity matching.

PubMed

Rinehart, Joseph; Lilot, Marc; Lee, Christine; Joosten, Alexandre; Huynh, Trish; Canales, Cecilia; Imagawa, David; Demirjian, Aram; Cannesson, Maxime

2015-03-19

Goal-directed fluid therapy strategies have been shown to benefit moderate- to high-risk surgery patients. Despite this, these strategies are often not implemented. The aim of this study was to assess a closed-loop fluid administration system in a surgical cohort and compare the results with those for matched patients who received manual management. Our hypothesis was that the patients receiving closed-loop assistance would spend more time in a preload-independent state, defined as percentage of case time with stroke volume variation less than or equal to 12%. Patients eligible for the study were all those over 18 years of age scheduled for hepatobiliary, pancreatic or splenic surgery and expected to receive intravascular arterial blood pressure monitoring as part of their anesthetic care. The closed-loop resuscitation target was selected by the primary anesthesia team, and the system was responsible for implementation of goal-directed fluid therapy during surgery. Following completion of enrollment, each study patient was matched to a non-closed-loop assisted case performed during the same time period using a propensity match to reduce bias. A total of 40 patients were enrolled, 5 were ultimately excluded and 25 matched pairs were selected from among the remaining 35 patients within the predefined caliper distance. There was no significant difference in fluid administration between groups. The closed-loop group spent a significantly higher portion of case time in a preload-independent state (95 ± 6% of case time versus 87 ± 14%, P =0.008). There was no difference in case mean or final stroke volume index (45 ± 10 versus 43 ± 9 and 45 ± 11 versus 42 ± 11, respectively) or mean arterial pressure (79 ± 8 versus 83 ± 9). Case end heart rate was significantly lower in the closed-loop assisted group (77 ± 10 versus 88 ± 13, P =0.003). In this case-control study with propensity matching, clinician use of closed-loop assistance resulted in a greater portion of case time spent in a preload-independent state throughout surgery compared with manual delivery of goal-directed fluid therapy. ClinicalTrials.gov Identifier: NCT02020863. Registered 19 December 2013.

A novel anisotropic inversion approach for magnetotelluric data from subsurfaces with orthogonal geoelectric strike directions

NASA Astrophysics Data System (ADS)

Schmoldt, Jan-Philipp; Jones, Alan G.

2013-12-01

The key result of this study is the development of a novel inversion approach for cases of orthogonal, or close to orthogonal, geoelectric strike directions at different depth ranges, for example, crustal and mantle depths. Oblique geoelectric strike directions are a well-known issue in commonly employed isotropic 2-D inversion of MT data. Whereas recovery of upper (crustal) structures can, in most cases, be achieved in a straightforward manner, deriving lower (mantle) structures is more challenging with isotropic 2-D inversion in the case of an overlying region (crust) with different geoelectric strike direction. Thus, investigators may resort to computationally expensive and more limited 3-D inversion in order to derive the electric resistivity distribution at mantle depths. In the novel approaches presented in this paper, electric anisotropy is used to image 2-D structures in one depth range, whereas the other region is modelled with an isotropic 1-D or 2-D approach, as a result significantly reducing computational costs of the inversion in comparison with 3-D inversion. The 1- and 2-D versions of the novel approach were tested using a synthetic 3-D subsurface model with orthogonal strike directions at crust and mantle depths and their performance was compared to results of isotropic 2-D inversion. Structures at crustal depths were reasonably well recovered by all inversion approaches, whereas recovery of mantle structures varied significantly between the different approaches. Isotropic 2-D inversion models, despite decomposition of the electric impedance tensor and using a wide range of inversion parameters, exhibited severe artefacts thereby confirming the requirement of either an enhanced or a higher dimensionality inversion approach. With the anisotropic 1-D inversion approach, mantle structures of the synthetic model were recovered reasonably well with anisotropy values parallel to the mantle strike direction (in this study anisotropy was assigned to the mantle region), indicating applicability of the novel approach for basic subsurface cases. For the more complex subsurface cases, however, the anisotropic 1-D inversion approach is likely to yield implausible models of the electric resistivity distribution due to inapplicability of the 1-D approximation. Owing to the higher number of degrees of freedom, the anisotropic 2-D inversion approach can cope with more complex subsurface cases and is the recommended tool for real data sets recorded in regions with orthogonal geoelectric strike directions.

Self-Directed Teacher Learning in Collaborative Contexts

ERIC Educational Resources Information Center

Slavit, David; Roth McDuffie, Amy

2013-01-01

Two related case studies of secondary mathematics teachers examine the roles and conditions helpful in initiating, directing, and/or supporting teachers' own professional development. Using multiple data sources from school-based and professional settings, we applied analytic induction to identify patterns of similarities and differences in…

Method for evaluating multiple mediators: mediating effects of smoking and COPD on the association between the CHRNA5-A3 variant and lung cancer risk.

PubMed

Wang, Jian; Spitz, Margaret R; Amos, Christopher I; Wu, Xifeng; Wetter, David W; Cinciripini, Paul M; Shete, Sanjay

2012-01-01

A mediation model explores the direct and indirect effects between an independent variable and a dependent variable by including other variables (or mediators). Mediation analysis has recently been used to dissect the direct and indirect effects of genetic variants on complex diseases using case-control studies. However, bias could arise in the estimations of the genetic variant-mediator association because the presence or absence of the mediator in the study samples is not sampled following the principles of case-control study design. In this case, the mediation analysis using data from case-control studies might lead to biased estimates of coefficients and indirect effects. In this article, we investigated a multiple-mediation model involving a three-path mediating effect through two mediators using case-control study data. We propose an approach to correct bias in coefficients and provide accurate estimates of the specific indirect effects. Our approach can also be used when the original case-control study is frequency matched on one of the mediators. We employed bootstrapping to assess the significance of indirect effects. We conducted simulation studies to investigate the performance of the proposed approach, and showed that it provides more accurate estimates of the indirect effects as well as the percent mediated than standard regressions. We then applied this approach to study the mediating effects of both smoking and chronic obstructive pulmonary disease (COPD) on the association between the CHRNA5-A3 gene locus and lung cancer risk using data from a lung cancer case-control study. The results showed that the genetic variant influences lung cancer risk indirectly through all three different pathways. The percent of genetic association mediated was 18.3% through smoking alone, 30.2% through COPD alone, and 20.6% through the path including both smoking and COPD, and the total genetic variant-lung cancer association explained by the two mediators was 69.1%.

Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction.

PubMed

Machado de Oliveira, J C; Siqueira, J F; Alves, G B; Hirata, R; Andrade, A F

2000-12-01

Porphyromonas endodontalis has been isolated from the endodontic infections mainly in symptomatic teeth. This study evaluated the occurrence of P. endodontalis in both symptomatic and asymptomatic endodontic infections using 16S rRNA gene-directed polymerase chain reaction. P. endodontalis was detected in 39.5% of the cases (17 of 43 teeth). It was present in 4 of the 6 cases with acute periradicular abscess (66.7%) and in 13 of the 37 other cases (35.1%). The presence of P. endodontalis was associated with an asymptomatic periradicular lesion in 6 cases (25%) and in 10 teeth with tenderness to percussion (52.6%). P. endodontalis was also found in one asymptomatic case without evidence of periradicular pathosis. Our results indicated that, although P. endodontalis is commonly detected in symptomatic cases, it can be present in asymptomatic root canal infections. Further studies should determine if this bacterial species is really an important endodontopathogen.

The Effects of Computer-Mediated Synchronous and Asynchronous Direct Corrective Feedback on Writing: A Case Study

ERIC Educational Resources Information Center

Shintani, Natsuko

2016-01-01

This case study investigated the characteristics of computer-mediated synchronous corrective feedback (SCF, provided while students wrote) and asynchronous corrective feedback (ACF, provided after students had finished writing) in an EFL writing task. The task, designed to elicit the use of the hypothetical conditional, was completed by two…

One size does not fit all: Adapting mark-recapture and occupancy models for state uncertainty

USGS Publications Warehouse

Kendall, W.L.; Thomson, David L.; Cooch, Evan G.; Conroy, Michael J.

2009-01-01

Multistate capture?recapture models continue to be employed with greater frequency to test hypotheses about metapopulation dynamics and life history, and more recently disease dynamics. In recent years efforts have begun to adjust these models for cases where there is uncertainty about an animal?s state upon capture. These efforts can be categorized into models that permit misclassification between two states to occur in either direction or one direction, where state is certain for a subset of individuals or is always uncertain, and where estimation is based on one sampling occasion per period of interest or multiple sampling occasions per period. State uncertainty also arises in modeling patch occupancy dynamics. I consider several case studies involving bird and marine mammal studies that illustrate how misclassified states can arise, and outline model structures for properly utilizing the data that are produced. In each case misclassification occurs in only one direction (thus there is a subset of individuals or patches where state is known with certainty), and there are multiple sampling occasions per period of interest. For the cases involving capture?recapture data I allude to a general model structure that could include each example as a special case. However, this collection of cases also illustrates how difficult it is to develop a model structure that can be directly useful for answering every ecological question of interest and account for every type of data from the field.

An application of boundary element method calculations to hearing aid systems: The influence of the human head

NASA Astrophysics Data System (ADS)

Rasmussen, Karsten B.; Juhl, Peter

2004-05-01

Boundary element method (BEM) calculations are used for the purpose of predicting the acoustic influence of the human head in two cases. In the first case the sound source is the mouth and in the second case the sound is plane waves arriving from different directions in the horizontal plane. In both cases the sound field is studied in relation to two positions above the right ear being representative of hearing aid microphone positions. Both cases are relevant for hearing aid development. The calculations are based upon a direct BEM implementation in Matlab. The meshing is based on the original geometrical data files describing the B&K Head and Torso Simulator 4128 combined with a 3D scan of the pinna.

Risk factors for human-directed canine aggression in a referral level clinical population.

PubMed

Lord, M; Casey, R A; Loftus, B A; Blackwell, E J

2017-07-07

Risk factors for human-directed aggression were investigated using retrospective analysis of data from a referral-level clinical behaviour population in the UK. A sample of 200 cases involving human-directed canine aggression and 200 control cases involving no instance of human-directed aggression were selected at random from a population of 746 cases. The final model suggested that clinical cases with human-directed aggression were significantly younger than those presenting with other undesired behaviours (P=0.008) and that male dogs were 1.4 times more likely to be aggressive towards human beings than female dogs (P=0.019). Dogs were 1.7 times more likely to be aggressive towards people if they had attended more than five puppy classes than if they had never attended puppy class (P=0.015) and that dogs were 2.8 times more likely to be aggressive towards human beings if there was another dog between 0 months and 24 months of age in the home (P=0.004). These factors only account for 7 per cent to 10 per cent of the variance between the human-directed aggression population and the control population, but factors such as attendance at puppy classes and numbers of dogs in the household suggest the need for longitudinal studies to investigate temporal relationships.

The Application of Self-Directed Learning in a Marketing Strategy Capstone Course

ERIC Educational Resources Information Center

Gray, David M.

2011-01-01

Capstone courses can create a space for students and educators to act as co-producers of desired learning outcomes which are directly relevant to the world of work. This study uses an auto-ethnographic case study approach to demonstrate how a mixed model learning approach evolved in a capstone marketing strategy unit in a marketing major at an…

Handbook Preparation as a Tool for Self-Directed Learning Process: A Case Study on Endocrine Topic

ERIC Educational Resources Information Center

Cerrah Ozsevgec, Lale; Ayas, Alipasa; Ozsevgec, Tuncay

2010-01-01

This study examines the effectiveness of handbook preparation as a method in the self-directed learning process of student teachers in teaching endocrine glands, and increasing their levels of knowledge. Thirty student teachers were selected from a biology department. A pencil and paper test and a clinical interview procedure were used to collect…

Heat transfer direction dependence of heat transfer coefficients in annuli

NASA Astrophysics Data System (ADS)

Prinsloo, Francois P. A.; Dirker, Jaco; Meyer, Josua P.

2018-04-01

In this experimental study the heat transfer phenomena in concentric annuli in tube-in-tube heat exchangers at different annular Reynolds numbers, annular diameter ratios, and inlet fluid temperatures using water were considered. Turbulent flow with Reynolds numbers ranging from 15,000 to 45,000, based on the average bulk fluid temperature was tested at annular diameter ratios of 0.327, 0.386, 0.409 and 0.483 with hydraulic diameters of 17.00, 22.98, 20.20 and 26.18 mm respectively. Both heated and cooled annuli were investigated by conducting tests at a range of inlet temperatures between 10 °C to 30 °C for heating cases, and 30 °C to 50 °C for cooling cases. Of special interest was the direct measurement of local wall temperatures on the heat transfer surface, which is often difficult to obtain and evasive in data-sets. Continuous verification and re-evaluation of temperatures measurements were performed via in-situ calibration. It is shown that inlet fluid temperature and the heat transfer direction play significant roles on the magnitude of the heat transfer coefficient. A new adjusted Colburn j-factor definition is presented to describe the heating and cooling cases and is used to correlate the 894 test cases considered in this study.

Clinico-epidemiological study of tinea incognito with microbiological correlation.

PubMed

Dutta, Bornali; Rasul, Elmy Samsul; Boro, Bobita

2017-01-01

Tinea incognito is a dermatophytic infection with a clinical presentation that is modified due to previous treatment with topical or systemic steroids, as well as topical immunomodulators. It tends to mimic other dermatological conditions. To evaluate the various clinical manifestations, sites, predisposing factors and causative agents of tinea incognito. A prospective observational study was done on one hundred clinically suspected cases of tinea incognito, with a history of topical or systemic steroid use for a period of at least six weeks. They were subject to direct microscopy and fungal culture, and re-evaluated at the end of the third and sixth week. Eczema-like conditions were the most common clinical manifestation, followed by inflammatory, autoimmune and infective conditions. The face was the most commonly affected site. Direct microscopy was positive in 85% of cases, and fungal culture was positive in 63% of cases. Trichophyton rubrum was the most common species isolated. Pharmacists were responsible for 78% of tinea incognito cases, and betamethasone dipropionate was the most common drug used. As this was a hospital outpatient-based study, cases with severe systemic problems could have attended other departments. Cases involving the hair and nails were negligible. Tinea incognito is a commonly encountered, yet poorly reported entity in the study population. An increased level of awareness and vigilance on the sale of steroid containing compounds will help control this dermatological condition.

Clinicopathologic assessment of Candida colonization of oral leukoplakia.

PubMed

Sarkar, Reena; Rathod, G P

2014-01-01

Leukoplakia is the most common premalignant lesion of the oral mucosa. We studied the colonization of Candida in oral leukoplakia using direct microscopy, culture and histopathology to determine if there is a statistical correlation between Candida invasion and the clinical appearance and presence of epithelial dysplasia in leukoplakia. Samples were collected from 40 patients with oral leukoplakia and 21 controls. The swabs collected were used to inoculate Sabouraud's dextrose agar slant and for direct microscopy with Gram's stain. Culture growths were subjected to germ tube and corn meal agar tests to differentiate between Candida albicans and non-albicans groups. Biopsies were also done in all patients for histopathological confirmation; Gomori's methanamine silver stain was used to identify fungal invasion of lesional epithelium. Nineteen cases of leukoplakia showed Candida on direct smears, compared to 3 controls. Eighteen cases and one control showed growth of Candida on culture. Non-homogenous leukoplakia showed a higher positivity rate on microscopy and culture than homogenous lesions. All these correlations were statistically significant. Forty percent of leukoplakia cases were simultaneously positive for Candida on direct microscopy, culture and histopathologic evaluation. No significant difference was found between non-dysplastic and distinctly dysplastic lesions with respect to Candida detection on microscopy or culture.

Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

PubMed Central

Vieira Machado, Alessandra A.; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-01-01

Background Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. Methods and Results To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). Conclusion The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care. PMID:25188295

Building Self-Directed Teachers: A Case Study of Teachers' Perspectives of the Effects of Cognitive Coaching on Professional Practices

ERIC Educational Resources Information Center

Bjerken, Kevin S.

2013-01-01

This case study of a single school district aims to identify teachers' perceptions of how their professional practices have been affected after four years of receiving Cognitive Coaching. Cognitive Coaching was used in participants' professional development as a part of an Alternative Teacher Professional Pay System and included three…

A simplified approach for monitoring hydrophobic organic contaminants associated with suspended sediment: Methodology and applications

USGS Publications Warehouse

Mahler, B.J.; Van Metre, P.C.

2003-01-01

Hydrophobic organic contaminants, although frequently detected in bed sediment and in aquatic biota, are rarely detected in whole-water samples, complicating determination of their occurrence, load, and source. A better approach for the investigation of hydrophobic organic contaminants is the direct analysis of sediment in suspension, but procedures for doing so are expensive and cumbersome. We describe a simple, inexpensive methodology for the dewatering of sediment and present the results of two case studies. Isolation of a sufficient mass of sediment for analyses of organochlorine compounds and PAHs is obtained by in-line filtration of large volumes of water. The sediment is removed from the filters and analyzed directly by standard laboratory methods. In the first case study, suspended-sediment sampling was used to determine occurrence, loads, and yields of contaminants in urban runoff affecting biota in Town Lake, Austin, TX. The second case study used suspended-sediment sampling to locate a point source of PCBs in the Donna Canal in south Texas, where fish are contaminated with PCBs. The case studies demonstrate that suspended-sediment sampling can be an effective tool for determining the occurrence, load, and source of hydrophobic organic contaminants in transport.

Transarterial treatment of direct carotico-cavernous fistulas with coils and Onyx.

PubMed

Ramalingaiah, Arvinda Hanumanthapura; Prasad, Chandrajit; Sabharwal, Paramveer Singh; Saini, Jitender; Pandey, Paritosh

2013-10-01

The purpose of this study was to evaluate the role of combination of liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) and detachable coils in the treatment of direct carotico-cavernous fistulas (CCFs). We prospectively collected clinical and radiological data of all patients who underwent embolization of direct CCFs at our institution over a period of 21 months. The clinical parameters, angioarchitecture, presence of cortical venous reflux, volume of Onyx used, number of coils used, extent of embolization and complications were recorded. A total of 21 consecutive patients (18 men and 3 women, 14 to 48 years) with direct CCF underwent embolization with a combination of coils and Onyx. Embolization was done through the arterial route in all cases. Complete obliteration of the fistula was achieved in 19 of 21 cases. Cast embolization in middle cerebral artery occurred in one patient; however, the cast was completely retrieved with Solitaire device, and the patient did not have any neurological deficit. All completely treated patients reported relief of symptoms at varying intervals. At 6-month follow-up, none of the patients with complete occlusion of the fistula showed any recurrence. The adjuvant use of Onyx with detachable coils in direct CCF through the arterial route is a safe and effective method for embolization with immediate and complete occlusion of the fistula. To the best of our knowledge, this is the first case series of demonstration of arterial use of Onyx with coils in the treatment of direct CCFs.

The Effects of Case-Based Team Learning on Students’ Learning, Self Regulation and Self Direction

PubMed Central

Rezaee, Rita; Mosalanejad, Leili

2015-01-01

Introduction: The application of the best approaches to teach adults in medical education is important in the process of training learners to become and remain effective health care providers. This research aims at designing and integrating two approaches, namely team teaching and case study and tries to examine the consequences of these approaches on learning, self regulation and self direction of nursing students. Material & Methods: This is aquasi experimental study of 40 students who were taking a course on mental health. The lessons were designed by using two educational techniques: short case based study and team based learning. Data gathering was based on two valid and reliablequestionnaires: Self-Directed Readiness Scale (SDLRS) and the self-regulating questionnaire. Open ended questions were also designed for the evaluation of students’with points of view on educational methods. Results: The Results showed an increase in the students’ self directed learning based on their performance on the post-test. The results showed that the students’ self-directed learning increased after the intervention. The mean difference before and after intervention self management was statistically significant (p=0.0001). Also, self-regulated learning increased with the mean difference after intervention (p=0.001). Other results suggested that case based team learning can have significant effects on increasing students’ learning (p=0.003). Conclusion: This article may be of value to medical educators who wish to replace traditional learning with informal learning (student-centered-active learning), so as to enhance not only the students’ ’knowledge, but also the advancement of long- life learning skills. PMID:25946918

Application of nonparametric regression methods to study the relationship between NO2 concentrations and local wind direction and speed at background sites.

PubMed

Donnelly, Aoife; Misstear, Bruce; Broderick, Brian

2011-02-15

Background concentrations of nitrogen dioxide (NO(2)) are not constant but vary temporally and spatially. The current paper presents a powerful tool for the quantification of the effects of wind direction and wind speed on background NO(2) concentrations, particularly in cases where monitoring data are limited. In contrast to previous studies which applied similar methods to sites directly affected by local pollution sources, the current study focuses on background sites with the aim of improving methods for predicting background concentrations adopted in air quality modelling studies. The relationship between measured NO(2) concentration in air at three such sites in Ireland and locally measured wind direction has been quantified using nonparametric regression methods. The major aim was to analyse a method for quantifying the effects of local wind direction on background levels of NO(2) in Ireland. The method was expanded to include wind speed as an added predictor variable. A Gaussian kernel function is used in the analysis and circular statistics employed for the wind direction variable. Wind direction and wind speed were both found to have a statistically significant effect on background levels of NO(2) at all three sites. Frequently environmental impact assessments are based on short term baseline monitoring producing a limited dataset. The presented non-parametric regression methods, in contrast to the frequently used methods such as binning of the data, allow concentrations for missing data pairs to be estimated and distinction between spurious and true peaks in concentrations to be made. The methods were found to provide a realistic estimation of long term concentration variation with wind direction and speed, even for cases where the data set is limited. Accurate identification of the actual variation at each location and causative factors could be made, thus supporting the improved definition of background concentrations for use in air quality modelling studies. Copyright © 2010 Elsevier B.V. All rights reserved.

Using a Classical Gluon Cascade to study the Equilibration of a Gluon-Plasma

NASA Astrophysics Data System (ADS)

McConnell, Lucas

2015-10-01

Using a classical gluon cascade, we study the thermalisation of a gluon-plasma in a homogeneous box by considering the time evolution of the entropy, and in particular how the thermalisation time depends on the strong coupling αs. We then partition the volume into cells with a linearly increasing temperature gradient in one direction, and homogeneous/isotropic in the the other two directions. We allow the gluons to stream in one direction in order to study how they then evolve spatially. We examine cases with and without collisions. We study the entropy as well as the flow-velocity in the z-direction and find that the system initially has a flow which dissipates over time as the gluons become distributed homogeneously throughout the box.

A better understanding of POLDER's cloud droplet size retrieval: impact of cloud horizontal inhomogeneity and directional sampling

NASA Astrophysics Data System (ADS)

Shang, H.; Chen, L.; Bréon, F.-M.; Letu, H.; Li, S.; Wang, Z.; Su, L.

2015-07-01

The principles of the Polarization and Directionality of the Earth's Reflectance (POLDER) cloud droplet size retrieval requires that clouds are horizontally homogeneous. Nevertheless, the retrieval is applied by combining all measurements from an area of 150 km × 150 km to compensate for POLDER's insufficient directional sampling. Using the POLDER-like data simulated with the RT3 model, we investigate the impact of cloud horizontal inhomogeneity and directional sampling on the retrieval, and then analyze which spatial resolution is potentially accessible from the measurements. Case studies show that the sub-scale variability in droplet effective radius (CDR) can mislead both the CDR and effective variance (EV) retrievals. Nevertheless, the sub-scale variations in EV and cloud optical thickness (COT) only influence the EV retrievals and not the CDR estimate. In the directional sampling cases studied, the retrieval is accurate using limited observations and is largely independent of random noise. Several improvements have been made to the original POLDER droplet size retrieval. For example, the measurements in the primary rainbow region (137-145°) are used to ensure accurate large droplet (> 15 μm) retrievals and reduce the uncertainties caused by cloud heterogeneity. We apply the improved method using the POLDER global L1B data for June 2008, the new CDR results are compared with the operational CDRs. The comparison show that the operational CDRs tend to be underestimated for large droplets. The reason is that the cloudbow oscillations in the scattering angle region of 145-165° are weak for cloud fields with CDR > 15 μm. Lastly, a sub-scale retrieval case is analyzed, illustrating that a higher resolution, e.g., 42 km × 42 km, can be used when inverting cloud droplet size parameters from POLDER measurements.

A systematic review of ultrasound-accelerated catheter-directed thrombolysis in the treatment of deep vein thrombosis.

PubMed

Shi, Yadong; Shi, Wanyin; Chen, Liang; Gu, Jianping

2018-04-01

To review the clinical evidence for ultrasound-accelerated catheter-directed thrombolysis (UACDT) using the EKOS system in the treatment of deep vein thrombosis (DVT) in terms of case selection, procedural outcomes, clinical outcomes and safety outcomes. A systematic literature search strategy was used to identify the use of the EKOS system in the treatment of DVT using the following electronic databases: MEDLINE, EMBASE, the Cochrane databases and the Web of Science. The references in the relevant literature were also screened. Our literature search identified a total of 16 unique clinical studies. Twelve of the sixteen studies were retrospective case series studies. To date, only one randomised controlled trial (RCT) is available. Overall, UACDT using the EKOS system was performed 548 times in 512 patients. Among all cases, 77-100% achieved substantial lysis (> 50%) based on the different definitions of the individual studies. This treatment modality appears to be safe, as there were no reported procedure-related pulmonary embolisms (PE) and only one procedure-related death was reported. Bleeding events were reported in 14 of the 16 studies, and 3.9% (20/512) of the cases of bleeding were considered major. During the follow-up, post-thrombotic syndrome was observed in 17.1% (20/117) of cases. UACDT using the EKOS system is an effective, safe and promising treatment modality for DVT, but the existing clinical evidence is inadequate to make UACDT using the EKOS system the first-line choice for DVT. Additional prospective large-sample RCTs with long-term follow-ups are warranted to define the role of UACDT using the EKOS system in the treatment of DVT.

Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier.

PubMed

Sola-Vera, Javier; Uceda, Francisco; Cuesta, Rubén; Vázquez, Narcís

2014-01-01

Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. Fifteen patients (8 men/7 women) were included. Mean age was 77.7 + or - 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3%). Biliary confluence was reached in 13/15 cases (86.7%). One complication was observed in one patient (oxigen desaturation). DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases.

Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

ERIC Educational Resources Information Center

Johnson, Yvonne M.; Stadel, Vivian L.

2007-01-01

Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a…

A note on the correlation between circular and linear variables with an application to wind direction and air temperature data in a Mediterranean climate

NASA Astrophysics Data System (ADS)

Lototzis, M.; Papadopoulos, G. K.; Droulia, F.; Tseliou, A.; Tsiros, I. X.

2018-04-01

There are several cases where a circular variable is associated with a linear one. A typical example is wind direction that is often associated with linear quantities such as air temperature and air humidity. The analysis of a statistical relationship of this kind can be tested by the use of parametric and non-parametric methods, each of which has its own advantages and drawbacks. This work deals with correlation analysis using both the parametric and the non-parametric procedure on a small set of meteorological data of air temperature and wind direction during a summer period in a Mediterranean climate. Correlations were examined between hourly, daily and maximum-prevailing values, under typical and non-typical meteorological conditions. Both tests indicated a strong correlation between mean hourly wind directions and mean hourly air temperature, whereas mean daily wind direction and mean daily air temperature do not seem to be correlated. In some cases, however, the two procedures were found to give quite dissimilar levels of significance on the rejection or not of the null hypothesis of no correlation. The simple statistical analysis presented in this study, appropriately extended in large sets of meteorological data, may be a useful tool for estimating effects of wind on local climate studies.

How would case managers' practice change in a consumer-directed care environment in Australia?

PubMed

You, Emily Chuanmei; Dunt, David; Doyle, Colleen

2017-01-01

The aim of this study was to explore case managers' perceived changes in their practice in the future when consumer-directed care (CDC) is widely implemented in Australia's community aged care system. Purposeful sampling was used and semi-structured individual and group interviews were conducted between September 2012 and March 2013. Participants were drawn from a list of all case managers who administered publicly funded community aged care packages in Victoria, Australia. Empowerment theory was used to guide the analysis and interpretation of the data. The thematic analysis revealed that case managers had mixed views about CDC. They also perceived changes in case managers' practice in the future when CDC is widely implemented. These might specifically include: first, case managers would not directly manage clients' budgets. While some case managers were concerned about losing power for this change, others believed that they would still have important financial roles to perform, such as setting rules, providing financial support and monitoring clients' use of budgets. Second, case managers would focus on performing roles in providing information, and empowering, facilitating and educating clients. These would help to strengthen clients' capacities and assist them to self-manage their care. Third, case managers would work in partnership with clients through frequent or skilful communication, mutual goal setting and goal facilitation. Fourth, case managers would manage more clients. In addition, they would provide less support to each individual client and perform less care co-ordination role. The findings suggest case managers paying attention to power balance regarding budget management in a CDC environment. Furthermore, they might frequently or skilfully communicate with, empower, facilitate and educate clients; work together with them to set up goals; and facilitate them to achieve goals. New research using empowerment theory to examine the actual practice of case managers in a well-established CDC system is warranted. © 2015 John Wiley & Sons Ltd.

Use of miniplates as a method for orthodontic anchorage: a case report.

PubMed

Peres, Fernando Gianzanti; Padovan, Luis Eduardo Marques; Kluppel, Leandro Eduardo; Albuquerque, Gustavo Calvalcanti; Souza, Paulo Cesar Ulson de; Claudino, Marcela

2016-01-01

Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

Is my study system good enough? A case study for identifying maternal effects.

PubMed

Holand, Anna Marie; Steinsland, Ingelin

2016-06-01

In this paper, we demonstrate how simulation studies can be used to answer questions about identifiability and consequences of omitting effects from a model. The methodology is presented through a case study where identifiability of genetic and/or individual (environmental) maternal effects is explored. Our study system is a wild house sparrow ( Passer domesticus ) population with known pedigree. We fit pedigree-based (generalized) linear mixed models (animal models), with and without additive genetic and individual maternal effects, and use deviance information criterion (DIC) for choosing between these models. Pedigree and R-code for simulations are available. For this study system, the simulation studies show that only large maternal effects can be identified. The genetic maternal effect (and similar for individual maternal effect) has to be at least half of the total genetic variance to be identified. The consequences of omitting a maternal effect when it is present are explored. Our results indicate that the total (genetic and individual) variance are accounted for. When an individual (environmental) maternal effect is omitted from the model, this only influences the estimated (direct) individual (environmental) variance. When a genetic maternal effect is omitted from the model, both (direct) genetic and (direct) individual variance estimates are overestimated.

Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis.

PubMed

Arnold, David; Girling, Alan; Stevens, Andrew; Lilford, Richard

2009-07-22

Utilities (values representing preferences) for healthcare priority setting are typically obtained indirectly by asking patients to fill in a quality of life questionnaire and then converting the results to a utility using population values. We compared such utilities with those obtained directly from patients or the public. Review of studies providing both a direct and indirect utility estimate. Papers reporting comparisons of utilities obtained directly (standard gamble or time tradeoff) or indirectly (European quality of life 5D [EQ-5D], short form 6D [SF-6D], or health utilities index [HUI]) from the same patient. PubMed and Tufts database of utilities. Sign test for paired comparisons between direct and indirect utilities; least squares regression to describe average relations between the different methods. Mean utility scores (or median if means unavailable) for each method, and differences in mean (median) scores between direct and indirect methods. We found 32 studies yielding 83 instances where direct and indirect methods could be compared for health states experienced by adults. The direct methods used were standard gamble in 57 cases and time trade off in 60(34 used both); the indirect methods were EQ-5D (67 cases), SF-6D (13), HUI-2 (5), and HUI-3 (37). Mean utility values were 0.81 (standard gamble) and 0.77 (time tradeoff) for the direct methods; for the indirect methods: 0.59(EQ-5D), 0.63 (SF-6D), 0.75 (HUI-2) and 0.68 (HUI-3). Direct methods of estimating utilities tend to result in higher health ratings than the more widely used indirect methods, and the difference can be substantial.Use of indirect methods could have important implications for decisions about resource allocation: for example, non-lifesaving treatments are relatively more favoured in comparison with lifesaving interventions than when using direct methods.

IVHS institutional issues and case studies : ADVANCE case study

DOT National Transportation Integrated Search

1994-04-01

This operational test case study is one of six performed in response to a Volpe National Transportation Systems Center technical task directive (TTD) to Science Applications International Corporation (SAIC) entitled, IVHS Institutional Issues and ...

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

PubMed Central

Rabiner, D J; Stearns, S C; Mutran, E

1994-01-01

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

COR V2: teaching observational research with multimedia courseware.

PubMed

Blasko, Dawn G; Kazmerski, Victoria A; Torgerson, Carla N

2004-05-01

Courseware for Observational Research (COR Version 2) is an interactive multimedia program designed to teach the foundation of the scientific method: systematic observation. COR uses digital video with interactive coding to teach basic concepts, such as creating precise operational definitions; using frequency, interval, and duration coding; developing sampling strategies; and analyzing and interpreting data. Through lessons, a case study, and laboratory exercises, it gradually scaffolds students from teacher-directed learning into self-directed learning. The newest addition to COR is a case study in which students work collaboratively, using their own observations to make recommendations about a child's disruptive behavior in an after-school program. Evaluations of the lessons showed that classes using COR received better grades on their field observations than did those using methods that are more traditional. Students' confidence and knowledge increased as they moved through each section of the program.

Multi-scale study on process of contravariant and covariant polymer elongation and drag reduction in viscoelastic turbulence

NASA Astrophysics Data System (ADS)

Horiuti, Kiyosi; Suzuki, Shu

2014-11-01

We study the elongation process of polymers released in the Newtonian homogeneous isotropic turbulence by connecting a mesoscopic description of ensemble of elastic dumbbells using Brownian dynamics (BDS) to the macroscopic description for the fluid using DNS. The dumbbells are allowed to be advected non-affinely with the macroscopically-imposed deformation. More drastic drag reduction is achieved when non-affinity is maximum than in the complete affine case. In the former case, the dumbbell is convected as a covariant vector, and in the latter as a contravariant vector. We derive the exact solution for the governing equation of the motion of dumbbells. The maximum stretching of dumbbell is achieved when the dumbbell aligns in the direction of vorticity in the contravariant case, and when the dumbbell directs outward perpendicularly on the vortex sheet in the covariant case. Alignment in the BDS-DNS data agrees with the theoretical results. In the mixture of contravariant and covariant dumbbells, the covariant dumbbells are transversely aligned with the contravariant dumbbells. Compared with the cases without mixture, stretching of covariant dumbbell is enhanced, while that of contravariant dumbbell is reduced. Application of this phenomenon is discussed.

Template-directed instrumentation in total knee arthroplasty: cost savings analysis.

PubMed

Hsu, Andrew R; Gross, Christopher E; Bhatia, Sanjeev; Levine, Brett R

2012-11-01

The use of digital radiography and templating software in total knee arthroplasty (TKA) continues to become more prevalent as the number of procedures performed increases every year. Template-directed instrumentation (TDI) is a novel approach to surgical planning that combines digital templating with limited intraoperative instruments. The purpose of this study was to evaluate the financial implications and radiographic outcomes of using TDI to direct instrumentation during primary TKA. Over a 1-year period, 82 consecutive TKAs using TDI were retrospectively reviewed. Patient demographics and preoperative templated sizes of predicted components were recorded, and OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida was used to determine the 2 most likely tibial and femoral component sizes for each case. This sizing information was used to direct component vendors to prepare 3 lightweight instrument trays based on these sizes. The sizes of implanted components and the number of total trays required were documented. A cost savings analysis was performed to compare TDI and non-TDI surgical expenses for TKA. In 80 (97%) of 82 cases, the prepared sizes determined by TDI using 3 instrument trays were sufficient. Preoperative templating correctly predicted the size of the tibial and femoral component sizes in 90% and 83% of cases, respectively. The average number of trays used with TDI was 3.0 (range, 3-5 trays) compared with 7.5 (range, 6-9 trays) used in 82 preceding non-TDI TKAs. Based on standard fees to sterilize and package implant trays (approximately $26 based on a survey of 10 orthopedic hospitals performing TKA), approximately $9612 was saved by using TDI over the 1-year study period. Overall, digital templating and TDI were a simple and cost-effective approach when performing primary TKA. Copyright 2012, SLACK Incorporated.

Direct and indirect effects of screening for Chlamydia trachomatis on the prevention of pelvic inflammatory disease: a mathematical modeling study.

PubMed

Herzog, Sereina A; Heijne, Janneke C M; Scott, Pippa; Althaus, Christian L; Low, Nicola

2013-11-01

Pelvic inflammatory disease (PID) results from the ascending spread of microorganisms, including Chlamydia trachomatis, to the upper genital tract. Screening could improve outcomes by identifying and treating chlamydial infections before they progress to PID (direct effect) or by reducing chlamydia transmission (indirect effect). We developed a compartmental model that represents a hypothetical heterosexual population and explicitly incorporates progression from chlamydia to clinical PID. Chlamydia screening was introduced, with coverage increasing each year for 10 years. We estimated the separate contributions of the direct and indirect effects of screening on PID cases prevented per 100,000 women. We explored the influence of varying the time point at which clinical PID could occur and of increasing the risk of PID after repeated chlamydial infections. The probability of PID at baseline was 3.1% by age 25 years. After 5 years, the intervention scenario had prevented 187 PID cases per 100,000 women and after 10 years 956 PID cases per 100,000 women. At the start of screening, most PID cases were prevented by the direct effect. The indirect effect produced a small net increase in PID cases, which was outweighed by the effect of reduced chlamydia transmission after 2.2 years. The later that progression to PID occurs, the greater the contribution of the direct effect. Increasing the risk of PID with repeated chlamydial infection increases the number of PID cases prevented by screening. This study shows the separate roles of direct and indirect PID prevention and potential harms, which cannot be demonstrated in observational studies.

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

PubMed

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost. Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention
.

PubMed

Masbah, Norliana; Macleod, Mary Joan

2017-03-01

Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Hospitalization records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospitalizations. Only 254 patients (39.4%) with confirmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically insignificant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.
.

Urban Environment Development based on Universal Design Principles

NASA Astrophysics Data System (ADS)

Harsritanto, Bangun Ir

2018-02-01

Universal Design is a design which facilitated full range of human diversity. By applying Universal design principles, urban environment can be more functional and more user-friendly for everyone. This study examined five urban streets of South Korea as a country experienced on developing various urban street designs based on universal design. This study aimed to examine and compare the South Korea cases using seven principles of universal design. The research methods of this study are literature study, case study, and site observation. The results of this study are: South Korea cases are good practices, urgency of implementing the direction into local regulations; and change of urban development paradigm.

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

PubMed

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

Software for real-time localization of baleen whale calls using directional sonobuoys: A case study on Antarctic blue whales.

PubMed

Miller, Brian S; Calderan, Susannah; Gillespie, Douglas; Weatherup, Graham; Leaper, Russell; Collins, Kym; Double, Michael C

2016-03-01

Directional frequency analysis and recording (DIFAR) sonobuoys can allow real-time acoustic localization of baleen whales for underwater tracking and remote sensing, but limited availability of hardware and software has prevented wider usage. These software limitations were addressed by developing a module in the open-source software PAMGuard. A case study is presented demonstrating that this software provides greater efficiency and accessibility than previous methods for detecting, localizing, and tracking Antarctic blue whales in real time. Additionally, this software can easily be extended to track other low and mid frequency sounds including those from other cetaceans, pinnipeds, icebergs, shipping, and seismic airguns.

Awareness and uptake of direct-to-consumer genetic testing among cancer cases, their relatives, and controls: the Northwest Cancer Genetics Network.

PubMed

Hall, Taryn O; Renz, Anne D; Snapinn, Katherine W; Bowen, Deborah J; Edwards, Karen L

2012-07-01

To determine if awareness of, interest in, and use of direct-to-consumer (DTC) genetic testing is greater in a sample of high-risk individuals (cancer cases and their relatives), compared to controls. Participants were recruited from the Northwest Cancer Genetics Network. A follow-up survey was mailed to participants to assess DTC genetic testing awareness, interest, and use. One thousand two hundred sixty-seven participants responded to the survey. Forty-nine percent of respondents were aware of DTC genetic testing. Of those aware, 19% indicated interest in obtaining and <1% reported having used DTC genetic testing. Additional information supplied by respondents who reported use of DTC genetic tests indicated that 55% of these respondents likely engaged in clinical genetic testing, rather than DTC genetic testing. Awareness of DTC genetic testing was greater in our sample of high-risk individuals than in controls and population-based studies. Although interest in and use of these tests among cases in our sample were equivalent to other population-based studies, interest in testing was higher among relatives and people who self-referred for a registry focused on cancer than among cases and controls. Additionally, our results suggest that there may be some confusion about what constitutes DTC genetic testing.

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study.

PubMed

Karimi, Hasti; Soleyman-Jahi, Saeed; Hafezi-Nejad, Nima; Rahimi-Movaghar, Afarin; Amin-Esmaeili, Masoumeh; Sharifi, Vandad; Hajebi, Ahmad; Saadat, Soheil; Akbari Sari, Ali; Rahimi-Movaghar, Vafa

2017-05-19

The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011. Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs. We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79-19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28-0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011. In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.

Response prediction techniques and case studies of a path blocking system based on Global Transmissibility Direct Transmissibility method

NASA Astrophysics Data System (ADS)

Wang, Zengwei; Zhu, Ping; Zhao, Jianxuan

2017-02-01

In this paper, the prediction capabilities of the Global Transmissibility Direct Transmissibility (GTDT) method are further developed. Two path blocking techniques solely using the easily measured variables of the original system to predict the response of a path blocking system are generalized to finite element models of continuous systems. The proposed techniques are derived theoretically in a general form for the scenarios of setting the response of a subsystem to zero and of removing the link between two directly connected subsystems. The objective of this paper is to verify the reliability of the proposed techniques by finite element simulations. Two typical cases, the structural vibration transmission case and the structure-borne sound case, in two different configurations are employed to illustrate the validity of proposed techniques. The points of attention for each case have been discussed, and conclusions are given. It is shown that for the two cases of blocking a subsystem the proposed techniques are able to predict the new response using measured variables of the original system, even though operational forces are unknown. For the structural vibration transmission case of removing a connector between two components, the proposed techniques are available only when the rotational component responses of the connector are very small. The proposed techniques offer relative path measures and provide an alternative way to deal with NVH problems. The work in this paper provides guidance and reference for the engineering application of the GTDT prediction techniques.

A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department

PubMed Central

Sakles, John C.; Mosier, Jarrod; Chiu, Stephen; Cosentino, Mari; Kalin, Leah

2015-01-01

Study objective We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When the C-MAC was used as a video laryngoscope, a Cormack-Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%). The C-MAC was associated with immediately recognized esophageal intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%). Conclusion When used for emergency intubations in the ED, the C-MAC was associated with a greater proportion of successful intubations and a greater proportion of Cormack-Lehane grade I or II views compared with a direct laryngoscope. PMID:22560464

Combined use of directional atherectomy and drug-coated balloon for the endovascular treatment of common femoral artery disease: immediate and one-year outcomes.

PubMed

Cioppa, Angelo; Stabile, Eugenio; Salemme, Luigi; Popusoi, Grigore; Pucciarelli, Armando; Iacovelli, Fortunato; Arcari, Antonella; Coscioni, Enrico; Trimarco, Bruno; Esposito, Giovanni; Tesorio, Tullio

2017-02-20

Surgical endarterectomy is the therapy of choice for atherosclerotic common femoral artery (CFA) obstruction. Recently, some large single-centre series have shown encouraging results for the percutaneous treatment of CFA obstructions. The purpose of this study was to evaluate the safety, feasibility, and one-year efficacy of the endovascular treatment of CFA obstructions with combined use of directional atherectomy (DA) and a paclitaxel-coated balloon (DCB). Between January 2012 and July 2014, 30 consecutive patients with severely calcified obstructions of the common femoral artery were treated in our centre using DA followed by DCB dilatation. Provisional stenting was allowed in the case of a suboptimal result. Twenty cases (66%) were isolated CFA interventions, whereas five (17%) and five (17%) also involved inflow and outflow vessels, respectively. Chronic total CFA occlusions (CTO) were recanalised in six cases (20%). Procedural success was achieved in all cases; stenting was needed in three cases (10%). At one year, restenosis and target lesion revascularisation were observed in two of 30 (6.6%) and one of 30 (3.3%) patients, respectively. The secondary patency rate was 96.7%. This single-centre prospective study suggests that the combined use of DA and DCB is a safe and effective alternative to surgery, a treatment option for common femoral artery lesions and provides encouraging results in this setting.

Relationship between Health Literacy and Self-Directed Learning Readiness of Older Adults

ERIC Educational Resources Information Center

Dennis, Robin Justice

2017-01-01

The primary purpose of this study was to determine if the health literacy level of older adults, age 65 and older, and the self-directed learning readiness score were correlated. After data cleaning, the number of cases was below the recommended rule of thumb. Deletion of cases indicated by the analyst of the self-directed learning readiness score…

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system.

PubMed

Clark, P; Carlos, F; Barrera, C; Guzman, J; Maetzel, A; Lavielle, P; Ramirez, E; Robinson, V; Rodriguez-Cabrera, R; Tamayo, J; Tugwell, P

2008-03-01

This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.

Regional projection of climate impact indices over the Mediterranean region

NASA Astrophysics Data System (ADS)

Casanueva, Ana; Frías, M.; Dolores; Herrera, Sixto; Bedia, Joaquín; San Martín, Daniel; Gutiérrez, José Manuel; Zaninovic, Ksenija

2014-05-01

Climate Impact Indices (CIIs) are being increasingly used in different socioeconomic sectors to transfer information about climate change impacts and risks to stakeholders. CIIs are typically based on different weather variables such as temperature, wind speed, precipitation or humidity and comprise, in a single index, the relevant meteorological information for the particular impact sector (in this study wildfires and tourism). This dependence on several climate variables poses important limitations to the application of statistical downscaling techniques, since physical consistency among variables is required in most cases to obtain reliable local projections. The present study assesses the suitability of the "direct" downscaling approach, in which the downscaling method is directly applied to the CII. In particular, for illustrative purposes, we consider two popular indices used in the wildfire and tourism sectors, the Fire Weather Index (FWI) and the Physiological Equivalent Temperature (PET), respectively. As an example, two case studies are analysed over two representative Mediterranean regions of interest for the EU CLIM-RUN project: continental Spain for the FWI and Croatia for the PET. Results obtained with this "direct" downscaling approach are similar to those found from the application of the statistical downscaling to the individual meteorological drivers prior to the index calculation ("component" downscaling) thus, a wider range of statistical downscaling methods could be used. As an illustration, future changes in both indices are projected by applying two direct statistical downscaling methods, analogs and linear regression, to the ECHAM5 model. Larger differences were found between the two direct statistical downscaling approaches than between the direct and the component approaches with a single downscaling method. While these examples focus on particular indices and Mediterranean regions of interest for CLIM-RUN stakeholders, the same study could be extended to other indices and regions.

Educational Technology as a Video Cases in Teaching Psychology for Future Teachers

ERIC Educational Resources Information Center

Shen, Pingxia; Gromova, Chulpan R.; Zakirova, Venera G.; Yalalov, Farit G.

2017-01-01

Relevance of the article is caused by need to form the teacher's psychological competences on the basis of life and professional situations. This article is directed to detection of the main difficulties, which students have in the course of studying psychology and efficiency of use of video cases at classes of psychology. The leading research…

Simulated bone remodeling around two types of osseointegrated implants for direct fixation of upper-leg prostheses.

PubMed

Tomaszewski, P K; Verdonschot, N; Bulstra, S K; Rietman, J S; Verkerke, G J

2012-11-01

Direct attachment of an upper leg prosthesis to the skeletal system by a percutaneous implant is an alternative solution to the traditional socket fixation. In this study, we investigated long-term periprosthetic bone changes around two types of fixation implants using two different initial conditions, namely immediate post-amputation implantation and the conventional implantation after considerable time of socket prosthesis use. We questioned the difference in bone modeling response the implants provoked and if it could lead to premature bone fracture. Generic CT-based finite element models of an intact femoral bone and amputated bone implanted with models of two existing direct-fixation implants, the OPRA system (Integrum AB) and the ISP Endo/Exo prosthesis (ESKA Implants AG) were created for this study. Adaptive bone-remodeling simulations used the heel-strike and toe-off loads from a normal walking cycle. The bone loss caused by prolonged use of socket prosthesis had more severe effects on the ultimate bone quality than adaptation induced by the direct-fixation implants. Both implants showed considerable bone remodeling; the titanium screw implant (OPRA system) provoked more bone loss than the porous coated CoCrMo stem (ISP implant). The chance of the peri-prosthetic bone fracture remained higher for the post-socket case as compared to the direct amputation cases. In conclusion, both direct-fixation implants lead to considerable bone loss and bone loss is more severe after a prolonged period of post-socket use. Hence, from a biomechanical perspective it is better to limit the post-socket time and to re-design direct fixation devices to reduce bone loss and the probability of peri-prosthetic bone fractures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluating interactive technology for an evolving case study on learning and satisfaction of graduate nursing students.

PubMed

Vogt, Marjorie A; Schaffner, Barbara H

2016-07-01

Nursing education is challenged to prepare students for complex healthcare needs through the integration of teamwork and informatics. Technology has become an important teaching tool in the blended classroom to enhance group based learning experiences. Faculty evaluation of classroom technologies is imperative prior to adoption. Few studies have directly compared various technologies and their impact on student satisfaction and learning. The purpose of this study was to evaluate technology enhanced teaching methods on the learning and satisfaction of graduate students in an advanced pharmacology class using an unfolding case study. After IRB approval, students were randomly assigned to one of three groups: blogging group, wiki group or webinar group. Students completed the evolving case study using the assigned interactive technology. Student names were removed from the case studies. Faculty evaluated the case study using a rubric, while blinded to the assigned technology method used. No significant difference was found on case study grades, the range of grades on the assignment demonstrated little differences between the methods used. Students indicated an overall positive impact related to networking and collaboration on a satisfaction survey. Impact of technology methods needs to be explored in other areas of graduate nursing education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of miniplates as a method for orthodontic anchorage: a case report

PubMed Central

Peres, Fernando Gianzanti; Padovan, Luis Eduardo Marques; Kluppel, Leandro Eduardo; Albuquerque, Gustavo Calvalcanti; de Souza, Paulo Cesar Ulson; Claudino, Marcela

2016-01-01

ABSTRACT Introduction: Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. Objectives: This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. Conclusions: The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars. PMID:27901235

ASSESSMENT OF INTAKE ACCORDING TO IDEAS GUIDANCE: CASE STUDY.

PubMed

Bitar, A; Maghrabi, M

2018-04-01

Estimation of radiation intake and internal dose can be carried out through direct or indirect measurements during routine or special monitoring program. In case of Iodine-131 contamination, direct measurements, such as thyroid counting, are fast and efficient to give quick results. Generally, the calculation method implements suitable values for known parameters whereas default values are used if no information is available. However, in view to avoid significant discrepancies, IDEAS guidelines put in route a comprehensive method to evaluate the monitoring data for one and different types of monitoring. This article deals with a case of internal contamination of a worker who inhaled aerosols containing 131I during the production of radiopharmaceuticals. The interpretation of data obtained was done by following IDEAS guidelines.

Influence of ballistic and autopsy parameters on the manner of death in case of long firearms fatalities.

PubMed

de la Grandmaison, Geoffroy Lorin; Fermanian, Christophe; Aegerter, Philippe; Durigon, Michel

2008-05-20

A retrospective study was carried out on 132 fatalities due to gunshot wounds secondary to long firearms. One group of suicide (n=72) and one group of homicide (n=60) were statistically compared regarding age and sex of the victim, number of shots, range of fire, direction of the projectile(s), anatomical distribution of entrance sites, weapon and ammunition types and the nature of eventual associated traumatic lesions. The frequency of suicide was higher when the victim's age increased. Females constituted about 43% of the homicide victims and about 8% of the suicide victims. 51.5% of the homicide victims and about 10% of the suicide victims had sustained more than one gunshot wound. Close range was respectively found in 53.5% of the homicide cases and in all suicide cases. Most of the suicide cases (85% of the cases) showed typical entrance sites. Entrance sites in the limbs and lateral or posterior wall of the chest were only encountered in homicide cases. Associated traumatic lesions were found in about 23% of the homicide cases and in 18% of the suicide cases. In case of suicidal gunshots to the left chest, both upwards and downwards directions, and also both right-to-left and left-to-right directions can occur. From 22 suicide cases showing entrance wound in the mouth, a downwards direction was found in only one. This study underlines the importance but also the limits of the autopsy findings (including direction of the projectile(s) related to the entrance site) for giving an indication of the manner of death (homicide vs. suicide).

Molecular Epidemiological Survey of Cutaneous Leishmaniasis in Two Highly Endemic Metropolises of Iran, Application of FTA Cards for DNA Extraction From Giemsa-Stained Slides.

PubMed

Izadi, Shahrokh; Mirhendi, Hossein; Jalalizand, Niloufar; Khodadadi, Hossein; Mohebali, Mehdi; Nekoeian, Shahram; Jamshidi, Ali; Ghatee, Mohammad Amin

2016-02-01

PCR has been used for confirmation of leishmaniasis in epidemiological studies, but complexity of DNA extraction and PCR approach has confined its routine use in developing countries. In this study, recent epidemiological situation of cutaneous leishmaniasis (CL) in two hyper-endemic metropolises of Shiraz and Isfahan in Iran was studied using DNA extraction by commercial FTA cards and kinetoplastid DNA (kDNA)-PCR amplification for detection/identification of Leishmania directly from stained skin scraping imprints. Fifty four and 30 samples were collected from clinically diagnosed CL patients referred to clinical laboratories of leishmaniasis control centers in Isfahan and Shiraz cities, respectively. The samples were examined by direct microscopy and then scrapings of the stained smears were applied to FTA cards and used directly as DNA source in a nested-PCR to amplify kDNA to detect and identify Leishmania species. Fifty four of 84 (64.2%) slides obtained from patients had positive results microscopically, while 79/84 (94%) of slides had positive results by FTA card-nested-PCR. PCR and microscopy showed a sensitivity of 96.4% and 64.2% and specificity of 100% and 100%, respectively. Interestingly, Leishmania major as causative agent of zoonotic CL was identified in 100% and 90.7% of CL cases from Isfahan and Shiraz cities, respectively, but L. tropica was detected from only 9.3% of cases from Shiraz city. All cases from central regions of Shiraz were L. tropica and no CL case was found in Isfahan central areas. Filter paper-based DNA extraction can facilitate routine use of PCR for diagnosis of CL in research and diagnostic laboratories in Iran and countries with similar conditions. Epidemiologic changes including dominancy of L. major in suburbs of Shiraz and Isfahan metropolises where anthroponotic CL caused by L. tropica had been established, showed necessity of precise studies on CL epidemiology in old urban and newly added districts in the suburbs.

Bridging the gap between self-directed learning of nurse educators and effective student support.

