Internet advertisements for public sexual encounters among men who have sex with men: are safe behaviors communicated?

PubMed

Downing, Martin J

2011-09-01

Public and commercial sex venues typically provide easy access to sexual encounters that are often anonymous and, therefore, may facilitate HIV/STD transmission among those men who attend. Recently, researchers have suggested that men who have sex with men may be using the Internet to search for sexual encounters to occur within sex venues. The current study explored the extent to which men who advertise for public or commercial sexual encounters initially communicate to potential partners their safe-sex intentions. Advertisements for sexual encounters (n = 99) were collected from a publicly accessible website and examined for content related to venue type, sexual behavior, and indications of sexual safety or risk. Word frequencies were calculated to provide a closer investigation of how individuals negotiate safe sex within these communications. The findings revealed that approximately half of the men who advertised for sex in a public or commercial sex venue failed to communicate to potential partners in their initial advertisement a desire to be safe during sexual encounters involving oral and anal practices. Additionally, a small percentage of men advertised specifically for risky encounters (e.g., barebacking). Together, these findings suggest that men do use the Internet to coordinate public sexual encounters, some of which may be unprotected from HIV/STD transmission. Future research should address the process of condom negotiation among men who initially meet their male sex partners on the Internet for subsequent encounters in sex venues.

Initiating Molecular Growth in the Interstellar Medium via Dimeric Complexes of Observed Ions and Molecules

NASA Technical Reports Server (NTRS)

Bera, Partha P.; Head-Gordon, Martin; Lee, Timothy J.

2011-01-01

A feasible initiation step for particle growth in the interstellar medium (ISM) is simulated by means of ab quantum chemistry methods. The systems studied are dimer ions formed by pairing nitrogen containing small molecules known to exist in the ISM with ions of unsaturated hydrocarbons or vice versa. Complexation energies, structures of ensuing complexes and electronic excitation spectra of the encounter complexes are estimated using various quantum chemistry methods. Moller-Plesset perturbation theory (MP2, Z-averaged perturbation theory (ZAP2), coupled cluster singles and doubles with perturbative triples corrections (CCSD(T)), and density functional theory (DFT) methods (B3LYP) were employed along with the correlation consistent cc-pVTZ and aug-cc-pVTZ basis sets. Two types of complexes are predicted. One type of complex has electrostatic binding with moderate (7-20 kcal per mol) binding energies, that are nonetheless significantly stronger than typical van der Waals interactions between molecules of this size. The other type of complex develops strong covalent bonds between the fragments. Cyclic isomers of the nitrogen containing complexes are produced very easily by ion-molecule reactions. Some of these complexes show intense ultraviolet visible spectra for electronic transitions with large oscillator strengths at the B3LYP, omegaB97, and equations of motion coupled cluster (EOM-CCSD) levels. The open shell nitrogen containing carbonaceous complexes especially exhibit a large oscillator strength electronic transition in the visible region of the electromagnetic spectrum.

The Worthwhile Risk of Education: From Initiation to Co-Belonging in and through Pedagogical Encounters

ERIC Educational Resources Information Center

Davids, Nuraan; Waghid, Yusef

2016-01-01

This article explores the idea of the worthwhile risk of education, as necessarily involving a transition from one of initiation and risk to that of co-belonging. We commence by considering a contention that while education is a human activity whereby an individual might be initiated into various encounters, the potential experience thereof is as…

Revisiting Rossion and Pourtois with new ratings for automated complexity, familiarity, beauty, and encounter.

PubMed

Forsythe, Alex; Street, Nichola; Helmy, Mai

2017-08-01

Differences between norm ratings collected when participants are asked to consider more than one picture characteristic are contrasted with the traditional methodological approaches of collecting ratings separately for image constructs. We present data that suggest that reporting normative data, based on methodological procedures that ask participants to consider multiple image constructs simultaneously, could potentially confounded norm data. We provide data for two new image constructs, beauty and the extent to which participants encountered the stimuli in their everyday lives. Analysis of this data suggests that familiarity and encounter are tapping different image constructs. The extent to which an observer encounters an object predicts human judgments of visual complexity. Encountering an image was also found to be an important predictor of beauty, but familiarity with that image was not. Taken together, these results suggest that continuing to collect complexity measures from human judgments is a pointless exercise. Automated measures are more reliable and valid measures, which are demonstrated here as predicting human preferences.

Mulliken Hush elucidation of the encounter (precursor) complex in intermolecular electron transfer via self-exchange of tetracyanoethylene anion-radical

NASA Astrophysics Data System (ADS)

Rosokha, S. V.; Newton, M. D.; Head-Gordon, M.; Kochi, J. K.

2006-05-01

The paramagnetic [1:1] encounter complex (TCNE)2-rad is established as the important precursor in the kinetics and mechanism of electron-transfer for the self-exchange between tetracyanoethylene acceptor ( TCNE) and its radical-anion as the donor. Spectroscopic observation of the dimeric complex (TCNE)2-rad by its intervalence absorption band at the solvent-dependent wavelength of λIV ˜ 1500 nm facilitates the application of Mulliken-Hush theory which reveals the significant electronic interaction extant between the pair of cofacial TCNE moieties with the sizable coupling of HDA = 1000 cm -1. The transient existence of such an encounter complex provides the critical link in the electron-transfer kinetics by lowering the classical Marcus reorganization barrier by the amount of HDA in this strongly adiabatic system. Ab initio quantum-mechanical methods as applied to independent theoretical computations of both the reorganization energy ( λ) and the electronic coupling element ( HDA) confirm the essential correctness of the Mulliken-Hush formalism for fast electron transfer via strongly coupled donor/acceptor encounter complexes.

Role of electrostatic interactions in binding of peptides and intrinsically disordered proteins to their folded targets. 1. NMR and MD characterization of the complex between the c-Crk N-SH3 domain and the peptide Sos.

PubMed

Xue, Yi; Yuwen, Tairan; Zhu, Fangqiang; Skrynnikov, Nikolai R

2014-10-21

Intrinsically disordered proteins (IDPs) often rely on electrostatic interactions to bind their structured targets. To obtain insight into the mechanism of formation of the electrostatic encounter complex, we investigated the binding of the peptide Sos (PPPVPPRRRR), which serves as a minimal model for an IDP, to the c-Crk N-terminal SH3 domain. Initially, we measured ¹⁵N relaxation rates at two magnetic field strengths and determined the binding shifts for the complex of Sos with wild-type SH3. We have also recorded a 3 μs molecular dynamics (MD) trajectory of this complex using the Amber ff99SB*-ILDN force field. The comparison of the experimental and simulated data shows that MD simulation consistently overestimates the strength of salt bridge interactions at the binding interface. The series of simulations using other advanced force fields also failed to produce any satisfactory results. To address this issue, we have devised an empirical correction to the Amber ff99SB*-ILDN force field whereby the Lennard-Jones equilibrium distance for the nitrogen-oxygen pair across the Arg-to-Asp and Arg-to-Glu salt bridges has been increased by 3%. Implementing this correction resulted in a good agreement between the simulations and the experiment. Adjusting the strength of salt bridge interactions removed a certain amount of strain contained in the original MD model, thus improving the binding of the hydrophobic N-terminal portion of the peptide. The arginine-rich C-terminal portion of the peptide, freed from the effect of the overstabilized salt bridges, was found to interconvert more rapidly between its multiple conformational states. The modified MD protocol has also been successfully used to simulate the entire binding process. In doing so, the peptide was initially placed high above the protein surface. It then arrived at the correct bound pose within ∼2 Å of the crystallographic coordinates. This simulation allowed us to analyze the details of the dynamic binding intermediate, i.e., the electrostatic encounter complex. However, an experimental characterization of this transient, weakly populated state remains out of reach. To overcome this problem, we designed the double mutant of c-Crk N-SH3 in which mutations Y186L and W169F abrogate tight Sos binding and shift the equilibrium toward the intermediate state resembling the electrostatic encounter complex. The results of the combined NMR and MD study of this engineered system will be reported in the next part of this paper.

Dimerization model of the C-terminal RNA Recognition Motif of HuR.

PubMed

Díaz-Quintana, Antonio; García-Mauriño, Sofía M; Díaz-Moreno, Irene

2015-04-28

Human antigen R (HuR) is a ubiquitous 32 kDa protein comprising three RNA Recognition Motifs (RRMs), whose main function is to bind Adenylate and uridylate Rich Elements (AREs) in 3' UnTranslated Regions (UTRs) of mRNAs. In addition to binding RNA molecules, the third domain (RRM3) is involved in HuR oligomerization and apoptotic signaling. The RRM3 monomer is able to dimerize, with its self-binding affinity being dependent on ionic strength. Here we provide a deeper structural insight into the nature of the encounter complexes leading to the formation of RRM3 dimers by using Brownian Dynamics and Molecular Dynamics. Our computational data show that the initial unspecific encounter follows a downhill pathway until reaching an optimum conformation stabilized by hydrophobic interactions. Copyright © 2015 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

The importance of motivation, weapons, and foul odors in driving encounter competition in carnivores.

PubMed

Allen, Maximilian L; Wilmers, Christopher C; Elbroch, L Mark; Golla, Julie M; Wittmer, Heiko U

2016-08-01

Encounter competition is interference competition in which animals directly contend for resources. Ecological theory predicts the trait that determines the resource holding potential (RHP), and hence the winner of encounter competition, is most often body size or mass. The difficulties of observing encounter competition in complex organisms in natural environments, however, has limited opportunities to test this theory across diverse species. We studied the outcome of encounter competition contests among mesocarnivores at deer carcasses in California to determine the most important variables for winning these contests. We found some support for current theory in that body mass is important in determining the winner of encounter competition, but we found that other factors including hunger and species-specific traits were also important. In particular, our top models were "strength and hunger" and "size and hunger," with models emphasizing the complexity of variables influencing outcomes of encounter competition. In addition, our wins above predicted (WAP) statistic suggests that an important aspect that determines the winner of encounter competition is species-specific advantages that increase their RHP, as bobcats (Lynx rufus) and spotted skunks (Spilogale gracilis) won more often than predicted based on mass. In complex organisms, such as mesocarnivores, species-specific adaptations, including strategic behaviors, aggressiveness, and weapons, contribute to competitive advantages and may allow certain species to take control or defend resources better than others. Our results help explain how interspecific competition shapes the occurrence patterns of species in ecological communities. © 2016 by the Ecological Society of America.

Exploring Digital Encounters in the Public Arena

NASA Astrophysics Data System (ADS)

Schieck, Ava Fatah Gen.; Kostakos, Vassilis; Penn, Alan

In this chapter, we explore the types of encounters that technology enables. We consider the differences between digital and nondigital encounters through two pilot studies carried out in the city of Bath, United Kingdom. We investigate how technology can be appropriated for shared interactions that support conscious (or unconscious) social encounters, and highlight the importance of space and the role of place in providing temporal and spatial mechanisms facilitating different types of shared encounters. Here, we apply a method based on intervention through "sensing and projecting" Bluetooth names and digital identity in the public arena, and describe initial observations about people's reaction toward the projection of their Bluetooth names in public. In particular, we note the significance of constructing socially meaningful relations between people mediated by these technologies. We discuss initial results and outline issues raised in detail before finally describing the ongoing work.

Free energy landscapes of encounter complexes in protein-protein association.

PubMed

Camacho, C J; Weng, Z; Vajda, S; DeLisi, C

1999-03-01

We report the computer generation of a high-density map of the thermodynamic properties of the diffusion-accessible encounter conformations of four receptor-ligand protein pairs, and use it to study the electrostatic and desolvation components of the free energy of association. Encounter complex conformations are generated by sampling the translational/rotational space of the ligand around the receptor, both at 5-A and zero surface-to-surface separations. We find that partial desolvation is always an important effect, and it becomes dominant for complexes in which one of the reactants is neutral or weakly charged. The interaction provides a slowly varying attractive force over a small but significant region of the molecular surface. In complexes with no strong charge complementarity this region surrounds the binding site, and the orientation of the ligand in the encounter conformation with the lowest desolvation free energy is similar to the one observed in the fully formed complex. Complexes with strong opposite charges exhibit two types of behavior. In the first group, represented by barnase/barstar, electrostatics exerts strong orientational steering toward the binding site, and desolvation provides some added adhesion within the local region of low electrostatic energy. In the second group, represented by the complex of kallikrein and pancreatic trypsin inhibitor, the overall stability results from the rather nonspecific electrostatic attraction, whereas the affinity toward the binding region is determined by desolvation interactions.

Helicase promotes replication re-initiation from an RNA transcript.

PubMed

Sun, Bo; Singh, Anupam; Sultana, Shemaila; Inman, James T; Patel, Smita S; Wang, Michelle D

2018-06-13

To ensure accurate DNA replication, a replisome must effectively overcome numerous obstacles on its DNA substrate. After encountering an obstacle, a progressing replisome often aborts DNA synthesis but continues to unwind. However, little is known about how DNA synthesis is resumed downstream of an obstacle. Here, we examine the consequences of a non-replicating replisome collision with a co-directional RNA polymerase (RNAP). Using single-molecule and ensemble methods, we find that T7 helicase interacts strongly with a non-replicating T7 DNA polymerase (DNAP) at a replication fork. As the helicase advances, the associated DNAP also moves forward. The presence of the DNAP increases both helicase's processivity and unwinding rate. We show that such a DNAP, together with its helicase, is indeed able to actively disrupt a stalled transcription elongation complex, and then initiates replication using the RNA transcript as a primer. These observations exhibit T7 helicase's novel role in replication re-initiation.

Physician as partner or salesman? Shared decision-making in real-time encounters.

PubMed

Karnieli-Miller, Orit; Eisikovits, Zvi

2009-07-01

The results of recent research have led to the increased advocacy of shared decision-making regarding medical treatment. Nonetheless, only a limited number of studies have focused on the process of decision-making in real-time encounters. The present paper aims to document and analyze this process. Specifically, we assess whether these decisions are the result of partnership or of persuasive tactics based on power and hierarchical relationships. We will describe and analyze different strategies used by pediatric gastroenterologists in breaking bad news encounters, as well as their consequences. The analysis is based on a multi-method, multi-participant phenomenological study on breaking bad news to adolescents and their families regarding a chronic illness. It included 17 units of analysis (actual encounters and 52 interviews with physicians, parents and adolescents). Data were collected from three hospitals in Northern Israel using observations and audiotapes of diagnosis disclosure encounters and audio-taped interviews with all participants. The analysis identified eight different presentation tactics used in actual encounters during which physicians made various use of language, syntax and different sources of power to persuade patients to agree with their preferred treatment choice. The tactics included various ways of presenting the illness, treatment and side effects; providing examples from other success or failure stories; sharing the decision only concerning technicalities; and using plurals and authority. The findings suggest that shared decision-making may be advocated as a philosophical tenet or a value, but it is not necessarily implemented in actual communication with patients. Rather, treatment decisions tend to be unilaterally made, and a variety of persuasive approaches are used to ensure agreement with the physician's recommendation. The discussion is focused on the complexity of sharing a decision, especially in the initial bad news encounter; and the potentially harmful implications on building a trusting relationship between the physician and the family when a decision is not shared.

Multiscale Mathematics for Biomass Conversion to Renewable Hydrogen

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

Plechac, Petr; Vlachos, Dionisios; Katsoulakis, Markos

2013-09-05

The overall objective of this project is to develop multiscale models for understanding and eventually designing complex processes for renewables. To the best of our knowledge, our work is the first attempt at modeling complex reacting systems, whose performance relies on underlying multiscale mathematics. Our specific application lies at the heart of biofuels initiatives of DOE and entails modeling of catalytic systems, to enable economic, environmentally benign, and efficient conversion of biomass into either hydrogen or valuable chemicals. Specific goals include: (i) Development of rigorous spatio-temporal coarse-grained kinetic Monte Carlo (KMC) mathematics and simulation for microscopic processes encountered in biomassmore » transformation. (ii) Development of hybrid multiscale simulation that links stochastic simulation to a deterministic partial differential equation (PDE) model for an entire reactor. (iii) Development of hybrid multiscale simulation that links KMC simulation with quantum density functional theory (DFT) calculations. (iv) Development of parallelization of models of (i)-(iii) to take advantage of Petaflop computing and enable real world applications of complex, multiscale models. In this NCE period, we continued addressing these objectives and completed the proposed work. Main initiatives, key results, and activities are outlined.« less

Application of Smart Infrastructure Systems approach to precision medicine.

PubMed

Govindaraju, Diddahally R; Annaswamy, Anuradha M

2015-12-01

All biological variation is hierarchically organized dynamic network system of genomic components, organelles, cells, tissues, organs, individuals, families, populations and metapopulations. Individuals are axial in this hierarchy, as they represent antecedent, attendant and anticipated aspects of health, disease, evolution and medical care. Humans show individual specific genetic and clinical features such as complexity, cooperation, resilience, robustness, vulnerability, self-organization, latent and emergent behavior during their development, growth and senescence. Accurate collection, measurement, organization and analyses of individual specific data, embedded at all stratified levels of biological, demographic and cultural diversity - the big data - is necessary to make informed decisions on health, disease and longevity; which is a central theme of precision medicine initiative (PMI). This initiative also calls for the development of novel analytical approaches to handle complex multidimensional data. Here we suggest the application of Smart Infrastructure Systems (SIS) approach to accomplish some of the goals set forth by the PMI on the premise that biological systems and the SIS share many common features. The latter has been successfully employed in managing complex networks of non-linear adaptive controls, commonly encountered in smart engineering systems. We highlight their concordance and discuss the utility of the SIS approach in precision medicine programs.

Encounter Models for the Littoral Regions of the National Airspace System

DTIC Science & Technology

2010-09-15

Jeff Richardson, Steven Schimmelpfennig, Richard Whitlock, Lt. Han Saydam, Lt. Tanuxay Keooudom, James Evans, TSgt. Christopher Cosper, Lt. Luke Marron...24 17 Correlated geometric feature comparison. 25 A- l Aircraft vertical rate in uncorrelated encounters. 31 A-2 Uncorrelated continuous feature...in correlated encounters. 35 B- l Approach angle (/3) and bearing (x) definition. 39 C- l Horizontal plane encounter initialization. 42 C-2

Electrostatically Accelerated Coupled Binding and Folding of Intrinsically Disordered Proteins

PubMed Central

Ganguly, Debabani; Otieno, Steve; Waddell, Brett; Iconaru, Luigi; Kriwacki, Richard W.; Chen, Jianhan

2012-01-01

Intrinsically disordered proteins (IDPs) are now recognized to be prevalent in biology, and many potential functional benefits have been discussed. However, the frequent requirement of peptide folding in specific interactions of IDPs could impose a kinetic bottleneck, which could be overcome only by efficient folding upon encounter. Intriguingly, existing kinetic data suggest that specific binding of IDPs is generally no slower than that of globular proteins. Here, we exploited the cell cycle regulator p27Kip1 (p27) as a model system to understand how IDPs might achieve efficient folding upon encounter for facile recognition. Combining experiments and coarse-grained modeling, we demonstrate that long-range electrostatic interactions between enriched charges on p27 and near its binding site on cyclin A not only enhance the encounter rate (i.e., electrostatic steering), but also promote folding-competent topologies in the encounter complexes, allowing rapid subsequent formation of short-range native interactions en route to the specific complex. In contrast, nonspecific hydrophobic interactions, while hardly affecting the encounter rate, can significantly reduce the efficiency of folding upon encounter and lead to slower binding kinetics. Further analysis of charge distributions in a set of known IDP complexes reveals that, although IDP binding sites tend to be more hydrophobic compared to the rest of the target surface, their vicinities are frequently enriched with charges to complement those on IDPs. This observation suggests that electrostatically accelerated encounter and induced folding might represent a prevalent mechanism for promoting facile IDP recognition. PMID:22721951

The Experiences of Licensed Mental Health Professionals Who Have Encountered and Navigated through Compassion Fatigue

ERIC Educational Resources Information Center

Jorgensen, Louise B.

2012-01-01

The purpose of this dissertation study was to increase understanding of licensed mental health professionals' experiences as they have encountered and navigated through compassion fatigue (CF). CF is a complex construct with an attendant constellation of secondary stress responses. In order to examine the complex and varying factors…

Hospital strategic preparedness planning: the new imperative.

PubMed

Ginter, Peter M; Duncan, W Jack; Abdolrasulnia, Maziar

2007-01-01

Strategic preparedness planning is an important new imperative for many hospitals. Strategic preparedness planning goes beyond traditional product/market strategic planning by focusing on disaster prevention, containment, and response roles. Hospitals, because of their unique mission, size, complexity, the types of materials they handle, and the types of patients they encounter, are especially vulnerable to natural and human-initiated disasters. In addition, when disasters occur, hospitals must develop well-conceived first responder (receiver) strategies. This paper argues the case for strategic preparedness planning for hospitals and proposes a process for this relatively new and much needed type of planning.

Common pediatric head and neck congenital/developmental anomalies.

PubMed

LaPlante, Justin K; Pierson, Nicholas S; Hedlund, Gary L

2015-01-01

Pediatric head and neck neuroradiology is a broad and complex topic. This article focuses on several of the common and sometimes challenging pediatric head and neck congenital/developmental anomalies physicians may encounter in clinical practice. Although some diagnoses may be evident on physical examination, others may present a diagnostic dilemma. Patients may initially present with a variety of secondary findings. Imaging serves an important role in making a diagnosis, guiding referral, and in some cases even providing treatment options through interventional radiology. Key diagnostic criteria and critical points of interest for each diagnosis are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

Microstructure-sensitive small fatigue crack growth assessment. Effect of strain ratio multiaxial strain state and geometric discontinuities

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

Castelluccio, Gustavo M.; McDowell, David L.

