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

Neurotization to innervate the deltoid and biceps: 3 cases.

PubMed

Dy, Christopher J; Kitay, Alison; Garg, Rohit; Kang, Lana; Feinberg, Joseph H; Wolfe, Scott W

2013-02-01

To describe our experience using direct muscle neurotization as a treatment adjunct during delayed surgical reconstruction for traumatic denervation injuries. Three patients who had direct muscle neurotization were chosen from a consecutive series of patients undergoing reconstruction for brachial plexus injuries. The cases are presented in detail, including long-term clinical follow-up at 2, 5, and 10 years with accompanying postoperative electrodiagnostic studies. Postoperative motor strength using British Medical Research Council grading and active range of motion were retrospectively extracted from the clinical charts. Direct muscle neurotization was performed into the deltoid in 2 cases and into the biceps in 1 case after delays of up to 10 months from injury. Two patients had recovery of M4 strength, and the other patient had recovery of M3 strength. All 3 patients had evidence on electrodiagnostic studies of at least partial muscle reinnervation after neurotization. Direct muscle neurotization has shown promising results in numerous basic science investigations and a limited number of clinical cases. The current series provides additional clinical and electrodiagnostic evidence that direct muscle neurotization can successfully provide reinnervation, even after lengthy delays from injury to surgical treatment. Microsurgeons should consider direct muscle neurotization as a viable adjunct treatment and part of a comprehensive reconstructive plan, especially for injuries associated with avulsion of the distal nerve stump from its insertion into the muscle. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Toward Understanding the Role of Web 2.0 Technology in Self-Directed Learning and Job Performance in a Single Organizational Setting: A Qualitative Case Study

ERIC Educational Resources Information Center

Caruso, Shirley J.

2016-01-01

This single instrumental qualitative case study explores and thickly describes job performance outcomes based upon the manner in which self-directed learning activities of a purposefully selected sample of 3 construction managers are conducted, mediated by the use of Web 2.0 technology. The data collected revealed that construction managers are…

Catheter-directed Endovascular Application of Thrombin: Report of 3 Cases and Review of the Literature

PubMed Central

Maybody, Majid; Madoff, David C.; Thornton, Raymond H; Morales, Steven A; Moskowitz, Chaya S; Hsu, Meier; Brody, Lynn A; Brown, Karen T; Covey, Anne M

2017-01-01

Purpose To report 3 new cases of catheter-directed endovascular application of thrombin and explore trends by analysis of published case series. Materials and Methods Institutional Review Board approved this retrospective study. All cases of non-tumoral arterial embolization performed from January 2003 to January 2015 at our institution were retrospectively reviewed. Thrombin was used in 7 of 589 cases. In 3 cases intra arterial thrombin was injected via catheter to treat active hemorrhage. Four cases were excluded due to percutaneous injection into visceral pseudoaneurysms (n=3) and making ex vivo autologous clot to be injected via catheter (n=1). Fisher’s exact and the Wilcoxon rank sum tests were used to assess for association with acute nontarget thrombosis. Results Catheter-directed thrombin was used in 3/589 (0.5%) cases at our institution. All three cases were technically successful with no further bleeding (100%). Nontarget thrombosis of proximal branches occurred in 2 patients (67%) with no significant clinical consequences. Including our 3 cases, a total of 28 cases were reviewed. Of the variables examined - location (p=0.99), size (p=0.66) and etiology of vascular lesion (p=0.92), pseudoaneurysm neck anatomy (p=0.14), thrombin units (p=0.47), volume (p=0.76) or technique of use of small doses (p=0.99), use of other embolic material (p=0.67) and use of adjunct techniques (p=0.99) - none were found to be significantly associated with acute nontarget thrombosis. Technical success was 96% with no reports of reperfusion after treatment. Conclusions Catheter-directed endovascular thrombin can be an additional tool to treat pseudoaneurysms not amenable to conventional embolization. Further studies are required to optimize technique and outcomes. PMID:27936421

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.

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.

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.

Remote Control and Children's Understanding of Robots

ERIC Educational Resources Information Center

Somanader, Mark C.; Saylor, Megan M.; Levin, Daniel T.

2011-01-01

Children use goal-directed motion to classify agents as living things from early in infancy. In the current study, we asked whether preschoolers are flexible in their application of this criterion by introducing them to robots that engaged in goal-directed motion. In one case the robot appeared to move fully autonomously, and in the other case it…

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.

Using Case Study Multi-Methods to Investigate Close(r) Collaboration: Course-Based Tutoring and the Directive/Nondirective Instructional Continuum

ERIC Educational Resources Information Center

Corbett, Steven J.

2011-01-01

This essay presents case studies of "course-based tutoring" (CBT) and one-to-one tutorials in two sections of developmental first-year composition (FYC) at a large West Coast research university. The author's study uses a combination of rhetorical and discourse analyses and ethnographic and case study multi-methods to investigate both…

Case studies on sugar production from underutilized woody biomass using sulfite chemistry

Treesearch

J.Y. Zhu; M. Subhosh Chandra; Roland Gleisner; William Gilles; Johnway Gao; Gevan Marrs; Dwight Anderson; John Sessions

2015-01-01

We examined two case studies to demonstrate the advantages of sulfite chemistry for pretreating underutilized woody biomass to produce sugars through enzymatic saccharification. In the first case study, we evaluated knot rejects from a magnesium-basedsulfite mill for direct enzymatic sugar production.We found that the sulfite mill rejects are an excellent feedstock for...

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.

Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study.

PubMed

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

Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining whether longitudinal resource use is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care use associated with constipation from childhood to early adulthood. A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5718 children in a population-based birth cohort who were born during 1976 to 1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all noncases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5 and 18 years of age or until the subject emigrated from the community. We identified 250 cases with a diagnosis of constipation in the birth cohort. Although the mean inpatient costs for cases were $9994 (95% Confidence interval [CI] 2538-37,201) compared with $2391 (95% CI 923-7452) for controls (P = 0.22) during the time period, the mean outpatient costs for cases were $13,927 (95% CI 11,325-16,525) compared with $3448 (95% CI 3771-4621) for controls (P < 0.001) during the same time period. The mean annual number of emergency department visits for cases was 0.66 (95% CI 0.62-0.70) compared with 0.34 (95% CI 0.32-0.35) for controls (P < 0.0001). Individuals with constipation have higher medical care use. Outpatient costs and emergency department use were significantly greater for individuals with constipation from childhood to early adulthood.

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.

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

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'…

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.

A retrospective study of the performance of video laryngoscopy in an obstetric unit.

PubMed

Aziz, Michael F; Kim, Diana; Mako, Jeffrey; Hand, Karen; Brambrink, Ansgar M

2012-10-01

We evaluated the performance of tracheal intubation using video laryngoscopy in an obstetric unit. We analyzed airway management details during a 3-year period, and observed 180 intubations. All cases were managed with direct or video laryngoscopy. Direct laryngoscopy resulted in 157 out of 163 (95% confidence interval [CI], 92%-99%) first attempt successful intubations and failed once. Video laryngoscopy resulted in 18 of 18 (95% CI, 81%-100%) successful intubations on first attempt. The failed direct laryngoscopy was rescued with video laryngoscopy. The patients managed with video laryngoscopy frequently required urgent or emergency surgery and had predictors of difficult direct laryngoscopy in 16 of 18 cases. Video laryngoscopy may be a useful adjunct for obstetric airway management, and its role in this difficult airway scenario should be further studied.

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.

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.

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

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

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…

Cautionary Tales: Ethics and Case Studies in Science

PubMed Central

Herreid, Clyde Freeman

2014-01-01

Ethical concerns are normally avoided in science classrooms in spite of the fact that many of our discoveries impinge directly on personal and societal values. We should not leave the ethical problems for another day, but deal with them using realistic case studies that challenge students at their ethical core. In this article we illustrate how case studies can be used to teach STEM students principles of ethics. PMID:25574280

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…

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.

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...

Nanomaterial Case Study: Nanoscale Silver in Disinfectant ...

EPA Pesticide Factsheets

This draft document presents 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 a comprehensive environmental assessment (CEA) framework, which combines a product life-cycle perspective with the risk assessment paradigm. 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 and can be used as 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.

Enabling Occupational Performance of Children through Coaching Parents: Three Case Reports

ERIC Educational Resources Information Center

Graham, Fiona; Rodger, Sylvia; Ziviani, Jenny

2010-01-01

This study explores the use of occupational performance coaching (OPC) with three parent-child dyads using descriptive case study methodology. OPC is a parent-directed intervention in which parents are coached to improve their own or their children's performance in home and community contexts. In this study, parent and child performance was…

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…

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…

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.

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…

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…

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').

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.

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…

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…

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,…

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

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.

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.

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…

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.

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.

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…

Undergraduate Labs for Biological Physics: Brownian Motion and Optical Trapping

NASA Astrophysics Data System (ADS)

Chu, Kelvin; Laughney, A.; Williams, J.

2006-12-01

We describe a set of case-study driven labs for an upper-division biological physics course. These labs are motivated by case-studies and consist of inquiry-driven investigations of Brownian motion and optical-trapping experiments. Each lab incorporates two innovative educational techniques to drive the process and application aspects of scientific learning. Case studies are used to encourage students to think independently and apply the scientific method to a novel lab situation. Student input from this case study is then used to decide how to best do the measurement, guide the project and ultimately evaluate the success of the program. Where appropriate, visualization and simulation using VPython is used. Direct visualization of Brownian motion allows students to directly calculate Avogadro's number or the Boltzmann constant. Following case-study driven discussion, students use video microscopy to measure the motion of latex spheres in different viscosity fluids arrive at a good approximation of NA or kB. Optical trapping (laser tweezer) experiments allow students to investigate the consequences of 100-pN forces on small particles. The case study consists of a discussion of the Boltzmann distribution and equipartition theorem followed by a consideration of the shape of the potential. Students can then use video capture to measure the distribution of bead positions to determine the shape and depth of the trap. This work supported by NSF DUE-0536773.

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…

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.

An Alternative Teacher Consultation Model: A Case Study.

ERIC Educational Resources Information Center

Langhorne, John E., Jr.; And Others

1979-01-01

This case history describes intervention techniques used with a nine-year-old male with behavior problems. The procedures used were classroom observation and teacher consultation; drug (Ritalin) withdrawal; direct consultant intervention; and class change and follow-up. (MH)

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…

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…

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…

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…

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 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…

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.

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.

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.

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.

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.

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.

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,…

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.

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.

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…

"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…

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…

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.

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…

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.

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.

Invited Reaction: The Strategic Value of HRD in Lean Strategy Implementation

ERIC Educational Resources Information Center

Yorks, Lyle; Barto, Jody

2013-01-01

This study by Meera Alagaraja and Toby Egan provides a case study of a Lean strategy implementation in which HRD was an integrated part of the process and offers a model that can give direction for both future research and strategic advocacy on behalf of HRD practice. The case is actually more a study of the importance of cross-functional and…

Corps G-2 Staff Competencies: A Desert Storm Case Study

DTIC Science & Technology

2017-06-09

processing and exploiting new information or produce updated analytic products for dissemination. 43 Intelligence Operations The corps directs IO by...CORPS G-2 STAFF COMPETENCIES: A DESERT STORM CASE STUDY A thesis presented to the Faculty of the US Army Command and General Staff...College in partial fulfillment of the requirements for the degree MASTER OF MILITARY ART AND SCIENCE General Studies by ERIK W

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.

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.

The Power of Self-Directed Journals: Being a Temporary "Other" for Learning to Teach

ERIC Educational Resources Information Center

Matsumoto, Yumi

2016-01-01

This case study investigates how an ESL teacher's activity of self-directed journal writing can facilitate learning and function as a mediational tool for teacher professional development. The participant for this study is a native English speaker who taught an ESL freshman writing course in an American university. Since he had little time to…

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…

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.

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.

Direct simulation Monte Carlo method for the Uehling-Uhlenbeck-Boltzmann equation.

PubMed

Garcia, Alejandro L; Wagner, Wolfgang

2003-11-01

In this paper we describe a direct simulation Monte Carlo algorithm for the Uehling-Uhlenbeck-Boltzmann equation in terms of Markov processes. This provides a unifying framework for both the classical Boltzmann case as well as the Fermi-Dirac and Bose-Einstein cases. We establish the foundation of the algorithm by demonstrating its link to the kinetic equation. By numerical experiments we study its sensitivity to the number of simulation particles and to the discretization of the velocity space, when approximating the steady-state distribution.

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.

Transport of airborne pollen into the city of Thessaloniki: the effects of wind direction, speed and persistence

NASA Astrophysics Data System (ADS)

Damialis, Athanasios; Gioulekas, Dimitrios; Lazopoulou, Chariklia; Balafoutis, Christos; Vokou, Despina

2005-01-01

We examined the effect of the wind vector analyzed into its three components (direction, speed and persistence), on the circulation of pollen from differe nt plant taxa prominent in the Thessaloniki area for a 4-year period (1996- 1999). These plant taxa were Ambrosia spp., Artemisia spp., Chenopodiaceae, spp., Cupressaceae, Olea europaea, Pinaceae, Platanus spp., Poaceae, Populus spp., Quercus spp., and Urticaceae. Airborne pollen of Cupressaceae, Urticaceae, Quercus spp. and O. europaea make up approximately 70% of the total average annual pollen counts. The set of data that we worked with represented days without precipitation and time intervals during which winds blew from the same direction for at least 4 consecutive hours. We did this in order to study the effect of the different wind components independently of precipitation, and to avoid secondary effects produced by pollen resuspension phenomena. Factorial regression analysis among the summed bi-hourly pollen counts for each taxon and the values of wind speed and persistence per wind direction gave significant results in 22 cases (combinations of plant taxa and wind directions). The pollen concentrations of all taxa correlated significantly with at least one of the three wind components. In seven out of the 22 taxon-wind direction combinations, the pollen counts correlated positively with wind persistence, whereas this was the case for only two of the taxon-wind speed combinations. In seven cases, pollen counts correlated with the interaction effect of wind speed and persistence. This shows the importance of wind persistence in pollen transport, particularly when weak winds prevail for a considerable part of the year, as is the case for Thessaloniki. Medium/long-distance pollen transport was evidenced for Olea (NW, SW directions), Corylus (NW, SW), Poaceae (SW) and Populus (NW).

Postgraduate Work-Based Learning Programmes in English Higher Education: Exploring Case Studies of Organizational Practice

ERIC Educational Resources Information Center

Smith, Paul; Preece, David

2009-01-01

The first part of the paper outlines and discusses the nature of work-based learning (WBL) and WBL programmes, and the overall direction of government strategy towards WBL programmes in Higher Education (HE) in England, with particular reference to postgraduate programmes, policy documents, and the WBL literature. Drawing upon case study research,…

The Quality of Life of a Child with Asperger's Disorder in a General Education Setting: A Pilot Case Study

ERIC Educational Resources Information Center

Mayton, Michael R.

2005-01-01

This pilot qualitative case study was designed to investigate how the quality of life (QOL) of a child with Asperger's Disorder was impacted by her placement in an inclusive education setting which provided no specialized social skills instruction. Direct and indirect data were gathered and examined regarding themes that centered around QOL…

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…

Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

ERIC Educational Resources Information Center

Broecher, Joachim

2012-01-01

This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

The Year in Review: Reports of Research Conducted by Adult Education Practitioners-Researchers in Virginia. Volume 5: 1995-1996.

ERIC Educational Resources Information Center

Virginia Adult Educators Research Network, Dayton.

This report contains four separate articles of interest to adult English-as-a-second-language (ESL) educators. "Learning Disabilities in Adult ESL: Case Studies and Directions" (Dorothy Almanza, Kate Singleton, Lynda Terrill) looks at three case studies of adult ESL students whom teachers have identified as possibly learning disabled.…

Blogs, Tweets, and Protests: Learning Movement Theory through Online Case Studies

ERIC Educational Resources Information Center

Muñoz, José A.; Culton, Kenneth R.

2016-01-01

This article takes the practical inquiry model as an approach to designing a course on social movements that combines self-directed investigation and group discussion as an avenue for deep learning. For the purpose of developing a case study, a guided approach is provided that allows the students to explore theory on their own and make connections…

Moving from the Classroom to the Workplace: A Service-Learning Case Study of a Media Production Capstone Course

ERIC Educational Resources Information Center

Giese, Mark

2013-01-01

This is a case study of how a capstone course, Producing and Directing, evolved into a service-learning course designed to provide graduating students with real-world workplace experience. It will examine issues including course structure, grading issues, course and client logistics, unaddressed skill sets, group work, and work-product quality…

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

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.

Graduand Student Attributes: A Canadian Case

ERIC Educational Resources Information Center

Kanuka, Heather; Cowley, Summer

2017-01-01

The purpose of this qualitative case study was to gain insights into how academics understand undergraduate graduand attributes. The findings reveal some alignment in views about student attributes, including that they are engaged citizens, are self-directed, have imagination, are questioning, are flexible, display leadership, are problem solvers,…

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.

Maternal and pregnancy-related death: causes and frequencies in an autopsy study population.

PubMed

Buschmann, Claas; Schmidbauer, Martina; Tsokos, Michael

2013-09-01

Maternal deaths during pregnancy, both from pregnancy-related or other causes, are rare in Western industrialized countries. In this study we report maternal and pregnancy-related deaths in a large autopsy population focusing on medical history, autopsy findings and histological examinations. Medico-legal autopsy files (n = 11,270) from the Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charité, University of Berlin, and the State Institute of Legal and Social Medicine, Berlin, from 2005 to 2010 were reviewed. All female cases between 15 and 49 years were checked for maternal and pregnancy-related death, and deaths of pregnant women from non-natural causes were also included. Fatalities that met the chosen criteria were classified as "direct gestational death," "indirect gestational death" or "non-gestational death." 13 female fatalities (0.12 %) met the chosen criteria (median age 28 years ± 6.87 SD). Eight (61.5 %) women died in-hospital, four (30.8 %) at home, and one woman died in public. Three cases (23.1 %) were "non-gestational deaths," and one case (7.7 %) remained unclear after autopsy and additional examinations. Of the remaining nine cases, six cases (46.5 %) were "direct gestational deaths," and two cases (15.4 %) were "indirect gestational deaths." One case (7.7 %) was not to be defined as "late maternal death," but the cause of death seemed to be directly related to previous gestation ["(very) late maternal death"]. Maternal deaths during pregnancy, both from pregnancy-related or other causes, remain an uncommon event in routine forensic autopsy practice. We report on the collection and analysis of maternal and pregnancy-related deaths in a large autopsy population, with particular attention to the phenomenology of pregnancy, pathophysiological changes in different organ systems and their detection, and the forensic autopsy assessment.

Determination of the direction to a source of antineutrinos via inverse beta decay in Double Chooz

NASA Astrophysics Data System (ADS)

Nikitenko, Ya.

2016-11-01

To determine the direction to a source of neutrinos (and antineutrinos) is an important problem for the physics of supernovae and of the Earth. The direction to a source of antineutrinos can be estimated through the reaction of inverse beta decay. We show that the reactor neutrino experiment Double Chooz has unique capabilities to study antineutrino signal from point-like sources. Contemporary experimental data on antineutrino directionality is given. A rigorous mathematical approach for neutrino direction studies has been developed. Exact expressions for the precision of the simple mean estimator of neutrinos' direction for normal and exponential distributions for a finite sample and for the limiting case of many events have been obtained.

Effects of Particle Size on the Shear Behavior of Coarse Grained Soils Reinforced with Geogrid.

PubMed

Kim, Daehyeon; Ha, Sungwoo

2014-02-07

In order to design civil structures that are supported by soils, the shear strength parameters of soils are required. Due to the large particle size of coarse-grained soils, large direct shear tests should be performed. In this study, large direct shear tests on three types of coarse grained soils (4.5 mm, 7.9 mm, and 15.9 mm) were performed to evaluate the effects of particle size on the shear behavior of coarse grained soils with/without geogrid reinforcements. Based on the direct shear test results, it was found that, in the case of no-reinforcement, the larger the maximum particle size became, the larger the friction angle was. Compared with the no-reinforcement case, the cases reinforced with either soft geogrid or stiff geogrid have smaller friction angles. The cohesion of the soil reinforced with stiff geogrid was larger than that of the soil reinforced with soft geogrid. The difference in the shear strength occurs because the case with a stiff geogrid has more soil to geogrid contact area, leading to the reduction in interlocking between soil particles.