PubMed

Van Rensburg, Gisela H; Botma, Yvonne

2015-11-26

Self-directed learning requires the ability to identify one's own learning needs, develop and implement a plan to gain knowledge and to monitor one's own progress. A lifelong learning approach cannot be forced, since it is in essence an internally driven process. Nurse educators can, however, act as role models to empower their students to become independent learners by modelling their own self-directed learning and applying a number of techniques in supporting their students in becoming ready for self-directed learning.  The aim of the article is to describe the manifestations and implications of the gap between self-directed learning readiness of nurse educators and educational trends in supporting students.  An instrumental case study design was used to gain insight into the manifestations and implications of self-directed learning of nurse educators. Based on the authentic foci of various critical incidents and literature, data were collected and constructed into a fictitious case. The authors then deductively analysed the case by using the literature on self-directed learning readiness as departure point. Four constructs of self-directed learning were identified, namely internal motivation, planning and implementation, self-monitoring and interpersonal communication. Supportive strategies were identified from the available literature.  Nine responses by nurse educators based on the fictitious case were analysed.Analysis showed that readiness for self-directed learning in terms of the identified constructswas interrelated and not mutually exclusive of one other.  The success of lifelong learning is the ability to engage in self-directed learning which requires openness to learning opportunities, good self-concept, taking initiative and illustrating independence in learning. Conscientiousness, an informed acceptance of a responsibility for one's own learning and creativity, is vital to one's future orientation towards goal-directed learning. Knowledge and understanding of one's own and students' selfdirected learning abilities are critical for nurse educators. In the nursing profession, it has been shown that self-directed learning by the nurse educators has a direct relationship towards the development of a lifelong learning approach by their students. Supporting students towards becoming self-directed learners throughout their professional life, in turn, will impact directly on the quality of nursing and midwifery practice. (Article to follow).

Cognitive neuropsychology and its vicissitudes: The fate of Caramazza's axioms.

PubMed

Shallice, Tim

2015-01-01

Cognitive neuropsychology is characterized as the discipline in which one draws conclusions about the organization of the normal cognitive systems from the behaviour of brain-damaged individuals. In a series of papers, Caramazza, later in collaboration with McCloskey, put forward four assumptions as the bridge principles for making such inferences. Four potential pitfalls, one for each axiom, are discussed with respect to the use of single-case methods. Two of the pitfalls also apply to case series and group study procedures, and the other two are held to be indirectly testable or avoidable. Moreover, four other pitfalls are held to apply to case series or group study methods. It is held that inferences from single-case procedures may profitably be supported or rejected using case series/group study methods, but also that analogous support needs to be given in the other direction for functionally based case series or group studies. It is argued that at least six types of neuropsychological method are valuable for extrapolation to theories of the normal cognitive system but that the single- or multiple-case study remains a critical part of cognitive neuropsychology's methods.

Estimating Am-241 activity in the body: comparison of direct measurements and radiochemical analyses

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

Lynch, Timothy P.; Tolmachev, Sergei Y.; James, Anthony C.

2009-06-01

The assessment of dose and ultimately the health risk from intakes of radioactive materials begins with estimating the amount actually taken into the body. An accurate estimate provides the basis to best assess the distribution in the body, the resulting dose, and ultimately the health risk. This study continues the time-honored practice of evaluating the accuracy of results obtained using in vivo measurement methods and techniques. Results from the radiochemical analyses of the 241Am activity content of tissues and organs from four donors to the United States Transuranium and Uranium Registries were compared to the results from direct measurements ofmore » radioactive material in the body performed in vivo and post mortem. Two were whole body donations and two were partial body donations The skeleton was the organ with the highest deposition of 241Am activity in all four cases. The activities ranged from 30 Bq to 300 Bq. The skeletal estimates obtained from measurements over the forehead were within 20% of the radiochemistry results in three cases and differed by 78% in one case. The 241Am lung activity estimates ranged from 1 Bq to 30 Bq in the four cases. The results from the direct measurements were within 40% of the radiochemistry results in 3 cases and within a factor of 3 for the other case. The direct measurement estimates of liver activity ranged from 2 Bq to 60 Bq and were generally lower than the radiochemistry results. The results from this study suggest that the measurement methods and calibration techniques used at the In Vivo Radiobioassay and Research Facility to quantify the activity in the lungs, skeleton and liver are reasonable under the most challenging conditions where there is 241Am activity in multiple organs. These methods and techniques are comparable to those used at other Department of Energy sites. This suggests that the current in vivo methods and calibration techniques provide reasonable estimates of radioactive material in the body. Not unexpectedly, there can be significant uncertainty in the estimates especially when activity is also present in other organs.« less

Integrating Financial Aid and Financial Policies: Case Studies from Five States. Changing Direction: Integrating Higher Education Financial Aid and Financing Policies.

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, Boulder, CO.

This report is a collection of five state case studies comprising a major component of the first phase of the project, "Changing Direction: Integrating Higher Education Financial Aid and Financing Policies." The project explored state-level strategies to better align financing and financial aid policies and support more informed decision…

Understanding Self-Directed Learning in the Context of Mobile Web 2.0--Case Study with Workplace Learners

ERIC Educational Resources Information Center

Gu, Jia

2016-01-01

This paper presents the findings from a multiple-case study which has investigated the impact of mobile Web 2.0 technologies on self-directed learning (SDL) of workplace learners by exploring participants' learning experiences with a mobile App. Drawing on existing literatures, we examined learners' SDL personal attributes and process in the…

Middle-Aged Independent-Living African Americans' Selections for Advance Directives: A Case Study

ERIC Educational Resources Information Center

McDaniel, Brenda J.

2013-01-01

The purpose of this collective embedded qualitative case study was to examine the perspectives of three middle-aged independent-living African Americans who had participated in the process of advance care planning (ACP) and completed at least two advance directives (ADs), a Durable Power of Attorney for Health Care (DPAHC) and a Living Will (LW).…

Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites.

PubMed

Binazzi, Alessandra; Marinaccio, Alessandro; Corfiati, Marisa; Bruno, Caterina; Fazzo, Lucia; Pasetto, Roberto; Pirastu, Roberta; Biggeri, Annibale; Catelan, Dolores; Comba, Pietro; Zona, Amerigo

2017-11-01

Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.

Clinical and immunological studies of 49 cases of various types of intercellular IgA dermatosis and 13 cases of classical subcorneal pustular dermatosis examined at Kurume University.

PubMed

Hashimoto, T; Teye, K; Ishii, N

2017-01-01

Intercellular IgA dermatosis (IAD) is a subset of autoimmune bullous disease exclusively with IgA antikeratinocyte cell-surface antibodies. The classification and pathogenesis of this condition are still obscure. To classify IAD and study its pathogenesis. From our cohort of 5402 cases of autoimmune bullous disease, we selected 49 cases of various types of intercellular IgA dermatosis (IAD) and 13 cases of classical subcorneal pustular dermatosis (SPD), for which sera and information were available. We studied these cases clinically and immunologically. There were 17 SPD-type IAD, 12 intraepidermal neutrophilic IgA dermatosis (IEN)-type IAD, two IgA-pemphigus vegetans, four IgA-pemphigus foliaceus, six IgA-pemphigus vulgaris and eight unclassified IAD cases. There was no sex predominance, and the average age at disease onset was 45·9 years. Clinically, bullous and pustular skin lesions developed on various sites, particularly intertriginous areas. Histopathology showed intraepidermal blisters or pustules at the upper epidermis in the SPD-type and at the midepidermis in the IEN-type. Immunological studies revealed that direct immunofluorescence, indirect immunofluorescence of normal human skin and enzyme-linked immunosorbent assays (ELISAs) of recombinant proteins of desmogleins and desmocollins frequently showed positive results, although no antigens were detected in many cases. All cases of classical SPD, which showed no positive immunological results, were indistinguishable clinically and histopathologically from SPD-type IAD. The present study of the largest cohort of cases of IAD showed that the major subtypes are SPD and IEN, and that the combination of indirect immunofluorescence and ELISAs of desmogleins and desmocollins, in addition to direct immunofluorescence, was useful for the diagnosis of IAD and its subtypes. © 2016 British Association of Dermatologists.

A Novel Classification System for Injuries After Electronic Cigarette Explosions.

PubMed

Patterson, Scott B; Beckett, Allison R; Lintner, Alicia; Leahey, Carly; Greer, Ashley; Brevard, Sidney B; Simmons, Jon D; Kahn, Steven A

Electronic cigarettes (e-cigarettes) contain lithium batteries that have been known to explode and/or cause fires that have resulted in burn injury. The purpose of this article is to present a case study, review injuries caused by e-cigarettes, and present a novel classification system from the newly emerging patterns of burns. A case study was presented and online media reports for e-cigarette burns were queried with search terms "e-cigarette burns" and "electronic cigarette burns." The reports and injury patterns were tabulated. Analysis was then performed to create a novel classification system based on the distinct injury patterns seen in the study. Two patients were seen at our regional burn center after e-cigarette burns. One had an injury to his thigh and penis that required operative intervention after ignition of this device in his pocket. The second had a facial burn and corneal abrasions when the device exploded while he was inhaling vapor. The Internet search and case studies resulted in 26 cases for evaluation. The burn patterns were divided in direct injury from the device igniting and indirect injury when the device caused a house or car fire. A numerical classification was created: direct injury: type 1 (hand injury) 7 cases, type 2 (face injury) 8 cases, type 3 (waist/groin injury) 11 cases, and type 5a (inhalation injury from using device) 2 cases; indirect injury: type 4 (house fire injury) 7 cases and type 5b (inhalation injury from fire started by the device) 4 cases. Multiple e-cigarette injuries are occurring in the United States and distinct patterns of burns are emerging. The classification system developed in this article will aid in further study and future regulation of these dangerous devices.

Difficult end-of-life treatment decisions: do other factors trump advance directives?

PubMed

Hardin, Steven B; Yusufaly, Yasmin A

2004-07-26

Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases of seriously ill patients. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Study participants were all internal medicine faculty and resident physicians from a single academic institution. A total of 47% analyzable surveys (117/250) were returned. Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was similar for faculty and residents (68% and 61%, respectively; P>.05). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions (89%; P<.001). Internists frequently made treatment decisions that were not consistent with an explicit advance directive. In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive. Future work needs to explore the generalizability of these findings and examine how strictly patients desire their advance directives to be followed.

Conductance spectra of asymmetric ferromagnet/ferromagnet/ferromagnet junctions

NASA Astrophysics Data System (ADS)

Pasanai, K.

2017-01-01

A theory of tunneling spectroscopy of ferromagnet/ferromagnet/ferromagnet junctions was studied. We applied a delta-functional approximation for the interface scattering properties under a one-dimensional system of a free electron approach. The reflection and transmission probabilities were calculated in the ballistic regime, and the conductance spectra were then calculated using the Landauer formulation. The magnetization directions were set to be either parallel (P) or anti-parallel (AP) alignments, for comparison. We found that the conductance spectra was suppressed when increasing the interfacial scattering at the interfaces. Moreover, the electron could exhibit direct transmission when the thickness was rather thin. Thus, there was no oscillation in this case. However, in the case of a thick layer the conductance spectra oscillated, and this oscillation was most prominent when the middle layer thickness increased. In the case of direct transmission, the conductance spectra of P and AP systems were definitely suppressed with increased exchange energy of the middle ferromagnet. This also refers to an increase in the magnetoresistance of the junction. In the case of oscillatory behavior, the positions of the resonance peaks were changed as the exchange energy was changed.

Incidence and use of resources for chickenpox and herpes zoster in Latin America and the Caribbean--a systematic review and meta-analysis.

PubMed

Bardach, Ariel; Cafferata, María Luisa; Klein, Karen; Cormick, Gabriela; Gibbons, Luz; Ruvinsky, Silvina

2012-12-01

Varicella-zoster virus causes chickenpox and herpes zoster. More than 90% of varicella cases occur in childhood. The aim of this study was to gather all relevant information on epidemiology and resource use in Latin America and the Caribbean since 2000. Epidemiologic studies published since 2000 with at least 50 cases of varicella or herpes zoster, or at least 10 cases of congenital disease were included. Gray literature was also searched. Outcomes included incidence, admission rate, mortality and case-fatality ratio. Use of resources and both direct and indirect costs associated were extracted. From the 495 records identified, 23 were included in the meta-analysis to report varicella-zoster virus outcomes and 3 in the herpes zoster analysis. The global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year (95% confidence interval: 26.9-58.9); children under 5 years of age were the most affected. Pooled general admission rate was 3.5 per 100,000 population (95% confidence interval: 2.9-4.1) and median hospitalization was 5-9 days. The most common varicella complications reported in studies were skin infections (3-61%), followed by respiratory infections (0-15%) and neurologic problems (1-5%). Direct costs averaged (2011/international dollar [I$]) $2040 per admission (range, I$ 298-5369) and I$70 per clinical visit (range, 11-188 I$). Limited information was available on the outcomes studied. Improvements in the surveillance of ambulatory cases are required to obtain a better epidemiologic picture. As of 2011, only 2 countries introduced the vaccine in national immunization programs in Latin America and the Caribbean.

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group.

PubMed

Aziz, Michael F; Brambrink, Ansgar M; Healy, David W; Willett, Amy Wen; Shanks, Amy; Tremper, Tyler; Jameson, Leslie; Ragheb, Jacqueline; Biggs, Daniel A; Paganelli, William C; Rao, Janavi; Epps, Jerry L; Colquhoun, Douglas A; Bakke, Patrick; Kheterpal, Sachin

2016-10-01

Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

Cyclotron line resonant transfer through neutron star atmospheres

NASA Technical Reports Server (NTRS)

Wang, John C. L.; Wasserman, Ira M.; Salpeter, Edwin E.

1988-01-01

Monte Carlo methods are used to study in detail the resonant radiative transfer of cyclotron line photons with recoil through a purely scattering neutron star atmosphere for both the polarized and unpolarized cases. For each case, the number of scatters, the path length traveled, the escape frequency shift, the escape direction cosine, the emergent frequency spectra, and the angular distribution of escaping photons are investigated. In the polarized case, transfer is calculated using both the cold plasma e- and o-modes and the magnetic vacuum perpendicular and parallel modes.

Geomagnetic field models for satellite angular motion studies

NASA Astrophysics Data System (ADS)

Ovchinnikov, M. Yu.; Penkov, V. I.; Roldugin, D. S.; Pichuzhkina, A. V.

2018-03-01

Four geomagnetic field models are discussed: IGRF, inclined, direct and simplified dipoles. Geomagnetic induction vector expressions are provided in different reference frames. Induction vector behavior is compared for different models. Models applicability for the analysis of satellite motion is studied from theoretical and engineering perspectives. Relevant satellite dynamics analysis cases using analytical and numerical techniques are provided. These cases demonstrate the benefit of a certain model for a specific dynamics study. Recommendations for models usage are summarized in the end.

NONLINEAR OPTICAL EFFECTS AND FIBER OPTICS: Pulsed neodymium amplifier with phase conjugation and direct amplification

NASA Astrophysics Data System (ADS)

Basov, N. G.; Efimkov, V. F.; Zubarev, I. G.; Kolobrodov, V. V.; Pastukhov, S. A.; Smirnov, M. G.; Sobolev, V. B.

1988-12-01

A study was made of the characteristics of an amplifier containing neodymium-activated silicate rods, 45 mm in diameter, used in direct amplification and phase conjugation systems. At low output energies the divergence of the output radiation in the presence of a phase-conjugating mirror was half ( ~ 10- 4 rad) that in the case of direct amplification. An increase in the output power caused the divergence to rise more rapidly in the presence of a phase-conjugating mirror, which was tentatively attributed to an earlier manifestation of large-scale self-focusing. Output energies of 130 J in the case of direct amplification and 80 J in the presence of a phase-conjugating mirror were obtained when the output pulse duration was ~ 2 ns and the fraction of the total energy contained within an angle of ~ 10- 4 rad was ~ 0.3.

Neural network method to correct bidirectional effects in water-leaving radiance.

PubMed

Fan, Yongzhen; Li, Wei; Voss, Kenneth J; Gatebe, Charles K; Stamnes, Knut

2016-01-01

Ocean color algorithms that rely on "atmospherically corrected" nadir water-leaving radiances to infer information about marine constituents such as the chlorophyll concentration depend on a reliable method to convert the angle-dependent measured radiances from the observation direction to the nadir direction. It is also important to convert the measured radiances to the nadir direction when comparing and merging products from different satellite missions. The standard correction method developed by Morel and coworkers requires knowledge of the chlorophyll concentration. Also, the standard method was developed based on the Case 1 (open ocean) assumption, which makes it unsuitable for Case 2 situations such as turbid coastal waters. We introduce a neural network method to convert the angle-dependent water-leaving radiance (or the corresponding remote sensing reflectance) from the observation direction to the nadir direction. This method relies on neither an "atmospheric correction" nor prior knowledge of the water constituents or the inherent optical properties. It directly converts the remote sensing reflectance from an arbitrary slanted viewing direction to the nadir direction by using a trained neural network. This method is fast and accurate, and it can be easily adapted to different remote sensing instruments. Validation using NuRADS measurements in different types of water shows that this method is suitable for both Case 1 and Case 2 waters. In Case 1 or chlorophyll-dominated waters, our neural network method produces corrections similar to those of the standard method. In Case 2 waters, especially sediment-dominated waters, a significant improvement was obtained compared to the standard method.

Evaluation of direct and indirect additive manufacture of maxillofacial prostheses.

PubMed

Eggbeer, Dominic; Bibb, Richard; Evans, Peter; Ji, Lu

2012-09-01

The efficacy of computer-aided technologies in the design and manufacture of maxillofacial prostheses has not been fully proven. This paper presents research into the evaluation of direct and indirect additive manufacture of a maxillofacial prosthesis against conventional laboratory-based techniques. An implant/magnet-retained nasal prosthesis case from a UK maxillofacial unit was selected as a case study. A benchmark prosthesis was fabricated using conventional laboratory-based techniques for comparison against additive manufactured prostheses. For the computer-aided workflow, photogrammetry, computer-aided design and additive manufacture (AM) methods were evaluated in direct prosthesis body fabrication and indirect production using an additively manufactured mould. Qualitative analysis of position, shape, colour and edge quality was undertaken. Mechanical testing to ISO standards was also used to compare the silicone rubber used in the conventional prosthesis with the AM material. Critical evaluation has shown that utilising a computer-aided work-flow can produce a prosthesis body that is comparable to that produced using existing best practice. Technical limitations currently prevent the direct fabrication method demonstrated in this paper from being clinically viable. This research helps prosthesis providers understand the application of a computer-aided approach and guides technology developers and researchers to address the limitations identified.

Impact of cloud horizontal inhomogeneity and directional sampling on the retrieval of cloud droplet size by the POLDER instrument

NASA Astrophysics Data System (ADS)

Shang, H.; Chen, L.; Bréon, F. M.; Letu, H.; Li, S.; Wang, Z.; Su, L.

2015-11-01

The principles of cloud droplet size retrieval via Polarization and Directionality of the Earth's Reflectance (POLDER) requires that clouds be horizontally homogeneous. The retrieval is performed by combining all measurements from an area of 150 km × 150 km to compensate for POLDER's insufficient directional sampling. Using POLDER-like data simulated with the RT3 model, we investigate the impact of cloud horizontal inhomogeneity and directional sampling on the retrieval and analyze which spatial resolution is potentially accessible from the measurements. Case studies show that the sub-grid-scale variability in droplet effective radius (CDR) can significantly reduce valid retrievals and introduce small biases to the CDR (~ 1.5 μm) and effective variance (EV) estimates. Nevertheless, the sub-grid-scale variations in EV and cloud optical thickness (COT) only influence the EV retrievals and not the CDR estimate. In the directional sampling cases studied, the retrieval using limited observations is accurate and is largely free of random noise. Several improvements have been made to the original POLDER droplet size retrieval. For example, measurements in the primary rainbow region (137-145°) are used to ensure retrievals of large droplet (> 15 μm) and to reduce the uncertainties caused by cloud heterogeneity. We apply the improved method using the POLDER global L1B data from June 2008, and the new CDR results are compared with the operational CDRs. The comparison shows that the operational CDRs tend to be underestimated for large droplets because the cloudbow oscillations in the scattering angle region of 145-165° are weak for cloud fields with CDR > 15 μm. Finally, a sub-grid-scale retrieval case demonstrates that a higher resolution, e.g., 42 km × 42 km, can be used when inverting cloud droplet size distribution parameters from POLDER measurements.

Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study.

PubMed

Wang, Sung Il; Kwon, Tae Young; Hwang, Hong Pil; Kim, Jung Ryul

2017-06-01

This was a retrospective observational study. The aim of this study was to evaluate functional outcomes in children treated for Gartland III supracondylar humerus (SCH) fracture with neurovascular (NV) injuries using validated outcome measures. A secondary goal was to determine whether clinical parameters such as age at injury, sex, weight, fracture site, and/or direction of displacement could predict NV injury at the time of fracture or long-term functional outcomes in these patients.One hundred fifty-four patients of Gartland III SCH fractures between March 2004 and May 2013 were studied retrospectively. The patients were divided into 2 groups according to the presence of NV injury. Medical records and radiographs were reviewed to assess several parameters, including age, sex, weight, treatment intervention, the extremity involved, direction of fracture displacement, and NV injury. Functional outcome was assessed on final follow-up using the Pediatric Outcomes Data Collection Instrument (PODCI) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) outcome measures. Statistical analysis was used to determine the relationship between NV injury and functional outcomes.There were 33 cases with Gartland III SCH fracture associated with NV injuries (10 cases of vascular compromise, 14 cases of neural injury, and 9 cases involving both vascular compromise and neural injury). There were significant differences between the 2 groups in age (P  =  .048), weight (P  =  .009), and direction of displacement (P  =  .004). Vascular compromise and median nerve injury were most common in fractures with posterolateral displacement, and radial nerve injuries were common in fractures with posteromedial displacement. The mean global function score in the PODCI was 91.4 points, and the mean Quick DASH score was 11.7 points, with excellent functional outcomes. No differences in outcomes were identified based upon age, fracture site, sex, weight, direction of displacement, or operative technique in NV injury patients (P > .05).The majority of patients with Gartland III SCH fractures associated with NV injuries returned to a high functioning level after treatment of their injuries. NV injury does not appear to influence functional outcomes. Good functional results can be expected regardless of age, fracture site, sex, weight, direction of displacement, and operative technique.

Health-Care Referrals from Direct-to-Consumer Genetic Testing

PubMed Central

Giovanni, Monica A.; Fickie, Matthew R.; Lehmann, Lisa S.; Green, Robert C.; Meckley, Lisa M.; Veenstra, David

2010-01-01

Background: Direct-to-consumer genetic testing (DTC-GT) provides personalized genetic risk information directly to consumers. Little is known about how and why consumers then communicate the results of this testing to health-care professionals. Aim: To query specialists in clinical genetics about their experience with individuals who consulted them after DTC-GT. Methods: Invitations to participate in a questionnaire were sent to three different groups of genetic professionals, totaling 4047 invitations, asking questions about individuals who consulted them after DTC-GT. For each case reported, respondents were asked to describe how the case was referred to them, the patient's rationale for DTC-GT, and the type of DTC-GT performed. Respondents were also queried about the consequences of the consultations in terms of additional testing ordered. The costs associated with each consultation were estimated. A clinical case series was compiled based upon clinician responses. Results: The invitation resulted in 133 responses describing 22 cases of clinical interactions following DTC-GT. Most consultations (59.1%) were self-referred to genetics professionals, but 31.8% were physician referred. Among respondents, 52.3% deemed the DTC-GT to be “clinically useful.” BRCA1/2 testing was considered clinically useful in 85.7% of cases; 35.7% of other tests were considered clinically useful. Subsequent referrals from genetics professionals to specialists and/or additional diagnostic testing were common, generating individual downstream costs estimated to range from $40 to $20,600. Conclusions: This clinical case series suggests that approximately half of clinical geneticists who saw patients after DTC-GT judged that testing was clinically useful, especially the BRCA1/2 testing. Further studies are needed in larger and more diverse populations to better understand the interactions between DTC-GT and the health-care system. PMID:20979566

Health-care referrals from direct-to-consumer genetic testing.

PubMed

Giovanni, Monica A; Fickie, Matthew R; Lehmann, Lisa S; Green, Robert C; Meckley, Lisa M; Veenstra, David; Murray, Michael F

2010-12-01

direct-to-consumer genetic testing (DTC-GT) provides personalized genetic risk information directly to consumers. Little is known about how and why consumers then communicate the results of this testing to health-care professionals. to query specialists in clinical genetics about their experience with individuals who consulted them after DTC-GT. invitations to participate in a questionnaire were sent to three different groups of genetic professionals, totaling 4047 invitations, asking questions about individuals who consulted them after DTC-GT. For each case reported, respondents were asked to describe how the case was referred to them, the patient's rationale for DTC-GT, and the type of DTC-GT performed. Respondents were also queried about the consequences of the consultations in terms of additional testing ordered. The costs associated with each consultation were estimated. A clinical case series was compiled based upon clinician responses. the invitation resulted in 133 responses describing 22 cases of clinical interactions following DTC-GT. Most consultations (59.1%) were self-referred to genetics professionals, but 31.8% were physician referred. Among respondents, 52.3% deemed the DTC-GT to be "clinically useful." BRCA1/2 testing was considered clinically useful in 85.7% of cases; 35.7% of other tests were considered clinically useful. Subsequent referrals from genetics professionals to specialists and/or additional diagnostic testing were common, generating individual downstream costs estimated to range from $40 to $20,600. this clinical case series suggests that approximately half of clinical geneticists who saw patients after DTC-GT judged that testing was clinically useful, especially the BRCA1/2 testing. Further studies are needed in larger and more diverse populations to better understand the interactions between DTC-GT and the health-care system.

The cost of hospital care for management of invasive group A streptococcal infections in England.

PubMed

Hughes, G J; VAN Hoek, A J; Sriskandan, S; Lamagni, T L

2015-06-01

The objective of this study was to estimate the direct financial costs of hospital care for management of invasive group A streptococcal (GAS) infections using hospital records for cases diagnosed in England. We linked laboratory-confirmed cases (n = 3696) identified through national surveillance to hospital episode statistics and reimbursement codes. From these codes we estimated the direct hospital costs of admissions. Almost all notified invasive GAS cases (92% of 3696) were successfully matched to a primary hospital admission. Of these, secondary admissions (within 30 days of primary admission) were further identified for 593 (17%). After exclusion of nosocomial cases (12%), the median costs of primary and secondary hospital admissions were estimated by subgroup analysis as £1984-£2212 per case, totalling £4·43-£6·34 million per year in England. With adjustment for unmatched cases this equated to £4·84-£6·93 million per year. Adults aged 16-64 years accounted for 48% of costs but only 40% of cases, largely due to an increased number of surgical procedures. The direct costs of hospital admissions for invasive GAS infection are substantial. These estimated costs will contribute to a full assessment of the total economic burden of invasive GAS infection as a means to assess potential savings through prevention measures.

Local health department leadership strategies for healthy built environments.

PubMed

Kuiper, Heather; Jackson, Richard J; Barna, Stefi; Satariano, William A

2012-01-01

The built environment is an important but less-recognized health determinant, and local health departments need expanded guidance to address it. In such situations, leadership is particularly relevant. To assess whether and how local public and environmental health leaders increase their departments' health-promoting impact on built environment design, and what pitfalls they should avoid. Mixed-methods employing cross-sectional surveys and a comparative case study. Local public and environmental health departments. PARTICIPANTS SURVEY: A total of 159 (89%) health officers, health directors, and environmental health directors from all 62 local jurisdictions in California. Case-Study: Three departments, 12 cases, 36 health and land-use professionals, and 30 key informants. The study measured the influence of leadership practices on health departments' built environment-related collaborations, land use activities, policy developments, and contributions to physical changes. Quantitative multivariate linear and logistic regression were used. Case-study content analysis and pattern-matching, which related strong and weak leadership practices to outcomes, were also employed. Departments having highly innovative leaders with positive attitudes had greater odds of achieving physical changes to the built environment (OR: 4.5, 3.4, respectively). Leadership that most prepared their departments for built environment work (by updating staffing, structure, and strategy) tripled interagency and cross-sector collaboration (OR: 3.4). Leadership of successful departments consistently (1) established and managed a healthy built environment vision, (2) cultivated innovation, (3) supported, empowered and protected staff, (4) directly engaged in land use and transportation processes, (5) established direct contacts with directors in other departments, and (6) leveraged their professional reputation. Inconsistency in these practices was twice as common among failure as success cases (80%, 43%). Local health leadership underlies public and environmental health departments' community design efforts and should receive technical support and targeted resources to do so effectively.

The business case for provider participation in clinical trials research: an application to the National Cancer Institute's community clinical oncology program.

PubMed

Song, Paula H; Reiter, Kristin L; Weiner, Bryan J; Minasian, Lori; McAlearney, Ann Scheck

2013-01-01

Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions. The aim of this study was to explore whether providers believe there is a business case for participating in PBRNs and what factors contribute to the business case. We use a multiple case study methodology approach to examine the National Cancer Institute's community clinical oncology program, a long-standing federally funded PBRN. Interviews with 41 key informants across five sites, selected on the basis of organizational maturity, were conducted using a semistructured interview guide. We analyzed interview transcripts using an iterative, deductive process to identify themes and subthemes in the data. We found that a business case for provider participation in PBRNs may exist if both direct and indirect financial benefits are identified and included in the analysis and if the time horizon is long enough to allow those benefits to be realized. We identified specific direct and indirect financial benefits that were perceived as important contributors to the business case and the perceived length of time required for a positive return to accrue. As the lack of a business case may result in provider reluctance to participate in PBRNs, knowledge of the benefits we identified may be crucial to encouraging and sustaining participation, thereby preserving patient access to innovative community-based treatments. The results are also relevant to federally funded PBRNs outside of oncology or to providers considering participation in any clinical trials research.

Assessing the spreading patterns of dengue infection and chikungunya fever outbreaks in lower southern Thailand using a geographic information system.

PubMed

Ditsuwan, Thanittha; Liabsuetrakul, Tippawan; Chongsuvivatwong, Virasakdi; Thammapalo, Suwich; McNeil, Edward

2011-04-01

The aims of this study were to assess the incidence of dengue infection (DEN) and chikungunya fever (CHIK) and determine the direction and speed of CHIK between August 2008 and June 2009 in lower southern Thailand. The National Communicable Disease Surveillance System database and a geographic information system containing data on case locations were combined. R and ArcView were used for identifying incidence, direction, and speed of disease outbreaks. A total of 27,166 patients were identified, of which 3319 and 23,847 had DEN and CHIK, with incidences of 73 and 521 per 100,000, respectively. The direction of the CHIK outbreak moved from south to north with a median speed of 7.5 km per week. CHIK cases increased after 6 weeks of increasing cumulative rainfall with variation of average daily temperatures (23.7-30.7 degrees C) per week. There was no clear association of DEN with climate variables. The combination of surveillance and geographic information system data of DEN and CHIK can be used to determine the speed and direction of disease spread. DEN is endemic, but CHIK is an emerging disease. Because of the rapid spread of CHIK, strict and timely integrated vector control programs after case notification must be implemented. Copyright © 2011 Elsevier Inc. All rights reserved.

Finite-difference method Stokes solver (FDMSS) for 3D pore geometries: Software development, validation and case studies

NASA Astrophysics Data System (ADS)

Gerke, Kirill M.; Vasilyev, Roman V.; Khirevich, Siarhei; Collins, Daniel; Karsanina, Marina V.; Sizonenko, Timofey O.; Korost, Dmitry V.; Lamontagne, Sébastien; Mallants, Dirk

2018-05-01

Permeability is one of the fundamental properties of porous media and is required for large-scale Darcian fluid flow and mass transport models. Whilst permeability can be measured directly at a range of scales, there are increasing opportunities to evaluate permeability from pore-scale fluid flow simulations. We introduce the free software Finite-Difference Method Stokes Solver (FDMSS) that solves Stokes equation using a finite-difference method (FDM) directly on voxelized 3D pore geometries (i.e. without meshing). Based on explicit convergence studies, validation on sphere packings with analytically known permeabilities, and comparison against lattice-Boltzmann and other published FDM studies, we conclude that FDMSS provides a computationally efficient and accurate basis for single-phase pore-scale flow simulations. By implementing an efficient parallelization and code optimization scheme, permeability inferences can now be made from 3D images of up to 109 voxels using modern desktop computers. Case studies demonstrate the broad applicability of the FDMSS software for both natural and artificial porous media.

A boundedness result for the direct heuristic dynamic programming.

PubMed

Liu, Feng; Sun, Jian; Si, Jennie; Guo, Wentao; Mei, Shengwei

2012-08-01

Approximate/adaptive dynamic programming (ADP) has been studied extensively in recent years for its potential scalability to solve large state and control space problems, including those involving continuous states and continuous controls. The applicability of ADP algorithms, especially the adaptive critic designs has been demonstrated in several case studies. Direct heuristic dynamic programming (direct HDP) is one of the ADP algorithms inspired by the adaptive critic designs. It has been shown applicable to industrial scale, realistic and complex control problems. In this paper, we provide a uniformly ultimately boundedness (UUB) result for the direct HDP learning controller under mild and intuitive conditions. By using a Lyapunov approach we show that the estimation errors of the learning parameters or the weights in the action and critic networks remain UUB. This result provides a useful controller convergence guarantee for the first time for the direct HDP design. Copyright © 2012 Elsevier Ltd. All rights reserved.

An Overview of the Percutaneous Antibiotic Delivery Technique for Osteomyelitis Treatment and a Case Study of Calcaneal Osteomyelitis.

PubMed

Karr, Jeffrey C

2017-11-01

A percutaneous antibiotic delivery technique (PAD-T) used for the adjunctive management of osteomyelitis is presented. This surgical technique incorporates a calcium sulfate and hydroxyapatite (calcium phosphate) bone void filler acting as a carrier vehicle with either an antibiotic or an antifungal medicine, delivering this combination directly into the area of osteomyelitis. The benefit of the PAD-T is reviewed with a case presentation of a successfully treated calcaneal osteomyelitis. No previously reported PAD-T using a simple bone cortex incision in the adjunctive treatment of osteomyelitis has been reported. The PAD-T safely and effectively uses a calcium sulfate and hydroxyapatite bone void filler carrier vehicle to deliver either an antibiotic or an antifungal medicine directly into the area of osteomyelitis.

Reclassifying causes of obstetric death in Mexico: a repeated cross-sectional study.

PubMed

Hogan, Margaret C; Saavedra-Avendano, Biani; Darney, Blair G; Torres-Palacios, Luis M; Rhenals-Osorio, Ana L; Sierra, Bertha L Vázquez; Soliz-Sánchez, Patricia N; Gakidou, Emmanuela; Lozano, Rafael

2016-05-01

To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. We conducted a repeated cross-sectional study using the 2006-2013 Búsqueda intencionada y reclasificación de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change in deaths from indirect obstetric causes. Direct deaths were concentrated in women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care.

Reclassifying causes of obstetric death in Mexico: a repeated cross-sectional study

PubMed Central

Hogan, Margaret C; Saavedra-Avendano, Biani; Darney, Blair G; Torres-Palacios, Luis M; Rhenals-Osorio, Ana L; Sierra, Bertha L Vázquez; Soliz-Sánchez, Patricia N; Gakidou, Emmanuela

2016-01-01

Abstract Objective To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. Methods We conducted a repeated cross-sectional study using the 2006–2013 Búsqueda intencionada y reclasificación de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. Findings A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change in deaths from indirect obstetric causes. Direct deaths were concentrated in women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. Conclusion The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care. PMID:27147766

Case study #3 -- severe scaling of an interstate bridge deck, and Potentially reactive carbonate aggregates, progress report #6 (partial): an example of bridge deterioration promoted by alkali-carbonate reaction.

DOT National Transportation Integrated Search

1971-01-01

The project designated "Concrete Durability Studies" comprises case studies of unusual durability, either in kind or extent. These case studies are directed toward situations in which appearances suggest materials or construction rather than structur...

Brand Caliphate And Recruitment Between The Genders

DTIC Science & Technology

2016-09-01

females. However, six case studies of radicalized females suggests the recruitment of these women does not appear to be directly attributable to the...propaganda, it appears IS tried to deliver messaging targeted toward females. However, six case studies of radicalized females suggests the...23 B. TEXTUAL ANALYSIS ...........................................................................23 C. CASE STUDIES

Wave scattering from a periodic dielectric surface for a general angle of incidence

NASA Technical Reports Server (NTRS)

Chuang, S. L.; Kong, J. A.

1982-01-01

Electromagnetic waves scattered from a periodic dielectric and perfectly conducting surface are studied for a general angle of incidence. It is shown that the one-dimensional corrugated surface can be solved by using two scalar functions: the components of the electric and magnetic fields along the row direction of the surface, and appropriate boundary conditions to obtain simple matrix equations. Results are compared to the case where the incident angle wave vector is perpendicular to the row direction. Numerical results demonstrate that energy conservation and reciprocity are obeyed for scattering by sinusoidal surfaces for the general case, which checks the consistency of the formalism.

Epidemiologic evaluation of diarrhea in dogs in an animal shelter.

PubMed

Sokolow, Susanne H; Rand, Courtney; Marks, Stanley L; Drazenovich, Niki L; Kather, Elizabeth J; Foley, Janet E

2005-06-01

To determine associations among infectious pathogens and diarrheal disease in dogs in an animal shelter and demonstrate the use of geographic information systems (GISs) for tracking spatial distributions of diarrheal disease within shelters. Feces from 120 dogs. Fresh fecal specimens were screened for bacteria and bacterial toxins via bacteriologic culture and ELISA, parvovirus via ELISA, canine coronavirus via nested polymerase chain reaction assay, protozoal cysts and oocysts via a direct fluorescent antibody technique, and parasite ova and larvae via microscopic examination of direct wet mounts and zinc sulfate centrifugation flotation. Salmonella enterica and Brachyspira spp were not common, whereas other pathogens such as canine coronavirus and Helicobacter spp were common among the dogs that were surveyed. Only intestinal parasites and Campylobacterjejuni infection were significant risk factors for diarrhea by univariate odds ratio analysis. Giardia lamblia was significantly underestimated by fecal flotation, compared with a direct fluorescent antibody technique. Spatial analysis of case specimens by use of GIS indicated that diarrhea was widespread throughout the entire shelter, and spatial statistical analysis revealed no evidence of spatial clustering of case specimens. This study provided an epidemiologic overview of diarrhea and interacting diarrhea-associated pathogens in a densely housed, highly predisposed shelter population of dogs. Several of the approaches used in this study, such as use of a spatial representation of case specimens and considering multiple etiologies simultaneously, were novel and illustrate an integrated approach to epidemiologic investigations in shelter populations.

Method for the technical, financial, economic and environmental pre-feasibility study of geothermal power plants by RETScreen - Ecuador's case study.

PubMed

Moya, Diego; Paredes, Juan; Kaparaju, Prasad

2018-01-01

RETScreen presents a proven focused methodology on pre-feasibility studies. Although this tool has been used to carry out a number of pre-feasibility studies of solar, wind, and hydropower projects; that is not the case for geothermal developments. This method paper proposes a systematic methodology to cover all the necessary inputs of the RETScreen-International Geothermal Project Model. As case study, geothermal power plant developments in the Ecuadorian context were analysed by RETScreen-International Geothermal Project Model. Three different scenarios were considered for analyses. Scenario I and II considered incentives of 132.1 USD/MWh for electricity generation and grants of 3 million USD. Scenario III considered the geothermal project with an electricity export price of 49.3 USD/MWh. Scenario III was further divided into IIIA and IIIB case studies. Scenario IIIA considered a 3 million USD grant while Scenario IIIB considered an income of 8.9 USD/MWh for selling heat in direct applications. Modelling results showed that binary power cycle was the most suitable geothermal technology to produce electricity along with aquaculture and greenhouse heating for direct use applications in all scenarios. Financial analyses showed that the debt payment would be 5.36 million USD/year under in Scenario I and III. The correspindig values for Scenario II was 7.06 million USD/year. Net Present Value was positive for all studied scenarios except for Scenario IIIA. Overall, Scenario II was identified as the most feasible project due to positive NPV with short payback period. Scenario IIIB could become financially attractive by selling heat for direct applications. The total initial investment for a 22 MW geothermal power plant was 114.3 million USD (at 2017 costs). Economic analysis showed an annual savings of 24.3 million USD by avoiding fossil fuel electricity generation. More than 184,000 tCO 2 eq. could be avoided annually.

A methodological framework to assess the socio-economic impact of underground quarries: A case study from Belgian Limburg.

PubMed

Sergeant, A; Poesen, J; Duchateau, P; Vranken, L

2016-01-15

This study developed a methodology to assess the socio-economic impact of the presence and collapse of underground limestone quarries. For this we rely on case study evidence from Riemst, a village located in Eastern Belgium and use both secondary and primary data sources. A sinkhole inventory as well as data about the prevention costs provided by the municipality was used. To estimate the recreational values of the quarries, visitor data was obtained from the tourist office of Riemst. Next, two surveys were conducted among inhabitants and four real estate agents and one notary. The direct and indirect damages were assessed using respectively the repair cost and production and real estate value losses. The total yearly direct and indirect damage equals €415000 (±€85000) and more than half of it can be attributed to the depreciation of real estate (€230000). The quarries have recreational, cultural-historical and ecological values and thus generate societal benefits. The yearly recreational value was at least €613000 in 2012 values. The ecological and cultural-historical values augment to €180000 per year (in 2012 values). Further, our study indicates that the gains from filling up the quarries below the houses located above an underground limestone quarry outweigh the costs in the case study area. The net gain from filling up the underground quarry ranges €38700 to €101700 per house. This is only the lower bound of the net gain from filling up these underground quarries since preventive filling makes future collapses less likely so that future direct repair costs will be most likely smaller. Copyright © 2015 Elsevier B.V. All rights reserved.

Direct Drive Hall Thruster System Development

NASA Technical Reports Server (NTRS)

Hoskins, W. Andrew; Homiak, Daniel; Cassady, R. Joseph; Kerslake, Tom; Peterson, Todd; Ferguson, Dale; Snyder, Dave; Mikellides, Ioannis; Jongeward, Gary; Schneider, Todd

2003-01-01

The sta:us of development of a Direct Drive Ha!! Thruster System is presented. 13 the first part. a s:udy of the impacts to spacecraft systems and mass benefits of a direct-drive architecture is reviewed. The study initially examines four cases of SPT-100 and BPT-4000 Hall thrusters used for north-south station keeping on an EXPRESS-like geosynchronous spacecraft and for primary propulsion for a Deep Space- 1 based science spacecraft. The study is also extended the impact of direct drive on orbit raising for higher power geosynchronous spacecraft and on other deep space missions as a function of power and delta velocity. The major system considerations for accommodating a direct drive Hall thruster are discussed, including array regulation, system grounding, distribution of power to the spacecraft bus, and interactions between current-voltage characteristics for the arrays and thrusters. The mass benefit analysis shows that, for the initial cases, up to 42 kg of dry mass savings is attributable directly to changes in the propulsion hardware. When projected mass impacts of operating the arrays and the electric power system at 300V are included, up to 63 kg is saved for the four initial cases. Adoption of high voltage lithium ion battery technology is projected to further improve these savings. Orbit raising of higher powered geosynchronous spacecraft, is the mission for which direct drive provides the most benefit, allowing higher efficiency electric orbit raising to be accomplished in a limited period of time, as well as nearly eliminating significant power processing heat rejection mass. The total increase in useful payload to orbit ranges up to 278 kg for a 25 kW spacecraft, launched from an Atlas IIA. For deep space missions, direct drive is found to be most applicable to higher power missions with delta velocities up to several km/s , typical of several Discovery-class missions. In the second part, the status of development of direct drive propulsion power electronics is presented. The core of this hardware is the heater-keeper-magnet supply being qualified for the BPT-4000 by Aerojet. A breadboard propulsion power unit is in fabrication and is scheduled for delivery late in 2003.

Elementary teachers' ideas about, planning for and implementation of learner-directed and teacher-directed inquiry: A mixed methods study

NASA Astrophysics Data System (ADS)

Biggers, Mandy Sue

Using a framework for variations of classroom inquiry (National Research Council [NRC], 2000, p. 29), this study explored 40 inservice elementary teachers' planning, modification, and enactment of kit-based science curriculum materials. As part of the study, a new observation protocol was modified from an existing protocol (Practices of Science Observation Protocol [P-SOP]) to measure the amount of teacher direction in science inquiry lessons (Practices of Science Observation Protocol + Directedness [P-SOPd]). An embedded mixed methods design was employed to investigate four questions: 1. How valid and reliable is the P-SOPd? 2. In what ways do inservice elementary teachers adapt existing elementary science curriculum materials across the inquiry continuum? 3. What is the relationship between the overall quality of inquiry and variations of inquiry in elementary teachers' enacted science instruction? 4. How do inservice elementary teachers' ideas about the inquiry continuum influence their adaptation of elementary science curriculum materials? Each teacher chose three lessons from a science unit for video-recorded observation, and submitted lesson plans for the three lessons. Lesson plans and videos were scored using the P-SOPd. The scores were also compared between the two protocols to determine if a correlation existed between the level of inquiry (measured on the P-SOP) and the amount of teacher direction (measured on the P-SOPd). Findings indicated no significant differences between planned and enacted lessons for the amount of teacher direction, but a correlation existed between the level of inquiry and the amount of teacher direction. In effect, the elementary teachers taught their science curriculum materials with a high level of fidelity for both the features of inquiry and the amount of teacher direction. A smaller group of three case study teachers were followed for the school year to give a more in-depth explanation of the quantitative findings. Case study findings revealed that the teachers' science instruction was teacher-directed while their conceptions of inquiry were student-directed. This study contributes to existing research on preservice teachers' learning about the continuum (Biggers & Forbes, 2012) and inservice teachers' ideas about the five features of inquiry (Biggers & Forbes, in press).

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

PubMed

Baraff, L J; Cameron, J M; Sekhon, R

1991-01-01

To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.

Physician staffed helicopter emergency medical service case identification - a before and after study in children.

PubMed

Garner, Alan A; Lee, Anna; Weatherall, Andrew; Langcake, Mary; Balogh, Zsolt J

2016-07-12

Severely injured children may have better outcomes when transported directly to a Paediatric Trauma Centre (PTC). A case identification system using the crew of a physician staffed helicopter emergency medical service (P-HEMS) that identified severely injured children for P-HEMS dispatch was previously associated with high rates of direct transfer. It was theorised that discontinuation of this system may have resulted in deterioration of system performance. Severe paediatric trauma cases were identified from a state based trauma registry over two time periods. In Period A the P-HEMS case identification system operated in parallel with a paramedic dispatcher (Rapid Launch Trauma Co-ordinator-RLTC) operating from a central control room (n = 71). In Period B the paramedic dispatcher operated in isolation (n = 126). Case identification and direct transfer rates were compared as was time to arrival at the PTC. After cessation of the P-HEMS system the rate of case identification fell from 62 to 31 % (P < 0.001), identification of fatal cases fell from 100 to 47 % (P < 0.001), the rate of direct transfer to a PTC fell from 66 to 53 % (P = 0.076) and the time to arrival in a PTC increased from a median 69 (interquartile range 52 - 104) mins to 97 (interquartile range 56 - 305) mins (P = 0.003). When analysing the rate of direct transfer to a PTC as a function of team composition, after adjusting for age and injury severity scores, there was no change in the rate between the physician and paramedic groups across the two time periods (relative risk 0.92, 95 % CI: 0.44 to 1.41). The parallel identification system improves case identification rates and decreases time to arrival at the PTC, whilst requiring RLTC authorisation preserves the safety and efficiency benefits of centralised dispatch. The model could be extended to adult patients with similar benefits. A case identification system relying solely on RLTC paramedics resulted in a significantly lower case identification rate and increased prehospital time with a non-significant fall in direct transfer rate to the PTC. The elimination of the P-HEMS input from the tasking system resulted in worse performance indicators and has the potential for poorer outcomes.

Field Safety Notes in Product Problems of Medical Devices for Use in Pulmonology.

PubMed

Hannig, Jürgen; Siekmeier, Rüdiger

2015-01-01

The current European system for medical devices is governed by three EC directives: the Medical Device Directive 93/42/EEC, the In-Vitro Diagnostic Directive 98/79/EC and the Active Implantable Medical Device Directive 90/385/EEC and regulates marketing and post-market surveillance of medical devices in the European Economic Area. In cases of incidents and field safety corrective actions (FSCA) manufacturers have to inform the responsible Competent Authority, which is the Federal Institute for Drugs and Medical Devices (BfArM) and the public by field safety notices (FSN). In this study we analyzed FSN of medical devices exclusively serving for diagnostics or treatment in pulmonology (e.g. nebulizers, oxygen concentrators, pulse oximeters, lung function analyzers, and non-active devices for treatment). FSCA and FSN publicized by BfArM in 2005-2013 were analyzed in respect to the MEDDEV 2.12-1 rev 8. In total 41 FSCA were publicized for the included products. German and English FSN were found in 36/35 cases, respectively. FSN were clearly characterized as FSN in 22/20 cases and declaration of the type of action was found in 27/26 cases, respectively. Product names were provided in all cases. Lot numbers or other information for product characterization were available in 7/8 and 26/24 cases, respectively. Detailed information regarding FSCA and product malfunction were found in 27/33 and 36/35 cases, respectively. Information on product related risks with previous use of the affected product was provided in 24/23 cases. In 34/34 cases manufacturers provided information to mitigate product related risks. Requests to pass FSN to persons needing awareness were found in 10/14 cases. Contact data were provided in 30/30 cases. Confirmation that the Competent Authority was informed was found in 12/14 cases and in 19/18 cases a customer confirmation was included. The obtained data suggest that there is an increasing annual number of FSCA and most FSN fulfill the criteria of MEDDEV 2.12-1 rev 8. However, there are differences between German and English FSN, e.g. regarding the distribution to persons needing awareness, missing statement that the Competent Authority was informed and missing customer confirmation. Due to the importance of FSN for reduction of product related risks in FSCA type and content of FSN should be further improved.

INVESTIGATION OF HYDROLOEGROLOGIC MAPPING TO DELINEATE PROTECTION ZONES AROUND SPRINGS: REPORT OF TWO CASE STUDIES

EPA Science Inventory

Methods commonly used to delineate protection zones for water-supply wells are often not directly applicable for springs. This investigation focuses on characterization of the hydrogeologic setting using hydrogeologic mapping methods to identify geologic and hydrologic features ...

How directional mobility affects coexistence in rock-paper-scissors models

NASA Astrophysics Data System (ADS)

Avelino, P. P.; Bazeia, D.; Losano, L.; Menezes, J.; de Oliveira, B. F.; Santos, M. A.

2018-03-01

This work deals with a system of three distinct species that changes in time under the presence of mobility, selection, and reproduction, as in the popular rock-paper-scissors game. The novelty of the current study is the modification of the mobility rule to the case of directional mobility, in which the species move following the direction associated to a larger (averaged) number density of selection targets in the surrounding neighborhood. Directional mobility can be used to simulate eyes that see or a nose that smells, and we show how it may contribute to reduce the probability of coexistence.

How directional mobility affects coexistence in rock-paper-scissors models.

PubMed

Avelino, P P; Bazeia, D; Losano, L; Menezes, J; de Oliveira, B F; Santos, M A

2018-03-01

This work deals with a system of three distinct species that changes in time under the presence of mobility, selection, and reproduction, as in the popular rock-paper-scissors game. The novelty of the current study is the modification of the mobility rule to the case of directional mobility, in which the species move following the direction associated to a larger (averaged) number density of selection targets in the surrounding neighborhood. Directional mobility can be used to simulate eyes that see or a nose that smells, and we show how it may contribute to reduce the probability of coexistence.

Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: a case study.

PubMed

Harrison, Rachel; Rucklidge, Julia J; Blampied, Neville

2013-01-01

Prior research shows that micronutrients, particularly amino acids, can assist individuals with substance dependence to quit various drugs of abuse, including cannabis, alcohol, and cocaine. As part of a wider investigation of the impact of micronutrients (mostly vitamins and minerals) on psychiatric symptoms, such as Attention-Deficit/Hyperactivity Disorder (ADHD), depression, and anxiety, we observed that many participants reduced or eliminated use of alcohol, cigarettes, and cannabis. One case using a single-case reversal (off-on-off-on-off) design is presented and shows not only on-off control of psychiatric symptoms as micronutrients are consumed or withdrawn, but also simultaneous on-off use of cannabis and cigarettes, despite not directly targeting this substance use as part of the treatment protocol. This case adds to a growing body of research supporting the use of micronutrients in the treatment of psychiatric symptoms and suggests it may extend to substance dependence. Micronutrients, by assisting with mood regulation and reductions in anxiety, may assist with successful cessation of drug use. Alternatively, they may directly impact on the brain reward circuitry believed to be involved in the expression of addictions, thereby providing the appropriate precursors and cofactors necessary for adequate neurotransmitter synthesis. This case should continue to stimulate researchers to consider the role of nutrients, in particular vitamins and minerals, in drug treatment programs and encourage more rigorous trials.

Fibrinogen Demonstration in Oral Lichen Planus: An Immunofluorescence Study on Archival Tissues.

PubMed

Shirol, Pallavi D; Naik, Veena; Kale, Alka

2015-10-01

Lichen planus is a premalignant condition with minimal diagnostic aids. This study is an attempt to use paraffin embedded sections of lichen planus with immunofluorescein stain and to evaluate the immunofluorescent sections to establish pattern of fibrinogen deposition. Thirty-five paraffin embedded sections of old and new cases of oral lichen planus (study group) and five normal oral mucosa (control group) were chosen. Two sections of each (H & E) case were taken, one was stained with hematoxylin and eosin and another with fluorescein isothiocynate conjugate (FITC) polyclonal rabbit antibody against fibrinogen. Fluorescent findings were examined with a fluorescent microscope. A high statistical significant correlation was found in respect to fluorescence positivity, intensity of fluorescence and distribution of fluorescence each with p < 0.0001 and fluorescence at blood vessel walls (p = 0.0003). This study suggested that paraffin embedded sections can be successfully used in direct immunofluorescence staining in routine set up where only formalin fixed tissues are received. Paraffin embedded sections can be successfully used in direct immunofluorescence staining when only formalin fixed tissues are received.

Voice recognition products-an occupational risk for users with ULDs?

PubMed

Williams, N R

2003-10-01

Voice recognition systems (VRS) allow speech to be converted both directly into text-which appears on the screen of a computer-and to direct equipment to perform specific functions. Suggested applications are many and varied, including increasing efficiency in the reporting of radiographs, allowing directed surgery and enabling individuals with upper limb disorders (ULDs) who cannot use other input devices, such as keyboards and mice, to carry out word processing and other activities. Aim This paper describes four cases of vocal dysfunction related to the use of such software, which have been identified from the database of the Voice and Speech Laboratory of the Massachusetts Eye and Ear infirmary (MEEI). The database was searched using key words 'voice recognition' and four cases were identified from a total of 4800. In all cases, the VRS was supplied to assist individuals with ULDs who could not use conventional input devices. Case reports illustrate time of onset and symptoms experienced. The cases illustrate the need for risk assessment and consideration of the ergonomic aspects of voice use prior to such adaptations being used, particularly in those who already experience work-related ULDs.

Direct medical costs associated with rheumatoid arthritis in Turkey: analysis from National Claims Database.

PubMed

Baser, Onur; Burkan, Abdulkadir; Baser, Erdem; Koselerli, Rasim; Ertugay, Emre; Altinbas, Akif

2013-10-01

This study aimed to estimate and identify determinants of direct medical costs associated with rheumatoid arthritis (RA) in Turkey using nationwide real-world data. Using the Turkish National Health Insurance Database (2009-2011), RA patients (ages 18-99) were identified using International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes. Patients were required to have two RA diagnoses at least 60 days apart and were grouped as prevalent and incident cases. The date of the first RA claim was identified for each patient and designated as the index date. Total healthcare costs were examined over the 12-month period following the index date. Descriptive and multivariate analyses are provided. Generalized linear models were used to calculate expected annual costs for incident and prevalent RA patients after controlling for age, gender, region, comorbid conditions and medication. A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to use non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average direct annual costs were 2,000 [(1,750, 2,247) 95 % CI] for incident cases and 2,385 [(2,224, 2,545) 95 % CI] for prevalent cases, most due to pharmacy costs (73 % for incident cases, 60 % for prevalent cases). For incident and prevalent cases, a significant portion of inpatient and outpatient costs were due to physician costs (31 % for incident cases, 40 % for prevalent cases). Although the costs were not significantly different in terms of age or region, prior comorbid conditions and medication use significantly affected the cost estimation. RA total annual costs were found to be lower in Turkey, relative to estimates in Europe. The significant portion of the annual costs was due to pharmaceutical expenditures. Comparative effectiveness analysis may be useful to decrease RA-related pharmacy costs.