Fatigue crack initiation in the high cycle fatigue regime is strongly influenced by microstructural features. Research efforts have usually focused on predicting fatigue resistance against crack incubation without considering the early fatigue crack growth after encountering the first grain boundary. However, a significant fraction of the variability of the total fatigue life can be attributed to growth of small cracks as they encounter the first few grain boundaries, rather than crack formation within the first grain. Our paper builds on the framework previously developed by the authors to assess microstructure-sensitive small fatigue crack formation and early growth under complex loadingmore » conditions. Moreover, the scheme employs finite element simulations that explicitly render grains and crystallographic directions along with simulation of microstructurally small fatigue crack growth from grain to grain. The methodology employs a crystal plasticity algorithm in ABAQUS that was previously calibrated to study fatigue crack initiation in RR1000 Ni-base superalloy. Our work present simulations with non-zero applied mean strains and geometric discontinuities that were not previously considered for calibration. Results exhibit trends similar to those found in experiments for multiple metallic materials, conveying a consistent physical description of fatigue damage phenomena.« less

Microstructure-sensitive small fatigue crack growth assessment. Effect of strain ratio multiaxial strain state and geometric discontinuities

DOE PAGES

Castelluccio, Gustavo M.; McDowell, David L.

2015-09-16

Fatigue crack initiation in the high cycle fatigue regime is strongly influenced by microstructural features. Research efforts have usually focused on predicting fatigue resistance against crack incubation without considering the early fatigue crack growth after encountering the first grain boundary. However, a significant fraction of the variability of the total fatigue life can be attributed to growth of small cracks as they encounter the first few grain boundaries, rather than crack formation within the first grain. Our paper builds on the framework previously developed by the authors to assess microstructure-sensitive small fatigue crack formation and early growth under complex loadingmore » conditions. Moreover, the scheme employs finite element simulations that explicitly render grains and crystallographic directions along with simulation of microstructurally small fatigue crack growth from grain to grain. The methodology employs a crystal plasticity algorithm in ABAQUS that was previously calibrated to study fatigue crack initiation in RR1000 Ni-base superalloy. Our work present simulations with non-zero applied mean strains and geometric discontinuities that were not previously considered for calibration. Results exhibit trends similar to those found in experiments for multiple metallic materials, conveying a consistent physical description of fatigue damage phenomena.« less

Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands.

PubMed

Koster, Ellen S; van Meeteren, Marijke M; van Dijk, Marloes; van de Bemt, Bart J F; Ensing, Hendrikus T; Bouvy, Marcel L; Blom, Lyda; van Dijk, Liset

2015-07-01

To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed based on an observation protocol for the following information: content of encounter, initiator of a theme and pharmacy staff's communication style. In total, 119 encounters were recorded which concerned 42 first prescriptions, 16 first refill prescriptions and 61 follow-up refill prescriptions. During all encounters, discussion was mostly initiated by pharmacy staff (85%). In first prescription encounters topics most frequently discussed included instructions for use (83%) and dosage instructions (95%). In first refill encounters, patient experiences such as adverse effects (44%) and beneficial effects (38%) were regularly discussed in contrast to follow-up refills (7% and 5%). Patients' opinion on medication was hardly discussed. Pharmacy staff in outpatient pharmacies generally provide practical information, less frequently they discuss patients' experiences and seldom discuss patients' perceptions and preferences about prescribed medication. This study shows there is room for improvement, as communication is still not according to professional guidelines. To implement professional guidelines successfully, it is necessary to identify underlying reasons for not following the guidelines. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The chaotic interaction of two walkers

NASA Astrophysics Data System (ADS)

Tadrist, Loic; Samara, Naresh; Schlagheck, Peter; Gilet, Tristan

2016-11-01

A droplet bouncing on a vertically vibrated bath may be propelled horizontally by the Faraday waves that it generates at each rebound. This association of a wave and a particle is called a walker. Ten years ago, Yves Couder and co-workers noted that the dynamical encounter of two walkers may lead to either scattered trajectories or orbital motion. In this work, we investigate the interaction of two walkers more systematically. The walkers are launched towards each other with finely controlled initial conditions. Output trajectories are classified in four types: scattering, orbiting, wandering and complex. The interaction appears stochastic: the same set of initial parameters (to the measurement accuracy) can produce different outputs. Our analysis of the underlying chaos provides new insights on the stochastic nature of this experiment. This work is supported by the ARC Quandrops of the Wallonia-Brussels Federation.

A laser-sheet flow visualization technique for the large wind tunnels of the National Full-Scale Aerodynamics Complex

NASA Technical Reports Server (NTRS)

Reinath, M. S.; Ross, J. C.

1990-01-01

A flow visualization technique for the large wind tunnels of the National Full Scale Aerodynamics Complex (NFAC) is described. The technique uses a laser sheet generated by the NFAC Long Range Laser Velocimeter (LRLV) to illuminate a smoke-like tracer in the flow. The LRLV optical system is modified slightly, and a scanned mirror is added to generate the sheet. These modifications are described, in addition to the results of an initial performance test conducted in the 80- by 120-Foot Wind Tunnel. During this test, flow visualization was performed in the wake region behind a truck as part of a vehicle drag reduction study. The problems encountered during the test are discussed, in addition to the recommended improvements needed to enhance the performance of the technique for future applications.

Use of a very flexible guide wire to permit dilation of complex malignant strictures of the esophagus.

PubMed

Vargas-Tank, L; Ovalle, L; Fernández, C; Mella, B; Estay, R; del Solar, M P; Soto, J R

1995-01-01

Risk of perforation is a major impediment to the use of polyvinyl bougies in palliative dilation of cancerous strictures of the esophagus. We encountered 23 patients with complex malignant strictures in whom initial dilation with Savary-Gilliard bougies was thwarted because attempts to pass a conventional Eder-Puestow guide wire were unsuccessful. As a recourse, we probed these strictures with a very flexible guide wire of the type used to implant prostheses in the biliary tract. The purpose was to establish a passage through which a standard guide wire could then be inserted. The procedure was successful in all but 4 of the 23 patients. We conclude that in such cases the preliminary use of the very flexible guide, even though time-consuming, improves the chance of effective dilation with minimal added risk.

Loop Heat Pipe Startup Behaviors

NASA Technical Reports Server (NTRS)

Ku, Jentung

2016-01-01

A loop heat pipe must start successfully before it can commence its service. The startup transient represents one of the most complex phenomena in the loop heat pipe operation. This paper discusses various aspects of loop heat pipe startup behaviors. Topics include the four startup scenarios, the initial fluid distribution between the evaporator and reservoir that determines the startup scenario, factors that affect the fluid distribution between the evaporator and reservoir, difficulties encountered during the low power startup, and methods to enhance the startup success. Also addressed are the pressure spike and pressure surge during the startup transient, and repeated cycles of loop startup and shutdown under certain conditions.

Crystal structure of RecBCD enzyme reveals a machine for processing DNA breaks

NASA Astrophysics Data System (ADS)

Singleton, Martin R.; Dillingham, Mark S.; Gaudier, Martin; Kowalczykowski, Stephen C.; Wigley, Dale B.

2004-11-01

RecBCD is a multi-functional enzyme complex that processes DNA ends resulting from a double-strand break. RecBCD is a bipolar helicase that splits the duplex into its component strands and digests them until encountering a recombinational hotspot (Chi site). The nuclease activity is then attenuated and RecBCD loads RecA onto the 3' tail of the DNA. Here we present the crystal structure of RecBCD bound to a DNA substrate. In this initiation complex, the DNA duplex has been split across the RecC subunit to create a fork with the separated strands each heading towards different helicase motor subunits. The strands pass along tunnels within the complex, both emerging adjacent to the nuclease domain of RecB. Passage of the 3' tail through one of these tunnels provides a mechanism for the recognition of a Chi sequence by RecC within the context of double-stranded DNA. Gating of this tunnel suggests how nuclease activity might be regulated.

Cisplatin Binding to Biological Ligands Revealed at the Encounter Complex Level by IR Action Spectroscopy.

PubMed

Corinti, Davide; Coletti, Cecilia; Re, Nazzareno; Chiavarino, Barbara; Crestoni, Maria Elisa; Fornarini, Simonetta

2016-03-07

Cisplatin [cis-diamminedichloroplatinum(II)] was the first platinum-based antineoplastic agent and is still a cornerstone for the treatment of various solid tumors. Reactive events responsible for cisplatin activity are unveiled here at the molecular level. Simple ligands (L) representing ubiquitous functional groups in the biological environment likely to be encountered by administered cisplatin have been allowed to react with cis-[PtCl(NH3)2 (H2O)](+), the primary intermediate from cisplatin hydrolysis. The substitution reactions have been examined by a combined experimental and computational approach and the structural features of the substitution product, cis-[PtCl(NH3)2(L)](+), have been probed by IR multiple-photon dissociation (IRMPD) spectroscopy. Furthermore, IRMPD spectroscopy has been exploited to elucidate the structure of [PtCl(NH3)2(L)(H2O)](+) clusters, also obtained by electrospray ionization (ESI) from the aqueous solution and representing the major focus of this investigation. These ions conform to the encounter complex of cis-[PtCl(NH3)2 (H2O)](+) with the incoming ligand and represent the first direct evidence of a prototypical Eigen-Wilkins encounter complex in solution, lying on the reaction coordinate for ligand substitution and extracted by ESI for mass spectrometric analysis. Activated [PtCl(NH3)2(L)(H2O)](+) ions dissociate by the loss of either H2O or L, the former process implying a ligand substitution event. IRMPD spectroscopy has thus revealed both structural details and reaction dynamics at the level of the isolated encounter complex. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Daphnia magna shows reduced infection upon secondary exposure to a pathogen

PubMed Central

McTaggart, Seanna J.; Wilson, Philip J.; Little, Tom J.

2012-01-01

Previous pathogen exposure is an important predictor of the probability of becoming infected. This is deeply understood for vertebrate hosts, and increasingly so for invertebrate hosts. Here, we test if an initial pathogen exposure changes the infection outcome to a secondary pathogen exposure in the natural host–pathogen system Daphnia magna and Pasteuria ramosa. Hosts were initially exposed to an infective pathogen strain, a non-infective pathogen strain or a control. The same hosts underwent a second exposure, this time to an infective pathogen strain, either immediately after the initial encounter or 48 h later. We observed that an initial encounter with a pathogen always conferred protection against infection compared with controls. PMID:22875818

Daphnia magna shows reduced infection upon secondary exposure to a pathogen.

PubMed

McTaggart, Seanna J; Wilson, Philip J; Little, Tom J

2012-12-23

Previous pathogen exposure is an important predictor of the probability of becoming infected. This is deeply understood for vertebrate hosts, and increasingly so for invertebrate hosts. Here, we test if an initial pathogen exposure changes the infection outcome to a secondary pathogen exposure in the natural host-pathogen system Daphnia magna and Pasteuria ramosa. Hosts were initially exposed to an infective pathogen strain, a non-infective pathogen strain or a control. The same hosts underwent a second exposure, this time to an infective pathogen strain, either immediately after the initial encounter or 48 h later. We observed that an initial encounter with a pathogen always conferred protection against infection compared with controls.

Drilling into Rhyolitic Magma at Shallow depth at Krafla Volcanic Complex, NE-Iceland

NASA Astrophysics Data System (ADS)

Mortensen, A. K.; Markússon, S. H.; Gudmundsson, Á.; Pálsson, B.

2017-12-01

Krafla volcanic complex in NE-Iceland is an active volcano but the latest eruption was the Krafla Fires in 1975-1984. Though recent volcanic activity has consisted of basaltic fissure eruptions, then it is rhyolitic magma that has been intercepted on at least two occasions while drilling geothermal production wells in the geothermal field suggesting a layered magma plumbing system beneath the Krafla volcanic complex. In 2008 quenched rhyolitic glass was retrieved from the bottom of well KJ-39, which is 2865 m deep ( 2571 m true vertical depth). In 2009 magma was again encountered at an even shallower depth and in more than 2,5 km distance from the bottom of well KJ-39, but in 2009 well IDDP-1 was drilled into magma three times just below 2100 m depth. Only on the last occasion was quenched glass retrieved to confirm that magma had been encountered. In well KJ-39 the quenched glass was rhyolitic in composition. The glass contained resorbed minerals of plagioclase, clinopyroxene and titanomagnetite, but the composition of the glass resembles magma that has formed by partial melting of hydrated basalt. The melt was encountered among cuttings from impermeable, coarse basaltic intrusives at a depth, where the well was anticipated to penetrate the Hólseldar volcanic fissure. In IDDP-1 the quenched glass was also rhyolitic in composition. The glass contained less than 5% of phenocrysts, but the phenocryst assemblage included andesine plagioclase, augite, pigeonite, and titanomagnetite. At IDDP-1 the melt was encountered below a permeable zone composed of fine to coarse grained felsite and granophyre. The disclosure of magma in two wells at Krafla volcanic complex verify that rhyolitic magma can be encountered at shallow depth across a larger area within the caldera. The encounter of magma at shallow depth conforms with that superheated conditions have been found at >2000 m depth in large parts of Krafla geothermal field.

Initiation of sporulation in Clostridium difficile: a twist on the classic model.

PubMed

Edwards, Adrianne N; McBride, Shonna M

2014-09-01

The formation of dormant endospores is a complex morphological process that permits long-term survival in inhospitable environments for many Gram-positive bacteria. Sporulation for the anaerobic gastrointestinal pathogen Clostridium difficile is necessary for survival outside of the gastrointestinal tract of its host. While the developmental stages of spore formation are largely conserved among endospore-forming bacteria, the genus Clostridium appears to be missing a number of conserved regulators required for efficient sporulation in other spore-forming bacteria. Several recent studies have discovered novel mechanisms and distinct regulatory pathways that control the initiation of sporulation and early-sporulation-specific gene expression. These differences in regulating the decision to undergo sporulation reflects the unique ecological niche and environmental conditions that C. difficile inhabits and encounters within the mammalian host. © 2014 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

Brownian Dynamics and Molecular Dynamics Study of the Association between Hydrogenase and Ferredoxin from Chlamydomonas reinhardtii

PubMed Central

Long, Hai; Chang, Christopher H.; King, Paul W.; Ghirardi, Maria L.; Kim, Kwiseon

2008-01-01

The [FeFe] hydrogenase from the green alga Chlamydomonas reinhardtii can catalyze the reduction of protons to hydrogen gas using electrons supplied from photosystem I and transferred via ferredoxin. To better understand the association of the hydrogenase and the ferredoxin, we have simulated the process over multiple timescales. A Brownian dynamics simulation method gave an initial thorough sampling of the rigid-body translational and rotational phase spaces, and the resulting trajectories were used to compute the occupancy and free-energy landscapes. Several important hydrogenase-ferredoxin encounter complexes were identified from this analysis, which were then individually simulated using atomistic molecular dynamics to provide more details of the hydrogenase and ferredoxin interaction. The ferredoxin appeared to form reasonable complexes with the hydrogenase in multiple orientations, some of which were good candidates for inclusion in a transition state ensemble of configurations for electron transfer. PMID:18621810

Interrogation of bimetallic particle oxidation in three dimensions at the nanoscale

PubMed Central

Han, Lili; Meng, Qingping; Wang, Deli; Zhu, Yimei; Wang, Jie; Du, Xiwen; Stach, Eric A.; Xin, Huolin L.

2016-01-01

An understanding of bimetallic alloy oxidation is key to the design of hollow-structured binary oxides and the optimization of their catalytic performance. However, one roadblock encountered in studying these binary oxide systems is the difficulty in describing the heterogeneities that occur in both structure and chemistry as a function of reaction coordinate. This is due to the complexity of the three-dimensional mosaic patterns that occur in these heterogeneous binary systems. By combining real-time imaging and chemical-sensitive electron tomography, we show that it is possible to characterize these systems with simultaneous nanoscale and chemical detail. We find that there is oxidation-induced chemical segregation occurring on both external and internal surfaces. Additionally, there is another layer of complexity that occurs during the oxidation, namely that the morphology of the initial oxide surface can change the oxidation modality. This work characterizes the pathways that can control the morphology in binary oxide materials. PMID:27928998

Principles of Genetic Circuit Design

PubMed Central

Brophy, Jennifer A.N.; Voigt, Christopher A.

2014-01-01

Cells are able to navigate environments, communicate, and build complex patterns by initiating gene expression in response to specific signals. Engineers need to harness this capability to program cells to perform tasks or build chemicals and materials that match the complexity seen in nature. This review describes new tools that aid the construction of genetic circuits. We show how circuit dynamics can be influenced by the choice of regulators and changed with expression “tuning knobs.” We collate the failure modes encountered when assembling circuits, quantify their impact on performance, and review mitigation efforts. Finally, we discuss the constraints that arise from operating within a living cell. Collectively, better tools, well-characterized parts, and a comprehensive understanding of how to compose circuits are leading to a breakthrough in the ability to program living cells for advanced applications, from living therapeutics to the atomic manufacturing of functional materials. PMID:24781324

Patterns of Clinical Reasoning in Physical Therapist Students.

PubMed

Gilliland, Sarah; Wainwright, Susan Flannery

2017-05-01

Clinical reasoning is a complex, nonlinear problem-solving process that is influenced by models of practice. The development of physical therapists' clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education. The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter. A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2 different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants' clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis. Participants demonstrated consistent signs of development of physical therapy-specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities. Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes. © 2017 American Physical Therapy Association

Facilitated recycling protects human RNA polymerase III from repression by Maf1 in vitro.

PubMed

Cabart, Pavel; Lee, JaeHoon; Willis, Ian M

2008-12-26

Yeast cells synthesize approximately 3-6 million molecules of tRNA every cell cycle at a rate of approximately 2-4 transcripts/gene/s. This high rate of transcription is achieved through many rounds of reinitiation by RNA polymerase (pol) III on stable DNA-bound complexes of the initiation factor TFIIIB. Studies in yeast have shown that the rate of reinitiation is increased by facilitated recycling, a process that involves the repeated reloading of the polymerase on the same transcription unit. However, when nutrients become limiting or stress conditions are encountered, RNA pol III transcription is rapidly repressed through the action of the conserved Maf1 protein. Here we examine the relationship between Maf1-mediated repression and facilitated recycling in a human RNA pol III in vitro system. Using an immobilized template transcription assay, we demonstrate that facilitated recycling is conserved from yeast to humans. We assessed the ability of recombinant human Maf1 to inhibit different steps in transcription before and after preinitiation complex assembly. We show that recombinant Maf1 can inhibit the recruitment of TFIIIB and RNA pol III to immobilized templates. However, RNA pol III bound to preinitiation complexes or in elongation complexes is protected from repression by Maf1 and can undergo several rounds of initiation. This indicates that recombinant Maf1 is unable to inhibit facilitated recycling. The data suggest that additional biochemical steps may be necessary for rapid Maf1-dependent repression of RNA pol III transcription.

Identifying familiar strangers in human encounter networks

NASA Astrophysics Data System (ADS)

Liang, Di; Li, Xiang; Zhang, Yi-Qing

2016-10-01

Familiar strangers, pairs of individuals who encounter repeatedly but never know each other, have been discovered for four decades yet lack an effective method to identify. Here we propose a novel method called familiar stranger classifier (FSC) to identify familiar strangers from three empirical datasets, and classify human relationships into four types, i.e., familiar stranger (FS), in-role (IR), friend (F) and stranger (S). The analyses of the human encounter networks show that the average number of FS one may encounter is finite but larger than the Dunbar Number, and their encounters are structurally more stable and denser than those of S, indicating the encounters of FS are not limited by the social capacity, and more robust than the random scenario. Moreover, the temporal statistics of encounters between FS over the whole time span show strong periodicity, which are diverse from the bursts of encounters within one day, suggesting the significance of longitudinal patterns of human encounters. The proposed method to identify FS in this paper provides a valid framework to understand human encounter patterns and analyse complex human social behaviors.

Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

PubMed

Levine, Michael; Sanko, Stephen; Eckstein, Marc

2016-01-01

EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study are consistent with previously reported studies.

Thermal Vacuum Testing of a Helium Loop Heat Pipe for Large Area Cryocooling

NASA Technical Reports Server (NTRS)

Ku, Jentung; Robinson, Franklin

2016-01-01

A loop heat pipe must start successfully before it can commence its service. The startup transient represents one of the most complex phenomena in the loop heat pipe operation. This paper discusses various aspects of loop heat pipe startup behaviors. Topics include the four startup scenarios, the initial fluid distribution between the evaporator and reservoir that determines the startup scenario, factors that affect the fluid distribution between the evaporator and reservoir, difficulties encountered during the low power startup, and methods to enhance the startup success. Also addressed are the pressure spike and pressure surge during the startup transient, and repeated cycles of loop startup and shutdown under certain conditions.

Split-shot sinker facilitates seton treatment of anal fistulae.

PubMed

Awad, M L; Sell, H W; Stahlfeld, K R

2009-06-01

The cutting seton is an inexpensive and effective method of treating high complex perianal fistulae. Following placement of the seton, advancement through the external sphincter muscles requires progressive tightening of the seton. The requirement for maintaining the appropriate tension and onset of perianal pressure necrosis are problems frequently encountered using this technique. Using a 3-0 polypropylene suture, a red-rubber catheter, and a nontoxic tin split-shot sinker, we minimized or eliminated these problems. We initially used this technique in one patient with satisfactory results. This technique is technically easy, safe, inexpensive, and efficient, and we are using it in all patients with high perianal fistulae who require a seton.

In "the Event" That Art and Teaching Encounter

ERIC Educational Resources Information Center

Garoian, Charles R.

2014-01-01

In this writing, I explore the performative correspondences between the complex, disparate, and disjunctive encounters, alliances, and movements that characterize the making of art and the making of teaching that--according to philosophers Deleuze and Guattari--are constituted by the "plane of consistency," "zone of…

Encountering Pedagogy through Relational Art Practices

ERIC Educational Resources Information Center

Irwin, Rita L.; O'Donoghue, Donal

2012-01-01

Two artists involved in "socially engaged art" practice were invited to work with art education teacher candidates and instructors in an effort to rethink notions of teaching, learning and art. We initiated this residency, which we called "The Summerhill Residency", to examine how learning encounters might create environments…

Optimal flight initiation distance.