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.

Miscommunication across Cultures: The Case of Marketing in Indian English. Revised.

ERIC Educational Resources Information Center

Frank, Jane

A study of intercultural business communication problems compared three examples of direct marketing sales letters similar in function, format, content, and targeted recipient but originating in different cultures (India, England, and the United States) and companies. The letters were directed to a single prospective purchaser of "Who's…

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…

DFT study of the polarization behaviors of various distorted barium titanate crystals: The role of atomic displacements

NASA Astrophysics Data System (ADS)

Mirseraji, Mojtaba; Shahraki, Mehran Gholipour

2018-06-01

A Local Density Approximation (LDA) was employed to investigate the influence of applied strains on valence charge distributions, atomic displacements, Tisbnd O (3) bond distances and the total polarizations in barium titanate (BaTiO3). Four types of various strains were imposed on perfect tetragonal BaTiO3 along the a, c, ab and abc axial directions. Electromechanical properties of BaTiO3 were evaluated in LDA framework and a good agreement with previous results was achieved. The results show that, in the cases of a, ab strains, the values of polarization are almost constant in negative strains and increased by gradual increasing of the positive strains after a sudden enhancement at about +0.1% strain. In the case of c-strain, axial oxygen and Ti atoms underwent the highest displacements and the polarization linearly increased by applied strain. The case of abc-strain, represent the both types of features. In negative abc-strain show a similar polarization behavior like c-strain case and in positive region, polarization behavior is the same as a- and ab-strain cases. In the abc-strains of -0.3% and +0.1%, an abrupt jump in total polarization curve and a small change, are observed due to abnormal atomic displacements. In the most cases a direct relation between polarization and Tisbnd O (3) bond distance was also beheld. Finally, the effects of valence charge distributions on the atomic displacements and total polarizations are studied. It is found that there is a direct relation between polarization and Valence Charge Asymmetry of 3d -orbitals.

The Hybrid Threat: Crime, Terrorism and Insurgency in Mexico. Proceedings of the Joint Policy and Research Forum

DTIC Science & Technology

2011-12-01

Placido Panel 2: Mexico as a Case Study Introduction Bert B. Tussing Not Just About Mexico; Not Just About Drugs Robert Killebrew, Colonel, USA (Retired...hybrid threat.” The second panel focuses on Mexico as a case study for those requirements. We hope you will join us in reflecting upon how best to...even though the outreach and transactions conducted by those charged in this case were (unwittingly) directed towards a DEA informant posing as a

The Salida Valley Unified School District: A Case Study in Policy Making with Regard to the Award of Credit for Experience-Based Learning.

ERIC Educational Resources Information Center

Banker, Nancy Sirmay

This case study of a small suburban school district in the San Francisco Bay Area examines the interplay among individuals and groups within the district who make and implement policy decisions. The issue of awarding credit for experience-based learning focuses and directs the study. As an introduction to examination of the ways decisions are…

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

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.

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).

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.

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.

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.

Self-Directed Learning with Web-Based Sites: How Well Do Students' Perceptions and Thinking Match with Their Teachers?

ERIC Educational Resources Information Center

Ng, Wan

2008-01-01

With research consistently showing that students can be motivated to learn with ICT, this case study sought to investigate Year 7 students' learning about simple machines in an ICT-enhanced environment where they could self-direct their own learning with minimal intervention from the teacher. The study is focused on how well do students and…

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.

Surface and guided waves on structured surfaces and inhomogeneous media

NASA Astrophysics Data System (ADS)

Polanco, Javier

Surface and guided waves on structured surfaces and inhomogeneous media studies the propagation of waves in systems with spatially varying parameters. In the rainbow case (chapter 1), the dielectric constant changes with coordinates. In the cylinder case: boundary and the metal (chapter 2), it is a curved surface. Finally, in the last case (chapter 3), the dielectric constant changes in z-direction.

A Comparison of Trajectory Optimization Methods for the Impulsive Minimum Fuel Rendezvous Problem

NASA Technical Reports Server (NTRS)

Hughes, Steven P.; Mailhe, Laurie M.; Guzman, Jose J.

2003-01-01

In this paper we present, a comparison of trajectory optimization approaches for the minimum fuel rendezvous problem. Both indirect and direct methods are compared for a variety of test cases. The indirect approach is based on primer vector theory. The direct approaches are implemented numerically and include Sequential Quadratic Programming (SQP). Quasi- Newton and Nelder-Meade Simplex. Several cost function parameterizations are considered for the direct approach. We choose one direct approach that appears to be the most flexible. Both the direct and indirect methods are applied to a variety of test cases which are chosen to demonstrate the performance of each method in different flight regimes. The first test case is a simple circular-to-circular coplanar rendezvous. The second test case is an elliptic-to-elliptic line of apsides rotation. The final test case is an orbit phasing maneuver sequence in a highly elliptic orbit. For each test case we present a comparison of the performance of all methods we consider in this paper.

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

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.

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.

English Teachers in the Digital Age--A Case Study of Policy and Expert Practice from England

ERIC Educational Resources Information Center

Goodwyn, Andy

2011-01-01

This article is a case study of how English teachers in England have coped with the paradigm shift from print to digital literacy. It reviews a large scale national initiative that was intended to upskill all teachers, considers its weak impact and explores the author's involvement in the evaluation of the project's direct value to English…

Building Better Beginnings: A Case Study of How a Daily Physical Skills Session Is Supporting Overall Learning and Development for Young Boys

ERIC Educational Resources Information Center

Chalke, Joy

2016-01-01

This case study argues for the consideration of an adult-directed physical skills session as an approach to supporting boys learning in the Early Years Foundation Stage in England. It exemplifies a model of professional development that utilises the individual knowledge and expertise of practitioners to support and extend others' practice. It…

Poetry for the Broken-Hearted: How a Marginal Year 12 English Class Was Turned on to Writing

ERIC Educational Resources Information Center

Locke, Terry; Kato, Helen

2012-01-01

This paper draws on a case study undertaken by an English teacher in a rural school with a Year 12 English class, most of whom had been singularly unsuccessful in terms of NCEA achievement. The case study was undertaken as part of a two-year project, directed by the first author, entitled: "Teachers as writers: Transforming professional…

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.

The Social Computer

NASA Astrophysics Data System (ADS)

Serugendo, Giovanna Di Marzo; Risoldi, Matteo; Solemayni, Mohammad

The following sections are included: * Introduction * Problem and Research Questions * State of the Art * TSC Structure and Computational Awareness * Methodology and Research Directions * Case Study: Democracy * Conclusions

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.

Anaphylactic Reactions to Oligosaccharides in Red Meat: a Syndrome in Evolution

PubMed Central

2012-01-01

Objective While most allergic responses to food are directed against protein epitopes and occur within 30 minutes of ingesting the allergen, recent studies suggest that delayed reactions may occur, sometimes mediated by IgE antibodies directed against carbohydrate moieties. The objective of this review is to summarize the clinical features and management of delayed hypersensitivity reactions to mammalian meat mediated by IgE antibodies to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide. Methods A PubMed search was conducted with MeSH terms: galactosyl-(1,3) galactose, oligosaccharides, cetuximab, allergy/hypersensitivity, and anaphylaxis. Reported cases with alpha-gal-mediated reactions were reviewed. This research study was approved by the Institutional Review Board of East Tennessee State University. Results Thirty-two cases of adults presenting with red-meat induced allergy thought to be related to oligosaccharides have been reported in the literature so far, making this a rare and evolving syndrome. Most of these patients demonstrated delayed reactions to beef, as was seen in the case reported by us in this manuscript. IgE specific to alpha-gal was identified in most patients with variable response to skin testing with beef and pork. Inhibition studies in some cases showed that the IgE antibodies to beef were directed towards alpha-gal in the meat rather than the protein. The patients often reported history of tick bites, the significance of which is unclear at present. Reactions to cetuximab, a monoclonal antibody, are mediated by a similar mechanism, with IgE antibodies directed against an alpha-gal moiety incorporated in the drug structure. Conclusion Alpha-gal is an oligosaccharide recently incriminated in delayed anaphylactic reactions to mammalian meats such as to beef, pork, and lamb. It appears that anaphylactic reactions to the anti-cancer biological agent, cetuximab, may be linked mechanistically to the same process. More studies are required to understand the underlying molecular basis for these delayed reactions in specific, and their broader implications for host defense in general. PMID:22397506

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.

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,…

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…

Persistent Left Unilateral Mirror Writing: A Neuropsychological Case Study

ERIC Educational Resources Information Center

Angelillo, Valentina G.; De Lucia, Natascia; Trojano, Luigi; Grossi, Dario

2010-01-01

Mirror writing (MW) is a rare disorder in which a script runs in direction opposite to normal and individual letters are reversed. The disorder generally occurs after left-hemisphere lesions, is transient and is observed on the left hand, whereas usually motor impairments prevent assessment of direction of right handwriting. We describe a…

Supporting Research Impact Metrics in Academic Libraries: A Case Study

ERIC Educational Resources Information Center

Braun, Steven

2017-01-01

Measuring research impact has become a nearly ubiquitous facet of scholarly communication. At the University of Minnesota Medical School, new administrative directives have directly tied impact metrics to faculty assessment, promotion, and tenure. In this paper, I describe a platform for the analysis and visualization of research impact that was…

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.

The Educational Philosophy and Development Direction of School of Foreign Studies in Engineering Colleges in China: A Case Study of North China University of Water Resources and Electric Power (NCWU)

ERIC Educational Resources Information Center

Xinqiang, Wei

2012-01-01

This paper gives a brief analysis on the educational advantages and objects of NCWU. It believes that the educational philosophy and development direction of foreign school in engineering colleges must be set up on the basis of need of China and talents need, moreover, the development of the School of Foreign Studies must be analyzed by…

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.

Some case studies of ocean wave physical processes utilizing the GSFC airborne radar ocean wave spectrometer

NASA Technical Reports Server (NTRS)

Jackson, F. C.

1984-01-01

The NASA K sub u band Radar Ocean Wave Spectrometer (ROWS) is an experimental prototype of a possible future satellite instrument for low data rate global waves measurements. The ROWS technique, which utilizes short pulse radar altimeters in a conical scan mode near vertical incidence to map the directional slope spectrum in wave number and azimuth, is briefly described. The potential of the technique is illustrated by some specific case studies of wave physical processes utilizing the aircraft ROWS data. These include: (1) an evaluation of numerical hindcast model performance in storm sea conditions, (2) a study of fetch limited wave growth, and (3) a study of the fully developed sea state. Results of these studies, which are briefly summarized, show how directional wave spectral observations from a mobile platform can contribute enormously to our understanding of wave physical processes.

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

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.

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.

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.

Mini-Journal Inquiry Laboratory: A Case Study in a General Chemistry Kinetics Experiment

ERIC Educational Resources Information Center

Zhao, Ningfeng; Wardeska, Jeffrey G.

2011-01-01

The mini-journal curriculum for undergraduate science laboratories mirrors the format of scientific literature and helps students improve their learning through direct scientific practices. The lab embodies the essential features of scientific inquiry and replaces the traditional "cookbook" lab to engage students in active learning. A case study…

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%.

Interspecific Infanticide and Infant-Directed Aggression by Spider Monkeys (Ateles hybridus) in a Fragmented Forest in Colombia

PubMed Central

Rimbach, Rebecca; Pardo-Martinez, Alejandra; Montes-Rojas, Andres; Di Fiore, Anthony; Link, Andres

2012-01-01

Interspecific aggression amongst nonhuman primates is rarely observed and has been mostly related to scenarios of resource competition. Interspecific infanticide is even rarer, and both the ultimate and proximate socio-ecological factors explaining this behavior are still unclear. We report two cases of interspecific infanticide and five cases of interspecific infant-directed aggression occurring in a well-habituated primate community living in a fragmented landscape in Colombia. All cases were initiated by male brown spider monkeys (Ateles hybridus) and were directed toward infants of either red howler monkeys (Alouatta seniculus: n = 6 cases) or white-fronted capuchins (Cebus albifrons: n = 1 case). One individual, a subadult spider monkey male, was involved in all but one case of interspecific infanticide or aggression. Other adult spider monkeys participated in interspecific aggression that did not escalate into potentially lethal encounters. We suggest that competition for food resources and space in a primate community living in high population densities and restricted to a forest fragment of ca. 65 ha might partly be driving the observed patterns of interspecific aggression. On the other hand, the fact that all but one case of interspecific infanticide and aggression involved the only subadult male spider monkey suggests this behavior might either be pathological or constitute a particular case of redirected aggression. Even if the underlying principles behind interspecific aggression and infanticide are poorly understood, they represent an important factor influencing the demographic trends of the primate community at this study site. Am. J. Primatol. 74:990–997, 2012. © 2012 Wiley Periodicals, Inc. PMID:22767357

Interspecific infanticide and infant-directed aggression by spider monkeys (Ateles hybridus) in a fragmented forest in Colombia.

PubMed

Rimbach, Rebecca; Pardo-Martinez, Alejandra; Montes-Rojas, Andres; Di Fiore, Anthony; Link, Andres

2012-11-01

Interspecific aggression amongst nonhuman primates is rarely observed and has been mostly related to scenarios of resource competition. Interspecific infanticide is even rarer, and both the ultimate and proximate socio-ecological factors explaining this behavior are still unclear. We report two cases of interspecific infanticide and five cases of interspecific infant-directed aggression occurring in a well-habituated primate community living in a fragmented landscape in Colombia. All cases were initiated by male brown spider monkeys (Ateles hybridus) and were directed toward infants of either red howler monkeys (Alouatta seniculus: n = 6 cases) or white-fronted capuchins (Cebus albifrons: n = 1 case). One individual, a subadult spider monkey male, was involved in all but one case of interspecific infanticide or aggression. Other adult spider monkeys participated in interspecific aggression that did not escalate into potentially lethal encounters. We suggest that competition for food resources and space in a primate community living in high population densities and restricted to a forest fragment of ca. 65 ha might partly be driving the observed patterns of interspecific aggression. On the other hand, the fact that all but one case of interspecific infanticide and aggression involved the only subadult male spider monkey suggests this behavior might either be pathological or constitute a particular case of redirected aggression. Even if the underlying principles behind interspecific aggression and infanticide are poorly understood, they represent an important factor influencing the demographic trends of the primate community at this study site. © 2012 Wiley Periodicals, Inc.

Transient heat transfer in viscous rarefied gas between concentric cylinders. Effect of curvature

NASA Astrophysics Data System (ADS)

Gospodinov, P.; Roussinov, V.; Dankov, D.

2015-10-01

The thermoacoustic waves arising in cylindrical or planar Couette rarefied gas flow between rotating cylinders is studied in the cases of suddenly cylinder (active) wall velocity direction turn on. An unlimited increase in the radius of the inner cylinder flow can be interpreted as Couette flow between the two flat plates. Based on the developed in previous publications Navier-Stockes-Fourier (NSF) model and Direct Simulation Monte Carlo (DSMC) method and their numerical solutions, are considered transient processes in the gas phase. Macroscopic flow characteristics (velocity, density, temperature) are received. The cylindrical flow cases for fixed velocity and temperature of the both walls are considered. The curvature effects over the wave's distribution and attenuation are studied numerically.

A Clinicopathological Study of Pemphigus in Eastern India with Special Reference to Direct Immunofluorescence

PubMed Central

Chowdhury, Joyeeta; Datta, Pijush Kanti; Chowdhury, Satyendra Nath; Das, Nilay Kanti

2016-01-01

Background: Pemphigus is a group of chronic autoimmune vesico-bullous disorders in which the epidermis and the basement membrane zone are the focus of attack resulting in cutaneous and mucosal blister formation. Direct immunofluorescence (DIF) test is a very sensitive test for the diagnosis Aim: To study the clinico histopathological patterns of pemphigus in eastern India. The study also aims to correlate DIF with clinical and histologic findings as well as severity of skin involvement [scoring systems]. Materials and Methods: Total 41 patients were studied over a period of 1 year in the Post-graduate centre of Dermatology in Eastern India. DIF, histopathology and clinical data were correlated. Results: In our study Pemphigus vulgaris (PV) was the predominant type with 32 cases followed by 8 cases of pemphigus foliaceus (PF) and a single case of IgA pemphigus. Mean age at presentation was late middle age. Majority of the patients, 26 (63.41%) initially had cutaneous involvement followed by mucosal involvement. In this study group 36 (87.80%) patients showed acantholytic cells on histopathological examination. Most patients of PV showed suprabasal blister 20 (62.50%) followed by intraspinous 5 (15.62%) and subcorneal 5 (15.62%) blister. In majority 28 (87.50%) of the PV patients IgG and C3 antibodies were deposited throughout the epidermis. The strength of antibody positivity was strong in most of the patients (71.87%). In cases of PF mostly IgG 6 (75%) antibodies were deposited in the upper epidermis. DIF intensity had poor correlation with disease activity/severity except in PF. Conclusion: Almost 85.36% cases of pemphigus were diagnosed clinicopathologically. But 6 cases couldn’t be diagnosed accurately on clinicopathological basis and in them DIF was confirmatory. Two cases of pure mucosal PV and 1 case of IgA pemphigus was confirmed by DIF. Two cases of bullous pemphigoid clinico-histologically mimicking PV were also excluded by DIF. So it appears from our study that DIF is confirmatory for diagnosis of pemphigus in all cases. PMID:27293249

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.

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.

The Development of Technical and Vocational Education in Malaysia--A Case Study in Quality Improvement. Case Studies on Technical and Vocational Education in Asia and the Pacific.

ERIC Educational Resources Information Center

Hee, Tieng Fok

The economic profile of Malaysia has changed from an economy mainly based on agriculture and the production of tin ore to a more balanced economy with continuing growth in the manufacturing and industrial sectors. Educational programs need to be upgraded and improved, particularly the direction and development of technical and vocational education…

Twelve Factors Leading to Fundamental Pedagogical Change in a Primary School: A Case-Study

ERIC Educational Resources Information Center

Norris, Cathleen; Soloway, Elliot

2016-01-01

A school can change. In this case study, the authors describe the 12 factors they have identified as being key in the transformation of the core pedagogical practices at Nan Chiau Primary School, Singapore, from direct instruction to inquiry, from a 20th to a 21st century school. While the adoption of 1:1 mobile devices played a catalytic role in…

Research impact in the community-based health sciences: an analysis of 162 case studies from the 2014 UK Research Excellence Framework.

PubMed

Greenhalgh, Trisha; Fahy, Nick

2015-09-21

The 2014 UK Research Excellence Framework (REF2014) generated a unique database of impact case studies, each describing a body of research and impact beyond academia. We sought to explore the nature and mechanism of impact in a sample of these. The study design was manual content analysis of a large sample of impact case studies (producing mainly quantitative data), plus in-depth interpretive analysis of a smaller sub-sample (for qualitative detail), thereby generating both breadth and depth. For all 162 impact case studies submitted to sub-panel A2 in REF2014, we extracted data on study design(s), stated impacts and audiences, mechanisms of impact, and efforts to achieve impact. We analysed four case studies (selected as exemplars of the range of approaches to impact) in depth, including contacting the authors for their narratives of impact efforts. Most impact case studies described quantitative research (most commonly, trials) and depicted a direct, linear link between research and impact. Research was said to have influenced a guideline in 122 case studies, changed policy in 88, changed practice in 84, improved morbidity in 44 and reduced mortality in 25. Qualitative and participatory research designs were rare, and only one case study described a co-production model of impact. Eighty-two case studies described strong and ongoing linkages with policymakers, but only 38 described targeted knowledge translation activities. In 40 case studies, no active efforts to achieve impact were described. Models of good implementation practice were characterised by an ethical commitment by researchers, strong institutional support and a proactive, interdisciplinary approach to impact activities. REF2014 both inspired and documented significant efforts by UK researchers to achieve impact. But in contrast with the published evidence on research impact (which depicts much as occurring indirectly through non-linear mechanisms), this sub-panel seems to have captured mainly direct and relatively short-term impacts one step removed from patient outcomes. Limited impacts on morbidity and mortality, and researchers' relatively low emphasis on the processes and interactions through which indirect impacts may occur, are concerns. These findings have implications for multi-stakeholder research collaborations such as UK National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care, which are built on non-linear models of impact.