The impact of science teachers' epistemological beliefs on authentic inquiry: A multiple-case study

NASA Astrophysics Data System (ADS)

Jackson, Dionne Bennett

The purpose of this study was to examine how science teachers' epistemological beliefs impacted their use of authentic inquiry in science instruction. Participants in this multiple-case study included a total of four teachers who represented the middle, secondary and post-secondary levels. Based on the results of the pilot study conducted with a secondary science teacher, adjustments were made to the interview questions and observation protocol. Data collection for the study included semi-structured interviews, direct observations of instructional techniques, and the collection of artifacts. The cross case analysis revealed that the cases epistemological beliefs were mostly Transitional and the method of instruction used most was Discussion. Two of the cases exhibited consistent beliefs and instructional practices, whereas the other two exhibited beliefs beyond their instruction. The findings of this study support the literature on the influence of contextual factors and professional development on teacher beliefs and practice. The findings support and contradict literature relevant to the consistency of teacher beliefs with instruction. This study's findings revealed that the use of reform-based instruction, or Authentic Inquiry, does not occur when science teachers do not have the beliefs and experiences necessary to implement this form of instruction.

Injection characteristics study of high-pressure direct injector for Compressed Natural Gas (CNG) using experimental and analytical method

NASA Astrophysics Data System (ADS)

Taha, Z.; Rahim, MF Abdul; Mamat, R.

2017-10-01

The injection characteristics of direct injector affect the mixture formation and combustion processes. In addition, the injector is converted from gasoline operation for CNG application. Thus measurement of CNG direct injector mass flow rate was done by independently tested a single injector on a test bench. The first case investigated the effect of CNG injection pressure and the second case evaluate the effect of pulse-width of injection duration. An analytical model was also developed to predict the mass flow rate of the injector. The injector was operated in a choked condition in both the experiments and simulation studies. In case 1, it was shown that mass flow rate through the injector is affected by injection pressure linearly. Based on the tested injection pressure of 20 bar to 60 bar, the resultant mass flow rate are in the range of 0.4 g/s to 1.2 g/s which are met with theoretical flow rate required by the engine. However, in Case 2, it was demonstrated that the average mass flow rate at short injection durations is lower than recorded in Case 1. At injection pressure of 50 bar, the average mass flow rate for Case 2 and Case 1 are 0.7 g/s and 1.1 g/s respectively. Also, the measured mass flow rate at short injection duration showing a fluctuating data in the range of 0.2 g/s - 1.3 g/s without any noticeable trends. The injector model able to predict the trend of the mass flow rate at different injection pressure but unable to track the fluctuating trend at short injection duration.

Accuracy of the unified approach in maternally influenced traits - illustrated by a simulation study in the honey bee (Apis mellifera)

PubMed Central

2013-01-01

Background The honey bee is an economically important species. With a rapid decline of the honey bee population, it is necessary to implement an improved genetic evaluation methodology. In this study, we investigated the applicability of the unified approach and its impact on the accuracy of estimation of breeding values for maternally influenced traits on a simulated dataset for the honey bee. Due to the limitation to the number of individuals that can be genotyped in a honey bee population, the unified approach can be an efficient strategy to increase the genetic gain and to provide a more accurate estimation of breeding values. We calculated the accuracy of estimated breeding values for two evaluation approaches, the unified approach and the traditional pedigree based approach. We analyzed the effects of different heritabilities as well as genetic correlation between direct and maternal effects on the accuracy of estimation of direct, maternal and overall breeding values (sum of maternal and direct breeding values). The genetic and reproductive biology of the honey bee was accounted for by taking into consideration characteristics such as colony structure, uncertain paternity, overlapping generations and polyandry. In addition, we used a modified numerator relationship matrix and a realistic genome for the honey bee. Results For all values of heritability and correlation, the accuracy of overall estimated breeding values increased significantly with the unified approach. The increase in accuracy was always higher for the case when there was no correlation as compared to the case where a negative correlation existed between maternal and direct effects. Conclusions Our study shows that the unified approach is a useful methodology for genetic evaluation in honey bees, and can contribute immensely to the improvement of traits of apicultural interest such as resistance to Varroa or production and behavioural traits. In particular, the study is of great interest for cases where negative correlation between maternal and direct effects and uncertain paternity exist, thus, is of relevance for other species as well. The study also provides an important framework for simulating genomic and pedigree datasets that will prove to be helpful for future studies. PMID:23647776

Accuracy of the unified approach in maternally influenced traits--illustrated by a simulation study in the honey bee (Apis mellifera).

PubMed

Gupta, Pooja; Reinsch, Norbert; Spötter, Andreas; Conrad, Tim; Bienefeld, Kaspar

2013-05-06

The honey bee is an economically important species. With a rapid decline of the honey bee population, it is necessary to implement an improved genetic evaluation methodology. In this study, we investigated the applicability of the unified approach and its impact on the accuracy of estimation of breeding values for maternally influenced traits on a simulated dataset for the honey bee. Due to the limitation to the number of individuals that can be genotyped in a honey bee population, the unified approach can be an efficient strategy to increase the genetic gain and to provide a more accurate estimation of breeding values. We calculated the accuracy of estimated breeding values for two evaluation approaches, the unified approach and the traditional pedigree based approach. We analyzed the effects of different heritabilities as well as genetic correlation between direct and maternal effects on the accuracy of estimation of direct, maternal and overall breeding values (sum of maternal and direct breeding values). The genetic and reproductive biology of the honey bee was accounted for by taking into consideration characteristics such as colony structure, uncertain paternity, overlapping generations and polyandry. In addition, we used a modified numerator relationship matrix and a realistic genome for the honey bee. For all values of heritability and correlation, the accuracy of overall estimated breeding values increased significantly with the unified approach. The increase in accuracy was always higher for the case when there was no correlation as compared to the case where a negative correlation existed between maternal and direct effects. Our study shows that the unified approach is a useful methodology for genetic evaluation in honey bees, and can contribute immensely to the improvement of traits of apicultural interest such as resistance to Varroa or production and behavioural traits. In particular, the study is of great interest for cases where negative correlation between maternal and direct effects and uncertain paternity exist, thus, is of relevance for other species as well. The study also provides an important framework for simulating genomic and pedigree datasets that will prove to be helpful for future studies.

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs.

PubMed

Bond, William F; Kim, Minchul; Franciskovich, Chris M; Weinberg, Jason E; Svendsen, Jessica D; Fehr, Linda S; Funk, Amy; Sawicki, Robert; Asche, Carl V

2018-04-01

Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6-54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02-1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (-0.37 admissions, 95% CI -0.66 to -0.08), and inpatient days (-3.66 days, 95% CI -6.23 to -1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI -$16,207 to -$2,793). ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients.

Comparison of causality analysis on simultaneously measured fMRI and NIRS signals during motor tasks.

PubMed

Anwar, Abdul Rauf; Muthalib, Makii; Perrey, Stephane; Galka, Andreas; Granert, Oliver; Wolff, Stephan; Deuschl, Guenther; Raethjen, Jan; Heute, Ulrich; Muthuraman, Muthuraman

2013-01-01

Brain activity can be measured using different modalities. Since most of the modalities tend to complement each other, it seems promising to measure them simultaneously. In to be presented research, the data recorded from Functional Magnetic Resonance Imaging (fMRI) and Near Infrared Spectroscopy (NIRS), simultaneously, are subjected to causality analysis using time-resolved partial directed coherence (tPDC). Time-resolved partial directed coherence uses the principle of state space modelling to estimate Multivariate Autoregressive (MVAR) coefficients. This method is useful to visualize both frequency and time dynamics of causality between the time series. Afterwards, causality results from different modalities are compared by estimating the Spearman correlation. In to be presented study, we used directionality vectors to analyze correlation, rather than actual signal vectors. Results show that causality analysis of the fMRI correlates more closely to causality results of oxy-NIRS as compared to deoxy-NIRS in case of a finger sequencing task. However, in case of simple finger tapping, no clear difference between oxy-fMRI and deoxy-fMRI correlation is identified.

A systematic review of publications studies on medical tourism.

PubMed

Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

2013-01-01

Medical tourism for any study area is complex. Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists' motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism.

A systematic review of publications studies on medical tourism

PubMed Central

Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

2013-01-01

Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists’ motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. Conclusion: The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism. PMID:24251287

Product Failures in Respirators and Consumables: Analysis of Field Safety Notices of 2005-2013 Publicized by the Federal Institute for Drugs and Medical Devices in Germany.

PubMed

Hannig, Jürgen; Siekmeier, Rüdiger

2015-01-01

The current European system governed by the three EC directives 93/42/EEC (Medical Device Directive), 98/79/EC (In-Vitro Diagnostic Directive) and 90/385/EEC (Active Implantable Medical Device Directive) regulates marketing and post-market surveillance of medical devices in the European Economic Area (EEA). In cases of incidents raising the field safety corrective actions (FSCA), manufacturers have to inform the responsible Competent Authority (CA; in Germany this is the Federal Institute for Drugs and Medical Devices, BfArM) and the public by field safety notices (FSN). In this study we analyzed FSN of respirators and consumables directly required for their function, whereas devices for anesthesia and gas delivery were excluded. FSCA and FSN of 2005-2013 publicized by BfArM for the included products were analyzed with respect to the MEDDEV 2.12-1 rev. 8. In total, 60 FSCA were publicized. German and English FSN were found in 59/53 cases, respectively. FSN were clearly characterized as FSN in 44/38 cases and declaration of the type of action in 45/44 cases, respectively. Product names were provided in all cases. Lot numbers or other information for product characterization were available in 7/7 and 43/40 cases, respectively. Detailed information regarding FSCA and product malfunction was found in all cases. Information on product related risks with previous use of affected devices was provided in 42/38 cases. In 53/53 cases manufacturers provided information to mitigate product related risks. Requests to pass FSN to persons needing awareness in the organization were found in 27/24 cases. Contact data were provided in 53/48 cases, respectively. Confirmation that a CA was informed was found in 28/26 cases and in 19/15 cases a customer confirmation was included. The identified risks were: total loss of function (19/16), short circuit (1/1) and burn (3/3), and inhalation of foreign particles (1/1) which might cause severe risk to patients and users. The most frequent FSCA were product modifications and customer information. The data suggest that there is an annually increasing number of FSCA on devices included in our study. Most FSN fulfill the criteria of MEDDEV 2.12-1 rev. 8. However, there are differences between German and English FSN, e.g., regarding the distribution to persons needing awareness, missing statement that a CA was informed, and missing customer confirmation. Due to the importance of FSN for reduction of product related risks in FSCA, the type and content of FSN should be further improved.

Morbidity and Mortality Conference in Obstetrics and Gynecology: A Tool for Addressing the 6 Core Competencies

PubMed Central

Bevis, Kerri S; Straughn, J. Michael; Kendrick, James E; Walsh-Covarrubias, Julie; Kilgore, Larry C

2011-01-01

Background Residency program directors are challenged to effectively teach and assess the Accreditation Council for Graduate Medical Education's (ACGME) 6 competencies. The purpose of this study was to characterize the morbidity and mortality (M&M) conference as a cost-effective and efficient approach for addressing the ACGME competencies through evaluation of resident participation and case diversity. Methods In our modified M&M conference, senior residents submit a weekly list of cases to the conference proctors. The resident presents the case, including a critique of management, using the medical literature. The resident submits a case summary evaluating patient care practices, integrating scientific evidence, and evaluating systemic barriers to care. Completed case summaries are distributed and archived for reference. Results During a 3-year period, 30 residents presented 196 cases. Of these, 37 (19%) directly related to systems-based practice, 20 (10%) involved problems with inadequate communication, and 11 (6%) included issues of professionalism or ethics. All cases involved practice-based learning and medical knowledge. Conclusions The M&M conference addresses the core competencies through resident participation as well as directed analysis of diverse cases. PMID:22379530

Directly observed treatment short-course (DOTS) for treatment of new tuberculosis cases in Somali Regional State, Eastern Ethiopia: ten years retrospective study.

PubMed

Woldeyohannes, Desalegn; Sisay, Solomon; Mengistu, Belete; Kassa, Hiwot

2015-08-19

A third of the world population is infected with tuberculosis (TB) bacilli. TB accounts for 25% of all avoidable deaths in developing countries. The objective of the study was to assess impact of directly observed treatment short-course (DOTS) strategy on new tuberculosis case finding and treatment outcomes in Somali Regional State, Ethiopia from 2003 up to 2012 and from 2004 up to 2013, respectively. A health facility based retrospective study was employed. Quarterly reports were collected using World Health Organization (WHO) reporting format for TB case finding and treatment outcome from all zones in the region to the Federal Ministry of Health. A total of 31, 198 all types of new TB cases were registered and reported during the period from 2003 up to 2012, in the region. Out of these, smear positive pulmonary TB cases were 12,466 (40%), and 10,537 (33.8%) and 8195 (26.2%) for smear negative pulmonary TB and extra-pulmonary TB cases, respectively. An average case detection rate (CDR) of 19.1% (SD 3.6) and treatment success rate (TSR) of 85.5% (SD 5.0) for smear positive pulmonary TB were reported for the specified years period. For the overall study period, trend chi-squire analysis for CDR was X(2) = 2.1; P > 0.05 and X(2) = 5.64; P < 0.05 for TSR. The recommended TSR set by WHO was achieved (85.5%) and the CDR reported was far below (19.1%) from the recommended target. Extensive efforts should be established to maintain the achieved TSR and to increase the low CDR for the smear positive pulmonary TB cases through implementing alternative case finding strategies.

The Directed Case Method.

ERIC Educational Resources Information Center

Cliff, William H.; Curtin, Leslie Nesbitt

2000-01-01

Provides an example of a directed case on human anatomy and physiology. Uses brief real life newspaper articles and clinical descriptions of medical reference texts to describe an actual, fictitious, or composite event. Includes interrelated human anatomy and physiology topics in the scenario. (YDS)

Detection of EML4-ALK fusion gene in Chinese non-small cell lung cancer by using a sensitive quantitative real-time reverse transcriptase PCR technique.

PubMed

Fu, Sha; Wang, Fang; Shao, Qiong; Zhang, Xu; Duan, Li-Ping; Zhang, Xiao; Zhang, Li; Shao, Jian-Yong

2015-04-01

Anaplastic lymphoma kinase (ALK) rearrangement is present in approximately 5% of lung adenocarcinoma. Clinical trials on ALK inhibitor phase I to III have shown an interesting disease control rate and acceptable tolerability in ALK rearrangement patients. In clinical application, the precise diagnostic strategy for identifying ALK rearrangements remains to be determined. In this study, ALK rearrangement was screened by using quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR), direct sequencing, 2 fluorescence in situ hybridization (FISH) assays, and immunohistochemistry in 173 lung adenocarcinomas. We identified 18 cases (10.4%) with EML4-ALK fusion-positive by qRT-PCR, and all were positive for EML4-ALK fusion gene validated by direct sequencing. The result was consistent with that of other methods. Furthermore, of the 18 EML4-ALK fusion-positive cases, 16 (9.2%) were positive by using EML4-ALK fusion probe FISH, and 15 (8.7%) were positive by using ALK break-apart probe FISH and immunohistochemistry staining. Of the 18 ALK fusion-positive lung adenocarcinomas, 8 cases (44.4%) were histologically diagnosed as subtypes of cribriform adenocarcinoma, 7 cases (38.9%) as cribriform adenocarcinoma mixed with papillary and/or mucinous pattern, 2 cases (11.1%) as papillary adenocarcinoma, and 1 case (5.6%) as mucinous adenocarcinoma. In the present study, the ALK rearrangement frequency detected by qRT-PCR in Chinese NSCLC patients was higher than that in the western populations. QRT-PCR is a rapid, sensitive technology that could be used as a screening tool for identifying EML4-ALK fusion-positive NSCLC patients who would be sensitive for receiving ALK inhibitor therapy.

Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

PubMed

Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

2014-01-01

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included 1 death (0.6%) due to vagal shock; 1 transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after 3 months; 1 acute thrombus embolism and the patient was completely saved with recombinant tissue plaminogen activator (rTPA); 1 balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic. Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.

Modified directly observed treatment for tuberculosis versus self-administered therapy: an observational study in rural Greece.

PubMed

Charokopos, N; Tsiros, G; Foka, A; Voila, P; Chrysanthopoulos, K; Spiliopoulou, I; Jelastopulu, E

2013-01-01

Directly Observed Treatment (DOT) is the key element of DOTS (directly observed treatment, short course), part of the internationally recommended control strategy for tuberculosis (TB). The evaluation of DOT has not been widely evaluated in rural areas in developed settings. The aim of this pilot study was to evaluate a modified DOT program (MDOT) by a general practitioner (GP) in a rural area of southwest Greece, where there is substantial underreporting of TB cases. Thirteen new TB cases with 30 close contacts were compared with 41 past-treated TB subjects (controls) with 111 close contacts in this observational, case-control study. Home visits by a GP were conducted and comparison of various data (laboratory findings, treatment outcomes, questionnaire-based parameters, on-site recorded conditions) was performed in both newly detected pulmonary TB cases and previously treated TB cases managed without DOT intervention. MDOT by GP implementation revealed that 11 cases (84.6%) were successfully treated, one (7.7%) case died, and one (7.7%) was lost to follow up. None of the close contacts of new TB cases was infected with active TB, while 6.3% of previously-treated TB subjects were infected with active TB and had to receive a complete anti-TB regimen. Chemoprophylaxis was administered to 13.3% of close contacts of new cases; whereas 12.6% of close contacts of previously-treated patients received chemoprophylaxis. This pilot study revealed that a GP is able to implement a program based on DOT resulting in high treatment adherence and prevention of TB compared with the conventional self-administration of treatment.

Case Studies of the Vertical Structure of the Direct Shortwave Aerosol Radiative Forcing During TARFOX

NASA Technical Reports Server (NTRS)

Redemann, J.; Turco, R. P.; Liou, K. N.; Hobbs, P. V.; Hartley, W. S.; Bergstrom, R. W.; Browell, E. V.; Russell, P. B.

2000-01-01

The vertical structure of aerosol-induced radiative flux changes in the Earth's troposphere affects local heating rates and thereby convective processes, the formation and lifetime of clouds, and hence the distribution of chemical constituents. We present observationally based estimates of the vertical structure of direct shortwave aerosol radiative forcing for two case studies from the Tropospheric Aerosol Radiative Forcing Observational Experiment (TARFOX) which took place on the U.S. east coast in July 1996. The aerosol radiative forcings are computed using the Fu-Liou broadband radiative transfer model. The aerosol optical properties used in the radiative transfer simulations are calculated from independent vertically resolved estimates of the complex aerosol indices of refraction in two to three distinct vertical layers, using profiles of in situ particle size distributions measured aboard the University of Washington research aircraft. Aerosol single-scattering albedos at 450 nm thus determined range from 0.9 to 0.985, while the asymmetry factor varies from 0.6 to 0.8. The instantaneous shortwave aerosol radiative forcings derived from the optical properties of the aerosols are of the order of -36 Wm(exp -2) at the top of the atmosphere and about -56 Wm(exp -2) at the surface for both case studies.

Hemangioblastomas: histogenesis of the stromal cell studied by immunocytochemistry.

PubMed

Jurco, S; Nadji, M; Harvey, D G; Parker, J C; Font, R L; Morales, A R

1982-01-01

Twenty-one cases of hemangioblastoma from the cerebellum, spinal cord and retina were studied using the unlabeled antibody peroxidase-antiperoxidase technique with antibodies directed against glial fibrillary acidic protein (GFAP) and factor VIII related antigen (VIIIR:Ag). In 19 of 21 cases studied with anti-GFAP, astrocytes were identified peripherally, and in 13 cases they were found centrally within the tumor. In no instance did stromal cells react positively for GFAP. Sixteen cases with anti-VIIIR:Ag antibody were examined, and in all cases many stromal cells showed positive staining. It is concluded that the stromal cells were of endothelial origin. The occasional stromal cells that other investigators have identified as reacting positively for GFAP may represent stromal cells capable of ingesting extracellular GFAP derived from reactive astrocytes within the tumor, or they may be lipidized astrocytes.

[Advance euthanasia directives in dementia rarely carried out. Qualitative study in physicians and patients].

PubMed

Rurup, Mette L; Pasman, H R W Roeline; Onwuteaka-Philipsen, Bregje D

2010-01-01

To study how advance euthanasia directives (AEDs) in dementia are viewed in practice in the Netherlands. Qualitative study. In-depth interviews on nine patients with the patients themselves and/or partners and their physicians. The patients were included from a cohort of people with an AED. All interviews were done in 2006. Cases were included with different diagnoses and at different stages of dementia. Interviewed patients and their relatives had very high expectations of the feasibility of the AED. Interviewed physicians often thought of AEDs as aids in starting up a dialogue about medical decisions at the end of life, but they did not always do this in practice. Most physicians were open to adhering to AEDs in exceptional cases, on condition that the patient obviously suffered, and that communication with the patient to some extent was possible. In this study two cases were found in which adhering to the AED was seriously considered. In one case, fear of legal consequences was the only reason the physician had not adhered to the AED, while it seemed all the requirements of due care could be met. Euthanasia was not carried out in the other patient either. Several physicians mentioned the need for more detailed practical guidelines for the use of AEDs for dementia. Patients had too high expectations of AEDs. It seemed that in exceptional cases the requirements for due care for euthanasia can be met in patients with dementia with an AED. It seems advisable that more detailed practical guidelines for the use of AEDs in cases of dementia be drawn up, as a first step to more clarity for patients and physicians.

Trapped in Transition: Findings from a UK Study of Student Suicide

ERIC Educational Resources Information Center

Stanley, Nicky; Mallon, Sharon; Bell, Jo; Manthorpe, Jill

2009-01-01

This study of student suicide within UK higher education directs attention to the community context of suicide. A modified psychological autopsy approach was used to explore 20 case studies of student suicide from the period 2000-2005, drawing on the perspectives of family members, friends and university staff. The study identifies features of the…

Behavioural Intention and Pre-Service Mathematics Teachers' Technological Pedagogical Content Knowledge

ERIC Educational Resources Information Center

Gonzalez, Maria Jose; González-Ruiz, Ignacio

2017-01-01

Teachers' beliefs, together with sound technological pedagogical content knowledge (TPACK), are directly related to the effective integration of technology in mathematics teaching. This study explored the relationship between pre-service teachers' behavioural intention to use technology to teach mathematics and their TPACK. A case-study analysis…

Morphological Priming by Itself: A Study of Portuguese Conjugations

ERIC Educational Resources Information Center

Verissimo, Joao; Clahsen, Harald

2009-01-01

Does the language processing system make use of abstract grammatical categories and representations that are not directly visible from the surface form of a linguistic expression? This study examines stem-formation processes and conjugation classes, a case of "pure" morphology that provides insight into the role of grammatical structure in…

Numerical investigation of the vortex-induced vibration of an elastically mounted circular cylinder at high Reynolds number (Re = 104) and low mass ratio using the RANS code.

PubMed

Khan, Niaz Bahadur; Ibrahim, Zainah; Nguyen, Linh Tuan The; Javed, Muhammad Faisal; Jameel, Mohammed

2017-01-01

This study numerically investigates the vortex-induced vibration (VIV) of an elastically mounted rigid cylinder by using Reynolds-averaged Navier-Stokes (RANS) equations with computational fluid dynamic (CFD) tools. CFD analysis is performed for a fixed-cylinder case with Reynolds number (Re) = 104 and for a cylinder that is free to oscillate in the transverse direction and possesses a low mass-damping ratio and Re = 104. Previously, similar studies have been performed with 3-dimensional and comparatively expensive turbulent models. In the current study, the capability and accuracy of the RANS model are validated, and the results of this model are compared with those of detached eddy simulation, direct numerical simulation, and large eddy simulation models. All three response branches and the maximum amplitude are well captured. The 2-dimensional case with the RANS shear-stress transport k-w model, which involves minimal computational cost, is reliable and appropriate for analyzing the characteristics of VIV.

Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature.

PubMed

Wong, Kam Cheong

2011-03-29

Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries.In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learning settings.An Ishikawa diagram annotated with references to relevant medical cases and literature can be continually updated and can assist memory and retrieval of relevant medical cases and literature. It could also be used to cultivate a lifelong learning habit in medical professionals.

Curious chiral cases of caddisfly larvae: handed behavior, asymmetric forms, evolutionary history.

PubMed

Hinchliffe, Robert; Palmer, A R

2010-10-01

Studies of right-left asymmetries have yielded valuable insights into the mechanisms of both development and evolution. Larvae from several groups of caddisflies (Trichoptera) build portable asymmetrical cases within which they live. In nearly all species that build spiral-walled tubular cases, the direction of wall coiling is random (equal numbers of dextral and sinistral cases within species) whereas in all species that build helicospiral, snail-like cases the direction of coiling is exclusively dextral. Asymmetrical tubes result from handed behavior, and ∼20% of larvae removed from a spiral-walled, tubular case build a replacement case of opposite chirality. So handed behavior (and hence direction of tube-wall spiraling) is likely learned rather than determined genetically. Asymmetrical larval cases appear to have evolved at least seven times in the Trichoptera, five times as spiral-walled tubes and twice as snail-like helicospiral cases. Helicospiral cases may reduce vulnerability to predation by mimicking snail shells, whereas spiral arrangements of vegetation fragments in tube walls may be more robust mechanically than other arrangements, but experimental evidence is lacking. Within one family (Phryganeidae), one or perhaps two species exhibit an excess of sinistral-walled cases, suggesting that genes that bias handed behavior in a particular direction evolved after handed behaviors already existed (genetic assimilation). © The Author 2010. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved.

Size and consistency of problem-solving consultation outcomes: an empirical analysis.

PubMed

Hurwitz, Jason T; Kratochwill, Thomas R; Serlin, Ronald C

2015-04-01

In this study, we analyzed extant data to evaluate the variability and magnitude of students' behavior change outcomes (academic, social, and behavioral) produced by consultants through problem-solving consultation with teachers. Research questions were twofold: (a) Do consultants produce consistent and sizeable positive student outcomes across their cases as measured through direct and frequent assessment? and (b) What proportion of variability in student outcomes is attributable to consultants? Analyses of extant data collected from problem-solving consultation outcome studies that used single-case, time-series AB designs with multiple participants were analyzed. Four such studies ultimately met the inclusion criteria for the extant data, comprising 124 consultants who worked with 302 school teachers regarding 453 individual students. Consultants constituted the independent variable, while the primary dependent variable was a descriptive effect size based on student behavior change as measured by (a) curriculum-based measures, (b) permanent products, or (c) direct observations. Primary analyses involved visual and statistical evaluation of effect size magnitude and variability observed within and between consultants and studies. Given the nested nature of the data, multilevel analyses were used to assess consultant effects on student outcomes. Results suggest that consultants consistently produced positive effect sizes on average across their cases, but outcomes varied between consultants. Findings also indicated that consultants, teachers, and the corresponding studies accounted for a significant proportion of variability in student outcomes. This investigation advances the use of multilevel and integrative data analyses to evaluate consultation outcomes and extends research on problem-solving consultation, consultant effects, and meta-analysis of case study AB designs. Practical implications for evaluating consultation service delivery in school settings are also discussed. Copyright © 2015 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

RESEARCH: Theory in Practice: Applying Participatory Democracy Theory to Public Land Planning

PubMed

Moote; Mcclaran; Chickering

1997-11-01

/ Application of participatory democracy theory to public participation in public land planning, while widely advocated, has not been closely examined. A case study is used here to explicate the application of participatory democracy concepts to public participation in public land planning and decision making. In this case, a Bureau of Land Management resource area manager decided to make a significant shift from the traditional public involvement process to a more participatory method-coordinated resource management (CRM). This case was assessed using document analysis, direct observation of CRM meetings, questionnaires, and interviews of key participants. These sources were used to examine the CRM case using participatory democracy concepts of efficacy, access and representation, continuous participation throughout planning, information exchange and learning, and decision-making authority. The case study suggests that social deliberation in itself does not ensure successful collaboration and that establishing rules of operation and decision making within the group is critical. Furthermore, conflicts between the concept of shared decision-making authority and the public land management agencies' accountability to Congress, the President, and the courts need further consideration.KEY WORDS: Case study; Coordinated resource management; Public participation; Administrative discretion; Representation; Consensus; Collaboration

Warpage optimization on a mobile phone case using response surface methodology (RSM)

NASA Astrophysics Data System (ADS)

Lee, X. N.; Fathullah, M.; Shayfull, Z.; Nasir, S. M.; Hazwan, M. H. M.; Shazzuan, S.

2017-09-01

Plastic injection moulding is a popular manufacturing method not only it is reliable, but also efficient and cost saving. It able to produce plastic part with detailed features and complex geometry. However, defects in injection moulding process degrades the quality and aesthetic of the injection moulded product. The most common defect occur in the process is warpage. Inappropriate process parameter setting of injection moulding machine is one of the reason that leads to the occurrence of warpage. The aims of this study were to improve the quality of injection moulded part by investigating the optimal parameters in minimizing warpage using Response Surface Methodology (RSM). Subsequent to this, the most significant parameter was identified and recommended parameters setting was compared with the optimized parameter setting using RSM. In this research, the mobile phone case was selected as case study. The mould temperature, melt temperature, packing pressure, packing time and cooling time were selected as variables whereas warpage in y-direction was selected as responses in this research. The simulation was carried out by using Autodesk Moldflow Insight 2012. In addition, the RSM was performed by using Design Expert 7.0. The warpage in y direction recommended by RSM were reduced by 70 %. RSM performed well in solving warpage issue.

Self-Service and E-Education: The Relationship to Self-Directed Learning

NASA Astrophysics Data System (ADS)

Wells, Marilyn A.; Brook, Phillip W. J.

Self-service via the Internet is becoming a common method of selling goods or services as customers have access to retailers’ websites whenever the “need” takes them. Higher education institutions are increasingly offering e-education which means that traditional teaching methods need modifying. Traditional teaching often consists of presenting and expanding upon material found in a prescribed text and delivering this content in lecture, seminar or workshop mode. Studies have confirmed that students learn more effectively when they can discuss the material with others and treat learning as a collaborative process. This chapter reports a case study, where students were required to decide on their level of involvement, discuss and propose the criteria for assessment evaluation, share ideas, concepts and understanding amongst themselves: in effect, self-directed learning. The learning environment used computer-mediated tools, such as discussion forums and chat rooms, and the case study assesses both the expectations of the teaching staff and the experiences of the students, and relates the outcomes to self-directed learning in a self-service environment.

Noninvasive diagnosis of fetal aneuploidy by shotgun sequencing DNA from maternal blood

PubMed Central

Fan, H. Christina; Blumenfeld, Yair J.; Chitkara, Usha; Hudgins, Louanne; Quake, Stephen R.

2008-01-01

We directly sequenced cell-free DNA with high-throughput shotgun sequencing technology from plasma of pregnant women, obtaining, on average, 5 million sequence tags per patient sample. This enabled us to measure the over- and underrepresentation of chromosomes from an aneuploid fetus. The sequencing approach is polymorphism-independent and therefore universally applicable for the noninvasive detection of fetal aneuploidy. Using this method, we successfully identified all nine cases of trisomy 21 (Down syndrome), two cases of trisomy 18 (Edward syndrome), and one case of trisomy 13 (Patau syndrome) in a cohort of 18 normal and aneuploid pregnancies; trisomy was detected at gestational ages as early as the 14th week. Direct sequencing also allowed us to study the characteristics of cell-free plasma DNA, and we found evidence that this DNA is enriched for sequences from nucleosomes. PMID:18838674

Schramm-Loewner (SLE) analysis of quasi two-dimensional turbulent flows

NASA Astrophysics Data System (ADS)

Thalabard, Simon

2012-02-01

Quasi two-dimensional turbulence can be observed in several cases: for example, in the laboratory using liquid soap films, or as the result of a strong imposed rotation as obtained in three-dimensional large direct numerical simulations. We study and contrast SLE properties of such flows, in the former case in the inverse cascade of energy to large scale, and in the latter in the direct cascade of energy to small scales in the presence of a fully-helical forcing. We thus examine the geometric properties of these quasi 2D regimes in the context of stochastic geometry, as was done for the 2D inverse cascade by Bernard et al. (2006). We show that in both cases the data is compatible with self-similarity and with SLE behaviors, whose different diffusivities can be heuristically determined.

The Business Case for Provider Participation in Clinical Trials Research: An Application to the National Cancer Institute's Community Clinical Oncology Program

PubMed Central

Song, Paula H.; Reiter, Kristin L.; Weiner, Bryan J.; Minasian, Lori; McAlearney, Ann Scheck

2012-01-01

Background Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions. Purpose This study explores whether providers believe there is a business case for participating in PBRNs and what factors contribute to the business case. Methodology/Approach We use a multiple case study methodology approach to examine the National Cancer Institute's Community Clinical Oncology Program, a longstanding federally funded PBRN. Interviews with 41 key informants across five sites, selected on the basis of organizational maturity, were conducted using a semi-structured interview guide. We analyzed interview transcripts using an iterative, deductive process to identify themes and subthemes in the data. Findings We found that a business case for provider participation in PBRNs may exist if both direct and indirect financial benefits are identified and included in the analysis, and if the time horizon is long enough to allow those benefits to be realized. We identified specific direct and indirect financial benefits that were perceived as important contributors to the business case and the perceived length of time required for a positive return to accrue. Practice Implications As the lack of a business case may result in provider reluctance to participate in PBRNs, knowledge of the benefits we identified may be crucial to encouraging and sustaining participation, thereby preserving patient access to innovative community-based treatments. The results are also relevant to federally-funded PBRNs outside of oncology or to providers considering participation in any clinical trials research. PMID:23044836

Tool to assess causality of direct and indirect adverse events associated with therapeutic interventions.

PubMed

Zorzela, Liliane; Mior, Silvano; Boon, Heather; Gross, Anita; Yager, Jeromy; Carter, Rose; Vohra, Sunita

2018-03-01

To develop and test a tool to assess the causality of direct and indirect adverse events associated with therapeutic interventions. The intervention was one or more drugs and/or natural health products, a device, or practice (professional delivering the intervention). Through the assessment of causality of adverse events, we can learn about factors contributing to the harm and consider what modification may prevent its reoccurrence. Existing scales (WHO-UMC, Naranjo and Horn) were adapted to develop a tool (algorithm and table) to evaluate cases of serious harmful events reported through a national surveillance study. We also incorporated a novel approach that assesses indirect harm (caused by the delay in diagnosis/treatment) and the health provider delivering the intervention (practice). The tool was tested, revised and then implemented to assess all reported cases of serious events resulting from use of complementary therapies. The use of complementary therapies was the trigger to report the event. Each case was evaluated by two assessors, out of a panel of five, representing different health care professionals. The tool was used in assessment of eight serious adverse events. Each event was independently evaluated by two assessors. The algorithm facilitated assessment of a serious direct or indirect harm. Assessors agreed in the final score on seven of eight cases (weighted kappa coefficient of 0.75). A tool to support the assessment of causality of adverse events was developed and tested. We propose a novel method to assess direct and indirect harms related to product(s), device(s), practice or a combination of the previous. Further research will probably help evaluate this approach across different settings and interventions.

Reinforcement learning: Solving two case studies

NASA Astrophysics Data System (ADS)

Duarte, Ana Filipa; Silva, Pedro; dos Santos, Cristina Peixoto

2012-09-01

Reinforcement Learning algorithms offer interesting features for the control of autonomous systems, such as the ability to learn from direct interaction with the environment, and the use of a simple reward signalas opposed to the input-outputs pairsused in classic supervised learning. The reward signal indicates the success of failure of the actions executed by the agent in the environment. In this work, are described RL algorithmsapplied to two case studies: the Crawler robot and the widely known inverted pendulum. We explore RL capabilities to autonomously learn a basic locomotion pattern in the Crawler, andapproach the balancing problem of biped locomotion using the inverted pendulum.

Single-Case Design Research: Building the Evidence-Base in the Field of Education of Deaf and Hard of Hearing Students

ERIC Educational Resources Information Center

Cannon, Joanna E.; Guardino, Caroline; Antia, Shirin D.; Luckner, John L.

2015-01-01

The field of education of deaf and hard of hearing (DHH) students has a paucity of evidence-based practices (EBPs) to guide instruction. The authors discussed how the research methodology of single-case design (SCD) can be used to build EBPs through direct and systematic replication of studies. An overview of SCD research methods is presented,…

Direct and indirect determination of electrocaloric effect in Na0.5Bi0.5TiO3

NASA Astrophysics Data System (ADS)

Birks, E.; Dunce, M.; Peräntie, J.; Hagberg, J.; Sternberg, A.

2017-06-01

Direct and indirect studies of the electrocaloric effect were carried out in poled and depoled Na0.5Bi0.5TiO3. For this purpose, polarization and electrocaloric effect temperature change measurements were made at different electric field pulses as a function of temperature. The applicability of the widely used indirect electrocaloric effect determination method, using the Maxwell relation, was critically analyzed with respect to the reliable direct measurements. Quantitative differences were observed between the results obtained by both approaches in the case of the poled Na0.5Bi0.5TiO3 sample. These differences can be explained by the temperature-dependent concentration of domains oriented in the direction of the applied electric field. Whereas in depoled Na0.5Bi0.5TiO3, which is characterized by the electric field dependence of polar nanoregions embedded in a nonpolar matrix, the Maxwell relation is not applicable at all, as it is indicated by the obtained results. Possible mechanisms which could be responsible for the electrocaloric effect in the relaxor state were considered. The results of this study are used to evaluate the numerous results obtained and published by other authors, using the Maxwell relation to indirectly determine the electrocaloric effect. The reason for the negative values of the electrocaloric effect, obtained in such a way and widely discussed in the literature in the case of Na0.5Bi0.5TiO3, has been explained in this study.

Molecular Epidemiological Survey of Cutaneous Leishmaniasis in Two Highly Endemic Metropolises of Iran, Application of FTA Cards for DNA Extraction From Giemsa-Stained Slides

PubMed Central

Izadi, Shahrokh; Mirhendi, Hossein; Jalalizand, Niloufar; Khodadadi, Hossein; Mohebali, Mehdi; Nekoeian, Shahram; Jamshidi, Ali; Ghatee, Mohammad Amin

2016-01-01

Background: PCR has been used for confirmation of leishmaniasis in epidemiological studies, but complexity of DNA extraction and PCR approach has confined its routine use in developing countries. Objectives: In this study, recent epidemiological situation of cutaneous leishmaniasis (CL) in two hyper-endemic metropolises of Shiraz and Isfahan in Iran was studied using DNA extraction by commercial FTA cards and kinetoplastid DNA (kDNA)-PCR amplification for detection/identification of Leishmania directly from stained skin scraping imprints. Patients and Methods: Fifty four and 30 samples were collected from clinically diagnosed CL patients referred to clinical laboratories of leishmaniasis control centers in Isfahan and Shiraz cities, respectively. The samples were examined by direct microscopy and then scrapings of the stained smears were applied to FTA cards and used directly as DNA source in a nested-PCR to amplify kDNA to detect and identify Leishmania species. Results: Fifty four of 84 (64.2%) slides obtained from patients had positive results microscopically, while 79/84 (94%) of slides had positive results by FTA card-nested-PCR. PCR and microscopy showed a sensitivity of 96.4% and 64.2% and specificity of 100% and 100%, respectively. Interestingly, Leishmania major as causative agent of zoonotic CL was identified in 100% and 90.7% of CL cases from Isfahan and Shiraz cities, respectively, but L. tropica was detected from only 9.3% of cases from Shiraz city. All cases from central regions of Shiraz were L. tropica and no CL case was found in Isfahan central areas. Conclusions: Filter paper-based DNA extraction can facilitate routine use of PCR for diagnosis of CL in research and diagnostic laboratories in Iran and countries with similar conditions. Epidemiologic changes including dominancy of L. major in suburbs of Shiraz and Isfahan metropolises where anthroponotic CL caused by L. tropica had been established, showed necessity of precise studies on CL epidemiology in old urban and newly added districts in the suburbs. PMID:27127596

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients.

PubMed

Spiliopoulos, Stavros; Kitrou, Panagiotis; Christeas, Nikolaos; Karnabatidis, Dimitris

2016-01-01

Direct superficial femoral artery (SFA) antegrade puncture is a valid alternative to common femoral artery (CFA) access for peripheral vascular interventions. Data investigating vascular closure device (VCD) hemostasis of distant SFA 6F access are limited. We aimed to investigate the safety and effectiveness of the Starclose SE® VCD for hemostasis, following direct 6F antegrade SFA access distal to the femoral head. This prospective, single-center study included patients who were not suitable for CFA puncture and were scheduled to undergo peripheral endovascular interventions using direct antegrade SFA 6F access, at least 2 cm below the inferior edge of femoral head. Hemostasis was obtained with the Starclose SE® VCD (Abbott Laboratories). Primary endpoints were successful hemostasis rate and periprocedural (30-day) major complication rate. Secondary endpoint was the rate of minor complications. Clinical and Doppler ultrasound follow-up was performed at discharge and at one month. Between September 2014 and August 2015, a total of 30 patients (21 male; 70.0%) with a mean body mass index of 41.2 kg/m2 were enrolled. Mean age was 72±9 years (range, 67-88 years). Most patients suffered from critical limb ischemia (87.1%) and diabetes (61.3%). Calcifications were present in eight cases (26.6%). Reason for direct SFA puncture was obesity (100%). Successful hemostasis was achieved in 100% of the cases. No major complications were noted after one-month follow-up. Minor complications included two <5 cm hematomas (6.6%) not necessitating treatment. In this prospective study, Starclose SE® VCD was safe and effective for hemostasis of antegrade direct SFA puncture. Uncomplicated hemostasis was achieved even in cases of puncturing 2 to 7 cm below the inferior edge of the femoral head.

Using surveys as input to comprehensive watershed management: a case study from Minnesota.

Treesearch

Tim Kelly; Ron Sushak

1996-01-01

As a compliment to direct citizen participation, the Minnesota Department of Natural Resources used a survey of area landowners to help inform its comprehensive watershed management initiative. Results from the survey have been useful to resource managers and area residents as they carry out this planning effort.

INVESTIGATION OF HYDROGEOLOGIC MAPPING TO DELINEATE PROTECTION ZONES AROUND SPRINGS: REPORT OF TWO CASE STUDIES

EPA Science Inventory

Methods commonly used to delineate protection zones for water-supply wells are often not directly applicable for springs. This investigation focuses on the use of hydrogeologic mapping methods to identify physical and hydrologic features that control ground-water flow to springs...

A collective case study of nursing students with learning disabilities.

PubMed

Kolanko, Kathrine M

2003-01-01

This collective case study described the meaning of being a nursing student with a learning disability and examined how baccalaureate nursing students with learning disabilities experienced various aspects of the nursing program. It also examined how their disabilities and previous educational and personal experiences influenced the meaning that they gave to their educational experiences. Seven nursing students were interviewed, completed a demographic data form, and submitted various artifacts (test scores, evaluation reports, and curriculum-based material) for document analysis. The researcher used Stake's model for collective case study research and analysis (1). Data analysis revealed five themes: 1) struggle, 2) learning how to learn with LD, 3) issues concerning time, 4) social support, and 5) personal stories. Theme clusters and individual variations were identified for each theme. Document analysis revealed that participants had average to above average intellectual functioning with an ability-achievement discrepancy among standardized test scores. Participants noted that direct instruction, structure, consistency, clear directions, organization, and a positive instructor attitude assisted learning. Anxiety, social isolation from peers, and limited time to process and complete work were problems faced by the participants.

Can value-based insurance impose societal costs?

PubMed

Koenig, Lane; Dall, Timothy M; Ruiz, David; Saavoss, Josh; Tongue, John

2014-09-01

Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA). Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes. We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study. We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA. We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Performance analysis of a SOFC under direct internal reforming conditions

NASA Astrophysics Data System (ADS)

Janardhanan, Vinod M.; Heuveline, Vincent; Deutschmann, Olaf

This paper presents the performance analysis of a planar solid-oxide fuel cell (SOFC) under direct internal reforming conditions. A detailed solid-oxide fuel cell model is used to study the influences of various operating parameters on cell performance. Significant differences in efficiency and power density are observed for isothermal and adiabatic operational regimes. The influence of air number, specific catalyst area, anode thickness, steam to carbon (s/c) ratio of the inlet fuel, and extend of pre-reforming on cell performance is analyzed. In all cases except for the case of pre-reformed fuel, adiabatic operation results in lower performance compared to isothermal operation. It is further discussed that, though direct internal reforming may lead to cost reduction and increased efficiency by effective utilization of waste heat, the efficiency of the fuel cell itself is higher for pre-reformed fuel compared to non-reformed fuel. Furthermore, criteria for the choice of optimal operating conditions for cell stacks operating under direct internal reforming conditions are discussed.

Mode of action from dose-response microarray data: case study using 10 environmental chemicals

EPA Science Inventory

Ligand-activated nuclear receptors regulate many biological processes through complex interactions with biological macromolecules. Certain xenobiotics alter nuclear receptor signaling through direct or indirect interactions. Defining the mode of action of such xenobiotics is di...

Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery.

PubMed

Kwak, Han Deok; Kim, Seon-Hahn; Seo, Yeon Seok; Song, Ki-Joon

2016-12-01

Hepatitis B virus (HBV) transmission is known to occur through direct contact with infected blood. There has been some suspicion that the virus can also be detected in aerosol form. However, this has never been directly shown. The purpose of this study was to sample and analyse surgical smoke from laparoscopic surgeries on patients with hepatitis B to determine whether HBV is present. A total of 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in this study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analysed by using nested PCR. Robotic or laparoscopic colorectal resections were performed in 5 cases, laparoscopic gastrectomies in 3 cases and laparoscopic hepatic wedge resections in another 3 cases. Preoperatively, all of the patients had positive hepatitis B surface antigen (HBsAg). 2 patients had detectable HBsAb, and 2 were positive for hepatitis B e antigen. 3 patients were taking antihepatitis B viral medications at the time of the study. The viral load measured in the patients' blood was undetectable to 1.7×10 8  IU/mL. HBV was detected in surgical smoke in 10 of the 11 cases. HBV is detectable in surgical smoke. This study provides preliminary data in the investigation of airborne HBV infection. 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/.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals.

PubMed

Lima, Antônio Fernandes Costa

2017-04-01

to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Hospital C presented the highest mean direct cost (BRL 184.52), 5.23 times greater than the value for Hospital A (BRL 35.29) and 3.91 times greater than Hospital B (BRL 47.22). the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

Today's Urban University Students: Part 2. A Case Study of Hunter College. Final Report on the Urban University Study.

ERIC Educational Resources Information Center

Davila, Evelyn M.

Characteristics and needs of Hunter College students were studied during 1981-1983. The college's use of institutional research to accommodate an increasingly nontraditional student body was also assessed. Attention was directed to: the student population's ethnicity, income, and employment; students' academic experiences; times of day most…

Case conceptualization research in cognitive behavior therapy: A state of the science review.

PubMed

Easden, Michael H; Kazantzis, Nikolaos

2018-03-01

Prominent models of cognitive behavior therapy (CBT) assert that case conceptualization is crucial for tailoring interventions to adequately address the needs of the individual client. We aimed to review the research on case conceptualization in CBT. We conducted a systematic search of PsychINFO, MEDLINE, Psychology and Behavioral Science Collection, and CINAHL databases to February 2016. A total of 24 studies that met inclusion criteria were identified. It was notable that studies (a) focused on the assessment function of case conceptualization, (b) employed diverse methodologies, and, overall, (c) there remains a paucity of studies examining the in-session process of using case conceptualization or examining relations with outcome. Results from the existing studies suggest that experienced therapists can reliably construct some elements of case conceptualizations, but importance for the efficacy of case conceptualization in CBT has yet to be demonstrated. Research that involves direct observation of therapist competence in case conceptualization as a predictor of CBT outcomes is recommended as a focus for future hypothesis testing. © 2017 Wiley Periodicals, Inc.

To Clone or Not To Clone: Method Analysis for Retrieving Consensus Sequences In Ancient DNA Samples

PubMed Central

Winters, Misa; Barta, Jodi Lynn; Monroe, Cara; Kemp, Brian M.

2011-01-01

The challenges associated with the retrieval and authentication of ancient DNA (aDNA) evidence are principally due to post-mortem damage which makes ancient samples particularly prone to contamination from “modern” DNA sources. The necessity for authentication of results has led many aDNA researchers to adopt methods considered to be “gold standards” in the field, including cloning aDNA amplicons as opposed to directly sequencing them. However, no standardized protocol has emerged regarding the necessary number of clones to sequence, how a consensus sequence is most appropriately derived, or how results should be reported in the literature. In addition, there has been no systematic demonstration of the degree to which direct sequences are affected by damage or whether direct sequencing would provide disparate results from a consensus of clones. To address this issue, a comparative study was designed to examine both cloned and direct sequences amplified from ∼3,500 year-old ancient northern fur seal DNA extracts. Majority rules and the Consensus Confidence Program were used to generate consensus sequences for each individual from the cloned sequences, which exhibited damage at 31 of 139 base pairs across all clones. In no instance did the consensus of clones differ from the direct sequence. This study demonstrates that, when appropriate, cloning need not be the default method, but instead, should be used as a measure of authentication on a case-by-case basis, especially when this practice adds time and cost to studies where it may be superfluous. PMID:21738625

SU-F-T-192: Study of Robustness Analysis Method of Multiple Field Optimized IMPT Plans for Head & Neck Patients

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

Li, Y; Wang, X; Li, H

Purpose: Proton therapy is more sensitive to uncertainties than photon treatments due to protons’ finite range depending on the tissue density. Worst case scenario (WCS) method originally proposed by Lomax has been adopted in our institute for robustness analysis of IMPT plans. This work demonstrates that WCS method is sufficient enough to take into account of the uncertainties which could be encountered during daily clinical treatment. Methods: A fast and approximate dose calculation method is developed to calculate the dose for the IMPT plan under different setup and range uncertainties. Effects of two factors, inversed square factor and range uncertainty,more » are explored. WCS robustness analysis method was evaluated using this fast dose calculation method. The worst-case dose distribution was generated by shifting isocenter by 3 mm along x,y and z directions and modifying stopping power ratios by ±3.5%. 1000 randomly perturbed cases in proton range and x, yz directions were created and the corresponding dose distributions were calculated using this approximated method. DVH and dosimetric indexes of all 1000 perturbed cases were calculated and compared with the result using worst case scenario method. Results: The distributions of dosimetric indexes of 1000 perturbed cases were generated and compared with the results using worst case scenario. For D95 of CTVs, at least 97% of 1000 perturbed cases show higher values than the one of worst case scenario. For D5 of CTVs, at least 98% of perturbed cases have lower values than worst case scenario. Conclusion: By extensively calculating the dose distributions under random uncertainties, WCS method was verified to be reliable in evaluating the robustness level of MFO IMPT plans of H&N patients. The extensively sampling approach using fast approximated method could be used in evaluating the effects of different factors on the robustness level of IMPT plans in the future.« less

Large fraction of crystal directions leads to ion channeling

NASA Astrophysics Data System (ADS)

Nordlund, K.; Djurabekova, F.; Hobler, G.

2016-12-01

It is well established that when energetic ions are moving in crystals, they may penetrate much deeper if they happen to be directed in some specific crystal directions. This `channeling' effect is utilized for instance in certain ion beam analysis methods and has been described by analytical theories and atomistic computer simulations. However, there have been very few systematic studies of channeling in directions other than the principal low-index ones. We present here a molecular dynamics-based approach to calculate ion channeling systematically over all crystal directions, providing ion `channeling maps' that easily show in which directions channeling is expected. The results show that channeling effects can be quite significant even at energies below 1 keV, and that in many cases, significant planar channeling occurs also in a wide range of crystal directions between the low-index principal ones. In all of the cases studied, a large fraction (˜20 -60 % ) of all crystal directions show channeling. A practical implication of this is that modern experiments on randomly oriented nanostructures will have a large probability of channeling. It also means that when ion irradiations are carried out on polycrystalline samples, channeling effects on the results cannot a priori be assumed to be negligible. The maps allow for easy selection of good `nonchanneling' directions in experiments or alternatively finding wide channels for beneficial uses of channeling. We implement channeling theory to also give the fraction of channeling directions in a manner directly comparable to the simulations. The comparison shows good qualitative agreement. In particular, channeling theory is very good at predicting which channels are active at a given energy. This is true down to sub-keV energies, provided the penetration depth is not too small.

Chronic urinary tract infection and bladder carcinoma risk: a meta-analysis of case-control and cohort studies.

PubMed

Akhtar, Saeed; Al-Shammari, Ahmad; Al-Abkal, Jarrah

2018-02-05

This meta-analysis of published case-control and cohort studies sought to quantify the magnitude and direction of association between chronic UTI (defined as the infection of the urinary tract that either does not respond to treatment or keeps recurring) and risk of bladder carcinoma (BCa) (i.e., including mainly urothelial carcinoma, squamous cell carcinoma or adenocarcinoma). A literature search was conducted using Medline, Embase, Ovid, Web of Science, Science Direct and Cochrane Library, which was supplemented with manual search of reference lists of the identified articles. Case-control and cohort studies examining UTI as a predictor of BCa risk published through June 2016 were eligible. Using random-effects models, odds ratios (OR) or relative risks (RR) from eligible studies were combined to synthesize summary effect estimates. The included studies were assessed for methodological quality and potential publication bias. Heterogeneity by study characteristics was examined by sub-group and meta-regression analyses. Eighteen case-control and three cohort studies published between 1963 and 2016 were eligible. Random-effects models showed that UTI was significantly associated with an increased BCa risk both in case-control studies (summary OR RE  = 2.33; 95% CI 1.86, 2.92) and cohort studies (summary RR RE  = 2.88; 95% CI 1.20, 6.89). The observed relationship of UTI with an increased BCa risk was independent of the study characteristics considered. No significant publication bias was detected. Chronic UTI was significantly and independently associated with an increased BCa risk. However, due to the presence of high between-study heterogeneity and inconsistent patterns of adjusted confounding effects, more data are needed to clarify the role of chronic UTI in causation of BCa and if established, prompt and effective treatment of UTI may minimize a substantial proportion of BCa risk.

Nursing home case mix in Wisconsin. Findings and policy implications.

PubMed

Arling, G; Zimmerman, D; Updike, L

1989-02-01

Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time.

Expert Qualifications in Japan: The Role of Higher Education

ERIC Educational Resources Information Center

Saito, Kiyoko

2018-01-01

The goal of this paper was to explore the directions for a Japanese Qualifications Framework (JQF) through the collation of Japanese Government expert viewpoints. This study used a qualitative case study design involving interviews with 15 Japanese government officials. It was found that Japan continues to have problems with academic degrees and…

Profile of a Museum Registrar: CASE Research Project 7-78.

ERIC Educational Resources Information Center

Hoachlander, Marjorie E.

This book represents the first independent research study directed toward the educational needs and interests of museum registrars to be undertaken by a university in collaboration with a nationally recognized museum. The study's primary objective was to provide data to be used for the development of materials and methods in the training and…

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

PubMed

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Reciprocity in directed networks

NASA Astrophysics Data System (ADS)

Yin, Mei; Zhu, Lingjiong

2016-04-01

Reciprocity is an important characteristic of directed networks and has been widely used in the modeling of World Wide Web, email, social, and other complex networks. In this paper, we take a statistical physics point of view and study the limiting entropy and free energy densities from the microcanonical ensemble, the canonical ensemble, and the grand canonical ensemble whose sufficient statistics are given by edge and reciprocal densities. The sparse case is also studied for the grand canonical ensemble. Extensions to more general reciprocal models including reciprocal triangle and star densities will likewise be discussed.