PubMed

Cooper, William E; Frederick, William G

2007-01-07

Decisions regarding flight initiation distance have received scant theoretical attention. A graphical model by Ydenberg and Dill (1986. The economics of fleeing from predators. Adv. Stud. Behav. 16, 229-249) that has guided research for the past 20 years specifies when escape begins. In the model, a prey detects a predator, monitors its approach until costs of escape and of remaining are equal, and then flees. The distance between predator and prey when escape is initiated (approach distance = flight initiation distance) occurs where decreasing cost of remaining and increasing cost of fleeing intersect. We argue that prey fleeing as predicted cannot maximize fitness because the best prey can do is break even during an encounter. We develop two optimality models, one applying when all expected future contribution to fitness (residual reproductive value) is lost if the prey dies, the other when any fitness gained (increase in expected RRV) during the encounter is retained after death. Both models predict optimal flight initiation distance from initial expected fitness, benefits obtainable during encounters, costs of escaping, and probability of being killed. Predictions match extensively verified predictions of Ydenberg and Dill's (1986) model. Our main conclusion is that optimality models are preferable to break-even models because they permit fitness maximization, offer many new testable predictions, and allow assessment of prey decisions in many naturally occurring situations through modification of benefit, escape cost, and risk functions.

Measuring the Process and Quality of Informed Consent for Clinical Research: Development and Testing

PubMed Central

Cohn, Elizabeth Gross; Jia, Haomiao; Smith, Winifred Chapman; Erwin, Katherine; Larson, Elaine L.

2013-01-01

Purpose/Objectives To develop and assess the reliability and validity of an observational instrument, the Process and Quality of Informed Consent (P-QIC). Design A pilot study of the psychometrics of a tool designed to measure the quality and process of the informed consent encounter in clinical research. The study used professionally filmed, simulated consent encounters designed to vary in process and quality. Setting A major urban teaching hospital in the northeastern region of the United States. Sample 63 students enrolled in health-related programs participated in psychometric testing, 16 students participated in test-retest reliability, and 5 investigator-participant dyads were observed for the actual consent encounters. Methods For reliability and validity testing, students watched and rated videotaped simulations of four consent encounters intentionally varied in process and content and rated them with the proposed instrument. Test-retest reliability was established by raters watching the videotaped simulations twice. Inter-rater reliability was demonstrated by two simultaneous but independent raters observing an actual consent encounter. Main Research Variables The essential elements of information and communication for informed consent. Findings The initial testing of the P-QIC demonstrated reliable and valid psychometric properties in both the simulated standardized consent encounters and actual consent encounters in the hospital setting. Conclusions The P-QIC is an easy-to-use observational tool that provides a quick assessment of the areas of strength and areas that need improvement in a consent encounter. It can be used in the initial trainings of new investigators or consent administrators and in ongoing programs of improvement for informed consent. Implications for Nursing The development of a validated observational instrument will allow investigators to assess the consent process more accurately and evaluate strategies designed to improve it. PMID:21708532

Thermal Evolution of Juvenile Subduction Zones ' New Constraints from Lu-Hf Geochronology on HP oceanic rocks (Halilbaǧi, Central Anatolia)

NASA Astrophysics Data System (ADS)

Pourteau, Amaury; Scherer, Erik; Schmidt, Alexander; Bast, Rebecca

2015-04-01

The thermal structure of subduction zones plays a key role on mechanical and chemical processes taking place along the slab-mantle interface. Until now, changes through time of this thermal structure have been explored mostly by the means of numerical simulations. However, both "warm" (i.e., epidote-bearing), and "cold" (i.e., lawsonite-bearing) HP oceanic rocks have been reported in some fossil subduction complexes exposed at the Earth's surface (e.g., Franciscan Complex, California; Rio San Juan Complex, Hispañola; Halilbağı Unit, Central Anatolia). These a-priori "incompatible" rocks witness different thermal stages of ancient subduction zones and their study might provide complementary constraints to numerical models. To decipher the meaning of these contrasting metamorphic rocks in the Halilbağı Unit, we are carrying out Lu-Hf geochronology on garnet (grt) and lws from a variety of HP oceanic rocks, as well as the metamorphic sole of the overlying ophiolite. We selected five samples that are representative of the variety of metamorphic evolutions (i.e. peak conditions and P-T paths) encountered in this area. Preliminary analyses yielded 110 Ma (grt-hbl isochron) for a sub-ophiolitic grt amphibolite; 92 Ma (grt-omp) for an eclogite with prograde and retrograde ep; 90 Ma (grt-omp) for an eclogitic metabasite with prograde ep and retrograde ep+lws; 87 Ma (grt-gln) for a lws eclogite with prograde ep; and 86 Ma (grt-gln) for a blueschist with prograde and retrograde lws. These ages are mainly two-point isochrons. Further-refined data will be presented at the EGU General Assembly 2015, in Vienna. The consistent younging trend from "warm" to "cold" metamorphic rocks revealed by these first-order results points to metamorphic-sole formation during the initiation of intra-oceanic subduction at ~110 Ma, and subsequent cooling of the slab-mantle interface between 92 and 86 Ma. Therefore, the contrasting metamorphic evolutions encountered in the Halilbağı Unit record the progressive thermal maturation of the juvenile Neotethyan subduction zone. This period of ~23 myr between subduction initiation and thermal "steady state" is significantly shorter than that obtained for the Rio San Juan Complex (~60 myr; Krebs et al. 2008, Lithos, 103, 106-137), but compares well with that for the Franciscan Complex (~22 myr; Anczkiewicz et al. 2004, EPSL, 225, 147-161) and falls in the range predicted in numerical simulations (e.g., Gerya et al. 2002, Tectonics, 21/6, 1056).

Secondary Transfer Effects of Intergroup Contact: A Cross-National Comparison in Europe

ERIC Educational Resources Information Center

Schmid, Katharina; Hewstone, Miles; Kupper, Beate; Zick, Andreas; Wagner, Ulrich

2012-01-01

This article examines so-called secondary transfer effects of intergroup contact, a phenomenon whereby positive intergroup contact experiences can influence attitudes not only toward encountered (primary) outgroups but also toward other (secondary) outgroups that were not initially involved in the intergroup encounter. The current study relies on…

Investigation of UV photocurable microcapsule inner crosslink extent

NASA Astrophysics Data System (ADS)

Li, Xiaowei; Meng, Shuangshuang; Lai, Weidong; Yu, Haiyang; Fu, Guangsheng

2008-11-01

UV photocuring technology has encountered increased applications in recent years, which finds a variety of applications on protective coating of the optical-fiber, ink and optical recording materials. Combined with techniques of photohardenable, microcapsule, heat-sensitive and interface-polymerization method, a novel photoheat sensitive recording material of non-silver salt is explored in this thesis. Microcapsules are particulate substance with a core and shell structure, where photopolymerizable composition, monofunctional/polyfunctional diluents, photopolymerization initiator, photosensitivity enhancing agent and dye precursor are encapsulated as the internal phase. In this paper introduced the characteristics and curing mechanism of photo-sensitive microcapsule materials. The photocuring process may be a complex-function with photopolymerizable compound and photopolymerization initiator. For the sake of high photocuring speed and degree, optimal photo-sensitive materials were selected. In order to match with the light source excitation wavelength and absorb more wider ultraviolet band, combined type of photo-polymerization initiators were employed. With the kinds and dosage of photopolymerization initiator changing, the photocuring speed and quality can be ameliorated. Through studying the UV-visible absorption spectrum and infra-red spectrum of the material , the optical response property of the inner compound can be obtained.

Surviving pregnancy and childbirth is a human right: the silent tragedy of maternal mortality

PubMed Central

Baraté, P.; Temmerman, M.

2010-01-01

More than two decades after the launch of the Safe Motherhood Initiative (Nairobi 1987) , maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow to foresee the silence will soon be broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on priority interventions has finally been reached, more coordinated actions and initiatives are being developed. The strive for achieving the Millennium Development Goals helps to create the political momentum strongly needed to generate new leadership, and to develop and implement adequate strategies. Sensible focus on resources and structures as well as innovative management will be crucial in that process. PMID:25206963

DSN radio science system design and testing for Voyager-Neptune encounter

NASA Technical Reports Server (NTRS)

Ham, N. C.; Rebold, T. A.; Weese, J. F.

1989-01-01

The Deep Space Network (DSN) Radio Science System presently implemented within the Deep Space Network was designed to meet stringent requirements imposed by the demands of the Voyager-Neptune encounter and future missions. One of the initial parameters related to frequency stability is discussed. The requirement, specification, design, and methodology for measuring this parameter are described. A description of special instrumentation that was developed for the test measurements and initial test data resulting from the system tests performed at Canberra, Australia and Usuda, Japan are given.

Multivalued classical mechanics arising from singularity loops in complex time

NASA Astrophysics Data System (ADS)

Koch, Werner; Tannor, David J.

2018-02-01

Complex-valued classical trajectories in complex time encounter singular times at which the momentum diverges. A closed time contour around such a singular time may result in final values for q and p that differ from their initial values. In this work, we develop a calculus for determining the exponent and prefactor of the asymptotic time dependence of p from the singularities of the potential as the singularity time is approached. We identify this exponent with the number of singularity loops giving distinct solutions to Hamilton's equations of motion. The theory is illustrated for the Eckart, Coulomb, Morse, and quartic potentials. Collectively, these potentials illustrate a wide variety of situations: poles and essential singularities at finite and infinite coordinate values. We demonstrate quantitative agreement between analytical and numerical exponents and prefactors, as well as the connection between the exponent and the time circuit count. This work provides the theoretical underpinnings for the choice of time contours described in the studies of Doll et al. [J. Chem. Phys. 58(4), 1343-1351 (1973)] and Petersen and Kay [J. Chem. Phys. 141(5), 054114 (2014)]. It also has implications for wavepacket reconstruction from complex classical trajectories when multiple branches of trajectories are involved.

Addressing Problems Encountered in Case-Based Teaching

ERIC Educational Resources Information Center

Turgeon, A. J.

2007-01-01

TURF 436 (Case Studies in Turfgrass Management) is the capstone course for turfgrass science majors at the Pennsylvania State University. Students are introduced to problems and complex problematic situations encountered in the management of golf and sports turf and in professional lawn-care operations. Following completion of the orientation case…

Association Mechanisms of Unsaturated C2 Hydrocarbons with Their Cations: Acetylene and Ethylene

NASA Technical Reports Server (NTRS)

Bera, Partha P.; Head-Gordon, Martin; Lee, Timothy J.

2013-01-01

The ion-molecule association mechanism of acetylene and ethylene with their cations is investigated by ab initio quantum chemical methods to understand the structures, association energies, and the vibrational and electronic spectra of the products. Stable puckered cyclic isomers are found as the result of first forming less stable linear and bridge isomers. The puckered cyclic complexes are calculated to be strongly bound, by 87, 35 and 56 kcal/mol for acetylene-acetylene cation, ethylene-ethylene cation and acetylene-ethylene cation, respectively. These stable complexes may be intermediates that participate in further association reactions. There are no association barriers, and no significant inter-conversion barriers, so the initial linear and bridge encounter complexes are unlikely to be observable. However, the energy gap between the bridged and cyclic puckered isomers greatly differs from complex to complex: it is 44 kcal/mol in C4H4 +, but only 6 kcal/mol in C4H8 +. The accurate CCSD(T) calculations summarized above are also compared against less computationally expensive MP2 and density functional theory (DFT) calculations for structures, relative energies, and vibrational spectra. Calculated vibrational spectra are compared against available experiments for cyclobutadiene cation. Electronic spectra are also calculated using time-dependent DFT.

Assigning Oxidation States to Some Metal Dioxygen Complexes of Biological Interest.

ERIC Educational Resources Information Center

Summerville, David A.; And Others

1979-01-01

The bonding of dioxygen in metal-dioxygen complexes is discussed, paying particular attention to the problems encountered in assigning conventional oxidation numbers to both the metal center and coordinated dioxygen. Complexes of iron, cobalt, chromium, and manganese are considered. (BB)

Potential value of health information exchange for people with epilepsy: crossover patterns and missing clinical data.

PubMed

Grinspan, Zachary M; Abramson, Erika L; Banerjee, Samprit; Kern, Lisa M; Kaushal, Rainu; Shapiro, Jason S

2013-01-01

For people with epilepsy, the potential value of health information exchange (HIE) is unknown. We reviewed two years of clinical encounters for 8055 people with epilepsy from seven Manhattan hospitals. We created network graphs illustrating crossover among these hospitals for multiple encounter types, and calculated a novel metric of care fragmentation: "encounters at risk for missing clinical data." Given two hospitals, a median of 109 [range 46 - 588] patients with epilepsy had visited both. Due to this crossover, recent, relevant clinical data may be missing at the time of care frequently (44.8% of ED encounters, 34.5% inpatient, 24.9% outpatient, and 23.2% radiology). Though a smaller percentage of outpatient encounters were at risk for missing data than ED encounters, the absolute number of outpatient encounters at risk was three times higher (14,579 vs. 5041). People with epilepsy may benefit from HIE. Future HIE initiatives should prioritize outpatient access.

Children as an Emotional Amplifier in Northern Illinois White-Tailed Deer Interactions

ERIC Educational Resources Information Center

Hicks, Jonathan R.

2016-01-01

This pilot study identified and provided initial exploration into the notion that the presence of children can increase or amplify the emotional significance of encounters with white-tailed deer. Qualitative data demonstrated that Northern Illinois natural area decision makers found deer encounters to be more memorable when simultaneously sharing…

Beyond Dramatic Truth: Theatre within the Therapeutic Encounter

ERIC Educational Resources Information Center

Pendle, Andy; Rowe, Nick

2010-01-01

Recorded footage of counselling sessions with real clients can be a valuable educational resource that gives training counsellors the opportunity to analyse the theories and practices they encounter in their education. However, the use of such material raises complex ethical issues: what are the safeguards against the misuse of the material? Can…

Generative Learning: Adults Learning within Ambiguity

ERIC Educational Resources Information Center

Nicolaides, Aliki

2015-01-01

This study explored the extent to which ambiguity can serve as a catalyst for adult learning. The purpose of this study is to understand learning that is generated when encountering ambiguity agitated by the complexity of liquid modernity. "Ambiguity," in this study, describes an encounter with an appearance of reality that is at first…

Unintended consequences of eliminating Medicare payments for consultations1

PubMed Central

Song, Zirui; Ayanian, John Z.; Wallace, Jacob; He, Yulei; Gibson, Teresa B.; Chernew, Michael E.

2013-01-01

Background Prior to 2010, Medicare payments for consultations (commonly billed by specialists) were substantially higher than for office visits of similar complexity (commonly billed by primary care physicians). In January 2010, Medicare eliminated consultation payments from the Part B Physician Fee Schedule and increased fees for office visits. This change was intended to be budget neutral and to decrease payments to specialists while increasing payments to primary care physicians. We assessed the impact of this policy on spending, volume, and complexity for outpatient office encounters in 2010. Methods We examined 2007–2010 outpatient claims for 2,247,810 Medicare beneficiaries with Medicare Supplemental (Medigap) coverage through large employers in the Thomson Reuters MarketScan Database. We used segmented regression analysis to study changes in spending, volume, and complexity of office encounters adjusted for age, sex, health status, secular trends, seasonality, and hospital referral region. Results “New” office visits largely replaced consultations in 2010. An average of $10.20 (6.5 percent) more was spent per beneficiary per quarter on physician encounters after the policy. The total volume of physician encounters did not change significantly. The increase in spending was largely explained by higher office visit fees from the policy and a shift toward higher complexity visits to both specialists and primary care physicians. Conclusions The elimination of consultations led to a net increase in spending on visits to both primary care physicians and specialists. Higher prices, partially due to the subjectivity of codes in the physician fee schedule, explained the spending increase, rather than higher volumes. PMID:23336095

Assessment of students' ability to incorporate a computer into increasingly complex simulated patient encounters.

PubMed

Ray, Sarah; Valdovinos, Katie

Pharmacy students should be exposed to and offered opportunities to practice the skill of incorporating a computer into a patient interview in the didactic setting. Faculty sought to improve retention of student ability to incorporate computers into their patient-pharmacist communication. Students were required to utilize a computer to document clinical information gathered during a simulated patient encounter (SPE). Students utilized electronic worksheets and were evaluated by instructors on their ability to effectively incorporate a computer into a SPE using a rubric. Students received specific instruction on effective computer use during patient encounters. Students were then re-evaluated by an instructor during subsequent SPEs of increasing complexity using standardized rubrics blinded from the students. Pre-instruction, 45% of students effectively incorporated a computer into a SPE. After receiving instruction, 67% of students were effective in their use of a computer during a SPE of performing a pharmaceutical care assessment for a patient with chronic obstructive pulmonary disease (COPD) (p < 0.05 compared to pre-instruction), and 58% of students were effective in their use of a computer during a SPE of retrieving a medication list and social history from a simulated alcohol-impaired patient (p = 0.087 compared to pre-instruction). Instruction can improve pharmacy students' ability to incorporate a computer into SPEs, a critical skill in building and maintaining rapport with patients and improving efficiency of patient visits. Complex encounters may affect students' ability to utilize a computer appropriately. Students may benefit from repeated practice with this skill, especially with SPEs of increasing complexity. Copyright © 2016 Elsevier Inc. All rights reserved.

Theory of the decision/problem state

NASA Technical Reports Server (NTRS)

Dieterly, D. L.

1980-01-01

A theory of the decision-problem state was introduced and elaborated. Starting with the basic model of a decision-problem condition, an attempt was made to explain how a major decision-problem may consist of subsets of decision-problem conditions composing different condition sequences. In addition, the basic classical decision-tree model was modified to allow for the introduction of a series of characteristics that may be encountered in an analysis of a decision-problem state. The resulting hierarchical model reflects the unique attributes of the decision-problem state. The basic model of a decision-problem condition was used as a base to evolve a more complex model that is more representative of the decision-problem state and may be used to initiate research on decision-problem states.

Shuttle payload S-band communications system

NASA Technical Reports Server (NTRS)

Batson, B. H.; Teasdale, W. E.; Pawlowski, J. F.; Schmidt, O. L.

1985-01-01

The Shuttle payload S-band communications system design, operational capabilities, and performance are described in detail. System design requirements, overall system and configuration and operation, and laboratory/flight test results are presented. Payload communications requirements development is discussed in terms of evolvement of requirements as well as the resulting technical challenges encountered in meeting the initial requirements. Initial design approaches are described along with cost-saving initiatives that subsequently had to be made. The resulting system implementation that was finally adopted is presented along with a functional description of the system operation. A description of system test results, problems encountered, how the problems were solved, and the system flight experience to date is presented. Finally, a summary of the advancements made and the lessons learned is discussed.

Behaviour of Solitary Adult Scandinavian Brown Bears (Ursus arctos) when Approached by Humans on Foot

PubMed Central

Moen, Gro Kvelprud; Støen, Ole-Gunnar; Sahlén, Veronica; Swenson, Jon E.

2012-01-01

Successful management has brought the Scandinavian brown bear (Ursus arctos L.) back from the brink of extinction, but as the population grows and expands the probability of bear-human encounters increases. More people express concerns about spending time in the forest, because of the possibility of encountering bears, and acceptance for the bear is decreasing. In this context, reliable information about the bear's normal behaviour during bear-human encounters is important. Here we describe the behaviour of brown bears when encountering humans on foot. During 2006–2009, we approached 30 adult (21 females, 9 males) GPS-collared bears 169 times during midday, using 1-minute positioning before, during and after the approach. Observer movements were registered with a handheld GPS. The approaches started 869±348 m from the bears, with the wind towards the bear when passing it at approximately 50 m. The bears were detected in 15% of the approaches, and none of the bears displayed any aggressive behaviour. Most bears (80%) left the initial site during the approach, going away from the observers, whereas some remained at the initial site after being approached (20%). Young bears left more often than older bears, possibly due to differences in experience, but the difference between ages decreased during the berry season compared to the pre-berry season. The flight initiation distance was longer for active bears (115±94 m) than passive bears (69±47 m), and was further affected by horizontal vegetation cover and the bear's age. Our findings show that bears try to avoid confrontations with humans on foot, and support the conclusions of earlier studies that the Scandinavian brown bear is normally not aggressive during encounters with humans. PMID:22363710

Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?

PubMed

Giourou, Evangelia; Skokou, Maria; Andrew, Stuart P; Alexopoulou, Konstantina; Gourzis, Philippos; Jelastopulu, Eleni

2018-03-22

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11 th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

Experimental and computational fluid dynamic studies of mixing for complex oral health products

NASA Astrophysics Data System (ADS)

Garcia, Marti Cortada; Mazzei, Luca; Angeli, Panagiota

2015-11-01

Mixing high viscous non-Newtonian fluids is common in the consumer health industry. Sometimes this process is empirical and involves many pilot plants trials which are product specific. The first step to study the mixing process is to build on knowledge on the rheology of the fluids involved. In this research a systematic approach is used to validate the rheology of two liquids: glycerol and a gel formed by polyethylene glycol and carbopol. Initially, the constitutive equation is determined which relates the viscosity of the fluids with temperature, shear rate, and concentration. The key variable for the validation is the power required for mixing, which can be obtained both from CFD and experimentally using a stirred tank and impeller of well-defined geometries at different impeller speeds. A good agreement between the two values indicates a successful validation of the rheology and allows the CFD model to be used for the study of mixing in the complex vessel geometries and increased sizes encountered during scale up.

Toolboxes for a standardised and systematic study of glycans

PubMed Central

2014-01-01

Background Recent progress in method development for characterising the branched structures of complex carbohydrates has now enabled higher throughput technology. Automation of structure analysis then calls for software development since adding meaning to large data collections in reasonable time requires corresponding bioinformatics methods and tools. Current glycobioinformatics resources do cover information on the structure and function of glycans, their interaction with proteins or their enzymatic synthesis. However, this information is partial, scattered and often difficult to find to for non-glycobiologists. Methods Following our diagnosis of the causes of the slow development of glycobioinformatics, we review the "objective" difficulties encountered in defining adequate formats for representing complex entities and developing efficient analysis software. Results Various solutions already implemented and strategies defined to bridge glycobiology with different fields and integrate the heterogeneous glyco-related information are presented. Conclusions Despite the initial stage of our integrative efforts, this paper highlights the rapid expansion of glycomics, the validity of existing resources and the bright future of glycobioinformatics. PMID:24564482

Early T-cell activation biophysics

PubMed Central

Henry, Nelly; Hivroz, Claire

2009-01-01

The T-cell is one of the main players in the mammalian immune response. It ensures antigen recognition at the surface of antigen-presenting cells in a complex and highly sensitive and specific process, in which the encounter of the T-cell receptor with the agonist peptide associated with the major histocompatibility complex triggers T-cell activation. While signaling pathways have been elucidated in increasing detail, the mechanism of TCR triggering remains highly controversial despite active research published in the past 10 years. In this paper, we present a short overview of pending questions on critical initial events associated with T-cell triggering. In particular, we examine biophysical approaches already in use, as well as future directions. We suggest that the most recent advances in fluorescence super-resolution imaging, coupled with the new classes of genetic fluorescent probes, will play an important role in elucidation of the T-cell triggering mechanism. Beyond this aspect, we predict that exploration of mechanical cues in the triggering process will provide new clues leading to clarification of the entire mechanism. PMID:20514131

Interrogation of bimetallic particle oxidation in three dimensions at the nanoscale

DOE PAGES

Han, Lili; Meng, Qingping; Wang, Deli; ...