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.

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.

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…

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.

Directional nonlinear guided wave mixing: Case study of counter-propagating shear horizontal waves

NASA Astrophysics Data System (ADS)

Hasanian, Mostafa; Lissenden, Cliff J.

2018-04-01

While much nonlinear ultrasonics research has been conducted on higher harmonic generation, wave mixing provides the potential for sensitive measurements of incipient damage unencumbered by instrumentation nonlinearity. Studies of nonlinear ultrasonic wave mixing, both collinear and noncollinear, for bulk waves have shown the robust capability of wave mixing for early damage detection. One merit of bulk wave mixing lies in their non-dispersive nature, but guided waves enable inspection of otherwise inaccessible material and a variety of mixing options. Co-directional guided wave mixing was studied previously, but arbitrary direction guided wave mixing has not been addressed until recently. Wave vector analysis is applied to study variable mixing angles to find wave mode triplets (two primary waves and a secondary wave) resulting in the phase matching condition. As a case study, counter-propagating Shear Horizontal (SH) guided wave mixing is analyzed. SH wave interactions generate a secondary Lamb wave mode that is readily receivable. Reception of the secondary Lamb wave mode is compared for an angle beam transducer, an air coupled transducer, and a laser Doppler vibrometer (LDV). Results from the angle beam and air coupled transducers are quite consistent, while the LDV measurement is plagued by variability issues.

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).

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

One Health and the Environment: Toxic Cyanobacteria, a Case Study

EPA Science Inventory

The study of environmental health typically focuses on human populations. However, companion animals, livestock and wildlife also experience adverse health effects from environmental pollutants. Animals may experience direct exposure to pollutants in ambient exposure situations. ...

An outbreak of chickenpox at a child care centre in Western Australia. Costs to the community and implications for vaccination policy.

PubMed

Vally, Hassan; Dowse, Gary K; Eastwood, Keith; Cameron, Scott

2007-04-01

Between May and June 2002 an outbreak of chickenpox (CP) occurred at a child care centre in Perth, Western Australia. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and to define the direct and indirect costs associated with CP infections in young children. A cohort study of the outbreak utilising attendance records and a telephone survey of parents was conducted. Of the 211 children attending the child care centre at the time of the outbreak, 44 contracted CP (attack rate 25.7%). In addition, two staff members, five secondary household contacts (secondary attack rate 38.5%) and four secondary non-household associated contacts were infected. There were no severe complications or any hospitalisations recorded in infected persons. Two cases had been vaccinated previously. Vaccine effectiveness for CP of any severity was 78.0% (95% CI 15.4-94.3%) while vaccine effectiveness against severe CP was 100%. Direct costs during this outbreak were estimated to be $54 per case and the total costs, including cost of parental time off work or study, were estimated to be $525.73 per case. Although morbidity associated with CP in young children is not great, infection in childhood is almost universal. This study found that the average costs associated with each CP case were considerable. Since varicella vaccine affords good protection against CP, the recent inclusion of this vaccine in the Australian childhood vaccination schedule should save the community a considerable amount in direct and indirect costs if high coverage rates can be achieved.

Case studies on direct liquefaction of low rank Wyoming coal

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

Adler, P.; Kramer, S.J.; Poddar, S.K.

Previous Studies have developed process designs, costs, and economics for the direct liquefaction of Illinois No. 6 and Wyoming Black Thunder coals at mine-mouth plants. This investigation concerns two case studies related to the liquefaction of Wyoming Black Thunder coal. The first study showed that reducing the coal liquefaction reactor design pressure from 3300 to 1000 psig could reduce the crude oil equivalent price by 2.1 $/bbl provided equivalent performing catalysts can be developed. The second one showed that incentives may exist for locating a facility that liquifies Wyoming coal on the Gulf Coast because of lower construction costs andmore » higher labor productivity. These incentives are dependent upon the relative values of the cost of shipping the coal to the Gulf Coast and the increased product revenues that may be obtained by distributing the liquid products among several nearby refineries.« less

Effect of driving voltages in dual capacitively coupled radio frequency plasma: A study by nonlinear global model

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

Bora, B., E-mail: bbora@cchen.cl

2015-10-15

On the basis of nonlinear global model, a dual frequency capacitively coupled radio frequency plasma driven by 13.56 MHz and 27.12 MHz has been studied to investigate the influences of driving voltages on the generation of dc self-bias and plasma heating. Fluid equations for the ions inside the plasma sheath have been considered to determine the voltage-charge relations of the plasma sheath. Geometrically symmetric as well as asymmetric cases with finite geometrical asymmetry of 1.2 (ratio of electrodes area) have been considered to make the study more reasonable to experiment. The electrical asymmetry effect (EAE) and finite geometrical asymmetry is found tomore » work differently in controlling the dc self-bias. The amount of EAE has been primarily controlled by the phase angle between the two consecutive harmonics waveforms. The incorporation of the finite geometrical asymmetry in the calculations shift the dc self-bias towards negative polarity direction while increasing the amount of EAE is found to increase the dc self-bias in either direction. For phase angle between the two waveforms ϕ = 0 and ϕ = π/2, the amount of EAE increases significantly with increasing the low frequency voltage, whereas no such increase in the amount of EAE is found with increasing high frequency voltage. In contrast to the geometrically symmetric case, where the variation of the dc self-bias with driving voltages for phase angle ϕ = 0 and π/2 are just opposite in polarity, the variation for the geometrically asymmetric case is different for ϕ = 0 and π/2. In asymmetric case, for ϕ = 0, the dc self-bias increases towards the negative direction with increasing both the low and high frequency voltages, but for the ϕ = π/2, the dc-self bias is increased towards positive direction with increasing low frequency voltage while dc self-bias increases towards negative direction with increasing high frequency voltage.« less

Magnetorotational dynamo action in the shearing box

NASA Astrophysics Data System (ADS)

Walker, Justin; Boldyrev, Stanislav

2017-09-01

Magnetic dynamo action caused by the magnetorotational instability is studied in the shearing-box approximation with no imposed net magnetic flux. Consistent with recent studies, the dynamo action is found to be sensitive to the aspect ratio of the box: it is much easier to obtain in tall boxes (stretched in the direction normal to the disc plane) than in long boxes (stretched in the radial direction). Our direct numerical simulations indicate that the dynamo is possible in both cases, given a large enough magnetic Reynolds number. To explain the relatively larger effort required to obtain the dynamo action in a long box, we propose that the turbulent eddies caused by the instability most efficiently fold and mix the magnetic field lines in the radial direction. As a result, in the long box the scale of the generated strong azimuthal (stream-wise directed) magnetic field is always comparable to the scale of the turbulent eddies. In contrast, in the tall box the azimuthal magnetic flux spreads in the vertical direction over a distance exceeding the scale of the turbulent eddies. As a result, different vertical sections of the tall box are permeated by large-scale non-zero azimuthal magnetic fluxes, facilitating the instability. In agreement with this picture, the cases when the dynamo is efficient are characterized by a strong intermittency of the local azimuthal magnetic fluxes.

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.

Evolution of egoism on semi-directed and undirected Barabási-Albert networks

NASA Astrophysics Data System (ADS)

Lima, F. W. S.

2015-05-01

Through Monte Carlo simulations, we study the evolution of the four strategies: Ethnocentric, altruistic, egoistic and cosmopolitan in one community of individuals. Interactions and reproduction among computational agents are simulated on undirected and semi-directed Barabási-Albert (BA) networks. We study the Hammond-Axelrod (HA) model on undirected and semi-directed BA networks for the asexual reproduction case. With a small modification in the traditional HA model, our simulations showed that egoism wins, differently from other results found in the literature where ethnocentric strategy is common. Here, mechanisms such as reciprocity are absent.

Interdisciplinary team communication among forensic nurses and rape victim advocates.

PubMed

Patterson, Debra

2014-01-01

Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.

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.

Governance of water resources in the phase of change: a case study of the implementation of the EU Water Framework Directive in Sweden.

PubMed

Hammer, Monica; Balfors, Berit; Mörtberg, Ulla; Petersson, Mona; Quin, Andrew

2011-03-01

In this article, focusing on the ongoing implementation of the EU Water Framework Directive, we analyze some of the opportunities and challenges for a sustainable governance of water resources from an ecosystem management perspective. In the face of uncertainty and change, the ecosystem approach as a holistic and integrated management framework is increasingly recognized. The ongoing implementation of the Water Framework Directive (WFD) could be viewed as a reorganization phase in the process of change in institutional arrangements and ecosystems. In this case study from the Northern Baltic Sea River Basin District, Sweden, we focus in particular on data and information management from a multi-level governance perspective from the local stakeholder to the River Basin level. We apply a document analysis, hydrological mapping, and GIS models to analyze some of the institutional framework created for the implementation of the WFD. The study underlines the importance of institutional arrangements that can handle variability of local situations and trade-offs between solutions and priorities on different hierarchical levels.

The Buffering Effect of Hope on Clinicians’ Behavior: A Test in Pediatric Primary Care

PubMed Central

Tennen, Howard; Cloutier, Michelle M.; Wakefield, Dorothy B.; Hall, Charles B.; Brazil, Kevin

2009-01-01

Although trait hope is thought to motivate goal directed actions in the face of impediments, few studies have examined directly hope’s role in overcoming obstacles, and none have done so while accounting for related goal constructs. We describe a study of 127 pediatric primary care providers who over the course of a year were asked to identify new cases of asthma and confirm previously diagnosed active disease by completing for each of their patients a brief survey validated for this purpose. These clinicians also completed measures of hope, self-efficacy, conscientiousness, and perceived obstacles to implementing a pediatric asthma management program. As predicted by hope theory, the agency component of hope buffered clinicians from perceived obstacles by facilitating the identification of asthma cases among high hope clinicians in the face of obstacles. This buffering effect remained after controlling for self-efficacy and conscientiousness. We discuss the study findings in terms of current theories of goal directed behavior and implications for delivering hope-related interventions, and we offer a testable hypothesis regarding when agency and pathways thinking facilitate goal-related behavior. PMID:20161067

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.

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.

Into the development of a model to assess beam shaping and polarization control effects on laser cutting

NASA Astrophysics Data System (ADS)

Rodrigues, Gonçalo C.; Duflou, Joost R.

2018-02-01

This paper offers an in-depth look into beam shaping and polarization control as two of the most promising techniques for improving industrial laser cutting of metal sheets. An assessment model is developed for the study of such effects. It is built upon several modifications to models as available in literature in order to evaluate the potential of a wide range of considered concepts. This includes different kinds of beam shaping (achieved by extra-cavity optical elements or asymmetric diode staking) and polarization control techniques (linear, cross, radial, azimuthal). A fully mathematical description and solution procedure are provided. Three case studies for direct diode lasers follow, containing both experimental data and parametric studies. In the first case study, linear polarization is analyzed for any given angle between the cutting direction and the electrical field. In the second case several polarization strategies are compared for similar cut conditions, evaluating, for example, the minimum number of spatial divisions of a segmented polarized laser beam to achieve a target performance. A novel strategy, based on a 12-division linear-to-radial polarization converter with an axis misalignment and capable of improving cutting efficiency with more than 60%, is proposed. The last case study reveals different insights in beam shaping techniques, with an example of a beam shape optimization path for a 30% improvement in cutting efficiency. The proposed techniques are not limited to this type of laser source, neither is the model dedicated to these specific case studies. Limitations of the model and opportunities are further discussed.

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…

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.

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.

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.

A Case Study Examining the Influence of Black Greek Letter Fraternal Presence, Policies, and Practices on African American Male Student Success at a Predominantly White Institution

ERIC Educational Resources Information Center

Singleton, Stanley Duane

2010-01-01

This qualitative case study was conducted at a mid-sized university in the southeastern United States to determine if a nexus existed among BGLF presence, policies, and practices at a PWI that influences the student success of African American males. This research focused on the analysis of two direct associations--the association between the BGLF…

Case study of psychophysiological diary: infradian rhythms.

PubMed

Slover, G P; Morris, R W; Stroebel, C F; Patel, M K

1987-01-01

A 4-year case study was made of a 42-year-old white woman as seen through the psychophysiological diary. There was an awakening diary and a bedtime diary composed of 125 variables. The data are divided into two series: series I containing a manic episode, and series II as a control. Spectral analysis shows infradian rhythms in hypoglycemia and fear (11 days) and time to fall asleep (5 days). Depressed feelings showed a circatrigintan (28-day) rhythm, which was not correlated with menses. Mania had an annual rhythm (spring) but no circatrigintan or less rhythm. The following correlations have a P value less than or equal to 0.01: mania was directly correlated with number of sleeping pills, time to really wake up, need for rest, moodiness, and helplessness, and indirectly with expectations, pressure at work, sense of time, and emotional state. Interestingly, awakening pulse is directly correlated with awakening temperature, number of sleeping pills, bedtime pulse, tiredness at bedtime, hypoglycemia, and fear. Bedtime pulse is directly correlated with awakening pulse and awakening temperature. Both pulse and temperature at bedtime are directly correlated with negative variables such as tiredness, moodiness, helplessness, and depression, and inversely correlated with positive variables such as happiness, loving, performance at work, and thinking efficiency. This study demonstrates a significant correlation between physiological variables.

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.

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

Cold-water coral banks and submarine landslides: a review

NASA Astrophysics Data System (ADS)

de Mol, Ben; Huvenne, Veerle; Canals, Miquel

2009-06-01

This paper aims to review the relation between cold-water coral bank development and submarine landslides. Both are common features on continental margins, but so far it has not been reviewed which effect—if at all—they may have upon each other. Indirect and direct relations between coral banks and landslides are evaluated here, based on four case studies: the Magellan Mound Province in the Porcupine Seabight, where fossil coral banks appear partly on top of a buried slide deposit; the Sula Ridge Reef Complex and the Storegga landslide both off mid-Norway; and the Mauritania coral bank province, associated with the Mauritanian Slide Complex. For each of these locations, positive and negative relationships between both features are discussed, based on available datasets. Locally submarine landslides might directly favour coral bank development by creating substratum where corals can settle on, enhancing turbulence due to abrupt seabed morphological variations and, in some cases, causing fluid seepage. In turn, some of these processes may contribute to increased food availability and lower sedimentation rates. Landslides can also affect coral bank development by direct erosion of the coral banks, and by the instantaneous increase of turbidity, which may smother the corals. On the other hand, coral banks might have a stabilising function and delay or stop the headwall retrogradation of submarine landslides. Although local relationships can be deduced from these case studies, no general and direct relationship exists between submarine landslides and cold-water coral banks.

Suicidal single gunshot injury to the head: differences in site of entrance wound and direction of the bullet path between right- and left-handed--an autopsy study.

PubMed

Nikolić, Slobodan; Zivković, Vladimir; Babić, Dragan; Juković, Fehim

2012-03-01

The aim of this study was to determine the differences in the anatomical site of a gunshot entrance wound and the direction of the bullet path between right- and left-handed subjects who committed a suicide by a single gunshot injury to the head. The retrospective autopsy study was performed for a 10-year period, and it included selected cases of single suicidal gunshot head injury, committed by handguns. We considered only contact or near-contact wounds. The sample included 479 deceased, with average age 47.1 ± 19.1 years (range, 12-89 years): 432 males and 47 females, with 317 right-handed, 25 left-handed, and 137 subjects with unknown dominant hand. In our observed sample, most cases involved the right temple as the site of entrance gunshot wound (about 67%), followed by the mouth (16%), forehead (7%), left temple (6%), submental (2%), and parietal region (1%). The left temple, right temple, and forehead were the sites of the gunshot entrance wounds, which were the best predictors of the handedness of the deceased (Spearman ρ = 0.149, P = 0.006). Our study showed that the direction of the bullet intracranial path in cases of suicide was even a more potent predictor of the handedness of the deceased (Spearman ρ = 0.263, P = 0.000; Wald = 149.503, P = 0.000).

One Health and the Environment: Toxic Cyanobacteria A Case Study

EPA Science Inventory

The study of environmental health typically focuses on human populations. However, companion animals, livestock and wildlife also experience adverse health effects from environmental pollutants. Animals may experience direct exposure to pollutants unlike people in most ambient ex...

Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry.

PubMed

Elms, Heather; Berman, Shawn; Wicks, Andrew C

2002-10-01

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

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.

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.

Renormalization of a tensorial field theory on the homogeneous space SU(2)/U(1)

NASA Astrophysics Data System (ADS)

Lahoche, Vincent; Oriti, Daniele

2017-01-01

We study the renormalization of a general field theory on the homogeneous space (SU(2)/ ≤ft. U(1)\\right){{}× d} with tensorial interaction and gauge invariance under the diagonal action of SU(2). We derive the power counting for arbitrary d. For the case d  =  4, we prove perturbative renormalizability to all orders via multi-scale analysis, study both the renormalized and effective perturbation series, and establish the asymptotic freedom of the model. We also outline a general power counting for the homogeneous space {{≤ft(SO(D)/SO(D-1)\\right)}× d} , of direct interest for quantum gravity models in arbitrary dimension, and point out the obstructions to the direct generalization of our results to these cases.

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.

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.

An Analysis of U.S. Foreign Direct Investment Policy and Economic Development. A.I.D. Discussion Paper No. 36.

ERIC Educational Resources Information Center

Bergsten, C. Fred; De Castro, Bruce

The purpose of the paper is to analyze U.S. policies toward financial investment in developing nations. The paper is presented in two sections. In section I, the controversial effects of direct foreign investment on development are discussed. Case studies of investment policies toward India, the Philippines, Ghana, Guatemala, and Argentina are…

Directed Diffusion Modelling for Tesso Nilo National Parks Case Study

NASA Astrophysics Data System (ADS)

Yasri, Indra; Safrianti, Ery

2018-01-01

— Directed Diffusion (DD has ability to achieve energy efficiency in Wireless Sensor Network (WSN). This paper proposes Directed Diffusion (DD) modelling for Tesso Nilo National Parks (TNNP) case study. There are 4 stages of scenarios involved in this modelling. It’s started by appointing of sampling area through GPS coordinate. The sampling area is determined by optimization processes from 500m x 500m up to 1000m x 1000m with 100m increment in between. The next stage is sensor node placement. Sensor node is distributed in sampling area with three different quantities i.e. 20 nodes, 30 nodes and 40 nodes. One of those quantities is choose as an optimized sensor node placement. The third stage is to implement all scenarios in stages 1 and stages 2 on DD modelling. In the last stage, the evaluation process to achieve most energy efficient in the combination of optimized sampling area and optimized sensor node placement on Direct Diffusion (DD) routing protocol. The result shows combination between sampling area 500m x 500m and 20 nodes able to achieve energy efficient to support a forest preventive fire system at Tesso Nilo National Parks.

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.

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.

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.

Somatic Consequences and Symptomatic Responses to Stress: Directions for Future Research

DTIC Science & Technology

1999-07-01

endeavors, some early work in developing multi- method , multi-source assessment approaches for identifying cases of PTSD; some clinical studies ... research dealing with the entire concept of the cultural shaping of what he calls the illness narrative and the way in which this tends to control the...talk for five to ten minutes about the pattern of the research you’ve been doing and the directions it’s been going in and the directions you think it

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.

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.

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.

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.

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.

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.

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.
.

Another Link in the Chain: State Policies and Practices for Case Management and Environmental Investigation for Lead-Poisoned Children.

ERIC Educational Resources Information Center

Guthrie, Anne M.; McLaine, Pat

Policy and practice for screening children for lead poisoning have dominated the dialogue about the health care system's role in lead poisoning prevention, with little attention directed to how the health care system responds to a lead-poisoned child once identified. This report details a study of the case management and environmental…

Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers.

PubMed

Black, Timothy R; Shah, Syed M; Busch, Angela J; Metcalfe, Judy; Lim, Hyun J

2011-04-01

Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR = 0.814; 95% CI = 0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR program for direct care health workers, especially in small hospitals.

Numerical simulations of atmospheric dispersion of iodine-131 by different models.