Heteroscedasticity as a Basis of Direction Dependence in Reversible Linear Regression Models.

PubMed

Wiedermann, Wolfgang; Artner, Richard; von Eye, Alexander

2017-01-01

Heteroscedasticity is a well-known issue in linear regression modeling. When heteroscedasticity is observed, researchers are advised to remedy possible model misspecification of the explanatory part of the model (e.g., considering alternative functional forms and/or omitted variables). The present contribution discusses another source of heteroscedasticity in observational data: Directional model misspecifications in the case of nonnormal variables. Directional misspecification refers to situations where alternative models are equally likely to explain the data-generating process (e.g., x → y versus y → x). It is shown that the homoscedasticity assumption is likely to be violated in models that erroneously treat true nonnormal predictors as response variables. Recently, Direction Dependence Analysis (DDA) has been proposed as a framework to empirically evaluate the direction of effects in linear models. The present study links the phenomenon of heteroscedasticity with DDA and describes visual diagnostics and nine homoscedasticity tests that can be used to make decisions concerning the direction of effects in linear models. Results of a Monte Carlo simulation that demonstrate the adequacy of the approach are presented. An empirical example is provided, and applicability of the methodology in cases of violated assumptions is discussed.

Detection of antibiotic resistance genes in samples from acute and chronic endodontic infections and after treatment.

PubMed

Rôças, Isabela N; Siqueira, José F

2013-09-01

The purpose of this study was twofold: survey samples from acute and chronic endodontic infections for the presence of genes encoding resistance to beta-lactams, tetracycline and erythromycin, and evaluate the ability of treatment to eliminate these genes from root canals. DNA extracts from samples of abscess aspirates (n=25) and root canals of teeth with asymptomatic apical periodontitis (n=24) were used as template for direct detection of the genes blaTEM, cfxA, tetM, tetQ, tetW, and ermC using real-time polymerase chain reaction (PCR). Bacterial presence was determined using PCR with universal bacterial primers. Root canals of the asymptomatic cases were also sampled and evaluated after chemomechanical procedures using NiTi instruments with 2.5% NaOCl irrigation. All abscess and initial root canal samples were positive for bacteria. At least one of the target resistance genes was found in 36% of the abscess samples and 67% of the asymptomatic cases. The most prevalent genes in abscesses were blaTEM (24%) and ermC (24%), while tetM (42%) and tetW (29%) prevailed in asymptomatic cases. The blaTEM gene was significantly associated with acute cases (p=0.02). Conversely, tetM was significantly more prevalent in asymptomatic cases (p=0.008). Treatment eliminated resistance genes from most cases. Acute and chronic endodontic infections harboured resistance genes for 3 classes of widely used antibiotics. In most cases, treatment was effective in eliminating these genes, but there were a few cases in which they persisted. The implications of persistence are unknown. Direct detection of resistance genes in abscesses may be a potential method for rapid diagnosis and establishment of proactive antimicrobial therapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Space Technology: A study of the significance of recognition for innovators of spinoff technologies. A case study on the impact of the space technology hall of fame award

NASA Technical Reports Server (NTRS)

1993-01-01

This report represents the preliminary effort in studying the significance of recognition for innovators of spinoff technologies. The purpose of this initial year's effort in this area was to gather preliminary data and define the direction for the remainder of the research. This report focuses on the most recent recipients of the Hall of Fame Award, the developers of liquid-cooled garments. Liquid-cooled garments technology and its spinoffs were used as a case study to define and explore the factors involved in technology transfer and to consider the possible incentives in developing commercial applications including the Hall of Fame Award. Through interviews, views of award recipients were obtained on factors encouraging spinoffs as well as impediments to spinoffs. The researchers observed complex inter-relationships among the significant entities (government, individuals, large and small business), the importance of people, the importance of resource availability, and the significance of intrinsic motivation; drew preliminary conclusions pertaining to the direct and indirect influence of recognition like the Hall of Fame Award; and planned the direction for next year's follow-on research.

Modelling climate change impacts on tourism demand: A comparative study from Sardinia (Italy) and Cap Bon (Tunisia).

PubMed

Köberl, Judith; Prettenthaler, Franz; Bird, David Neil

2016-02-01

Tourism represents an important source of income and employment in many Mediterranean regions, including the island of Sardinia (Italy) and the Cap Bon peninsula (Tunisia). Climate change may however impact tourism in both regions, for example, by altering the regions' climatic suitability for common tourism types or affecting water availability. This paper assesses the potential impacts of climate change on tourism in the case study regions of Sardinia and Cap Bon. Direct impacts are studied in a quantitative way by applying a range of climate scenario data on the empirically estimated relationship between climatic conditions and tourism demand, using two different approaches. Results indicate a potential for climate-induced tourism revenue gains especially in the shoulder seasons during spring and autumn, but also a threat of climate-induced revenue losses in the summer months due to increased heat stress. Annual direct net impacts are nevertheless suggested to be (slightly) positive in both case study regions. Significant climate-induced reductions in total available water may however somewhat counteract the positive direct impacts of climate change by putting additional water costs on the tourism industry. Copyright © 2015 Elsevier B.V. All rights reserved.

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

PubMed

Khan, M A; Walley, J D; Witter, S N; Imran, A; Safdar, N

2002-06-01

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group (172 dollars per case cured). This approach should be investigated further, along with other approaches to improving patient compliance.

Using AMS to Help Interpret Glaciogenic Deposits of the Late Paleozoic Ice Age in the Parana Basin, Brazil

NASA Astrophysics Data System (ADS)

Amato, James Anthony

The term 'diamictite' is used as a lithologic descriptive term without assigning a particular origin to a rock unit as either glacial deposits (till), proglacial, glacially influenced deposits (resulting from meltwater plumes and ice rafted debris), or mass transport deposits (glacial or non-glacial related). While in some cases, it is possible to delineate between the origins of diamictites, in other instances, weathering and lack of exposures make it difficult to determine. In general, the occurrence of diamictites within the Gondwana succession has been traditionally used to indicate the occurrence of subglacial deposition despite the potential occurrence of other depositional modes. Thus, the extent of glaciation during the Late Paleozoic Ice Age is interpreted to be much greater than it actually was. . One area of interest in Gondwana where interpretation of these deposits is problematic, and hence has resulted in problems determining ice extent, is the Parana Basin in Brazil. The ability to better differentiate subglacial processes from proglacial, subaqueous mass transport, glaciomarine/glaciolacustrine rainout, and/or ice rafting, in addition to determining glacier flow or mass transport directions, will allow researchers studying these deposits to more accurately reconstruct the environments timing and extent of glaciation during the LPIA. In sedimentary fabrics, anisotropy of magnetic susceptibility (AMS) is a geophysical method, which depicts the preferred orientation of magnetic particles during the final stages of transport and/or synsedimentary deformation. The technique is used to determine the preferred orientation of the constituent grains, therefore a useful indicator to help determine the mode of deposition, direction of sediment transport, and the nature of stress and strain during deformation. In August of 2016, samples were collected from deposits assigned to the Itarare Group, which outcrop along the southern and eastern margins of the Parana Basin, Brazil. 19 fabrics were analyzed from seven different locations (Alfredo Wagner, Aurora, Cachoeira do Sul, Campo do Tenente, Ibare, Porto Amazonas, and Sao Gabriel), stretching across the states of Rio Grande do Sul, Santa Catarina, and Parana. While in most cases, AMS allowed us to delineate between the origins of diamictites, in other cases, it proved to be more difficult. In most cases, AMS measurements were beneficial in determining the direction of sediment transport. Our findings are consistent with past studies in which AMS was used to infer a variety of glaciogenic deposits, but also acts as a study case for the different types of fabrics that may develop as a result of Newtonian vs non-Newtonian sediment gravity flows. While flow directions along the southern margin of the basin are consistent with the inferred N/NW ice movement into the basin, some of the flow directions along the eastern margin are not, revealing deviations in topography. Flow directions obtained from mass transport deposits in the area stretching from Campo do Tenente to Porto Amazonas (an area in which different stratigraphic levels of glaciation are exposed) tend to show uniform flow to the south. This observation is consistent with other AMS studies of similar deposits within the area, suggesting the existence of a southward paleoslope, which strongly influenced subaqueous deposition throughout the extent of the Itarare Group.

Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia.

PubMed

Verguet, Stéphane; Memirie, Solomon Tessema; Norheim, Ole Frithjof

2016-10-21

Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty. We used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition. In Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases. We present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.

Integrating Army Aviation into the Combined Arms Team: Operational Art in Desert Shield and Desert Storm

DTIC Science & Technology

2017-05-25

new doctrine, the ideal organization, and what would eventually become a branch. The framework for the historical case study is the doctrinal...operational art were apparent in the case study , and were enabled, either directly or indirectly, by rotary-wing aviation. This case study illuminated the...would eventually become a branch. The framework for the historical case study is the doctrinal relationship between the elements of operational art

Temporal Visualization for Legal Case Histories.

ERIC Educational Resources Information Center

Harris, Chanda; Allen, Robert B.; Plaisant, Catherine; Shneiderman, Ben

1999-01-01

Discusses visualization of legal information using a tool for temporal information called "LifeLines." Explores ways "LifeLines" could aid in viewing the links between original case and direct and indirect case histories. Uses the case of Apple Computer, Inc. versus Microsoft Corporation and Hewlett Packard Company to…

Teaching Evolution & the Nature of Science.

ERIC Educational Resources Information Center

Farber, Paul

2003-01-01

The theory of evolution provides direction in many fields, such as ecology, genetics, and embryology. Examines issues concerning the teaching of the subject in the United States. Presents a case study approach to teach about the nature of science using the theory of evolution. (SOE)

TU-H-CAMPUS-IeP1-01: Bias and Computational Efficiency of Variance Reduction Methods for the Monte Carlo Simulation of Imaging Detectors

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

Sharma, D; Badano, A; Sempau, J

Purpose: Variance reduction techniques (VRTs) are employed in Monte Carlo simulations to obtain estimates with reduced statistical uncertainty for a given simulation time. In this work, we study the bias and efficiency of a VRT for estimating the response of imaging detectors. Methods: We implemented Directed Sampling (DS), preferentially directing a fraction of emitted optical photons directly towards the detector by altering the isotropic model. The weight of each optical photon is appropriately modified to maintain simulation estimates unbiased. We use a Monte Carlo tool called fastDETECT2 (part of the hybridMANTIS open-source package) for optical transport, modified for VRT. Themore » weight of each photon is calculated as the ratio of original probability (no VRT) and the new probability for a particular direction. For our analysis of bias and efficiency, we use pulse height spectra, point response functions, and Swank factors. We obtain results for a variety of cases including analog (no VRT, isotropic distribution), and DS with 0.2 and 0.8 optical photons directed towards the sensor plane. We used 10,000, 25-keV primaries. Results: The Swank factor for all cases in our simplified model converged fast (within the first 100 primaries) to a stable value of 0.9. The root mean square error per pixel for DS VRT for the point response function between analog and VRT cases was approximately 5e-4. Conclusion: Our preliminary results suggest that DS VRT does not affect the estimate of the mean for the Swank factor. Our findings indicate that it may be possible to design VRTs for imaging detector simulations to increase computational efficiency without introducing bias.« less

18 CFR 281.206 - Priority 1 reclassification.

Code of Federal Regulations, 2010 CFR

2010-04-01

... entitlements” means, with respect to a particular interstate pipeline. (1) In the case of a direct sale customer, the volume of natural gas such direct sale customer is entitled to receive for high-priority uses...; (2) In the case of a local distribution company, the volume of natural gas which such local...

Investigation on the Characteristics of Pellet Ablation in a Toroidal Plasma

NASA Astrophysics Data System (ADS)

Sato, K. N.; Sakakita, H.; Fujita, H.

2003-06-01

Characteristics of a cloud ablated from an ice pellet has been investigated in detail in the JIPP T-IIU tokamak plasma by utilizing a new scheme of pellet injection system, "the injection-angle controllable system". A long "helical tail" of ablation light has been observed using CCD cameras and a high speed framing photograph in the case of on-axis and off-axis injection with the injection angle smaller than a certain value. The direction of the helical tail is found to be independent to that of the total magnetic field lines of the torus. From the experiments with the combination of two toroildal filed directions and two plasma current directions, it is considered that the tail seems to rotate, in most cases, to the electron diamagnetic direction poloidally, and to the opposite to the plasma current direction toroidally. Consideration on various cross sections including charge exchange, ionization and elastic collisions leads us to the conclusion that the tail-shaped phenomena may come from the situation of charge exchange equilibrium of hydrogen ions and neutrals at extremely high density regime in the cloud. The relation of ablation behavior with plasma potential and rotation has also been studied. Potential measurements of pellet-injected plasmas using heavy ion beam probe (HIBP) method were carried out for the first time. In the case of an injection angle to be anti-parallel to the electron diamagnetic direction in the poloidal plane, the result shows that the direction of potential change is negative, and consequently the potential after the injection should be negative because it has been measured to be negative in usual ohmic plasmas without pellet injection. Thus, the direction of the "tail" structure seems to be consistent to that of the plasma potential measured, if it is considered that tail structure may be caused by the effect of the plasma potential and the rotation.

"I Can't "Evn" Get Why She Would Make Me "Rite" in Her Class:" Using Think-Alouds in Middle School Math for "At-Risk" Students

ERIC Educational Resources Information Center

Bernadowski, Carianne

2016-01-01

A qualitative case study design was used to explore the use of the think-aloud reading comprehension strategy in the implementation of math journals. The goal of the study was to determine if a teacher's direct instruction in the implementation of think-alouds improved "at risk" eighth-graders' abilities to answer word problems more…

Academic Performance and the Practice of Self-Directed Learning: The Adult Student Perspective

ERIC Educational Resources Information Center

Khiat, Henry

2017-01-01

The practice of self-directed learning is important to adult students as it allows them to learn effectively while juggling work, family and other commitments. This study set out to examine the self-directed learning characteristics present in the adult students' study process at the case university. The relationship between the adult students'…

When previously expressed wishes conflict with best interests.

PubMed

Smith, Alexander K; Lo, Bernard; Sudore, Rebecca

2013-07-08

Rising use of advance directives has made surrogate decision making both easier and harder. In many cases, these directives help guide decision making for patients who have lost decision-making capacity. In some cases, however, directives may conflict with what physicians or surrogates view as what is in the patient's best interest. These conflicts can place substantial emotional and moral burdens on physicians and surrogates, and there is little practical guidance for how to address them. We propose a 5-question framework for untangling the conflict between advance directives and best interests of a patient with a surrogate decision maker: (1) Is the clinical situation an emergency? (2) In view of the patient's values and goals, how likely is it that the benefits of the intervention will outweigh the burdens? (3) How well does the advance directive fit the situation at hand? (4) How much leeway did the patient provide the surrogate for overriding the advance directive? (5) How well does the surrogate represent the patient's best interests? We use 2 clinical cases with contrasting outcomes to demonstrate how this framework can help resolve common dilemmas.

Profile and follow-up of patients with tuberculosis in a priority city in Brazil

PubMed Central

Pereira, Jisleny da Cruz; Silva, Marcio Roberto; da Costa, Ronaldo Rodrigues; Guimarães, Mark Drew Crosland; Leite, Isabel Cristina Gonçalves

2015-01-01

OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality. PMID:25741659

Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary.

PubMed

McCroskey, Zulfia; Sneige, Nour; Herman, Carolyn R; Miller, Ross A; Venta, Luz A; Ro, Jae Y; Schwartz, Mary R; Ayala, Alberto G

2018-02-21

The aim of this study was to analyze the clinicopathological features of patients with flat epithelial atypia, diagnosed in directional vacuum-assisted biopsy targeting microcalcifications, to identify upgrade rate to in situ ductal or invasive breast carcinoma, and determine factors predicting carcinoma in the subsequent excision. We retrospectively evaluated the histological, clinical, and mammographic features of 69 cases from 65 women, with directional vacuum-assisted biopsy-diagnosed flat epithelial atypia with or without atypical ductal hyperplasia or atypical lobular hyperplasia, which underwent subsequent surgical excision. The extent and percentage of microcalcifications sampled by directional vacuum-assisted biopsy were evaluated by mammography. All biopsy and surgical excision slides were reviewed. The age of the women ranged from 40 to 85 years (mean 57 years). All patients presented with mammographically detected microcalcifications only, except in one case that had associated architectural distortion. Extent of calcifications ranged from <1 cm (n = 47), 1-3 cm (n = 15) to > 3 cm (n = 6), and no measurement (n = 1). A mean of 11 cores (range 6-25) was obtained from each lesion. Post-biopsy mammogram revealed >90% removal of calcifications in 81% of cases. Pure flat epithelial atypia represented nearly two-thirds of directional vacuum-assisted biopsy specimens (n = 43, 62%), while flat epithelial atypia coexisted with atypical ductal hyperplasia (18 cases, 26%), or atypical lobular hyperplasia (8 cases, 12%). Upon excision, none of the cases were upgraded to in situ ductal or invasive breast cancer. In one case, however, an incidental, tubular carcinoma (4 mm) was found away from biopsy site. Excluding this case, the upgrade rate was 0%. Our study adds to the growing evidence that diagnosis of flat epithelial atypia on directional vacuum-assisted biopsy for microcalcifications as the only imaging finding is not associated with a significant upgrade to carcinoma on excision, and therefore, excision may not be necessary. Additionally, excision may not be necessary for flat epithelial atypia with atypical ductal hyperplasia limited to ≤2 terminal duct-lobular units, if at least 90% of calcifications have been removed on biopsy.

Dynamics of a minimal consumer network with bi-directional influence

NASA Astrophysics Data System (ADS)

Ekaterinchuk, Ekaterina; Jungeilges, Jochen; Ryazanova, Tatyana; Sushko, Iryna

2018-05-01

We study the dynamics of a model of interdependent consumer behavior defined by a family of two-dimensional noninvertible maps. This family belongs to a class of coupled logistic maps with different nonlinearity parameters and coupling terms that depend on one variable only. In our companion paper we considered the case of independent consumers as well as the case of uni-directionally connected consumers. The present paper aims at describing the dynamics in the case of a bi-directional connection. In particular, we investigate the bifurcation structure of the parameter plane associated with the strength of coupling between the consumers, focusing on the mechanisms of qualitative transformations of coexisting attractors and their basins of attraction.

Applications of a direct/iterative design method to complex transonic configurations

NASA Technical Reports Server (NTRS)

Smith, Leigh Ann; Campbell, Richard L.

1992-01-01

The current study explores the use of an automated direct/iterative design method for the reduction of drag in transport configurations, including configurations with engine nacelles. The method requires the user to choose a proper target-pressure distribution and then develops a corresponding airfoil section. The method can be applied to two-dimensional airfoil sections or to three-dimensional wings. The three cases that are presented show successful application of the method for reducing drag from various sources. The first two cases demonstrate the use of the method to reduce induced drag by designing to an elliptic span-load distribution and to reduce wave drag by decreasing the shock strength for a given lift. In the second case, a body-mounted nacelle is added and the method is successfully used to eliminate increases in wing drag associated with the nacelle addition by designing to an arbitrary pressure distribution as a result of the redesigning of a wing in combination with a given underwing nacelle to clean-wing, target-pressure distributions. These cases illustrate several possible uses of the method for reducing different types of drag. The magnitude of the obtainable drag reduction varies with the constraints of the problem and the configuration to be modified.

Two case studies: QuietRock QR-530 drywall panels in new and remediated multifamily construction

NASA Astrophysics Data System (ADS)

Tinianov, Brian D.

2005-09-01

Reliable acoustical isolation continues to be a high risk element of contemporary multifamily construction. Traditional construction techniques, offering potentially high acoustical performance, exist but may be compromised during typical construction or occupation. This paper presents two case studies using a new class of construction material-drywall panels employing constrained layer damping. QuietRock QR-530 damped gypsum board panels are used in a new construction project and as part of a remediation treatment. In a first study, QR-530 panels were used as a drywall alternative in a 2×6, semistaggered, framed wall separating luxury condominiums. Field evaluation per ASTM E36 revealed a normalized noise isolation class of 56. In a second case study, a single layer of QuietRock was applied directly to an existing single stud assembly in a resort hotel. Before and after testing yielded a change of 14 points, raising the noise isolation class from 36 to 50. This paper reviews the details of the test cases and the underlying physical principals of the subject materials.

Palliative care communication curriculum: what can students learn from an unfolding case?

PubMed

Goldsmith, Joy; Wittenberg-Lyles, Elaine; Shaunfield, Sara; Sanchez-Reilly, Sandra

2011-06-01

Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs.

The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study.

PubMed

Hoell, Steffen; Sander, Marius; Gosheger, Georg; Ahrens, Helmut; Dieckmann, Ralf; Hauschild, Gregor

2014-03-12

There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm. A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months). The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations. THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular.

Data driven CAN node reliability assessment for manufacturing system

NASA Astrophysics Data System (ADS)

Zhang, Leiming; Yuan, Yong; Lei, Yong

2017-01-01

The reliability of the Controller Area Network(CAN) is critical to the performance and safety of the system. However, direct bus-off time assessment tools are lacking in practice due to inaccessibility of the node information and the complexity of the node interactions upon errors. In order to measure the mean time to bus-off(MTTB) of all the nodes, a novel data driven node bus-off time assessment method for CAN network is proposed by directly using network error information. First, the corresponding network error event sequence for each node is constructed using multiple-layer network error information. Then, the generalized zero inflated Poisson process(GZIP) model is established for each node based on the error event sequence. Finally, the stochastic model is constructed to predict the MTTB of the node. The accelerated case studies with different error injection rates are conducted on a laboratory network to demonstrate the proposed method, where the network errors are generated by a computer controlled error injection system. Experiment results show that the MTTB of nodes predicted by the proposed method agree well with observations in the case studies. The proposed data driven node time to bus-off assessment method for CAN networks can successfully predict the MTTB of nodes by directly using network error event data.

Enhancement of global flood damage assessments using building material based vulnerability curves

NASA Astrophysics Data System (ADS)

Englhardt, Johanna; de Ruiter, Marleen; de Moel, Hans; Aerts, Jeroen

2017-04-01

This study discusses the development of an enhanced approach for flood damage and risk assessments using vulnerability curves that are based on building material information. The approach draws upon common practices in earthquake vulnerability assessments, and is an alternative for land-use or building occupancy approach in flood risk assessment models. The approach is of particular importance for studies where there is a large variation in building material, such as large scale studies or studies in developing countries. A case study of Ethiopia is used to demonstrate the impact of the different methodological approaches on direct damage assessments due to flooding. Generally, flood damage assessments use damage curves for different land-use or occupancy types (i.e. urban or residential and commercial classes). However, these categories do not necessarily relate directly to vulnerability of damage by flood waters. For this, the construction type and building material may be more important, as is used in earthquake risk assessments. For this study, we use building material classification data of the PAGER1 project to define new building material based vulnerability classes for flood damage. This approach will be compared to the widely applied land-use based vulnerability curves such as used by De Moel et al. (2011). The case of Ethiopia demonstrates and compares the feasibility of this novel flood vulnerability method on a country level which holds the potential to be scaled up to a global level. The study shows that flood vulnerability based on building material also allows for better differentiation between flood damage in urban and rural settings, opening doors to better link to poverty studies when such exposure data is available. Furthermore, this new approach paves the road to the enhancement of multi-risk assessments as the method enables the comparison of vulnerability across different natural hazard types that also use material-based vulnerability curves. Finally, this approach allows for more accuracy in estimating losses as a result of direct damages. 1 http://earthquake.usgs.gov/data/pager/

Survivors of School Bullying: A Collective Case Study

ERIC Educational Resources Information Center

Ramirez, Octavio

2013-01-01

This article explores the coping strategies of five junior-high school students with a history of peer victimization and how those strategies help them manage the effects of bullying. The data were collected using observations, interviews, and a review of school records. The data were analyzed using categorical aggregation, direct interpretation,…

A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish healthcare direct: a case-control study.

PubMed

Ernesäter, Annica; Engström, Maria; Winblad, Ulrika; Holmström, Inger K

2014-10-03

The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems. 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.

Erythema-directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris.

PubMed

Micali, G; Dall'Oglio, F; Tedeschi, A; Lacarrubba, F

2018-01-31

Erythema-directed digital photography is a novel method for evaluating the efficacy and tolerability of topical acne treatments. Here, we describe three case reports in which erythema-directed digital photography was used to evaluate acne before and after up to 12 weeks of treatment with clindamycin 1%/tretinoin 0.025% (Clin-RA). Erythema-directed digital photography was used to evaluate acne in three patients with mild-to-moderate facial acne, two of whom had refused to continue previous topical acne treatment (benzoyl peroxide 5% and clindamycin 1%/benzoyl peroxide 5%) due to persistent irritation. Acne lesions and erythema were evaluated using standard clinical photography and erythema-directed digital photography (VISIA-CR ™ system) before and after 8-12 weeks of treatment with Clin-RA. Erythema-directed digital photography revealed background erythema from previous topical acne treatments that was not evident from standard clinical photographs and allowed a better visualization of both inflammatory and non-inflammatory lesions. In all patients, there was a clear improvement in background erythema and a reduction in acne lesions following treatment with Clin-RA. This study has demonstrated for the first time that erythema-directed digital photography can enhance the evaluation of the efficacy and tolerability of topical acne treatments. These cases show that Clin-RA was associated with improved efficacy and tolerability vs previous treatments with topical monotherapy (benzoyl peroxide 5%) or a topical fixed-dose combination (clindamycin 1%/benzoyl peroxide 5%). © 2018 The Authors. Skin Research and Technology Published by John Wiley & Sons Ltd.

The U.K.'s "Dash for Gas".

PubMed

Watterson, Andrew; Dinan, William

2017-05-01

The evidence on public health regulation of the unconventional gas extraction (fracking) industry was examined using a rapid evidence assessment of fifteen case studies from multiple countries. They included scientific and academic papers, professional reports, government agency reports, industry and industry-funded reports, and a nongovernment organization report. Each case study review was structured to address strengths and weaknesses of the publication in relation to our research questions. Some case studies emphasized inherent industry short-, medium-, and long-term dangers to public health directly and through global climate change impacts. Other case studies argued that fracking could be conducted safely assuming industry best practice, "robust" regulation, and mitigation, but the evidence base for such statements proved generally sparse. U.K. regulators' own assessments on fracking regulation are also evaluated. The existing evidence points to the necessity of a precautionary approach to protect public health from unconventional gas extraction development.

Direct medical costs of constipation in children over 15 years: a population-based birth cohort

PubMed Central

Choung, Rok Seon; Shah, Nilay D.; Chitkara, Denesh; Branda, Megan E.; Van Tilburg, Miranda A.; Whitehead, William E.; Katusic, Slavica K.; Locke, G. Richard; Talley, Nicholas J.

2011-01-01

Background Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining if longitudinal resource utilization is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care utilization associated with constipation from childhood to early adulthood. Methods A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5,718 children in a population-based birth cohort who were born during 1976–1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all non-cases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5–18 years of age or until the subject emigrated from the community. Results We identified 250 cases with a diagnosis of constipation in the birth cohort. While the mean inpatient costs for cases were $9994 (95% CI=2538, 37201) compared to $2391 (95% CI=923, 7452) for controls (p=0.22) over the time period, the mean outpatient costs for cases were $13927 (95% CI=11325, 16525) compared to $3448 (95% CI=3771, 4621) for controls (p<0.001) over the same time period. The mean annual number emergency department visits for cases were 0.66 (95% CI=0.62, 0.70) compared to 0.34 (95% CI=0.32, 0.35) for controls (p<0.0001). Conclusion Individuals with constipation have higher medical care utilization. Outpatient costs and ER utilization were significantly greater for individuals with constipation from childhood to early adulthood. PMID:20890220

When hawks attack: animal-borne video studies of goshawk pursuit and prey-evasion strategies

PubMed Central

Kane, Suzanne Amador; Fulton, Andrew H.; Rosenthal, Lee J.

2015-01-01

Video filmed by a camera mounted on the head of a Northern Goshawk (Accipiter gentilis) was used to study how the raptor used visual guidance to pursue prey and land on perches. A combination of novel image analysis methods and numerical simulations of mathematical pursuit models was used to determine the goshawk's pursuit strategy. The goshawk flew to intercept targets by fixing the prey at a constant visual angle, using classical pursuit for stationary prey, lures or perches, and usually using constant absolute target direction (CATD) for moving prey. Visual fixation was better maintained along the horizontal than vertical direction. In some cases, we observed oscillations in the visual fix on the prey, suggesting that the goshawk used finite-feedback steering. Video filmed from the ground gave similar results. In most cases, it showed goshawks intercepting prey using a trajectory consistent with CATD, then turning rapidly to attack by classical pursuit; in a few cases, it showed them using curving non-CATD trajectories. Analysis of the prey's evasive tactics indicated that only sharp sideways turns caused the goshawk to lose visual fixation on the prey, supporting a sensory basis for the surprising frequency and effectiveness of this tactic found by previous studies. The dynamics of the prey's looming image also suggested that the goshawk used a tau-based interception strategy. We interpret these results in the context of a concise review of pursuit–evasion in biology, and conjecture that some prey deimatic ‘startle’ displays may exploit tau-based interception. PMID:25609783

Case study: Comparison of motivation for achieving higher performance between self-directed and manager-directed aerospace engineering teams

NASA Astrophysics Data System (ADS)

Erlick, Katherine

"The stereotype of engineers is that they are not people oriented; the stereotype implies that engineers would not work well in teams---that their task emphasis is a solo venture and does not encourage social aspects of collaboration" (Miner & Beyerlein, 1999, p. 16). The problem is determining the best method of providing a motivating environment where design engineers may contribute within a team in order to achieve higher performance in the organization. Theoretically, self-directed work teams perform at higher levels. But, allowing a design engineer to contribute to the team while still maintaining his or her anonymity is the key to success. Therefore, a motivating environment must be established to encourage greater self-actualization in design engineers. The purpose of this study is to determine the favorable motivational environment for design engineers and describe the comparison between two aerospace design-engineering teams: one self-directed and the other manager directed. Following the comparison, this study identified whether self-direction or manager-direction provides the favorable motivational environment for operating as a team in pursuit of achieving higher performance. The methodology used in this research was the case study focusing on the team's levels of job satisfaction and potential for higher performance. The collection of data came from three sources, (a) surveys, (b) researcher observer journal and (c) collection of artifacts. The surveys provided information regarding personal behavior characteristics, potentiality for higher performance and motivational attributes. The researcher journal provided information regarding team dynamics, individual interaction, conflict and conflict resolution. The milestone for performance was based on the collection of artifacts from the two teams. The findings from this study illustrated that whether the team was manager-directed or self-directed does not appear to influence the needs and wants of the team members. The self-directed team was more motivated to learn their topic than was the manager-directed team, but they struggled with their path in following their vision whereas the manager-directed team kept their focus under the guidance of their manager. Finally, both teams are in fact effective; however specific circumstances may be an important objective when deciding to utilize either a self-directed or manager-directed team.

The Special Place Project: Efficacy of a Place-Based Case Study Approach for Teaching Geoscience

NASA Astrophysics Data System (ADS)

Moosavi, Sadredin

2014-05-01

Achieving geoscience literacy of the general population has become increasingly important world wide as ever more connected and growing societies depend more and more on our planet's limited natural resource base. Building citizen understanding of their dependence on the local environment, and the geologic processes which created and continue to change it, has become a great challenge to educators at all levels of the education system. The Special Place Project described in this presentation explores use of a place-based case study approach combining instruction in geoscience content with development of observation, reasoning, writing and presentation skills. The approach allows students to select the locations for their individual case studies affording development of personal connections between the learner and his environment. The approach gives instructors at many grade levels the ability to develop core pedagogical content and skills while exploring the unique geologic environments relevant to the local population including such critical issues as land use, resource depletion, energy, climate change and the future of communities in a changing world. The geologic reasons for the location of communities and key events in their histories can be incorporated into the students' case studies as appropriate. The project is unique in placing all course instruction in the context of the quest to explore and gain understanding of the student's chosen location by using the inherently more generalized course content required by the curriculum. By modeling how scientists approach their research questions, this pedagogical technique not only integrates knowledge and skills from across the curriculum, it captures the excitement of scientific thinking on real world questions directly relevant to students' lives, increasing student engagement and depth of learning as demonstrated in the case study reports crafted by the students and exam results. Student learning of topics directly touched upon by the case study, such as geomorphologic features and processes observable at Earth's surface, is compared to learning on more abstract topics, such as subsurface Earth structure and tectonic processes, to provide a quantitative assessment of this pedagogical approach.

Chronic Sequelae of E. coli O157: Systematic Review and Meta-analysis of the Proportion of E. coli O157 Cases That Develop Chronic Sequelae

PubMed Central

Sargeant, Jan; Thomas, M. Kate; Fazil, Aamir

2014-01-01

Abstract Objective: This was a systematic review and meta-analysis to determine the proportion of Escherichia coli O157 cases that develop chronic sequelae. Data Sources: We conducted a systematic review of articles published prior to July 2011 in Pubmed, Agricola, CabDirect, or Food Safety and Technology Abstracts. Study Selection: Studies were selected that reported the number of E. coli O157 cases that developed reactive arthritis (ReA), hemolytic uremic syndrome (HUS), irritable bowel syndrome, inflammatory bowel disease, or Guillain Barré syndrome. Methods: Three levels of screening and data extraction of articles were conducted using predefined data fields. Meta-analysis was performed on unique outcome measures using a random-effects model, and heterogeneity was assessed using the I2 value. Meta-regression was used to explore the influence of nine study-level variables on heterogeneity. Results: A total of 82 studies were identified reporting 141 different outcome measures; 81 reported on HUS and one reported on ReA. Depending on the number of cases of E. coli O157, the estimate for the proportion of E. coli O157 cases that develop HUS ranged from 17.2% in extra-small studies (<50 cases) to 4.2% in extra-large studies (>1000 cases). Heterogeneity was significantly associated with group size (p<0.0001); however, the majority of the heterogeneity was unexplained. Conclusions: High unexplained heterogeneity indicated that the study-level factors examined had a minimal influence on the variation of estimates reported. PMID:24404780

Insider Threat: Preventing Direct Action Attacks Within the United States Army

DTIC Science & Technology

2017-06-09

violence within the United States, this study focused solely on cases where a US Army Soldier attacked fellow Soldiers. For the purposes of this study ...chapters will examine Army doctrine and two case studies , in detail. The conclusion of this project will provide recommendations on improved... study specifically on insider threats pertaining to targeted violence, this literature review does not include information pertaining to cases

The Clinical Impact of Rapid, Direct MALDI-ToF Identification of Bacteria from Positive Blood Cultures.

PubMed

French, Kathryn; Evans, Jason; Tanner, Hannah; Gossain, Savita; Hussain, Abid

2016-01-01

Faster identification of bacterial isolates from blood cultures can enable earlier clinical intervention for patients with sepsis. We evaluated the clinical impact of direct identification of micro-organisms from positive blood cultures using MALDI-ToF. Positive blood cultures with organisms seen on Gram stain were included over a four week period. For each patient case, comparison was made between the clinical advice given on day one with only a Gram stain result, and the follow up advice given on day two with the benefit of organism identification. Culture results were then compared with direct MALDI-ToF identification. For 73 of 115 cases (63.5%), direct organism identification was obtained by MALDI-ToF. Of those 73, 70 (95.5%) had a result concordant with that of the plate culture. In 28 of the 115 cases (24.3%) direct MALDI-ToF identification on day one would have had a clear clinical benefit. In 11 cases it would have helped to identify the potential source of bacteraemia. In 11 cases it would have indicated a different antibiotic regimen on day one, with five patients receiving appropriate antibiotics 24 hours earlier. For 14 cases the blood culture isolate could have been designated as unlikely to be clinically significant. We have demonstrated that organism identification on day one of blood culture positivity can have a direct clinical impact. Faster identification using MALDI-ToF assists the clinician in assessing the significance of a blood culture isolate on day one. It can allow earlier appropriate choice of antimicrobial agent, even in the absence of susceptibility testing, and help narrow down the potential source of infection providing a focus for further investigation in a more timely way than conventional techniques alone.

Policy implementation in practice: the case of national service frameworks in general practice.

PubMed

Checkland, Kath; Harrison, Stephen

2004-10-01

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

Analysis of Clinical Cohort Data Using Nested Case-control and Case-cohort Sampling Designs. A Powerful and Economical Tool.

PubMed

Ohneberg, K; Wolkewitz, M; Beyersmann, J; Palomar-Martinez, M; Olaechea-Astigarraga, P; Alvarez-Lerma, F; Schumacher, M

2015-01-01

Sampling from a large cohort in order to derive a subsample that would be sufficient for statistical analysis is a frequently used method for handling large data sets in epidemiological studies with limited resources for exposure measurement. For clinical studies however, when interest is in the influence of a potential risk factor, cohort studies are often the first choice with all individuals entering the analysis. Our aim is to close the gap between epidemiological and clinical studies with respect to design and power considerations. Schoenfeld's formula for the number of events required for a Cox' proportional hazards model is fundamental. Our objective is to compare the power of analyzing the full cohort and the power of a nested case-control and a case-cohort design. We compare formulas for power for sampling designs and cohort studies. In our data example we simultaneously apply a nested case-control design with a varying number of controls matched to each case, a case cohort design with varying subcohort size, a random subsample and a full cohort analysis. For each design we calculate the standard error for estimated regression coefficients and the mean number of distinct persons, for whom covariate information is required. The formula for the power of a nested case-control design and the power of a case-cohort design is directly connected to the power of a cohort study using the well known Schoenfeld formula. The loss in precision of parameter estimates is relatively small compared to the saving in resources. Nested case-control and case-cohort studies, but not random subsamples yield an attractive alternative for analyzing clinical studies in the situation of a low event rate. Power calculations can be conducted straightforwardly to quantify the loss of power compared to the savings in the num-ber of patients using a sampling design instead of analyzing the full cohort.

Prevalence of building-related symptoms as an indicator of health and productivity.

PubMed

Niemelä, Raimo; Seppänen, Olli; Korhonen, Pirjo; Reijula, Kari

2006-10-01

The prevalence of building-related symptoms (BRS) is commonly used to characterize the indoor air quality in office buildings. To analyze the costs of building renovation and the improvement of the indoor environment, it is useful to quantitatively relate the prevalence or intensity of BRS to productivity. The intent of this study is to summarize the links between the BRS and productivity, and demonstrate this linkage in two case buildings. A literature was surveyed for studies that measured simultaneously the prevalence or intensity of BRS and subjectively reported or objectively measured productivity. Case studies in two office environments were performed. An association between the prevalence of BRS and productivity of workers in a call center and in an insurance office were investigated. In the first case study, the productivity was expressed using the direct productivity metrics, namely the number of telephone contacts during active working hours while in the second case, the productivity was assessed by using the data concerning sick leave rates. Employees who report more BRS also have more often absences which relate to indoor environment quality (IEQ). Their productivity is lower than those who have better IEQ in their offices. Despite uncertainties related to the data concerning recorded sick leave and self-reported productivity, the number of studies showing an association between BRS and productivity or sick leave suggests that such a relationship exists. The present case studies also demonstrated an association between the BRS and the direct productivity. Based on the data from the call center, a reduction of 10%-units in the prevalence of general symptoms (such as fatigue, headache, nausea, etc.) corresponded with a gain of 1.5% in performance. Based on the findings in the insurance company, a reduction of 10%-units in the prevalence of irritation symptoms corresponded with a decrease of 0.7% in the short-term absenteeism. A review of 23 studies suggests that a linkage exists between typical BRS and productivity indicators such as task or work performance or absence from work. Quantitative associations between BRS and productivity were demonstrated in two office environments. Quantitative associations between BRS and economic metrics enable cost-benefits analysis.

Onyx injection by direct puncture for the treatment of hypervascular spinal metastases close to the anterior spinal artery: initial experience.

PubMed

Clarençon, Frédéric; Di Maria, Federico; Cormier, Evelyne; Sourour, Nader-Antoine; Enkaoua, Eric; Sailhan, Frédéric; Iosif, Christina; Le Jean, Lise; Chiras, Jacques

2013-06-01

Presurgical devascularization of hypervascular spinal metastases has been shown to be effective in preventing major blood loss during open surgery. Most often, embolization can be performed using polyvinyl alcohol (PVA) microparticles. However, in some cases, the close relationship between the feeders of the metastases and the feeders of the anterior spinal artery (ASA) poses a risk of spinal cord ischemia when PVA microparticle embolization is performed. The authors present their early experience in the treatment of spinal metastases close to the ASA; in 2 cases they injected Onyx-18, by direct puncture, into hypervascular posterior arch spinal metastases situated close to the ASA. Two women, one 36 and the other 55 years of age, who presented with spinal lesions (at the posterior arch of C-4 and T-6, respectively) from thyroid and a kidney tumors, were sent to the authors' department to undergo presurgical embolization. After having performed a complete spinal digital subtraction angiography study, a regular angiography catheter was positioned at the ostium of the artery that mainly supplied the lesion. Then, with the patient in the left lateral decubitus position, direct puncture with 18-gauge needles of the lesion was performed using roadmap guidance. Onyx-18 was injected through the needles under biplanar fluoroscopy. Satisfactory devascularization of the lesions was obtained; the ASA remained patent in both cases. The metastases were surgically removed in both cases within the 48 hours after the embolization and major blood loss did not occur. Presurgical devascularization of hypervascular spinal metastases close the ASA by direct puncture with Onyx-18 seems to be an effective technique and appears to be safe in terms of the preserving the ASA's patency.

Case report: on the use of the HID-Ion AmpliSeq™ Ancestry Panel in a real forensic case.

PubMed

Hollard, C; Keyser, C; Delabarde, T; Gonzalez, A; Vilela Lamego, C; Zvénigorosky, V; Ludes, B

2017-03-01

In the absence of any other conclusive forensic evidence, DNA profiling is the method of choice for body identification. This study focuses on the case of a carbonized corpse whose complete autosomal short tandem repeat (STR) profile could not lead to direct identification by the investigators. To assist in the progress of investigation, we endeavoured to determine the biogeographical origin and eye colour of the deceased individual. Along with Y chromosome and mitochondrial DNA analyses, we applied a next-generation sequencing (NGS) approach to the study of ancestry informative markers (AIMs) using the HID-Ion AmpliSeq™ Ancestry Panel launched by Thermo Fisher Scientific. This work gave us the opportunity to test this new technology in a real forensic case. Although this study highlights the benefits of such a combined approach, as it markedly improves the specificity of the biogeographical profile, it also underlines the need for the accurate characterization of a larger collection of reference populations and the necessity of caution in data interpretation.

Archaeomagnetic evidence of temporal diachronies in Middle-Palaeolithic palimpsests. A case study from El Salt (SE Spain)

NASA Astrophysics Data System (ADS)

Herrejón Lagunilla, Ángela; Carrancho, Ángel; José Villalaín, Juan; Mallol, Carolina; Hernández, Cristo Manuel; Galván, Bertila

2017-04-01

Archaeomagnetism is a very useful tool to the study of Palaeolithic palimpsests and this line of research is almost unexplored. Middle Palaeolithic palimpsests (ca. 250 - 40 ky BP) as El Salt site (Alcoy, Spain) contain a big amount of hearths with thousands of lithic and faunal remains associated to them. Most of these hearths and associated materials are so densely overlapped that individualization of human occupations discerning temporal differences is virtually impossible. Archaeomagnetism can be very helpful to that aim. In this work the goal of archaeomagnetic study is not to obtain a dating since no palaeosecular variation (PSV) curve for that age is available, but to identificate diachronies between hearths exposed on the same palaeosurface. It is archaeologically relevant as that information cannot be often easily determined. For this purpose, an archaeomagnetic study has been carried out on some hearths from El Salt unit X (ca. 50-55 ky BP). Assuming that each hearth recorded the Earth's magnetic field (EMF) direction during the last cooling by means of a thermoremanence (TRM), here is proposed a hypothesis to temporally dissect palimpsests: if the mean directions obtained from two (or more) hearths are statistically distinguishable, directional differences can be interpreted in terms of the PSV of EMF, being therefore diachronic. The mean archaeomagnetic direction from each hearth was calculated. Statistical tests were performed in order to evaluate if the means are distinguishable. In case of distinguishable means, the angle among directions was calculated. Assuming that the features of the EMF during the Middle Palaeolithic were similar to those during Holocene times, the geomagnetic field model SHA.DIF.14K (Pavón-Carrasco et al. 2014) was used to interpret these angle deviations in temporal terms. Series of angles between successive directions of the EMF separated by intervals of 50/100/200/400/800 years for the last 5000 years were calculated from the model. The angle between the distinguishable mean archaeomagnetic directions was compared with maximum angles from these series. If the angle between archaeomagnetic directions is higher than the maximum angle from one of those series of successive directions separated by certain ages, it can be assumed that the studied hearts should have been fired with a minimum temporal difference of that time span. The overall interpretation is based not only in archaeomagnetic data but in other techniques such as soil micromorphology, FTIR, organic chemistry, lithic and faunal refitting, etc. In addition, experimental hearths under controlled conditions were performed and analyzed using different techniques including archaeomagnetism in order to study how reliably the EMF direction is recorded under different taphonomical conditions. The experimental data support the hypothesis that hearths are reliable recorders of the EMF direction, both in cave and open-air conditions.

An Observational Study of the Relationship between Diagnosis and Remediation in Reading. Research Series No. 72.

ERIC Educational Resources Information Center

Weinshank, Annette B.

A study was conducted to determine whether reading specialists' diagnoses lead directly to remedial recommendations. Eight experienced reading specialists were observed during 24 sessions as they performed a series of tasks using three simulated cases of reading difficulty, two of which were thinly disguised versions of the same reading problem.…

The Effect of Implementing Instructional Coaching with Digital Learning on High School Math and Science

ERIC Educational Resources Information Center

McKaveney, Edward W.

2017-01-01

A number of national directives and successful case studies, focus on the need for change in teaching and learning, particularly emphasizing increasingly rigorous STEM learning tied to the use of ICT and digital tools for technological literacy and future workforce development. This action research study investigated the role of instructional…

Superficial middle cerebral vein connection to the cavernous sinus is not infrequent in brain arteriovenous malformations: an argument against their congenital origin?

PubMed

Shotar, Eimad; Guédon, Alexis; Sourour, Nader; Di Maria, Federico; Gabrieli, Joseph; Nouet, Aurélien; Chiras, Jacques; Clarençon, Frédéric

2016-07-01

The aim of this study was to test the hypothesis that the superficial middle cerebral vein (SMCV) is frequently absent or fails to connect with the cavernous sinus (CS) in the presence of brain arteriovenous malformations (AVMs), a frequently reported argument for the congenital origin of brain AVMs. The SMCV was retrospectively compared between patients with a brain AVM and a control group. The presence or absence of the SMCV, its direct or indirect connection to the CS and its termination in a laterocavernous sinus (LCS), paracavernous sinus (PCS), or directly in the CS was studied on digital subtraction angiography. One hundred twenty-five left or right side carotid angiograms from 70 patients with a brain AVM were compared to 125 angiograms from 74 controls. The SMCV was present in 88 (70.4 %) cases in the brain AVM group and 96 (76.8 %) cases in controls (p = 0.25). The SMCV was connected directly or indirectly to the CS in 65 (52 %) cases in the brain AVM group and 65 (52 %) cases in controls (p = 1). When comparing the subgroup of carotid angiograms ipsilateral to a supratentorial AVM, no statistically significant difference was found with controls. In three of six cases in which a SMCV drained an AVM, the vein terminated directly or indirectly in the CS. No difference of SMCV presence and direct or indirect connection to the CS was found between patients with AVM and a control group. SMCV anatomy does not support the congenital origin of brain AVMs.

Observational evidence and strength of evidence domains: case examples

PubMed Central

2014-01-01

Background Systematic reviews of healthcare interventions most often focus on randomized controlled trials (RCTs). However, certain circumstances warrant consideration of observational evidence, and such studies are increasingly being included as evidence in systematic reviews. Methods To illustrate the use of observational evidence, we present case examples of systematic reviews in which observational evidence was considered as well as case examples of individual observational studies, and how they demonstrate various strength of evidence domains in accordance with current Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) methods guidance. Results In the presented examples, observational evidence is used when RCTs are infeasible or raise ethical concerns, lack generalizability, or provide insufficient data. Individual study case examples highlight how observational evidence may fulfill required strength of evidence domains, such as study limitations (reduced risk of selection, detection, performance, and attrition); directness; consistency; precision; and reporting bias (publication, selective outcome reporting, and selective analysis reporting), as well as additional domains of dose-response association, plausible confounding that would decrease the observed effect, and strength of association (magnitude of effect). Conclusions The cases highlighted in this paper demonstrate how observational studies may provide moderate to (rarely) high strength evidence in systematic reviews. PMID:24758494

Acoustical case studies of three green buildings

NASA Astrophysics Data System (ADS)

Siebein, Gary; Lilkendey, Robert; Skorski, Stephen

2005-04-01

Case studies of 3 green buildings with LEED certifications that required extensive acoustical retrofit work to become satisfactory work environments for their intended user groups will be used to define areas where green building design concepts and acoustical design concepts require reconciliation. Case study 1 is an office and conference center for a city environmental education agency. Large open spaces intended to collect daylight through clerestory windows provided large, reverberant volumes with few acoustic finishes that rendered them unsuitable as open office space and a conference room/auditorium. Case Study 2 describes one of the first gold LEED buildings in the southeast whose primary design concepts were so narrowly focused on thermal and lighting issues that they often worked directly against basic acoustical requirements resulting in sound levels of NC 50-55 in classrooms and faculty offices, crosstalk between classrooms and poor room acoustics. Case study 3 is an environmental education and conference center with open public areas, very high ceilings, and all reflective surfaces made from wood and other environmentally friendly materials that result in excessive loudness when the building is used by the numbers of people which it was intended to serve.

Stakeholder involvement for management of the coastal zone.

PubMed

Oen, Amy Mp; Bouma, Geiske M; Botelho, Maria; Pereira, Patrícia; Haeger-Eugensson, Marie; Conides, Alexis; Przedrzymirska, Joanna; Isaksson, Ingela; Wolf, Christina; Breedveld, Gijs D; Slob, Adriaan

2016-10-01

The European Union (EU) has taken the lead to promote the management of coastal systems. Management strategies are implemented by the Water Framework Directive (WFD) and the Marine Strategy Framework Directive (MSFD), as well as the recent Maritime Spatial Planning (MSP) Directive. Most EU directives have a strong focus on public participation; however, a recent review found that the actual involvement of stakeholders was variable. The "Architecture and roadmap to manage multiple pressures on lagoons" (ARCH) research project has developed and implemented participative methodologies at different case study sites throughout Europe. These cases represent a broad range of coastal systems, and they highlight different legislative frameworks that are relevant for coastal zone management. Stakeholder participation processes were subsequently evaluated at 3 case study sites in order to assess the actual implementation of participation in the context of their respective legislative frameworks: 1) Byfjorden in Bergen, Norway, in the context of the WFD; 2) Amvrakikos Gulf, Greece, in the context of the MSFD; and 3) Nordre Älv Estuary, Sweden, in the context of the MSP Directive. An overall assessment of the evaluation criteria indicates that the ARCH workshop series methodology of focusing first on the current status of the lagoon or estuary, then on future challenges, and finally on identifying management solutions provided a platform that was conducive for stakeholder participation. Results suggest that key criteria for a good participatory process were present and above average at the 3 case study sites. The results also indicate that the active engagement that was initiated at the 3 case study sites has led to capacity building among the participants, which is an important intermediary outcome of public participation. A strong connection between participatory processes and policy can ensure the legacy of the intermediary outcomes, which is an important and necessary start toward more permanent resource management outcomes such as ecological and economic improvement. Integr Environ Assess Manag 2016;12:701-710. © 2016 SETAC. © 2016 SETAC.

Numerical investigation of the vortex-induced vibration of an elastically mounted circular cylinder at high Reynolds number (Re = 104) and low mass ratio using the RANS code

PubMed Central

2017-01-01

This study numerically investigates the vortex-induced vibration (VIV) of an elastically mounted rigid cylinder by using Reynolds-averaged Navier–Stokes (RANS) equations with computational fluid dynamic (CFD) tools. CFD analysis is performed for a fixed-cylinder case with Reynolds number (Re) = 104 and for a cylinder that is free to oscillate in the transverse direction and possesses a low mass-damping ratio and Re = 104. Previously, similar studies have been performed with 3-dimensional and comparatively expensive turbulent models. In the current study, the capability and accuracy of the RANS model are validated, and the results of this model are compared with those of detached eddy simulation, direct numerical simulation, and large eddy simulation models. All three response branches and the maximum amplitude are well captured. The 2-dimensional case with the RANS shear–stress transport k-w model, which involves minimal computational cost, is reliable and appropriate for analyzing the characteristics of VIV. PMID:28982172

Task partitioning in a robot swarm: object retrieval as a sequence of subtasks with direct object transfer.

PubMed

Pini, Giovanni; Brutschy, Arne; Scheidler, Alexander; Dorigo, Marco; Birattari, Mauro

2014-01-01

We study task partitioning in the context of swarm robotics. Task partitioning is the decomposition of a task into subtasks that can be tackled by different workers. We focus on the case in which a task is partitioned into a sequence of subtasks that must be executed in a certain order. This implies that the subtasks must interface with each other, and that the output of a subtask is used as input for the subtask that follows. A distinction can be made between task partitioning with direct transfer and with indirect transfer. We focus our study on the first case: The output of a subtask is directly transferred from an individual working on that subtask to an individual working on the subtask that follows. As a test bed for our study, we use a swarm of robots performing foraging. The robots have to harvest objects from a source, situated in an unknown location, and transport them to a home location. When a robot finds the source, it memorizes its position and uses dead reckoning to return there. Dead reckoning is appealing in robotics, since it is a cheap localization method and it does not require any additional external infrastructure. However, dead reckoning leads to errors that grow in time if not corrected periodically. We compare a foraging strategy that does not make use of task partitioning with one that does. We show that cooperation through task partitioning can be used to limit the effect of dead reckoning errors. This results in improved capability of locating the object source and in increased performance of the swarm. We use the implemented system as a test bed to study benefits and costs of task partitioning with direct transfer. We implement the system with real robots, demonstrating the feasibility of our approach in a foraging scenario.

Using radiative transfer models to study the atmospheric water vapor content and to eliminate telluric lines from high-resolution optical spectra

NASA Astrophysics Data System (ADS)

Gardini, A.; Maíz Apellániz, J.; Pérez, E.; Quesada, J. A.; Funke, B.

2013-05-01

The Radiative Transfer Model (RTM) and the retrieval algorithm, incorporated in the SCIATRAN 2.2 software package developed at the Institute of Remote Sensing/Institute of Enviromental Physics of Bremen University (Germany), allows to simulate, among other things, radiance/irradiance spectra in the 2400--24 000 Å range. In this work we present applications of RTM to two case studies. In the first case the RTM was used to simulate direct solar irradiance spectra, with different water vapor amounts, for the study of the water vapor content in the atmosphere above Sierra Nevada Observatory. Simulated spectra were compared with those measured with a spectrometer operating in the 8000--10 000 Å range. In the second case the RTM was used to generate telluric model spectra to subtract the atmospheric contribution and correct high-resolution stellar spectra from atmospheric water vapor and oxygen lines. The results of both studies are discussed.

Occurrence of two newly named oral treponemes - Treponema parvum and Treponema putidum - in primary endodontic infections.