2016-12-08

An understanding of bimetallic alloy oxidation is key to the design of hollow-structured binary oxides and the optimization of their catalytic performance. However, one roadblock encountered in studying these binary oxide systems is the difficulty in describing the heterogeneities that occur in both structure and chemistry as a function of reaction coordinate. This is due to the complexity of the three-dimensional mosaic patterns that occur in these heterogeneous binary systems. By combining real-time imaging and chemical-sensitive electron tomography, we show that it is possible to characterize these systems with simultaneous nanoscale and chemical detail. We find that there is oxidation-inducedmore » chemical segregation occurring on both external and internal surfaces. Additionally, there is another layer of complexity that occurs during the oxidation, namely that the morphology of the initial oxide surface can change the oxidation modality. As a result, this work characterizes the pathways that can control the morphology in binary oxide materials.« less

Assessment of the Gaussian Covariance Approximation over an Earth-Asteroid Encounter Period

NASA Technical Reports Server (NTRS)

Mattern, Daniel

2017-01-01

In assessing the risk an asteroid may pose to the Earth, the asteroids state is often predicted for many years, often decades. Only by accounting for the asteroids initial state uncertainty can a measure of the risk be calculated. With the asteroids state uncertainty growing as a function of the initial velocity uncertainty, orbit velocity at the last state update, and the time from the last update to the epoch of interest, the asteroids position uncertainties can grow to many times the size of the Earth when propagated to the encounter risk corridor. This paper examines the merits of propagating the asteroids state covariance as an analytical matrix. The results of this study help to bound the efficacy of applying different metrics for assessing the risk an asteroid poses to the Earth. Additionally, this work identifies a criterion for when different covariance propagation methods are needed to continue predictions after an Earth-encounter period.

An Inquiry into Action Research: Teaching and Doing Action Research for the First-Time

ERIC Educational Resources Information Center

Palak, Deniz

2013-01-01

I undertook this inquiry into action research while teaching research methods within a graduate degree teacher education program. This inquiry represents my initial encounter with action research and describes the tools, challenges, and uncertainties that I encountered while teaching and doing action research for the first-time. The main purpose…

Communicative Language Teaching: A Practical Scenario in the Context of Bangladesh

ERIC Educational Resources Information Center

Ahmed, Md. Kawser

2016-01-01

Communicative Language Teaching, popularly known as CLT, has become a newly adopted methodology in the teaching and learning context of Bangladesh. This methodology, since the initiation, has encountered and is still encountering a number of hurdles that need to be dealt with best care and feasible strategy. Of all methods, most of the educational…

Close encounters: Moving along bumps, breaks, and bubbles on expanded trinucleotide tracts

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

Polyzos, Aris A.; McMurray, Cynthia T.

2017-06-09

Expansion of simple triplet repeats (TNR) underlies greater than 30 severe degenerative diseases. There is a good understanding of the major pathways generating an expansion, and the associated polymerases that operate during gap filling synthesis at these “difficult to copy” sequences. However, the mechanism by which a TNR is repaired depends on the type of lesion, the structural features imposed by the lesion, the assembled replication/repair complex, and the polymerase that encounters it. The relationships among these parameters are exceptionally complex and how they direct pathway choice is poorly understood. In this review, we consider the properties of polymerases, andmore » how encounters with GC-rich or abnormal structures might influence polymerase choice and the success of replication and repair. Insights over the last three years have highlighted new mechanisms that provide interesting choices to consider in protecting genome stability.« less

Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative

PubMed Central

Klinis, Spyridon; Markaki, Adelais; Kounalakis, Dimitrios; Symvoulakis, Emmanouil K.

2012-01-01

The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented. PMID:23091407

Recreation management in the Bob Marshall, Great Bear, and Scapegoat Wilderness: 1987 to 1997

Treesearch

Greg A. Warren

1997-01-01

The Bob Marshall Wilderness Complex Recreation Management Direction was approved in April 1987. Monitoring of recreational use has focused on encounters with other parties, the number of campsites impacted, and number of aircraft landings at Schafer Meadows airstrip. The available monitoring information indicates standards are being met for encountering other parties,...

INTERRUPTED STELLAR ENCOUNTERS IN STAR CLUSTERS

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

Geller, Aaron M.; Leigh, Nathan W. C., E-mail: a-geller@northwestern.edu, E-mail: nleigh@amnh.org

Strong encounters between single stars and binaries play a pivotal role in the evolution of star clusters. Such encounters can also dramatically modify the orbital parameters of binaries, exchange partners in and out of binaries, and are a primary contributor to the rate of physical stellar collisions in star clusters. Often, these encounters are studied under the approximation that they happen quickly enough and within a small enough volume to be considered isolated from the rest of the cluster. In this paper, we study the validity of this assumption through the analysis of a large grid of single–binary and binary–binarymore » scattering experiments. For each encounter we evaluate the encounter duration, and compare this with the expected time until another single or binary star will join the encounter. We find that for lower-mass clusters, similar to typical open clusters in our Galaxy, the percent of encounters that will be “interrupted” by an interloping star or binary may be 20%–40% (or higher) in the core, though for typical globular clusters we expect ≲1% of encounters to be interrupted. Thus, the assumption that strong encounters occur in relative isolation breaks down for certain clusters. Instead, many strong encounters develop into more complex “mini-clusters,” which must be accounted for in studying, for example, the internal dynamics of star clusters, and the physical stellar collision rate.« less

Comparing Effects of Cluster-Coupled Patterns on Opinion Dynamics

NASA Astrophysics Data System (ADS)

Liu, Yun; Si, Xia-Meng; Zhang, Yan-Chao

2012-07-01

Community structure is another important feature besides small-world and scale-free property of complex networks. Communities can be coupled through specific fixed links between nodes, or occasional encounter behavior. We introduce a model for opinion evolution with multiple cluster-coupled patterns, in which the interconnectivity denotes the coupled degree of communities by fixed links, and encounter frequency controls the coupled degree of communities by encounter behaviors. Considering the complicated cognitive system of people, the CODA (continuous opinions and discrete actions) update rules are used to mimic how people update their decisions after interacting with someone. It is shown that, large interconnectivity and encounter frequency both can promote consensus, reduce competition between communities and propagate some opinion successfully across the whole population. Encounter frequency is better than interconnectivity at facilitating the consensus of decisions. When the degree of social cohesion is same, small interconnectivity has better effects on lessening the competence between communities than small encounter frequency does, while large encounter frequency can make the greater degree of agreement across the whole populations than large interconnectivity can.

Radio science ground data system for the Voyager-Neptune encounter, part 1

NASA Technical Reports Server (NTRS)

Kursinski, E. R.; Asmar, S. W.

1991-01-01

The Voyager radio science experiments at Neptune required the creation of a ground data system array that includes a Deep Space Network complex, the Parkes Radio Observatory, and the Usuda deep space tracking station. The performance requirements were based on experience with the previous Voyager encounters, as well as the scientific goals at Neptune. The requirements were stricter than those of the Uranus encounter because of the need to avoid the phase-stability problems experienced during that encounter and because the spacecraft flyby was faster and closer to the planet than previous encounters. The primary requirement on the instrument was to recover the phase and amplitude of the S- and X-band (2.3 and 8.4 GHz) signals under the dynamic conditions encountered during the occultations. The primary receiver type for the measurements was open loop with high phase-noise and frequency stability performance. The receiver filter bandwidth was predetermined based on the spacecraft's trajectory and frequency uncertainties.

Challenges in recruitment and retention of clinical trial subjects.

PubMed

Kadam, Rashmi Ashish; Borde, Sanghratna Umakant; Madas, Sapna Amol; Salvi, Sundeep Santosh; Limaye, Sneha Saurabh

2016-01-01

Successful recruitment of patients is known to be one of the most challenging aspects in conduct of randomized controlled trials. Inadequate patient retention during conduct of trial affects conclusive results. To assess the level of challenges faced by Indian investigators in recruitment and retention of trial subjects. We developed a survey questionnaire on challenges encountered by investigators in subject recruitment and retention which was hosted on a web portal. Seventy-three investigators from India participated in the survey. The frequently encountered challenges in subject recruitment were complexity of study protocol (38%), lack of awareness about clinical trials in patients (37%), and sociocultural issues related to trial participation (37%). About 63% of participants strongly agreed that creating a positive awareness about clinical trials among people through press and media, having a dedicated clinical research coordinator for trial (50.7%), and designing a recruitment strategy prior to study initiation (46.6%) would enhance recruitment. Almost 50.7% of participants agreed that interacting with medical community in vicinity of the study site and educating patients about clinical trials during routine outpatient department visits (46.6%) would enhance recruitment. Experiencing a serious adverse event, subject's fear for study procedures (47%) and side effects (44%) were thought to have a moderate effect on subject retention. Our survey has put forth factors related to negative publicity by media, lack of patient education about clinical trials; complex study designs are barriers to clinical trial recruitment in India. It is essential to devise innovative and effective strategies focusing on education of public and mass media about clinical research in India.

Listening Competence in Initial Interactions I: Distinguishing between What Listening Is and What Listeners Do

ERIC Educational Resources Information Center

Bodie, Graham D.; St. Cyr, Kellie; Pence, Michelle; Rold, Michael; Honeycutt, James

2012-01-01

The impressions we form of others during initial interactions are powerful. These impressions are a product of various implicit theories--mental representations of people and actions. This article investigates the structure of implicit theories of listening used when forming impressions of others after an initial encounter. Specifically, three…

Asset - An application in mission automation for science planning

NASA Technical Reports Server (NTRS)

Finnerty, D. F.; Martin, J.; Doms, P. E.

1987-01-01

Recent advances in computer technology were used to great advantage in planning science observation sequences for the Voyager 2 encounter with Uranus in 1986. Despite a loss of experienced personnel, a challenging schedule, workforce limitations, and the complex nature of the Uranus encounter itself, the resultant science observation timelines were the most highly optimized of the five Voyager encounters with the outer planets. In part, this was due to the development of a microcomputer-based system, called ASSET (Automated Science Sequence Encounter Timelines generator), which was used to design those science observation timelines. This paper details the development of that system. ASSET demonstrates several features essential to the design of the first expert systems for science planning which will be applied for future missions.

A characterization of the current communication patterns in Danish community pharmacies - an observational study.

PubMed

Kaae, Susanne; Mygind, Anna; Saleem, Sahdia

2013-01-01

Community pharmacies have been trying to expand their core function by counseling customers at the counter. This has been challenging given that customers' interest in receiving counseling may be limited. To characterize the current pharmacist-customer communication patterns to inform future studies and models of communication. Non-participant structured observations based on the works of Stevenson et al. were conducted. A random selection of one hundred encounters in five pharmacies in Denmark was obtained. Type of encounter, type of medicine purchased and the age and gender of the customer were observed, and associations between the parameters identified. Customers initiated 13% of the dialogs, whereas 60% were initiated by the staff (with 38% of the customers declining the offer). 26% of the encounters saw no communication about the medicine. The customers' level of interest in counseling varied significantly and more with the type of medicine purchased than the level of encouragement from the staff to initiate a dialog. The customers' interest in dialog, in contrast with the staff behavior, depended significantly on age and gender. Customers' interest in counseling varies significantly. Pharmacy staff should take this into consideration when trying to optimize communication. Copyright © 2013 Elsevier Inc. All rights reserved.

An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters.

PubMed

Farrell, Laura; Bourgeois-Law, Gisele; Ajjawi, Rola; Regehr, Glenn

2017-03-01

Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.

Joined up Thinking? Evaluating the Use of Concept-Mapping to Develop Complex System Learning

ERIC Educational Resources Information Center

Stewart, Martyn

2012-01-01

In the physical and natural sciences, the complexity of natural systems and their interactions is becoming better understood. With increased emphasis on learning about complex systems, students will be encountering concepts that are dynamic, ill-structured and interconnected. Concept-mapping is a method considered particularly valuable for…

Modeling close encounters with massive asteroids: a Markovian approach. An application to the Vesta family

NASA Astrophysics Data System (ADS)

Carruba, V.; Roig, F.; Michtchenko, T. A.; Ferraz-Mello, S.; Nesvorný, D.

2007-04-01

Context: Nearly all members of the Vesta family cross the orbits of (4) Vesta, one of the most massive asteroids in the main belt, and some of them approach it closely. When mutual velocities during such close encounters are low, the trajectory of the small body can be gravitationally deflected, consequently changing its heliocentric orbital elements. While the effect of a single close encounter may be small, repeated close encounters may significantly change the proper element distribution of members of asteroid families. Aims: We develop a model of the long-term effect of close encounters with massive asteroids, so as to be able to predict how far former members of the Vesta family could have drifted away from the family. Methods: We first developed a new symplectic integrator that simulates both the effects of close encounters and the Yarkovsky effect. We analyzed the results of a simulation involving a fictitious Vesta family, and propagated the asteroid proper element distribution using the probability density function (pdf hereafter), i.e. the function that describes the probability of having an encounter that modifies a proper element x by Δx, for all the possible values of Δx. Given any asteroids' proper element distribution at time t, the distribution at time t+T may be predicted if the pdf is known (Bachelier 1900, Théorie de la spéculation; Hughes 1995, Random Walks and Random Environments, Vol. I). Results: We applied our new method to the problem of V-type asteroids outside the Vesta family (i.e., the 31 currently known asteroids in the inner asteroid belt that have the same spectral type of members as the Vesta family, but that are outside the limits of the dynamical family) and determined that at least ten objects have a significant diffusion probability over the minimum estimated age of the Vesta family of 1.2 Gyr (Carruba et al. 2005, A&A, 441, 819). These objects can therefore be explained in the framework of diffusion via repeated close encounters with (4) Vesta of asteroids originally closer to the parent body. Conclusions: We computed diffusion probabilities at the location of four of these asteroids for various initial conditions, parametrized by values of initial ejection velocity V_ej. Based on our results, we believe the Vesta family age is (1200 ± 700) Myr old, with an initial ejection velocity of (240 ± 60) m/s. Appendices are only available in electronic form at http://www.aanda.org

New Evidence for the Presence of Indigenous Microfossils in Carbonaceous Chondrites

NASA Technical Reports Server (NTRS)

Hoover, Richard B.; Rozanov, Alexei Yu.

2004-01-01

We present additional evidence for the presence of indigenous microfossils in carbonaceous meteorites scanning electron micrograph studies of freshly fractured interior surfaces of pristine samples of the Murchison CM2 carbonaceous meteorite have revealed forms in-situ that are recognizable as biofilms as well as complex and highly structured forms similar to calcareous and siliceous microfossils. Some of the forms encountered are very well-preserved and exhibit complex associated microstructures similar to bacterial flagella. New images will be presented of forms recently encountered in carbonaceous meteorites and they will be compared with those of known microbial extremophiles. KEYWORDS: carbonaceous chondrites, Murchison, microfossils, extremophiles

Exosites in the substrate specificity of blood coagulation reactions.

PubMed

Bock, P E; Panizzi, P; Verhamme, I M A

2007-07-01

The specificity of blood coagulation proteinases for substrate, inhibitor, and effector recognition is mediated by exosites on the surfaces of the catalytic domains, physically separated from the catalytic site. Some thrombin ligands bind specifically to either exosite I or II, while others engage both exosites. The involvement of different, overlapping constellations of exosite residues enables binding of structurally diverse ligands. The flexibility of the thrombin structure is central to the mechanism of complex formation and the specificity of exosite interactions. Encounter complex formation is driven by electrostatic ligand-exosite interactions, followed by conformational rearrangement to a stable complex. Exosites on some zymogens are in low affinity proexosite states and are expressed concomitant with catalytic site activation. The requirement for exosite expression controls the specificity of assembly of catalytic complexes on the coagulation pathway, such as the membrane-bound factor Xa*factor Va (prothrombinase) complex, and prevents premature assembly. Substrate recognition by prothrombinase involves a two-step mechanism with initial docking of prothrombin to exosites, followed by a conformational change to engage the FXa catalytic site. Prothrombin and its activation intermediates bind prothrombinase in two alternative conformations determined by the zymogen to proteinase transition that are hypothesized to involve prothrombin (pro)exosite I interactions with FVa, which underpin the sequential activation pathway. The role of exosites as the major source of substrate specificity has stimulated development of exosite-targeted anticoagulants for treatment of thrombosis.

Integration of a CAD System Into an MDO Framework

NASA Technical Reports Server (NTRS)

Townsend, J. C.; Samareh, J. A.; Weston, R. P.; Zorumski, W. E.

1998-01-01

NASA Langley has developed a heterogeneous distributed computing environment, called the Framework for Inter-disciplinary Design Optimization, or FIDO. Its purpose has been to demonstrate framework technical feasibility and usefulness for optimizing the preliminary design of complex systems and to provide a working environment for testing optimization schemes. Its initial implementation has been for a simplified model of preliminary design of a high-speed civil transport. Upgrades being considered for the FIDO system include a more complete geometry description, required by high-fidelity aerodynamics and structures codes and based on a commercial Computer Aided Design (CAD) system. This report presents the philosophy behind some of the decisions that have shaped the FIDO system and gives a brief case study of the problems and successes encountered in integrating a CAD system into the FEDO framework.

Loop Heat Pipe Startup Behaviors

NASA Technical Reports Server (NTRS)

Ku, Jentung

2014-01-01

A loop heat pipe must start successfully before it can commence its service. The start-up transient represents one of the most complex phenomena in the loop heat pipe operation. This paper discusses various aspects of loop heat pipe start-up behaviors. Topics include the four start-up scenarios, the initial fluid distribution between the evaporator and reservoir that determines the start-up scenario, factors that affect the fluid distribution between the evaporator and reservoir, difficulties encountered during the low power start-up, and methods to enhance the start-up success. Also addressed are the thermodynamic constraint between the evaporator and reservoir in the loop heat pipe operation, the superheat requirement for nucleate boiling, pressure spike and pressure surge during the start-up transient, and repeated cycles of loop start-up andshutdown under certain conditions.

Deployment of the MARSIS Radar Antennas On-Board Mars Express

NASA Technical Reports Server (NTRS)

Denis, Michel; Moorhouse, A.; Smith, A.; McKay, Mike; Fischer, J.; Jayaraman, P.; Mounzer, Z.; Schmidt, R.; Reddy, J.; Ecale, E.;

Psychosomatic approaches to obstetrics, gynaecology and andrology--a review.

PubMed

Lal, Mira

2009-01-01

This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.

RNA-Mediated Thermoregulation of Iron-Acquisition Genes in Shigella dysenteriae and Pathogenic Escherichia coli

PubMed Central

Kouse, Andrew B.; Righetti, Francesco; Kortmann, Jens; Narberhaus, Franz; Murphy, Erin R.

2013-01-01

The initiation, progression and transmission of most bacterial infections is dependent upon the ability of the invading pathogen to acquire iron from each of the varied environments encountered during the course of a natural infection. In total, 95% of iron within the human body is complexed within heme, making heme a potentially rich source of host-associated nutrient iron for invading bacteria. As heme is encountered only within the host, pathogenic bacteria often regulate synthesis of heme utilization factors such that production is maximal under host-associated environmental conditions. This study examines the regulated production of ShuA, an outer-membrane receptor required for the utilization of heme as a source of nutrient iron by Shigella dysenteriae, a pathogenic bacterium that causes severe diarrheal diseases in humans. Specifically, the impact of the distinct environmental temperatures encountered during infection within a host (37°C) and transmission between hosts (25°C) on shuA expression is investigated. We show that shuA expression is subject to temperature-dependent post-transcriptional regulation resulting in increased ShuA production at 37°C. The observed thermoregulation is mediated by nucleic acid sequences within the 5′ untranslated region. In addition, we have identified similar nucleotide sequences within the 5′ untranslated region of the orthologous chuA transcript of enteropathogenic E. coli and have demonstrated that it also functions to confer temperature-dependent post-transcriptional regulation. In both function and predicted structure, the regulatory element within the shuA and chuA 5′ untranslated regions closely resembles a FourU RNA thermometer, a zipper-like RNA structure that occludes the Shine-Dalgarno sequence at low temperatures. Increased production of ShuA and ChuA in response to the host body temperature allows for maximal production of these heme acquisition factors within the environment where S. dysenteriae and pathogenic E. coli strains would encounter heme, a host-specific iron source. PMID:23704938

Convective Weather Avoidance with Uncertain Weather Forecasts

NASA Technical Reports Server (NTRS)

Karahan, Sinan; Windhorst, Robert D.