PubMed

Leelőssy, Ádám; Mészáros, Róbert; Kovács, Attila; Lagzi, István; Kovács, Tibor

2017-01-01

Nowadays, several dispersion models are available to simulate the transport processes of air pollutants and toxic substances including radionuclides in the atmosphere. Reliability of atmospheric transport models has been demonstrated in several recent cases from local to global scale; however, very few actual emission data are available to evaluate model results in real-life cases. In this study, the atmospheric dispersion of 131I emitted to the atmosphere during an industrial process was simulated with different models, namely the WRF-Chem Eulerian online coupled model and the HYSPLIT and the RAPTOR Lagrangian models. Although only limited data of 131I detections has been available, the accuracy of modeled plume direction could be evaluated in complex late autumn weather situations. For the studied cases, the general reliability of models has been demonstrated. However, serious uncertainties arise related to low level inversions, above all in case of an emission event on 4 November 2011, when an important wind shear caused a significant difference between simulated and real transport directions. Results underline the importance of prudent interpretation of dispersion model results and the identification of weather conditions with a potential to cause large model errors.

Numerical simulations of atmospheric dispersion of iodine-131 by different models

PubMed Central

Leelőssy, Ádám; Mészáros, Róbert; Kovács, Attila; Lagzi, István; Kovács, Tibor

2017-01-01

Nowadays, several dispersion models are available to simulate the transport processes of air pollutants and toxic substances including radionuclides in the atmosphere. Reliability of atmospheric transport models has been demonstrated in several recent cases from local to global scale; however, very few actual emission data are available to evaluate model results in real-life cases. In this study, the atmospheric dispersion of 131I emitted to the atmosphere during an industrial process was simulated with different models, namely the WRF-Chem Eulerian online coupled model and the HYSPLIT and the RAPTOR Lagrangian models. Although only limited data of 131I detections has been available, the accuracy of modeled plume direction could be evaluated in complex late autumn weather situations. For the studied cases, the general reliability of models has been demonstrated. However, serious uncertainties arise related to low level inversions, above all in case of an emission event on 4 November 2011, when an important wind shear caused a significant difference between simulated and real transport directions. Results underline the importance of prudent interpretation of dispersion model results and the identification of weather conditions with a potential to cause large model errors. PMID:28207853

Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers.

PubMed

Karadakhy, Kamaran; Othman, Nasih; Ibrahimm, Faredun; Saeed, Akam Ali; Amin, Ari Abdul-Adheem Hama

2016-01-01

Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3-36.1, P=0.03). The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment.

Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers

PubMed Central

Karadakhy, Kamaran; Ibrahimm, Faredun; Saeed, Akam Ali; Amin, Ari Abdul-Adheem Hama

2016-01-01

Background: Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. Materials and Methods: A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. Results: During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3–36.1, P=0.03). Conclusion: The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment. PMID:28469675

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.

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.

32 CFR 117.55 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

...))” (available at http://www.dtic.mil/whs/directives/corres/pdf/514301p.pdf) and DoD Instruction 5220.22, “National Industrial Security Program” (see http://www.dtic.mil/whs/directives/corres/pdf/522022p.pdf): (1...://www.dtic.mil/whs/directives/corres/pdf/522022p.pdf). (1) Make FOCI determinations on a case-by-case...

Flat Plate Wake Velocity Statistics Obtained With Circular And Elliptic Trailing Edges

NASA Technical Reports Server (NTRS)

Rai, Man Mohan

2016-01-01

The near wake of a flat plate with circular and elliptic trailing edges is investigated with data from direct numerical simulations. The plate length and thickness are the same in both cases. The separating boundary layers are turbulent and statistically identical. Therefore the wake is symmetric in the two cases. The emphasis in this study is on a comparison of the wake-distributions of velocity components, normal intensity and fluctuating shear stress obtained in the two cases.

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

PubMed

Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C

2012-08-01

This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.

[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.

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.

Spatial distribution of structural defects in Cz-seeded directionally solidified silicon ingots: An etch pit study

NASA Astrophysics Data System (ADS)

Lantreibecq, A.; Legros, M.; Plassat, N.; Monchoux, J. P.; Pihan, E.

2018-02-01

The PV properties of wafers processed from Cz-seeded directionally solidified silicon ingots suffer from variable structural defects. In this study, we draw an overview on the types of structural defects encountered in the specific case of full 〈1 0 0〉 oriented growth. We found micro twins, background dislocations, and subgrains boundaries. We discuss the possible links between thermomechanical stresses and growth processes with spatial evolution of both background dislocation densities and subgrain boundaries length.

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)

When Can We Choose to Forget? An ERP Study into Item-Method Directed Forgetting of Emotional Words

ERIC Educational Resources Information Center

Bailey, Kate; Chapman, Peter

2012-01-01

Emotionally arousing information is treated in a specialised manner across a number of different processing stages, and memory for affective events is often found to be heightened by virtue of this. However, in some cases, emotional experiences might be the very ones that we would like to forget. Here, two item-method directed forgetting studies…

Countering Terrorist Financing: A Case Study of the Kurdistan Workers Party (PKK)

DTIC Science & Technology

2014-12-01

category of Improving Global Anti - Money Laundering /Countering Terrorist Financing Compliance.197 Turkey’s further countermeasures would serve both to...directives in 1991, 2001, and 2005. The first two directives brought responsibilities to financial institutions about anti - money - laundering and required...as the PKK’s money laundering center. Furthermore, the International Criminal Police Organization (Interpol) identified the PKK’s involvement in

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.

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.

Integrating exhaled breath diagnostics by disease-sniffing dogs with instrumental laboratory analysis

EPA Science Inventory

Dogs have been studied for many years as a medical diagnostic tool to detect a pre-clinical disease state by sniffing emissions directly from a human or an in vitro biological sample. Some of the studies report high sensitivity and specificity in blinded case-control studies. How...

A Case Study on Primary, Secondary and University Students' Environmentally Responsible Behaviors in Turkey

ERIC Educational Resources Information Center

Kahyaoglu, Mustafa

2013-01-01

The purpose of the study is to prove the environmentally responsible behaviors of primary, secondary and university students in Turkey. The students', who attended the study as participants, environmentally political behaviors, consumer/economical behaviors, direct behaviors toward protecting the environment and individual and public persuasion…

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.

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.

Duplex scanning diagnosis of internal carotid artery dissections. A case control study.

PubMed

Alecu, C; Fortrat, J O; Ducrocq, X; Vespignani, H; de Bray, J M

2007-01-01

The reliability of duplex scanning (DS) for the diagnosis of internal carotid artery dissections (ICAD) is not clear. Nine DS signs known to be suggestive for the diagnosis of ICAD were compared between 70 patients with ICAD and 70 matched patients without dissection. Visible internal tapering occlusion, regular eccentric narrowing channel, ectasia beyond the carotid bulb, resistive index asymmetry, blood flow slowdown, ophthalmic artery blood flow inversion, and biphasic flow are more frequent in cases than in controls (p < 0.001). Atheroma plaques were absent in 80% of ICAD. When DS direct signs and hemodynamic signs were studied, sensitivity was 90% and specificity 60%. Diagnosis of ICAD by DS could be improved if direct signs were combined with hemodynamic signs, giving a high sensitivity and a rather good specificity. Copyright 2007 S. Karger AG, Basel.

Motivation recycling: pre-recycling case study in Minsk, Belarus.

PubMed

Miafodzyeva, Sviatlana; Brandt, Nils; Olsson, Monika

2010-04-01

Given the aim of motivating householders to behave in a recycling-friendly manner, there is a need to understand consumers' recycling behaviour. This paper documents and analyses acceptability and awareness of a pre-recycling society, through a survey carried out in the region of Minsk, Belarus. The results show a large number of people have no strong awareness about separate collection of household waste for recycling. By analysing the pre-recycling behaviour of Minsk citizens and substantive comparison with literature studies of a more mature recycling society such as Sweden, we indicate common sociodemographic variables for both cases and determine that these sociodemographic characteristics will directly influence recycling behaviour in countries like Belarus. It is also noted that the lack of recycling habit cannot directly predict subsequent recycling behaviour on the stage of implementation the recycling system.

Penetration of Magnetosheath Plasma into Dayside Magnetosphere. 2. ; Magnetic Field in Plasma Filaments

NASA Technical Reports Server (NTRS)

Lyatsky, Wladislaw; Pollock, Craig; Goldstein, Melvyn L.; Lyatskaya, Sonya Inna; Avanov, Levon Albert

2016-01-01

In this paper, we examined plasma structures (filaments), observed in the dayside magnetosphere but containing magnetosheath plasma. These filaments show the stable antisunward motion (while the ambient magnetospheric plasma moved in the opposite direction) and the existence of a strip of magnetospheric plasma, separating these filaments from the magnetosheath. These results, however, contradict both theoretical studies and simulations by Schindler (1979), Ma et al. (1991), Dai and Woodward (1994, 1998), and other researchers, who reported that the motion of such filaments through the magnetosphere is possible only when their magnetic field is directed very close to the ambient magnetic field, which is not the situation that is observed. In this study, we show that this seeming contradiction may be related to different events as the theoretical studies and simulations are related to the case when the filament magnetic field is about aligned with filament orientation, whereas the observations show that the magnetic field in these filaments may be rotating. In this case, the rotating magnetic field, changing incessantly its direction, drastically affects the penetration of plasma filaments into the magnetosphere. In this case, the filaments with rotating magnetic field, even if in each moment it is significantly inclined to the ambient magnetic field, may propagate through the magnetosphere, if their average (for the rotation period) magnetic field is aligned with the ambient magnetic field. This shows that neglecting the rotation of magnetic field in these filaments may lead to wrong results.

Case studies continue to illuminate the cognitive neuroscience of memory.

PubMed

Rosenbaum, R Shayna; Gilboa, Asaf; Moscovitch, Morris

2014-05-01

The current ubiquity of functional neuroimaging studies, and the importance they have had in elucidating brain function, obscures the fact that much of what we know about brain-behavior relationships derives largely from the study of single- and multiple-patient cases. A major goal of the present review is to describe how single cases continue to uniquely and critically contribute to cognitive neuroscience theory. With several recent examples from the literature, we demonstrate that single cases can both challenge accepted dogma and generate hypotheses and theories that steer the field in new directions. We discuss recent findings from case studies that specify critical functions of the hippocampus in episodic memory and recollection, and clarify its role in nonmnemonic abilities. Although we focus on the hippocampus, we discuss other regions and the occurrence of new associative learning, as well as the involvement of the ventromedial prefrontal and parietal cortices in memory encoding and retrieval. We also describe ways of dealing with the shortcomings of case studies, and emphasize the partnership of patient and neuroimaging methods in constraining neurocognitive models of memory. © 2014 New York Academy of Sciences.

Strategic planning and marketing research for older, inner-city health care facilities: a case study.

PubMed

Wood, V R; Robertson, K R

1992-01-01

Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.

Proceedings: Army Medical Department Service Psychology Symposium Held at El Paso, Texas on 13-17 November 1978

DTIC Science & Technology

1978-11-01

Assessing the Psychological Component in Low Back Pain with the MMPI P003 754 Hypnosis in Army Aviation: A Case Study P003 755 Psychiatric Symptoms...in Low Back Pain with the MMPI - Frank H. Rath, Jr. and Thomas Scully . o ...... ° . 77 Hypnosis in Amy Aviation: A Case Study - William R. Gentry...and New Directions Dr. Ray Gentry Weight Control Program (Thursday) Hypnosis in Army Aviation (Friday) Dr. Gary Greenfiel• Desertion in the Volunteer

30 CFR 77.701-2 - Approved methods of grounding metallic frames, casings, and other enclosures of electric...

Code of Federal Regulations, 2010 CFR

2010-07-01

... from a direct-current power system with one polarity grounded will be approved: (1) A solid connection..., casings, and other enclosures of electric equipment receiving power from a direct-current power system. 77... enclosures of electric equipment receiving power from a direct-current power system. (a) The following...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 77.701-2 - Approved methods of grounding metallic frames, casings, and other enclosures of electric...

Code of Federal Regulations, 2011 CFR

2011-07-01

... from a direct-current power system with one polarity grounded will be approved: (1) A solid connection..., casings, and other enclosures of electric equipment receiving power from a direct-current power system. 77... enclosures of electric equipment receiving power from a direct-current power system. (a) The following...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

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

Outer planet probe navigation. [considering Pioneer space missions

NASA Technical Reports Server (NTRS)

Friedman, L.

1974-01-01

A series of navigation studies in conjunction with outer planet Pioneer missions are reformed to determine navigation requirements and measurement systems in order to target probes. Some particular cases are established where optical navigation is important and some cases where radio alone navigation is suffucient. Considered are a direct Saturn mission, a Saturn Uranus mission, a Jupiter Uranus mission, and a Titan probe mission.

Supercritical Fluid Extraction versus Traditional Solvent Extraction of Caffeine from Tea Leaves: A Laboratory-Based Case Study for an Organic Chemistry Course

ERIC Educational Resources Information Center

Schaber, Peter M.; Larkin, Judith E.; Pines, Harvey A.; Berchou, Kelly; Wierchowski, Elizabeth; Marconi, Andrew; Suriani, Allison

2012-01-01

In this case-based laboratory, an instrument sales person attempts to convince an analysis laboratory of the virtues of supercritical fluid extraction (SFE). The sales person deals directly with the laboratory technicians who will make the decision. Arrangements are made to have SFE instrumentation brought into the laboratory for a comparative…

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.

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.

Two cases of erosive oral lichen planus with autoantibodies to desmoglein 3.

PubMed

Muramatsu, Ken; Nishie, Wataru; Natsuga, Ken; Fujita, Yasuyuki; Iwata, Hiroaki; Yamada, Tamaki; Yamashita, Emi; Asaka, Takuya; Shimizu, Hiroshi

2016-11-01

Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa of unknown etiology. Clinically, the erosive type of OLP (erosive OLP) can show features similar to those of pemphigus vulgaris (PV), an autoimmune blistering disorder in which desmoglein (Dsg)3 is targeted. In addition to clinical and histopathological findings, immunological studies, including direct immunofluorescence (IF), indirect IF and enzyme-linked immunosorbent assay (ELISA) that detect autoantibodies to Dsg3, are helpful in differentiating erosive OLP from PV. Here, we show two cases of erosive OLP with autoantibodies to Dsg3. Patient 1 was a 68-year-old woman with chronic erosions of the oral mucosa, in which elevated levels of immunoglobulin (Ig)G autoantibodies to Dsg1 and Dsg3 were detected by ELISA. Patient 2 was an 85-year-old woman with white striae with erosions on the lateral sides of the buccal mucosa with elevated levels of IgG autoantibodies to Dsg3 detected by ELISA. Histopathological findings from both cases showed lichenoid dermatitis, and both direct and indirect IF showed no tissue-bound IgG autoantibodies. From these findings, the diagnosis of erosive OLP was made. Immunological assays revealed both cases to have IgG-directing calcium-independent linear epitopes on Dsg3, which are suggestive of non-pathogenic autoantibodies. In addition, autoantibodies to Dsg3 in patient 2 reacted with a prosequence-possessing precursor form of Dsg3 but not with the mature form of the molecule. The present study suggests that erosive OLP may develop anti-Dsg3 autoantibodies, which should be carefully assessed. © 2016 Japanese Dermatological Association.

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.

Sodium Tetradecyl Sulphate Direct Intralesional Sclerotherapy of Venous Malformations of the Vulva and Vagina: Report of Five Cases

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

Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com; Venetucci, Pietro; Hatzidakis, Adam

2011-02-15

We report five cases of female patients affected by symptomatic focal external genital venous malformations treated with percutaneous direct intralesional injection of sodium tetradecyl sulphate (STS). All patients were referred because of discomfort and pain when sexual intercourse was attempted. Direct sclerotherapy with 3% STS was performed on a day-hospital basis with the patient under local anesthesia. Complete resolution of the symptoms was achieved in all cases. No major adverse effects were reported. Direct intralesional sclerotherapy with STS may be considered a safe and effective method for the treatment of female external genital malformation without the necessity of general anesthesiamore » for pain control.« less

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)

Increasing awareness with recognition of pulsatile tinnitus for nurse practitioners in the primary care setting: A case study.

PubMed

Vecchiarelli, Kelly; Amar, Arun Paul; Emanuele, Donna

2017-09-01

Pulsatile tinnitus is a whooshing sound heard synchronous with the heartbeat. It is an uncommon symptom affecting fewer than 10% of patients with tinnitus. It often goes unrecognized in the primary care setting. Failure to recognize this symptom can result in a missed or delayed diagnosis of a potentially life-threatening condition known as a dural arteriovenous fistula. The purpose of this case study is to provide a structured approach to the identification of pulsatile tinnitus and provide management recommendations. A case study and review of pertinent literature. Pulsatile tinnitus usually has a vascular treatable cause. A comprehensive history and physical examination will alert the nurse practitioner (NP) when pulsatile tinnitus is present. Auscultation in specific areas of the head can detect audible or objective pulsatile tinnitus. Pulsatile tinnitus that is audible to the examiner is an urgent medical condition requiring immediate consultation and referral. Knowledge of pulsatile tinnitus and awareness of this often treatable condition directs the NP to perform a detailed assessment when patients present with tinnitus, directs appropriate referral for care and treatment, and can reduce the risk of delayed or missed diagnosis. ©2017 American Association of Nurse Practitioners.

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.

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.

Single-particle dispersion in stably stratified turbulence

NASA Astrophysics Data System (ADS)

Sujovolsky, N. E.; Mininni, P. D.; Rast, M. P.

2018-03-01

We present models for single-particle dispersion in vertical and horizontal directions of stably stratified flows. The model in the vertical direction is based on the observed Lagrangian spectrum of the vertical velocity, while the model in the horizontal direction is a combination of a continuous-time eddy-constrained random walk process with a contribution to transport from horizontal winds. Transport at times larger than the Lagrangian turnover time is not universal and dependent on these winds. The models yield results in good agreement with direct numerical simulations of stratified turbulence, for which single-particle dispersion differs from the well-studied case of homogeneous and isotropic turbulence.

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.

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.

One- and Two-dimensional Solitary Wave States in the Nonlinear Kramers Equation with Movement Direction as a Variable

NASA Astrophysics Data System (ADS)

Sakaguchi, Hidetsugu; Ishibashi, Kazuya

2018-06-01

We study self-propelled particles by direct numerical simulation of the nonlinear Kramers equation for self-propelled particles. In our previous paper, we studied self-propelled particles with velocity variables in one dimension. In this paper, we consider another model in which each particle exhibits directional motion. The movement direction is expressed with a variable ϕ. We show that one-dimensional solitary wave states appear in direct numerical simulations of the nonlinear Kramers equation in one- and two-dimensional systems, which is a generalization of our previous result. Furthermore, we find two-dimensionally localized states in the case that each self-propelled particle exhibits rotational motion. The center of mass of the two-dimensionally localized state exhibits circular motion, which implies collective rotating motion. Finally, we consider a simple one-dimensional model equation to qualitatively understand the formation of the solitary wave state.

The effect of the EU tissues and cells directive on bone banking in Denmark: a case study.

PubMed

Birk, Sofie Okkels; Hoeyer, Klaus

2010-08-01

As a result of the EU Tissues and Cells Directive (2004/23/EC), therapeutic tissue banking is currently being restructured throughout Europe. The stated objectives are to enhance a safe and stable supply of bone and tissue in Europe and to facilitate internal exchange. We conducted an interview study to explore the effect of the Directive on Danish bone banks in terms of (1) organizational restructuring, (2) supply and range of exchange, (3) economic costs. We found that the Directive stimulated extensive re-organization of bone banks with a substantial adjoining workload; that it is doubtful whether it will increase supply and range of exchange; and that the transposition of the Directive is associated with considerable extra cost. Additionally, we found that elements in the documentation of safety were fabricated by surgeons to avoid what was seen as unnecessary questioning of potential donors.

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.

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.

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.

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.

Neural correlates of mirth and laughter: a direct electrical cortical stimulation study.