PubMed

Rôças, I N; Siqueira, J F

2005-12-01

Recent evidence from molecular genetic studies has revealed that oral Treponema species are involved in infections of endodontic origin. This study assessed the occurrence of two newly named oral treponemes - Treponema parvum and Treponema putidum - in primary endodontic infections using a culture-independent identification technique. Genomic DNA was isolated directly from clinical samples, and a 16S rRNA gene-based nested polymerase chain reaction (PCR) assay was used to determine the presence of T. parvum and T. putidum. Species-specific primer pairs were developed by aligning closely related 16S rRNA gene sequences. The specificity for each primer pair was validated by running PCR against a panel of oral bacteria and by sequence analysis of PCR products from positive clinical samples. T. parvum was detected in 52% of the root canals associated with chronic apical periodontitis, in 20% of the cases diagnosed as acute apical periodontitis, and in no abscessed case. In general, T. parvum was detected in 26% of the samples from primary endodontic infections. T. putidum was found in only one case of acute apical periodontitis (2% of the total number of cases investigated). The devised nested PCR protocol was able to identify both T. parvum and T. putidum directly in clinical samples and demonstrated that these two treponemes can take part in endodontic infections.

Tobacco control advocacy in the age of social media: using Facebook, Twitter and change.

PubMed

Hefler, Marita; Freeman, Becky; Chapman, Simon

2013-05-01

The tobacco industry's use of social media sites, such as Facebook, is an emerging area of research; however, this is the first study of the potential for social media to advance tobacco control. This paper presents three case studies of using social media for tobacco control advocacy, demonstrates how social media can facilitate direct and effective action, and provides tools and lessons learned for future campaigns.

Studying the Positive Influence of the Use of Video in Teaching & Learning Environments, Focusing on Registration of the Directions Where It Improves the PBL Effectiveness: A Systematic Literature Review

ERIC Educational Resources Information Center

Aronis, Alexis

2016-01-01

Previous studies report the involvement of the use of video in the frameworks of problem-based learning (PBL), case-based learning, and project-based learning. This systematic literature review, through two research questions, explores the positive influence of the use of video in those instructional methods, and, while focusing on PBL, identifies…

Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

PubMed

Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

2015-11-06

Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in system performance with some paediatric drowning cases subsequently not identified for P-HEMS response being transported to adult hospitals.

[Osteochondral lesions of the talar dome: surgical treatment in a series of 30 cases].

PubMed

Jarde, O; Trinquier-Lautard, J L; Garate, F; de Lestang, M; Vives, P

2000-10-01

We reviewed 30 cases of osteochondral lesions of the astragalar vault treated surgically. Among the 30 patients, 17 participated in sports activities and 24 had a history of trauma. Mean delay to surgery was 10 months. Treatment included osteochondritis curettage and Pridie perforations. Direct access was used in 11 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone grafts were used in 6 cases. Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was based on clinical assessment and arthroscan findings. Surgical treatment provided very good results in 75 p. 100 of cases with pain relief and improved walking distance. Our cases pointed out the important contribution of the FOG (Fracture Osteonecrosis Geode) classification to pathogenic and prognostic analysis. The Berndt and Harty classifications were not found to be useful. In case of localized necrosis, we propose arthroscopic perforation curettage. In case of bone loss, a direct cancellous graft may be used.

Spectroscopic Measurement of Ion Flow During Merging Start-up of Field-Reversed Configuration

NASA Astrophysics Data System (ADS)

Oka, Hirotaka; Inomoto, Michiaki; Tanabe, Hiroshi; Annoura, Masanobu; Ono, Yasushi; Nemoto, Koshichi

2012-10-01

The counter-helicity merging method [1] of field-reversed configuration (FRC) formation involves generation of bidirectional toroidal flow, known as a ``sling-shot.'' In two fluids regime, reconnection process is strongly affected by the Hall effect [2]. In this study, we have investigated the behavior of toroidal bidirectional flow generated by the counter-helicity merging in two-fluids regime. We use 2D Ion Doppler Spectroscopy to mesure toroidal ion flow during merging start-up of FRC from Ar gas. We defined two cases: one case with a radially pushed-in X line (case I) and the other case with a radially pushed-out X line(case O). The flow during the plasma merging shows radial asymmetry, as expected from the magnetic measurement, but finally relaxes to a unidirectional flow in plasma current direction in both cases. We observed larger toroidal flow in the plasma current direction in case I after FRC is formed, though the FRC in case O has larger magnetic flux. These results suggest that more ions are lost during merging start-up in case I. This selective ion loss might account for stability and confinement of FRCs probably maintained by high energy ions.[4pt] [1] Y. Ono, et al., Nucl. Fusion 39, pp. 2001-2008 (1999).[0pt] [2] M. Inomoto, et al., Phys. Rev. Lett., 97, 135002, (2006)

A theoretical study on directivity control of multiple-loudspeaker system with a quadrupole radiation pattern in low frequency range

NASA Astrophysics Data System (ADS)

Irwansyah, Kuse, Naoyuki; Usagawa, Tsuyoshi

2017-08-01

Directivity pattern of an ordinary loudspeaker becomes more directive at higher frequencies. However, because a single loudspeaker tends to radiate uniformly in all directions at low frequencies, reverberation from surrounding building walls may affect speech intelligibility when installing a multiple-loudspeaker system at crossroads. As an alternative, a sharply directive sound source is recommended to be used, but in many cases the directivity of an ordinary loudspeaker is less sharp at lower frequencies. Therefore, in order to overcome such a limitation, this paper discusses the possibility of using four loudspeakers under active control to realize a quadrupole radiation pattern in low frequency range. In this study, the radiation pattern of a primary loudspeaker and three secondary loudspeakers has been modelled. By placing the loudspeakers close together in the direction of 0°, 90°, 180°, and 270°, it was theoretically demonstrated that a quadrupole radiation pattern can be shaped in the target frequency range up to 600 Hz by simply controlling the directivity in three of four directions which are 45°, 135°, 225°, and 315°. Although, the radiation pattern model is far from realistic configurations and conditions, it is possible to realize a quadrupole radiation pattern in the low frequency range.

A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks.

PubMed

Reiter, Kristin L; Song, Paula H; Minasian, Lori; Good, Marjorie; Weiner, Bryan J; McAlearney, Ann Scheck

2012-09-01

The Community Clinical Oncology Program (CCOP) plays an essential role in the efforts of the National Cancer Institute (NCI) to increase enrollment in clinical trials. Currently, there is little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. In this article, the authors present a conceptual model of the business case for PBRN participation, a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization. A comparative, case-study approach was used to identify key components of the business case for hospitals attempting to support a CCOP research infrastructure. Semistructured interviews were conducted with providers and administrators. Key themes were identified and used to develop the financial analysis tool. Key components of the business case included CCOP start-up costs, direct revenue from the NCI CCOP grant, direct expenses required to maintain the CCOP research infrastructure, and incidental benefits, most notably downstream revenues from CCOP patients. The authors recognized the value of incidental benefits as an important contributor to the business case for CCOP participation; however, currently, this component is not calculated. The current results indicated that providing a method for documenting the business case for CCOP or other PBRN involvement will contribute to the long-term sustainability and expansion of these programs by improving providers' understanding of the financial implications of participation. Copyright © 2011 American Cancer Society.

Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain.

PubMed

Barranco, R J; Gomez-Peralta, F; Abreu, C; Delgado-Rodriguez, M; Moreno-Carazo, A; Romero, F; de la Cal, M A; Barranco, J M; Pasquel, F J; Umpierrez, G E

2017-07-01

Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact. An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012. Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8. Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system. © 2017 Diabetes UK.

An application of computer image-processing and filmy replica technique to the copper electroplating method of stress analysis

NASA Astrophysics Data System (ADS)

Sugiura, M.; Seika, M.

1994-02-01

In this study, a new technique to measure the density of slip-bands automatically is developed, namely, a TV image of the slip-bands observed through a microscope is directly processed by an image-processing system using a personal computer and an accurate value of the density of slip-bands is measured quickly. In the case of measuring the local stresses in machine parts of large size with the copper plating foil, the direct observation of slip-bands through an optical microscope is difficult. In this study, to facilitate a technique close to the direct microscopic observation of slip-bands in the foil attached to a large-sized specimen, the replica method using a platic film of acetyl cellulose is applied to replicate the slip-bands in the attached foil.

Houston managed lanes case study : the evolution of the Houston HOV system

DOT National Transportation Integrated Search

2003-09-01

A nine-mile contraflow High Occupancy Vehicle (HOV) lane on the I-45 North Freeway in Houston, Texas was implemented as a demonstration project in 1979. This demonstration borrowed an off-peak direction traffic lane for use by buses and vanpools in t...

THE USE OF MODELED ATMOSPHERIC WIND TRAJECTORIES TO DETERMINE POTENTIAL DOWNWIND GENE FLOW; A CASE STUDY USING GM-BENTGRASS

EPA Science Inventory

The down-wind dispersal of pollen and the airborne spread of seed are affected by the size, shape and weight of the particles and by the strength, buoyancy and direction of surface winds. An atmospheric model (HYSPLIT model: www.arl.noaa.gov\\ready.html) was used to reconstruct w...

Development of case statements in academic administration: a proactive method for achieving outcomes.

PubMed

Mundt, Mary H

2005-01-01

The complex nature of higher education presents academic administrators with unique challenges to communicate vision and strategic direction to a variety of internal and external audiences. The administrator must be prepared to engage in persuasive communication to describe the needs and desired outcomes of the academic unit. This article focuses on the use of the case statement as a communication tool for the nursing academic administrator. The case statement is a form of persuasive communication where a situation or need is presented in the context of the mission, vision, and strategic direction of a group or organization. The aim of the case statement is to enlist support in meeting the identified need. Fundamental assumptions about communicating case statements are described, as well as guidelines for how the academic administrator can prepare themselves for using the case statement method.

Do therapeutic homework assignments address areas of need for individuals with severe mental illness?

PubMed

Kelly, Peter J; Deane, Frank P

2011-04-01

The current study explores the types of homework assignments used in a recovery orientated case management approach. It also examines the relationship between the types of homework used and the clients' area of need as rated on the CANSAS. There were 129 client and mental health case manager dyads that participated in the study. Written copies of all homework assignments administered during the 12-month research period were collected (N = 1,054). The homework assignments were categorised according to the 'type' and the 'need domain addressed by the task'. The majority of these tasks were behavioural in nature. On a group level homework tended to broadly address areas of need for clients in the study. Only 2 of the 1,054 homework assignments administered directly addressed areas of Intimate Relationships or Sexual Expression. The importance of addressing Intimate Relationship and Sexual Expression within mental health case management is discussed.

A digital computer simulation and study of a direct-energy-transfer power-conditioning system

NASA Technical Reports Server (NTRS)

Burns, W. W., III; Owen, H. A., Jr.; Wilson, T. G.; Rodriguez, G. E.; Paulkovich, J.

1975-01-01

An investigation of the behavior of the power-conditioning system as a whole is a necessity to ensure the integrity of the aggregate system in the case of space applications. An approach for conducting such an investigation is considered. A description is given of the application of a general digital analog simulator program to the study of an aggregate power-conditioning system which is being developed for use on the International Ultraviolet Explorer spacecraft. The function of the direct energy transfer system studied involves a coupling of a solar array through a main distribution bus to the spacecraft electrical loads.

Air Force Fitness Program. Case Studies on the Impact on Aircraft Maintenance

DTIC Science & Technology

2009-04-01

reduced or avoided pain after childbirth if one is muscularly fit. Also, in menopausal women, exercise reduces the effects of osteoporosis. Post ...workforce, show that exercise and increased productivity are directly linked. The first case, covered in the New Zealand Dominion Post , directly...menopausal depression has shown to greatly reduce with participation in a regular exercise program.20 While benefits of regular exercise and healthy

Seeing tobacco mosaic virus through direct electron detectors

PubMed Central

Fromm, Simon A.; Bharat, Tanmay A.M.; Jakobi, Arjen J.; Hagen, Wim J.H.; Sachse, Carsten

2015-01-01

With the introduction of direct electron detectors (DED) to the field of electron cryo-microscopy, a wave of atomic-resolution structures has become available. As the new detectors still require comparative characterization, we have used tobacco mosaic virus (TMV) as a test specimen to study the quality of 3D image reconstructions from data recorded on the two direct electron detector cameras, K2 Summit and Falcon II. Using DED movie frames, we explored related image-processing aspects and compared the performance of micrograph-based and segment-based motion correction approaches. In addition, we investigated the effect of dose deposition on the atomic-resolution structure of TMV and show that radiation damage affects negative carboxyl chains first in a side-chain specific manner. Finally, using 450,000 asymmetric units and limiting the effects of radiation damage, we determined a high-resolution cryo-EM map at 3.35 Å resolution. Here, we provide a comparative case study of highly ordered TMV recorded on different direct electron detectors to establish recording and processing conditions that enable structure determination up to 3.2 Å in resolution using cryo-EM. PMID:25528571

Assessment and Calibration of Ultrasonic Measurement Errors in Estimating Weathering Index of Stone Cultural Heritage

NASA Astrophysics Data System (ADS)

Lee, Y.; Keehm, Y.

2011-12-01

Estimating the degree of weathering in stone cultural heritage, such as pagodas and statues is very important to plan conservation and restoration. The ultrasonic measurement is one of commonly-used techniques to evaluate weathering index of stone cultual properties, since it is easy to use and non-destructive. Typically we use a portable ultrasonic device, PUNDIT with exponential sensors. However, there are many factors to cause errors in measurements such as operators, sensor layouts or measurement directions. In this study, we carried out variety of measurements with different operators (male and female), different sensor layouts (direct and indirect), and sensor directions (anisotropy). For operators bias, we found that there were not significant differences by the operator's sex, while the pressure an operator exerts can create larger error in measurements. Calibrating with a standard sample for each operator is very essential in this case. For the sensor layout, we found that the indirect measurement (commonly used for cultural properties, since the direct measurement is difficult in most cases) gives lower velocity than the real one. We found that the correction coefficient is slightly different for different types of rocks: 1.50 for granite and sandstone and 1.46 for marble. From the sensor directions, we found that many rocks have slight anisotropy in their ultrasonic velocity measurement, though they are considered isotropic in macroscopic scale. Thus averaging four different directional measurement (0°, 45°, 90°, 135°) gives much less errors in measurements (the variance is 2-3 times smaller). In conclusion, we reported the error in ultrasonic meaurement of stone cultural properties by various sources quantitatively and suggested the amount of correction and procedures to calibrate the measurements. Acknowledgement: This study, which forms a part of the project, has been achieved with the support of national R&D project, which has been hosted by National Research Institute of Cultural Heritage of Cultural Heritage Administration(No. NRICH-1107-B01F).

Computer simulation modeling of recreation use: Current status, case studies, and future directions

Treesearch

David N. Cole

2005-01-01

This report compiles information about recent progress in the application of computer simulation modeling to planning and management of recreation use, particularly in parks and wilderness. Early modeling efforts are described in a chapter that provides an historical perspective. Another chapter provides an overview of modeling options, common data input requirements,...

Walking the Talk: Continuous Improvement of a Quality Management Field Exercise

ERIC Educational Resources Information Center

Coy, Steven; Adams, Jeffery

2012-01-01

This article provides results from a three semester case study of the pedagogical efficacy of an innovative quality management field exercise. A series of direct and indirect measures were used to assess the extent to which the field exercise met a set of learning objectives. The results indicate that the assessment framework is useful in…

Multiple-Choice Question Tests: A Convenient, Flexible and Effective Learning Tool? A Case Study

ERIC Educational Resources Information Center

Douglas, Mercedes; Wilson, Juliette; Ennis, Sean

2012-01-01

The research presented in this paper is part of a project investigating assessment practices, funded by the Scottish Funding Council. Using established principles of good assessment and feedback, the use of online formative and summative multiple choice tests (MCT's) was piloted to support independent and self-directed learning and improve…

Tensile strength of Iß crystalline cellulose predicted by molecular dynamics simulation

Treesearch

Xiawa Wu; Robert J. Moon; Ashlie Martini

2014-01-01

The mechanical properties of Iß crystalline cellulose are studied using molecular dynamics simulation. A model Iß crystal is deformed in the three orthogonal directions at three different strain rates. The stress-strain behaviors for each case are analyzed and then used to calculate mechanical properties. The results show that the elastic modulus, Poisson's ratio...

Cooking under Pressure: Applying the Ideal Gas Law in the Kitchen

ERIC Educational Resources Information Center

Chen, Ling; Anderson, Jennifer Y.; Wang, Diane R.

2010-01-01

This case study uses a daily cooking scenario to demonstrate how the boiling point of water is directly related to the external pressures in order to reinforce the concepts of boiling and boiling point, apply ideal gas law, and relate chemical reaction rates with temperatures. It also extends its teaching to autoclaves used to destroy…

Assessing Complex Emergency Management with Clinical Case-Vignettes: A Validation Study

PubMed Central

2015-01-01

Objective To evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another obstetrician would be the same as the actual management. Methods A multicenter vignette-based study was used in 7 French maternity units. We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other obstetricians’ cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the obstetricians previously managed and the cases of others. Results Thirty obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62–0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other obstetricians’ cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12–0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p<0.001). Conclusions Dynamic case-vignettes accurately reflect actual practices in complex emergency situations. Therefore, they can be used to assess the quality of management in these situations. PMID:26383261

From catʼs eyes to multiple disjoint natural convection flow in tall tilted cavities: A direct primitive variables approach

NASA Astrophysics Data System (ADS)

Báez, Elsa; Nicolás, Alfredo

2013-11-01

Natural convection fluid flow in air-filled tall tilted cavities is studied numerically with a new direct projection method on the Boussinesq approximation in primitive variables. The study deals with “cat's eyes” instabilities and multiple disjoint cells as the aspect ratio A and the angle of inclination ϕ of the cavity vary. The flows are validated with those reported before using the stream function-vorticity variables. New cases, A=12 and 20 varying ϕ, lead to get more insight on the physical phenomenon.

Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports.

PubMed

Akuthota, Venu; Chou, Larry H; Drake, David F; Nadler, Scott F; Toledo, Santiago D

2004-03-01

This self-directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. To discuss shoulder and elbow overuse injuries in sports.

Jeans instability of rotating magnetized quantum plasma: Influence of radiation

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

Joshi, H., E-mail: hjoshi8525@yahoo.com; Pensia, R. K.

2015-07-31

The effect of radiative heat-loss function and rotation on the Jeans instability of quantum plasma is investigated. The basic set of equations for this problem is constructed by considering quantum magnetohydrodynamic (QMHD) model. Using normal mode analysis, the general dispersion relation is obtained. This dispersion relation is studied in both, longitudinal and transverse direction of propagations. In both case of longitudinal and transverse direction of propagation, the Jeans instability criterion is modified due to presence of radiative heat-loss function and quantum correction.

Direct cellular vs. indirect pager communication during orthopaedic surgical procedures: a prospective study.

PubMed

Ortega, Gil R; Taksali, Sudeep; Smart, Ryan; Baumgaertner, Michael R

2009-01-01

Cellular phone use within the hospital setting has increased as physicians, nurses, and ancillary staff incorporate wireless technologies in improving efficiencies, cost, and maintaining patient safety and high quality healthcare [11]. Through the use of wireless, cellular communication, an overall improvement in communication accuracy and efficiency between intraoperative orthopaedic surgeons and floor nurses may be achieved. Both communication types occurred while the surgeon was scrubbed in the operating room (OR). Indirect communication occurred when the pager call was answered by the OR circulating nurse with communication between the surgeon, circulating nurse, and floor nurse. Direct communication consisted of cell phone and Jabra Bluetooth BT200 wireless ear piece used by the surgeon. The surgeon answered the floor nurse's cellular call by phone ring-activated automatic answering. The study was conducted during scheduled orthopaedic procedures. An independent observer measured time variables with a stop-watch while orthopaedic nurses randomly called via pager or cell phone. The nurses asked for patient caregiver confirmation and answers to 30 different patient-care questions. Sixty trials were performed with 30 cell and 30 page communications. Direct cellular communication showed a better response rate than indirect page (Cell 100%, Page 73%). Indirect page communication allowed a 27% and 33% error rate with patient problem and surgeon solution communications, respectively. There were no reported communication errors while using direct wireless, cellular communication. When compared to page communications, cellular communications showed statistically significant improvements in mean time intervals in response time (Cell = 11s, Page = 211s), correct patient identification (Cell = 5s, Page = 172s), patient problem and solution time (Cell = 13s, Page = 189s), and total communication time (Cell = 32s, Page = 250s) (s = seconds, all P < 0.001). Floor nurse satisfaction ratings (dependent on communication times and/or difficulties) were improved with direct cellular communication (Cell = 29 excellent, Page = 11 excellent). Intraoperative case interruptions (defined as delaying surgical progress) were more frequent with indirect page communication (10 page v. 0 cell). Our study demonstrates that direct wireless communication may be used to improve intraoperative communication and enhance patient safety. Direct wireless, cellular intraoperative communication improves communication times, communication accuracy, communication satisfaction, and minimizes intraoperative case interruption. As a result of this study, we hope to maintain our transition to direct wireless, cellular intraoperative orthopaedic communication to reduce medical errors, improve patient care, and enhance both orthopaedic surgeon and nursing efficiencies.

Economic Cost and Burden of Dengue in the Philippines

PubMed Central

Edillo, Frances E.; Halasa, Yara A.; Largo, Francisco M.; Erasmo, Jonathan Neil V.; Amoin, Naomi B.; Alera, Maria Theresa P.; Yoon, In-Kyu; Alcantara, Arturo C.; Shepard, Donald S.

2015-01-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008–2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. PMID:25510723

Economic cost and burden of dengue in the Philippines.

PubMed

Edillo, Frances E; Halasa, Yara A; Largo, Francisco M; Erasmo, Jonathan Neil V; Amoin, Naomi B; Alera, Maria Theresa P; Yoon, In-Kyu; Alcantara, Arturo C; Shepard, Donald S

2015-02-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008-2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. © The American Society of Tropical Medicine and Hygiene.

Seeking instructional specificity: An example from analogical instruction

NASA Astrophysics Data System (ADS)

Kuo, Eric; Wieman, Carl E.

2015-12-01

Broad instructional methods like "interactive engagement" have been shown to be effective, but such general characterization provides little guidance on the details of how to structure instructional materials. In this study, we seek instructional specificity by comparing two ways of using an analogy to learn a target physical principle: (i) applying the analogy to the target physical domain on a case-by-case basis and (ii) using the analogy to create a general rule in the target physical domain. In the discussion sections of a large, introductory physics course (N =2 3 1 ), students who sought a general rule were better able to discover and apply a correct physics principle than students who analyzed the examples case by case. The difference persisted at a reduced level after subsequent direct instruction. We argue that students who performed case-by-case analyses were more likely to focus on idiosyncratic problem-specific features rather than the deep structural features. This study provides an example of investigations into how the specific structure of instructional materials can be consequential for what is learned.

Case mix, quality, and cost relationships in Colorado nursing homes.

PubMed

Schlenker, R E; Shaughessy, P W

1984-01-01

The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.

Case study: reconciling the quality and safety gap through strategic planning.

PubMed

Jeffs, Lianne; Merkley, Jane; Jeffrey, Jana; Ferris, Ella; Dusek, Janice; Hunter, Catherine

2006-05-01

An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance).

The Direction and Autonomy of Interdisciplinary Study and Research Paths in Teacher Education

ERIC Educational Resources Information Center

Rasmussen, Klaus

2016-01-01

This paper presents a case study of didactic infrastructures to direct Study and Research Paths (SRP) in teacher education within the context of interdisciplinary inquiry. The disciplines of school mathematics and school biology, and their didactics, are made to interconnect through the investigation of a generating question concerning the illness…

Advance directives and living wills.

PubMed Central

Stewart, K.; Bowker, L.

1998-01-01

Under certain circumstances, living wills or advance directives may carry legal force in the UK. This paper traces the development of advance directives, clarifies their current legal position and discusses potential problems with their use. Case histories are used to illustrate some of the common dilemmas which doctors may face. PMID:9640440

Probing of congenital nasolacrimal duct obstruction with dacryoendoscope

PubMed Central

Kato, Kumiko; Matsunaga, Koichi; Takashima, Yuko; Kondo, Mineo

2014-01-01

Background A congenital nasolacrimal duct obstruction (CNLDO) is a relatively common disease in infants. We evaluated the results of probing three patients with CNLDO, under direct view, with a dacryoendoscope. Methods Three cases of CNLDO were examined and treated by probing with a dacryoendoscope, under intravenous anesthesia. The diameter of the dacryoendoscope probe was 0.7 mm, and we were able to observe the inner walls of the lacrimal duct and able to guide the probe through the duct. Results In all cases, the site of obstruction was detected, and the probe was used to remove the obstruction. At 2 weeks after the removal of the obstruction, there was no epiphora or mucopurulent discharge in any of the cases. No complications were detected intra- and postoperatively. Conclusion Although only three cases were studied, we believe that probing with a dacryoendoscope is a safe and effective method of treating a CNLDO. More cases need to be studied. PMID:24876765

Maternal mortality in Denmark, 1985-1994.

PubMed

Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit; Weber, Tom; Møller, Margrete; Sørensen, Jette Led

2009-02-01

In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.

Direction, site and the muzzle target distance of bullet in the head and neck at close range as an indication of suicide or homicide.

PubMed

Suwanjutha, T

1988-05-01

Direction, site and muzzle target distance can indicate suicide or homicide. This conclusion can be drawn from autopsies of 57 cases of suicide and 68 cases of homicide by handgun fired at close range to the head and neck together with going to the crimescene in some cases. This study was carried out in Bangkok during the period from January 1983 to January 1986. In order to determine whether it was suicide or homicide, the path of the bullet, the site, the muzzle target distance must be considered. The angle of the bullet would be either elevated (from below upward), horizontal or an angle of depression (from above downward). For suicide, the direction of the bullet should be at an angle of elevation in the majority of cases. The position of the handgun in relation to the head in suicide was most often in tight contact and near contact. For homicide, the direction of the bullet should be horizontal in most cases. The bullet was at close range in the majority of the cases. There are 8 common sites for suicide and homicide and 10 different sites in the case of homicide which are at neck, left cheek, left aural region, lip, left occipital area orbit, chin, left eyebrow, submental and nose.

Molecular cytogenetic characterization and origin of two de novo duplication 9p cases.

PubMed

Tsezou, A; Kitsiou, S; Galla, A; Petersen, M B; Karadima, G; Syrrou, M; Sahlèn, S; Blennow, E

2000-03-13

We report on two additional cases with duplication of 9p, minor with facial anomalies and developmental delay. Using fluorescence in situ hybridization and single-copy probes, we showed that the first case was a direct duplication, whereas the second case was inverted. The extent of the direct duplication was defined as 9p12 --> p24 by microdissection and microcloning of the aberrant chromosome and subsequent chromosome-specific comparative genomic hybridization. DNA polymorphism analysis with eight microsatellite markers revealed that the origin of the dup(9p) was maternal in the first case, whereas it was paternal in the second. Copyright 2000 Wiley-Liss, Inc.

INNOVATIVE CLEAN TECHNOLOGIES CASE STUDIES - PROJECT REPORT

EPA Science Inventory

The innovative Clean Technologies Case Studies contained herein are the products of the "Pollution Prevention by and for Small Business" Program (P2SB) The P2SB was an outreach program directed to small businesses that had developed innovative concepts for pollution prevention i...

INNOVATIVE CLEAN TECHNOLOGIES CASE STUDIES - SECOND YEAR PROJECT REPORT

EPA Science Inventory

The Innovative Clean Technologies Case Studies contained herein are the products of the "Pollution Prevention by and for Small Business" Program (P2SB). The P2SB was an outreach program directed to small businesses that had developed innovative concepts for pollution pr...

The impact of instructional design in a case-based, computer-assisted instruction module on learning liver pathology in a medical school pathology course

NASA Astrophysics Data System (ADS)

Latham, Patricia S.

The purpose of this quantitative experimental study was to test the impact of three learning interventions on student learning and satisfaction when the interventions were embedded in the instructional design of case-based, Computer-Assisted Instruction (CAI) modules for learning liver pathology in an in-class, self-study, laboratory exercise during a Year-2 medical school Pathology course. The hypothesis was that inclusion of the learning interventions would enhance student satisfaction in using the CAI and improve subsequent CAI-directed exam performance. Three learning interventions were studied, including the use of microscopic virtual slides instead of only static images, the use of interactive image annotations instead of only still annotations, and the use of guiding questions before presenting new information. Students were randomly assigned to with one of eight CAI learning modules configured to control for each of the three learning interventions. Effectiveness of the CAI for student learning was assessed by student performance on questions included in subsequent CAI-directed exams in a pretest and on posttests immediately after the lab exercise, at two weeks and two months. Student satisfaction and perceived learning was assessed by a student survey. Results showed that the learning interventions did not improve subsequent student exam performance, although satisfaction and perceived learning with use of the CAI learning modules was enhanced. Student class rank was evaluated to determine if the learning interventions might have a differential effect based on class rank, but there were no significant differences. Class rank at the time of the lab exercise was itself the strongest predictor of exam performance. The findings suggest that the addition of virtual slides, interactive annotations and guiding questions as learning interventions in self-study, case-based CAI for learning liver pathology in a medical class room setting are not likely to increase performance on subsequent MCQ-based exams, but student satisfaction with use of the CAI can be enhanced, which could provide to be an incentive for students to use similar CAI learning modules for future self-directed learning.

Effects of testosterone administration on threat and escape anticipation in the orbitofrontal cortex.

PubMed

Heany, Sarah J; Bethlehem, Richard A I; van Honk, Jack; Bos, Peter A; Stein, Dan J; Terburg, David

2018-05-30

Recent evidence suggests that the steroid hormone testosterone can decrease the functional coupling between orbitofrontal cortex (OFC) and amygdala. Theoretically this decoupling has been linked to a testosterone-driven increase of goal-directed behaviour in case of threat, but this has never been studied directly. Therefore, we placed twenty-two women in dynamically changing situations of escapable and inescapable threat after a within-subject placebo controlled testosterone administration. Using functional magnetic resonance imaging (fMRI) we provide evidence that testosterone activates the left lateral OFC (LOFC) in preparation of active goal-directed escape and decouples this OFC area from a subcortical threat system including the central-medial amygdala, hypothalamus and periaqueductal gray. This LOFC decoupling was specific to threatening situations, a point that was further emphasized by an absence of such decoupling in a second experiment focused on resting-state connectivity. These results not only confirm that testosterone administration decouples the LOFC from the subcortical threat system, but also show that this is specifically the case in response to acute threat, and ultimately leads to an increase in LOFC activity when the participant prepares a goal-directed action to escape. Together these results for the first time provide a detailed understanding of functional brain alterations induced by testosterone under threat conditions, and corroborate and extend the view that testosterone prepares the brain for goal-directed action in case of threat. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Direct Medical Costs Attributable to Cancer-Associated Venous Thromboembolism: A Population-Based Longitudinal Study.

PubMed

Cohoon, Kevin P; Ransom, Jeanine E; Leibson, Cynthia L; Ashrani, Aneel A; Petterson, Tanya M; Long, Kirsten Hall; Bailey, Kent R; Heit, John A

2016-09-01

The purpose of this study is to estimate medical costs attributable to venous thromboembolism among patients with active cancer. In a population-based cohort study, we used Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minn. residents with incident venous thromboembolism and active cancer over the 18-year period, 1988-2005 (n = 374). One Olmsted County resident with active cancer without venous thromboembolism was matched to each case on age, sex, cancer diagnosis date, and duration of prior medical history. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs from 1 year prior to index (venous thromboembolism event date or control-matched date) to the earliest of death, emigration from Olmsted County, or December 31, 2011, with censoring on the shortest follow-up to ensure a similar follow-up duration for each case-control pair. We used generalized linear modeling to predict costs for cases and controls and bootstrapping methods to assess uncertainty and significance of mean adjusted cost differences. Outpatient drug costs were not included in our estimates. Adjusted mean predicted costs were 1.9-fold higher for cases ($49,351) than for controls ($26,529) (P < .001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months (mean difference = $13,504) and remained significantly higher from 3 months to 5 years post index (mean difference = $12,939). Venous thromboembolism-attributable costs among patients with active cancer contribute a substantial economic burden and are highest from index to 3 months, but may persist for up to 5 years. Copyright © 2016 Elsevier Inc. All rights reserved.

Application of the method of steepest descent to laminated shield weight optimization with several constraints: Theory

NASA Technical Reports Server (NTRS)

Lahti, G. P.

1971-01-01

The method of steepest descent used in optimizing one-dimensional layered radiation shields is extended to multidimensional, multiconstraint situations. The multidimensional optimization algorithm and equations are developed for the case of a dose constraint in any one direction being dependent only on the shield thicknesses in that direction and independent of shield thicknesses in other directions. Expressions are derived for one-, two-, and three-dimensional cases (one, two, and three constraints). The precedure is applicable to the optimization of shields where there are different dose constraints and layering arrangements in the principal directions.

Integration, status and potential of environmental justice and the social impact assessment process in transportation development in Missouri

DOT National Transportation Integrated Search

2004-07-01

This research examines the Social Impact Assessment Process at the Missouri Department of Transportation as directed by the National Environmental Policy Act (NEPA). Four case studies are used to assess the influence of human-dimension impacts in tra...

Accommodating the Consumer-Student

ERIC Educational Resources Information Center

Schweitzer, Leah

2009-01-01

Increasingly, students come to the university with a consumer mentality, which gives students a sense that they are entitled to negotiate their student positions within the university and the classroom. This article, using Directed Self-Placement as a sort of case study, considers the role student-centered assessments and pedagogies play in…

SUMMARY OF TECHNIQUES AND UNIQUE USES FOR DIRECT PUSH METHODS IN SITE CHARACTERIZATION ON CONTAMINATED FIELD SITES

EPA Science Inventory

Site characterization of subsurface contaminant transport is often hampered by a lack of knowledge of site heterogeneity and temporal variations in hydrogeochemistry. Two case studies are reviewed to illustrate the utility of macro-scale mapping information along with spatially-...

A Direct Numerical Simulation of a Temporally Evolving Liquid-Gas Turbulent Mixing Layer

NASA Astrophysics Data System (ADS)

Vu, Lam Xuan; Chiodi, Robert; Desjardins, Olivier

2017-11-01

Air-blast atomization occurs when streams of co-flowing high speed gas and low speed liquid shear to form drops. Air-blast atomization has numerous industrial applications from combustion engines in jets to sprays used for medical coatings. The high Reynolds number and dynamic pressure ratio of a realistic air-blast atomization case requires large eddy simulation and the use of multiphase sub-grid scale (SGS) models. A direct numerical simulations (DNS) of a temporally evolving mixing layer is presented to be used as a base case from which future multiphase SGS models can be developed. To construct the liquid-gas mixing layer, half of a channel flow from Kim et al. (JFM, 1987) is placed on top of a static liquid layer that then evolves over time. The DNS is performed using a conservative finite volume incompressible multiphase flow solver where phase tracking is handled with a discretely conservative volume of fluid method. This study presents statistics on velocity and volume fraction at different Reynolds and Weber numbers.

Low Contrast Dose Catheter-Directed CT Angiography (CCTA)

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

Formosa, Amanda, E-mail: amandaformosa@yahoo.ca; Santos, Denise May, E-mail: contact@denisemaysantos.com; Marcuzzi, Daniel

2016-04-15

PurposeCatheter-directed computed tomography angiography (CCTA) has been shown to reduce the contrast volumes required in conventional CTA, thus minimizing the risk of contrast-induced nephropathy (CIN).Materials and MethodsA retrospective analysis was performed on cases where CCTA was used to assess access vessels prior to transfemoral aortic valve implantation (TAVI, n = 53), abdominal aortic aneurysm assessment for endovascular aneurysm repair (EVAR, n = 11), and peripheral vascular disease (PVD, n = 24).ResultsWe show that CCTA can image vasculature with adequate diagnostic detail to allow assessment of lower extremity disease, anatomic suitability for EVAR, as well as potential contraindications to TAVI. Average contrast volumes for pre-TAVI, pre-EVAR, andmore » PVD cases were 7, 11, and 28 mL, respectively.ConclusionThis study validates the use of CCTA in obtaining diagnostic images of the abdominal and pelvic vessels and in imaging lower extremity vasculature.« less

Reply to Boyle's "Who is entitled to double effect?

PubMed

Quinn, Warren

1991-10-01

I have only minor quibbles with Boyle's presentation of my version of the Doctrine of Double Effect (DDE) (Boyle, 1991). On my view, the extra morally problematic element in cases of direct intention is the subordination of a victim to purposes that he or she either rightfully rejects or (and this is something that I should now wish to add in light of Boyle's criticisms) cannot rightfully accept. In cases of indirect intention the victim is incidentally affected by an agent's strategy, but in cases of direct intention the victim is made part of the strategy. Boyle suggests at one point that this amounts to using the person.... But I do not think the "using" metaphor is always apt in these cases, although it is perhaps helpful in pointing to the objectionable element in direct intention, which in its perfectly general form can be put only more abstractly.... My only other concern with Boyle's exposition of my view involves his use of the expression "intentionally harming"....The discussion there tends to suggest, in contrast to what Boyle has said earlier, that I represent DDE as discriminating between cases of incidental and intentional harming. But this is precisely what I tried to avoid....

Development, Characterization, and Resultant Properties of a Carbon, Boron, and Chromium Ternary Diffusion System

NASA Astrophysics Data System (ADS)

Domec, Brennan S.

In today's industry, engineering materials are continuously pushed to the limits. Often, the application only demands high-specification properties in a narrowly-defined region of the material, such as the outermost surface. This, in combination with the economic benefits, makes case hardening an attractive solution to meet industry demands. While case hardening has been in use for decades, applications demanding high hardness, deep case depth, and high corrosion resistance are often under-served by this process. Instead, new solutions are required. The goal of this study is to develop and characterize a new borochromizing process applied to a pre-carburized AISI 8620 alloy steel. The process was successfully developed using a combination of computational simulations, calculations, and experimental testing. Process kinetics were studied by fitting case depth measurement data to Fick's Second Law of Diffusion and an Arrhenius equation. Results indicate that the kinetics of the co-diffusion method are unaffected by the addition of chromium to the powder pack. The results also show that significant structural degradation of the case occurs when chromizing is applied sequentially to an existing boronized case. The amount of degradation is proportional to the chromizing parameters. Microstructural evolution was studied using metallographic methods, simulation and computational calculations, and analytical techniques. While the co-diffusion process failed to enrich the substrate with chromium, significant enrichment is obtained with the sequential diffusion process. The amount of enrichment is directly proportional to the chromizing parameters with higher parameters resulting in more enrichment. The case consists of M7C3 and M23C6 carbides nearest the surface, minor amounts of CrB, and a balance of M2B. Corrosion resistance was measured with salt spray and electrochemical methods. These methods confirm the benefit of surface enrichment by chromium in the sequential diffusion method with corrosion resistance increasing directly with chromium concentration. The results also confirm the deleterious effect of surface-breaking case defects and the need to reduce or eliminate them. The best combination of microstructural integrity, mean surface hardness, effective case depth, and corrosion resistance is obtained in samples sequentially boronized and chromized at 870°C for 6hrs. Additional work is required to further optimize process parameters and case properties.

A Circular Microstrip Antenna Sensor for Direction Sensitive Strain Evaluation.

PubMed

Lopato, Przemyslaw; Herbko, Michal

2018-01-20

In this paper, a circular microstrip antenna for stress evaluation is studied. This kind of microstrip sensor can be utilized in structural health monitoring systems. Reflection coefficient S 11 is measured to determine deformation/strain value. The proposed sensor is adhesively connected to the studied sample. Applied strain causes a change in patch geometry and influences current distribution both in patch and ground plane. Changing the current flow in patch influences the value of resonant frequency. In this paper, two different resonant frequencies were analysed because in each case, different current distributions in patch were obtained. The sensor was designed for operating frequency of 2.5 GHz (at fundamental mode), which results in a diameter less than 55 mm. Obtained sensitivity was up to 1 MHz/100 MPa, resolution depends on utilized vector network analyser. Moreover, the directional characteristics for both resonant frequencies were defined, studied using numerical model and verified by measurements. Thus far, microstrip antennas have been used in deformation measurement only if the direction of external force was well known. Obtained directional characteristics of the sensor allow the determination of direction and value of stress by one sensor. This method of measurement can be an alternative to the rosette strain gauge.

Global Existence and Uniqueness of Weak and Regular Solutions of Shallow Shells with Thermal Effects

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

Menzala, G. Perla, E-mail: perla@lncc.br; Cezaro, F. Travessini De, E-mail: fabianacezaro@furg.br

2016-10-15

We study a dynamical thin shallow shell whose elastic deformations are described by a nonlinear system of Marguerre–Vlasov’s type under the presence of thermal effects. Our main result is the proof of a global existence and uniqueness of a weak solution in the case of clamped boundary conditions. Standard techniques for uniqueness do not work directly in this case. We overcame this difficulty using recent work due to Lasiecka (Appl Anal 4:1376–1422, 1998).

On "Stepping Back and Letting Go": The Role of Control in the Success or Failure of Social Studies Simulations

ERIC Educational Resources Information Center

Wright-Maley, Cory

2015-01-01

This comparative case study presents one key challenge that 2 experienced teachers faced when using simulations: control. Simulations are activities that place high demands on teachers, including the ability to anticipate pitfalls in advance, act in multiple capacities, shape the direction of the activity without unduly interfering, and to be…

Measuring the Cost of a College Degree: A Case Study of a SUNY Community College

ERIC Educational Resources Information Center

Romano, Richard M.; Losinger, Regina; Millard, Tim

2011-01-01

Inspired by a white paper produced by the Delta Project on Postsecondary Education Costs, Productivity, and Accountability, this study uses different measures of calculating the cost of a college degree at an upstate community college in New York. Departmental cost per credit hour, direct instructional costs, and full costs are all explained. A…

Case Study: Effect of Handrim Diameter on Performance in a Paralympic Wheelchair Athlete

ERIC Educational Resources Information Center

Costa, Gabriel Brizuela; Rubio, Miguel Polo; Belloch, Salvador Llana; Soriano, Pedro Perez

2009-01-01

This study, with a top T-52 class athlete, determines the relationship between stroke frequency (SF) and push time (PT) and wheelchair velocity (Wv) using different handrim diameters (HD) and the effect of different HDs on the athlete's heart rate (HR) and blood lactate (LACT) at competition speeds. Wv shows a linear-direct relationship with SF…

Meat Processing Company Staff as Innovation Intermediaries: Developing a Framework from New Zealand's Red Meat Sector

ERIC Educational Resources Information Center

Westbrooke, Victoria; Guenther, Meike; Bewsell, Denise; Greer, Glen

2018-01-01

Purpose: Meat processing companies have the potential to raise farm and sector productivity by directly working with farmers. This study assesses how commercial companies can undertake the roles of innovation intermediaries to increase productivity in New Zealand's sheep and beef sector. Design/methodology/approach: This study uses a case study…

Age adjustment in ecological studies: using a study on arsenic ingestion and bladder cancer as an example.

PubMed

Guo, How-Ran

2011-10-20

Despite its limitations, ecological study design is widely applied in epidemiology. In most cases, adjustment for age is necessary, but different methods may lead to different conclusions. To compare three methods of age adjustment, a study on the associations between arsenic in drinking water and incidence of bladder cancer in 243 townships in Taiwan was used as an example. A total of 3068 cases of bladder cancer, including 2276 men and 792 women, were identified during a ten-year study period in the study townships. Three methods were applied to analyze the same data set on the ten-year study period. The first (Direct Method) applied direct standardization to obtain standardized incidence rate and then used it as the dependent variable in the regression analysis. The second (Indirect Method) applied indirect standardization to obtain standardized incidence ratio and then used it as the dependent variable in the regression analysis instead. The third (Variable Method) used proportions of residents in different age groups as a part of the independent variables in the multiple regression models. All three methods showed a statistically significant positive association between arsenic exposure above 0.64 mg/L and incidence of bladder cancer in men and women, but different results were observed for the other exposure categories. In addition, the risk estimates obtained by different methods for the same exposure category were all different. Using an empirical example, the current study confirmed the argument made by other researchers previously that whereas the three different methods of age adjustment may lead to different conclusions, only the third approach can obtain unbiased estimates of the risks. The third method can also generate estimates of the risk associated with each age group, but the other two are unable to evaluate the effects of age directly.

Detecting a Defective Casing Seal at the Top of a Bedrock Aquifer.

PubMed

Richard, Sandra K; Chesnaux, Romain; Rouleau, Alain

2016-03-01

An improperly sealed casing can produce a direct hydraulic connection between two or more originally isolated aquifers with important consequences regarding groundwater quantity and quality. A recent study by Richard et al. (2014) investigated a monitoring well installed in a fractured rock aquifer with a defective casing seal at the soil-bedrock interface. A hydraulic short circuit was detected that produced some leakage between the rock and the overlying deposits. A falling-head permeability test performed in this well showed that the usual method of data interpretation is not valid in this particular case due to the presence of a piezometric error. This error is the direct result of the preferential flow originating from the hydraulic short circuit and the subsequent re-equilibration of the piezometric levels of both aquifers in the vicinity of the inlet and the outlet of the defective seal. Numerical simulations of groundwater circulation around the well support the observed impact of the hydraulic short circuit on the results of the falling-head permeability test. These observations demonstrate that a properly designed falling-head permeability test may be useful in the detection of defective casing seals. © 2015, National Ground Water Association.

Estimating the costs of induced abortion in Uganda: A model-based analysis

PubMed Central

2011-01-01

Background The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. Methods A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. Results The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was $92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred $14 ($10-$20) on average. Conclusion Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical. PMID:22145859

Estimating the costs of induced abortion in Uganda: a model-based analysis.

PubMed

Babigumira, Joseph B; Stergachis, Andy; Veenstra, David L; Gardner, Jacqueline S; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Garrison, Louis P

2011-12-06

The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was $92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred $14 ($10-$20) on average. Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical.

Advantages of video trigger in problem-based learning.

PubMed

Chan, Lap Ki; Patil, Nivritti G; Chen, Julie Y; Lam, Jamie C M; Lau, Chak S; Ip, Mary S M

2010-01-01

Traditionally, paper cases are used as 'triggers' to stimulate learning in problem-based learning (PBL). However, video may be a better medium because it preserves the original language, encourages the active extraction of information, avoids depersonalization of patients and allows direct observation of clinical consultations. In short, it exposes the students to the complexity of actual clinical problems. The study aims to find out whether students and facilitators who are accustomed to paper cases would prefer video triggers or paper cases and the reasons for their preference. After students and facilitators had completed a video PBL tutorial, their responses were measured by a structured questionnaire using a modified Likert scale. A total of 257 students (92%) and 26 facilitators (100%) responded. The majority of students and facilitators considered that using video triggers could enhance the students' observational powers and clinical reasoning, help them to integrate different information and better understand the cases and motivate them to learn. They found PBL using video triggers more interesting and preferred it to PBL using paper cases. Video triggers are preferred by both students and facilitators over paper cases in PBL.

Misconceptions about case-mix payments for nursing homes.

PubMed

Grimaldi, P L

1987-04-01

Despite the increasing use of case-mix payment systems for skilled and intermediate nursing home care (at least 10 state Medicaid programs have adopted or are considering adopting such a system), misconceptions about such systems still exist. Unless these inaccurate perceptions are corrected, a state may adopt a system that fails to realize its goals. Some of these misconceptions include the beliefs that case-mix payment systems: Apply to all nursing homes costs; Will benefit hospital-based facilities; Will resolve the access problems of heavy care public patients; Will result in higher statewide payment rates because patient characteristics are factored directly into the calculations. In fact, case-mix adjustments are applied only to costs that can be traced directly to patients' impairments. Nursing services and some ancillary services are dependent on case mix, while administrative and support services are largely independent of case mix. Capital costs usually can be ignored in formulating the case-mix adjustment. Although hospital-based facilities frequently have sicker patients than freestanding facilities, studies show that only a portion of the cost differential is explained by case-mix differences. In the case of heavy-care patients, some believe that case-mix payment systems will resolve access problems by paying higher rates in response to the higher treatment costs. Access may not improve, however, if the new rates are lower than those paid by comparable private patients. Perhaps a loosening in the certificate-of-need process will also be needed to resolve the access problem.(ABSTRACT TRUNCATED AT 250 WORDS)

The Effects of Incest: A Review of the Literature Pertaining to Women and Children.

ERIC Educational Resources Information Center

Warner, Lisa Elaine

The number of children and adult women known to have experienced an incestuous relationship is growing. Clinical case studies, systematic empirical case studies, and comparative empirical studies have been conducted to examine the effects of incest. Although few studies have been able to directly connect psychological and relational problems of…

Systematic review and meta-analysis of hemodynamic-directed feedback during cardiopulmonary resuscitation in cardiac arrest.

PubMed

Chopra, A S; Wong, N; Ziegler, C P; Morrison, L J

2016-04-01

Physiologic monitoring of resuscitative efforts during cardiac arrest is gaining in importance, as it provides a real-time window into the cellular physiology of patients. The aim of this review is to assess the quality of evidence surrounding the use of physiologic monitoring to guide cardiopulmonary resuscitation (CPR), and to examine whether the evidence demonstrates an improvement in patient outcome when comparing hemodynamic-directed CPR versus standard CPR. Studies were obtained through a search of the PubMed, Embase and Cochrane databases. Peer-reviewed randomized trials, case-control studies, systematic reviews, and cohort studies that titrated CPR to physiologic measures, compared results to standard CPR, and examined patient outcome were included. Six studies met inclusion criteria, with all studies conducted in animal populations. Four studies examined the effects of hemodynamic-directed CPR on survival, with 35/37 (94.6%) animals surviving in the hemodynamic-directed CPR groups and 12/35 (34.3%) surviving in the control groups (p<0.001). Two studies examined the effects of hemodynamic-directed CPR on ROSC, with 22/30 (73.3%) achieving ROSC in the hemodynamic-directed CPR group and 19/30 (63.3%) achieving ROSC in the control group (p=0.344). These results suggest a trend in survival from hemodynamic-directed CPR over standard CPR, however the small sample size and lack of human data make these results of limited value. Future human studies examining hemodynamic-directed CPR versus current CPR standards are needed to enhance our understanding of how to effectively use physiologic measures to improve resuscitation efforts and ultimately incorporate concrete targets into international resuscitation guidelines. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

Design and validity of a clinic-based case-control study on the molecular epidemiology of lymphoma

PubMed Central

Cerhan, James R; Fredericksen, Zachary S; Wang, Alice H; Habermann, Thomas M; Kay, Neil E; Macon, William R; Cunningham, Julie M; Shanafelt, Tait D; Ansell, Stephen M; Call, Timothy G; Witzig, Thomas E; Slager, Susan L; Liebow, Mark

2011-01-01

We present the design features and implementation of a clinic-based case-control study on the molecular epidemiology of lymphoma conducted at the Mayo Clinic (Rochester, Minnesota, USA), and then assess the internal and external validity of the study. Cases were newly diagnosed lymphoma patients from Minnesota, Iowa and Wisconsin seen at Mayo and controls were patients from the same region without lymphoma who had a pre-scheduled general medical examination, frequency matched on age, sex and residence. Overall response rates were 67% for cases and 70% for controls; response rates were lower for cases and controls over age 70 years, cases with more aggressive disease, and controls from the local area, although absolute differences were modest. Cases and controls were well-balanced on age, sex, and residence characteristics. Demographic and disease characteristics of NHL cases were similar to population-based cancer registry data. Control distributions were similar to population-based data on lifestyle factors and minor allele frequencies of over 500 SNPs, although smoking rates were slightly lower. Associations with NHL in the Mayo study for smoking, alcohol use, family history of lymphoma, autoimmune disease, asthma, eczema, body mass index, and single nucleotide polymorphisms in TNF (rs1800629), LTA (rs909253), and IL10 (rs1800896) were at a magnitude consistent with estimates from pooled studies in InterLymph, with history of any allergy the only directly discordant result in the Mayo study. These data suggest that this study should have strong internal and external validity. This framework may be useful to others who are designing a similar study. PMID:21686124

ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.

PubMed

Ingham, Gerard; Fry, Jennifer; Morgan, Simon; Ward, Bernadette

2015-12-10

Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments. A sample of general practice medical educators and matched registrars were recruited. Following the ARCADO workplace assessment, semi-structured qualitative interviews were conducted. The data was analysed thematically. Ten registrars and eight medical educators participated. Four major themes emerged - formative versus summative assessment; strengths (acceptability, flexibility, time efficiency, complementarity and authenticity); weaknesses (reduced observation and integrity risks); and contextual factors (variation in assessment content, assessment timing, registrar-medical educator relationship, medical educator's approach and registrar ability). ARCADO is a well-accepted workplace-based formative assessment perceived by registrars and assessors to be valid and flexible. The use of ARCADO enabled complementary insights that would not have been achieved with direct observation alone. Whilst there are some contextual factors to be considered in its implementation, ARCADO appears to have utility as formative assessment and, subject to further evaluation, high-stakes assessment.

Culturally Responsive Teaching in the Context of Mathematics: A Grounded Theory Case Study

ERIC Educational Resources Information Center

Bonner, Emily P.; Adams, Thomasenia L.

2012-01-01

In this grounded theory case study, four interconnected, foundational cornerstones of culturally responsive mathematics teaching (CRMT), communication, knowledge, trust/relationships, and constant reflection/revision, were systematically unearthed to develop an initial working theory of CRMT that directly informs classroom practice. These…

Empathy, social media, and directed altruistic living organ donation.

PubMed

Moorlock, Greg; Draper, Heather

2018-06-01

In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable 'statistical victims' into 'real people' with whom we can identify and feel empathy: the so-called 'identifiable victim effect', which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non-directed altruistic donation; (b) personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two. © 2018 The Authors Bioethics Published by John Wiley & Sons Ltd.

Genomic structures of dysplastic nodule and concurrent hepatocellular carcinoma.

PubMed

Lee, Minho; Kim, Kyung; Kim, Shinn Young; Jung, Seung-Hyun; Yoon, Jonghwan; Kim, Min Sung; Park, Hyeon-Chun; Jung, Eun Sun; Chung, Yeun-Jun; Lee, Sug Hyung

2018-06-24

Although high-grade dysplastic nodule (HGDN) is a preneoplastic lesion that precedes hepatocellular carcinoma (HCC), the genomic structures of HGDN in conjunction with HCC remain elusive. The objective of this study was to identify genomic alterations of HGDN and its difference from HCC that may drive HGDN progression to HCC. We analyzed 16 regions of paired HGDN and HCC from 6 patients using whole-exome sequencing to find somatic mutation and copy number alteration (CNA) profiles of HGDN and HCC. The number of mutations, driver mutations, and CNAs of HGDNs were not significantly different from those of HCCs. We identified that the CNA gain of 1q25.3-1q42.13 was predominant in the HCCs compared to that in the HGDNs. Two cases (one nodule-in-nodule case and another case with closely attached HCC and HGDN) showed several overlapped driver mutations (CTNNB1 and CEBPA) and CNAs (losses of CDKN2A, RB1 and TP53) between HGDNs and HCCs, suggesting their roles in the early HCC development. The other 4 cases with spatially separated HCCs and HGDNs showed few overlapped alterations between the paired HCCs and HGDNs. Mutations in ERBB2 and CCND1, and CNAs (gains of CTNNB1, MET and SMO and losses of PTEN, TP53 and SETD2) were identified as 'HCC-predominant', suggesting their roles in the progression of HGDN to HCC. Our data show that HCCs are direct descendants of HGDNs in some cases, but there is no direct evidence of such relationship in spatially separated cases. Genomic features of HGDN identified in this study provide a useful resource for dissecting clues for the genetic diagnosis of HGDN and HCC. Copyright © 2018. Published by Elsevier Inc.