2009-01-01

Convective weather events have a disruptive impact on air traffic both in terminal area and in en-route airspaces. In order to make sure that the national air transportation system is safe and efficient, it is essential to respond to convective weather events effectively. Traffic flow control initiatives in response to convective weather include ground delay, airborne delay, miles-in-trail restrictions as well as tactical and strategic rerouting. The rerouting initiatives can potentially increase traffic density and complexity in regions neighboring the convective weather activity. There is a need to perform rerouting in an intelligent and efficient way such that the disruptive effects of rerouting are minimized. An important area of research is to study the interaction of in-flight rerouting with traffic congestion or complexity and developing methods that quantitatively measure this interaction. Furthermore, it is necessary to find rerouting solutions that account for uncertainties in weather forecasts. These are important steps toward managing complexity during rerouting operations, and the paper is motivated by these research questions. An automated system is developed for rerouting air traffic in order to avoid convective weather regions during the 20- minute - 2-hour time horizon. Such a system is envisioned to work in concert with separation assurance (0 - 20-minute time horizon), and longer term air traffic management (2-hours and beyond) to provide a more comprehensive solution to complexity and safety management. In this study, weather is dynamic and uncertain; it is represented as regions of airspace that pilots are likely to avoid. Algorithms are implemented in an air traffic simulation environment to support the research study. The algorithms used are deterministic but periodically revise reroutes to account for weather forecast updates. In contrast to previous studies, in this study convective weather is represented as regions of airspace that pilots are likely to avoid. The automated system periodically updates forecasts and reassesses rerouting decisions in order to account for changing weather predictions. The main objectives are to reroute flights to avoid convective weather regions and determine the resulting complexity due to rerouting. The eventual goal is to control and reduce complexity while rerouting flights during the 20 minute - 2 hour planning period. A three-hour simulation is conducted using 4800 flights in the national airspace. The study compares several metrics against a baseline scenario using the same traffic and weather but with rerouting disabled. The results show that rerouting can have a negative impact on congestion in some sectors, as expected. The rerouting system provides accurate measurements of the resulting complexity in the congested sectors. Furthermore, although rerouting is performed only in the 20-minute - 2-hour range, it results in a 30% reduction in encounters with nowcast weather polygons (100% being the ideal for perfectly predictable and accurate weather). In the simulations, rerouting was performed for the 20-minute - 2-hour flight time horizon, and for the en-route segment of air traffic. The implementation uses CWAM, a set of polygons that represent probabilities of pilot deviation around weather. The algorithms were implemented in a software-based air traffic simulation system. Initial results of the system's performance and effectiveness were encouraging. Simulation results showed that when flights were rerouted in the 20-minute - 2-hour flight time horizon of air traffic, there were fewer weather encounters in the first 20 minutes than for flights that were not rerouted. Some preliminary results were also obtained that showed that rerouting will also increase complexity. More simulations will be conducted in order to report conclusive results on the effects of rerouting on complexity. Thus, the use of the 20-minute - 2-hour flight time horizon weather avoidance teniques performed in the simulation is expected to provide benefits for short-term weather avoidance.

A Rough Energy Landscape to Describe Surface-Linked Antibody and Antigen Bond Formation

NASA Astrophysics Data System (ADS)

Limozin, Laurent; Bongrand, Pierre; Robert, Philippe

2016-10-01

Antibodies and B cell receptors often bind their antigen at cell-cell interface while both molecular species are surface-bound, which impacts bond kinetics and function. Despite the description of complex energy landscapes for dissociation kinetics which may also result in significantly different association kinetics, surface-bound molecule (2D) association kinetics usually remain described by an on-rate due to crossing of a single free energy barrier, and few experimental works have measured association kinetics under conditions implying force and two-dimensional relative ligand-receptor motion. We use a new laminar flow chamber to measure 2D bond formation with systematic variation of the distribution of encounter durations between antigen and antibody, in a range from 0.1 to 10 ms. Under physiologically relevant forces, 2D association is 100-fold slower than 3D association as studied by surface plasmon resonance assays. Supported by brownian dynamics simulations, our results show that a minimal encounter duration is required for 2D association; an energy landscape featuring a rough initial part might be a reasonable way of accounting for this. By systematically varying the temperature of our experiments, we evaluate roughness at 2kBT, in the range of previously proposed rough parts of landscapes models during dissociation.

NASA Controller Acceptability Study 1(CAS-1) Experiment Description and Initial Observations

NASA Technical Reports Server (NTRS)

Chamberlain, James P.; Consiglio, Maria C.; Comstock, James R., Jr.; Ghatas, Rania W.; Munoz, Cesar

2015-01-01

This paper describes the Controller Acceptability Study 1 (CAS-1) experiment that was conducted by NASA Langley Research Center personnel from January through March 2014 and presents partial CAS-1 results. CAS-1 employed 14 air traffic controller volunteers as research subjects to assess the viability of simulated future unmanned aircraft systems (UAS) operating alongside manned aircraft in moderate-density, moderate-complexity Class E airspace. These simulated UAS were equipped with a prototype pilot-in-the-loop (PITL) Detect and Avoid (DAA) system, specifically the Self-Separation (SS) function of such a system based on Stratway+ software to replace the see-and-avoid capabilities of manned aircraft pilots. A quantitative CAS-1 objective was to determine horizontal miss distance (HMD) values for SS encounters that were most acceptable to air traffic controllers, specifically HMD values that were assessed as neither unsafely small nor disruptively large. HMD values between 0.5 and 3.0 nautical miles (nmi) were assessed for a wide array of encounter geometries between UAS and manned aircraft. The paper includes brief introductory material about DAA systems and their SS functions, followed by descriptions of the CAS-1 simulation environment, prototype PITL SS capability, and experiment design, and concludes with presentation and discussion of partial CAS-1 data and results.

A Rough Energy Landscape to Describe Surface-Linked Antibody and Antigen Bond Formation

PubMed Central

Limozin, Laurent; Bongrand, Pierre; Robert, Philippe

2016-01-01

Antibodies and B cell receptors often bind their antigen at cell-cell interface while both molecular species are surface-bound, which impacts bond kinetics and function. Despite the description of complex energy landscapes for dissociation kinetics which may also result in significantly different association kinetics, surface-bound molecule (2D) association kinetics usually remain described by an on-rate due to crossing of a single free energy barrier, and few experimental works have measured association kinetics under conditions implying force and two-dimensional relative ligand-receptor motion. We use a new laminar flow chamber to measure 2D bond formation with systematic variation of the distribution of encounter durations between antigen and antibody, in a range from 0.1 to 10 ms. Under physiologically relevant forces, 2D association is 100-fold slower than 3D association as studied by surface plasmon resonance assays. Supported by brownian dynamics simulations, our results show that a minimal encounter duration is required for 2D association; an energy landscape featuring a rough initial part might be a reasonable way of accounting for this. By systematically varying the temperature of our experiments, we evaluate roughness at 2kBT, in the range of previously proposed rough parts of landscapes models during dissociation. PMID:27731375

A Rough Energy Landscape to Describe Surface-Linked Antibody and Antigen Bond Formation.

PubMed

Limozin, Laurent; Bongrand, Pierre; Robert, Philippe

2016-10-12

Antibodies and B cell receptors often bind their antigen at cell-cell interface while both molecular species are surface-bound, which impacts bond kinetics and function. Despite the description of complex energy landscapes for dissociation kinetics which may also result in significantly different association kinetics, surface-bound molecule (2D) association kinetics usually remain described by an on-rate due to crossing of a single free energy barrier, and few experimental works have measured association kinetics under conditions implying force and two-dimensional relative ligand-receptor motion. We use a new laminar flow chamber to measure 2D bond formation with systematic variation of the distribution of encounter durations between antigen and antibody, in a range from 0.1 to 10 ms. Under physiologically relevant forces, 2D association is 100-fold slower than 3D association as studied by surface plasmon resonance assays. Supported by brownian dynamics simulations, our results show that a minimal encounter duration is required for 2D association; an energy landscape featuring a rough initial part might be a reasonable way of accounting for this. By systematically varying the temperature of our experiments, we evaluate roughness at 2k B T, in the range of previously proposed rough parts of landscapes models during dissociation.

The wound/burn guidelines - 6: Guidelines for the management of burns.

PubMed

Yoshino, Yuichiro; Ohtsuka, Mikio; Kawaguchi, Masakazu; Sakai, Keisuke; Hashimoto, Akira; Hayashi, Masahiro; Madokoro, Naoki; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kukino, Ryuichi; Kono, Takeshi; Kodera, Masanari; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hasegawa, Minoru; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Yamasaki, Osamu; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

2016-09-01

Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures. © 2016 Japanese Dermatological Association.

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

PubMed

Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

Polysaccharide-based hydrogels with tunable composition as 3D cell culture systems.

PubMed

Gentilini, Roberta; Munarin, Fabiola; Bloise, Nora; Secchi, Eleonora; Visai, Livia; Tanzi, Maria Cristina; Petrini, Paola

2018-04-01

To date, cell cultures have been created either on 2-dimensional (2D) polystyrene surfaces or in 3-dimensional (3D) systems, which do not offer a controlled chemical composition, and which lack the soft environment encountered in vivo and the chemical stimuli that promote cell proliferation and allow complex cellular behavior. In this study, pectin-based hydrogels were developed and are proposed as versatile cell culture systems. Pectin-based hydrogels were produced by internally crosslinking pectin with calcium carbonate at different initial pH, aiming to control crosslinking kinetics and degree. Additionally, glucose and glutamine were added as additives, and their effects on the viscoelastic properties of the hydrogels and on cell viability were investigated. Pectin hydrogels showed in high cell viability and shear-thinning behavior. Independently of hydrogel composition, an initial swelling was observed, followed by a low percentage of weight variation and a steady-state stage. The addition of glucose and glutamine to pectin-based hydrogels rendered higher cell viability up to 90%-98% after 1 hour of incubation, and these hydrogels were maintained for up to 7 days of culture, yet no effect on viscoelastic properties was detected. Pectin-based hydrogels that offer tunable composition were developed successfully. They are envisioned as synthetic extracellular matrix (ECM) either to study complex cellular behaviors or to be applied as tissue engineering substitutes.

The EnRiCH Community Resilience Framework for High-Risk Populations

PubMed Central

O'Sullivan, Tracey L.; Kuziemsky, Craig E.; Corneil, Wayne; Lemyre, Louise; Franco, Zeno

2014-01-01

Introduction: Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. Methods: The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. Results: Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. Discussion: We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities. PMID:25642373

The EnRiCH Community Resilience Framework for High-Risk Populations.

PubMed

O'Sullivan, Tracey L; Kuziemsky, Craig E; Corneil, Wayne; Lemyre, Louise; Franco, Zeno

2014-10-02

Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.

To regain participation in occupations through human encounters--narratives from women with spinal cord injury.

PubMed

Isaksson, Gunilla; Josephsson, Staffan; Lexell, Jan; Skär, Lisa

2007-11-30

To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation. The data were collected through two or three in-depth interviews with 13 women (age 25-61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability.

Stress and aversive learning in a wild vertebrate: the role of corticosterone in mediating escape from a novel stressor.

PubMed

Thaker, Maria; Vanak, Abi T; Lima, Steven L; Hews, Diana K

2010-01-01

Elevated plasma corticosterone during stressful events is linked to rapid changes in behavior in vertebrates and can mediate learning and memory consolidation. We tested the importance of acute corticosterone elevation in aversive learning of a novel stressor by wild male eastern fence lizards (Sceloporus undulatus). We found that inhibiting corticosterone elevation (using metyrapone, a corticosterone synthesis blocker) during an encounter with a novel attacker impaired immediate escape responses and limited learning and recall during future encounters. In the wild and in outdoor enclosures, lizards whose acute corticosterone response was blocked by an earlier metyrapone injection did not alter their escape behavior during repeated encounters with the attacker. Control-injected (unblocked) lizards, however, progressively increased flight initiation distance and decreased hiding duration during subsequent encounters. Aversive responses were also initially higher for control lizards exposed to a higher intensity first attack. Further, we demonstrate a role of corticosterone elevation in recollection, since unblocked lizards had heightened antipredator responses 24-28 h later. Exogenously restoring corticosterone levels in metyrapone-injected lizards maintained aversive behaviors and learning at control (unblocked) levels. We suggest that the corticosterone mediation of antipredator behaviors and aversive learning is a critical and general mechanism for the behavioral flexibility of vertebrate prey.

Conflict Resolution in the Genome: How Transcription and Replication Make It Work.

PubMed

Hamperl, Stephan; Cimprich, Karlene A

2016-12-01

The complex machineries involved in replication and transcription translocate along the same DNA template, often in opposing directions and at different rates. These processes routinely interfere with each other in prokaryotes, and mounting evidence now suggests that RNA polymerase complexes also encounter replication forks in higher eukaryotes. Indeed, cells rely on numerous mechanisms to avoid, tolerate, and resolve such transcription-replication conflicts, and the absence of these mechanisms can lead to catastrophic effects on genome stability and cell viability. In this article, we review the cellular responses to transcription-replication conflicts and highlight how these inevitable encounters shape the genome and impact diverse cellular processes. Copyright © 2016 Elsevier Inc. All rights reserved.

Human Trafficking in the Emergency Department

PubMed Central

Patel, Ronak B.; Ahn, Roy; Burke, Thomas F.

2010-01-01

Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients. PMID:21293753

Neural Overlap in Item Representations Across Episodes Impairs Context Memory.

PubMed

Kim, Ghootae; Norman, Kenneth A; Turk-Browne, Nicholas B

2018-06-12

We frequently encounter the same item in different contexts, and when that happens, memories of earlier encounters can get reactivated. We examined how existing memories are changed as a result of such reactivation. We hypothesized that when an item's initial and subsequent neural representations overlap, this allows the initial item to become associated with novel contextual information, interfering with later retrieval of the initial context. Specifically, we predicted a negative relationship between representational similarity across repeated experiences of an item and subsequent source memory for the initial context. We tested this hypothesis in an fMRI study, in which objects were presented multiple times during different tasks. We measured the similarity of the neural patterns in lateral occipital cortex that were elicited by the first and second presentations of objects, and related this neural overlap score to subsequent source memory. Consistent with our hypothesis, greater item-specific pattern similarity was linked to worse source memory for the initial task. In contrast, greater reactivation of the initial context was associated with better source memory. Our findings suggest that the influence of novel experiences on an existing context memory depends on how reliably a shared component (i.e., item) is represented across these episodes.

Assembly of β-barrel proteins in the mitochondrial outer membrane.

PubMed

Höhr, Alexandra I C; Straub, Sebastian P; Warscheid, Bettina; Becker, Thomas; Wiedemann, Nils

2015-01-01

Mitochondria evolved through endosymbiosis of a Gram-negative progenitor with a host cell to generate eukaryotes. Therefore, the outer membrane of mitochondria and Gram-negative bacteria contain pore proteins with β-barrel topology. After synthesis in the cytosol, β-barrel precursor proteins are first transported into the mitochondrial intermembrane space. Folding and membrane integration of β-barrel proteins depend on the mitochondrial sorting and assembly machinery (SAM) located in the outer membrane, which is related to the β-barrel assembly machinery (BAM) in bacteria. The SAM complex recognizes β-barrel proteins by a β-signal in the C-terminal β-strand that is required to initiate β-barrel protein insertion into the outer membrane. In addition, the SAM complex is crucial to form membrane contacts with the inner mitochondrial membrane by interacting with the mitochondrial contact site and cristae organizing system (MICOS) and shares a subunit with the endoplasmic reticulum-mitochondria encounter structure (ERMES) that links the outer mitochondrial membrane to the endoplasmic reticulum (ER). Copyright © 2014 Elsevier B.V. All rights reserved.

A case study of multi-seam coal mine entry stability analysis with strength reduction method

PubMed Central

Tulu, Ihsan Berk; Esterhuizen, Gabriel S; Klemetti, Ted; Murphy, Michael M.; Sumner, James; Sloan, Michael

2017-01-01

In this paper, the advantage of using numerical models with the strength reduction method (SRM) to evaluate entry stability in complex multiple-seam conditions is demonstrated. A coal mine under variable topography from the Central Appalachian region is used as a case study. At this mine, unexpected roof conditions were encountered during development below previously mined panels. Stress mapping and observation of ground conditions were used to quantify the success of entry support systems in three room-and-pillar panels. Numerical model analyses were initially conducted to estimate the stresses induced by the multiple-seam mining at the locations of the affected entries. The SRM was used to quantify the stability factor of the supported roof of the entries at selected locations. The SRM-calculated stability factors were compared with observations made during the site visits, and the results demonstrate that the SRM adequately identifies the unexpected roof conditions in this complex case. It is concluded that the SRM can be used to effectively evaluate the likely success of roof supports and the stability condition of entries in coal mines. PMID:28239503

A case study of multi-seam coal mine entry stability analysis with strength reduction method.

PubMed

Tulu, Ihsan Berk; Esterhuizen, Gabriel S; Klemetti, Ted; Murphy, Michael M; Sumner, James; Sloan, Michael

2016-03-01

In this paper, the advantage of using numerical models with the strength reduction method (SRM) to evaluate entry stability in complex multiple-seam conditions is demonstrated. A coal mine under variable topography from the Central Appalachian region is used as a case study. At this mine, unexpected roof conditions were encountered during development below previously mined panels. Stress mapping and observation of ground conditions were used to quantify the success of entry support systems in three room-and-pillar panels. Numerical model analyses were initially conducted to estimate the stresses induced by the multiple-seam mining at the locations of the affected entries. The SRM was used to quantify the stability factor of the supported roof of the entries at selected locations. The SRM-calculated stability factors were compared with observations made during the site visits, and the results demonstrate that the SRM adequately identifies the unexpected roof conditions in this complex case. It is concluded that the SRM can be used to effectively evaluate the likely success of roof supports and the stability condition of entries in coal mines.

A Correlational Study Assessing the Relationships among Information Technology Project Complexity, Project Complication, and Project Success

ERIC Educational Resources Information Center

Williamson, David J.

2011-01-01

The specific problem addressed in this study was the low success rate of information technology (IT) projects in the U.S. Due to the abstract nature and inherent complexity of software development, IT projects are among the most complex projects encountered. Most existing schools of project management theory are based on the rational systems…

The effect of multiplicity of stellar encounters and the diffusion coefficients in a locally homogeneous three-dimensional stellar medium: Removing the classical divergence

NASA Astrophysics Data System (ADS)

Rastorguev, A. S.; Utkin, N. D.; Chumak, O. V.

2017-08-01

Agekyan's λ-factor that allows for the effect of multiplicity of stellar encounters with large impact parameters has been used for the first time to directly calculate the diffusion coefficients in the phase space of a stellar system. Simple estimates show that the cumulative effect, i.e., the total contribution of distant encounters to the change in the velocity of a test star, given the multiplicity of stellar encounters, is finite, and the logarithmic divergence inherent in the classical description of diffusion is removed, as was shown previously byKandrup using a different, more complex approach. In this case, the expressions for the diffusion coefficients, as in the classical description, contain the logarithm of the ratio of two independent quantities: the mean interparticle distance and the impact parameter of a close encounter. However, the physical meaning of this logarithmic factor changes radically: it reflects not the divergence but the presence of two characteristic length scales inherent in the stellar medium.

Kinetic studies of the folding of heterodimeric monellin: evidence for switching between alternative parallel pathways.

PubMed

Aghera, Nilesh; Udgaonkar, Jayant B

2012-07-13

Determining whether or not a protein uses multiple pathways to fold is an important goal in protein folding studies. When multiple pathways are present, defined by transition states that differ in their compactness and structure but not significantly in energy, they may manifest themselves by causing the dependence on denaturant concentration of the logarithm of the observed rate constant of folding to have an upward curvature. In this study, the folding mechanism of heterodimeric monellin [double-chain monellin (dcMN)] has been studied over a range of protein and guanidine hydrochloride (GdnHCl) concentrations, using the intrinsic tryptophan fluorescence of the protein as the probe for the folding reaction. Refolding is shown to occur in multiple kinetic phases. In the first stage of refolding, which is silent to any change in intrinsic fluorescence, the two chains of monellin bind to one another to form an encounter complex. Interrupted folding experiments show that the initial encounter complex folds to native dcMN via two folding routes. A productive folding intermediate population is identified on one route but not on both of these routes. Two intermediate subpopulations appear to form in a fast kinetic phase, and native dcMN forms in a slow kinetic phase. The chevron arms for both the fast and slow phases of refolding are shown to have upward curvatures, suggesting that at least two pathways each defined by a different intermediate are operational during these kinetic phases of structure formation. Refolding switches from one pathway to the other as the GdnHCl concentration is increased. Copyright © 2012 Elsevier Ltd. All rights reserved.

Distribution of the different species of the Pseudallescheria boydii/Scedosporium apiospermum complex in French patients with cystic fibrosis.

PubMed

Zouhair, Rachid; Rougeron, Amandine; Razafimandimby, Bienvenue; Kobi, Abdessamad; Bouchara, Jean-Philippe; Giraud, Sandrine

2013-08-01

As various new sibling species within the Pseudallescheria boydii/Scedosporium apiospermum complex have been described recently with differences in their susceptibility to antifungals, this study was conducted in order to determine their respective frequency in cystic fibrosis. Results indicated that P. boydii largely predominated (62%), followed by S. apiospermum (24%), Scedosporium aurantiacum (10%) and Pseudallescheria minutispora (4%). Scedosporium dehoogii was not recovered in this study. The multiple correspondence factor analysis highlighted geographical discrepancies within species distribution: P. boydii was rarely encountered in Northern France, while S. apiospermum was less represented in the west of the country. Additionally, we demonstrated that all species encountered in the cystic fibrosis context were capable to chronically colonize the respiratory tract of patients. Molecular typing of a large set of environmental and clinical isolates should be conducted to delineate the epidemiology of each sibling species in the complex.

Pigmented Paraaxillary Located "Complex" Basal Cell Carcinoma Imitating clinically irritated Melanocytic Lesion - Succesfull Surgical Approach in Bulgarian Patient.

PubMed

Voicu, Cristiana; Mihai, Mara; Lupu, Mihai; Patterson, James W; Koleva, Nely; Wollina, Uwe; Lotti, Torello; Lotti, Jacopo; França, Katlein; Batashki, Atanas; Gianfaldoni, Serena; Bakardzhiev, Ilko; Mangarov, Hristo; Tchernev, Georgi

2017-07-25

Basal cell carcinoma (BCC) is the most frequently encountered neoplasm worldwide. While nodular BCC is the most frequent clinical subtype, other forms of BCC, such as superficial, cystic, morpheiform, infiltrative, and pigmented may also be encountered. We present the case of a 67-year-old male with a relatively well-defined infiltrative, pigmented plaque with multiple colours and peripheral growth situated in the right axillary region. The histopathologic examination performed after complete surgical excision of the tumour revealed a complex pigmented BCC with macronodular, fibroepithelioma-like, cystic, focally infiltrative and basosquamous features. Uncommon locations of BCCs in sun-protected areas such as the axillary region require a higher degree of suspicion for diagnosis. The complex histology of the presented case, including subtypes with differing biologic attributes, emphasises the importance of histopathological examination in the diagnosis and therapeutic management of BCC.