PubMed

Yamao, Yukihiro; Matsumoto, Riki; Kunieda, Takeharu; Shibata, Sumiya; Shimotake, Akihiro; Kikuchi, Takayuki; Satow, Takeshi; Mikuni, Nobuhiro; Fukuyama, Hidenao; Ikeda, Akio; Miyamoto, Susumu

2015-05-01

Laughter consists of both motor and emotional aspects. The emotional component, known as mirth, is usually associated with the motor component, namely, bilateral facial movements. Previous electrical cortical stimulation (ES) studies revealed that mirth was associated with the basal temporal cortex, inferior frontal cortex, and medial frontal cortex. Functional neuroimaging implicated a role for the left inferior frontal and bilateral temporal cortices in humor processing. However, the neural origins and pathways linking mirth with facial movements are still unclear. We hereby report two cases with temporal lobe epilepsy undergoing subdural electrode implantation in whom ES of the left basal temporal cortex elicited both mirth and laughter-related facial muscle movements. In one case with normal hippocampus, high-frequency ES consistently caused contralateral facial movement, followed by bilateral facial movements with mirth. In contrast, in another case with hippocampal sclerosis (HS), ES elicited only mirth at low intensity and short duration, and eventually laughter at higher intensity and longer duration. In both cases, the basal temporal language area (BTLA) was located within or adjacent to the cortex where ES produced mirth. In conclusion, the present direct ES study demonstrated that 1) mirth had a close relationship with language function, 2) intact mesial temporal structures were actively engaged in the beginning of facial movements associated with mirth, and 3) these emotion-related facial movements had contralateral dominance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lessons learned from public health campaigns and applied to anti-DWI norms development

DOT National Transportation Integrated Search

1995-05-01

The purpose of this study was to examine norms development in past public health campaigns to direct lessons learned from those efforts to future anti-DNN'l programming. Three campaigns were selected for a multiple case study. The anti-smoking, anti-...

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

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

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.

Exploring Techniques of Developing Writing Skill in IELTS Preparatory Courses: A Data-Driven Study

ERIC Educational Resources Information Center

Ostovar-Namaghi, Seyyed Ali; Safaee, Seyyed Esmail

2017-01-01

Being driven by the hypothetico-deductive mode of inquiry, previous studies have tested the effectiveness of theory-driven interventions under controlled experimental conditions to come up with universally applicable generalizations. To make a case in the opposite direction, this data-driven study aims at uncovering techniques and strategies…

Disorders of Arousal From Sleep and Violent Behavior: The Role of Physical Contact and Proximity

PubMed Central

Pressman, Mark R.

2007-01-01

Study Objectives: To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors – is triggered by direct physical contact or close proximity to that individual and does not occur randomly or spontaneously. Design: Historical review of case reports in the medical and legal literature. Measurements and Results: A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were associated with provocation or close proximity in 40%–90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered differed among sleepwalking, confusional arousals, and sleep terrors. Conclusions: In the cases reviewed, violent behavior directed against other individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders. The conclusions of this case series await confirmation by the results of future sleep laboratory based studies. Citation: Pressman MR. Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. SLEEP 2007;30(8):1039–1047. PMID:17702274

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.

Time Safety Margin: Theory and Practice

DTIC Science & Technology

2016-09-01

Basic Dive Recovery Terminology The Simplest Definition of TSM: Time Safety Margin is the time to directly travel from the worst-case vector to an...Safety Margin (TSM). TSM is defined as the time in seconds to directly travel from the worst case vector (i.e. worst case combination of parameters...invoked by this AFI, base recovery planning and risk management upon the calculated TSM. TSM is the time in seconds to di- rectly travel from the worst case

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.

Small traveling clusters in attractive and repulsive Hamiltonian mean-field models.

PubMed

Barré, Julien; Yamaguchi, Yoshiyuki Y

2009-03-01

Long-lasting small traveling clusters are studied in the Hamiltonian mean-field model by comparing between attractive and repulsive interactions. Nonlinear Landau damping theory predicts that a Gaussian momentum distribution on a spatially homogeneous background permits the existence of traveling clusters in the repulsive case, as in plasma systems, but not in the attractive case. Nevertheless, extending the analysis to a two-parameter family of momentum distributions of Fermi-Dirac type, we theoretically predict the existence of traveling clusters in the attractive case; these findings are confirmed by direct N -body numerical simulations. The parameter region with the traveling clusters is much reduced in the attractive case with respect to the repulsive case.

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…

Optimized model tuning in medical systems.

PubMed

Kléma, Jirí; Kubalík, Jirí; Lhotská, Lenka

2005-12-01

In medical systems it is often advantageous to utilize specific problem situations (cases) in addition to or instead of a general model. Decisions are then based on relevant past cases retrieved from a case memory. The reliability of such decisions depends directly on the ability to identify cases of practical relevance to the current situation. This paper discusses issues of automated tuning in order to obtain a proper definition of mutual case similarity in a specific medical domain. The main focus is on a reasonably time-consuming optimization of the parameters that determine case retrieval and further utilization in decision making/ prediction. The two case studies - mortality prediction after cardiological intervention, and resource allocation at a spa - document that the optimization process is influenced by various characteristics of the problem domain.

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.

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.

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.

Incidence of Leptospirosis infection in the East Zone of Sao Paulo City, Brazil

PubMed Central

2013-01-01

Background Leptospirosis is a zoonosis which is spread through contamined running water. This contaminations is seriously affected by the flooding which occurs in the area surrounding the Aricanduva river. The transmission of the disease results mainly from the contact of water with soil contaminated by the urine of infected animals. We aimed to conduct an epidemiological survey on Leptospirosis cases in Sao Paulo East Zone area. Method The analysis conducted in this study was based on data collected from the health authorities of that region close the Aricanduva river between 2007 and 2008 years, which give the rates of confirmed cases, mortality and death from human Leptospirosis. Other information concerned with the relationships among rainfall index, points of flooding and incidence of Leptospirosis. Results We observed a direct and important water contamination. Records of flooding points and dates of the reported cases in the region showed a direct relationship from which the period of higher rainfall also recorded an increase in cases. The annual record of the city and the region and rainfall regions also presented correlation. Conclusion The association between the indices of flooding and Leptospirosis cases indicates that preventive measures are necessary to avoid exposing the community. PMID:23672682

A One-Year Case Study: Understanding the Rich Potential of Project-Based Learning in a Virtual Reality Class for High School Students

ERIC Educational Resources Information Center

Morales, Teresa M.; Bang, EunJin; Andre, Thomas

2013-01-01

This paper presents a qualitative case analysis of a new and unique, high school, student-directed, project-based learning (PBL), virtual reality (VR) class. In order to create projects, students learned, on an independent basis, how to program an industrial-level VR machine. A constraint was that students were required to produce at least one…

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,…

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.

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.

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.

Acute Low Back Pain? Do Not Blame the Weather-A Case-Crossover Study.

PubMed

Beilken, Keira; Hancock, Mark J; Maher, Chris G; Li, Qiang; Steffens, Daniel

2017-06-01

To investigate the influence of various weather parameters on the risk of developing a low back pain (LBP) episode. Case-crossover study. Primary care clinics in Sydney, Australia. 981 participants with a new episode of acute LBP. Weather parameters were obtained from the Australian Bureau of Meteorology. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived comparing two exposure variables in the case window-(1) the average of the weather variable for the day prior to pain onset and (2) the change in the weather variable from 2 days prior to 1 day prior to pain onset-with exposures in two control windows (1 week and 1 month before the case window). The weather parameters of precipitation, humidity, wind speed, wind gust, wind direction, and air pressure were not associated with the onset of acute LBP. For one of the four analyses, higher temperature slightly increased the odds of pain onset. Common weather parameters that had been previously linked to musculoskeletal pain, such as precipitation, humidity, wind speed, wind gust, wind direction, and air pressure, do not increase the risk of onset for LBP. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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.

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

Comparative Case Studies Of Corridor Safety Improvement Efforts

DOT National Transportation Integrated Search

1999-12-01

In 1988, following a series of fatal crashes on U.S. Route 322, Pennsylvania's governor directed Pennsylvania's secretary of transportation to develop immediate, short-term measures to improve safety on the roadway. In response, the Pennsylvania Depa...

Genomics in childhood acute myeloid leukemia comes of age | Office of Cancer Genomics

Cancer.gov

TARGET investigator’s study of nearly 1,000 pediatric acute myeloid leukemia (AML) cases reveals marked differences between the genomic landscapes of pediatric and adult AML and offers directions for future work.

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.

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.

Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment.

PubMed

Theodossiadis, G P; Panopoulos, M; Kollia, A K; Georgopoulos, G

1992-08-01

During the period 1970-87 we evaluated the changes of the optic disc, peripapillary area, detached macula and visual acuity in 16 cases with congenital pit of the optic nerve and macular detachment. The study revealed in 9 of the 16 cases (56%) an increase of the dimension of the pit or changes in its color, findings which were directly related to the duration of the macular detachment. Chorioretinal scarring, pigment migration, or both, were also noted mainly at the temporal margin of optic disc. In 5/16 cases we found during the follow-up an extension of macular elevation. In altogether 10 out of 16 cases the retinal elevation covered the larger portion of the mid-periphery temporally. In 7/16 cases the final visual acuity remained unchanged, in 9/16 cases deteriorated. The difference, however, in the latter 9 cases between initial and final visual acuity was negligible. During the follow-up period deterioration of the visual fields was also noted.

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

Voices from the Community: A Case for Reciprocity in Service-Learning

ERIC Educational Resources Information Center

d'Arlach, Lucia; Sanchez, Bernadette; Feuer, Rachel

2009-01-01

Few studies have directly examined how recipients of service view the service. This qualitative study presents the results of interviews and observations of nine community members who participated in a service-learning, language exchange program, Intercambio, in which Spanish-speaking Latino immigrants were paired with English-speaking university…

Education and Social Integration: A Case Study of Institutional Effect on Malaysia.

ERIC Educational Resources Information Center

Bock, John C.

The study's objective was to examine the interrelationships of education and other social institutions of Malaysia's transitional society to understand those conditions which facilitate, or impede, the formal educational institutions' effectiveness as an agent of directed social change, especially regarding national integration and shared…

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…

Does School Desegregation Policy Stimulate Residential Integration? Evidence from a Case Study.

ERIC Educational Resources Information Center

Clark, William A. V.

1988-01-01

Study of desegregation efforts in the Oklahoma Independent School District and residence patterns in the Oklahoma City metropolitan region reveals that desegregated schools do not lead to desegregated housing: there is little if any direct relationship between student assignments and household relocation behavior. (BJV)

Learning Medical School Biochemistry Through Self-Directed Case-Oriented Study.

ERIC Educational Resources Information Center

Morley, Colin G. D.; Blumberg, Phyllis

1987-01-01

Describes an alternative medical school curriculum for the first two years of preclinical basic science studies. Discusses student and faculty selection for the program. Details the format for teaching biochemistry in the Alternative Curriculum, including program structure, content organization and exams. Evaluates the success of the program. (CW)

Violence against Teachers: Case Studies from the APA Task Force

ERIC Educational Resources Information Center

Reddy, Linda A.; Espelage, Dorothy; McMahon, Susan D.; Anderman, Eric M.; Lane, Kathleen Lynne; Brown, Veda Evanell; Reynolds, Cecil R.; Jones, Abraham; Kanrich, Jaclyn

2013-01-01

Violence directed toward teachers has been understudied despite significant media and empirical investigation on school violence, such as student-to-student victimization and bullying. To date, there are relatively few published studies scattered across many countries. To address this void, the American Psychological Association, in collaboration…

Academic Leadership in a Private University: An Iranian Case Study

ERIC Educational Resources Information Center

Hamidifar, Fatemeh; Ebrahimi, Mansoureh

2016-01-01

This study explores effective academic leadership as well as hindrances within Iran's private higher educational institutions. The author employed a qualitative approach that utilized purposive sampling to collect and analyze data. Findings were categorized into three classes comprising the (i) setting of direction, (ii) organizational and (iii)…

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…

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)

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.

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.

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

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.

The complex legal and ethical issues related to generic medications. Viral hepatitis: a case study.

PubMed

Danta, M; Ghinea, N

2017-04-01

The economic impact of medications is significant, with many countries unable to afford the essential medicines listed by the WHO. Generic medications are one strategy to address this issue. Generic medications are similar to but not the same as originator medications. They have a significant cost advantage because they do not require the background research and development studies to support registration. Consequently, they are gaining increased market share in both the developed and developing world. Many new medications are now licensed to generic manufacturers in the developing world. As a result, it is possible for patients to bypass regulatory and cost barriers by importing medications directly from generic producers. Importation of the novel hepatitis C direct-acting antiviral therapy into Australia before it was registered in the country is an illustrative case study. This review will characterise generic medications and some of the legal and ethical issues around their utilisation, focusing on the relevant players, including pharma, government, patients and doctors.

Study of energetic particle physics with advanced ECEI system on the HL-2A tokamak

NASA Astrophysics Data System (ADS)

Shi, Zhongbing; Jiang, Min; Yu, Liming; Chen, Wei; Shi, Peiwan; Zhong, Wulyu; Yang, Zengchen; Zhang, Boyu; Ji, Xiaoquan; Li, Yonggao; Zhou, Yan; Song, Shaodong; Huang, Mei; Song, Xianming; Li, Jiaxuan; Yuan, Baoshan; Fu, Bingzhong; Liu, Zetian; Ding, Xuantong; Xu, Yuhong; Yang, Qingwei; Duan, Xuru

2017-07-01

Understanding the physics of energetic particles (EP) is crucial for the burning plasmas in next generation fusion devices such as ITER. In this work, three types of internal kink modes (a saturated internal kink mode (SK), a resonant internal kink mode (RK), and a double e-fishbone) excited by energetic particles in the low density discharges during ECRH/ECCD heating have been studied by the newly developed 24(poloidal) × 16(radial) = 384 channel ECEI system on the HL-2A tokamak. The SK and RK rotate in the electron diamagnetic direction poloidally and are destabilized by the energetic trapped electrons. The SK is destabilized in the case of qmin > 1, while the RK is destabilized in the case of qmin < 1. The double e-fishbone, which has two m/n = 1/1 modes propagating in the opposite directions poloidally, has been observed during plasma current ramp-up with counter-ECCD. Strong thermal transfer and mode coupling between the two m/n = 1/1 modes have been studied.

Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support.

PubMed

Chlan, Linda L; Heiderscheit, Annette; Skaar, Debra J; Neidecker, Marjorie V

2018-05-04

Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Midwestern ICUs. Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.

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.

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.

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.

Inhibition of Platelet Aggregation by the Leaf Extract of Carica papaya During Dengue Infection: An In Vitro Study.

PubMed

Chinnappan, Shobia; Ramachandrappa, Vijayakumar Shettikothanuru; Tamilarasu, Kadhiravan; Krishnan, Uma Maheswari; Pillai, Agiesh Kumar Balakrishna; Rajendiran, Soundravally

2016-04-01

Dengue cases were reported to undergo platelet activation and thrombocytopenia by a poorly understood mechanism. Recent studies suggested that Carica papaya leaf extract could recover the platelet count in dengue cases. However, no studies have attempted to unravel the mechanism of the plant extract in platelet recovery. Since there are no available drugs to treat dengue and considering the significance of C. papaya in dengue treatment, the current study aimed to evaluate two research questions: First one is to study if the C. papaya leaf extract exerts its action directly on platelets and second one is to understand if the extract can specifically inhibit the platelet aggregation during dengue viral infection. Sixty subjects with dengue positive and 60 healthy subjects were recruited in the study. Platelet-rich plasma (PRP) and platelet-poor plasma were prepared from both the dengue-infected and healthy control blood samples. Effect of the leaf extract obtained from C. papaya leaves was assessed on plasma obtained as well as platelets collected from both healthy and dengue-infected individuals. Platelet aggregation was significantly reduced when leaf extract preincubated with dengue plasma was added into control PRP, whereas no change in aggregation when leaf extract incubated-control plasma was added into control PRP. Upon direct addition of C. papaya leaf extract, both dengue PRP and control PRP showed a significant reduction in platelet aggregation. Within the dengue group, PRP from severe and nonsevere cases showed a significant decrease in aggregation without any difference between them. From the study, it is evident that C. papaya leaf extract can directly act on platelet. The present study, the first of its kind, found that the leaf extract possesses a dengue-specific neutralizing effect on dengue viral-infected plasma that may exert a protective role on platelets.

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.

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.

Nonlinear dynamics in ecosystem response to climatic change: Case studies and policy implications

USGS Publications Warehouse

Burkett, Virginia R.; Wilcox, Douglas A.; Stottlemyer, Robert; Barrow, Wylie; Fagre, Dan; Baron, Jill S.; Price, Jeff; Nielsen, Jennifer L.; Allen, Craig D.; Peterson, David L.; Ruggerone, Greg; Doyle, Thomas

2005-01-01

Many biological, hydrological, and geological processes are interactively linked in ecosystems. These ecological phenomena normally vary within bounded ranges, but rapid, nonlinear changes to markedly different conditions can be triggered by even small differences if threshold values are exceeded. Intrinsic and extrinsic ecological thresholds can lead to effects that cascade among systems, precluding accurate modeling and prediction of system response to climate change. Ten case studies from North America illustrate how changes in climate can lead to rapid, threshold-type responses within ecological communities; the case studies also highlight the role of human activities that alter the rate or direction of system response to climate change. Understanding and anticipating nonlinear dynamics are important aspects of adaptation planning since responses of biological resources to changes in the physical climate system are not necessarily proportional and sometimes, as in the case of complex ecological systems, inherently nonlinear.

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

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.

Measuring Up: How to Track and Evaluate Local Sustainability Projects

EPA Pesticide Factsheets

Learn about two new federal resources to help you measure, track, and report progress, based directly on the experiences of local governments across the country, and hear from one case study taking place in northwest Washington.

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.

A Study on the Directed Living Non-Related Donor Kidney Transplantation Submitted to the Hospital Transplant Ethics Committee at the National Kidney and Transplant Institute.

PubMed

Suguitan, G; Arakama, M-H I; Danguilan, R

2017-03-01

In the latter part of 2009, the Department of Health of the Philippines prohibited kidney transplantation with non-related kidney donors. Hence, the National Kidney and Transplant Institute created a Hospital Transplant Ethics Committee. This study describes directed non-related kidney donation at the National Kidney and Transplant Institute. This retrospective study reviewed the profiles of recipients and directed living non-related kidney transplant donors submitted to the Hospital Transplant Ethics Committee. A total 74 recipients and donors were reviewed by the Hospital Transplant Ethics Committee in 2014. Donors initiated the talks about being a donor (75%) to repay the good deeds that were done by the recipient for them or their families; examples of which are: sometime in their lives they needed financial assistance for hospitalization for their relatives and it was the patient who paid the hospital bill; or because they pitied the recipient, whom they found to be a good person, thus they would want to give one of their kidneys. Seventy-four (100%) said that they were not expecting anything in return for this act but wanted to be of help to the recipient. Of these 74 cases, 70 cases (95%) were approved and the others were disapproved. With a Hospital Transplant Ethics Committee in place, directed kidney donation is a valuable tool as an additional source of kidney donor without violating any ethical issues. Copyright © 2016. Published by Elsevier Inc.

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.

A Case Study: An ACT Stress Management Group in a University Counseling Center

ERIC Educational Resources Information Center

Daltry, Rachel M.

2015-01-01

The aim of this study was to examine the effectiveness of an acceptance and commitment therapy (ACT) stress management group in a college counseling center setting. This study explored (a) the effectiveness of ACT in increasing participants' ability to tolerate distress, which directly affects their ability to function in a stressful college…

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…

Placement-Based Learning and Learner Engagement: Findings from a New University in the UK

ERIC Educational Resources Information Center

Murphy, Timothy R. N.; Folgueiras Bertomeu, Pilar; Mannix McNamara, Patricia

2016-01-01

This paper addresses the potential for engaged learning among final-year undergraduate Education Studies students at a new, post-1992. It discusses a case study analysis of a "Directed Experiential Learning" (DEL) intervention in the final year of an education studies degree designed to engage and motivate students and emphasise the…

[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).

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

Varicella at sea: a two-year study on cruise ships.