The comparison of pyrosequencing molecular Gram stain, culture, and conventional Gram stain for diagnosing orthopaedic infections.

PubMed

Kobayashi, Naomi; Bauer, Thomas W; Tuohy, Marion J; Lieberman, Isador H; Krebs, Viktor; Togawa, Daisuke; Fujishiro, Takaaki; Procop, Gary W

2006-08-01

We have developed a combined real-time PCR and pyrosequencing assay that successfully differentiated the vast majority of gram-positive and gram-negative bacteria when bacterial isolates were tested. The purpose of this study was to evaluate this assay on clinical specimens obtained from orthopedic surgeries, and to prospectively compare the results of "molecular Gram stain" with culture and conventional direct Gram stain. Forty-five surgical specimens were obtained from patients who underwent orthopedic surgery procedures. The DNA was extracted and a set of broad-range PCR primers that targeted a part of the 16S rDNA gene was used for pan-bacterial PCR. The amplicons were submitted for pyrosequencing and the resulting molecular Gram stain characteristics were recorded. Culture and direct Gram staining were performed using standard methods for all cases. Surgical specimens were reviewed histologically for all cases that had a discrepancy between culture and molecular results. There was an 86.7% (39/45) agreement between the traditional and molecular methods. In 12/14 (85.7%) culture-proven cases of bacterial infection, molecular Gram stain characteristics were in agreement with the culture results, while the conventional Gram stain result was in agreement only for five cases (35.7%). In the 31 culture negative cases, 27 cases were also PCR negative, whereas 4 were PCR positive. Three of these were characterized as gram negative and one as gram positive by this molecular method. Molecular determination of the Gram stain characteristics of bacteria that cause orthopedic infections may be achieved, in most instances, by this method. Further studies are necessary to understand the clinical importance of PCR-positive/culture-negative results.

Sequential and direct ionic excitation in the strong-field ionization of 1-butene molecules.

PubMed

Schell, Felix; Boguslavskiy, Andrey E; Schulz, Claus Peter; Patchkovskii, Serguei; Vrakking, Marc J J; Stolow, Albert; Mikosch, Jochen

2018-05-18

We study the Strong-Field Ionization (SFI) of the hydrocarbon 1-butene as a function of wavelength using photoion-photoelectron covariance and coincidence spectroscopy. We observe a striking transition in the fragment-associated photoelectron spectra: from a single Above Threshold Ionization (ATI) progression for photon energies less than the cation D0-D1 gap to two ATI progressions for a photon energy greater than this gap. For the first case, electronically excited cations are created by SFI populating the ground cationic state D0, followed by sequential post-ionization excitation. For the second case, direct sub-cycle SFI to the D1 excited cation state contributes significantly. Our experiments access ionization dynamics in a regime where strong-field and resonance-enhanced processes can interplay.

Fast model updating coupling Bayesian inference and PGD model reduction

NASA Astrophysics Data System (ADS)

Rubio, Paul-Baptiste; Louf, François; Chamoin, Ludovic

2018-04-01

The paper focuses on a coupled Bayesian-Proper Generalized Decomposition (PGD) approach for the real-time identification and updating of numerical models. The purpose is to use the most general case of Bayesian inference theory in order to address inverse problems and to deal with different sources of uncertainties (measurement and model errors, stochastic parameters). In order to do so with a reasonable CPU cost, the idea is to replace the direct model called for Monte-Carlo sampling by a PGD reduced model, and in some cases directly compute the probability density functions from the obtained analytical formulation. This procedure is first applied to a welding control example with the updating of a deterministic parameter. In the second application, the identification of a stochastic parameter is studied through a glued assembly example.

Referrals in Primary Care: Is the Family Physician a “Gatekeeper”?

PubMed Central

Norton, Peter G.; Dunn, Earl V.; Bestvater, David

1989-01-01

The increasing financial restraints on the use of health care resources make it important to examine the appropriateness of present usage patterns. The authors studied referral patterns for a group of academic family physicians practising in a health service organization in Ontario. They found that for all consultant encounters, the family physician directly controlled 65% of these consultations, whereas 13% were continuing consultations with the specialist without direct family physician referral. The remainder were either unknown or referred from other sources, for example, emergency room or specialist-to-specialist referrals. The family physician made the exact same diagnosis as the consultant in 73.4% of cases for which data were available, and the patient was referred to an inappropriate specialist in only 2.7% of cases. PMID:21249055

Direct Observation Of Nanoparticle-Surfactant Interactions Using Small Angle Neutron Scattering

NASA Astrophysics Data System (ADS)

Kumar, Sugam; Aswal, V. K.

2010-12-01

Interactions of anionic silica nanoparticles with anionic, cationic and nonionic surfactants have directly been studied by contrast variation small angle neutron scattering (SANS). The measurements are performed on 1 wt% of both silica nanoparticles and surfactants of anionic sodium dodecyle sulphate (SDS), cationic dodecyltrimethyl ammonium bromide (DTAB) and non-ionic polyoxyethylene 10 lauryl ether (C12E10) in aqueous solution. We show that there is no direct interaction in the case of SDS with silica particles, whereas strong interaction for DTAB leads to the aggregation of silica particles. The interaction of C12E10 is found through the micelles adsorbed on the silica particles.

Direct measurement of 3D elastic anisotropy on rocks from the Ivrea zone (Southern Alps, NW Italy)

NASA Astrophysics Data System (ADS)

Pros, Z.; Lokajíček, T.; Přikryl, R.; Klíma, K.

2003-07-01

Lower crustal and upper mantle rocks exposed at the earth's surface present direct possibility to measure their physical properties that must be, in other cases, interpreted using indirect methods. The results of these direct measurements can be then used for the corrections of models based on the indirect data. Elastic properties are among the most important parameters studied in geophysics and employed in many fields of earth sciences. In laboratory, dynamic elastic properties are commonly tested in three mutually perpendicular directions. The spatial distribution of P- and S-wave velocities are then computed using textural data, modal composition, density and elastic constants. During such computation, it is virtually impossible to involve all microfabric parameters like different types of microcracking, micropores, mineral alteration or quality of grain boundaries. In this study, complete 3D ultrasonic transmission of spherical samples in 132 independent directions at several levels of confining pressure up to 400 MPa has been employed for study of selected mafic and ultrabasic rocks sampled in and nearby Balmuccia ultrabasic massif (Ivrea zone, Southern Alps, NW Italy). This method revealed large directional variance of maximum P-wave velocity and different symmetries (orthorhombic vs. transversal isotropic) of elastic waves 3D distribution that has not been recorded on these rocks before. Moreover, one dunite sample exhibits P-wave velocity approaching to that of olivine single crystal being interpreted as influence of CPO.

SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

PubMed

Ahmadi, Qudratullah; Danesh, Homayoon; Makharashvili, Vasil; Mishkin, Kathryn; Mupfukura, Lovemore; Teed, Hillary; Huff-Rousselle, Maggie

2016-07-01

This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Costs of Dengue to the Health System and Individuals in Colombia from 2010 to 2012

PubMed Central

Rodriguez, Raul Castro; Galera-Gelvez, Katia; Yescas, Juan Guillermo López; Rueda-Gallardo, Jorge A.

2015-01-01

Dengue fever (DF) is an important health issue in Colombia, but detailed information on economic costs to the healthcare system is lacking. Using information from official databases (2010–2012) and a face-to-face survey of 1,483 households with DF and dengue hemorrhagic fever (DHF) patients, we estimated the average cost per case. In 2010, the mean direct medical costs to the healthcare system per case of ambulatory DF, hospitalized DF, and DHF (in Colombian pesos converted to US dollars using the average exchange rate for 2012) were $52.8, $235.8, and $1,512.2, respectively. The mean direct non-medical costs to patients were greater ($29.7, $46.7, and $62.6, respectively) than the mean household direct medical costs ($13.3, $34.8, and $57.3, respectively). The average direct medical cost to the healthcare system of a case of ambulatory DF in 2010 was 57% of that in 2011. Our results highlight the high economic burden of the disease and could be useful for assigning limited health resources. PMID:25667054

Factors associated with positive direct antiglobulin tests in pretransfusion patients: a case-control study.

PubMed

Toy, P T; Chin, C A; Reid, M E; Burns, M A

1985-01-01

During routine pretransfusion testing, the presence of IgG on patient red cells is suggested by a positive autocontrol and confirmed by a positive direct antiglobulin test (DAT) using monospecific anti-IgG sera. Most IgG on patient red cells detected in this manner are of unknown etiology. We recently showed an association between elevated serum globulin levels and positive DAT with unreactive eluate in patients with acquired immunodeficiency syndrome (AIDS). In the present study, we wished to determine whether elevated serum globulin levels contribute to some of the positive DAT encountered in pretransfusion testing of patients without AIDS. 76 patients with positive DAT were compared with 90 controls without IgG detected on their red cells during pretransfusion testing. The rate of elevated serum globulin levels was 75% in positive DAT cases versus 29% in controls (p less than 0.001); the odds ratio was 7.6. Elevated blood urea nitrogen levels occurred in 42% of cases versus 19% of controls (p less than 0.025); the odds ratio was 3.1. Cases and controls were not significantly different with regard to age, sex, race, quinidine usage, or hyperalimentation. Elevated serum globulin and blood urea nitrogen levels are significantly associated with a positive DAT with unreactive eluate in pretransfusion patients.

The Processing of Case in Near-Native Spanish

ERIC Educational Resources Information Center

Jegerski, Jill

2015-01-01

This article reports a study that sought to determine whether non-native sentence comprehension can show sensitivity to two different types of Spanish case marking. Sensitivity to case violations was generally more robust with indirect objects in ditransitive constructions than with differential object marking of animate direct objects, even among…

Comparison of direct and indirect methods of measuring airborne chrysotile fibre concentration.

PubMed

Eypert-Blaison, Celine; Veissiere, Sylvie; Rastoix, Olivier; Kauffer, Edmond

2010-01-01

Transmission electron microscopy observations most frequently form a basis for estimating asbestos fibre concentration in the environment and in buildings with asbestos-containing materials. Sampled fibres can be transferred to microscope grids by applying either a direct [ISO (1995) Draft International ISO/DIS 10312. Ambient air. Determination of asbestos fibres. Direct transfer transmission electron microscopy procedure. Geneva, Switzerland: International Standardization Organization] or an indirect [AFNOR (1996) Détermination de la concentration en fibres d'amiante par microscopie électronique à transmission-Méthode indirecte. Cedex, France: AFNOR, p. 42; ISO (1997) Draft International ISO/DIS 13794. Ambient air. Determination of asbestos fibres. Indirect-transfer transmission electron microscopy procedure. Geneva, Switzerland: International Standardization Organization] method. In the latter case, ISO Standard 13794 recommends filtering calcination residues either on a polycarbonate (PC) filter (PC indirect method) or on a cellulose ester (CE) membrane (CE indirect method). The PC indirect method requires that fibres deposited on a PC filter be covered by a carbon layer, whereas in the CE indirect method, the CE membrane has to be directly processed using a method described in ISO Standard 10312. The purpose of this study was to compare results obtained using, on the one hand, direct preparation methods and, on the other hand, PC indirect or CE indirect methods, for counting asbestos fibres deposited on filters as a result of liquid filtration or air sampling. In direct method-based preparation, we observed that an etching time of 6-14 min does not affect the measured densities, except for fibres <1 microm deposited by liquid filtration. Moreover, in all cases, the direct method gives higher densities than the PC indirect method because of possible fibre disappearance when using the carbon evaporator implemented in the PC indirect method. The CE membrane used for sample preparation in the CE indirect method is collapsed prior to passing it through the carbon evaporator, so the fibres are less likely to disappear at this stage. We then note that the resulting fibre densities for chrysotile-loaded filters prepared using the direct method are close to those obtained with filters prepared using the CE indirect method. Our study therefore shows that, under the implemented experimental conditions, the PC and CE indirect preparation methods described in ISO Standard 13794 are not equivalent.

The Role of Re-Appropriation in Open Design: A Case Study on How Openness in Higher Education for Industrial Design Engineering Can Trigger Global Discussions on the Theme of Urban Gardening

ERIC Educational Resources Information Center

Ostuzzi, Francesca; Conradie, Peter; De Couvreur, Lieven; Detand, Jan; Saldien, Jelle

2016-01-01

This case study explores the opportunities for students of Industrial Design Engineering to engage with direct and indirect stakeholders by making their design process and results into open-ended designed solutions. The reported case study involved 47 students during a two-weeks intensive course on the topic of urban gardening. Observations were…

A new atraumatic method of removing fractured palatal root using endodontic H-files luted with resin modified glass ionomercement: A pilot study.

PubMed

Kannan, V Sadesh; Narayanan, G R Sathya; Ahamed, A Saneem; Velavan, K; Elavarasi, E; Danavel, C

2014-07-01

The purpose of this study is to evaluate the efficacy of using endodontic H-files luted with Resin modified glass ionomer cement (RMGIC) in removing fractured palatal root. This study consists of 30 patients, of which 16 were males and 14 were females with a mean age of 36 years. In which, 19 were maxillary first molar and 11 were maxillary second molar. In that, 18 were fractured at the level of apical 1/3(rd) and 12 were at the level of apical 2/3(rd). All cases were first tried with endodontic H-files, within few attempts, it was wedged tightly in the remaining pulp chamber with one or two clockwise direction and using sudden jerk with a downward pull the remnant part was removed. The cases, which fail to deliver after several attempts were taken up for study. After sufficient isolation with a rubber dam and the socket was dried using sterile gauze, under good lighting and vision again the same file was introduced, which was now luted with RMGIC, after 5 min of setting time, the same attempt using sudden jerk with a downward pull was given. In those 30 cases, 20 cases were removed in the first few attempts using endodontic H-files. The 10 cases (7 cases were apical 2/3(rd) and 3 cases were of apical 1/3(rd)), which fails to come out were tried using endodontic H-files luted with RMGIC, in which 9 cases were successfully removed (90%) and 1 case of apical 1/3(rd) was again failed to come out. Even though, the number of cases were too small to come to a definitive conclusion, the encouraging result (90%) and technically easy, this is a novel method of removing fractured palatal root atraumatically and devoid of any complication.

A new atraumatic method of removing fractured palatal root using endodontic H-files luted with resin modified glass ionomercement: A pilot study

PubMed Central

Kannan, V. Sadesh; Narayanan, G. R. Sathya; Ahamed, A. Saneem; Velavan, K.; Elavarasi, E.; Danavel, C.

2014-01-01

Purpose: The purpose of this study is to evaluate the efficacy of using endodontic H-files luted with Resin modified glass ionomer cement (RMGIC) in removing fractured palatal root. Materials and Methods: This study consists of 30 patients, of which 16 were males and 14 were females with a mean age of 36 years. In which, 19 were maxillary first molar and 11 were maxillary second molar. In that, 18 were fractured at the level of apical 1/3rd and 12 were at the level of apical 2/3rd. All cases were first tried with endodontic H-files, within few attempts, it was wedged tightly in the remaining pulp chamber with one or two clockwise direction and using sudden jerk with a downward pull the remnant part was removed. The cases, which fail to deliver after several attempts were taken up for study. After sufficient isolation with a rubber dam and the socket was dried using sterile gauze, under good lighting and vision again the same file was introduced, which was now luted with RMGIC, after 5 min of setting time, the same attempt using sudden jerk with a downward pull was given. Results: In those 30 cases, 20 cases were removed in the first few attempts using endodontic H-files. The 10 cases (7 cases were apical 2/3rd and 3 cases were of apical 1/3rd), which fails to come out were tried using endodontic H-files luted with RMGIC, in which 9 cases were successfully removed (90%) and 1 case of apical 1/3rd was again failed to come out. Conclusion: Even though, the number of cases were too small to come to a definitive conclusion, the encouraging result (90%) and technically easy, this is a novel method of removing fractured palatal root atraumatically and devoid of any complication. PMID:25210360

Direct non-medical costs double the total direct costs to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series.

PubMed

Ibrahim, Nazaradden; Pozo-Martin, Francisco; Gilbert, Clare

2015-04-16

Cost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs. Participants were those aged 17 years and above attending their first post-operative visit after first eye, subsidised, day case cataract surgery. Systematic random sampling was used to select participants who were interviewed to obtain data on socio-demographic details, and on expenditure during the assessment visit, the surgical visit, and the first follow-up visit. Costs were a) direct medical costs (patients' costs for registration, investigations, surgery, medication), and b) direct non-medical costs (patients' and escorts' costs for transport, accommodation, meals). The source of funds to pay for the services received was also assessed. Almost two thirds (63%) of the 104 participants were men. The mean age of men was 64 (± 12.5) years, being 63 (± 12.9) years for women. All men were married and 35% of women were widows. 84% of men were household heads compared with 6% of women. The median total direct cost for all visits by all participants was N8,245 (US$51), being higher for men than women (N9,020; US$56 and N7,620; US$47) (p < 0.09) respectively. Direct non-medical cost constituted 49% of total direct cost. 92% of participants had adequate money to pay, but 8% had to sell possessions to raise the money. 20% of unmarried women sold possessions or took out a loan. Despite the subsidy, cost is still likely to be a barrier to accessing cataract surgery, as the total direct costs represented at least 50 days income for 70% of the local population. Provision of transport would reduce direct non-medical costs.

BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data.

PubMed

Ehrensperger, Michael M; Taylor, Kirsten I; Berres, Manfred; Foldi, Nancy S; Dellenbach, Myriam; Bopp, Irene; Gold, Gabriel; von Gunten, Armin; Inglin, Daniel; Müri, René; Rüegger, Brigitte; Kressig, Reto W; Monsch, Andreas U

2014-01-01

Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients' subjective impairments, (b) cognitive testing, and (c) information from informants. The present study developed a new, very quick and easily administered case-finding tool combining these assessments ('BrainCheck') and tested the feasibility and validity of this instrument in two independent studies. We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6; 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer's disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7; 40% female) partook. All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE. Feasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable. Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4%; sensitivity = 97.4%, specificity = 81.6%). A new and very brief instrument for general practitioners, 'BrainCheck', combined three sources of information deemed critical for effective case-finding (that is, patients' subject impairments, cognitive testing, informant information) and resulted in a nearly 90% CCR. Thus, it provides a very efficient and valid tool to aid general practitioners in deciding whether patients with suspected cognitive impairments should be further evaluated or not ('watchful waiting').

The utility of case formulation in treatment decision making; the effect of experience and expertise.

PubMed

Dudley, Robert; Ingham, Barry; Sowerby, Katy; Freeston, Mark

2015-09-01

We examined whether case formulation guides the endorsement of appropriate treatment strategies. We also considered whether experience and training led to more effective treatment decisions. To examine these questions two related studies were conducted both of which used a novel paradigm using clinically relevant decision-making tasks with multiple sources of information. Study one examined how clinicians utilised a pre-constructed CBT case formulation to plan treatment. Study two utilised a clinician-generated formulation to further examine the process of formulation development and the impact on treatment planning. Both studies considered the effect of therapist experience. Both studies indicated that clinicians used the case formulation to select treatment choices that were highly matched to the case as described in the vignette. However, differences between experts and novice clinicians were only demonstrated when clinicians developed their own formulations of case material. When they developed their own formulations the experts' formulations were more parsimonious, internally consistent, and contained fewer errors and the experts were less swayed by irrelevant treatment options. The nature of the experimental task, involving ratings of suitability of possible treatment options suggested for the case, limits the interpretation that formulation directs the development or generation of the clinician's treatment plan. In study two the task may still have limited the capacity to demonstrate further differences between expert and novice therapists. Formulation helps guide certain aspects of effective treatment decision making. When asked to generate a formulation clinicians with greater experience and expertise do this more effectively. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Genotype-Based Association Mapping of Complex Diseases: Gene-Environment Interactions with Multiple Genetic Markers and Measurement Error in Environmental Exposures

PubMed Central

Lobach, Irvna; Fan, Ruzone; Carroll, Raymond T.

2011-01-01

With the advent of dense single nucleotide polymorphism genotyping, population-based association studies have become the major tools for identifying human disease genes and for fine gene mapping of complex traits. We develop a genotype-based approach for association analysis of case-control studies of gene-environment interactions in the case when environmental factors are measured with error and genotype data are available on multiple genetic markers. To directly use the observed genotype data, we propose two genotype-based models: genotype effect and additive effect models. Our approach offers several advantages. First, the proposed risk functions can directly incorporate the observed genotype data while modeling the linkage disequihbrium information in the regression coefficients, thus eliminating the need to infer haplotype phase. Compared with the haplotype-based approach, an estimating procedure based on the proposed methods can be much simpler and significantly faster. In addition, there is no potential risk due to haplotype phase estimation. Further, by fitting the proposed models, it is possible to analyze the risk alleles/variants of complex diseases, including their dominant or additive effects. To model measurement error, we adopt the pseudo-likelihood method by Lobach et al. [2008]. Performance of the proposed method is examined using simulation experiments. An application of our method is illustrated using a population-based case-control study of association between calcium intake with the risk of colorectal adenoma development. PMID:21031455

The Roles of Science in Local Resilience Policy Development: A Case Study of Three U.S. Cities

NASA Astrophysics Data System (ADS)

Clavin, C.; Gupta, N.

2015-12-01

The development and deployment of resilience policies within communities in the United States often respond to the place-based, hazard-specific nature of disasters. Prior to the onset of a disaster, municipal and regional decision makers establish long-term development policies, such as land use planning, infrastructure investment, and economic development policies. Despite the importance of incorporating disaster risk within community decision making, resilience and disaster risk are only one consideration community decision makers weigh when choosing how and whether to establish resilience policy. Using a case study approach, we examine the governance, organizational, management, and policy making processes and the involvement of scientific advice in designing and implementing resilience policy in three U.S. communities: Los Angeles, CA; Norfolk, VA; and Flagstaff, AZ. Disaster mitigation or resilience initiatives were developed and deployed in each community with differing levels and types of scientific engagement. Engagement spanned from providing technical support with traditional risk assessment to direct engagement with community decision makers and design of community resilience outreach. Best practices observed include embedding trusted, independent scientific advisors with strong community credibility within local government agencies, use of interdisciplinary and interdepartmental expert teams with management and technical skillsets, and establishing scientifically-informed disaster and hazard scenarios to enable community outreach. Case study evidence suggest science communication and engagement within and across municipal government agencies and scientifically-informed direct engagement with community stakeholders are effective approaches and roles that disaster risk scientists can fill to support resilience policy development.

Boiling of the interface between two immiscible liquids below the bulk boiling temperatures of both components.

PubMed

Pimenova, Anastasiya V; Goldobin, Denis S

2014-11-01

We consider the problem of boiling of the direct contact of two immiscible liquids. An intense vapour formation at such a direct contact is possible below the bulk boiling points of both components, meaning an effective decrease of the boiling temperature of the system. Although the phenomenon is known in science and widely employed in technology, the direct contact boiling process was thoroughly studied (both experimentally and theoretically) only for the case where one of liquids is becoming heated above its bulk boiling point. On the contrary, we address the case where both liquids remain below their bulk boiling points. In this paper we construct the theoretical description of the boiling process and discuss the actualisation of the case we consider for real systems.

Tug of war in motility assay experiments

NASA Astrophysics Data System (ADS)

Hexner, Daniel; Kafri, Yariv

2009-09-01

The dynamics of two groups of molecular motors pulling in opposite directions on a rigid filament is studied theoretically. To this end we first consider the behavior of one set of motors pulling in a single direction against an external force using a new mean-field approach. Based on these results we analyze a similar setup with two sets of motors pulling in opposite directions in a tug of war in the presence of an external force. In both cases we find that the interplay of fluid friction and protein friction leads to a complex phase diagram where the force-velocity relations can exhibit regions of bistability and spontaneous symmetry breaking. Finally, motivated by recent work, we turn to the case of motility assay experiments where motors bound to a surface push on a bundle of filaments. We find that, depending on the absence or the presence of bistability in the force-velocity curve at zero force, the bundle exhibits anomalous or biased diffusion on long-time and large-length scales.

The Seneca Babcock Business Plan: A Case Study in Using Service Learning to Meet the AICPA Core Competencies

ERIC Educational Resources Information Center

Tschopp, Daniel J.

2004-01-01

In this article, the author explains the trend toward service learning projects in higher education and justifies their use in the field of accounting. He describes a service learning project that was used to directly address the development of the competencies listed in the Core Competency Framework created by the American Institute of Certified…

Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

PubMed Central

Castillo, Lesley S.; Williams, Brie A.; Hooper, Sarah M.; Sabatino, Charles P.; Weithorn, Lois A.; Sudore, Rebecca L.

2011-01-01

Background Advance directive law may compromise the clinical effectiveness of advance directives. Purpose To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Data Sources Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Study Selection Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Data Extraction Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Data Synthesis Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Limitation Only appellate-level legal cases were available, which may have excluded relevant cases. Conclusion Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. Primary Funding Source U.S. Department of Veterans Affairs and the Pfizer Foundation. PMID:21242368

A standardized mean difference effect size for multiple baseline designs across individuals.

PubMed

Hedges, Larry V; Pustejovsky, James E; Shadish, William R

2013-12-01

Single-case designs are a class of research methods for evaluating treatment effects by measuring outcomes repeatedly over time while systematically introducing different condition (e.g., treatment and control) to the same individual. The designs are used across fields such as behavior analysis, clinical psychology, special education, and medicine. Emerging standards for single-case designs have focused attention on methods for summarizing and meta-analyzing findings and on the need for effect sizes indices that are comparable to those used in between-subjects designs. In the previous work, we discussed how to define and estimate an effect size that is directly comparable to the standardized mean difference often used in between-subjects research based on the data from a particular type of single-case design, the treatment reversal or (AB)(k) design. This paper extends the effect size measure to another type of single-case study, the multiple baseline design. We propose estimation methods for the effect size and its variance, study the estimators using simulation, and demonstrate the approach in two applications. Copyright © 2013 John Wiley & Sons, Ltd.

North Carolina's direct care workforce development journey: the case of the North Carolina New Organizational Vision Award Partner Team.

PubMed

Brannon, S Diane; Kemper, Peter; Barry, Theresa

2009-01-01

Better Jobs Better Care was a five-state direct care workforce demonstration designed to change policy and management practices that influence recruitment and retention of direct care workers, problems that continue to challenge providers. One of the projects, the North Carolina Partner Team, developed a unified approach in which skilled nursing, home care, and assisted living providers could be rewarded for meeting standards of workplace excellence. This case study documents the complex adaptive system agents and processes that coalesced to result in legislation recognizing the North Carolina New Organizational Vision Award. We used a holistic, single-case study design. Qualitative data from project work plans and progress reports as well as notes from interviews with key stakeholders and observation of meetings were coded into a simple rubric consisting of characteristics of complex adaptive systems. Key system agents in the state set the stage for the successful multistakeholder coalition. These included leadership by the North Carolina Department of Health and Human Services and a several year effort to develop a unifying vision for workforce development. Grant resources were used to facilitate both content and process work. Structure was allowed to emerge as needed. The coalition's own development is shown to have changed the context from which it was derived. An inclusive and iterative process produced detailed standards and measures for the voluntary recognition process. With effective facilitation, the interests of the multiple stakeholders coalesced into a policy response that encourages practice changes. Implications for managing change-oriented coalitions are discussed.

Impact assessment of land use planning driving forces on environment

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

Chen, Longgao, E-mail: chenlonggao@163.com; Yang, Xiaoyan; School of Environment and Spatial Informatics, China University of Mining and Technology, Xuzhou 221116

Land use change may exert a negative impact on environmental quality. A state–impact–state (SIS) model describing a state transform under certain impacts has been integrated into land use planning (LUP) environmental impact assessment (LUPEA). This logical model is intuitive and easy to understand, but the exploration of impact is essential to establish the indicator system and to identify the scope of land use environmental impact when it is applied to a specific region. In this study, we investigated environmental driving forces from land use planning (LUPF), along with the conception, components, scope, and impact of LUPF. This method was illustratedmore » by a case study in Zoucheng, China. Through the results, we concluded that (1) the LUPF on environment are impacts originated from the implementation of LUP on a regional environment, which are characterized by four aspects: magnitude, direction, action point, and its owner; (2) various scopes of LUPF on individual environmental elements based on different standards jointly define the final scope of LUPEA; (3) our case study in Zoucheng demonstrates the practicability of this proposed approach; (4) this method can be embedded into LUPEA with direction, magnitudes, and scopes of the LUPF on individual elements obtained, and the identified indicator system can be directly employed into LUPEA and (5) the assessment helps to identify key indicators and to set up a corresponding strategy to mitigate the negative impact of LUP on the environment, which are two important objectives of strategic environmental assessment (SEA) in LUP. - Highlights: • Environmental driving forces from land use planning (LUPF) are investigated and categorized. • Our method can obtains the direction, magnitudes and scopes of environmental driving forces. • The LUPEA scope is determined by the combination of various scopes of LUPF on individual elements. • LUPF assessment can be embedded into LUPEA. • The method can help to identify key indicators and set up a strategy to mitigate negative environmental impact.« less

Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol

PubMed Central

Kriege, Marc; Alflen, Christian; Tzanova, Irene; Schmidtmann, Irene; Piepho, Tim; Noppens, Ruediger R

2017-01-01

Introduction The direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients. Methods and analysis The EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications. Ethics and dissemination The project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings. Trial registration number ClinicalTrials.gov NCT 02611986; pre-results. PMID:28827261

Using a telehealth service delivery approach to working with an undergraduate student with a traumatic brain injury: A case study.

PubMed

Quaco, Carrie

2017-09-14

Project Career is a five year NIDILRR-funded interprofessional demonstration project aimed to improve the academic and career success of undergraduate students who have a traumatic brain injury (TBI). The information for this case study was collected and synthesized by an occupational therapy graduate student intern for one of the Project Career sites in collaboration with the Technology and Employment Coordinator for the site, the co-PI for Project Career, and the student participant. A case study is presented to provide an understanding of one of the Project Career participant's experience using a telehealth service delivery approach to working with Project Career for academic and career support. The participant's case notes, direct communication with the intern, and outcome assessments were used to perform a qualitative analysis. The participant reported that he believed Project Career was an effective support service for him. However, the participant's initial and 6-month outcome assessment scores are inconclusive regarding improvements in his academic abilities and satisfaction with academic and career attainment. Further research on the effectiveness of using a telehealth service delivery approach to working with undergraduate students with a TBI is needed.

Inflation and Collapse of the Wai'anae Volcano (Oahu,Hawaii, USA):Insights from Magnetic Fabric Studies of Dikes

NASA Astrophysics Data System (ADS)

Lau, J. K. S.; Herrero-Bervera, E.; Moreira, M. A. D. A.

2016-12-01

The Waianae Volcano is the older of two shield volcanoes that make up the island of Oahu. Previous age determinations suggest that the subaerial portion of the edifice erupted between approximately 3.7 and 2.7 Ma. The eroded Waianae Volcano had a well-developed caldera centered near the back of its two most prominent valleys and two major rift zones: a prominent north-west rift zone, well-defined by a complex of sub-parallel dikes trending approximately N52W, and a more diffuse south rift zone trending between S20W to due South. In order to investigate the volcanic evolution, the plumbing and the triggering mechanisms of the catastrophic mass wasting that had occurred in the volcano, we have undertaken an AMS study of 7 dikes from the volcano. The width of the dikes ranged between 0.5 to 4 m. Low-field susceptibility versus temperature (k-T) and SIRM experiments were able to identify magnetite at 575 0C and at about 250-300 0C, corresponding to titanomagnetite.. Magnetic fabric studies of the dikes along a NW-SE section across the present southwestern part of the Waianae volcano have been conducted. The flow direction was studied using the imbrication angle between the dike walls and the magnetic foliation. The flow direction has been obtained in the 7 studied dikes. For the majority of the cases, the maximum axis, K1, appears to be perpendicular to the flow direction, and in some cases, with a permutation with respect to the intermediate axis, K2, or even with respect to the minimum axis, K3. In addition, in one of the sites studied, the minimum axis, K3, is very close to the flow direction. In all cases, the magma flowed along a direction with a moderate plunge. For six of the dikes, the interpreted flow was from the internal part of the volcano towards the volcano border, and corresponds probably to the inflation phase of the volcano. In two cases (dikes located on the northwestern side of the volcano), the flow is slightly downwards, possibly related to the distal extension due to inflation of the central part of the volcano. . It also revealed a downward flow that could correspond to another magma pulse that resulted from a flow-back during distension due to the collapsing of the Waianae volcano.

Direct reduction may need to be considered to avoid postoperative subtype P in patients with an unstable trochanteric fracture: a retrospective study using a multivariate analysis.

PubMed

Kozono, Naoya; Ikemura, Satoshi; Yamashita, Akihisa; Harada, Takashi; Watanabe, Tetsuya; Shirasawa, Kenzo

2014-12-01

It has recently been reported that the cases with an anterior femoral neck cortex posterior to the distal fragment (subtype P) in the lateral view of a postoperative radiograph have a risk of excessive sliding of lag screws compared to those located anterior to the distal fragment (subtype A) or perfectly continuous to the distal fragment (subtype N) following osteosynthesis for the treatment of a trochanteric fracture. The purpose of this study was to investigate factors that influence the postoperative subtype in the lateral view of radiographs. This study reviewed 136 patients who underwent osteosynthesis using an intramedullary hip nail for the treatment of a trochanteric fracture. A closed reduction was performed in 130 patients (95.6 %), while a direct reduction via a small elevator with a small skin incision was performed in the other six patients (4.4 %). The 136 patients were divided into two groups (subtype P and subtype A or N) based on postoperative radiographs taken of the lateral view. Both clinical and radiological factors were analyzed using the univariate and multivariable analyses. Thirty-nine patients (29 %) were categorized as subtype P and 97 patients (71 %) were categorized as subtype A or N. A multivariate analysis demonstrated that unstable fractures were associated with a significant risk of postoperative subtype P (Odds ratio: 24.45, P = 0.0024). The results of this study suggest that direct reduction via a small elevator with a small skin incision or percutaneous intrafocal pinning may be needed in these cases.

On the Strong Direct Summand Conjecture

ERIC Educational Resources Information Center

McCullough, Jason

2009-01-01

In this thesis, our aim is the study the Vanishing of Maps of Tor Conjecture of Hochster and Huneke. We mainly focus on an equivalent characterization called the Strong Direct Summand Conjecture, due to N. Ranganathan. Our results are separated into three chapters. In Chapter 3, we prove special cases of the Strong Direct Summand Conjecture in…

Interactive Land-Use Optimization Using Laguerre Voronoi Diagram with Dynamic Generating Point Allocation

NASA Astrophysics Data System (ADS)

Chaidee, S.; Pakawanwong, P.; Suppakitpaisarn, V.; Teerasawat, P.

2017-09-01

In this work, we devise an efficient method for the land-use optimization problem based on Laguerre Voronoi diagram. Previous Voronoi diagram-based methods are more efficient and more suitable for interactive design than discrete optimization-based method, but, in many cases, their outputs do not satisfy area constraints. To cope with the problem, we propose a force-directed graph drawing algorithm, which automatically allocates generating points of Voronoi diagram to appropriate positions. Then, we construct a Laguerre Voronoi diagram based on these generating points, use linear programs to adjust each cell, and reconstruct the diagram based on the adjustment. We adopt the proposed method to the practical case study of Chiang Mai University's allocated land for a mixed-use complex. For this case study, compared to other Voronoi diagram-based method, we decrease the land allocation error by 62.557 %. Although our computation time is larger than the previous Voronoi-diagram-based method, it is still suitable for interactive design.

Realizing 2D magnetotelluric inversion in the case of divergent geoelectric strike directions in the crust and mantle - Case study using synthetic models and real data from the Tajo Basin (Spain)

NASA Astrophysics Data System (ADS)

Schmoldt, J.; Jones, A. G.; Muller, M. R.; Kiyan, D.; Hogg, C.; Rosell, O.

2010-12-01

Two-dimensional (2D) inversions of magnetotelluric (MT) data are presently far more commonly used than three-dimensional (3D) inversions as they still significantly outperform 3D inversions in terms of speed, thus allowing for much better resolution of the subsurface through a larger feasible number of grid cells. The suitability of 2D inversion needs thereby to be tested for cases where the electric resistivity structure of the subsurface is potentially 3D to some extent. One particular case of a 3D subsurface structure consists of lateral interfaces with varying orientations at crustal and mantle depths. Such a case might emerge, for instance, where crustal faulting, originating from present day tectonics, is situated above a mantle where structures are dominated by earlier or current plate tectonic processes. Those plate tectonic processes could comprise continental collision from an oblique direction, or lattice preferred orientation in the lithosphere-asthenosphere transition zone due to an oblique relative motion between lithosphere and asthenosphere. Whereas recovery of crustal structures can usually be achieved in a straightforward manner by confining the modelled frequency range to the crustal depths, deriving mantle structures is more challenging. Different approaches for this case have been investigated here using synthetic model studies as well as inversion of a real MT dataset collected in southern Spain as part of the PICASSO fieldwork campaign. The PICASSO project intends to enhance knowledge about the geological setting of the Alboran Domain beneath the western Mediterranean Sea and its surrounding regions, and through that knowledge to understand processes related to continent-continent collision. The Iberian Peninsula is the focus of the first phase of DIAS’s PICASSO efforts, and comprised a magnetotelluric profile crossing the Tajo Basin and Betics Cordillera. Analyses of MT responses and seismic tomography data indicate varying geologic strike direction with depth and along the profile. Geoelectric strike direction in the Tajo Basin crust is approximately NW-SE, coinciding with the direction of the Iberian Range and Neogene faults, whereas at mantle depths a dominant NNE-SSW direction is determined; the Betics region on the contrary exhibits a highly 3D structure originating from its complex tectonic orogeny. This circumstance motivated separate inversions for crustal and mantle structures of the Tajo Basin, as well as for the Betics region. Inversion results of the Tajo Basin subsurface indicate a relatively conducting upper crust underlain by more resistive structures in the lower crust and mantle. The most noticeable features of the models are the apparent upward extension of an electrical resistive lower crustal layer beneath the centre of the basin and the presence of a resistive mantle region that coincides with an area of low seismic velocity. The later indicates an unusual geological situation since typical causes for decreased seismic velocity, e.g. higher temperature, fluids, and less depleted rock chemistry, are commonly thought to decrease electric resistivity.

Effects of Competitive E-Learning Tools on Higher Education Students: A Case Study

ERIC Educational Resources Information Center

Regueras, L. M.; Verdu, E.; Munoz, M. F.; Perez, M. A.; de Castro, J. P.; Verdu, M. J.

2009-01-01

Over the last few years, most of the attempts to introduce active learning methodologies in the classroom have made use of Information and Communication Technology (ICT). Many of these efforts have been directed to collaborative scenarios used in remote, blended or face-to-face experiences, in order to take advantage of the flexibility provided by…

A Case Study of Servant Leadership in the NHL

ERIC Educational Resources Information Center

Crippen, Carolyn

2017-01-01

An examination of the organizational culture of the Vancouver Canucks of the NHL provides exemplars for all learning institutions. A culture connected directly to a servant-leader philosophy was identified through a cumulative qualitative case study of key personnel within the organization. Data included transcribed interviews, archival research,…

Comparison of Optimization and Two-point Methods in Estimation of Soil Water Retention Curve

NASA Astrophysics Data System (ADS)

Ghanbarian-Alavijeh, B.; Liaghat, A. M.; Huang, G.

2009-04-01

Soil water retention curve (SWRC) is one of the soil hydraulic properties in which its direct measurement is time consuming and expensive. Since, its measurement is unavoidable in study of environmental sciences i.e. investigation of unsaturated hydraulic conductivity and solute transport, in this study the attempt is to predict soil water retention curve from two measured points. By using Cresswell and Paydar (1996) method (two-point method) and an optimization method developed in this study on the basis of two points of SWRC, parameters of Tyler and Wheatcraft (1990) model (fractal dimension and air entry value) were estimated and then water content at different matric potentials were estimated and compared with their measured values (n=180). For each method, we used both 3 and 1500 kPa (case 1) and 33 and 1500 kPa (case 2) as two points of SWRC. The calculated RMSE values showed that in the Creswell and Paydar (1996) method, there exists no significant difference between case 1 and case 2. However, the calculated RMSE value in case 2 (2.35) was slightly less than case 1 (2.37). The results also showed that the developed optimization method in this study had significantly less RMSE values for cases 1 (1.63) and 2 (1.33) rather than Cresswell and Paydar (1996) method.

Reduction of Direct Health Costs Associated with Pertussis Vaccination with Acellular Vaccines in Children Aged 0-9 Years with Pertussis in Catalonia (Spain).

PubMed

Plans-Rubió, Pedro; Navas, Encarna; Godoy, Pere; Carmona, Gloria; Domínguez, Angela; Jané, Mireia; Muñoz-Almagro, Carmen; Brotons, Pedro

2018-05-14

The aim of this study was to assess direct health costs in children with pertussis aged 0-9 years who were vaccinated, partially vaccinated, and unvaccinated during childhood, and to assess the association between pertussis costs and pertussis vaccination in Catalonia (Spain) in 2012-2013. Direct healthcare costs included pertussis treatment, pertussis detection, and preventive chemotherapy of contacts. Pertussis patients were considered vaccinated when they had received 4-5 doses, and unvaccinated or partially vaccinated when they had received 0-3 doses of vaccine. The Chi square test and the odds ratios were used to compare percentages and the t test was used to compare mean pertussis costs in different groups, considering a p < 0.05 as statistically significant. The correlation between pertussis costs and study variables was assessed using the Spearman's ρ, with a p < 0.05 as statistically significant. Multiple linear regression analysis (IBM-SPSS program) was used to quantify the association of pertussis vaccination and other study variables with pertussis costs. Vaccinated children with pertussis aged 0-9 years had significantly lower odds ratios of hospitalizations (OR 0.02, p < 0.001), laboratory confirmation (OR 0.21, p < 0.001), and severe disease (OR 0.02, p < 0.001) than unvaccinated or partially vaccinated children with pertussis of the same age. Mean direct healthcare costs were significantly lower (p < 0.001) in vaccinated patients (€190.6) than in unvaccinated patients (€3550.8), partially vaccinated patients (€1116.9), and unvaccinated/partially vaccinated patients (€2330). Multivariable linear regression analysis showed that pertussis vaccination with 4-5 doses was associated with a non-significant reduction of pertussis costs of €107.9 per case after taking into account the effect of other study variables, and €200 per case after taking into account pertussis severity. Direct healthcare costs were lower in children with pertussis aged 0-9 years vaccinated with 4-5 doses of acellular vaccines than in unvaccinated or partially vaccinated children with pertussis of the same age.

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection.

PubMed

Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi

2008-01-01

Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection

PubMed Central

Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi

2008-01-01

Background and aims Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Materials and methods Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. Results 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). Conclusion According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance. PMID:23285329

Creative work. The case of Charles Darwin.

PubMed

Gruber, H E; Wallace, D B

2001-04-01

The evolving systems approach (ESA) addresses the need for direct study of the creative process in recognized creators at work, in contrast to indirect methods, such as those used in psychometric studies. The ESA emerged from H. E. Gruber's prolonged study of Charles Darwin's manuscripts, especially the notebooks he kept after the Beagle voyage. Gruber's interviews with J. Piaget about the latter's creative processes, as well as many doctoral dissertations, also helped shape the authors' approach. Using Gruber's (1974/1981) study of Darwin, the authors describe some facets of creative work identified in the course of their work. Among these are networks of enterprise, ensembles of metaphors, insights, and evolving belief systems. Although the ESA emphasizes cognitive processes, social, affective, and esthetic aspects of the case are not neglected. Each creative case is unique, otherwise the individual would not meet the criterion of originality. Uniqueness does not mean isolation; people who differ must and do work together. The integration of all these facets into a plausible system for each creator remains the authors' central task.

Pinning down inelastic dark matter in the Sun and in direct detection

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

Blennow, Mattias; Clementz, Stefan; Herrero-Garcia, Juan, E-mail: emb@kth.se, E-mail: scl@kth.se, E-mail: juhg@kth.se

2016-04-01

We study the solar capture rate of inelastic dark matter with endothermic and/or exothermic interactions. By assuming that an inelastic dark matter signal will be observed in next generation direct detection experiments we can set a lower bound on the capture rate that is independent of the local dark matter density, the velocity distribution, the galactic escape velocity as well as the scattering cross section. In combination with upper limits from neutrino observatories we can place upper bounds on the annihilation channels leading to neutrinos. We find that, while endothermic scattering limits are weak in the isospin-conserving case, strong boundsmore » may be set for exothermic interactions, in particular in the spin-dependent case. Furthermore, we study the implications of observing two direct detection signals, in which case one can halo-independently obtain the dark matter mass and the mass splitting, and disentangle the endothermic/exothermic nature of the scattering. Finally we discuss isospin violation.« less

Risk factors of direct heat-related hospital admissions during the 2009 heatwave in Adelaide, Australia: a matched case-control study.

PubMed

Zhang, Ying; Nitschke, Monika; Krackowizer, Antoinette; Dear, Keith; Pisaniello, Dino; Weinstein, Philip; Tucker, Graeme; Shakib, Sepehr; Bi, Peng

2016-06-02

The extreme heatwave of 2009 in South Australia dramatically increased morbidity, with a 14-fold increase in direct heat-related hospitalisation in metropolitan Adelaide. Our study aimed to identify risk factors for the excess morbidity. A matched case-control study of risk factors was conducted. Patients and matched community controls were interviewed to gather data on demographics, living environment, social support, health status and behaviour changes during the heatwave. Cases were all hospital admissions with heat-related diagnoses during the 5-day heatwave in 2009. Controls were randomly selected from communities. Descriptive analyses, simple and multiple conditional logistic regressions were performed. Adjusted ORs (AORs) were estimated. In total, 143 hospital patients and 143 matched community controls were interviewed, with a mean age of 73 years (SD 21), 96% European ethnicity, 63% retired, 36% with high school or higher education, and 8% institutional living. The regression model indicated that compared with the controls, cases were more likely to have heart disease (AOR=13.56, 95% CI 1.27 to 144.86) and dementia (AOR=26.43, 95% CI 1.99 to 350.73). The protective factors included higher education level (AOR=0.48, 95% CI 0.23 to 0.99), having air-conditioner in the bedroom (AOR=0.12, 95% CI 0.02 to 0.74), having an emergency button (AOR=0.09, 95% CI 0.01 to 0.96), using refreshment (AOR=0.10, 95% CI 0.01 to 0.84), and having more social activities (AOR=0.11, 95% CI 0.02 to 0.57). Pre-existing heart disease and dementia significantly increase the risk of direct heat-related hospitalisations during heatwaves. The presence of an air-conditioner in the bedroom, more social activities, a higher education level, use of emergency buttons and refreshments reduce the risk during heatwaves. 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/

Global assessment of limitation to symbiotic nitrogen fixation by phosphorus availability in terrestrial ecosystems using a meta-analysis approach

NASA Astrophysics Data System (ADS)

Augusto, Laurent; Delerue, Florian; Gallet-Budynek, Anne; Achat, David L.

2013-09-01

nitrogen fixation (SNF) is the main natural source of nitrogen (N) in terrestrial ecosystems worldwide. Previous studies have shown that fixation of N by plants can be limited by the availability of phosphorus (P) in soils. We used global meta-analysis to investigate how P availability controls SNF. In experiments in which plants were grown in an artificial medium, severe P deficiencies in the nutritive solution ([PO4] < 5-42 μM) depressed SNF flux through both a direct decrease in the plant fixation rate (i.e., decreased N fixed per unit of plant biomass) and an indirect effect (i.e., through plant biomass). In most experiments with plants grown in soils, SNF was proportional to plant biomass and was consequently only indirectly limited by P. Some cases using unfertilized and weathered soils (ultisols or oxisols), where plants were particularly P stressed, were an exception with both direct and indirect P limitations. Our global analysis of the P-SNF relationship indicated that P bioavailability commonly limited SNF flux. We conclude that the main driver of in situ P limitation is indirect via limitation of plant growth, except in certain cases where both indirect and direct constraints may play a role. These cases of severe P deficiency may be mainly found in weathered tropical soils of Africa and South America, probably in unfertilized croplands which are depleted in P due to repeated biomass harvests.

In vivo anatomical analysis of arterial contact with trigeminal nerve: detection with three-dimensional spoiled grass imaging.

PubMed

Ueda, F; Suzuki, M; Fujinaga, Y; Kadoya, M; Takashima, T

1999-09-01

The purpose of this study was to review the normal in vivo neurovascular relationship between the trigeminal nerve and surrounding arteries without the use of volunteers. 290 nerves in 145 cases were reviewed during a 1-year period. Axial source images and multiplanar reconstructed (MPR) images were used to determine the neurovascular contact and direction of contact. Multiplanar volume reformation (MPVR) was used to identify the contact vessels and to demonstrate the relationship between the nerve and arteries. Vascular contact was found in 29% of the 290 nerves (83 nerves). The arteries involved were the superior cerebellar artery (SCA) or the anterior inferior cerebellar artery (AICA). Vascular contact with two arteries was found in 3%. Of the 286 asymptomatic nerves, the nerve was located between the two vessels in 3% and compression was seen in 1%. Three points of vascular contact by the two arteries were identified in one asymptomatic nerve. The direction of contact between the SCA and the nerve was superior (38%), superomedial (32%) or medial (15%) in most cases. The direction of contact between the AICA and the nerve was inferior, inferolateral or lateral in all cases. Vascular contact at the root entry zone (REZ) was noted in 90%. Four nerves were affected by trigeminal neuralgia, one of which touched an artery and two were compressed. It was concluded that arterial contact can be assessed without difficulty but evaluation of vascular compression is not easy.

No direct correlation between rotavirus diarrhea and breast feeding: A meta-analysis.

PubMed

Shen, Jian; Zhang, Bi-Meng; Zhu, Sheng-Guo; Chen, Jian-Jie

2018-04-01

Some studies indicated that children with exclusive breast feeding had a reduction in the prevalence of rotavirus diarrhea, while some others held the opposite views. In this study, we aimed to systematically find the associations between rotavirus diarrhea and breast feeding. A literature search up to June 2016 in electronic literature databases, including PubMed and Embase, was performed. The Newcastle-Ottawa Scale was used to conduct the quality assessment of all the selected studies. Statistical analyses were performed using the R package version 3.12 (R Foundation for Statistical Computing, Beijing1, China, meta package), and odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of the association. The heterogeneity was assessed by Cochran's Q-statistic and I 2 test, and the sensitivity analysis was performed by trimming one study at a time. A total of 17 articles, which included 10,841 participants, were investigated in the present meta-analysis. There was no significant difference between the case group and control group (OR, 0.59 95% CI 0.33-1.07) in the meta-analysis of exclusive breast feeding, and no significant difference was found between the case group and the control group (OR, 0.86; 95% CI 0.63-1.16) in the meta-analysis of breast feeding. No significant difference was found between the case group and control group (OR, 0.78 95% CI 0.59-1.04) for all quantitative data. There may be no direct correlation between rotavirus diarrhea and breast feeding. Copyright © 2017. Published by Elsevier B.V.

[Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis].

PubMed

Margarit Mallol, J; Vallejo Aparicio, S; García Henares, A; Grande Moreillo, C; Glasmeyer, P; Magro Benito, N; Buxeda Figuerola, M

2011-08-01

As the radiation received in conventional cystography is about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral reflux, we consider the use of radionuclide cystography in early detection of reflux in patients with prenatally detected hydronephrosis. Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide scintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed severe dilatation, or in general in cases with parenchymatous atrophy or if a duplex system was suspected. In 13 (20%) of the 65 cases (18 kidneys) reflux was detected (3 minor, 8 moderate and 7 severe). In most cases, follow up was performed with radionuclide cystography. None of the patients with reflux placed on prophylactic antibiotics developed a febrile urinary tract infection during the first year of life. Direct radionuclide cystography is a useful diagnostic method in early detection of vesicoureteral reflux in patients with prenatal hydronephrosis with higher sensitivity than conventional cystography, and with an important advantage concerning radiation of the patient. Patients screened and placed on prophylactic antibiotics are probably going to present less episodes of pielonephrytis.

Endovascular abdominal aortic aneurysm repair is more profitable than open repair based on contribution margin per day.

PubMed

Rosenberg, Barry L; Comstock, Matthew C; Butz, David A; Taheri, Paul A; Williams, David M; Upchurch, Gilbert R

2005-03-01

Earlier studies have reported that endovascular abdominal aortic aneurysm (EAAA) repair yields lower total profit margins than open AAA (OAAA) repair. This study compared EAAA versus OAAA based on contribution margin per day, which may better measure profitability of new clinical technologies. Contribution margin equals revenue less variable direct costs (VDCs). VDCs capture incremental resources tied directly to individual patients' activity (eg, invoice price of endograft device, nursing labor). Overhead costs factor into total margin, but not contribution margin. The University of Michigan Health System's cost accounting system was used to extract fiscal year 2002-2003 information on revenue, total margin, contribution margin, and duration of stay for Medicare patients with principal diagnosis of AAA (ICD-9 code 441.4). OAAA had revenues of $37,137 per case versus $28,960 for EAAA, similar VDCs per case, and thus higher contribution margin per case ($24,404 for OAAA vs $13,911 for EAAA, P < .001). However, OAAA had significantly longer mean duration of stay per case (10.2 days vs 2.2 days, P < .001). Therefore, mean contribution margin per day was $2948 for OAAA, but $8569 for EAAA ( P < .001). On the basis of contribution margin per day, EAAA repair dominates OAAA repair. The shorter duration of stay with EAAA allows higher throughput, fuller overhead amortization, better use of scarce inpatient beds, and higher health system profits. Surgeons must understand overhead allocation to devices, especially when new technologies cut duration of stay markedly.

The costs of hepatitis A infections in South Korea

PubMed Central

Kim, Kyohyun; Jeong, Baek-Geun; Ki, Moran; Park, Mira; Park, Jin Kyung; Choi, Bo Youl; Yoo, Weon-Seob

2014-01-01

OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate. PMID:25139060

Evolution of ethnocentrism on undirected and directed Barabási-Albert networks

NASA Astrophysics Data System (ADS)

Lima, F. W. S.; Hadzibeganovic, Tarik; Stauffer, Dietrich

2009-12-01

Using Monte Carlo simulations, we study the evolution of contingent cooperation and ethnocentrism in the one-shot game. Interactions and reproduction among computational agents are simulated on undirected and directed Barabási-Albert (BA) networks. We first replicate the Hammond-Axelrod model of in-group favoritism on a square lattice and then generalize this model on undirected and directed BA networks for both asexual and sexual reproduction cases. Our simulations demonstrate that irrespective of the mode of reproduction, the ethnocentric strategy becomes common even though cooperation is individually costly and mechanisms such as reciprocity or conformity are absent. Moreover, our results indicate that the spread of favoritism towards similar others highly depends on the network topology and the associated heterogeneity of the studied population.

33 CFR 209.140 - Operations of the Corps of Engineers under the Federal Power Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... directing studies to be made. In the case of an application for permit or license for an unconstructed... required to insure coordination of the applicant's studies with the Division or District Engineer in cases... studies, will when requested by the Chief of Engineers submit an estimate of the cost of the investigation...

A Case Study on Educators' Perceptions of Leader Behaviors throughout Response-to-Intervention Implementation

ERIC Educational Resources Information Center

Strickland, Thomas Joel

2017-01-01

The purpose of this two-case study was to describe the perceptions of middle school administrators and teachers concerning leader behaviors throughout the implementation of Response-to-Intervention (RTI) programs. The theory which guided this study is transformational leadership theory (Bass, 1990) as it related directly to how administrators and…

Higher Education and Social Change. Promising Experiments in Developing Countries. Volume 2: Case Studies.