Celebrating methodological challenges and changes: reflecting on the emergence and importance of the role of qualitative evidence in Cochrane reviews

PubMed Central

2013-01-01

Cochrane systematic reviews have proven to be beneficial for decision making processes, both on a practitioner and a policy level, and there are current initiatives to extend the types of evidence used by them, including qualitative research. In this article we outline the major achievements of the Cochrane Qualitative and Implementation Methods Group. Although the Group has encountered numerous challenges in dealing with the evolution of qualitative evidence synthesis, both outside and within the Cochrane Collaboration, it has successfully responded to the challenges posed in terms of incorporating qualitative evidence in systematic reviews. The Methods Group will continue to advocate for more flexible and inclusive approaches to evidence synthesis in order to meet the exciting challenges and opportunities presented by mixed methods systematic reviews and reviews of complex interventions. PMID:24135194

Recent experience in seeding transonic/supersonic flows at AEDC

NASA Astrophysics Data System (ADS)

Heltsley, F. L.

1985-10-01

The laser velocimeter has been utilized for several years at the Arnold Engineering and Development Center (AEDC) as a flow diagnostics tool. Most applications, following the initial proof-of-concept experiments, have involved relatively complex unknown flow fields in which the more conventional, intrusive techniques had either not been attempted or had yielded unsatisfactory results. A blunt-base nozzle-afterbody base flow study is discussed as a respresentative example of such applications. A wide variety of problems have been encountered during these tests, many of which have proven to be closely related to the size and/or size distribution of the seeding material within the fluid. Resulting measurement uncertainties could often not be conclusively resolved because of the unknown nature of the flow field. The other experiments listed were conducted to provide known aerodynamic conditions for comparison with the velocimeter results.

Recent experience in seeding transonic/supersonic flows at AEDC

NASA Technical Reports Server (NTRS)

Heltsley, F. L.

1985-01-01

The laser velocimeter has been utilized for several years at the Arnold Engineering and Development Center (AEDC) as a flow diagnostics tool. Most applications, following the initial proof-of-concept experiments, have involved relatively complex unknown flow fields in which the more conventional, intrusive techniques had either not been attempted or had yielded unsatisfactory results. A blunt-base nozzle-afterbody base flow study is discussed as a respresentative example of such applications. A wide variety of problems have been encountered during these tests, many of which have proven to be closely related to the size and/or size distribution of the seeding material within the fluid. Resulting measurement uncertainties could often not be conclusively resolved because of the unknown nature of the flow field. The other experiments listed were conducted to provide known aerodynamic conditions for comparison with the velocimeter results.

Accounting for the Relationship between Initial Status and Growth in Regression Models

ERIC Educational Resources Information Center

Kelly, Sean; Ye, Feifei

2017-01-01

Educational analysts studying achievement and other educational outcomes frequently encounter an association between initial status and growth, which has important implications for the analysis of covariate effects, including group differences in growth. As explicated by Allison (1990), where only two time points of data are available, identifying…

Factors associated with opioid dose increases: a chart review of patients’ first year on long-term opioids

PubMed Central

Bautista, Christopher A.; Iosif, Ana-Maria; Wilsey, Barth L.; Melnikow, Joy A.; Crichlow, Althea; Henry, Stephen G.

2016-01-01

OBJECTIVE To examine encounter-level factors associated with opioid dose increases during patients’ first year on opioid therapy for chronic pain. DESIGN Case-control study analyzing all opioid prescriptions for patients with chronic pain during their first year after opioid initiation. Cases were patients who experienced an overall dose escalation of ≥30 mg morphine equivalents over the 1-year period; controls did not experience overall dose escalation. Main measures were encounter type; opioid dose change; documented prescribing rationale; documentation of guideline-concordant opioid prescribing practices. Two coders reviewed all encounters associated with opioid prescriptions. Analysis of factors associated with dose increases and provider documentation of prescribing rationale was conducted using multiple logistic regression. RESULTS 674 encounters were coded for 66 patients (22 cases, 44 controls). Fifty-three percent of opioid prescriptions were associated with telephone encounters; 13% were associated with email encounters. No prescribing rationale was documented for 43% of all opioid prescriptions and 25% of dose increases. Likelihood of dose increase and documentation of prescribing rationale did not significantly differ for cases versus controls. Compared to face-to-face encounters, dose increases were significantly less likely for telephone (OR 0.18, 95%CI 0.11 – 0.28) and email (OR 0.23, 95%CI 0.12 – 0.47) encounters; documentation of prescribing rationale was significantly more likely for email (OR 5.06, 95%CI 1.87–13.72) and less likely for telephone (OR 0.30, 95%CI 0.18–0.51) encounters. CONCLUSION Most opioid prescriptions were written without face-to-face encounters. One quarter of dose increases contained no documented prescribing rationale. Documented encounter-level factors were not significantly associated with overall opioid dose escalation. PMID:27477581

Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.

PubMed

Click, Benjamin; Anderson, Alyce M; Ramos Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael A; Schwartz, Marc; Swoger, Jason; Barrie, Arthur; Szigethy, Eva; Regueiro, Miguel; Schoen, Robert E; Binion, David G

2018-04-01

Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates. Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

Black Women's Intersectional Complexities: The Impact on Leadership

ERIC Educational Resources Information Center

Curtis, Sharon

2017-01-01

Recent educational literature has produced a plethora of gendered experiences encountered by women working towards leadership positions in education. Gender plays a complex role that shapes the relationship between perceived ideals of womanhood and leadership. This paper focuses on the variations in leadership and management distributed in the…

Inclusive Education for Students with Hearing Impairment in the Regular Secondary Schools in the North-West Region of Cameroon: Initiatives and Challenges

ERIC Educational Resources Information Center

Bamu, Beryl Ndongwa; De Schauwer, Elisabeth; Verstraete, Sara; Van Hove, Geert

2017-01-01

Although some initiatives are implemented in the education of students with hearing impairments in the regular school, challenges are still encountered in their education. This article which is part of the results from an ongoing qualitative study in the North-West region of Cameroon addresses the different initiatives and challenges involved with…

Measuring verbal communication in initial physical therapy encounters.

PubMed

Roberts, Lisa C; Whittle, Christopher T; Cleland, Jennifer; Wald, Mike

2013-04-01

Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician. The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application. A cross-sectional study was conducted. Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes. In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%). Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded. This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (i.e., Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.

Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication.

PubMed

Klein, Lauren R; Cole, Jon B; Driver, Brian E; Battista, Christopher; Jelinek, Ryan; Martel, Marc L

2018-03-01

Emergency department (ED) visits for acute alcohol intoxication are common, but this population is at risk for decompensation and occult critical illness. The purpose of this study is to describe the incidence and predictors of unsuspected critical illness among patients with acute alcohol intoxication. This was a retrospective observational study of ED patients from 2011 to 2016 with acute alcohol intoxication. The study cohort included patients presenting for alcohol intoxication, whose initial assessment was uncomplicated alcohol intoxication without any other active acute medical or traumatic complaints. The primary outcome was defined as the unanticipated subsequent use of critical care resources during the encounter or admission to an ICU. We investigated potential predictors for this outcome with generalized estimating equations. We identified 31,364 eligible patient encounters (median age 38 years; 71% men; median breath alcohol concentration 234 mg/dL); 325 encounters (1%) used critical care resources. The most common diagnoses per 1,000 ED encounters were acute hypoxic respiratory failure (3.1), alcohol withdrawal (1.7), sepsis or infection (1.1), and intracranial hemorrhage (1.0). Three patients sustained a cardiac arrest. Presence of the following had an increased adjusted odds ratio (aOR) of developing critical illness: hypoglycemia (aOR 9.2), hypotension (aOR 3.8), tachycardia (aOR 1.8), fever (aOR 7.6), hypoxia (aOR 3.8), hypothermia (aOR 4.2), and parenteral sedation (aOR 2.4). The initial blood alcohol concentration aOR was 1.0. Critical care resources were used for 1% of ED patients with alcohol intoxication who were initially assessed by physicians to have low risk. Abnormal vital signs, hypoglycemia, and chemical sedation were associated with increased odds of critical illness. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Japan's long-term care policy for older people: the emergence of innovative "mobilisation" initiatives following the 2005 reforms.

PubMed

Hayashi, Mayumi

2015-04-01

Japan leads the global race for solutions to the increasing long-term care demand from an ageing population. Initial responses in 2000 saw the launch of the public Long-Term Care Insurance (LTCI) system which witnessed an unexpectedly substantial uptake - with doubts raised about financial viability and sustainability. The post-2005 LTCI reform led to the adoption of innovations - including the "mobilisation" of active, older volunteers to support their frailer peers. This strategy, within the wider government's "2025 Vision" to provide total care for the entire older population, sought to secure financial viability and sustainability. Drawing on qualitative in-depth interviews with 21 provider organisations this study will examine three "mobilisation" schemes and identify those factors contributing to overall strengths while acknowledging complexities, diversities and challenges the schemes encountered. Initial literature written by mobilisation proponents may have been overly optimistic: this study seeks to balance such views through providing an understanding and analysis of these mobilisation schemes' realities. The findings will provide insights and suggest more caution to policy-makers intending to promote such schemes - in both Japan and in countries considering doing so. Furthermore, more evaluation is required to obtain evidence to support financial feasibility and sustainability. Copyright © 2015 Elsevier Inc. All rights reserved.

A dual promoter system regulating λ DNA replication initiation

PubMed Central

Olszewski, Paweł; Szambowska, Anna; Barańska, Sylwia; Narajczyk, Magdalena; Węgrzyn, Grzegorz; Glinkowska, Monika

2014-01-01

Transcription and DNA replication are tightly regulated to ensure coordination of gene expression with growth conditions and faithful transmission of genetic material to progeny. A large body of evidence has accumulated, indicating that encounters between protein machineries carrying out DNA and RNA synthesis occur in vivo and may have important regulatory consequences. This feature may be exacerbated in the case of compact genomes, like the one of bacteriophage λ, used in our study. Transcription that starts at the rightward pR promoter and proceeds through the λ origin of replication and downstream of it was proven to stimulate the initiation of λ DNA replication. Here, we demonstrate that the activity of a convergently oriented pO promoter decreases the efficiency of transcription starting from pR. Our results show, however, that a lack of the functional pO promoter negatively influences λ phage and λ-derived plasmid replication. We present data, suggesting that this effect is evoked by the enhanced level of the pR-driven transcription, occurring in the presence of the defective pO, which may result in the impeded formation of the replication initiation complex. Our data suggest that the cross talk between the two promoters regulates λ DNA replication and coordinates transcription and replication processes. PMID:24500197

Complex Cooperative Strategies in Group-Territorial African Lions

NASA Astrophysics Data System (ADS)

Heinsohn, Robert; Packer, Craig

1995-09-01

Female lions (Panthera leo) showed persistent individual differences in the extent to which they participated in group-territorial conflict. When intergroup encounters were simulated by playback of aggressive vocalizations, some individuals consistently led the approach to the recorded intruder, whereas others lagged behind and avoided the risks of fighting. The lead females recognized that certain companions were laggards but failed to punish them, which suggests that cooperation is not maintained by reciprocity. Modification of the "odds" in these encounters revealed that some females joined the group response when they were most needed, whereas other lagged even farther behind. The complexity of these responses emphasizes the great diversity of individual behavior in this species and the inadequacy of current theory to explain cooperation in large groups.

Conditional data watchpoint management

DOEpatents

Burdick, Dean Joseph; Vaidyanathan, Basu

2010-08-24

A method, system and computer program product for managing a conditional data watchpoint in a set of instructions being traced is shown in accordance with illustrative embodiments. In one particular embodiment, the method comprises initializing a conditional data watchpoint and determining the watchpoint has been encountered. Upon that determination, examining a current instruction context associated with the encountered watchpoint prior to completion of the current instruction execution, further determining a first action responsive to a positive context examination; otherwise, determining a second action.

Voyager 2 Saturn encounter attitude and articulation control experience

NASA Technical Reports Server (NTRS)

Hill, M.

1982-01-01

A description is given of the Voyager Attitude and Articulation Control System (AACS). The complex series of maneuvers required for Voyager 2 during the near encounter period to obtain fields and particle data, track the limb of Saturn during the earth occultation period, and reflect the RF beam off the Saturnian ring system are discussed. It is noted that some of these maneuvers involved rotating the spacecraft simultaneously about multiple axes while maintaining accurate pointing of the scan platform, a first for interplanetary missions. Also described are two anomalies experienced by the AACS during the near encounter period. The first was the significant roll attitude error that occurred shortly after all axis inertial control and that continued to grow until celestial reacquisition. The second was that the scan platform slewing in the azimuth axis stopped midway through the near encounter. These anomalies are analyzed, and their effect on future missions is assessed.

Deep Impact comet encounter: design, development, and operations of the Big Event at Tempel 1

NASA Technical Reports Server (NTRS)

Wissler, Steven

2005-01-01

Deep Impact is NASA's eighth Discovery mission. This low-cost, focused planetary science investigation gathered the data necessary to help scientists unlock early secrets of our solar system. The comet encounter with Tempel 1 was a complex event - requiring extremely accurate timing, robutstness to an unknown environment, and flight team adaptability. The mission operations and flight systems performance were spectacular for approach, impact, and lookback imaging on July 4, 2005.

Deep Impact comet encounter: design, development, and operations of the big event at Tempel 1

NASA Technical Reports Server (NTRS)

Wissler, Steven; Rocca, Jennifer; Kubitschek, Daniel

2005-01-01

Deep Impact is NASA's eighth Discovery mission. This low-cost, focused planetary science investigation gathered the data necessary to help scientists unlock early secrets of our solar system. The comet encounter with Tempel 1 was a complex event - requiring extremely accurate timing, robustness to an unknown environment, and flight team adaptibility. The mission operations and flight systems performance were spectacular for approach, impact, and lookback imaging on July 4, 2005.

'A good fit?' Bringing the sociology of footwear to the clinical encounter in podiatry services: a narrative review.

PubMed

Nicholls, Emily; Robinson, Victoria; Farndon, Lisa; Vernon, Wesley

2018-01-01

This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development.Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and - crucially - any barriers to adopting 'healthier' footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary 'moment' of the clinical encounter.

Ethical Issues in the Assessment and Treatment of a Rational Suicidal Client.

ERIC Educational Resources Information Center

Snipe, Rosetta M.

1988-01-01

Notes that rational client's decision to commit suicide may present complex ethical issues for therapist. Presents and discusses three-month account of therapy with client, from perspective of ethical values and principles upon which assessment and treatment decisions were made, and complex ethical dilemmas encountered as therapist juxtaposed…

Disequilibrium, complexity, the Schottky effect, and q-entropies, in paramagnetism

NASA Astrophysics Data System (ADS)

Pennini, F.; Plastino, A.

2017-12-01

We investigate connections between statistical quantifiers and paramagnetism. More concretely, we apply the notions of (i) disequilibrium and (ii) statistical complexity, to a paramagnetic system of non-coupled dipoles. Interesting insights are thereby obtained. In particular, we encounter a kind of criticality, not associated to the temperature but to the disequilibrium.

When Students Say "I Just Couldn't Think": Challenges in Teaching Skilful Thinking

ERIC Educational Resources Information Center

Row, Bavani Nageswana; Subramaniam, Selvaranee; Sathasivam, Renuka V.

2016-01-01

This paper discusses challenges encountered by selected Year Four science teachers regarding their knowledge and implementation of skilful thinking (ST) in their classrooms. ST is a complex concept comprising three elements; specific thinking strategies, habits of mind and metacognitive thinking. Due of the complexity of ST, the implementation of…

Value Differentiation in Adolescence: The Role of Age and Cultural Complexity

ERIC Educational Resources Information Center

Daniel, Ella; Schiefer, David; Mollering, Anna; Benish-Weisman, Maya; Boehnke, Klaus; Knafo, Ariel

2012-01-01

Living in complex social worlds, individuals encounter discordant values across life contexts, potentially resulting in different importance of values across contexts. Value differentiation is defined here as the degree to which values receive different importance depending on the context in which they are considered. Early and mid-adolescents (N…

Marks, Spaces and Boundaries: Punctuation (and Other Effects) in the Typography of Dictionaries

ERIC Educational Resources Information Center

Luna, Paul

2011-01-01

Dictionary compilers and designers use punctuation to structure and clarify entries and to encode information. Dictionaries with a relatively simple structure can have simple typography and simple punctuation; as dictionaries grew more complex, and encountered the space constraints of the printed page, complex encoding systems were developed,…

Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review

PubMed Central

Légaré, France; Moher, David; Elwyn, Glyn; LeBlanc, Annie; Gravel, Karine

2007-01-01

Background The measurement of processes and outcomes that reflect the complexity of the decision-making process within specific clinical encounters is an important area of research to pursue. A systematic review was conducted to identify instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. Methods For every year available up until April 2007, PubMed, PsycINFO, Current Contents, Dissertation Abstracts and Sociological Abstracts were searched for original studies in English or French. Reference lists from retrieved studies were also consulted. Studies were included if they reported a self-administered instrument evaluating physicians' perceptions of the decision-making process within specific clinical encounters, contained sufficient description to permit critical appraisal and presented quantitative results based on administering the instrument. Two individuals independently assessed the eligibility of the instruments and abstracted information on their conceptual underpinnings, main evaluation domain, development, format, reliability, validity and responsiveness. They also assessed the quality of the studies that reported on the development of the instruments with a modified version of STARD. Results Out of 3431 records identified and screened for evaluation, 26 potentially relevant instruments were assessed; 11 met the inclusion criteria. Five instruments were published before 1995. Among those published after 1995, five offered a corresponding patient version. Overall, the main evaluation domains were: satisfaction with the clinical encounter (n = 2), mutual understanding between health professional and patient (n = 2), mental workload (n = 1), frustration with the clinical encounter (n = 1), nurse-physician collaboration (n = 1), perceptions of communication competence (n = 2), degree of comfort with a decision (n = 1) and information on medication (n = 1). For most instruments (n = 10), some reliability and validity criteria were reported in French or English. Overall, the mean number of items on the modified version of STARD was 12.4 (range: 2 to 18). Conclusion This systematic review provides a critical appraisal and repository of instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. More research is needed to pursue the validation of the existing instruments and the development of patient versions. This will help researchers capture the complexity of the decision-making process within specific clinical encounters. PMID:17937801

Systems and complexity thinking in general practice: part 1 - clinical application.

PubMed

Sturmberg, Joachim P

2007-03-01

Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different approaches will lead to different outcomes.

Pain Management for Sickle Cell Disease in the Pediatric Emergency Department: Medications and Hospitalization Trends.

PubMed

Cacciotti, Chantel; Vaiselbuh, Sarah; Romanos-Sirakis, Eleny

2017-10-01

The majority of emergency department (ED) visits and hospitalizations for patients with sickle cell disease (SCD) are pain related. Adequate and timely pain management may improve quality of life and prevent worsening morbidities. We conducted a retrospective chart review of pediatric patients with SCD seen in the ED, selected by sickle cell-related ICD-9 codes. A total of 176 encounters were reviewed from 47 patients to record ED pain management and hospitalization trends. Mean time to pain medication administration was 63 minutes. Patients received combination (nonsteroidal anti-inflammatory drug [NSAID] + narcotic) pain medications for initial treatment at a minority of ED encounters (19%). A higher percentage of patients who received narcotics alone as initial treatment were hospitalized as compared with those who received combination treatment initially ( P= 0.0085). Improved patient education regarding home pain management as well as standardized ED guidelines for assessment and treatment of sickle cell pain may result in superior and more consistent patient care.

Form and function of long-range vocalizations in a Neotropical fossorial rodent: the Anillaco Tuco-Tuco (Ctenomys sp.)

PubMed Central

Valentinuzzi, Veronica S.; Zufiaurre, Emmanuel

2016-01-01

The underground environment poses particular communication challenges for subterranean rodents. Some loud and low-pitched acoustic signals that can travel long distances are appropriate for long-range underground communication and have been suggested to be territorial signals. Long-range vocalizations (LRVs) are important in long-distance communication in Ctenomys tuco-tucos. We characterized the LRV of the Anillaco Tuco-Tuco (Ctenomys sp.) using recordings from free-living individuals and described the behavioral context in which this vocalization was produced during laboratory staged encounters between individuals of both sexes. Long-range calls of Anillaco tuco-tucos are low-frequency, broad-band, loud, and long sounds composed by the repetition of two syllable types: series (formed by notes and soft-notes) and individual notes. All vocalizations were initiated with series, but not all had individual notes. Males were heavier than females and gave significantly lower-pitched vocalizations, but acoustic features were independent of body mass in males. The pronounced variation among individuals in the arrangement and number of syllables and the existence of three types of series (dyads, triads, and tetrads), created a diverse collection of syntactic patterns in vocalizations that would provide the opportunity to encode multiple types of information. The existence of complex syntactic patterns and the description of soft-notes represent new aspects of the vocal communication of Ctenomys. Long-distance vocalizations by Anillaco Tuco-Tucos appear to be territorial signals used mostly in male-male interactions. First, emission of LRVs resulted in de-escalation or space-keeping in male-male and male-female encounters in laboratory experiments. Second, these vocalizations were produced most frequently (in the field and in the lab) by males in our study population. Third, males produced LRVs with greater frequency during male-male encounters compared to male-female encounters. Finally, males appear to have larger home ranges that were more spatially segregated than those of females, suggesting that males may have greater need for long-distance signals that advertise their presence. Due to their apparent rarity, the function and acoustic features of LRV in female tuco-tucos remain inadequately known. PMID:27761344

Health and Environment Linked for Information Exchange in Atlanta (HELIX-Atlanta): A Pilot Tracking System

NASA Technical Reports Server (NTRS)

Rickman, Doug; Shire, J.; Qualters, J.; Mitchell, K.; Pollard, S.; Rao, R.; Kajumba, N.; Quattrochi, D.; Estes, M., Jr.; Meyer, P.;

Getting here: five steps forwards and four back

NASA Astrophysics Data System (ADS)

Griffin, R. Elizabeth

The concept of libraries of stellar spectra is by no means new, though access to on-line ones is a relatively recent achievement. The road to the present state has been rocky, and we are still far short of what is needed and what can easily be attained. Spectra as by-products of individual research projects are inhomogeneous, biassed, and can be dangerously inadequate for modelling complex stellar systems. Archival products are eclectic, but unique in the time domain. Getting telescope time for the required level of homogeneity, inclusivity and completeness for new libraries requires strong scientific arguments that must be competitive. Using synthetic spectra builds misconceptions into the modelling. Attempts to set up the initial requirements (archives of observed spectra) encountered dogged resistance, much of which has never been resolved. Those struggles, and the indelible effects they have upon our science, will be reviewed, and the basics of a promotional programme outlined.