PubMed

Acevedo, Fabio; Diskin, Arthur L; Dahl, Eilif

2011-01-01

Being highly contagious by person-to-person transmission, varicella can easily spread within the multinational population of a cruise ship and into communities ashore. The aim of the study was to report the prevalence of varicella infections in a fleet of cruise ships during a two-year period and to discuss measures to prevent and contain shipboard outbreaks. All probable varicella cases among passengers and crew on 34 cruise ships were registered for 2 years by the medical facilities onboard. Patients remained isolated until 6 days after rash onset. Susceptible contacts were identified and offered post-exposure prophylaxis. Crew nationality, number of vaccinated contacts, and direct vaccination costs were registered. During two years 187 varicella cases (36 passengers, 151 crew) were registered and 2,685 varicella vaccinations were administered at an estimated direct vaccination cost of US $ 283,832. Of the 34 ships, only 3 reported no cases of varicella. There were 8 clusters ('outbreaks') of ≥ 5 varicella cases presenting less than 42 days apart, comprising a total of 89 patients. While > 130 nations were represented among the crew, the 151 crew cases came from 26 countries, and 88 (58%) of them came from 5 sub-tropical/tropical countries. All cruise vessels must expect to encounter varicella cases or outbreaks onboard every few years. Every varicella case can start an outbreak and thus trigger several time-consuming and expensive containment measures, including isolation and mass vaccination of susceptible contacts. Mandatory pre-contract evidence of varicella immunity from all seafarers or from subgroups according to position or nationality might be worth considering. Seafarers known to be immune to varicella should always carry valid documentation while traveling.

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.

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.

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.

Men and Arms in the Middle East: The Human Factor in Military Modernization

DTIC Science & Technology

1979-06-01

countries under study supports their abilities to wield military power effectively, their large- scale reliance on importation of military technologies...statistics, and on quality from area experts. In many cases , we were unable to arrive at numerical estimates of the sources of supply. . Likely future...government agencies); on -the-job training (as in the case of counterpart pro- grams); and thle direct importation of both military and civilian labor

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.

Phrenic nerve reconstruction in complete video-assisted thoracic surgery.

PubMed

Kawashima, Shun; Kohno, Tadasu; Fujimori, Sakashi; Yokomakura, Naoya; Ikeda, Takeshi; Harano, Takashi; Suzuki, Souichiro; Iida, Takahiro; Sakai, Emi

2015-01-01

Primary or metastatic lung cancer or mediastinal tumours may at times involve the phrenic nerve and pericardium. To remove the pathology en bloc, the phrenic nerve must be resected. This results in phrenic nerve paralysis, which in turn reduces pulmonary function and quality of life. As a curative measure of this paralysis and thus a preventive measure against decreased pulmonary function and quality of life, we have performed immediate phrenic nerve reconstruction under complete video-assisted thoracic surgery, and with minimal additional stress to the patient. This study sought to ascertain the utility of this procedure from an evaluation of the cases experienced to date. We performed 6 cases of complete video-assisted thoracic surgery phrenic nerve reconstruction from October 2009 to December 2013 in patients who had undergone phrenic nerve resection or separation to remove tumours en bloc. In all cases, it was difficult to separate the phrenic nerve from the tumour. Reconstruction involved direct anastomosis in 3 cases and intercostal nerve interposition anastomosis in the remaining 3 cases. In the 6 patients (3 men, 3 women; mean age 50.8 years), we performed two right-sided and four left-sided procedures. The mean anastomosis time was 5.3 min for direct anastomosis and 35.3 min for intercostal nerve interposition anastomosis. Postoperative phrenic nerve function was measured on chest X-ray during inspiration and expiration. Direct anastomosis was effective in 2 of the 3 patients, and intercostal nerve interposition anastomosis was effective in all 3 patients. Diaphragm function was confirmed on X-ray to be improved in these 5 patients. Complete video-assisted thoracic surgery phrenic nerve reconstruction was effective for direct anastomosis as well as for intercostal nerve interposition anastomosis in a small sample of selected patients. The procedure shows promise for phrenic nerve reconstruction and further data should be accumulated over time. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Combined direct and indirect traumatic carotid-cavernous fistula (CCF): Case report and review of the literature.

PubMed

Abecassis, Isaac Josh; Morton, Ryan P; Kim, Louis J; Ghodke, Basavaraj V; Levitt, Michael R

2017-10-01

Within the current Barrow classification system, there are no categorical descriptions or reports in the literature of cavernous carotid fistulas (CCFs) with both a direct component (type A) and separate indirect contribution (type B, C, or D). We report the first definitive case of a combined simultaneous traumatic direct and indirect CCF, and review the literature on the similar existing entity of traumatic indirect CCFs presenting delayed and subsequent to the treatment of traumatic, direct CCFs. We report a case of simultaneous direct type A CCF with a traumatic indirect CCF component and a review of the relevant literature. An 18year-old female presented after a motor vehicle collision. A diagnostic cerebral angiogram confirmed the diagnosis of CCF, with contribution both directly from the ICA and indirectly via branches of the ECA. The direct component of the CCF was first treated in 3 stages via both transarterial and transvenous coil embolization, followed by a final 4th stage of parent vessel sacrifice in order to treat the residual direct component, with transarterial embolization to treat residual indirect CCF activity. To our knowledge, this is the first report of a traumatic CCF with simultaneous direct (type A) and indirect via the ECA (type C) contributions. Copyright © 2017 Elsevier Ltd. All rights reserved.

21 CFR 1230.14 - Directions for treatment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... word “Poison,” directions for treatment in the case of internal personal injury; in addition, if the substance may cause external injury, directions for appropriate treatment shall be given. The directions...

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.

Existing data sources for clinical epidemiology: Scandinavian Cohort for osteonecrosis of the jaw – work in progress and challenges

PubMed Central

Schiodt, Morten; Larsson Wexell, Cecilia; Herlofson, Bente Brokstad; Giltvedt, Karen Marie; Norholt, Sven Erik; Ehrenstein, Vera

2015-01-01

Osteonecrosis of the jaw (ONJ) is a severe side effect associated with antiresorptive treatment. Monitoring of ONJ using routine databases in Scandinavian countries is a challenge owing to lack of valid algorithms and to heterogeneous referral practices. The aim of this paper is to describe the process of establishing a Scandinavian ONJ Cohort enrolling all ONJ cases related to antiresorptive treatment arising in Denmark, Norway, and Sweden between 2011 and 2019. The initial purpose of the cohort is to support an ongoing pharmacovigilance study of denosumab and zoledronic acid in Denmark, Norway, and Sweden. The three countries, with their 199 clinics, departments, and units of oral and maxillofacial surgery, both hospital-based and freestanding, differ somewhat in referral practices of the ONJ patients. By directly contacting all providers of care to ONJ patients in the three countries, we established a network for reporting incident cases to each country’s research database directly or through a member of the Scandinavian ONJ task force as a liaison. The task force includes a Scandinavian coordinator and three national coordinators collaborating directly with the clinics. A uniform ONJ registration form has been developed, and the relevant medical community has been informed either directly or through presentations at professional meetings. A website with study information is published in each country, and data entry is ongoing. This large-scale systematic uniform registration of ONJ cases in Denmark, Norway, and Sweden, with an underlying total population of more than 20 million people, merged into the Scandinavian ONJ Cohort, will contribute to better knowledge and understanding of this challenging group of patients, and ultimately, help improve patient care. The Scandinavian ONJ Cohort as a whole and its component national ONJ research databases may offer the potential for large-scale multinational intervention and safety studies in the future. PMID:25657594

DIAGNOSTIC IMAGING IN A DIRECT-ACCESS SPORTS PHYSICAL THERAPY CLINIC: A 2-YEAR RETROSPECTIVE PRACTICE ANALYSIS.

PubMed

Crowell, Michael S; Dedekam, Erik A; Johnson, Michael R; Dembowski, Scott C; Westrick, Richard B; Goss, Donald L

2016-10-01

While advanced diagnostic imaging is a large contributor to the growth in health care costs, direct-access to physical therapy is associated with decreased rates of diagnostic imaging. No study has systematically evaluated with evidence-based criteria the appropriateness of advanced diagnostic imaging, including magnetic resonance imaging (MRI), when ordered by physical therapists. The primary purpose of this study was to describe the appropriateness of magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) exams ordered by physical therapists in a direct-access sports physical therapy clinic. Retrospective observational study of practice. Greater than 80% of advanced diagnostic imaging orders would have an American College of Radiology (ACR) Appropriateness Criteria rating of greater than 6, indicating an imaging order that is usually appropriate. A 2-year retrospective analysis identified 108 MRI/MRA examination orders from four physical therapists. A board-certified radiologist determined the appropriateness of each order based on ACR appropriateness criteria. The principal investigator and co-investigator radiologist assessed agreement between the clinical diagnosis and MRI/surgical findings. Knee (31%) and shoulder (25%) injuries were the most common. Overall, 55% of injuries were acute. The mean ACR rating was 7.7; scores from six to nine have been considered appropriate orders and higher ratings are better. The percentage of orders complying with ACR appropriateness criteria was 83.2%. Physical therapist's clinical diagnosis was confirmed by MRI/MRA findings in 64.8% of cases and was confirmed by surgical findings in 90% of cases. Physical therapists providing musculoskeletal primary care in a direct-access sports physical therapy clinic appropriately ordered advanced diagnostic imaging in over 80% of cases. Future research should prospectively compare physical therapist appropriateness and utilization to other groups of providers and explore the effects of physical therapist imaging privileging on outcomes. Diagnosis, Level 3.

Inhibition of the cellular function of perforin by 1-amino-2,4-dicyanopyrido[1,2-a]benzimidazoles.

PubMed

Lyons, Dani M; Huttunen, Kristiina M; Browne, Kylie A; Ciccone, Annette; Trapani, Joseph A; Denny, William A; Spicer, Julie A

2011-07-01

A high throughput screen showed the ability of a 1-amino-2,4-dicyanopyrido[1,2-a]benzimidazole analogue to directly inhibit the lytic activity of the pore-forming protein perforin. A series of analogues were prepared to study structure-activity relationships (SAR) for the this activity, either directly added to cells or released in situ by KHYG-1 NK cells, at non-toxic concentrations. These studies showed that the pyridobenzimidazole moiety was required for effective activity, with strongly basic centres disfavoured. This class of compounds was relatively unaffected by the addition of serum, which was not the case for a previous class of direct inhibitors. Copyright © 2011 Elsevier Ltd. All rights reserved.

Listeriosis--a review of eighty-four cases.

PubMed

Paul, M L; Dwyer, D E; Chow, C; Robson, J; Chambers, I; Eagles, G; Ackerman, V

1994-04-18

To review the epidemiology, risk factors for acquisition, clinical features and outcomes of Listeria monocytogenes infection in Sydney. A retrospective study over the period 1983-1992 at four university teaching hospitals in Sydney. Cases were identified from microbiology laboratory records of the isolation of L. monocytogenes from sterile sites. Eighty-four cases were reviewed, with 72 patients (86%) having a predisposing underlying condition, including 13 perinatal patients (15%). Septicaemia (56%) and central nervous system disease (41%) were the major clinical presentations. Nineteen patients (23%) had hospital-associated infection. A mortality of 21% (18 patients) was directly attributable to L. monocytogenes infection, with another 10% (nine patients) dying of their underlying disease during admission. The 84 cases represented 80% of all L. monocytogenes cases occurring in Sydney during the study period. Listeriosis is predominantly a disease of the elderly or of immunosuppressed individuals, pregnant women and neonates. The presentation and outcome in these groups are similar to those reported in other Western countries. A significant feature of this study was the number of cases occurring in already hospitalised patients, suggesting that L. monocytogenes may be an important hospital-associated pathogen in immunocompromised patients.

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.

Pre-market approval and post-market direct-to-consumer advertising of medical devices in Australia: a case study of breast cancer screening and diagnostic devices.

PubMed

Vreugdenburg, T D; Willis, C D; Mundy, L; Hiller, J E

2013-01-01

While research investigating direct-to-consumer advertising of therapeutic goods in Australia has historically focused on prescription medicines, recent action taken by regulators against companies promoting medical devices has placed the industry into the spotlight. Despite the need to effectively regulate direct-to-consumer advertising of medical devices due to its potential harms, inadequacies in the current regulatory system have been noted. Under the present system, devices with a questionable evidence base may enter the Australian marketplace without an evaluation of their effectiveness, and regulators are reliant on industry self-regulation and consumer complaints to draw attention to cases of advertising misconduct. Although some successes in the present system have been observed, we argue that the outlined inadequacies continue to enable the promotion of medical devices to consumers without thorough or sufficient examination of evidence. © 2011 The Authors; Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

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.

Improving adolescent pregnancy outcomes and maternal health:a case study of comprehensive case managed services.

PubMed

Bowman, Elizabeth K; Palley, Howard A

2003-01-01

Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.

Satellite observed impacts of wildfires on regional atmosphere composition and shortwave radiative forcing: multiple cases study

NASA Astrophysics Data System (ADS)

Fu, Y.; Li, R.; Huang, J.; Bergeron, Y.; Fu, Y.

2017-12-01

Emissions of aerosols and trace gases from wildfires and the direct shortwave radiative forcing were studied using multi-satellite/sensor observations from Aqua Moderate-Resolution Imaging Spectroradiometer (MODIS), Aqua Atmospheric Infrared Sounder (AIRS), Aura Ozone Monitoring Instrument (OMI), and Aqua Cloud's and the Earth's Radiant Energy System (CERES). The selected cases occurred in Northeast of China (NEC), Siberia of Russia, California of America have dominant fuel types of cropland, mixed forest and needleleaf forest, respectively. The Fire radiative power (FRP) based emission coefficients (Ce) of aerosol, NOx (NO2+NO), formaldehyde (HCHO), and carbon monoxide (CO) showed significant differences from case to case. 1) the FRP of the cropland case in NEC is strongest, however, the Ce of aerosol is the lowest (20.51 ± 2.55 g MJ-1). The highest Ce of aerosol is 71.34 ± 13.24 g MJ-1 in the needleleaf fire case in California. 2) For NOx, the highest Ce existed in the cropland case in NEC (2.76 ± 0.25 g MJ-1), which is more than three times of those in the forest fires in Siberia and California. 3) The Ce of CO is 70.21±10.97 and 88.38±46.16 g MJ-1 in the forest fires in Western Siberia and California, which are about four times of that in cropland fire. 4) The variation of Ce of HCHO are relatively small among cases. Strong spatial correlations are found among aerosol optical depth (AOD), NOx, HCHO, and CO. The ratios of NOx to AOD, HCHO, and CO in the cropland case in NEC show much higher values than those in other cases. Although huge differences of emissions and composition ratios exist among cases, the direct shortwave (SW) radiative forcing efficiency (SWARFE) of smoke at the top of the atmosphere (TOA) are in good agreement, with the shortwave radiative forcing efficiencies values of 20.09 to 22.93 per unit AOD. Results in this study reveal noteworthy variations of the FRP-based emissions coefficient and relative chemical composition in the smoke. Nitrogen content in the fuel and/or soil, the biomes type burned, the combustion states (flaming or smoldering) and/or the weather condition might be respond for those differences among cases. This study also prove remarkable and consistent cooling effect of shortwave radiation forcing at TOA from the wildfire emissions in all selected cases.

Probing Competitive and Co-operative Hydroxyl and Ammonium Hydrogen-Bonding Directed Epoxidations.

PubMed

Brambilla, Marta; Brennan, Méabh B; Csatayová, Kristína; Davies, Stephen G; Fletcher, Ai M; Kennett, Alice M R; Lee, James A; Roberts, Paul M; Russell, Angela J; Thomson, James E

2017-10-06

The diastereoselectivities and rates of epoxidation (upon treatment with Cl 3 CCO 2 H then m-CPBA) of a range of cis- and trans-4-aminocycloalk-2-en-1-ol derivatives (containing five-, six-, and seven-membered rings) have been investigated. In all cases where the two potential directing groups can promote epoxidation on opposite faces of the ring scaffold, evidence of competitive epoxidation pathways, promoted by hydrogen-bonding to either the in situ formed ammonium moiety or the hydroxyl group, was observed. In contrast to the relative directing group abilities already established for the six-membered ring system (NHBn ≫ OH > NBn 2 ), an N,N-dibenzylammonium moiety appeared more proficient than a hydroxyl group at directing the stereochemical course of the epoxidation reaction in a five- or seven-membered system. In the former case, this was rationalized by the drive to minimize torsional strain in the transition state being coupled with assistance from hydrogen-bonding to the ammonium moiety. In the latter case, this was ascribed to the steric bulk of the ammonium moiety disfavoring conformations in which hydrogen-bonding to the hydroxyl group results in direction of the epoxidation to the syn face. In cases where the two potential directing groups can promote epoxidation on the same face of the ring scaffold, an enhancement of epoxidation diastereoselectivity was not observed, while introduction of a second, allylic heteroatom to the substrate results in diminishment of the rate of epoxidation in all cases. Presumably, reduction of the nucleophilicity of the olefin by the second, inductively electron-withdrawing heteroatom is the dominant factor, and any assistance to the epoxidation reaction by the potential to form hydrogen-bonds to two directing groups rather than one is clearly unable to overwhelm it.

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.

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.

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.

A Comparison of Juror Decision Making in Race-Based and Sexual Orientation-Based Hate Crime Cases.

PubMed

Gamblin, Bradlee W; Kehn, Andre; Vanderzanden, Karen; Ruthig, Joelle C; Jones, Kelly M; Long, Brittney L

2018-05-01

Several constructs have been identified as relevant to the juror decision-making process in hate crime cases. However, there is a lack of research on the relationships between these constructs and their variable influence across victim group. The purpose of the current study was to reexamine factors relevant to the juror decision-making process in hate crime cases within a structural model, and across victim group, to gauge the relative strength and explanatory power of various predictors. In the current study, 313 participants sentenced a perpetrator found guilty of a hate crime committed against either a Black man or a gay man; participants also responded to individual difference measures relevant to mock juror hate crime decision making, including prejudice toward the victim's social group. Using path analysis, we explored the role of juror prejudice on sentencing decisions in hate crime cases as well as similarities and differences based on the victimized group. Results indicated that, when the victim was a Black man, modern racism influenced sentencing both directly and indirectly through perpetrator blame attributions, explaining 18% of the variance in sentencing. In contrast, when the victim was a gay man, modern homophobia did not directly predict sentencing, and the overall model explained only 4% of the variance in sentencing, suggesting variables beyond juror prejudice may be better suited to explain juror decision making in sexual orientation-based hate crimes. The current study suggests that the role of juror prejudice in hate crime cases varies as a function of the victimized group and raises questions about the importance of juror prejudice in the sentencing of hate crime cases, particularly antigay prejudice. The importance of blame attributions, social dominance orientation, and juror beliefs regarding penalty enhancements for hate crime cases, as well as policy implications, are also addressed.

Synchronization of an optomechanical system to an external drive

NASA Astrophysics Data System (ADS)

Amitai, Ehud; Lörch, Niels; Nunnenkamp, Andreas; Walter, Stefan; Bruder, Christoph

2017-05-01

Optomechanical systems driven by an effective blue-detuned laser can exhibit self-sustained oscillations of the mechanical oscillator. These self-oscillations are a prerequisite for the observation of synchronization. Here, we study the synchronization of the mechanical oscillations to an external reference drive. We study two cases of reference drives: (1) an additional laser applied to the optical cavity; (2) a mechanical drive applied directly to the mechanical oscillator. Starting from a master equation description, we derive a microscopic Adler equation for both cases, valid in the classical regime in which the quantum shot noise of the mechanical self-oscillator does not play a role. Furthermore, we numerically show that, in both cases, synchronization arises also in the quantum regime. The optomechanical system is therefore a good candidate for the study of quantum synchronization.

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.

High-Definition transcranial direct current stimulation in early onset epileptic encephalopathy: a case study.

PubMed

Meiron, Oded; Gale, Rena; Namestnic, Julia; Bennet-Back, Odeya; David, Jonathan; Gebodh, Nigel; Adair, Devin; Esmaeilpour, Zeinab; Bikson, Marom

2018-01-01

Early onset epileptic encephalopathy is characterized by high daily seizure-frequency, multifocal epileptic discharges, severe psychomotor retardation, and death at infancy. Currently, there are no effective treatments to alleviate seizure frequency and high-voltage epileptic discharges in these catastrophic epilepsy cases. The current study examined the safety and feasibility of High-Definition transcranial direct current stimulation (HD-tDCS) in reducing epileptiform activity in a 30-month-old child suffering from early onset epileptic encephalopathy. HD-tDCS was administered over 10 intervention days spanning two weeks including pre- and post-intervention video-EEG monitoring. There were no serious adverse events or side effects related to the HD-tDCS intervention. Frequency of clinical seizures was not significantly reduced. However, interictal sharp wave amplitudes were significantly lower during the post-intervention period versus baseline. Vital signs and blood biochemistry remained stable throughout the entire study. These exploratory findings support the safety and feasibility of 4 × 1 HD-tDCS in early onset epileptic encephalopathy and provide the first evidence of HD-tDCS effects on paroxysmal EEG features in electroclinical cases under the age of 36 months. Extending HD-tDCS treatment may enhance electrographic findings and clinical effects.