ERIC Educational Resources Information Center

Thompson, Kenneth W., Ed.; And Others

Presented are the results of a study made by developing country educators for twelve national and international agencies, directed and coordinated by the International Council for Educational Development. Volume 2 contains the reports of 25 case studies of higher education institutions and systems in Africa, Asia, and Latin America: University of…

The Influence of Academic Values on Scholarly Publication and Communication Practices. Research and Occasional Paper Series: CSHE.13.06

ERIC Educational Resources Information Center

Harley, Diane; Earl-Novell, Sarah; Arter, Jennifer; Lawrence, Shannon; King, C. Judson

2006-01-01

This study reports on five disciplinary case studies that explore academic value systems as they influence publishing behavior and attitudes of University of California, Berkeley faculty. The case studies are based on direct interviews with relevant stakeholders--faculty, advancement reviewers, librarians, and editors--in five fields: chemical…

A Case Study on Reducing Children's Screen Time: The Project of Screen Free Week

ERIC Educational Resources Information Center

Kara, Hatice Gözde Ertürk

2018-01-01

The current study aims to direct children to alternative activities within a week period by applying the project of screen free week to voluntary families. The ultimate aim of the study is to reduce children's screen time. The instrumental case study method; one of the qualitative research methods, was employed. Five children attending the…

Impact of European Union Legislation On The Wash Catchment, U.k.

NASA Astrophysics Data System (ADS)

Daldorph, P.; Wheater, H.; Saunders, A.

A case study is presented which shows the impact of existing European Legislation (Urban Waste Water Directive, Nitrate Directive, Bathing Waters Directive, Habitats Directive) on aquatic nutrient concentrations in the 16112 km2 catchment area of The Wash in eastern England , including both the inland and coastal zones. Information is provided on the implementation process (administrative and economic) and the observed impacts of measures to reduce environmental nutrient levels. Impacts are compared with simulations of nutrients in the inland and coastal zones, and the modeling tools are further used to predict impacts of future management change, e.g. to meet possible requirements of the Water Framework Directive. The issues in setting future environmental targets and research needs to underpin this process are discussed in the context of developing river basin management plans to support the Common Implementation Strategy for the Water Framework Directive.

Future directions for simulation of recreation use

Treesearch

David N. Cole

2005-01-01

As the case studies in Chapter 4 illustrate, simulation modeling can be a valuable tool for recreation planning and management. Although simulation modeling is already well developed for business applications, its adaptation to recreation management is less developed. Relatively few resources have been devoted to realizing its potential. Further progress is needed in...

A case study: using members' values to increase plan awareness.

PubMed

Monfiletto, E; Greitzer, C; Tortu, D

1994-02-01

Consumer awareness of a health plan is the direct result of name recognition and overall health plan identity. After many name changes and transitioning ownerships, Greater Atlantic Health Service found that its membership was waning, and a lack of consumer awareness of the HMO was a substantial part of the problem.

Investigating Good Practice in Supporting Deaf Pupils in Mainstream Schools.

ERIC Educational Resources Information Center

Powers, Steve

2001-01-01

A survey of parents, teachers, therapists, psychologists, and deaf adults (n=628) and 15 case study sites were used to identify the following good practices supporting deaf students in mainstream schools: direct support for teachers of the deaf, joint planning by support and mainstream teachers, student involvement in decision making, and…

A Case Study of a Community-Based Transition Education Project.

ERIC Educational Resources Information Center

Lake, John; Williamson, John

Evaluation of a 3-year transition education program at the Pingelly School in Western Australia used data from 29 students and staff interviews, direct observation, and document analysis to compare 4 projects established to improve the employability of students (in particular, Aboriginal students and girls who were at highest risk of being early…

Biocomplexity and conservation of biodiversity hotspots: three case studies from the Americas.

PubMed

Callicott, J Baird; Rozzi, Ricardo; Delgado, Luz; Monticino, Michael; Acevedo, Miguel; Harcombe, Paul

2007-02-28

The perspective of 'biocomplexity' in the form of 'coupled natural and human systems' represents a resource for the future conservation of biodiversity hotspots in three direct ways: (i) modelling the impact on biodiversity of private land-use decisions and public land-use policies, (ii) indicating how the biocultural history of a biodiversity hotspot may be a resource for its future conservation, and (iii) identifying and deploying the nodes of both the material and psycho-spiritual connectivity between human and natural systems in service to conservation goals. Three biocomplexity case studies of areas notable for their biodiversity, selected for their variability along a latitudinal climate gradient and a human-impact gradient, are developed: the Big Thicket in southeast Texas, the Upper Botanamo River Basin in eastern Venezuela, and the Cape Horn Archipelago at the austral tip of Chile. More deeply, the biocomplexity perspective reveals alternative ways of understanding biodiversity itself, because it directs attention to the human concepts through which biodiversity is perceived and understood. The very meaning of biodiversity is contestable and varies according to the cognitive lenses through which it is perceived.

On the direct detection of multi-component dark matter: sensitivity studies and parameter estimation

NASA Astrophysics Data System (ADS)

Herrero-Garcia, Juan; Scaffidi, Andre; White, Martin; Williams, Anthony G.

2017-11-01

We study the case of multi-component dark matter, in particular how direct detection signals are modified in the presence of several stable weakly-interacting-massive particles. Assuming a positive signal in a future direct detection experiment, stemming from two dark matter components, we study the region in parameter space where it is possible to distinguish a one from a two-component dark matter spectrum. First, we leave as free parameters the two dark matter masses and show that the two hypotheses can be significantly discriminated for a range of dark matter masses with their splitting being the critical factor. We then investigate how including the effects of different interaction strengths, local densities or velocity dispersions for the two components modifies these conclusions. We also consider the case of isospin-violating couplings. In all scenarios, we show results for various types of nuclei both for elastic spin-independent and spin-dependent interactions. Finally, assuming that the two-component hypothesis is confirmed, we quantify the accuracy with which the parameters can be extracted and discuss the different degeneracies that occur. This includes studying the case in which only a single experiment observes a signal, and also the scenario of having two signals from two different experiments, in which case the ratios of the couplings to neutrons and protons may also be extracted.

Verification of respiratory-gated radiotherapy with new real-time tumour-tracking radiotherapy system using cine EPID images and a log file

NASA Astrophysics Data System (ADS)

Shiinoki, Takehiro; Hanazawa, Hideki; Yuasa, Yuki; Fujimoto, Koya; Uehara, Takuya; Shibuya, Keiko

2017-02-01

A combined system comprising the TrueBeam linear accelerator and a new real-time tumour-tracking radiotherapy system, SyncTraX, was installed at our institution. The objectives of this study are to develop a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine electronic portal image device (EPID) images and a log file and to verify this treatment in clinical cases. Respiratory-gated radiotherapy was performed using TrueBeam and the SyncTraX system. Cine EPID images and a log file were acquired for a phantom and three patients during the course of the treatment. Digitally reconstructed radiographs (DRRs) were created for each treatment beam using a planning CT set. The cine EPID images, log file, and DRRs were analysed using a developed software. For the phantom case, the accuracy of the proposed method was evaluated to verify the respiratory-gated radiotherapy. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker used as an internal surrogate were calculated to evaluate the gating accuracy and set-up uncertainty in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions. The proposed method achieved high accuracy for the phantom verification. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker were  ⩽3 mm and  ±3 mm in the SI, AP, and LR directions. We proposed a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine EPID images and a log file and showed that this treatment is performed with high accuracy in clinical cases. This work was partly presented at the 58th Annual meeting of American Association of Physicists in Medicine.

Verification of respiratory-gated radiotherapy with new real-time tumour-tracking radiotherapy system using cine EPID images and a log file.

PubMed

Shiinoki, Takehiro; Hanazawa, Hideki; Yuasa, Yuki; Fujimoto, Koya; Uehara, Takuya; Shibuya, Keiko

2017-02-21

A combined system comprising the TrueBeam linear accelerator and a new real-time tumour-tracking radiotherapy system, SyncTraX, was installed at our institution. The objectives of this study are to develop a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine electronic portal image device (EPID) images and a log file and to verify this treatment in clinical cases. Respiratory-gated radiotherapy was performed using TrueBeam and the SyncTraX system. Cine EPID images and a log file were acquired for a phantom and three patients during the course of the treatment. Digitally reconstructed radiographs (DRRs) were created for each treatment beam using a planning CT set. The cine EPID images, log file, and DRRs were analysed using a developed software. For the phantom case, the accuracy of the proposed method was evaluated to verify the respiratory-gated radiotherapy. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker used as an internal surrogate were calculated to evaluate the gating accuracy and set-up uncertainty in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions. The proposed method achieved high accuracy for the phantom verification. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker were  ⩽3 mm and  ±3 mm in the SI, AP, and LR directions. We proposed a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine EPID images and a log file and showed that this treatment is performed with high accuracy in clinical cases.

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.

PubMed

Urquhart, Robin; Porter, Geoffrey A; Sargeant, Joan; Jackson, Lois; Grunfeld, Eva

2014-09-16

The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.

The Management of Teachers' Non-Directed Time in a Secondary School

ERIC Educational Resources Information Center

Holmes, Beth

2017-01-01

This article describes a study which investigated the motivations behind why teachers dedicate non-directed time to school-related tasks and the extent to which managers understand and harness these motivations. Data were collected through three case studies within one secondary school. Three heads of department (HoDs) and three teachers were…

Word Order, Referential Expression, and Case Cues to the Acquisition of Transitive Sentences in Italian

ERIC Educational Resources Information Center

Abbot-Smith, Kirsten; Serratrice, Ludovica

2015-01-01

In Study 1 we analyzed Italian child-directed-speech (CDS) and selected the three most frequent active transitive sentence frames used with overt subjects. In Study 2 we experimentally investigated how Italian-speaking children aged 2;6, 3;6, and 4;6 comprehended these orders with novel verbs when the cues of animacy, gender, and subject-verb…

Don't Give Me a Fish; Teach Me How to Fish: A Case Study of an International Adult Learner

ERIC Educational Resources Information Center

Mohammed, Methal R.

2010-01-01

A Learning Contract can be understood as an approach in teaching where students are viewed as lifelong learners. It aims to develop students' self-directedness and control of their own learning experience. The purpose of this paper is to critically reflect on the Learning Contract used in Directed Studies courses for graduate students. The author…

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

PubMed

Fraser, Kimberly D; Estabrooks, Carole; Allen, Marion; Strang, Vicki

2009-03-01

Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Effects of nonuniform Mach-number entrance on scramjet nozzle flowfield and performance

NASA Astrophysics Data System (ADS)

Zhang, Pu; Xu, Jinglei; Quan, Zhibin; Mo, Jianwei

2016-12-01

Considering the non-uniformities of nozzle entrance influenced by the upstream, the effects of nonuniform Mach-number coupled with shock and expansion-wave on the flowfield and performances of single expansion ramp nozzle (SERN) are numerically studied using Reynolds-Averaged Navier-Stokes equations. The adopted Reynolds-averaged Navier-Stokes methodology is validated by comparing the numerical results with the cold experimental data, and the average method used in this paper is discussed. Uniform and nonuniform facility nozzles are designed to generate different Mach-number profile for the inlet of SERN, which is direct-connected with different facility nozzle, and the whole flowfield is simulated. Because of the coupling of shock and expansion-wave, flow direction of nonuniform SERN entrance is distorted. Compared with Mach contour of uniform case, the line is more curved for coupling shock-wave entrance (SWE) case, and flatter for the coupling expansion-wave entrance (EWE) case. Wall pressure distribution of SWE case appears rising region, whereas decreases like stairs of EWE case. The numerical results reveal that the coupled shock and expansion-wave play significant roles on nozzle performances. Compared with the SERN performances of uniform entrance case at the same work conditions, the thrust of nonuniform entrance cases reduces by 3-6%, pitch moment decreases by 2.5-7%. The negative lift presents an incremental trend with EWE while the situation is the opposite with SWE. These results confirm that considering the entrance flow parameter nonuniformities of a scramjet nozzle coupled with shock or expansion-wave from the upstream is necessary.

Case-Based Learning: Educating Future Human Service Managers

ERIC Educational Resources Information Center

Austin, Michael J.; Packard, Thomas

2009-01-01

Using teaching cases in professional education programs has gained increased attention in the past several decades. While the use of teaching cases has been an important part of social work education, the majority of current casebooks focus on micro or direct practice issues and settings. Over the past forty years only four major casebooks have…

The impact of the global economic crisis on HIV and AIDS programmes directed at women and children in Zambia.

PubMed

Serieux, John; Njelesani, Mwansa; Chompolola, Abson; Sepehri, Ardeshir; Guliani, Harminder

2015-01-01

This investigation sought to ascertain the extent to which the global economic crisis of 2008-2009 affected the delivery of HIV/AIDS-related services directed at pregnant and lactating mothers, children living with HIV and children orphaned through HIV in Zambia. Using a combined macroeconomic analysis and a multiple case study approach, the authors found that from mid-2008 to mid-2009 the Zambian economy was indeed buffeted by the global economic crisis. During that period the case study subjects experienced challenges with respect to the funding, delivery and effectiveness of services that were clearly attributable, directly or indirectly, to the global economic crisis. The source of funding most often compromised was external private flows. The services most often compromised were non-medical services (such as the delivery of assistance to orphans and counselling to HIV-positive mothers) while the more strictly medical services (such as antiretroviral therapy) were protected from funding cuts and service interruptions. Impairments to service effectiveness were experienced relatively equally by (HIV-positive) pregnant women and lactating mothers and children orphaned through HIV. Children living with AIDS were least affected because of the primacy of ARV therapy in their care.

Evaluating the Effects of Medical Explorers a Case Study Curriculum on Critical Thinking, Attitude toward Life Science, and Motivational Learning Strategies in Rural High School Students

ERIC Educational Resources Information Center

Brand, Lance G.

2011-01-01

The purpose of this study was three-fold: to measure the ability of the "Medical Explorers" case-based curriculum to improve higher order thinking skills; to evaluate the impact of the "Medical Explorers" case-based curriculum to help students be self directed learners; and to investigate the impact of the "Medical…

Delusional jealousy and person directed hostility: 5-year follow-up of a patient after anoxic brain injury.

PubMed

Shah, Rajendra; Faruqui, Rafey A

2013-01-01

This study presents a case report on the emergence of delusional jealousy and person-directed hostility in a patient following anoxic brain injury. The patient did not have a pre-injury history of mental illness, nor a family history of a psychotic disorder. This patient was followed-up over a 5-year period and his history of treatment response, violence risk management and successful rehabilitation are presented. This study also highlights issues in relation to continuation of treatment with antipsychotic medication, use of compulsory admission under the Mental Health Act and principles of risk assessment and risk management.

Noninvasive screening for genital chlamydial infections in asymptomatic men: Strategies and costs using a urine PCR assay

PubMed Central

Peeling, Rosanna W; Toye, Baldwin; Jessamine, Peter; Gemmill, Ian

1998-01-01

OBJECTIVE: To evaluate cost saving strategies to screen for genital chlamydial infection in men using polymerase chain reaction (PCR) technology. METHODS: Men with no urethral symptoms presenting to a sexually transmitted disease (STD) clinic were recruited. Study participants underwent a questionnaire interview. Urethral swabs were taken to perform a smear for polymorphonuclear leucocytes (PMN) and for the detection of Chlamydia trachomatis by culture and PCR. First-catch urine was collected for a leukocyte esterase test (LET) and PCR. RESULTS: C trachomatis infection was detected in 36 of 463 (7.8%) men. LET and PMN were positive in 10 (28%) and 12 (33%) infected men, respectively. Risk factors for chlamydial infection were younger than age 25 years, LET-positive, PMN-positive and STD contact (P<0.001). The direct cost of genital chlamydial infection in men in Canada has been previously estimated at $381/case. Based on a sensitivity of 90% for urine PCR, the estimated direct cost of testing all participants to detect 32 cases was $453/case. Using risk factors recommended in the Canadian STD Guidelines (age younger than 25 years, new partner, STD contact or unprotected sex), the same number of cases would have been detected by testing only 384 men at $376/case. Using age younger than 25 years or STD contact as the screening criterion, 78% of those infected would have been detected at $259/case, and no new cases would have been detected by adding LET-positive or PMN-positive as risk factors. CONCLUSION: Targeted screening for chlamydial infection using urine PCR assay and risk factors recommended in the Canadian guidelines could substantially reduce the cost of screening at a STD clinic setting. LET and PMN smear did not appear to be useful indicators of chlamydial infection in this population. PMID:22346549

A guide to using case-based learning in biochemistry education.

PubMed

Kulak, Verena; Newton, Genevieve

2014-01-01

Studies indicate that the majority of students in undergraduate biochemistry take a surface approach to learning, associated with rote memorization of material, rather than a deep approach, which implies higher cognitive processing. This behavior relates to poorer outcomes, including impaired course performance and reduced knowledge retention. The use of case-based learning (CBL) into biochemistry teaching may facilitate deep learning by increasing student engagement and interest. Abundant literature on CBL exists but clear guidance on how to design and implement case studies is not readily available. This guide provides a representative review of CBL uses in science and describes the process of developing CBL modules to be used in biochemistry. Included is a framework to implement a directed CBL assisted with lectures in a content-driven biochemistry course regardless of class size. Moreover, this guide can facilitate adopting CBL to other courses. Consequently, the information presented herein will be of value to undergraduate science educators with an interest in active learning pedagogies. © 2014 The International Union of Biochemistry and Molecular Biology.

Autonomy and the Moral Authority of Advance Directives.

PubMed

Vogelstein, Eric

2016-10-01

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based (e.g., in cases of severe dementia). The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is "yes." I argue that a patient's autonomy is not respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient's previous values must be in that patient's best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A controlled experiment in ground water flow model calibration

USGS Publications Warehouse

Hill, M.C.; Cooley, R.L.; Pollock, D.W.

1998-01-01

Nonlinear regression was introduced to ground water modeling in the 1970s, but has been used very little to calibrate numerical models of complicated ground water systems. Apparently, nonlinear regression is thought by many to be incapable of addressing such complex problems. With what we believe to be the most complicated synthetic test case used for such a study, this work investigates using nonlinear regression in ground water model calibration. Results of the study fall into two categories. First, the study demonstrates how systematic use of a well designed nonlinear regression method can indicate the importance of different types of data and can lead to successive improvement of models and their parameterizations. Our method differs from previous methods presented in the ground water literature in that (1) weighting is more closely related to expected data errors than is usually the case; (2) defined diagnostic statistics allow for more effective evaluation of the available data, the model, and their interaction; and (3) prior information is used more cautiously. Second, our results challenge some commonly held beliefs about model calibration. For the test case considered, we show that (1) field measured values of hydraulic conductivity are not as directly applicable to models as their use in some geostatistical methods imply; (2) a unique model does not necessarily need to be identified to obtain accurate predictions; and (3) in the absence of obvious model bias, model error was normally distributed. The complexity of the test case involved implies that the methods used and conclusions drawn are likely to be powerful in practice.Nonlinear regression was introduced to ground water modeling in the 1970s, but has been used very little to calibrate numerical models of complicated ground water systems. Apparently, nonlinear regression is thought by many to be incapable of addressing such complex problems. With what we believe to be the most complicated synthetic test case used for such a study, this work investigates using nonlinear regression in ground water model calibration. Results of the study fall into two categories. First, the study demonstrates how systematic use of a well designed nonlinear regression method can indicate the importance of different types of data and can lead to successive improvement of models and their parameterizations. Our method differs from previous methods presented in the ground water literature in that (1) weighting is more closely related to expected data errors than is usually the case; (2) defined diagnostic statistics allow for more effective evaluation of the available data, the model, and their interaction; and (3) prior information is used more cautiously. Second, our results challenge some commonly held beliefs about model calibration. For the test case considered, we show that (1) field measured values of hydraulic conductivity are not as directly applicable to models as their use in some geostatistical methods imply; (2) a unique model does not necessarily need to be identified to obtain accurate predictions; and (3) in the absence of obvious model bias, model error was normally distributed. The complexity of the test case involved implies that the methods used and conclusions drawn are likely to be powerful in practice.

A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients

PubMed Central

Lu, Xiaojian; Hussain, Mohammed; Ni, Lanchun; Huang, Qinfeng; Zhou, Fei; Gu, Zhikai; Chen, Jian; Ding, Yuchuan; Xu, Feng

2014-01-01

Objective Transarterial treatment of direct carotid cavernous fistulas (DCCF) via embolic materials has been well documented. This study reports, validates, and compares with existing literature our experience treating DCCFs via endovascular approaches by using detachable balloons, coils, and covered stents. Methods Between June 2006 to October 2011, 32 patients (21 male, 11 female) with 32 DCCFs (30 traumatic, 2 spontaneous cavernous ICA aneurysms) were embolized endovascularly. Followup was performed for at least 6 months. Results Among the 32 DCCFs, 21 (65.6%) were embolized using detachable balloons, eight (25.0%) with coils, one (3.1%) with balloons and coils, and two (6.3%) with covered stents. Complete DCCF obliteration was achieved in 31 (96.9%) cases. One fistula failed to respond due to premature balloon detachment. Intracranial bruit in 31 (100%) chemosis and exophthalmos in 28 (100%) cases resolved after embolization. Visual acuity and oculomotor palsy improved in 18 (90%) and 18 (69.2%) cases, respectively. There was no evidence of DCCF recurrence. Thirteen DCCFs were followed up by MRI and five by DSA. In these cases, four (4/13, 30.8%) balloon-embolized DCCFs showed pseudoaneurysms. Three patients were asymptomatic; one had minor left oculomotor palsy. Conclusions Our results correlate and reinforce literature regarding endovascular treatment of DCCFs. Application of Transarterial embolization with detachable balloons, despite extensive use has been decreasing. Coil embolization is an effective and safe alternative for treatment, especially when balloon embolization fails. Covered stent placement may be used as another alternative for selected cases. PMID:25566340

Neural differences in processing of case particles in Japanese: an fMRI study

PubMed Central

Hashimoto, Yosuke; Yokoyama, Satoru; Kawashima, Ryuta

2014-01-01

Introduction In subject–object–verb (SOV) languages, such as Japanese, sentence processing proceeds incrementally to the late presentation of the head (verb). Japanese case particles play a crucial role in sentence processing; however, little is known about how these particles are processed. In particular, it is still unclear how the functional difference between case particles is represented in the human brain. Methods In this study, we conducted an fMRI experiment using an event-related design to directly compare brain activity during Japanese case particle processing among the nominative case ga, accusative case o, and dative case ni. Twenty five native Japanese speakers were asked to judge whether the presented character was a particle in a particle judgment task and whether the character ended with a specific vowel in a phonological judgment task, which was used as a control condition. Results A particle comparison demonstrated that the processing of ni was associated with significantly weaker brain activity than that of ga and o in the left middle frontal gyrus (MFG) and the inferior frontal gyrus (IFG). Significantly greater brain activity associated with ni relative to ga in the right IFG was also observed. Conclusion These results suggest that the Japanese case particles ga, ni, and o are represented differently in the brain. PMID:24683511

[DNA prints instead of plantar prints in neonatal identification].

PubMed

Rodríguez-Alarcón Gómez, J; Martińez de Pancorbo Gómez, M; Santillana Ferrer, L; Castro Espido, A; Melchor Maros, J C; Linares Uribe, M A; Fernández-Llebrez del Rey, L; Aranguren Dúo, G

1996-06-22

To check the possible usefulness in studying DNA in dried blood spots taken on filter paper blotters for newborn identification. It set out to establish: 1. The validity of the method for analysis; 2. The validity of all stored samples (such as those kept in clinical records); 3. Guarantee of non-intrusion in the genetic code; 4. Acceptable price and execution time. Forty (40) anonymous 13-year-old samples of 20 subjects (2 per subject) were studied. DNA was extracted using Chelex resin and the STR ("small tandem repeat") of microsatellite DNA was studies using the "polimerase chain reaction method" (PCR). Three non coding DNA loci (CSF1PO, TPOX and THO1) were analyzed by Multiplex amplification. It was possible to type 39 samples, making it possible to match the 20 cases (one by exclusion). The complete procedure yielded the results within 24 hours in all cases. The estimated final cost was found to be a fifth of that conventional maternity/paternity tests. The study carried out made matching possible in all 20 cases (directly in 19 cases). It was not necessary to study DNA coding areas. The validity of the method for analyzing samples stored for 13 years without any special care was also demonstrated. The technic was fast, producing the results within 24 hours, and at reasonable cost.

Detection of clonal aberrations by cytogenetic analysis after different culture methods and by FISH in 129 patients with Chronic Lymphocytic Leukemia.

PubMed

Jenderny, Jutta; Goldmann, Claudia; Thede, Rebekka; Ebrecht, Monika; Korioth, Frank

2014-01-01

There are only a few cytogenetic analysis (CA) studies that directly compare the novel cultivation technique using immunostimulatory CpG-oligonucleotide DSP30/interleukin-2 (DSP30/IL2) with other culture methods. Therefore, parallel cultures of peripheral blood of 129 chronic lymphocytic leukemia (CLL) patients were set up in unstimulated cultures, in the presence of pokeweed medium (PWM), and with DSP30/IL2. Furthermore, CA results were compared with data obtained by FISH. Clonal aberrations were observed by CA in 6% of the cases in unstimulated cultures, in 27% of the cases with PWM, and in 40% of the cases with DSP30/IL2. Some clonal aberrations were detected by CA only with one culture method. Using 3 different culture methods, clonal aberrations were detected in 41% of the cases by CA and in 71% of the cases by FISH. Altogether, 78% of the cases exhibited clonal aberrations discovered by CA and FISH. Also, CA detected clonal aberrations not targeted by FISH in 7% of the cases, and FISH identified clonal aberrations not detected by CA in 36% of the cases. Our study demonstrates that the combined use of CA with different culture methods together with FISH increases our knowledge of the genetic complexity and heterogeneity in CLL pathogenesis. © 2014 S. Karger AG, Basel.

Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion.

PubMed

Venderink, Wulphert; Govers, Tim M; de Rooij, Maarten; Fütterer, Jurgen J; Sedelaar, J P Michiel

2017-05-01

Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective. A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed. The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective. Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.

Pediatric Surgeon-Directed Wound Classification Improves Accuracy

PubMed Central

Zens, Tiffany J.; Rusy, Deborah A.; Gosain, Ankush

2015-01-01

Background Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes amongst centers. We hypothesized that changing from nurse-directed to surgeon-directed SWC during a structured operative debrief we will improve accuracy of documentation. Methods An IRB-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (Pre-Debrief 6/2012-5/2013) and allowing six months for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (Post-Debrief 1/2014-8/2014). Accuracy of SWC was determined for four commonly performed Pediatric General Surgery operations: inguinal hernia repair (clean), gastrostomy +/− Nissen fundoplication (clean-contaminated), appendectomy without perforation (contaminated), and appendectomy with perforation (dirty). Results 183 cases Pre-Debrief and 142 cases Post-Debrief met inclusion criteria. No differences between time periods were noted in regards to patient demographics, ASA class, or case mix. Accuracy of wound classification improved Post-Debrief (42% vs. 58.5%, p=0.003). Pre-Debrief, 26.8% of cases were overestimated or underestimated by more than one wound class, vs. 3.5% of cases Post-Debrief (p<0.001). Interestingly, the majority of Post-Debrief contaminated cases were incorrectly classified as clean-contaminated. Conclusions Implementation of a structured operative debrief including surgeon-directed SWC improves the percentage of correctly classified wounds and decreases the degree of inaccuracy in incorrectly classified cases. However, following implementation of the debriefing, we still observed a 41.5% rate of incorrect documentation, most notably in contaminated cases, indicating further education and process improvement is needed. PMID:27020829

Multistep-Ahead Air Passengers Traffic Prediction with Hybrid ARIMA-SVMs Models

PubMed Central

Ming, Wei; Xiong, Tao

2014-01-01

The hybrid ARIMA-SVMs prediction models have been established recently, which take advantage of the unique strength of ARIMA and SVMs models in linear and nonlinear modeling, respectively. Built upon this hybrid ARIMA-SVMs models alike, this study goes further to extend them into the case of multistep-ahead prediction for air passengers traffic with the two most commonly used multistep-ahead prediction strategies, that is, iterated strategy and direct strategy. Additionally, the effectiveness of data preprocessing approaches, such as deseasonalization and detrending, is investigated and proofed along with the two strategies. Real data sets including four selected airlines' monthly series were collected to justify the effectiveness of the proposed approach. Empirical results demonstrate that the direct strategy performs better than iterative one in long term prediction case while iterative one performs better in the case of short term prediction. Furthermore, both deseasonalization and detrending can significantly improve the prediction accuracy for both strategies, indicating the necessity of data preprocessing. As such, this study contributes as a full reference to the planners from air transportation industries on how to tackle multistep-ahead prediction tasks in the implementation of either prediction strategy. PMID:24723814

A Study on the Wind Environment and Effects of Wind Fences around the Jang-Bogo Antarctica Station

NASA Astrophysics Data System (ADS)

Wang, J. W.; Kim, J.; Choi, W.; Kwon, H.

2017-12-01

This study investigated the influence of Jang-Bogo Antarctic Research Station on detailed flow and the effectiveness of wind fences on the surrounding observation environment using a computational fluid dynamics (CFD) model. The data obtained from the computer aided design (CAD) drawing were used to construct the terrain and buildings around Jang-Bogo Antarctic Research Station. To investigate the flow characteristics altered by Jang-Bogo Antarctic Research Station, we conducted the simulations for 16 different inflow directions and, for each inflow direction, we compared the flow characteristics before and after the construction of Jang-Bogo Antarctic Research Station. The observation data of automatic weather system (AWS) were used for comparison. The wind rose analysis shows that the wind speed and direction after the construction of the Jang-Bogo Antarctic Research Station are quite different from those before the construction. We also investigated effects of wind fences on the reduction of wind speeds around Jang-Bogo Antarctic Research Station, as one of the studies to reduce potential damages caused by katabatic wind. For this, we changed systematically the distance between the fences and the Jang-Bogo Antarctic Research Station (2H 8H with the increment of 2H, H is fence of height) and porosity of fences (0%, 25%, 33%, 50%, 67% and 75%). In the affiliated westerly cases, the AWS was located at the downwind side of the Jang-Bogo Antarctic Research Station and the effect of the construction were maximized (in the west-north-westerly case, the maximum decrease in wind speed was 81% compared to the wind speeds before the construction). In the case that the distance between the wind fence and the Jang-Bogo Antarctic Research Station was shortest, the wind speed reduction was maximized. With the same distance, the fence with medium porosities (25 33%) maximized the wind speed reduction.

Legal issues in governing genetic biobanks: the Italian framework as a case study for the implications for citizen's health through public-private initiatives.

PubMed

Piciocchi, Cinzia; Ducato, Rossana; Martinelli, Lucia; Perra, Silvia; Tomasi, Marta; Zuddas, Carla; Mascalzoni, Deborah

2018-04-01

This paper outlines some of the challenges faced by regulation of genetic biobanking, using case studies coming from the Italian legal system. The governance of genetic resources in the context of genetic biobanks in Italy is discussed, as an example of the stratification of different inputs and rules: EU law, national law, orders made by authorities and soft law, which need to be integrated with ethical principles, technological strategies and solutions. After providing an overview of the Italian legal regulation of genetic data processing, it considers the fate of genetic material and IP rights in the event of a biobank's insolvency. To this end, it analyses two case studies: a controversial bankruptcy case which occurred in Sardinia, one of the first examples of private and public partnership biobanks. Another case study considered is the Chris project: an example of partnership between a research institute in Bolzano and the South Tyrolean Health System. Both cases seem to point in the same direction, suggesting expediency of promoting and improving public-private partnerships to manage biological tissues and biotrust to conciliate patent law and public interest.

Impact of a stay in the intensive care unit on the preparation of Advance Directives: Descriptive, exploratory, qualitative study.

PubMed

Andreu, Pascal; Dargent, Auguste; Large, Audrey; Meunier-Beillard, Nicolas; Vinault, Sandrine; Leiva-Rojas, Uriel; Ecarnot, Fiona; Prin, Sébastien; Charles, Pierre-Emmanuel; Fournel, Isabelle; Rigaud, Jean-Philippe; Quenot, Jean-Pierre

2018-04-01

Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of "advance directives". Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD: withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions. Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Selection bias in population-based cancer case-control studies due to incomplete sampling frame coverage.

PubMed

Walsh, Matthew C; Trentham-Dietz, Amy; Gangnon, Ronald E; Nieto, F Javier; Newcomb, Polly A; Palta, Mari

2012-06-01

Increasing numbers of individuals are choosing to opt out of population-based sampling frames due to privacy concerns. This is especially a problem in the selection of controls for case-control studies, as the cases often arise from relatively complete population-based registries, whereas control selection requires a sampling frame. If opt out is also related to risk factors, bias can arise. We linked breast cancer cases who reported having a valid driver's license from the 2004-2008 Wisconsin women's health study (N = 2,988) with a master list of licensed drivers from the Wisconsin Department of Transportation (WDOT). This master list excludes Wisconsin drivers that requested their information not be sold by the state. Multivariate-adjusted selection probability ratios (SPR) were calculated to estimate potential bias when using this driver's license sampling frame to select controls. A total of 962 cases (32%) had opted out of the WDOT sampling frame. Cases age <40 (SPR = 0.90), income either unreported (SPR = 0.89) or greater than $50,000 (SPR = 0.94), lower parity (SPR = 0.96 per one-child decrease), and hormone use (SPR = 0.93) were significantly less likely to be covered by the WDOT sampling frame (α = 0.05 level). Our results indicate the potential for selection bias due to differential opt out between various demographic and behavioral subgroups of controls. As selection bias may differ by exposure and study base, the assessment of potential bias needs to be ongoing. SPRs can be used to predict the direction of bias when cases and controls stem from different sampling frames in population-based case-control studies.

Integrated Operations Architecture Technology Assessment Study

NASA Technical Reports Server (NTRS)

2001-01-01

As part of NASA's Integrated Operations Architecture (IOA) Baseline, NASA will consolidate all communications operations. including ground-based, near-earth, and deep-space communications, into a single integrated network. This network will make maximum use of commercial equipment, services and standards. It will be an Internet Protocol (IP) based network. This study supports technology development planning for the IOA. The technical problems that may arise when LEO mission spacecraft interoperate with commercial satellite services were investigated. Commercial technology and services that could support the IOA were surveyed, and gaps in the capability of existing technology and techniques were identified. Recommendations were made on which gaps should be closed by means of NASA research and development funding. Several findings emerged from the interoperability assessment: in the NASA mission set, there is a preponderance of small. inexpensive, low data rate science missions; proposed commercial satellite communications services could potentially provide TDRSS-like data relay functions; and. IP and related protocols, such as TCP, require augmentation to operate in the mobile networking environment required by the space-to-ground portion of the IOA. Five case studies were performed in the technology assessment. Each case represented a realistic implementation of the near-earth portion of the IOA. The cases included the use of frequencies at L-band, Ka-band and the optical spectrum. The cases also represented both space relay architectures and direct-to-ground architectures. Some of the main recommendations resulting from the case studies are: select an architecture for the LEO/MEO communications network; pursue the development of a Ka-band space-qualified transmitter (and possibly a receiver), and a low-cost Ka-band ground terminal for a direct-to-ground network, pursue the development of an Inmarsat (L-band) space-qualified transceiver to implement a global, low data rate network for LEO/MEO, mission spacecraft; and, pursue developmental research for a miniaturized, high data rate optical transceiver.

A Qualitative Case Study of Expert Special Educators Effectively Negotiating Their Job Demands

ERIC Educational Resources Information Center

Ortogero, Shawna P.

2013-01-01

This qualitative case study explored how three expert secondary special education teachers in Hawaii constructed their perceived roles and successfully negotiated their job demands. There is a strong connection between role problems and special education teachers leaving the profession. The special education teacher shortage has a direct impact on…

Problem Solving by 5-6 Years Old Kindergarten Children in a Computer Programming Environment: A Case Study

ERIC Educational Resources Information Center

Fessakis, G.; Gouli, E.; Mavroudi, E.

2013-01-01

Computer programming is considered an important competence for the development of higher-order thinking in addition to algorithmic problem solving skills. Its horizontal integration throughout all educational levels is considered worthwhile and attracts the attention of researchers. Towards this direction, an exploratory case study is presented…

Two Case Studies of L2 Writers' Experiences across Learning-Directed Portfolio Contexts

ERIC Educational Resources Information Center

Hirvela, Alan; Sweetland, Yuerong Liu

2005-01-01

Portfolios have attracted considerable interest among ESL writing and assessment specialists since the 1980s. Whether they have fulfilled the promise their proponents envision is a question still under investigation. This paper describes two case studies which looked at student experiences with portfolios in two ESL writing courses where the…

Increasing Unit Effectiveness in a Dynamic Environment by Implementing a Leadership Mathematical Model

DTIC Science & Technology

2011-06-10

research . For example, Creswell presents five types of qualitative research : narrative , phenomenological , grounded theory , ethnographic research , and... case study (2007, 53). According to Denzin and Lincoln (2005) there are six research directions: case study , ethnography , grounded theory , life 32...commanders. A method could be a kind of theory . Hence, grounded

A Comparative Analysis of Polymerase Chain Reaction and Direct Fluorescent Antibody Test for Diagnosis of Genital Herpes.

PubMed

Patwardhan, Vrushali; Bhalla, Preena; Rawat, Deepti; Garg, Vijay Kumar; Sardana, Kabir; Sethi, Sumit

2017-01-01

To compare laboratory tests that can simultaneously detect and type herpes simplex virus (HSV) directly from the genital ulcer specimens in clinically suspected cases of genital herpes. A study was conducted over 10 months and 44 adult male and female patients clinically suspected with genital herpes were recruited. Genital ulcer swab specimens were subjected to glycoprotein-G gene-based conventional polymerase chain reaction (PCR) and commercially available direct fluorescent antibody (DFA) test and the results were compared. PCR for HSV was positive in 82% (36/44) cases. DFA was positive in 68.2% (30/44) cases. There was 100% agreement between HSV types detected by DFA and PCR. The strength of agreement between the results was better in primary genital herpes than recurrent cases. PCR was found to be better in the detection of HSV in recurrent genital herpes patients. It is a better modality, especially when genital herpes clinically presents with ulcerative or crusted lesions, and is also a cheaper alternative as compared to DFA.

The role of predictive uncertainty in the operational management of reservoirs

NASA Astrophysics Data System (ADS)

Todini, E.

2014-09-01

The present work deals with the operational management of multi-purpose reservoirs, whose optimisation-based rules are derived, in the planning phase, via deterministic (linear and nonlinear programming, dynamic programming, etc.) or via stochastic (generally stochastic dynamic programming) approaches. In operation, the resulting deterministic or stochastic optimised operating rules are then triggered based on inflow predictions. In order to fully benefit from predictions, one must avoid using them as direct inputs to the reservoirs, but rather assess the "predictive knowledge" in terms of a predictive probability density to be operationally used in the decision making process for the estimation of expected benefits and/or expected losses. Using a theoretical and extremely simplified case, it will be shown why directly using model forecasts instead of the full predictive density leads to less robust reservoir management decisions. Moreover, the effectiveness and the tangible benefits for using the entire predictive probability density instead of the model predicted values will be demonstrated on the basis of the Lake Como management system, operational since 1997, as well as on the basis of a case study on the lake of Aswan.

Dark matter direct detection of a fermionic singlet at one loop

NASA Astrophysics Data System (ADS)

Herrero-García, Juan; Molinaro, Emiliano; Schmidt, Michael A.

2018-06-01

The strong direct detection limits could be pointing to dark matter - nucleus scattering at loop level. We study in detail the prototype example of an electroweak singlet (Dirac or Majorana) dark matter fermion coupled to an extended dark sector, which is composed of a new fermion and a new scalar. Given the strong limits on colored particles from direct and indirect searches we assume that the fields of the new dark sector are color singlets. We outline the possible simplified models, including the well-motivated cases in which the extra scalar or fermion is a Standard Model particle, as well as the possible connection to neutrino masses. We compute the contributions to direct detection from the photon, the Z and the Higgs penguins for arbitrary quantum numbers of the dark sector. Furthermore, we derive compact expressions in certain limits, i.e., when all new particles are heavier than the dark matter mass and when the fermion running in the loop is light, like a Standard Model lepton. We study in detail the predicted direct detection rate and how current and future direct detection limits constrain the model parameters. In case dark matter couples directly to Standard Model leptons we find an interesting interplay between lepton flavor violation, direct detection and the observed relic abundance.

Mitochondrial dysfunction in Gulf War illness revealed by 31Phosphorus Magnetic Resonance Spectroscopy: a case-control study.

PubMed

Koslik, Hayley J; Hamilton, Gavin; Golomb, Beatrice A

2014-01-01

Approximately 1/3 of 1990-1 Gulf War veterans developed chronic multisymptom health problems. Implicated exposures bear mechanisms that adversely affect mitochondria. Symptoms emphasize fatigue, cognition and muscle (brain and muscle are aerobically demanding); with protean additional domains affected, compatible with mitochondrial impairment. Recent evidence supports treatments targeting cell bioenergetics (coenzyme10) to benefit Gulf War illness symptoms. However, no evidence has directly documented mitochondrial or bioenergetic impairment in Gulf War illness. We sought to objectively assess for mitochondrial dysfunction, examining post-exercise phosphocreatine-recovery time constant (PCr-R) using (31)Phosphorus Magnetic Resonance Spectroscopy ((31)P-MRS), in Gulf War veterans with Gulf War illness compared to matched healthy controls. PCr-R has been described as a "robust and practical" index of mitochondrial status. Case-control study from 2012-2013. Fourteen community-dwelling Gulf War veterans and matched controls from the San Diego area comprised 7 men meeting CDC and Kansas criteria for Gulf War illness, and 7 non-deployed healthy controls matched 1:1 to cases on age, sex, and ethnicity. Calf muscle phosphocreatine was evaluated by (31)P-MRS at rest, through 5 minutes of foot pedal depression exercise, and in recovery, to assess PCr-R. Paired t-tests compared cases to matched controls. PCr-R was significantly prolonged in Gulf War illness cases vs their matched controls: control values, mean ± SD, 29.0 ± 8.7 seconds; case values 46.1 ± 18.0 seconds; difference 17.1 ± 14.9 seconds; p = 0.023. PCr-R was longer for cases relative to their matched controls for all but one pair; moreover while values clustered under 31 seconds for all but one control, they exceeded 35 seconds (with a spread up to 70 seconds) for all but one case. These data provide the first direct evidence supporting mitochondrial dysfunction in Gulf War illness. Findings merit replication in a larger study and/or corroboration with additional mitochondrial assessment tools.

Safety Case Development as an Information Modelling Problem

NASA Astrophysics Data System (ADS)

Lewis, Robert

This paper considers the benefits from applying information modelling as the basis for creating an electronically-based safety case. It highlights the current difficulties of developing and managing large document-based safety cases for complex systems such as those found in Air Traffic Control systems. After a review of current tools and related literature on this subject, the paper proceeds to examine the many relationships between entities that can exist within a large safety case. The paper considers the benefits to both safety case writers and readers from the future development of an ideal safety case tool that is able to exploit these information models. The paper also introduces the idea that the safety case has formal relationships between entities that directly support the safety case argument using a methodology such as GSN, and informal relationships that provide links to direct and backing evidence and to supporting information.

Properties of multivariable root loci. M.S. Thesis

NASA Technical Reports Server (NTRS)

Yagle, A. E.

1981-01-01

Various properties of multivariable root loci are analyzed from a frequency domain point of view by using the technique of Newton polygons, and some generalizations of the SISO root locus rules to the multivariable case are pointed out. The behavior of the angles of arrival and departure is related to the Smith-MacMillan form of G(s) and explicit equations for these angles are obtained. After specializing to first order and a restricted class of higher order poles and zeros, some simple equations for these angles that are direct generalizations of the SISO equations are found. The unusual behavior of root loci on the real axis at branch points is studied. The SISO root locus rules for break-in and break-out points are shown to generalize directly to the multivariable case. Some methods for computing both types of points are presented.

Can Universities Develop Advanced Technology and Solve Social Problems?

NASA Astrophysics Data System (ADS)

Pérez Ones, Isarelis; Núñez Jover, Jorge

This paper presents case studies on how Cuban universities have increasingly become directly involved with the economic and social development of the country. The paper shows how Cuban universities, from the early 1980s and early 1990s, started reorientation and organization of their scientific research, becoming more directly and intensely involved in the economic and social development of the country. In this way, special reference is made to the case of a research group at the University of Havana: the Laboratory of Synthetic Antigens. This group developed the first synthetic vaccine for human use approved in the world. In the article, public policies involved in this success as well as different obstacles are discussed. These obstacles demonstrate the difficulties and challenges that universities face when carrying out research and innovation activities related to economic and social development.

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013.

PubMed

O'Connor, L; Ward, M; Bennett, D; Mulhall, R; O'Lorcain, P; Cunney, R; McDermott, R; Neville, E; Heslin, J; FitzGerald, R; Meyler, K; Conlon, M; Clarke, A; Corcoran, B; Fitzpatrick, G; O'Connor, B; Flanagan, P; O'Flanagan, D; Cotter, S

2015-05-28

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7–2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.

Computerized bioterrorism education and training for nurses on bioterrorism attack agents.

PubMed

Nyamathi, Adeline M; Casillas, Adrian; King, Major L; Gresham, Louise; Pierce, Elaine; Farb, Daniel; Wiechmann, Carrie; Weichmann, Carrie

2010-08-01

Biological agents have the ability to cause large-scale mass casualties. For this reason, their likely use in future terrorist attacks is a concern for national security. Recent studies show that nurses are ill prepared to deal with agents used in biological warfare. Achieving a goal for bioterrorism preparedness is directly linked to comprehensive education and training that enables first-line responders such as nurses to diagnose infectious agents rapidly. The study evaluated participants' responses to biological agents using a computerized bioterrorism education and training program versus a standard bioterrorism education and training program. Both programs improved participants' ability to complete and solve case studies involving the identification of specific biological agents. Participants in the computerized bioterrorism education and training program were more likely to solve the cases critically without reliance on expert consultants. However, participants in the standard bioterrorism education and training program reduced the use of unnecessary diagnostic tests.

Can Vocational Programmes Change Use and Exchange Value Attributions of School Leavers: A Kenyan Case Study?

ERIC Educational Resources Information Center

Saunders, Murray; Sambili, Helen

1995-01-01

A survey of Kenyan school leavers (200 responses) and 34 interviews show that the exchange value of school-leaving exams is predominant and the use value of vocational programs has little impact. Apparently, 80% of school effort has actual exchange value for only 20% of school leavers, whereas 20% of effort directed at self-employment has…

A Case for Direct and Indirect Feedback: The Other Side of Coin

ERIC Educational Resources Information Center

Hashemnezhad, Hossein; Mohammadnejad, Saeed

2012-01-01

The use of WCF is a striking necessity in learning of English as a foreign language. If teachers and students can manipulate well the use of written feedback, both parties will benefit. This research looked at the types of feedback given to EFL students during a 16-week study. For the purpose of the current survey eighty students enrolled freely…

Histopathological examination of nail clippings using PAS staining (HPE-PAS): gold standard in diagnosis of Onychomycosis.

PubMed

Jeelani, Shazia; Ahmed, Qazi Masood; Lanker, Audil Mohmad; Hassan, Iffat; Jeelani, Nasir; Fazili, Tawheeda

2015-01-01

Onychomycosis is fungal infection of one or more of the nail units. However, because fungi cause only about half of all nail dystrophies, the use of appropriate diagnostic techniques is important to ensure correct diagnosis and treatment. Aim of the present study was to compare direct microscopy, culture and HPE-PAS for diagnosis of onychomycosis by evaluating their sensitivity and various other relevant statistical parameters. A prospective, hospital-based, cross-sectional study was conducted on 216 patients with a high degree of clinical suspicion of onychomycosis. Nail specimens were evaluated using three diagnostic methods, i.e. direct microscopy using 20% Potassium hydroxide (KOH) & 40% Di-methyl-suphoxide (DMSO), culture and histopathological examination using PAS stain (HPE-PAS). Of 216 patients direct microscopy was positive in 138 (63.9%), culture in 147 (68%) and HPE-PAS in 164 patients (76%). One hundred and seventy-nine patients fitted into the criteria set for confirmed diagnosis of onychomycosis. Using this as a denominator; direct microscopy, culture and HPE-PAS had sensitivities of 77.1%, 70% and 91.6% respectively. Also, HPE-PAS showed the highest sensitivity of 94.7% in 19 cases with prediagnostic antimycotic treatment compared to direct microscopy (42.1%) or culture (57.9%). HPE-PAS shows high sensitivity for diagnosis of onychomycosis and can be considered as a gold standard in the diagnosis of onychomycosis. © 2014 Blackwell Verlag GmbH.

Universal design characteristic on themed streets

NASA Astrophysics Data System (ADS)

Harsritanto, Bangun IR; Indriastjario; Wijayanti

2017-12-01

People around the world can access the streets to fulfil their daily activities regardless of their gender, age, and abilities. The streetscape is an urban public space which is built to facilitate the basic needs of people as social being. The themed street is an urban streetscape designed and built in detail with a theme or special purpose in an of urban development process. Universal design facilitates the full range of human diversity as physical appearance, perception, cognitive abilities, sizes, and shapes. By designing for the diversity, the specialized streets become more functional and user-friendly. The purpose of this study is to examine several design characteristics of themed streets in several countries from three different continents using universal design principles for giving proper directions to develop more user-friendly streets. Literature review and case study were used as research methods. The literature review was extracted and compiled from manuscripts, streetscape design books, and from universal design principles. Furthermore, the constructed theory were used to examine the case studies of themed streets. The findings indicated that themed streets’ character design were strongly influenced by local cultural aspect even though the basic guidelines were universal design principles; the resumed design direction can be suggested universal along with the richness of local aspects.

Test of a new heat-flow equation for dense-fluid shock waves.

PubMed

Holian, Brad Lee; Mareschal, Michel; Ravelo, Ramon

2010-09-21

Using a recently proposed equation for the heat-flux vector that goes beyond Fourier's Law of heat conduction, we model shockwave propagation in the dense Lennard-Jones fluid. Disequilibrium among the three components of temperature, namely, the difference between the kinetic temperature in the direction of a planar shock wave and those in the transverse directions, particularly in the region near the shock front, gives rise to a new transport (equilibration) mechanism not seen in usual one-dimensional heat-flow situations. The modification of the heat-flow equation was tested earlier for the case of strong shock waves in the ideal gas, which had been studied in the past and compared to Navier-Stokes-Fourier solutions. Now, the Lennard-Jones fluid, whose equation of state and transport properties have been determined from independent calculations, allows us to study the case where potential, as well as kinetic contributions are important. The new heat-flow treatment improves the agreement with nonequilibrium molecular-dynamics simulations under strong shock wave conditions, compared to Navier-Stokes.

Finding the Sacred Direction: Medieval Books on the Qibla

NASA Astrophysics Data System (ADS)

Rius, M.

2009-08-01

Medieval Islamic scholars wrote a great number of books on the qibla, the Sacred Direction. These books had a huge readership and provided instructions for finding the direction of Mecca by either exact or approximate means. In principle, the qibla was a purely religious subject, but in practice its determination required the use of astronomy as an applied science. As so often, religion and politics had many points of contact and, in this case, it was generally political considerations that prevailed. Finally, the analysis of nautical charts can offer new perspectives. As yet, modern scholarship has not established the link between this area of study and the classical literature on this subject.

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs

PubMed Central

Kim, Minchul; Franciskovich, Chris M.; Weinberg, Jason E.; Svendsen, Jessica D.; Fehr, Linda S.; Funk, Amy; Sawicki, Robert; Asche, Carl V.

2018-01-01

Abstract Background: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. Objective: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. Design: This was a case–control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Setting/subjects: Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. Measurements: The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. Results: We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6–54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02–1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (−0.37 admissions, 95% CI −0.66 to −0.08), and inpatient days (−3.66 days, 95% CI −6.23 to −1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI −$16,207 to −$2,793). Conclusions: ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients. PMID:29206564

A case study of the Weather Research and Forecasting model applied to the Joint Urban 2003 tracer field experiment. Part 2: Gas tracer dispersion

DOE PAGES

Nelson, Matthew A.; Brown, Michael J.; Halverson, Scot A.; ...

2016-07-28

Here, the Quick Urban & Industrial Complex (QUIC) atmospheric transport, and dispersion modelling, system was evaluated against the Joint Urban 2003 tracer-gas measurements. This was done using the wind and turbulence fields computed by the Weather Research and Forecasting (WRF) model. We compare the simulated and observed plume transport when using WRF-model-simulated wind fields, and local on-site wind measurements. Degradation of the WRF-model-based plume simulations was cased by errors in the simulated wind direction, and limitations in reproducing the small-scale wind-field variability. We explore two methods for importing turbulence from the WRF model simulations into the QUIC system. The firstmore » method uses parametrized turbulence profiles computed from WRF-model-computed boundary-layer similarity parameters; and the second method directly imports turbulent kinetic energy from the WRF model. Using the WRF model’s Mellor-Yamada-Janjic boundary-layer scheme, the parametrized turbulence profiles and the direct import of turbulent kinetic energy were found to overpredict and underpredict the observed turbulence quantities, respectively. Near-source building effects were found to propagate several km downwind. These building effects and the temporal/spatial variations in the observed wind field were often found to have a stronger influence over the lateral and vertical plume spread than the intensity of turbulence. Correcting the WRF model wind directions using a single observational location improved the performance of the WRF-model-based simulations, but using the spatially-varying flow fields generated from multiple observation profiles generally provided the best performance.« less

A case study of the Weather Research and Forecasting model applied to the Joint Urban 2003 tracer field experiment. Part 2: Gas tracer dispersion

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

Nelson, Matthew A.; Brown, Michael J.; Halverson, Scot A.

Here, the Quick Urban & Industrial Complex (QUIC) atmospheric transport, and dispersion modelling, system was evaluated against the Joint Urban 2003 tracer-gas measurements. This was done using the wind and turbulence fields computed by the Weather Research and Forecasting (WRF) model. We compare the simulated and observed plume transport when using WRF-model-simulated wind fields, and local on-site wind measurements. Degradation of the WRF-model-based plume simulations was cased by errors in the simulated wind direction, and limitations in reproducing the small-scale wind-field variability. We explore two methods for importing turbulence from the WRF model simulations into the QUIC system. The firstmore » method uses parametrized turbulence profiles computed from WRF-model-computed boundary-layer similarity parameters; and the second method directly imports turbulent kinetic energy from the WRF model. Using the WRF model’s Mellor-Yamada-Janjic boundary-layer scheme, the parametrized turbulence profiles and the direct import of turbulent kinetic energy were found to overpredict and underpredict the observed turbulence quantities, respectively. Near-source building effects were found to propagate several km downwind. These building effects and the temporal/spatial variations in the observed wind field were often found to have a stronger influence over the lateral and vertical plume spread than the intensity of turbulence. Correcting the WRF model wind directions using a single observational location improved the performance of the WRF-model-based simulations, but using the spatially-varying flow fields generated from multiple observation profiles generally provided the best performance.« less

On entropy change measurements around first order phase transitions in caloric materials.

PubMed

Caron, Luana; Ba Doan, Nguyen; Ranno, Laurent

2017-02-22

In this work we discuss the measurement protocols for indirect determination of the isothermal entropy change associated with first order phase transitions in caloric materials. The magneto-structural phase transitions giving rise to giant magnetocaloric effects in Cu-doped MnAs and FeRh are used as case studies to exemplify how badly designed protocols may affect isothermal measurements and lead to incorrect entropy change estimations. Isothermal measurement protocols which allow correct assessment of the entropy change around first order phase transitions in both direct and inverse cases are presented.