A Conceptual framework of Strategy, Structure and Innovative Behaviour for the Development of a Dynamic Simulation Model

NASA Astrophysics Data System (ADS)

Konstantopoulos, Nikolaos; Trivellas, Panagiotis; Reklitis, Panagiotis

2007-12-01

According to many researchers of organizational theory, a great number of problems encountered by the manufacturing firms are due to their failure to foster innovative behaviour by aligning business strategy and structure. From this point of view, the fit between strategy and structure is essential in order to facilitate firms' innovative behaviour. In the present paper, we adopt Porter's typology to operationalise business strategy (cost leadership, innovative and marketing differentiation, and focus). Organizational structure is built on four dimensions (centralization, formalization, complexity and employees' initiatives to implement new ideas). Innovativeness is measured as product innovation, process and technological innovation. This study provides the necessary theoretical framework for the development of a dynamic simulation method, although the simulation of social events is a quite difficult task, considering that there are so many alternatives (not all well understood).

Kushenol A and 8-prenylkaempferol, tyrosinase inhibitors, derived from Sophora flavescens.

PubMed

Kim, Jang Hoon; Cho, In Sook; So, Yang Kang; Kim, Hyeong-Hwan; Kim, Young Ho

2018-12-01

Tyrosinase is known for an enzyme that plays a key role in producing the initial precursor of melanin biosynthesis. Inhibition of the catalytic reaction of this enzyme led to some advantage such as skin-whitening and anti-insect agents. To find a natural compound with inhibitory activity towards tyrosinase, the five flavonoids of kushenol A (1), 8-prenylkaempferol (2), kushenol C (3), formononetin (4) and 8-prenylnaringenin (5) were isolated by column chromatography from a 95% methanol extract of Sophora flavescens. The ability of these flavonoids to block the conversion of L-tyrosine to L-DOPA by tyrosinase was tested in vitro. Compounds 1 and 2 exhibited potent inhibitory activity, with IC50 values less than 10 µM. Furthermore, enzyme kinetics and molecular docking analysis revealed the formation of a binary encounter complex between compounds 1-4 and the enzyme. Also, all of the isolated compounds (1-5) were confirmed to possess antioxidant activity.

Plasma Spraying of Ceramics with Particular Difficulties in Processing

NASA Astrophysics Data System (ADS)

Mauer, G.; Schlegel, N.; Guignard, A.; Jarligo, M. O.; Rezanka, S.; Hospach, A.; Vaßen, R.

2015-01-01

Emerging new applications and growing demands of plasma-sprayed coatings initiate the development of new materials. Regarding ceramics, often complex compositions are employed to achieve advanced material properties, e.g., high thermal stability, low thermal conductivity, high electronic and ionic conductivity as well as specific thermo-mechanical properties and microstructures. Such materials however, often involve particular difficulties in processing by plasma spraying. The inhomogeneous dissociation and evaporation behavior of individual constituents can lead to changes of the chemical composition and the formation of secondary phases in the deposited coatings. Hence, undesired effects on the coating characteristics are encountered. In this work, examples of such challenging materials are investigated, namely pyrochlores applied for thermal barrier coatings as well as perovskites for gas separation membranes. In particular, new plasma spray processes like suspension plasma spraying and plasma spray-physical vapor deposition are considered. In some cases, plasma diagnostics are applied to analyze the processing conditions.

The Development of Computational Biology in South Africa: Successes Achieved and Lessons Learnt

PubMed Central

Mulder, Nicola J.; Christoffels, Alan; de Oliveira, Tulio; Gamieldien, Junaid; Hazelhurst, Scott; Joubert, Fourie; Kumuthini, Judit; Pillay, Ché S.; Snoep, Jacky L.; Tastan Bishop, Özlem; Tiffin, Nicki

2016-01-01

Bioinformatics is now a critical skill in many research and commercial environments as biological data are increasing in both size and complexity. South African researchers recognized this need in the mid-1990s and responded by working with the government as well as international bodies to develop initiatives to build bioinformatics capacity in the country. Significant injections of support from these bodies provided a springboard for the establishment of computational biology units at multiple universities throughout the country, which took on teaching, basic research and support roles. Several challenges were encountered, for example with unreliability of funding, lack of skills, and lack of infrastructure. However, the bioinformatics community worked together to overcome these, and South Africa is now arguably the leading country in bioinformatics on the African continent. Here we discuss how the discipline developed in the country, highlighting the challenges, successes, and lessons learnt. PMID:26845152

The Development of Computational Biology in South Africa: Successes Achieved and Lessons Learnt.

PubMed

Mulder, Nicola J; Christoffels, Alan; de Oliveira, Tulio; Gamieldien, Junaid; Hazelhurst, Scott; Joubert, Fourie; Kumuthini, Judit; Pillay, Ché S; Snoep, Jacky L; Tastan Bishop, Özlem; Tiffin, Nicki

2016-02-01

Bioinformatics is now a critical skill in many research and commercial environments as biological data are increasing in both size and complexity. South African researchers recognized this need in the mid-1990s and responded by working with the government as well as international bodies to develop initiatives to build bioinformatics capacity in the country. Significant injections of support from these bodies provided a springboard for the establishment of computational biology units at multiple universities throughout the country, which took on teaching, basic research and support roles. Several challenges were encountered, for example with unreliability of funding, lack of skills, and lack of infrastructure. However, the bioinformatics community worked together to overcome these, and South Africa is now arguably the leading country in bioinformatics on the African continent. Here we discuss how the discipline developed in the country, highlighting the challenges, successes, and lessons learnt.

Formation of massive clouds and dwarf galaxies during tidal encounters

NASA Technical Reports Server (NTRS)

Kaufman, Michele; Elmegreen, Bruce G.; Thomasson, Magnus; Elmegreen, Debra M.

1993-01-01

Gerola et al. (1983) propose that isolated dwarf galaxies can form during galaxy interactions. As evidence of this process, Mirabel et al. (1991) find 10(exp 9) solar mass clouds and star formation complexes at the outer ends of the tidal arms in the Antennae and Superantennae galaxies. We describe observations of HI clouds with mass greater than 10(exp 8) solar mass in the interacting galaxy pair IC 2163/NGC 2207. This pair is important because we believe it represents an early stage in the formation of giant clouds during an encounter. We use a gravitational instability model to explain why the observed clouds are so massive and discuss a two-dimensional N-body simulation of an encounter that produces giant clouds.

Do lions Panthera leo actively select prey or do prey preferences simply reflect chance responses via evolutionary adaptations to optimal foraging?

PubMed

Hayward, Matt W; Hayward, Gina J; Tambling, Craig J; Kerley, Graham I H

2011-01-01

Research on coursing predators has revealed that actions throughout the predatory behavioral sequence (using encounter rate, hunting rate, and kill rate as proxy measures of decisions) drive observed prey preferences. We tested whether similar actions drive the observed prey preferences of a stalking predator, the African lion Panthera leo. We conducted two 96 hour, continuous follows of lions in Addo Elephant National Park seasonally from December 2003 until November 2005 (16 follows), and compared prey encounter rate with prey abundance, hunt rate with prey encounter rate, and kill rate with prey hunt rate for the major prey species in Addo using Jacobs' electivity index. We found that lions encountered preferred prey species far more frequently than expected based on their abundance, and they hunted these species more frequently than expected based on this higher encounter rate. Lions responded variably to non-preferred and avoided prey species throughout the predatory sequence, although they hunted avoided prey far less frequently than expected based on the number of encounters of them. We conclude that actions of lions throughout the predatory behavioural sequence, but particularly early on, drive the prey preferences that have been documented for this species. Once a hunt is initiated, evolutionary adaptations to the predator-prey interactions drive hunting success.

Revealing the Naturalization of Language and Literacy: The Common Sense of Text Complexity

ERIC Educational Resources Information Center

Newhouse, Erica H.

2017-01-01

This article illustrates the process and obstacles encountered when applying the Common Core's three-part model of determining text complexity to an urban literature text. This analysis revealed how the model privileges language and literacy practices that limit the range of texts used in classrooms through a process of naturalization and by…

Overcoming Matrix Effects in a Complex Sample: Analysis of Multiple Elements in Multivitamins by Atomic Absorption Spectroscopy

ERIC Educational Resources Information Center

Arnold, Randy J.; Arndt, Brett; Blaser, Emilia; Blosser, Chris; Caulton, Dana; Chung, Won Sog; Fiorenza, Garrett; Heath, Wyatt; Jacobs, Alex; Kahng, Eunice; Koh, Eun; Le, Thao; Mandla, Kyle; McCory, Chelsey; Newman, Laura; Pithadia, Amit; Reckelhoff, Anna; Rheinhardt, Joseph; Skljarevski, Sonja; Stuart, Jordyn; Taylor, Cassie; Thomas, Scott; Tse, Kyle; Wall, Rachel; Warkentien, Chad

2011-01-01

A multivitamin tablet and liquid are analyzed for the elements calcium, magnesium, iron, zinc, copper, and manganese using atomic absorption spectrometry. Linear calibration and standard addition are used for all elements except calcium, allowing for an estimate of the matrix effects encountered for this complex sample. Sample preparation using…

The Complexities of Teaching Historical Conflictual Narratives in Integrated Palestinian-Jewish Schools in Israel

ERIC Educational Resources Information Center

Bekerman, Zvi

2009-01-01

This paper addresses the complexities encountered by teachers and students when dealing with conflictual historical narratives in the context of integrated bilingual schools in Israel. The narratives presented are based on rich ethnographic data gathered from a long-standing research effort in the schools. They offer insights into how those…

Encountering Productive Forms of Complexity in Learning Modern Physics

ERIC Educational Resources Information Center

Levrini, Olivia; Fantini, Paola

2013-01-01

This paper aims at supporting the claim that some forms of hyper-simplification, by making physics seem easy, are at risk of dangerously distorting the content as well as the process of learning physics. The paper presents examples of dangerous simplifications in the teaching of quantum physics. Then, examples of productive forms of complexity are…

Multilevel Modeling for Research in Group Work

ERIC Educational Resources Information Center

Selig, James P.; Trott, Arianna; Lemberger, Matthew E.

2017-01-01

Researchers in group counseling often encounter complex data from individual clients who are members of a group. Clients in the same group may be more similar than clients from different groups and this can lead to violations of statistical assumptions. The complexity of the data also means that predictors and outcomes can be measured at both the…

The Difficult Process of Scientific Modelling: An Analysis Of Novices' Reasoning During Computer-Based Modelling

ERIC Educational Resources Information Center

Sins, Patrick H. M.; Savelsbergh, Elwin R.; van Joolingen, Wouter R.

2005-01-01

Although computer modelling is widely advocated as a way to offer students a deeper understanding of complex phenomena, the process of modelling is rather complex itself and needs scaffolding. In order to offer adequate support, a thorough understanding of the reasoning processes students employ and of difficulties they encounter during a…

An Interview with Crosby Bonsall: A Writer for Beginning Readers.

ERIC Educational Resources Information Center

Cox, Carole

1985-01-01

Crosby Bonsall, a prolific author-illustrator for young readers, comments on many topics related to writing, illustrating, and young children's initial independent encounters with print in books. (HOD)

Identification of Arbitrary Zonation in Groundwater Parameters using the Level Set Method and a Parallel Genetic Algorithm

NASA Astrophysics Data System (ADS)

Lei, H.; Lu, Z.; Vesselinov, V. V.; Ye, M.

2017-12-01

Simultaneous identification of both the zonation structure of aquifer heterogeneity and the hydrogeological parameters associated with these zones is challenging, especially for complex subsurface heterogeneity fields. In this study, a new approach, based on the combination of the level set method and a parallel genetic algorithm is proposed. Starting with an initial guess for the zonation field (including both zonation structure and the hydraulic properties of each zone), the level set method ensures that material interfaces are evolved through the inverse process such that the total residual between the simulated and observed state variables (hydraulic head) always decreases, which means that the inversion result depends on the initial guess field and the minimization process might fail if it encounters a local minimum. To find the global minimum, the genetic algorithm (GA) is utilized to explore the parameters that define initial guess fields, and the minimal total residual corresponding to each initial guess field is considered as the fitness function value in the GA. Due to the expensive evaluation of the fitness function, a parallel GA is adapted in combination with a simulated annealing algorithm. The new approach has been applied to several synthetic cases in both steady-state and transient flow fields, including a case with real flow conditions at the chromium contaminant site at the Los Alamos National Laboratory. The results show that this approach is capable of identifying the arbitrary zonation structures of aquifer heterogeneity and the hydrogeological parameters associated with these zones effectively.

Relative merits of reactive and forward-look detection for wind-shear encounters during landing approach for various microburst escape strategies

NASA Technical Reports Server (NTRS)

Hinton, David A.

1990-01-01

The goal was to quantify the benefits of airborne forward-look windshear detection and to develop and test a candidate set of strategies for recovery from inadvertent microburst encounters during the landing approach, given the utilization of both reactive-only and forward-look windshear detection. Candidate strategies were developed and evaluated using a non-piloted simulation consisting of a simple point-mass performance model of a transport-category airplane flying through an analytical microburst model. The results indicate that the factor which most strongly effects a microburst recovery is the time at which the recovery is initiated. Forward-look alerts given 10 seconds prior to microburst entry permitted recoveries to be made with negligible altitude loss. The results also show that no single microburst scenario can be used to evaluate the relative merits of various recovery strategies. The type of alert used to initiate the recovery (reactive or forward-look) and the altitude of the microburst encounter had an effect on the type of recovery strategy that performed best. These factors may have serious implications for the design and certification of windshear systems.

The first year: Development of a LANDSAT capability at Sam Houston State University

NASA Technical Reports Server (NTRS)

Bounds, J. H.

1981-01-01

Problems encountered in initiating a LANDSAT data processing capability at Sam Houston State University are discussed. Computer requirements, financing, and academic and administrative support are addressed.

14 CFR 91.1065 - Initial and recurrent pilot testing requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... method of determining compliance with weight and balance limitations for takeoff, landing and en route... situations; (ii) Escaping from severe weather situations, in case of inadvertent encounters, including low...

A Gaussian beam method for ultrasonic non-destructive evaluation modeling

NASA Astrophysics Data System (ADS)

Jacquet, O.; Leymarie, N.; Cassereau, D.

2018-05-01

The propagation of high-frequency ultrasonic body waves can be efficiently estimated with a semi-analytic Dynamic Ray Tracing approach using paraxial approximation. Although this asymptotic field estimation avoids the computational cost of numerical methods, it may encounter several limitations in reproducing identified highly interferential features. Nevertheless, some can be managed by allowing paraxial quantities to be complex-valued. This gives rise to localized solutions, known as paraxial Gaussian beams. Whereas their propagation and transmission/reflection laws are well-defined, the fact remains that the adopted complexification introduces additional initial conditions. While their choice is usually performed according to strategies specifically tailored to limited applications, a Gabor frame method has been implemented to indiscriminately initialize a reasonable number of paraxial Gaussian beams. Since this method can be applied for an usefully wide range of ultrasonic transducers, the typical case of the time-harmonic piston radiator is investigated. Compared to the commonly used Multi-Gaussian Beam model [1], a better agreement is obtained throughout the radiated field between the results of numerical integration (or analytical on-axis solution) and the resulting Gaussian beam superposition. Sparsity of the proposed solution is also discussed.

Self-healing bolted joint employing a shape memory actuator

NASA Astrophysics Data System (ADS)

Muntges, Daniel E.; Park, Gyuhae; Inman, Daniel J.

2001-08-01

This paper is a report of an initial investigation into the active control of preload in the joint using a shape memory actuator around the axis of the bolt shaft. Specifically, the actuator is a cylindrical Nitinol washer that expands axially when heated, according to the shape memory effect. The washer is actuated in response to an artificial decrease in torque. Upon actuation, the stress generated by its axial strain compresses the bolted members and creates a frictional force that has the effect of generating a preload and restoring lost torque. In addition to torque wrenches, the system in question was monitored in all stages of testing using piezoelectric impedance analysis. Impedance analysis drew upon research techniques developed at Center for Intelligent Material Systems and Structures, in which phase changes in the impedance of a self-sensing piezoceramic actuator correspond to changes in joint stiffness. Through experimentation, we have documented a successful actuation of the shape memory element. Due to complexity of constitutive modeling, qualitative analysis by the impedance method is used to illustrate the success. Additional considerations encountered in this initial investigation are made to guide further thorough research required for the successful commercial application of this promising technique.

Workarounds and obstacles: unexpected source of innovation.

PubMed

Lalley, Cathy

2014-01-01

Nurse leaders are aware that nurses are finding ways to adapt health information technology to patient care activities. Previous literature has presented nurses' response to technology obstacles as a work-around, characterized as a negative behavior. Using narrative inquiry, this article examines 9 direct care nurses' interactions on a medical/surgical/telemetry unit. Specifically, nurses' encounters with technology obstacles will be addressed from a complexity science perspective. Four support staff including the clinical nurse manager, pharmacist, quality nurse, and project manager who is also a nurse were interviewed as part of data collection. Complexity science provides nurse leaders' insight into nurses' behavior where outcomes emerge from tensions in the environment through multidirectional and self-organizing interactions. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, and multidirectionality. Their actions were also influenced by many sets of rules. Nurses self-organized with coworkers to find better ways to deliver care to patients when using technology. Opportunities exist for nurse leaders to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves the patient experience.

Prescriptive authority for advanced practice nurses: current and future perspectives.

PubMed

McDermott, K C

1995-09-01

To present an overview of the issues related to prescriptive authority and advanced practice nurses (APNs) in oncology. Professional journals and books, print media, and professional and government releases. Discussion of issues related to complex political, educational, economic, and healthcare environmental factors. Strategies to achieve increased recognition for APN prescriptive authority include increasing APNs' knowledge about the effects of the political process on prescriptive authority, educating legislators and consumers, promoting standardization of pharmacology curricula, and encouraging formation of coalitions. Failure to pass a national healthcare plan, escalating managed-care markets, and the reform efforts of individual states to forge their own healthcare initiatives will challenge the APN's ability to practice and prescribe. The subject of prescriptive authority highlights the controversies and debates that APNs encounter in a dynamic healthcare environment. These include the complexity of state-to-state regulations, non-nursing professions making key decisions regarding scope of practice and prescriptive authority, and the challenge for APNs to carve out new roles while overcoming state regulatory inconsistencies and market-reform barriers. If not resolved, these issues will continue to prevent qualified APNs from providing appropriate and comprehensive care to patients with cancer.

Hardware problems encountered in solar heating and cooling systems

NASA Technical Reports Server (NTRS)

Cash, M.

1978-01-01

Numerous problems in the design, production, installation, and operation of solar energy systems are discussed. Described are hardware problems, which range from simple to obscure and complex, and their resolution.

Relativistic tidal interaction of a white dwarf with a massive black hole

NASA Technical Reports Server (NTRS)

Frolov, V. P.; Khokhlov, A. M.; Novikov, I. D.; Pethick, C. J.

1994-01-01

We compute encounters of a realistic white dwarf model with a massive black hole in the regime where relativistic effects are important, using a three-dimensional, finite-difference, Eulerian, piecewise parabolic method (PPM) hydrodynamical code. Both disruptive and nondisruptive encounters are considered. We identify and discuss relativistic effects important for the problem: relativistic shift of the pericenter distance, time delay, relativistic precession, and the tensorial structure of the tidal forces. In the nondisruptive case, stripping of matter takes place. In the surface layers of the surviving core, complicated hydrodynamical phenomena are revealed. In both disruptive and nondispruptive encounters, material flows out in the form of two thin, S-shaped, supersonic jets. Our results provide realistic initial conditions for the subsequent investigation of the dynamics of the debris in the field of the black hole. We evaluate the critical conditions for complete disruption of the white dwarf, and compare our results with the corresponding results for nonrelativistic encounters.

Role of dietary immunomodulatory factors in the development of immune tolerance.

PubMed

Prescott, Susan L

2009-01-01

The development of oral tolerance occurs during critical early stages of immune development. Rising rates of food allergy and other immune-mediated food reactions are an indication that oral tolerance is highly susceptible to environmental change. There is growing evidence that this many not be due food allergens per se, but rather to changing exposure to other key immunomodulatory exposures in this critical period. Successful tolerance appears to depend on many concurrent environmental influences during the period of first allergen encounter, including favorable gut colonization, and the presence of key immunomodulatory factors in breast milk and the infant diet. This review explores the potential effects of early dietary and nutritional factors in tolerogenic immune processes that are normally initiated during initial food allergen encounter. Copyright 2009 Nestec Ltd., Vevey/S. Karger AG, Basel.

Impact trajectories of the asteroid Apophis in the 21st century

NASA Astrophysics Data System (ADS)

Sokolov, L. L.; Bashakov, A. A.; Borisova, T. P.; Petrov, N. A.; Pitjev, N. P.; Shaidulin, V. S.

2012-07-01

The asteroid Apophis is one of the most hazardous near-Earth asteroids. As a result of the scattering of Apophis' potential trajectories after its close approach in 2029, and its possible approach in 2036, there are many dangerous trajectories including impact trajectories after 2036. The purpose of this study is to identify and investigate these trajectories. We use the Everhart integrator; the DE405, DE423, and EPM2008 ephemerides; and two sets of initial data for Apophis (those collected by NASA in 2006 and by the IAA in 2010). More than 50 possible encounters in this century are presented, including 13 encounters between 2036 and 2050. The minimum geocentric distances obtained using a different ephemeris and initial conditions differ little between themselves. Analogous results in (Yeomans et al., 2009) are consistent with our results.