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.

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...

Case Study: OpenSSL 2012 Validation

DTIC Science & Technology

2013-08-01

there are probably millions of users who are impacted directly, and hundreds of millions who are indirectly affected. Cryptographic libraries are...UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESSES 8. PERFORMING ORGANIZATION REPORT NUMBER D-4991 H13 -001174 Institute for Defense

Anthropogenic features and hillslope processes interaction

NASA Astrophysics Data System (ADS)

Tarolli, Paolo; Sofia, Giulia

2016-04-01

Topography emerges as a result of natural driving forces, but some human activities (such as mining, agricultural practices and the construction of road networks) directly or indirectly move large quantities of soil, which leave clear topographic signatures embedded on the Earth's morphology. These signatures can cause drastic changes to the geomorphological organization of the landscape, with direct consequences on Earth surface processes (Tarolli and Sofia, 2016). To this point, the present research investigates few case studies highlighting the influences of anthropogenic topographic signatures on hillslope processes, and it shows the effectiveness of High-Resolution Topography (HRT) derived from the recent remote sensing technologies (e.g. lidar, satellite, structure from motion photogrammetry), to better understand this interaction. The first example is related to agricultural terraces. In recent times, terraced areas acquired a new relevance to modern concerns about erosion and land instability, being the agricultural land mostly threatened by abandonment or intensification and specialization of agriculture, resulting in more landslide-prone bench terraces, or heavy land levelling with increased erosion. The second case study discusses about the role of agricultural and forest roads on surface erosion and landslides. The third case study investigates geomorphic processes in an open pit mine. In all case studies, HRT served as the basis for the development of new methodologies able to recognize and analyze changes on Earth surface processes along hillslopes. The results show how anthropogenic elements have crucial effects on sediment production and sediment delivery, also influencing the landscape connectivity. The availability of HRT can improve our ability to actually model anthropogenic morphologies, quantify them, and analyse the links between anthropogenic elements and geomorphic processes. The results presented here, and the creation and dissemination of HR datasets might allow the transfer the knowledge of geomorphic processes from the scientific to the practical world. Thus, it may allow an improved understanding and targeted mitigation of geomorphic changes during anthropogenic development and help guide future research directions for development-based watershed studies. References Tarolli, P., Sofia, G. (2016). Human topographic signatures and derived geomorphic processes across landscapes, Geomorphology, 255, 140-161, 10.1016/j.geomorph.2015.12.007.

Impacts of Directed Tutorial Activities in Computer Conferencing: A Case Study

ERIC Educational Resources Information Center

Painter, Clare; Coffin, Caroline; Hewings, Ann

2003-01-01

This paper describes a qualitative study of asynchronous electronic conferencing by three tutorial groups on the same postgraduate course ("Teaching English to Speakers of Other Languages Worldwide"), forming part of an MA in Applied Linguistics (via Distance Education) at the Open University, UK. The groups varied in the degree to which…

The Expense Tied to Secondary Course Failure: The Case of Ontario

ERIC Educational Resources Information Center

Faubert, Brenton

2016-01-01

This article describes a study that examined the volume of secondary course failure and its direct budget impact on Ontario's K-12 public education system. The study employed a straightforward, descriptive accounting method to estimate the annual expenditure tied to secondary course failure, taking into account some factors known to be…

Parental Action and Referral Patterns in Spatial Clusters of Childhood Autism Spectrum Disorder

ERIC Educational Resources Information Center

Schelly, David; Jiménez González, Patricia; Solís, Pedro J.

2018-01-01

Sociodemographic factors have long been associated with disparities in autism spectrum disorder (ASD) diagnosis. Studies that identified spatial clustering of cases have suggested the importance of information about ASD moving through social networks of parents. Yet there is no direct evidence of this mechanism. This study explores the…

Mobile Learning in Medical Education: A Case Study through the Lens of Sleep Education

ERIC Educational Resources Information Center

Wells, Mary Ellen

2014-01-01

Sleep disorders affect millions of Americans and are directly associated with many deadly diseases, including neurological disorders. Despite this impact, sleep medicine education is not included in many U.S.-based neurology residency education programs, resulting in under-diagnosed patients and missed therapeutic opportunities. This study aims to…

Virtual and Material Buildings: Construction and Constructivism in Architecture and Writing.

ERIC Educational Resources Information Center

Medway, Peter

1996-01-01

Endorses recent arguments for more study of writing that shapes and directs the production of material artifacts and for considering writing as one semiotic mode among others. Considers a case of "nonwritten" symbolic production, architectural design, for what it may suggest for the study and teaching of writing. (TB)

Educational Challenges of Internal Migrant Girls: A Case Study among Primary School Children in Turkey

ERIC Educational Resources Information Center

Altinyelken, Hulya Kosar

2009-01-01

This article seeks to investigate education-related challenges encountered by internal migrant girls studying at primary schools in Turkey. From the perspectives of participants, the emerging themes included adaptation, language, low socio-economic status, peer relations, discrimination and bullying. These challenges seem to have direct or…

The Role of Education in the Social and Economic Development of Japan.

ERIC Educational Resources Information Center

Japanese National Commission for UNESCO, Tokyo.

Emphasis in this study of Japanese education since the Meiji Restoration of 1868 was on interactions between industrialization and education, the development of a national school system, the rise of vocational education, the foundation and direction of economic and educational development, and case studies of modernization and education in…

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…

School Bullying and Collective Efficacy: A Study of Elementary Schools

ERIC Educational Resources Information Center

Hyde, Tonya Nichelle

2014-01-01

Recently, widely publicized incidents of school violence have prompted questions about the abilities of school leaders to educate students in safe and socially productive environments. In many cases, incidents of school violence are linked directly to bullying episodes. The primary objective of this study is to examine the relationship between…

A New Context Affording for Regulation: The Case of Musical Play

ERIC Educational Resources Information Center

Zachariou, Antonia; Whitebread, David

2017-01-01

The present study set out to investigate theoretical speculations that regulation and musical play, an initial manifestation of musicality, are directly linked. This study aimed to explore the potential for regulation to occur during musical play and investigate the nature of the regulatory behaviours. Thirty-six children, aged 6 and 8, were…

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…

New Directions in Composition Research. Perspectives in Writing Research.

ERIC Educational Resources Information Center

Beach, Richard, Ed.; Bridwell, Lillian S., Ed.

This book contains 20 articles, from a wide variety of perspectives, designed to bridge the interests of researchers and teachers on the topic of current composition research. The following articles are included: "Studying the Writing Abilities of a University Freshman Class: Strategies from a Case Study" (Charles R. Cooper, with Roger…

Two Related Approaches to Teacher Professional Learning in the Asia Pacific Region

ERIC Educational Resources Information Center

White, Allan

2007-01-01

This paper examines the similarities and differences between two successful programmes of teacher professional learning. Firstly, Lesson Study developed in Japan over 40 years ago. It examines practice either through direct observation or through classroom artefacts and case studies. It assumes that teacher learning will be more meaningful and…

The effects of gear reduction on robot dynamics

NASA Technical Reports Server (NTRS)

Chen, J.

1989-01-01

The effect of the joint drive system with gear reduction for a generic two-link system is studied. It is done by comparing the kinetic energy of such a system with that of a direct drive two-link system. The only difference are two terms involving the inertia of the motor rotor and gear ratio. Modifications of the equations of motion from a direct drive system are then developed and generalized to various cases encountered in robot manipulators.

UUGM Code Development

DTIC Science & Technology

1993-07-26

atmospheres of at this time. certain solar system planets. The JPL work was directed at very specific applications; however, the Studi"ss-1 7 WorkRe ported in...pressure atmospheres of certain 1-60 Hz. The spark plug power output was varied inversely solar system planets. The JPL work was directed at very with...general case of explosive dust diaper - deposited as a thin layer over the surface area of the sion. We will consider particle density variation from 4

Hankel-Bessel laser beams.

PubMed

Kotlyar, Victor V; Kovalev, Alexey A; Soifer, Victor A

2012-05-01

An analytical solution of the scalar Helmholtz equation to describe the propagation of a laser light beam in the positive direction of the optical axis is derived. The complex amplitude of such a beam is found to be in direct proportion to the product of two linearly independent solutions of Kummer's differential equation. Relationships for a particular case of such beams-namely, the Hankel-Bessel (HB) beams-are deduced. The focusing of the HB beams is studied. © 2012 Optical Society of America

Warming experiments elucidate the drivers of observed directional changes in tundra vegetation

PubMed Central

Hollister, Robert D; May, Jeremy L; Kremers, Kelseyann S; Tweedie, Craig E; Oberbauer, Steven F; Liebig, Jennifer A; Botting, Timothy F; Barrett, Robert T; Gregory, Jessica L

2015-01-01

Few studies have clearly linked long-term monitoring with in situ experiments to clarify potential drivers of observed change at a given site. This is especially necessary when findings from a site are applied to a much broader geographic area. Here, we document vegetation change at Barrow and Atqasuk, Alaska, occurring naturally and due to experimental warming over nearly two decades. An examination of plant cover, canopy height, and community indices showed more significant differences between years than due to experimental warming. However, changes with warming were more consistent than changes between years and were cumulative in many cases. Most cases of directional change observed in the control plots over time corresponded with a directional change in response to experimental warming. These included increases in canopy height and decreases in lichen cover. Experimental warming resulted in additional increases in evergreen shrub cover and decreases in diversity and bryophyte cover. This study suggests that the directional changes occurring at the sites are primarily due to warming and indicates that further changes are likely in the next two decades if the regional warming trend continues. These findings provide an example of the utility of coupling in situ experiments with long-term monitoring to accurately document vegetation change in response to global change and to identify the underlying mechanisms driving observed changes. PMID:26140204

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.

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.

Direct oral anticoagulants and its implications in dentistry. A review of literature.

PubMed

Lanau, Neus; Mareque, Javier; Giner, Lluis; Zabalza, Michel

2017-11-01

Four novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously. A comprehensive search of the PubMed, Scopus and ISI Web of Science databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The quality of the reported information was assessed following the PRISMA statement. Eleven studies that met the inclusion criteria were included in the review: 2 randomized clinical trials, 3 prospective studies, 3 retrospective studies, 2 case series and 1 case report. DOACs are safe drugs in terms of bleeding. The possible postoperative bleeding complications are manageable with conventional haemostasis measurements. The bridging approach with heparin does not seem to be recommended. Consensus among the professionals involved in the management of the patient is fundamental in invasive dental treatments and in complex patients. Key words: Oral anticoagulants, DOAC, NOAC, dabigatran, rivaroxaban, apixaban, edoxaban, bleeding, oral surgery.

Assessing work disability for social security benefits: international models for the direct assessment of work capacity.

PubMed

Geiger, Ben Baumberg; Garthwaite, Kayleigh; Warren, Jon; Bambra, Clare

2017-08-25

It has been argued that social security disability assessments should directly assess claimants' work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted. The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews. Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants' functional capacities; (ii) demonstrated assessment, which looks at claimants' actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals. Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are "demonstrated assessment" (using claimants' experiences in the labour market), "structured assessment" (matching functional requirements to workplace demands), and "expert assessment" (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.

[Direct osteosynthesis of instable Gehweiler Type III atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function].

PubMed

Böhm, H; Kayser, R; El Saghir, H; Heyde, C-E

2006-09-01

This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. We introduce a new technique of direct reconstruction of the atlas vertebra. This technique leads to a stable ring construct that allows compression osteosynthesis of the fracture. Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.

[Studies on anaerobic infection in oro-maxillary region--rapid diagnosis by gas-liquid chromatography and antibiotic susceptibilities of anaerobic bacteria].

PubMed

Tanaka, J I

1989-08-01

Subject material for this study was pus collected from patients with purulent inflammation in the oro-maxillary region. Direct gas-liquid chromatography (GLC) analysis was made, bacterial isolation and identification were carried out, and comparisons were made with results from GLC analysis and anaerobic isolates in a PYG medium. In addition, antibiotic susceptibilities of anaerobic bacteria were examined. Results 1. Anaerobic bacteria were isolated from 85 of 100 cases of obstructive abscesses. Of the 85, 49 were cases of mixed infection involving both anaerobic and aerobic bacteria; and 64 cases were involved with more than 2 species of anaerobic bacteria. Of the 184 strains of anaerobic isolates, 53 were Bacteroides sp. and 51 were Peptostreptococcus sp. The 2 groups accounted for more than half of the isolates. 2. Group A, in which no VFA was detected, accounted for 17 out of 100 cases. Group B, in which acetic acid was detected, accounted for 20 cases; and Group C, in which butyric acid was detected, accounted for 20 cases; and Group D, in which iso-valeric acid was detected, accounted for 8 cases. Direct GLC analysis revealed iso-caproic and caproic acids in the 35 cases constituting Group E. 3. Whereas the percentage of anaerobic bacteria was 64.7% in Group A and 60% in Group B, significantly higher percentages were noted in Group C (95%), Group D (100%) and Group E (100%). The following species were isolated as major member in the groups; Group A--Streptococcus intermedius, Group B--Peptostreptococcus micros, Group C--Fusobacterium nucleatum, Group D--Bacteroides gingivalis, and Group E--Peptostreptococcus anaerobius. 4. In all cases, the sum of VFA produced in the PYG medium by anaerobic isolates was classified into Group A' to E'. Ratios of agreement between VFA as revealed by direct GLC and VFA as revealed by PYG.GLC were as follows: Group A-A'; 47.1%, Group B-B' and C-C'; 45%, Group D-D'; 87.5%, and Group E-E'; 62.9%. 5. In Group B, no propionic acid was detected. The 2 cases in which acetic acid occurred in a concentration greater than 14 x 10(-4) meq/ml belonged to Group B'. In Group C, no isobutyric acid was detected; and the 5 cases in which butyric acid was detected in a concentration of more than 7 x 10(-4) meq/ml belonged to Group C'. Varelic acid was not detected in Group D; and 7 out of the 8 cases in which iso-valeric acid, irrespective of concentration, was detected belonged to Group D'.(ABSTRACT TRUNCATED AT 400 WORDS)

Sensitivity of directed networks to the addition and pruning of edges and vertices

NASA Astrophysics Data System (ADS)

Goltsev, A. V.; Timár, G.; Mendes, J. F. F.

2017-08-01

Directed networks have various topologically different extensive components, in contrast to a single giant component in undirected networks. We study the sensitivity (response) of the sizes of these extensive components in directed complex networks to the addition and pruning of edges and vertices. We introduce the susceptibility, which quantifies this sensitivity. We show that topologically different parts of a directed network have different sensitivity to the addition and pruning of edges and vertices and, therefore, they are characterized by different susceptibilities. These susceptibilities diverge at the critical point of the directed percolation transition, signaling the appearance (or disappearance) of the giant strongly connected component in the infinite size limit. We demonstrate this behavior in randomly damaged real and synthetic directed complex networks, such as the World Wide Web, Twitter, the Caenorhabditis elegans neural network, directed Erdős-Rényi graphs, and others. We reveal a nonmonotonic dependence of the sensitivity to random pruning of edges or vertices in the case of C. elegans and Twitter that manifests specific structural peculiarities of these networks. We propose the measurements of the susceptibilities during the addition or pruning of edges and vertices as a new method for studying structural peculiarities of directed networks.

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/.

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.

Building a New Model of Care for Rapid Breast Radiotherapy Treatment Planning: Evaluation of the Advanced Practice Radiation Therapist in Cavity Delineation.

PubMed

Lee, G; Dinniwell, R; Liu, F F; Fyles, A; Han, K; Conrad, T; Levin, W; Marshall, A; Purdie, T G; Koch, C A

2016-12-01

Breast radiotherapy treatment is commonly managed by a multidisciplinary team to ensure optimal delivery of care. We sought a new model of care whereby a clinical specialist radiation therapist (CSRT) delineates the cavity target for whole breast radiotherapy treatment planning and the radiation oncologist validates the contour during final plan review. This study evaluated the radiation oncologist's acceptance of these contours and identified characteristics of cavities suitable for CSRT-directed contouring. Following specialised breast oncology education and training by the radiation oncologist, the CSRT prospectively delineated cavities in 30 tangential breast radiotherapy cases and consulted the radiation oncologist in 'complex' cases but directed 'non-complex' cases for treatment planning. Changes to CSRT contours were evaluated using the conformity index. Breast density, time since surgery and cavity location, size and visualisation score [CVS: range 1 (no visible cavity) to 5 (homogenous cavity)] were captured. Of the 30 CSRT delineated cavities contours, the CSRT directed 20 (66.7%) cases for planning without radiation oncology review; 19 were accepted (without changes) by the radiation oncologist upon final plan review and one was changed by the radiation oncologist (conformity index = 0.93) for boost treatment and did not affect the tangential treatment plan. Ten (33.3%) cases, all CVS ≤ 3, were reviewed with the radiation oncologist before planning (conformity index = 0.88 ± 0.12). CVS was inversely correlated with breast density and cavity size (P < 0.01). The CSRT delineated cavities appropriate for clinical radiotherapy treatment planning in women with well-visualised cavities, whereas 'complex' cases with dense breast parenchyma, CVS ≤ 3, and/or cases needing boost radiotherapy treatment required review with the radiation oncologist before planning. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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

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

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.

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

Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity.

PubMed

Pressman, Mark R

2007-08-01

To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors - is triggered by direct physical contact or close proximity to that individual and does not occur randomly or spontaneously. Historical review of case reports in the medical and legal literature. A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were associated with provocation or close proximity in 40%-90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered differed among sleepwalking, confusional arousals, and sleep terrors. In the cases reviewed, violent behavior directed against other individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders. The conclusions of this case series await confirmation by the results of future sleep laboratory based studies.

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.

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.

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

Effect of anisotropy on mechanical properties of Ti-6Al-4V in superplastic region

NASA Astrophysics Data System (ADS)

Wahed, MA; Gupta, AK; Singh, SK; Kotkunde, N.

2018-04-01

This paper presents an experimental investigation on the flow stress behaviour of Ti-6Al-4V alloy at elevated temperatures and very low strain rate. Though Ti-6Al-4V alloy is very hard to deform at room temperature, having only about 16 % elongation, it exhibits super-plasticity at elevated temperatures. To investigate this, the tensile tests were conducted from 700°C to 900°C temperatures at an interval of 50°C and at a very low strain rate 0.0001/s along three different directions: rolling direction, 45° to rolling direction and transverse direction. The experimental study shows more than 50% elongation in all the cases and particularly more than 250% elongation at 0.0001 / s strain rate and at 750°C to 900°C temperature in all directions, which is an indication of super-plasticity in the material. This is also corroborated by the microstructural study of the fractured specimens.

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.

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.

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.

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.

Direct cost of dengue hospitalization in Zhongshan, China: Associations with demographics, virus types and hospital accreditation.

PubMed

Zhang, Jing Hua; Yuan, Juan; Wang, Tao

2017-08-01

Zhongshan City of Guangdong Province (China) is a key provincial and national level area for dengue fever prevention and control. The aim of this study is to analyze how the direct hospitalization costs and the length of stay of dengue hospitalization cases vary according to associated factors such as the demographics, virus types and hospital accreditation. This study is based on retrospective census data from the Chinese National Disease Surveillance Reporting System. Totally, the hospital administrative data of 1432 confirmed dengue inpatients during 2013-2014 was obtained. A quantile regression model was applied to analyze how the direct cost of Dengue hospitalization varies with the patient demographics and hospital accreditation across the data distribution. The Length of Stay (LOS) was also examined. The average direct hospitalization cost of a dengue case in this study is US$ 499.64 during 2013, which corresponded to about 3.71% of the gross domestic product per capita in Zhongshan that year. The mean of the Length of Stay (LOS) is 7.2 days. The multivariate quantile regression results suggest that, after controlling potential compounding variables, the median hospitalization costs of male dengue patients were significantly higher than female ones by about US$ 18.23 (p<0.1). The hospitalization cost difference between the pediatric and the adult patients is estimated to be about US$ 75.25 at the median (p<0.01), but it increases sharply among the top 25 percentiles and reaches US$ 329 at the 90th percentile (p<0.01). The difference between the senior (older than 64 years old) and the adult patients increases steadily across percentiles, especially sharply among the top quartiles too. The LOS of the city-level hospitals is significantly shorter than that in the township-level hospitals by one day at the median (p<0.05), but no significant differences in their hospitalization costs. The direct hospitalization costs of dengue cases vary widely according to the associated demographics factors, virus types and hospital accreditations. The findings in this study provide information for adopting hospitalization strategy, cost containment and patient allocation in dengue prevention and control. Also the results can be used as the cost-effective reference for future dengue vaccine adoption strategy in China.