An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

PubMed

Barterian, Justin A; Sanchez, Joel M; Magen, Jed; Siroky, Allison K; Mash, Brittany L; Carlson, John S

2018-01-01

This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

Transcardiac conducted electrical weapon (TASER) probe deployments: incidence and outcomes.

PubMed

Bozeman, William P; Teacher, Eric; Winslow, James E

2012-12-01

TASER (TASER International, Scottsdale, AZ) conducted electrical weapons (CEWs) are commonly used by law enforcement officers. Although animal studies have suggested that transcardiac CEW discharges may produce direct cardiac effects, this has not been demonstrated in human studies. This study sought to determine the incidence and outcomes of transcardiac CEW probe impact locations in a large series of actual CEW deployments. A multi-center database of consecutive CEW uses by law enforcement officers was retrospectively reviewed. Case report forms were independently reviewed by three investigators to identify cases with paired probe configurations potentially producing a transcardiac discharge vector. Descriptive analysis was performed and inter-rater reliability was assessed. Among 1201 total CEW uses, 813 included probe deployments and 178 cases had paired anterior probe impacts potentially capable of producing a transcardiac discharge vector. This represents 14.8% of all CEW uses (95% confidence interval [CI] 12.9-16.9%) and 21.9% of CEW uses in probe mode (95% CI 19.1-24.9%). Inter-rater agreement was very good, with kappa = 0.82. There were no immediate deaths in any cases (97.5% CI 0.0-0.3%) to suggest a cardiac dysrhythmia, including those with transcardiac discharge vector. CEW deployments with probe impact configurations capable of producing a transcardiac discharge occur in a minority of cases in field use conditions. None of these cases, transcardiac or otherwise, produced immediately fatal dysrhythmias. These data support the overall safety of CEWs and provide a benchmark estimate of the likelihood of transcardiac discharge vectors occurring in field use of CEWs. Copyright © 2012 Elsevier Inc. All rights reserved.

Pesticide exposure and risk of Parkinson's disease: A family-based case-control study

PubMed Central

Hancock, Dana B; Martin, Eden R; Mayhew, Gregory M; Stajich, Jeffrey M; Jewett, Rita; Stacy, Mark A; Scott, Burton L; Vance, Jeffery M; Scott, William K

2008-01-01

Background Pesticides and correlated lifestyle factors (e.g., exposure to well-water and farming) are repeatedly reported risk factors for Parkinson's disease (PD), but few family-based studies have examined these relationships. Methods Using 319 cases and 296 relative and other controls, associations of direct pesticide application, well-water consumption, and farming residences/occupations with PD were examined using generalized estimating equations while controlling for age-at-examination, sex, cigarette smoking, and caffeine consumption. Results Overall, individuals with PD were significantly more likely to report direct pesticide application than their unaffected relatives (odds ratio = 1.61; 95% confidence interval, 1.13–2.29). Frequency, duration, and cumulative exposure were also significantly associated with PD in a dose-response pattern (p ≤ 0.013). Associations of direct pesticide application did not vary by sex but were modified by family history of PD, as significant associations were restricted to individuals with no family history. When classifying pesticides by functional type, both insecticides and herbicides were found to significantly increase risk of PD. Two specific insecticide classes, organochlorines and organophosphorus compounds, were significantly associated with PD. Consuming well-water and living/working on a farm were not associated with PD. Conclusion These data corroborate positive associations of broadly defined pesticide exposure with PD in families, particularly for sporadic PD. These data also implicate a few specific classes of pesticides in PD and thus emphasize the need to consider a more narrow definition of pesticides in future studies. PMID:18373838

The influence of direct compression powder blend transfer method from the container to the tablet press on product critical quality attributes: a case study.

PubMed

Teżyk, Michał; Jakubowska, Emilia; Milczewska, Kasylda; Milanowski, Bartłomiej; Voelkel, Adam; Lulek, Janina

2017-06-01

The aim of this article is to compare the gravitational powder blend loading method to the tablet press and manual loading in terms of their influence on tablets' critical quality attributes (CQA). The results of the study can be of practical relevance to the pharmaceutical industry in the area of direct compression of low-dose formulations, which could be prone to content uniformity (CU) issues. In the preliminary study, particle size distribution (PSD) and surface energy of raw materials were determined using laser diffraction method and inverse gas chromatography, respectively. For trials purpose, a formulation containing two pharmaceutical ingredients (APIs) was used. Tablet samples were collected during the compression progress to analyze their CQAs, namely assay and CU. Results obtained during trials indicate that tested direct compression powder blend is sensitive to applied powder handling method. Mild increase in both APIs content was observed during manual scooping. Gravitational approach (based on discharge into the drum) resulted in a decrease in CU, which is connected to a more pronounced assay increase at the end of tableting than in the case of manual loading. The correct design of blend transfer over single unit processes is an important issue and should be investigated during the development phase since it may influence the final product CQAs. The manual scooping method, although simplistic, can be a temporary solution to improve the results of API's content and uniformity when compared to industrial gravitational transfer.

Recent Direct Reaction Experimental Studies with Radioactive Tin Beams

DOE PAGES

Jones, K. L.; Ahn, S.; Allmond, J. M.; ...

2015-01-01

Direct reaction techniques are powerful tools to study the single-particle nature of nuclei. Performing direct reactions on short-lived nuclei requires radioactive ion beams produced either via fragmentation or the Isotope Separation OnLine (ISOL) method. Some of the most interesting regions to study with direct reactions are close to the magic numbers where changes in shell structure can be tracked. These changes can impact the final abundances of explosive nucleosynthesis. The structure of the chain of tin isotopes is strongly influenced by the Z = 50 proton shell closure, as well as the neutron shell closures lying in the neutron-rich, Nmore » = 82, and neutron-deficient, N = 50, regions. Here, we present two examples of direct reactions on exotic tin isotopes. The first uses a one-neutron transfer reaction and a low-energy reaccelerated ISOL beam to study states in Sn-131 from across the N = 82 shell closure. The second example utilizes a one-neutron knockout reaction on fragmentation beams of neutron-deficient Sn- 106,108Sn. In conclusion, In both cases, measurements of γ rays in coincidence with charged particles proved to be invaluable.« less

A Circular Microstrip Antenna Sensor for Direction Sensitive Strain Evaluation †

PubMed Central

Herbko, Michal

2018-01-01

In this paper, a circular microstrip antenna for stress evaluation is studied. This kind of microstrip sensor can be utilized in structural health monitoring systems. Reflection coefficient S11 is measured to determine deformation/strain value. The proposed sensor is adhesively connected to the studied sample. Applied strain causes a change in patch geometry and influences current distribution both in patch and ground plane. Changing the current flow in patch influences the value of resonant frequency. In this paper, two different resonant frequencies were analysed because in each case, different current distributions in patch were obtained. The sensor was designed for operating frequency of 2.5 GHz (at fundamental mode), which results in a diameter less than 55 mm. Obtained sensitivity was up to 1 MHz/100 MPa, resolution depends on utilized vector network analyser. Moreover, the directional characteristics for both resonant frequencies were defined, studied using numerical model and verified by measurements. Thus far, microstrip antennas have been used in deformation measurement only if the direction of external force was well known. Obtained directional characteristics of the sensor allow the determination of direction and value of stress by one sensor. This method of measurement can be an alternative to the rosette strain gauge. PMID:29361697

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China.

PubMed

Li, Jie; Li, Qing Ling; Li, Ji; Chen, Ming Liang; Xie, Hong Fu; Li, Ya Ping; Chen, Xiang

2013-01-01

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear. To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions. A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions. Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases. Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.

Case-control Studies on the Effectiveness of Breast Cancer Screening: Insights from the UK Age Trial.

PubMed

van der Waal, Daniëlle; Broeders, Mireille J M; Verbeek, André L M; Duffy, Stephen W; Moss, Sue M

2015-07-01

Ongoing breast cancer screening programs can only be evaluated using observational study designs. Most studies have observed a reduction in breast cancer mortality, but design differences appear to have resulted in different estimates. Direct comparison of case-control and trial analyses gives more insight into this variation. Here, we performed case-control analyses within the randomized UK Age Trial. The Age Trial assessed the effect of screening on breast cancer mortality in women ages 40-49 years. In our approach, case subjects were defined as breast cancer deaths between trial entry (1991-1997) and 2004. Women were ages 39-41 years at entry. For every case subject, five control subjects were selected. All case subjects were included in analyses of screening invitation (356 case subjects, 1,780 controls), whereas analyses of attendance were restricted to women invited to screening (105 case subjects, 525 age-matched controls). Odds ratios (OR) were estimated with conditional logistic regression. We used and compared two methods to correct for self-selection bias. Screening invitation resulted in a breast cancer mortality reduction of 17% (95% confidence interval [CI]: -36%, +6%), similar to trial results. Different exposure definitions and self-selection adjustments influenced the observed breast cancer mortality reduction. Depending on the method, "ever screened" appeared to be associated with a small reduction (OR: 0.86, 95% CI: 0.40, 1.89) or no reduction (OR: 1.02, 95% CI: 0.48, 2.14) using the two methods of correction. Recent attendance resulted in an adjusted mortality reduction of 36% (95% CI: -69%, +31%) or 45% (95% CI: -71%, +5%). Observational studies, and particularly case-control studies, are an important monitoring tool for breast cancer screening programs. The focus should be on diminishing bias in observational studies and gaining a better understanding of the influence of study design on estimates of mortality reduction.

Direct identification of bacteria from BacT/ALERT anaerobic positive blood cultures by MALDI-TOF MS: MALDI Sepsityper kit versus an in-house saponin method for bacterial extraction.

PubMed

Meex, Cécile; Neuville, Florence; Descy, Julie; Huynen, Pascale; Hayette, Marie-Pierre; De Mol, Patrick; Melin, Pierrette

2012-11-01

In cases of bacteraemia, a rapid species identification of the causal agent directly from positive blood culture broths could assist clinicians in the timely targeting of empirical antimicrobial therapy. For this purpose, we evaluated the direct identification of micro-organisms from BacT/ALERT (bioMérieux) anaerobic positive blood cultures without charcoal using the Microflex matrix-assisted laser desorption/ionization (MALDI) time of flight MS (Bruker), after bacterial extraction by using two different methods: the MALDI Sepsityper kit (Bruker) and an in-house saponin lysis method. Bruker's recommended criteria for identification were expanded in this study, with acceptance of the species identification when the first three results with the best matches with the MALDI Biotyper database were identical, whatever the scores were. In total, 107 monobacterial cultures and six polymicrobial cultures from 77 different patients were included in this study. Among monomicrobial cultures, we identified up to the species level 67 and 66 % of bacteria with the MALDI Sepsityper kit and the saponin method, respectively. There was no significant difference between the two extraction methods. The direct species identification was particularly inconclusive for Gram-positive bacteria, as only 58 and 52 % of them were identified to the species level with the MALDI Sepsityper kit and the saponin method, respectively. Results for Gram-negative bacilli were better, with 82.5 and 90 % of correct identification to the species level with the MALDI Sepsityper kit and the saponin method, respectively. No misidentifications were given by the direct procedures when compared with identifications provided by the conventional method. Concerning the six polymicrobial blood cultures, whatever the extraction method used, a correct direct identification was only provided for one of the isolated bacteria on solid medium in all cases. The analysis of the time-to-result demonstrated a reduction in the turnaround time for identification ranging from 1 h 06 min to 24 h 44 min, when performing the blood culture direct identification in comparison with the conventional method, whatever the extraction method.

Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection: initial experience with 13 cases.

PubMed

Saito, Taiichi; Tamura, Manabu; Muragaki, Yoshihiro; Maruyama, Takashi; Kubota, Yuichi; Fukuchi, Satoko; Nitta, Masayuki; Chernov, Mikhail; Okamoto, Saori; Sugiyama, Kazuhiko; Kurisu, Kaoru; Sakai, Kuniyoshi L; Okada, Yoshikazu; Iseki, Hiroshi

2014-10-01

The objective in the present study was to evaluate the usefulness of cortico-cortical evoked potentials (CCEP) monitoring for the intraoperative assessment of speech function during resection of brain tumors. Intraoperative monitoring of CCEP was applied in 13 patients (mean age 34 ± 14 years) during the removal of neoplasms located within or close to language-related structures in the dominant cerebral hemisphere. For this purpose strip electrodes were positioned above the frontal language area (FLA) and temporal language area (TLA), which were identified with direct cortical stimulation and/or preliminary mapping with the use of implanted chronic subdural grid electrodes. The CCEP response was defined as the highest observed negative peak in either direction of stimulation. In 12 cases the tumor was resected during awake craniotomy. An intraoperative CCEP response was not obtained in one case because of technical problems. In the other patients it was identified from the FLA during stimulation of the TLA (7 cases) and from the TLA during stimulation of the FLA (5 cases), with a mean peak latency of 83 ± 15 msec. During tumor resection the CCEP response was unchanged in 5 cases, decreased in 4, and disappeared in 3. Postoperatively, all 7 patients with a decreased or absent CCEP response after lesion removal experienced deterioration in speech function. In contrast, in 5 cases with an unchanged intraoperative CCEP response, speaking abilities after surgery were preserved at the preoperative level, except in one patient who experienced not dysphasia, but dysarthria due to pyramidal tract injury. This difference was statistically significant (p < 0.01). The time required to recover speech function was also significantly associated with the type of intraoperative change in CCEP recordings (p < 0.01) and was, on average, 1.8 ± 1.0, 5.5 ± 1.0, and 11.0 ± 3.6 months, respectively, if the response was unchanged, was decreased, or had disappeared. Monitoring CCEP is feasible during the resection of brain tumors affecting language-related cerebral structures. In the intraoperative evaluation of speech function, it can be a helpful adjunct or can be used in its direct assessment with cortical and subcortical mapping during awake craniotomy. It can also be used to predict the prognosis of language disorders after surgery and decide on the optimal resection of a neoplasm.

Self-Directed English Language Learning through Watching English Television Drama in China

ERIC Educational Resources Information Center

Wang, Danping

2012-01-01

This paper presents a case study of a group of Chinese ESL learners in China, who study English by immersing themselves regularly and rigorously in English television drama. A self-directed learning pedagogy has been developed and discussed, which seems to have signposted an effective and economic way for ESL learners to improve linguistic,…

[Clinical characteristics and surgical treatment of idiopathic congenital nystagmus in 224 patients].

PubMed

Ding, J; Zhao, K X; Li, Y P; Ma, H Z; Chen, X; Guo, X; Zhu, L N; Li, N D; Zhang, W

2016-08-01

To study clinical characteristics and surgical treatment of idiopathic congenital nystagmus (ICN). A retrospective study was conducted in 224 patients with ICN in Tianjin eye hospital from July 2007 to February 2013. There were 224 patients, 158 (70.54%) males and 66 (29.5%) females, mean age was (11.6±8.4) years and (11.4±6.4) years separately. Horizontal nystgamus happened in 215 cases, 3 cases were vertical type and 6 cases were mixed. 214 cases were with no history of operation and 10 patients had ever underwent surgeries before. Furthermore, 151 patients combined with strabismus and refractive error, anterior segment or retinal disorders, which accounting for 67.4% of all the patients. 48 patients were associated myopia, 30 patients with hyperopia, 43 patients with strabismus. Among them, 153 cases of compensatory head position direction were horizontal with face turn, 43 cases (43/153, 28.1%) showed face turning to the left, 110 cases (110/153, 71.9%) showed face turning to the right. Surgeries were designed according to the compensatory head position and head retroversion angle. For 15 patients with double intermediate zones, the position which was often used with good visual function was chosen for operation design. As for the patients with nystagmus and strabismus, the transfer null zone to primary position for the dominant eye and strabismus surgery for the other eye was chosen. And for complicated patients with compensative head position, the dominant head posture were designed for surgery. ICN is dominated by male with variable clinical manifestations. Surgical choice for ICN depends on the direction of head position and if there is strabismus accompanying it.The aim of ocular muscle surgery is to transfer null zone to primary position. (Chin J Ophthalmol, 2016, 52: 574-578).

Promotion of self-directed learning using virtual patient cases.

PubMed

Benedict, Neal; Schonder, Kristine; McGee, James

2013-09-12

To assess the effectiveness of virtual patient cases to promote self-directed learning (SDL) in a required advanced therapeutics course. Virtual patient software based on a branched-narrative decision-making model was used to create complex patient case simulations to replace lecture-based instruction. Within each simulation, students used SDL principles to learn course objectives, apply their knowledge through clinical recommendations, and assess their progress through patient outcomes and faculty feedback linked to their individual decisions. Group discussions followed each virtual patient case to provide further interpretation, clarification, and clinical perspective. Students found the simulated patient cases to be organized (90%), enjoyable (82%), intellectually challenging (97%), and valuable to their understanding of course content (91%). Students further indicated that completion of the virtual patient cases prior to class permitted better use of class time (78%) and promoted SDL (84%). When assessment questions regarding material on postoperative nausea and vomiting were compared, no difference in scores were found between the students who attended the lecture on the material in 2011 (control group) and those who completed the virtual patient case on the material in 2012 (intervention group). Completion of virtual patient cases, designed to replace lectures and promote SDL, was overwhelmingly supported by students and proved to be as effective as traditional teaching methods.

Promotion of Self-directed Learning Using Virtual Patient Cases

PubMed Central

Schonder, Kristine; McGee, James

2013-01-01

Objective. To assess the effectiveness of virtual patient cases to promote self-directed learning (SDL) in a required advanced therapeutics course. Design. Virtual patient software based on a branched-narrative decision-making model was used to create complex patient case simulations to replace lecture-based instruction. Within each simulation, students used SDL principles to learn course objectives, apply their knowledge through clinical recommendations, and assess their progress through patient outcomes and faculty feedback linked to their individual decisions. Group discussions followed each virtual patient case to provide further interpretation, clarification, and clinical perspective. Assessments. Students found the simulated patient cases to be organized (90%), enjoyable (82%), intellectually challenging (97%), and valuable to their understanding of course content (91%). Students further indicated that completion of the virtual patient cases prior to class permitted better use of class time (78%) and promoted SDL (84%). When assessment questions regarding material on postoperative nausea and vomiting were compared, no difference in scores were found between the students who attended the lecture on the material in 2011 (control group) and those who completed the virtual patient case on the material in 2012 (intervention group). Conclusion. Completion of virtual patient cases, designed to replace lectures and promote SDL, was overwhelmingly supported by students and proved to be as effective as traditional teaching methods. PMID:24052654

Spatial variation in mortality risk for haematological malignancies near a petrochemical refinery: a population-based case-control study

PubMed Central

Di Salvo, Francesca; Meneghini, Elisabetta; Vieira, Veronica; Baili, Paolo; Mariottini, Mauro; Baldini, Marco; Micheli, Andrea; Sant, Milena

2015-01-01

Introduction The study investigated the geographic variation of mortality risk for hematological malignancies (HMs) in order to identify potential high-risk areas near an Italian petrochemical refinery. Material and methods A population-based case-control study was conducted and residential histories for 171 cases and 338 sex- and age-matched controls were collected. Confounding factors were obtained from interviews with consenting relatives for 109 HM deaths and 267 controls. To produce risk mortality maps, two different approaches were applied. We mapped (1) adptive kernel density relative risk estimation (KDE) for case-control studies which estimates a spatial relative risk function using the ratio between cases and controls’ densities, and (2) estimated odds ratios for case-control study data using generalized additive models (GAMs) to smooth the effect of location, a proxy for exposure, while adjusting for confounding variables. Results No high-risk areas for HM mortality were identified among all subjects (men and women combined), by applying both approaches. Using the adaptive KDE approach, we found a significant increase in death risk only among women in a large area 2–6 km southeast of the refinery and the application of GAMs also identified a similarly-located significant high-risk area among women only (global p-value<0.025). Potential confounding risk factors we considered in the GAM did not alter the results. Conclusion Both approaches identified a high-risk area close to the refinery among women only. Those spatial methods are useful tools for public policy management to determine priority areas for intervention. Our findings suggest several directions for further research in order to identify other potential environmental exposures that may be assessed in forthcoming studies based on detailed exposure modeling. PMID:26073202

Detection of IDH1 mutation in human gliomas: comparison of immunohistochemistry and sequencing.

PubMed

Takano, Shingo; Tian, Wei; Matsuda, Masahide; Yamamoto, Tetsuya; Ishikawa, Eiichi; Kaneko, Mika Kato; Yamazaki, Kentaro; Kato, Yukinari; Matsumura, Akira

2011-04-01

Isocitrate dehydrogenase 1 (IDH1) mutations have recently been identified as early and frequent genetic alterations in astrocytomas, oligodendrogliomas, and oligoastrocytomas, as well as secondary glioblastomas, whereas primary glioblastomas very rarely contain IDH1 mutations. Furthermore, a specific monoclonal antibody, IMab-1, which recognizes IDH1-R132H-the most frequent IDH1 mutation-has been generated. IMab-1 has been reported to react with the IDH1-R132H protein, but not the wild-type IDH1 or the other IDH1 mutant proteins in Western-blot analysis. However, the importance of immunohistochemistry using IMab-1 has not yet been elucidated. In this study, we compared the findings from IMab-1 immunohistochemistry and direct DNA sequencing using 49 glioma samples. IMab-1 detected 12 out of 49 cases; however, only nine cases were found to be IDH1-R132H by direct DNA sequencing because of a small population of IDH1-R132H mutation-possessing tumor cells, indicating that IMab-1 immunohistochemistry is useful for detecting IDH1-R132H. We conducted immunohistochemical detection in 52 cases of grade III astrocytomas. The median time to progression (TTP) was significantly longer in the cases with the IDH1 mutation (86.7 months) compared to the cases without the IDH1 mutation (wild type, 10.4 months) (p < 0.01). In conclusion, the anti-IDH1-R132H-specific monoclonal antibody IMab-1 is very useful for detecting IDH1-R132H in immunohistochemistry, and predicting the time to progression in grade III anaplastic astrocytomas. Therefore, IMab-1 is likely to be useful for the diagnosis of mutation-bearing gliomas and for determining the treatment strategy of grade III gliomas.

Experimental study of a smart foam sound absorber.

PubMed

Leroy, Pierre; Berry, Alain; Herzog, Philippe; Atalla, Noureddine

2011-01-01

This article presents the experimental implementation and results of a hybrid passive/active absorber (smart foam) made up from the combination of a passive absorbent (foam) and a curved polyvinylidene fluoride (PVDF) film actuator bonded to the rear surface of the foam. Various smart foam prototypes were built and tested in active absorption experiments conducted in an impedance tube under plane wave propagation condition at frequencies between 100 and 1500 Hz. Three control cases were tested. The first case used a fixed controller derived in the frequency domain from estimations of the primary disturbance at a directive microphone position in the tube and the transfer function between the control PVDF and the directive microphone. The two other cases used an adaptive time-domain feedforward controller to absorb either a single-frequency incident wave or a broadband incident wave. The non-linearity of the smart foams and the causality constraint were identified to be important factors influencing active control performance. The effectiveness of the various smart foam prototypes is discussed in terms of the active and passive absorption coefficients as well as the control voltage of the PVDF actuator normalized by the incident sound pressure.

Improvements for retrieval of cloud droplet size by the POLDER instrument

NASA Astrophysics Data System (ADS)

Shang, H.; Husi, L.; Bréon, F. M.; Ma, R.; Chen, L.; Wang, Z.

2017-12-01

The principles of cloud droplet size retrieval via Polarization and Directionality of the Earth's Reflectance (POLDER) requires that clouds be horizontally homogeneous. The retrieval is performed by combining all measurements from an area of 150 km × 150 km to compensate for POLDER's insufficient directional sampling. Using POLDER-like data simulated with the RT3 model, we investigate the impact of cloud horizontal inhomogeneity and directional sampling on the retrieval and analyze which spatial resolution is potentially accessible from the measurements. Case studies show that the sub-grid-scale variability in droplet effective radius (CDR) can significantly reduce valid retrievals and introduce small biases to the CDR ( 1.5µm) and effective variance (EV) estimates. Nevertheless, the sub-grid-scale variations in EV and cloud optical thickness (COT) only influence the EV retrievals and not the CDR estimate. In the directional sampling cases studied, the retrieval using limited observations is accurate and is largely free of random noise. Several improvements have been made to the original POLDER droplet size retrieval. For example, measurements in the primary rainbow region (137-145°) are used to ensure retrievals of large droplet (>15 µm) and to reduce the uncertainties caused by cloud heterogeneity. A premium resoltion of 0.8° is determined by considering successful retrievals and cloud horizontal homogeneity. The improved algorithm is applied to measurements of POLDER in 2008, and we further compared our retrievals with cloud effective radii estimations of Moderate Resolution Imaging Spectroradiometer (MODIS). The results indicate that in global scale, the cloud effective radii and effective variance is larger in the central ocean than inland and coast areas. Over heavy polluted regions, the cloud droplets has small effective radii and narraw distribution due to the influence of aerosol particles.

Free-Flight-Tunnel Investigation of the Dynamic Stability and Control Characteristics of a Chance Vought F7U-3 Airplane in Towed Flight

NASA Technical Reports Server (NTRS)

Grana, David C.; Shanks, Robert E.

1952-01-01

As part of a program to determine the feasibility of using a fighter airplane as a parasite in combination with a Consolidated Vultee RB-36 for long-range reconnaissance missions (project FICON), an experimental investigation has been made in the Langley free-flight tunnel to determine the dynamic stability and control characteristics of a 1/17.5-scale model of a Chance Vought F7U-3 airplane in several tow configurations. The investigation consisted of flight tests in which the model was towed from a strut in the tunnel by a towline and by a direct coupling which provided complete angular freedom. The tests with the direct coupling also included a study of the effect of spring restraint in roll in order to simulate approximately the proposed full-scale arrangement in which the only freedom is that permitted by the flexibility of the launching and retrieving trapeze carried by the-bomber. For the tow configurations in which a towline was used (15 and 38 feet full scale), the model had a very unstable lateral oscillation which could not be controlled. The stability was also unsatisfactory for the tow configuration in Which the model was coupled directly to the strut with complete angular freedom. When spring restraint in roll was added, however, the stability was satisfactory. The use of the yaw damper which increased the damping in yaw to about six times the normal value of the model appeared to have no appreciable effect on the lateral oscillations in the towline configurations, but produced a slight improvement in the case of the direct coupling configurations. The longitudinal stability was satisfactory for those cases in which the lateral stability was good enough to permit study of longitudinal motions.

Deploying response surface methodology (RSM) and glowworm swarm optimization (GSO) in optimizing warpage on a mobile phone cover

NASA Astrophysics Data System (ADS)

Lee, X. N.; Fathullah, M.; Shayfull, Z.; Nasir, S. M.; Hazwan, M. H. M.; Shazzuan, S.

2017-09-01

Plastic injection moulding is a popular manufacturing method not only it is reliable, but also efficient and cost saving. It able to produce plastic part with detailed features and complex geometry. However, defects in injection moulding process degrades the quality and aesthetic of the injection moulded product. The most common defect occur in the process is warpage. Inappropriate process parameter setting of injection moulding machine is one of the reason that leads to the occurrence of warpage. The aims of this study were to improve the quality of injection moulded part by investigating the optimal parameters in minimizing warpage using Response Surface Methodology (RSM) and Glowworm Swarm Optimization (GSO). Subsequent to this, the most significant parameter was identified and recommended parameters setting was compared with the optimized parameter setting using RSM and GSO. In this research, the mobile phone case was selected as case study. The mould temperature, melt temperature, packing pressure, packing time and cooling time were selected as variables whereas warpage in y-direction was selected as responses in this research. The simulation was carried out by using Autodesk Moldflow Insight 2012. In addition, the RSM was performed by using Design Expert 7.0 whereas the GSO was utilized by using MATLAB. The warpage in y direction recommended by RSM were reduced by 70 %. The warpages recommended by GSO were decreased by 61 % in y direction. The resulting warpages under optimal parameter setting by RSM and GSO were validated by simulation in AMI 2012. RSM performed better than GSO in solving warpage issue.

The Grammar Movie Project

ERIC Educational Resources Information Center

Kreutner, Edith

2015-01-01

In this case study, I will show how directing a movie on grammar can help students improve their oral skills as well as their language competency, team working and planning skills, and also teach them about learning itself. I will present an innovative teaching project that uses the medium of film to get students engaged with grammar and that aims…

Apprehending Mathematical Structure: A Case Study of Coming to Understand a Commutative Ring

ERIC Educational Resources Information Center

Simpson, Adrian; Stehlikova, Nada

2006-01-01

Abstract algebra courses tend to take one of two pedagogical routes: from examples of mathematics structures through definitions to general theorems, or directly from definitions to general theorems. The former route seems to be based on the implicit pedagogical intention that students will use their understanding of particular examples of an…

Language and Literacy Acquisition through Parental Mediation in American Sign Language

ERIC Educational Resources Information Center

Bailes, Cynthia Neese; Erting, Lynne C.; Thumann-Prezioso, Carlene; Erting, Carol J.

2009-01-01

This longitudinal case study examined the language and literacy acquisition of a Deaf child as mediated by her signing Deaf parents during her first three years of life. Results indicate that the parents' interactions with their child were guided by linguistic and cultural knowledge that produced an intuitive use of child-directed signing (CDSi)…

Coding, modulation, and relays for deep space communication Mars Rovers Case Study

NASA Technical Reports Server (NTRS)

Statman, Joseph I.; Edwards, Charles D.

2004-01-01

This paper presents the communications challenges for the MER mission, the use of DSN and MER tools to maximize the science return, and the application of standards-based relays to the problem. To date, more than 90% of the data returned from MER has been returned via relays, not direct-to-Earath (DTE).

The Value of Assessment and Accreditation for Hospitality and Tourism Graduate Education

ERIC Educational Resources Information Center

Roberson, Richard D., Jr.

2010-01-01

Graduate education in hospitality is a growing field with a number of different approaches and philosophies which inform the decisions and directions put forth by program administrators. A case study explains the methods and justifications used by one institution to conduct a self assessment to assure high quality graduate hospitality education.…

English for Specific Purposes: A Case Study in an Industrial Setting.

ERIC Educational Resources Information Center

Alexander, Clare

A course outline and sample materials for a course in English for garment workshop employees in New York are presented, and theoretical considerations in establishing an English for specific purposes (ESP) course are explored. Attention is directed to the needs analysis process undertaken in the garment industry. Specifically, ESP is used to mean…

The Effects of Merging Technology and Thinking Skills in the Classroom

ERIC Educational Resources Information Center

Arencibia, David E.

2013-01-01

Technology in the classroom helps today's student to be competitive in school and the business world, but there has been a lack of research directly connecting technology use in the classroom with thinking skills. The purpose of this qualitative case study was to examine the impact of technology on student engagement and class performance. The…

An Open Educational Resource Supports a Diversity of Inquiry-Based Learning

ERIC Educational Resources Information Center

Schmidt-Jones, Catherine Anne

2012-01-01

There have been numerous calls for research that demonstrates how open education resources (OERs) are actually being used. This case study sought to shed light on the users of a well-visited set of modular music-education materials published at Connexions. Respondents to a voluntary survey included teachers, students, self-directed learners, music…

A GPR agricultural drainage pipe detection case study: Effects of antenna orientation relative to drainage pipe directional trend

USDA-ARS?s Scientific Manuscript database

Locating buried drainage pipes is a difficult task confronting farmers and land improvement contractors, especially in the Midwest U.S., where the removal of excess soil water using subsurface drainage systems is a common farm practice. Enhancing the efficiency of soil water removal on land containi...

The Cost of Publishing an Electronic Journal: A General Model and a Case Study.

ERIC Educational Resources Information Center

Bot, Marjolein; Burgemeester, Johan; Roes, Hans

1998-01-01

Describes the Electronic Journal of Comparative Law (EJCL) project from Tilburg University and Utrecht University (Netherlands). A general costing model was developed to chart shared and direct costs of producing electronic journals. Data from the developing/publishing EJCL were used to illustrated the application of this model and to assess the…

Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study.

PubMed

Song, Fujian; Xiong, Tengbin; Parekh-Bhurke, Sheetal; Loke, Yoon K; Sutton, Alex J; Eastwood, Alison J; Holland, Richard; Chen, Yen-Fu; Glenny, Anne-Marie; Deeks, Jonathan J; Altman, Doug G

2011-08-16

To investigate the agreement between direct and indirect comparisons of competing healthcare interventions. Meta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic. Inconsistency measured by the difference in the log odds ratio between the direct and indirect methods. The study included 112 independent trial networks (including 1552 trials with 478,775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined. Significant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence.

Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study

PubMed Central

Xiong, Tengbin; Parekh-Bhurke, Sheetal; Loke, Yoon K; Sutton, Alex J; Eastwood, Alison J; Holland, Richard; Chen, Yen-Fu; Glenny, Anne-Marie; Deeks, Jonathan J; Altman, Doug G

2011-01-01

Objective To investigate the agreement between direct and indirect comparisons of competing healthcare interventions. Design Meta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic. Main outcome measure Inconsistency measured by the difference in the log odds ratio between the direct and indirect methods. Results The study included 112 independent trial networks (including 1552 trials with 478 775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined. Conclusions Significant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence. PMID:21846695

A graph decomposition-based approach for water distribution network optimization

NASA Astrophysics Data System (ADS)

Zheng, Feifei; Simpson, Angus R.; Zecchin, Aaron C.; Deuerlein, Jochen W.

2013-04-01

A novel optimization approach for water distribution network design is proposed in this paper. Using graph theory algorithms, a full water network is first decomposed into different subnetworks based on the connectivity of the network's components. The original whole network is simplified to a directed augmented tree, in which the subnetworks are substituted by augmented nodes and directed links are created to connect them. Differential evolution (DE) is then employed to optimize each subnetwork based on the sequence specified by the assigned directed links in the augmented tree. Rather than optimizing the original network as a whole, the subnetworks are sequentially optimized by the DE algorithm. A solution choice table is established for each subnetwork (except for the subnetwork that includes a supply node) and the optimal solution of the original whole network is finally obtained by use of the solution choice tables. Furthermore, a preconditioning algorithm is applied to the subnetworks to produce an approximately optimal solution for the original whole network. This solution specifies promising regions for the final optimization algorithm to further optimize the subnetworks. Five water network case studies are used to demonstrate the effectiveness of the proposed optimization method. A standard DE algorithm (SDE) and a genetic algorithm (GA) are applied to each case study without network decomposition to enable a comparison with the proposed method. The results show that the proposed method consistently outperforms the SDE and GA (both with tuned parameters) in terms of both the solution quality and efficiency.

Polygenic dissection of diagnosis and clinical dimensions of bipolar disorder and schizophrenia.

PubMed

Ruderfer, Douglas M; Fanous, Ayman H; Ripke, Stephan; McQuillin, Andrew; Amdur, Richard L; Gejman, Pablo V; O'Donovan, Michael C; Andreassen, Ole A; Djurovic, Srdjan; Hultman, Christina M; Kelsoe, John R; Jamain, Stephane; Landén, Mikael; Leboyer, Marion; Nimgaonkar, Vishwajit; Nurnberger, John; Smoller, Jordan W; Craddock, Nick; Corvin, Aiden; Sullivan, Patrick F; Holmans, Peter; Sklar, Pamela; Kendler, Kenneth S

2014-09-01

Bipolar disorder and schizophrenia are two often severe disorders with high heritabilities. Recent studies have demonstrated a large overlap of genetic risk loci between these disorders but diagnostic and molecular distinctions still remain. Here, we perform a combined genome-wide association study (GWAS) of 19 779 bipolar disorder (BP) and schizophrenia (SCZ) cases versus 19 423 controls, in addition to a direct comparison GWAS of 7129 SCZ cases versus 9252 BP cases. In our case-control analysis, we identify five previously identified regions reaching genome-wide significance (CACNA1C, IFI44L, MHC, TRANK1 and MAD1L1) and a novel locus near PIK3C2A. We create a polygenic risk score that is significantly different between BP and SCZ and show a significant correlation between a BP polygenic risk score and the clinical dimension of mania in SCZ patients. Our results indicate that first, combining diseases with similar genetic risk profiles improves power to detect shared risk loci and second, that future direct comparisons of BP and SCZ are likely to identify loci with significant differential effects. Identifying these loci should aid in the fundamental understanding of how these diseases differ biologically. These findings also indicate that combining clinical symptom dimensions and polygenic signatures could provide additional information that may someday be used clinically.

Evaluating the Impact of Database Heterogeneity on Observational Study Results

PubMed Central

Madigan, David; Ryan, Patrick B.; Schuemie, Martijn; Stang, Paul E.; Overhage, J. Marc; Hartzema, Abraham G.; Suchard, Marc A.; DuMouchel, William; Berlin, Jesse A.

2013-01-01

Clinical studies that use observational databases to evaluate the effects of medical products have become commonplace. Such studies begin by selecting a particular database, a decision that published papers invariably report but do not discuss. Studies of the same issue in different databases, however, can and do generate different results, sometimes with strikingly different clinical implications. In this paper, we systematically study heterogeneity among databases, holding other study methods constant, by exploring relative risk estimates for 53 drug-outcome pairs and 2 widely used study designs (cohort studies and self-controlled case series) across 10 observational databases. When holding the study design constant, our analysis shows that estimated relative risks range from a statistically significant decreased risk to a statistically significant increased risk in 11 of 53 (21%) of drug-outcome pairs that use a cohort design and 19 of 53 (36%) of drug-outcome pairs that use a self-controlled case series design. This exceeds the proportion of pairs that were consistent across databases in both direction and statistical significance, which was 9 of 53 (17%) for cohort studies and 5 of 53 (9%) for self-controlled case series. Our findings show that clinical studies that use observational databases can be sensitive to the choice of database. More attention is needed to consider how the choice of data source may be affecting results. PMID:23648805

Is there a substitution of Pinaceae by Fagaceae in temperate forests at the global scale?

NASA Astrophysics Data System (ADS)

Alfaro Reyna, Teresa; Retana, Javier; Martínez-Vilalta, Jordi

2018-07-01

Reports on forest decline, changes in species composition and the distribution of forests in response to changes in climate and land use are increasing worldwide. Temperate forests are largely dominated by two tree families: Pinaceae and Fagaceae. These two families have distinct functional properties and different responses to environmental factors. Several local and regional assessments, particularly in Europe, have found that species of Fagaceae are invading areas previously dominated by Pinaceae. The main aim of this synthesis study is to analyze the relative dynamics of Pinaceae and Fagaceae species in temperate forests around the world, with the following specific objectives: (1) establish if there is a consistent directional substitution of Pinaceae by Fagaceae worldwide; and (2) determine whether these directional changes are associated with specific climatic conditions or certain geographic regions, reflecting differences in historical forest management and land use. A bibliographic review was performed and 51 papers were found that met the search criteria, including a total of 121 case studies in which the relative dynamics of Pinaceae and Fagaceae were evaluated. Our results show that the relative abundance of Fagaceae increased in 71% of cases (P → F dynamics), whereas Pinaceae relative abundance increased in 17% of cases (F → P) and 12% of cases did not show clear changes. Increases of Fagaceae relative to Pinaceae were less clear in areas where vegetation dynamics were driven by natural disturbances. Our results indicate a widespread increase in dominance of Fagaceae species at the expense of Pinaceae across northern temperate forests, with the exception of Eastern North America. The potential implications for ecosystem function and forest resilience under ongoing climate change are large and clearly deserve further study.

Use of a Trellis Device for Endovascular Treatment of Venous Thrombosis Involving a Duplicated Inferior Vena Cava

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

Saettele, Megan R., E-mail: SaetteleM@umkc.edu; Morelli, John N., E-mail: dr.john.morelli@gmail.com; Chesis, Paul

Congenital anomalies of the inferior vena cava (IVC) are increasingly recognized with CT and venography techniques. Although many patients with IVC anomalies are asymptomatic, recent studies have suggested an association with venous thromboembolism. We report the case of a 62-year-old woman with extensive venous clot involving the infrarenal segment of a duplicated left IVC who underwent pharmacomechanical thrombectomy and tissue plasminogen activator catheter-directed thrombolysis with complete deep venous thrombosis resolution. To our knowledge this is the first reported case in the English literature of the use of a Trellis thrombectomy catheter in the setting of duplicated IVC.

An analysis of contingency statements in a DRO procedure: A case report.

PubMed

Gerow, Stephanie; Rispoli, Mandy; Boles, Margot B; Neely, Leslie C

2015-06-01

To examine latency to criterion for reduction of challenging behaviour with and without stating a contingency statement immediately prior to a DRO procedure. An ABAC design in which A was baseline, B was used to evaluate the efficacy of a DRO procedure, and C was used to evaluate the efficacy of a DRO procedure with a contingency statement. The DRO with the contingency statement intervention was associated with a shorter latency to behaviour change than the DRO procedure without the contingency statement. These preliminary findings from this case study highlight the importance of examining the efficiency of behaviour change procedures. Directions for future research are provided.

Clinico-serologic co-relation in bi-directional ABO incompatible hemopoietic stem cell transplantation.

PubMed

Basu, Sabita; Dhar, Supriya; Mishra, Deepak; Chandy, Mammen

2015-01-01

The ABO blood group system is of prime significance in red cell transfusion and organ transplantation. However, ABO compatibility is not critical in allogenic hemopoietic stem cell transplantation (HSCT) and approximately 40-50% of hemopoietic stem cell transplants are ABO incompatible. This incompatibility may be major, minor or bi-directional. Though there are descriptions of transfusion practice and protocols in ABO incompatible HSCT, there are considerable variations and transfusion support in these patients can be very challenging. The immunohematologic observations in two cases of bi-directional ABO incompatible HSCT have been described, and clinico-serologic correlation has been attempted. In both cases, peripheral blood stem cell harvests were obtained using the Cobe spectra cell separator. Immunohematologic assessments in the donor and recipient were done as a part of pre HSCT evaluation. Both the standard tube technique and column agglutination method (Ortho Biovue Micro Bead System) was used. Antibody screen was done by column agglutination method using three cell panel (Surgiscreen cells). Isoagglutinin titration was done by the master dilution method and standard validated techniques were used. The pattern of laboratory findings in the two cases was different and so were the clinical outcomes. Although there was early engraftment in the first case, the second case developed pure red cell aplasia and this was well-reflected in the immunohematologic assessments. Immunohematologic assessment correlated well with the clinical picture and could be used to predict clinical outcome and onset of complications in ABO incompatible HSCT.

"The Public" in Public Schools: The Social Construction/Constriction of Moral Communities.

ERIC Educational Resources Information Center

Fine, Michelle

This essay, written from the point of view of a social researcher with a direct personal involvement in the cases studied, discusses how public schools, as universally accessible moral communities, engage in patterns of systematic exclusion. Through three case studies of public secondary schools in which groups of students have been situated…

Advisory Groups to Encourage Collaboration: A Case Study

ERIC Educational Resources Information Center

Stephens, Lisa A.; Glynn, Graham; Lavallee, David; Moreau, Joseph; Orzech, Mary Jo; Pence, Harry E.

2011-01-01

This article is a case study of how the provost and senior executive leadership of one large university system capitalized on a long-standing advisory group as a tool to support communication and collaboration across a broad constituency. These advisory efforts help guide both future directions and investment. It is the story of how this group has…

Lifelong Education and Community Learning: Three Case Studies in India. UIE Monographs, 7.

ERIC Educational Resources Information Center

Patel, V; Shukla, N. N.

Three case studies of educational practices in India illustrate that lifelong learning (1) is not confined to childhood; (2) encompasses a large number of sources outside formal education; and (3) can lead to improvement of everday life. These three educational activities, all at semi-rural institutions, and directed toward improving aborigines'…

A Friend in Need Is a Friend Indeed: A Case Study on Human Respiratory Physiology

ERIC Educational Resources Information Center

Cliff, William H.; Wright, Ann W.

2005-01-01

The dynamics of oxygen transport by the blood can be a particularly difficult topic for students to grasp. A directed case study about carbon monoxide poisoning was designed to help deepen student understanding of the solution chemistry of the oxygen-hemoglobin reaction and the role that hemoglobin plays in external respiration.

Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery.

PubMed

Singh, Priyanka; Sharma, Kalpana; Agarwal, Sunita

2017-09-01

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy ( p value 0.001). Level of evidence III.

Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

PubMed

Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

2011-01-01

Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in patients at high-risk of future fracture when compared with a multifaceted quality improvement intervention aimed at patients and physicians. Even with case-management, nearly half of patients did not receive appropriate care. clinicaltrials.gov identifier: NCT00152321.

Does the Latissimus dorsi insert on the iliac crest in man? Anatomic and ontogenic study.

PubMed

Ben Hadj Yahia, Sihem; Vacher, Christian

2011-11-01

The Latissimus dorsi muscle is usually considered as inserted on the iliac crest, but it is separated from it by the thoracolumbar fascia. In our experience based on the harvesting of pedicled Latissimus dorsi flaps to cover cervicofacial loss of substances, we have found that in some cases, the muscular fibers of the anterior border of the muscle are directly inserted on the iliac crest. In these cases, the harvesting of the flap could be more distal. To determine whether this direct muscular insertion is frequent or not, we performed dissections on 30 fresh cadavers of the lower insertion of the Latissimus dorsi muscle, and 6 dissections of human fetuses to study the ontogeny of these insertions. The Latissimus dorsi muscle presented direct muscular insertions on the iliac crest in 13.33% of cases. The fetal dissections showed that before 30 weeks of development, the anterior part of the muscle was directly inserted on the iliac crest, and after it was separated from it by the thoracolumbar fascia. Although the harvesting of the Latissimus dorsi in continuity with the thoracolumbar fascia has been described in pedicled flaps, it is usually considered that it is impossible to harvest Latissimus dorsi musculocutaneous flaps in contact with the iliac crest, because there are no perforating vessels from the thoracolumbar fascia to the skin. According to our results, in some cases, it could be possible to harvest a pedicled musculo-cutaneous LD flap more distal that it is usually described.

COSTS OF INTERSTITAL CYSTITIS IN A MANAGED CARE POPULATION

PubMed Central

Clemens, J. Quentin; Meenan, Richard T.; O’Keeffe Rosetti, Maureen C.; Kimes, Terry; Calhoun, Elizabeth A.

2008-01-01

Objective This study assessed the direct medical costs, medication and procedure use associated with interstitial cystitis (IC) in women in the Kaiser Permanente Northwest (KPNW) managed care population. Methods The KPNW electronic medical record was utilized to identify women diagnosed with interstitial cystitis (n=239). Each of these cases was matched with three controls based on age and duration in the health plan. Health plan cost accounting data were used to determine inpatient, outpatient, and pharmacy costs for 1998-2003. An analysis of prescription medication use, cystoscopic and urodynamic procedures commonly associated with IC was also performed. To evaluate for comorbidities, an automated risk-adjustment model (RxRisk) linked to 28 chronic medical conditions was applied to the administrative datasets from both groups. Results The mean duration from the date of IC diagnosis to the end of the study period was 36.6 months (range 1.4-60). Mean yearly costs were 2.4-fold greater in cases than controls ($7100 vs. $2994), and median yearly costs were 3.8-fold greater ($5000 vs. $1304). These cost differences were predominantly due to outpatient and pharmacy expenses. Medication and procedure use were significantly greater in cases than controls. These findings were consistent across RxRisk categories, which suggest that the observed cost differences are IC-specific. Conclusions The direct per-person costs of IC are high, with average yearly costs approximately $4000 greater than age-matched controls. This cost differential is an underestimate, as costs preceding the diagnosis, use of alternative therapies, indirect costs and costs of those with IC that is not diagnosed are not included. PMID:18329077

Ventilation Processes in a Three-Dimensional Street Canyon

NASA Astrophysics Data System (ADS)

Nosek, Štěpán; Kukačka, Libor; Kellnerová, Radka; Jurčáková, Klára; Jaňour, Zbyněk

2016-05-01

The ventilation processes in three different street canyons of variable roof geometry were investigated in a wind tunnel using a ground-level line source. All three street canyons were part of an urban-type array formed by courtyard-type buildings with pitched roofs. A constant roof height was used in the first case, while a variable roof height along the leeward or windward walls was simulated in the two other cases. All street-canyon models were exposed to a neutrally stratified flow with two approaching wind directions, perpendicular and oblique. The complexity of the flow and dispersion within the canyons of variable roof height was demonstrated for both wind directions. The relative pollutant removals and spatially-averaged concentrations within the canyons revealed that the model with constant roof height has higher re-emissions than models with variable roof heights. The nomenclature for the ventilation processes according to quadrant analysis of the pollutant flux was introduced. The venting of polluted air (positive fluctuations of both concentration and velocity) from the canyon increased when the wind direction changed from perpendicular to oblique, irrespective of the studied canyon model. Strong correlations (>0.5) between coherent structures and ventilation processes were found at roof level, irrespective of the canyon model and wind direction. This supports the idea that sweep and ejection events of momentum bring clean air in and detrain the polluted air from the street canyon, respectively.

Direct Microscopy: A Useful Tool to Diagnose Oral Candidiasis in Children and Adolescents.

PubMed

Marty, Mathieu; Bourrat, Emmanuelle; Vaysse, Frédéric; Bonner, Mark; Bailleul-Forestier, Isabelle

2015-12-01

Oral candidiasis is one of the most common opportunistic fungal infections of the oral cavity in human. Among children, this condition represents one of the most frequent affecting the mucosa. Although most diagnoses are made based on clinical signs and features, a microbiological analysis is sometimes necessary. We performed a literature review on the diagnosis of oral candidiasis to identify the techniques most commonly employed in routine clinical practice. A Medline-PubMed search covering the last 10 years was performed. Microbiological techniques were used in cases requiring confirmation of the clinical diagnosis. In such cases, direct microscopy was the method most commonly used for diagnosing candidiasis. Direct microscopy appears as the method of choice for confirming clinical diagnosis and could become a routine chair-side technique.

Imaging Planet Formation Inside the Diffraction Limit

NASA Astrophysics Data System (ADS)

Sallum, Stephanie Elise

For decades, astronomers have used observations of mature planetary systems to constrain planet formation theories, beginning with our own solar system and now the thousands of known exoplanets. Recent advances in instrumentation have given us a direct view of some steps in the planet formation process, such as large-scale protostar and protoplanetary disk features and evolution. However, understanding the details of how planets accrete and interact with their environment requires direct observations of protoplanets themselves. Transition disks, protoplanetary disks with inner clearings that may be caused by forming planets, are the best targets for these studies. Their large distances, compared to the stars normally targeted for direct imaging of exoplanets, make protoplanet detection difficult and necessitate novel imaging techniques. In this dissertation, I describe the results of using non-redundant masking (NRM) to search for forming planets in transition disk clearings. I first present a data reduction pipeline that I wrote to this end, using example datasets and simulations to demonstrate reduction and imaging optimizations. I discuss two transition disk NRM case studies: T Cha and LkCa 15. In the case of T Cha, while we detect significant asymmetries, the data cannot be explained by orbiting companions. The fluxes and orbital motion of the LkCa 15 companion signals, however, can be naturally explained by protoplanets in the disk clearing. I use these datasets and simulated observations to illustrate the effects of scattered light from transition disk material on NRM protoplanet searches. I then demonstrate the utility of the dual-aperture Large Binocular Telescope Interferometer's NRM mode on the bright B[e] star MWC 349A. I discuss the implications of this work for planet formation studies as well as future prospects for NRM and related techniques on next generation instruments.

Cholesterol embolisms as possible adverse drug reaction of direct oral anticoagulants.

PubMed

Muller-Hansma, A H G; Daemen-Gubbels, C R G M; Schut, N H

2018-04-01

The Netherlands Pharmacovigilance Centre Lareb has received two reports of cholesterol crystal embolisms associated with the use of a direct oral anticoagulant (DOAC). The European pharmacovigilance database contains several other cases concerning this association, and one report was published in the scientific literature. Cholesterol crystal embolisms were described in association with the use of several other antithrombotic drugs, although the role as an independent risk factor is not conclusive. The case series described in this article, indicates the possibility of an adverse drug reaction when a patient develops cholesterol crystal embolisms while using a DOAC.

A compromise too far: a review of Canadian cases of direct-to-consumer advertising regulation.

PubMed

Lexchin, Joel; Mintzes, Barbara

2014-01-01

Since the mid 1990's, Canada has introduced partial direct-to-consumer advertising (DTCA) of prescription drugs through administrative policy shifts. Little documentation exists on how regulation occurs in practice. To evaluate Health Canada's response to complaints about DTCA. We use case studies about DTCA spanning from 2000 to 2011 to examine the stringency of regulation by Health Canada. The aim was to identify key themes in Health Canada's approach to regulation from a public health perspective. All of the material related to the cases was independently read by each of the authors and any disagreements in interpretation were resolved through discussion. We identified six weaknesses in how Health Canada deals with DTCA: failure to act on concerns about promotion for unapproved "off-label" uses, possible financial inducements to use a product, advertisements perceived to stimulate unwarranted fear about disease risks, and advertising of products with serious safety concerns identified in Health Canada safety advisories; ineffective enforcement actions undertaken by Health Canada; and lack of transparency in Health Canada's decision-making. There is an astonishing degree of discordance between public health priorities and regulation of DTCA in Canada. The current approach to enforcement is notable both for its lack of teeth and lack of accountability and transparency.

A Framework for Testing Scientific Software: A Case Study of Testing Amsterdam Discrete Dipole Approximation Software

NASA Astrophysics Data System (ADS)

Shao, Hongbing

Software testing with scientific software systems often suffers from test oracle problem, i.e., lack of test oracles. Amsterdam discrete dipole approximation code (ADDA) is a scientific software system that can be used to simulate light scattering of scatterers of various types. Testing of ADDA suffers from "test oracle problem". In this thesis work, I established a testing framework to test scientific software systems and evaluated this framework using ADDA as a case study. To test ADDA, I first used CMMIE code as the pseudo oracle to test ADDA in simulating light scattering of a homogeneous sphere scatterer. Comparable results were obtained between ADDA and CMMIE code. This validated ADDA for use with homogeneous sphere scatterers. Then I used experimental result obtained for light scattering of a homogeneous sphere to validate use of ADDA with sphere scatterers. ADDA produced light scattering simulation comparable to the experimentally measured result. This further validated the use of ADDA for simulating light scattering of sphere scatterers. Then I used metamorphic testing to generate test cases covering scatterers of various geometries, orientations, homogeneity or non-homogeneity. ADDA was tested under each of these test cases and all tests passed. The use of statistical analysis together with metamorphic testing is discussed as a future direction. In short, using ADDA as a case study, I established a testing framework, including use of pseudo oracles, experimental results and the metamorphic testing techniques to test scientific software systems that suffer from test oracle problems. Each of these techniques is necessary and contributes to the testing of the software under test.

Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

PubMed Central

Shin, Soon Ae; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

2015-01-01

Purpose This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program. PMID:25510771

Effects of diabetic case management on knowledge, self-management abilities, health behaviors, and health service utilization for diabetes in Korea.

PubMed

Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

2015-01-01

This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.

Case study of flexure and shear strengthening of RC beams by CFRP using FEA

NASA Astrophysics Data System (ADS)

Jankowiak, Iwona

2018-01-01

In the paper the preliminary results of study on strengthening RC beams by means of CFRP materials under mixed shear-flexural work condition are presented. The Finite Element Method analyses were performed using numerical models proposed and verified earlier by the results of laboratory tests [4, 5] for estimation of effectiveness of CFRP strengthening of RC beams under flexure. The currently conducted analyses deal with 3D models of RC beams under mixed shear-flexural loading conditions. The symmetry of analyzed beams was taken into account (in both directions). The application of Concrete Damage Plasticity (CDP) model of RC beam allowed to predict a layout and propagation of cracks leading to failure. Different cases of strengthening were analyzed: with the use of CFRP strip or CFRP closed hoops as well as with the combination of above mentioned. The preliminary study was carried out and the first results were presented.