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...

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.

Position control of desiccation cracks by memory effect and Faraday waves.

PubMed

Nakayama, Hiroshi; Matsuo, Yousuke; Takeshi, Ooshida; Nakahara, Akio

2013-01-01

Pattern formation of desiccation cracks on a layer of a calcium carbonate paste is studied experimentally. This paste is known to exhibit a memory effect, which means that a short-time application of horizontal vibration to the fresh paste predetermines the direction of the cracks that are formed after the paste is dried. While the position of the cracks (as opposed to their direction) is still stochastic in the case of horizontal vibration, the present work reports that their positioning is also controllable, at least to some extent, by applying vertical vibration to the paste and imprinting the pattern of Faraday waves, thus breaking the translational symmetry of the system. The experiments show that the cracks tend to appear in the node zones of the Faraday waves: in the case of stripe-patterned Faraday waves, the cracks are formed twice more frequently in the node zones than in the anti-node zones, presumably due to the localized horizontal motion. As a result of this preference of the cracks to the node zones, the memory of the square lattice pattern of Faraday waves makes the cracks run in the oblique direction differing by 45 degrees from the intuitive lattice direction of the Faraday waves.

Student teaching and research laboratory focusing on brain-computer interface paradigms--A creative environment for computer science students.

PubMed

Rutkowski, Tomasz M

2015-08-01

This paper presents an applied concept of a brain-computer interface (BCI) student research laboratory (BCI-LAB) at the Life Science Center of TARA, University of Tsukuba, Japan. Several successful case studies of the student projects are reviewed together with the BCI Research Award 2014 winner case. The BCI-LAB design and project-based teaching philosophy is also explained. Future teaching and research directions summarize the review.

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.

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.

Resolvent analysis of suboptimal control for turbulent skin friction drag reduction

NASA Astrophysics Data System (ADS)

Nakashima, Satoshi; Fukagata, Koji; Luhar, Mitul

2017-11-01

We study the drag reduction mechanisms of suboptimal control (Lee et al. 1998) via the resolvent formulation developed by McKeon and Sharma (2010). Under this formulation, the nonlinear term in the Navier-Stokes equations is regarded as a forcing which acts upon the linear dynamics to output a velocity response across Fourier space. This analysis enables targeted analyses of the effects of the control on modes resembling dynamically important coherent structures such as the near-wall (NW) cycle. Suboptimal control generates blowing and suction at the wall that is proportional to the streamwise (Case ST) or spanwise (Case SP) wall shear-stress, with the magnitude of blowing and suction being a design parameter. Both Case ST and SP can suppress resolvent modes resembling the NW cycle. However, for Case ST, the analysis reveals that the control leads to substantial increase in amplification for structures that are long in the spanwise direction. High actuation of such energetic spanwise structures was confirmed by conducting limited direct numerical simulations. In addition to the study of modes resembling the NW cycle, we will discuss modes of varying propagating speed and wavelength to provide insight into the effects of suboptimal control across spectral space. This work was supported through Grant-in-Aid for Scientific Research (C) (No. 25420129) by Japan Society for the Promotion of Science (JSPS).

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.

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

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

PubMed Central

2005-01-01

Introduction Risk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme. Methods All obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit. Results A total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions. Conclusion This study confirms that APACHE II overestimates mortality in obstetric admissions to critical care units. This may be because of the physiological changes in pregnancy or the unique scoring profile of obstetric pathologies such as HELLP syndrome. It may be possible to recalibrate the APACHE II score for obstetric admissions or to devise an alternative score specifically for obstetric admissions.

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)

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.

Risk Factors for Influenza A(H7N9) Disease in China, a Matched Case Control Study, October 2014 to April 2015

PubMed Central

Zhou, Lei; Ren, Ruiqi; Ou, Jianming; Kang, Min; Wang, Xiaoxiao; Havers, Fiona; Huo, Xiang; Liu, Xiaoqing; Sun, Qianlai; He, Yongchao; Liu, Bo; Wu, Shenggen; Wang, Yali; Sui, Haitian; Zhang, Yongjie; Tang, Shaopei; Chang, Caiyun; Xiang, Lunhui; Wang, Dong; Zhao, Shiguang; Zhou, Suizan; Chen, Tao; Xiang, Nijuan; Greene, Carolyn M.; Zhang, Yanping; Shu, Yuelong; Feng, Zijian; Li, Qun

2016-01-01

Background. Human infections with avian influenza A(H7N9) virus have been associated with exposure to poultry and live poultry markets (LPMs). We conducted a case-control study to identify additional and more specific risk factors. Methods. Cases were laboratory-confirmed A(H7N9) infections in persons in China reported from October 1, 2014 to April 30, 2015. Poultry workers, those with insufficient data, and those refusing participation were excluded. We matched up to 4 controls per case by sex, age, and residential community. Using conditional logistic regression, we examined associations between A(H7N9) infection and potential risk factors. Results. Eighty-five cases and 334 controls were enrolled with similar demographic characteristics. Increased risk of A(H7N9) infection was associated with the following: visiting LPMs (adjusted odds ratio [aOR], 6.3; 95% confidence interval [CI], 2.6–15.3), direct contact with live poultry in LPMs (aOR, 4.1; 95% CI, 1.1–15.6), stopping at a live poultry stall when visiting LPMs (aOR, 2.7; 95% CI, 1.1–6.9), raising backyard poultry at home (aOR, 7.7; 95% CI, 2.0–30.5), direct contact with backyard poultry (aOR, 4.9; 95% CI, 1.1–22.1), and having ≥1 chronic disease (aOR, 3.1; 95% CI, 1.5–6.5). Conclusions. Our study identified raising backyard poultry at home as a risk factor for illness with A(H7N9), suggesting the need for enhanced avian influenza surveillance in rural areas. PMID:27704029

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

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 case of direct intracranial extension of tuberculous otitis media.

PubMed

Kim, Dong-Kee; Park, Shi-Nae; Park, Kyung-Ho; Yeo, Sang Won

2014-02-01

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

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

Opinion: the case for advertising pharmaceuticals direct to consumers.

PubMed

Auton, Frank

2009-07-01

Direct-to-consumer advertising (DCTA) of prescription-only medicines is currently only permitted in the USA and New Zealand. While proponents of DCTA argue that it allows patients to make more informed choices about available treatment options, opponents claim that marketing inevitably presents a biased viewpoint of pharmaceutical products. Frank Auton, senior lecturer in marketing and business strategy at the University of Westminster, UK, presents his case in favor of advertising pharmaceuticals directly to patients.

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.

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.

Advance directives outside the USA: are they the best solution everywhere?

PubMed

Sanchez-Gonzalez, M A

1997-09-01

This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and "American moralism." The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism verus empiricism, statism versus citizens' initiative, and justice versus autonomy. The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.

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.

Association Between Surgeon Scorecard Use and Operating Room Costs.

PubMed

Zygourakis, Corinna C; Valencia, Victoria; Moriates, Christopher; Boscardin, Christy K; Catschegn, Sereina; Rajkomar, Alvin; Bozic, Kevin J; Soo Hoo, Kent; Goldberg, Andrew N; Pitts, Lawrence; Lawton, Michael T; Dudley, R Adams; Gonzales, Ralph

2017-03-01

Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls. Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

Muscle metastasis from non-small cell lung cancer: two cases and literature review.

PubMed

Tezcan, Y; Koc, M

2014-08-01

Non-small cell lung cancers (NSCLC) is the most commonly observed group among lung cancers. Adenocancers are histopathologically more common. Males are more affected than females, an effect which is directly related to smoking. They generally cause distant haematogenous and lymphatic metastasis. Distant haematogenous metastases are often seen in contralateral lung, brain, bone, adrenals, and liver. Muscle metastases from NSCLC are quite rare and male cases are more frequently affected compared to female cases. NSCLC cases with muscle metastasis are at the same time accompanied by distant organ metastases such as bone, brain, and liver. All treatment approaches are considered to be palliative in these cases, which are symptomatologically quite severe. In the present study, we presented the rarely observed cases of two male patients with muscle metastasis from NSCLC together with the related literature.

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 Retrospective Case-Control Study, Factors Affecting Treatment Outcomes for Pulmonary Tuberculosis in İstanbul, Turkey

PubMed Central

Babalık, Aylin; Kılıçaslan, Zeki; Kızıltaş, Şule; Gencer, Serap; Öngen, Gül

2013-01-01

Background: Tuberculosis is a public health problem and its transmission is a threat to the community. Aims: The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey. Study Design: Case-Control Study Methods: A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up. Results: The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99–5.76)) ; male gender (OR:2.11 (1.49–2.99)); born outside Turkey (OR: 5.48 (2.13–14.04)); co-morbidity (OR: 1.85 (1.29–2.65)); bilateral radiologic lesions (OR: 2.07 (1.41–3.00); previous treatment history (OR: 3.99 (2.78–5.74)); 3rd month positive microscopy (OR: 4.96 (3.04–8.09)) and any H&R +/− others multidrug resistant (MDR) resistance (OR: 22.64 (6.92–74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors. Conclusion: Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated. PMID:25207101

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 comparison of phase-sensitive vibrational sum frequency generation with maximum entropy method: case study of water.

PubMed

de Beer, Alex G F; Samson, Jean-Sebastièn; Hua, Wei; Huang, Zishuai; Chen, Xiangke; Allen, Heather C; Roke, Sylvie

2011-12-14

We present a direct comparison of phase sensitive sum-frequency generation experiments with phase reconstruction obtained by the maximum entropy method. We show that both methods lead to the same complex spectrum. Furthermore, we discuss the strengths and weaknesses of each of these methods, analyzing possible sources of experimental and analytical errors. A simulation program for maximum entropy phase reconstruction is available at: http://lbp.epfl.ch/. © 2011 American Institute of Physics

Safety of audiology direct access for medicare patients complaining of impaired hearing.

PubMed

Zapala, David A; Stamper, Greta C; Shelfer, Janet S; Walker, David A; Karatayli-Ozgursoy, Selmin; Ozgursoy, Ozan B; Hawkins, David B

2010-06-01

Allowing Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss has been advocated as a cost-effective service delivery model. Resistance to audiology direct access is based, in part, on the concern that audiologists might miss significant otologic conditions. To evaluate the relative safety of audiology direct access by comparing the treatment plans of audiologists and otolaryngologists in a large group of Medicare-eligible patients seeking hearing evaluation. Retrospective chart review study comparing assessment and treatment plans developed by audiologists and otolaryngologists. 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment. Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. Records of patients seen jointly by audiology and otolaryngology practitioners (Group 1: 352 cases) were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist's treatment plan. Records of patients seen by audiology but not otolaryngology (Group 2: 1198 cases) were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist's documentation and test results. Additionally, the audiologist and reviewing neurotologist judgments about hearing asymmetry were compared to two mathematical measures of hearing asymmetry (Charing Cross and AAO-HNS [American Academy of Otolaryngology-Head and Neck Surgery] calculations). In the analysis of Group 1 records, the jury of four judges found no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist. In the analysis of Group 2 records, the neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history. In 0.33% of cases, unexplained hearing asymmetry was potentially missed by the audiologist. Audiologists and the neurotologist demonstrated comparable accuracy in identifying Charing Cross and AAO-HNS pure-tone asymmetries. Of study patients evaluated for hearing problems in the one-year period of this study, the majority (95%) ultimately required audiological services, and in most of these cases, audiological services were the only hearing health-care services that were needed. Audiologist treatment plans did not differ substantially from otolaryngologist plans for the same condition; there was no convincing evidence that audiologists missed significant symptoms of otologic disease; and there was strong evidence that audiologists referred to otolaryngology when appropriate. These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment. American Academy of Audiology.

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.

[Epidemiology of Tinea capitis in the suburbs of Tipasa, Algeria].

PubMed

Bendjaballah-Laliam, A; Djazer, H

2014-06-01

Tinea capitis represent a public health problem in Algeria, despite improvement of living conditions. We conducted a retrospective study of cases diagnosed in the hospital Hadjout (Tipasa), Algeria, during 3 years (January 2010-January 2013). Among a total of 213 hair samples, 133 were positive (direct examination or culture). Incidence average was 44 cases per year. Patients were under 12 years of age in 91%. Three species of dermatophytes were isolated: Trichophyton violaceum (66%), Microsporum canis (32.5%) and Trichophyton mentagrophytes (1.5%). No favus was diagnosed during the study period. Copyright © 2014. Published by Elsevier Masson SAS.

Anxious bliss: a case study of dissociation in a Mexican nun.

PubMed

Lester, Rebecca J

2008-03-01

This is a case study of Celeste, postulant in a Roman Catholic convent in Mexico who experienced frequent episodes of leaving her body to commune with God. During these experiences, Celeste felt immersed in an ;incredibly beautiful profound silence' where ;time and space were broken.' But as much as Celeste craved these experiences, they also alarmed her; she was acutely aware that they might be indicative of psychological or neurological dysfunction. This article chronicles Celeste's struggles to make sense of her experiences in light of competing explanatory models. Her ultimate resolution suggests intriguing new directions for transcultural psychiatric research.

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.

Frozen section evaluation via dynamic real-time non-robotic Telepathology system in a university Cancer center by resident / faculty cooperation team.

PubMed

Vosoughi, Aram; Smith, Paul Taylor; Zeitouni, Joseph A; Sodeman, Gregori M; Jorda, Merce; Gomez-Fernandez, Carmen; Garcia-Buitrago, Monica; Petito, Carol K; Chapman, Jennifer R; Campuzano-Zuluaga, German; Rosenberg, Andrew E; Kryvenko, Oleksandr N

2018-04-30

Frozen section telepathology interpretation experience has been largely limited to practices with locations significantly distant from one another with sporadic need for frozen section diagnosis. In 2010 we established a real-time non-robotic telepathology system in a very active cancer center for daily frozen section service. Herein, we evaluate its accuracy compared to direct microscopic interpretation performed in the main hospital by the same faculty and its cost-efficiency over a 1-year period. From 643 (1416 parts) cases requiring intraoperative consultation, 333 cases (690 parts) were examined by telepathology and 310 cases (726 parts) by direct microscopy. Corresponding discrepancy rates were 2.6% (18 cases: 6 (0.9%) sampling and 12 (1.7%) diagnostic errors) and 3.2% (23 cases: 8 (1.1%) sampling and 15 (2.1%) diagnostic errors), P=.63. The sensitivity and specificity of intraoperative frozen diagnosis were 0.92 and 0.99, respectively, in telepathology, and 0.90 and 0.99, respectively, in direct microscopy. There was no correlation of error incidence with post graduate year level of residents involved in the telepathology service. Cost analysis indicated that the time saved by telepathology was $19691 over one year of the study period while the capital cost for establishing the system was $8924. Thus, real-time non-robotic telepathology is a reliable and easy to use tool for frozen section evaluation in busy clinical settings, especially when frozen section service involves more than one hospital, and it is cost efficient when travel is a component of the service. Copyright © 2018. Published by Elsevier Inc.

The association between imported factors and prisoners' mental health: Implications for adaptation and intervention.

PubMed

Bowler, Nicholas; Phillips, Ceri; Rees, Paul

In the United Kingdom (UK) the prison population has increased by around one third since the turn of the millennium amid growing concern over the correctional mission of prisons, the number of prisoners exhibiting mental health difficulties and high levels of recidivism. This study aims to explore the relationship between 'imported' (pre-prison) factors and prisoner mental health status. Prisoners (N = 756) from two UK prisons completed an established measure of mental health (General Health Questionnaire: GHQ-12) and a bespoke survey on pre-prison characteristics and experiences (for example, dispositions, childhood abuse, substance misuse, learning difficulties and employment). Prevalence of mental health difficulties was high, with 40.3% reaching the 'caseness' threshold. Binary logistic regression and odds ratio analyses were used to explore the ability of imported factors to predict mental health 'caseness' and the direction of influence. Collectively, the imported factors correctly predicted the caseness category of 76.5% of participants (p < .001). Pre-prison dispositions proved to be strong predictors of caseness as did childhood sexual abuse and learning difficulties at school. We found the direction of influence of three imported factors differed from all others: unemployment, prior experience of prison and a history of substance misuse. These three factors are associated with a lower rate of mental health caseness. It is of concern that, on release, these same factors are likely to militate against re-integration into society. Imported factors can serve as powerful predictors of 'within-prison' mental health status, but practitioners need to be cognisant of the relative importance and direction of influence of factors, as evidenced by these findings. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

[Possibilities of medical opinionating in cases associated with "exposure to direct danger of death or serious health damage"].

PubMed

Konopka, Tomasz; Skupień, Elzbieta

2008-01-01

In the opinion of some forensic medicine experts, assessment of potential consequences in keeping with Article 160 of the Polish Penal code, which refers to the crime of "exposure to direct danger of death or severe health damage", lies within the competence of medicolegal specialists. This view is accepted by courts and prosecution offices. However, the knowledge of physicians in the field of predicting consequences which did not occur is only somewhat better than that of lawyers. In simple cases, e.g. in trauma involving a sensitive area of the body, passing an opinion confirming a serious danger is not associated with any major problems. Similarly, no problems arise when passing an opinion on the lack of such a danger e.g. in the case of traumawithout any injuries. In complex cases, however, which include the majority of medical error cases, passing an opinion on exposure to direct danger of death or severe health damage may be not feasible.

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.

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.

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.

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.

Electrolyte status in birth asphyxia.

PubMed

Basu, Pallab; Som, Sabyasachi; Das, Harendranath; Choudhuri, Nabendu

2010-03-01

To study electrolyte status in asphyxiated newborns of different severity in early neonatal period and compare with controls. Sodium, potassium and total calcium levels were estimated in the serum samples of asphyxiated newborns of different severity and control group immediately after birth. Mean serum sodium level was significantly lower (122.1 +/- 6.0 mEq/L vs 138.8 +/- 2.7 mEq/L; P < 0.001), mean serum potassium was higher (5.05 +/- 0.63 mEq/L vs 4.19 +/- 0.40 mEq/L; P < 0.001) and mean serum calcium level was found lower (6.85 +/- 0.95 mg/dl vs 9.50 +/- 0.51 mg/dl; P < 0.001) in cases than controls. Among cases, a strong positive linear correlation was found between the serum sodium, serum calcium levels and their Apgar scores, between sodium levels and total calcium levels and significant negative linear correlation between Apgar scores and serum potassium level. Among cases, hyponatremia and hypocalcemia developed early and simultaneously and the decrease in their serum levels was directly proportional to each other and to the degree of asphyxia. Though, mean potassium level was within the normal limit, the value was higher among cases than controls and directly proportional to asphyxia.

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.

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.

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.

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.

Consumer and case manager perspectives of service empowerment: relationship to mental health recovery.

PubMed

Crane-Ross, Dushka; Lutz, Wilma J; Roth, Dee

2006-04-01

This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.

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.

Willingness to Communicate in English as a Second Language: A Case Study of Pakistani Undergraduates

ERIC Educational Resources Information Center

Bukhari, Syeda Farzana; Cheng, Xiaoguang; Khan, Salman Ali

2015-01-01

Willingness to communicate (WTC) construct plays an important role in second language (L2) teaching and learning. Almost any second language learner is likely to respond to a direct question, but many will not continue or initiate communication. The present study investigates Pakistani undergraduate students' perception of their willingness to…

Quality of Care in Creches for Disadvantaged Children: A Brazilian Case Study.

ERIC Educational Resources Information Center

Ferreira, M. C. Rossetti; And Others

A study was conducted to critically assess the developmental conditions of 187 children (ages 1 month to 6 years) in eight creches (day nurseries) located in and around Ribeirao Preto, Brazil. Data were collected through informal interviews of day care staff and from 20 hours of direct observations of day care units. Findings indicated inadequate…

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.…