Making a Case for Organizational Change in Patient Safety Initiatives

DTIC Science & Technology

2005-05-01

or medical staff could be required to directly observe patient care processes. Such firsthand encounters with process flaws are particularly...can actually make patient safety worse. Take, for example, the previously described situation where nurses stopped reporting when the medication ...455 Making a Case for Organizational Change in Patient Safety Initiatives Rangaraj Ramanujam, Donna J. Keyser, Carl A. Sirio Abstract

Upper gastrointestinal bleeding.

PubMed

Feinman, Marcie; Haut, Elliott R

2014-02-01

Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

The study of the physics of cometary nuclei

NASA Technical Reports Server (NTRS)

Whipple, F. L.

1984-01-01

The observations of comet P/Holmes 1892III, exhibiting two 8 to 10 magnitude bursts, were carefully analyzed. The phenomena are consistent with the grazing encounter of a small satellite with the nucleus. The grazing encounter produced, besides the first great burst, an active area on the nucleus, which was rotating retrograde with a period of 16.3 hr and inclination nearly 180 deg. After the final encounter, the spin period was essentially unchanged, but two areas became active, separated some 164 deg in longitude on the nucleus. After the first burst the total magnitude fell less than two magnitudes, while the nuclear region remained diffuse or complex, rarely if ever showing a stellar appearance. The fading was much more rapid after the second burst (barely naked eye at maximum) while the nucleus frequently stellar after the first day. It seems reasonable to conclude that the grazing encounter distributed a volume of large chunks in the neighborhood of the nucleus, maintaining activity for weeks.

Heuristic approach to the development of ratings and tactics applicable to the one-on-one aerial combat (dogfight) encounter

NASA Technical Reports Server (NTRS)

Hague, D. S.

1977-01-01

Computer simulations of the one-on-one aerial combat encounter are generated under the control of specified guidance laws. Given an initial state, the vehicle and atmospheric characteristics, and the guidance laws, the aerial combat encounter is simulated by forward integration of the two vehicles' motions. The development of a combat guidance law which converts positional advantage into an improved firing opportunity is reported. A combination of lag, line of sight, and lead pursuit steering paths are followed in the guidance law. The law is based on steering error, target angle-off and the relative velocities. It readily is automated either as an onboard aid to manned aircraft pilots or as a combat guidance law for unmanned vehicles.

The Influence of Neighborhood Characteristics on Police Officers’ Encounters with Persons Suspected to Have a Serious Mental Illness

PubMed Central

Krishan, Shaily; Bakeman, Roger; Broussard, Beth; Cristofaro, Sarah L.; Hankerson-Dyson, Dana; Husbands, Letheshia; Watson, Amy C.; Compton, Michael T.

2014-01-01

Objective Police officers’ decisions and behaviors are impacted by the neighborhood context in which police encounters occur. For example, officers may use greater force and be more likely to make arrests in disadvantaged neighborhoods. We examined whether neighborhood characteristics influence police encounters with individuals suspected to have a serious mental illness, addictive disorder, or developmental disability. Method We obtained data on 916 encounters from 166 officers in six jurisdictions in Georgia, USA and abstracted geographical data pertaining to the location of these encounters from United States Decennial Census data. Encounters were nested within 163 census tracts. Officer-reported data covered general encounter characteristics, the officer’s perception of the subject’s condition, subject demographics, use of force, and disposition of the encounter (e.g., arrest v. referral or transport to treatment services). Geographical data included 17 variables representing population and housing characteristics of the census tracts, from which three indices pertaining to neighborhood income, stability, and immigration status were derived using factor-analytic techniques. We then examined associations of these indices with various encounter-related variables using multi-level analysis. Results Encounters taking place in higher-income and higher-stability census tracts were more likely to be dispatch-initiated and take place in a private home compared to those in lower-income and lower-stability neighborhoods. In higher-income neighborhoods, encounters were more likely to involve a subject suspected to have a mental illness (as opposed to an addictive disorder or developmental disability) and less likely to involve a subject suspected to have alcohol problems. The officer’s level of force used was not associated with neighborhood factors. Regarding disposition, although the likelihood of arrest was unrelated to neighborhood characteristics, encounters taking place in higher-immigrant neighborhoods were more likely to result in referral or transport to services than those in lower-immigrant neighborhoods. Conclusion Neighborhood characteristics are important to consider in research on police interactions with individuals with serious mental illnesses, addictive disorders, or developmental disabilities. Such research could inform departmental training policies and procedures based on the needs of the jurisdictions served. PMID:24636571

The influence of neighborhood characteristics on police officers' encounters with persons suspected to have a serious mental illness.

PubMed

Krishan, Shaily; Bakeman, Roger; Broussard, Beth; Cristofaro, Sarah L; Hankerson-Dyson, Dana; Husbands, Letheshia; Watson, Amy C; Compton, Michael T

2014-01-01

Police officers' decisions and behaviors are impacted by the neighborhood context in which police encounters occur. For example, officers may use greater force and be more likely to make arrests in disadvantaged neighborhoods. We examined whether neighborhood characteristics influence police encounters with individuals suspected to have a serious mental illness, addictive disorder, or developmental disability. We obtained data on 916 encounters from 166 officers in six jurisdictions in Georgia, USA and abstracted geographical data pertaining to the location of these encounters from United States Decennial Census data. Encounters were nested within 163 census tracts. Officer-reported data covered general encounter characteristics, the officer's perception of the subject's condition, subject demographics, use of force, and disposition of the encounter (e.g., arrest v. referral or transport to treatment services). Geographical data included 17 variables representing population and housing characteristics of the census tracts, from which three indices pertaining to neighborhood income, stability, and immigration status were derived using factor-analytic techniques. We then examined associations of these indices with various encounter-related variables using multi-level analysis. Encounters taking place in higher-income and higher-stability census tracts were more likely to be dispatch-initiated and take place in a private home compared to those in lower-income and lower-stability neighborhoods. In higher-income neighborhoods, encounters were more likely to involve a subject suspected to have a mental illness (as opposed to an addictive disorder or developmental disability) and less likely to involve a subject suspected to have alcohol problems. The officer's level of force used was not associated with neighborhood factors. Regarding disposition, although the likelihood of arrest was unrelated to neighborhood characteristics, encounters taking place in higher-immigrant neighborhoods were more likely to result in referral or transport to services than those in lower-immigrant neighborhoods. Neighborhood characteristics are important to consider in research on police interactions with individuals with serious mental illnesses, addictive disorders, or developmental disabilities. Such research could inform departmental training policies and procedures based on the needs of the jurisdictions served. Copyright © 2014 Elsevier Ltd. All rights reserved.

Piloted-simulation evaluation of escape guidance for microburst wind shear encounters. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Hinton, David A.

1989-01-01

Numerous air carrier accidents and incidents result from encounters with the atmospheric wind shear associated with microburst phenomena, in some cases resulting in heavy loss of life. An important issue in current wind shear research is how to best manage aircraft performance during an inadvertent wind shear encounter. The goals of this study were to: (1) develop techniques and guidance for maximizing an aircraft's ability to recover from microburst encounters following takeoff, (2) develop an understanding of how theoretical predictions of wind shear recovery performance might be achieved in actual use, and (3) gain insight into the piloting factors associated with recovery from microburst encounters. Three recovery strategies were implemented and tested in piloted simulation. Results show that a recovery strategy based on flying a flight path angle schedule produces improved performance over constant pitch attitude or acceleration-based recovery techniques. The best recovery technique was initially counterintuitive to the pilots who participated in the study. Evidence was found to indicate that the techniques required for flight through the turbulent vortex of a microburst may differ from the techniques being developed using classical, nonturbulent microburst models.

Integrating Palliative Care in Pediatric Oncology: An Evolving Paradigm for Comprehensive Cancer Care

PubMed Central

Levine, Deena R.; Johnson, Liza-Marie; Snyder, Angela; Wiser, Robert K.; Gibson, Deborah; Kane, Javier R.; Baker, Justin N.

2017-01-01

Background The demonstrated benefit of integrating palliative care (PC) into cancer treatment has triggered an increased need for PC services. The trajectory of integrating PC in comprehensive cancer centers, particularly pediatric centers, is unknown. We describe our eight-year experience of initiating and establishing PC with the Quality of Life Service (QoLS) at St. Jude Children’s Research Hospital. Patients and Methods We retrospectively reviewed records of patients seen by the QoLS (n= 615) from March 2007 to December 2014. Variables analyzed for each year, using descriptive statistics, included diagnostic groups, QoLS encounters, goals of care, duration of survival, and location of death. Results Total QoLS patient encounters increased from 58 (2007) to 1297 (2014), new consults increased from 17 (2007) to 115 (2014), and mean encounters per patient increased from 5.06 (2007) to 16.11 (2014). Goal of care at initial consultation shifted from primarily comfort to an increasing goal of cure. The median number of days from initial consult to death increased from 52 days (2008) to 223 days (2014). A trend toward increased outpatient location of death was noted with 42% outpatient deaths in 2007 increasing to a majority in each subsequent year (range 51–74%). Hospital-wide, patients receiving PC services before death increased from approximately 50% to nearly 100%. Conclusions Since its inception, the QoLS experienced a dramatic rise in referrals and encounters per patient, utilization by all clinical services, a trend toward earlier consultation and longer term follow-up, increasing outpatient location of death, and near-universal PC involvement at the end-of-life. The successful integration of PC in a comprehensive cancer center, and resulting potential for improved care provision over time, can serve as a model for other programs on a broad scale. PMID:27283167

A T-Cell Receptor Breaks the Rules | Center for Cancer Research

Cancer.gov

Most mature T cells function immunologically when a T-cell receptor (TCR) located on the cell surface encounters and engages its ligand, a major histocompatability complex (MHC), which displays a specific part of a target protein called an antigen. This antigen-presenting complex is assembled from one of the dozen or so MHC molecules that every person inherits from their

A general method for computing the total solar radiation force on complex spacecraft structures

NASA Technical Reports Server (NTRS)

Chan, F. K.

1981-01-01

The method circumvents many of the existing difficulties in computational logic presently encountered in the direct analytical or numerical evaluation of the appropriate surface integral. It may be applied to complex spacecraft structures for computing the total force arising from either specular or diffuse reflection or even from non-Lambertian reflection and re-radiation.

Specific and Non-Specific Protein Association in Solution: Computation of Solvent Effects and Prediction of First-Encounter Modes for Efficient Configurational Bias Monte Carlo Simulations

PubMed Central

Cardone, Antonio; Pant, Harish; Hassan, Sergio A.

2013-01-01

Weak and ultra-weak protein-protein association play a role in molecular recognition, and can drive spontaneous self-assembly and aggregation. Such interactions are difficult to detect experimentally, and are a challenge to the force field and sampling technique. A method is proposed to identify low-population protein-protein binding modes in aqueous solution. The method is designed to identify preferential first-encounter complexes from which the final complex(es) at equilibrium evolves. A continuum model is used to represent the effects of the solvent, which accounts for short- and long-range effects of water exclusion and for liquid-structure forces at protein/liquid interfaces. These effects control the behavior of proteins in close proximity and are optimized based on binding enthalpy data and simulations. An algorithm is described to construct a biasing function for self-adaptive configurational-bias Monte Carlo of a set of interacting proteins. The function allows mixing large and local changes in the spatial distribution of proteins, thereby enhancing sampling of relevant microstates. The method is applied to three binary systems. Generalization to multiprotein complexes is discussed. PMID:24044772

The Fate of Exomoons when Planets Scatter

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2018-03-01

Four examples of close-encounter outcomes: a) the moon stays in orbit around its host, b) the moon is captured into orbit around its perturber, c) and d) the moon is ejected from the system from two different starting configurations. [Adapted from Hong et al. 2018]Planet interactions are thought to be common as solar systems are first forming and settling down. A new study suggests that these close encounters could have a significant impact on the moons of giant exoplanets and they may generate a large population of free-floating exomoons.Chaos in the SystemIn the planetplanet scattering model of solar-system formation, planets are thought to initially form in closely packed systems. Over time, planets in a system perturb each other, eventually entering an instability phase during which their orbits cross and the planets experience close encounters.During this scattering process, any exomoons that are orbiting giant planets can be knocked into unstable orbits directly by close encounters with perturbing planets. Exomoons can also be disturbed if their host planets properties or orbits change as a consequence of scattering.Led by Yu-Cian Hong (Cornell University), a team of scientists has now explored the fate of exomoons in planetplanet scattering situations using a suite of N-body numerical simulations.Chances for SurvivalHong and collaborators find that the vast majority roughly 80 to 90% of exomoons around giant planets are destabilized during scattering and dont survive in their original place in the solar system. Fates of these destabilized exomoons include:moon collision with the star or a planet,moon capture by the perturbing planet,moon ejection from the solar system,ejection of the entire planetmoon system from the solar system, andmoon perturbation onto a new heliocentric orbit as a planet.Unsurprisingly, exomoons that have close-in orbits and those that orbit larger planets are the most likely to survive close encounters; as an example, exomoons on orbits similar to Jupiters Galilean satellites (i.e., orbiting at a distance of less than 4% of their host planets Hill radius) have a 2040% chance of survival.Moon initial semimajor axis vs. moon survival rate. Three of Jupiters Galilean moons are shown for reference. [Hong et al. 2018]Free-Floating MoonsAn intriguing consequence of Hong and collaborators results is the prediction of a population of free-floating exomoons that were ejected from solar systems during planetplanet scattering and now wander through the universe alone. According to the authors models, there may be as many of these free-floating exomoons as there are stars in the universe!Future surveys that search for objects using gravitational microlensing like that planned with the Wide-Field Infrared Survey Telescope (WFIRST) may be able to detect such objects down to masses of a tenth of an Earth mass. In the meantime, were a little closer to understanding the complex dynamics of early solar systems.CitationYu-Cian Hong et al 2018 ApJ 852 85. doi:10.3847/1538-4357/aaa0db

Do Lions Panthera leo Actively Select Prey or Do Prey Preferences Simply Reflect Chance Responses via Evolutionary Adaptations to Optimal Foraging?

PubMed Central

Hayward, Matt W.; Hayward, Gina J.; Tambling, Craig J.; Kerley, Graham I. H.

2011-01-01

Research on coursing predators has revealed that actions throughout the predatory behavioral sequence (using encounter rate, hunting rate, and kill rate as proxy measures of decisions) drive observed prey preferences. We tested whether similar actions drive the observed prey preferences of a stalking predator, the African lion Panthera leo. We conducted two 96 hour, continuous follows of lions in Addo Elephant National Park seasonally from December 2003 until November 2005 (16 follows), and compared prey encounter rate with prey abundance, hunt rate with prey encounter rate, and kill rate with prey hunt rate for the major prey species in Addo using Jacobs' electivity index. We found that lions encountered preferred prey species far more frequently than expected based on their abundance, and they hunted these species more frequently than expected based on this higher encounter rate. Lions responded variably to non-preferred and avoided prey species throughout the predatory sequence, although they hunted avoided prey far less frequently than expected based on the number of encounters of them. We conclude that actions of lions throughout the predatory behavioural sequence, but particularly early on, drive the prey preferences that have been documented for this species. Once a hunt is initiated, evolutionary adaptations to the predator-prey interactions drive hunting success. PMID:21915261

Chariklo vs Chiron: the stability of the rings due to planetary close encounters

NASA Astrophysics Data System (ADS)

Sfair, Rafael; Araujo, Rosana; Cabo Winter, Othon

2017-10-01

The surprising discovery of a two well defined rings around the Centaur Chariklo was the first finding of such structures around a small body (Braga Ribas et al., 2014). Since it is known that the centaurs have a short lifetime (up to ten million years) and they experience a large number of encounters with the giant planets, one raises the question whether the rings would survive along the orbital evolution of Chariklo. In a previous work we analyzed through numerical simulations the effects of the close encounters with the giant planets experienced by an ensemble of 729 Chariklo-like objects (Araujo, Sfair & Winter, 2016). Even when considering the most extreme encounters, the most likely result (>90%) is the survival of the ring system without any significant orbital change. Here we intend to broaden our analysis to 2060 Chiron, another Centaur with a presumed ring system (Ortiz et al., 2015). Applying the same method of Araujo, Sfair & Winter (2016), initially we recorded the encounters with the giant planets performed by the clones of Chiron. We first notice Chiron's lifetime is shorter, and the number of encounters it experienced is significantly larger than by Chariklo. As a consequence, the rings of Chiron would be more susceptible to be disrupted by the close approaches with the giant planets. We attribute this dichotomy to the difference of orbital and physical parameters of the two centaurs.

An efficient grid layout algorithm for biological networks utilizing various biological attributes

PubMed Central

Kojima, Kaname; Nagasaki, Masao; Jeong, Euna; Kato, Mitsuru; Miyano, Satoru

2007-01-01

Background Clearly visualized biopathways provide a great help in understanding biological systems. However, manual drawing of large-scale biopathways is time consuming. We proposed a grid layout algorithm that can handle gene-regulatory networks and signal transduction pathways by considering edge-edge crossing, node-edge crossing, distance measure between nodes, and subcellular localization information from Gene Ontology. Consequently, the layout algorithm succeeded in drastically reducing these crossings in the apoptosis model. However, for larger-scale networks, we encountered three problems: (i) the initial layout is often very far from any local optimum because nodes are initially placed at random, (ii) from a biological viewpoint, human layouts still exceed automatic layouts in understanding because except subcellular localization, it does not fully utilize biological information of pathways, and (iii) it employs a local search strategy in which the neighborhood is obtained by moving one node at each step, and automatic layouts suggest that simultaneous movements of multiple nodes are necessary for better layouts, while such extension may face worsening the time complexity. Results We propose a new grid layout algorithm. To address problem (i), we devised a new force-directed algorithm whose output is suitable as the initial layout. For (ii), we considered that an appropriate alignment of nodes having the same biological attribute is one of the most important factors of the comprehension, and we defined a new score function that gives an advantage to such configurations. For solving problem (iii), we developed a search strategy that considers swapping nodes as well as moving a node, while keeping the order of the time complexity. Though a naïve implementation increases by one order, the time complexity, we solved this difficulty by devising a method that caches differences between scores of a layout and its possible updates. Conclusion Layouts of the new grid layout algorithm are compared with that of the previous algorithm and human layout in an endothelial cell model, three times as large as the apoptosis model. The total cost of the result from the new grid layout algorithm is similar to that of the human layout. In addition, its convergence time is drastically reduced (40% reduction). PMID:17338825

Productivity and cost implications of implementing electronic medical records into an ambulatory surgical subspecialty clinic.

PubMed

Patil, Mukul; Puri, Lalit; Gonzalez, Chris M

2008-02-01

Electronic medical records (EMRs) have been proposed as technology through which the quality of healthcare could be improved. We present an analysis of the cost and productivity implications associated with the transition from transcription to an EMR system in an ambulatory setting. Data were collected from eight consecutive fiscal years from 1998 to 2005. Transcription was used in the first 4-year period, and EMR was implemented and used in the later 4-year period. Productivity was defined as ambulatory revenue and the number of patient encounters. All costs related to transcription and EMR implementation were calculated. All data were adjusted for inflation. Within the transcription era, the transcription costs were $395,404, total revenue was $18,137,945, and patient encounters numbered 52,027. The average transcription cost per encounter was $7.60, average revenue per encounter was $348.63, and average revenue per provider was $505,615. Within the EMR era, the EMR-related costs were $293,406, total revenue was $30,370,647 and patient encounters numbered 65,102. The average documentation cost per encounter was $4.51, average revenue per encounter was $466.51, and average revenue per provider was $690,242. The startup costs of initial EMR implementation were $10,329 per physician provider. The results of our study have shown that the implementation of an EMR system when an economy of scale exists coincides with an increase in the revenue per encounter and per provider compared with transcription. The advantage of the fixed costs of an EMR system compared with the variable costs of a transcription-based system is the allowance of cash savings in an ambulatory surgical subspecialty practice.

The most common nonconformities encountered during the assessments of medical laboratories in Hong Kong using ISO 15189 as accreditation criteria

PubMed Central

Ho, Bella; Ho, Eric

2012-01-01

Introduction: ISO 15189 was a new standard published in 2003 for accrediting medical laboratories. We believe that some requirements of the ISO 15189 standard are especially difficult to meet for majority of laboratories. The aim of this article was to present the frequency of nonconformities to requirements of the ISO 15189 accreditation standard, encountered during the assessments of medical laboratories in Hong Kong, during 2004 to 2009. Materials and methods: Nonconformities reported in assessments based on ISO 15189 were analyzed in two periods – from 2004 to 2006 and in 2009. They are categorized according to the ISO 15189 clause numbers. The performance of 27 laboratories initially assessed between 2004 and 2006 was compared to their performance in the second reassessment in 2009. Results: For management requirements, nonconformities were most frequently reported against quality management system, quality and technical records and document control; whereas for technical requirements, they were reported against examination procedures, equipment, and assuring quality of examination procedures. There was no major difference in types of common nonconformities reported in the two study periods. The total number of nonconformities reported in the second reassessment of 27 laboratories in 2009 was almost halved compared to their initial assessments. The number of significant nonconformities per laboratory significantly decreased (P = 0.023). Conclusion: Similar nonconformities were reported in the two study periods though the frequency encountered decreased. The significant decrease in number of significant nonconformities encountered in the same group of laboratories in the two periods substantiated that ISO15189 contributed to quality improvement of accredited laboratories. PMID:22838190

The most common nonconformities encountered during the assessments of medical laboratories in Hong Kong using ISO 15189 as accreditation criteria.

PubMed

Ho, Bella; Ho, Eric

2012-01-01

ISO 15189 was a new standard published in 2003 for accrediting medical laboratories. We believe that some requirements of the ISO 15189 standard are especially difficult to meet for majority of laboratories. The aim of this article was to present the frequency of nonconformities to requirements of the ISO 15189 accreditation standard, encountered during the assessments of medical laboratories in Hong Kong, during 2004 to 2009. Nonconformities reported in assessments based on ISO 15189 were analyzed in two periods - from 2004 to 2006 and in 2009. They are categorized according to the ISO 15189 clause numbers. The performance of 27 laboratories initially assessed between 2004 and 2006 was compared to their performance in the second reassessment in 2009. For management requirements, nonconformities were most frequently reported against quality management system, quality and technical records and document control; whereas for technical requirements, they were reported against examination procedures, equipment, and assuring quality of examination procedures. There was no major difference in types of common nonconformities reported in the two study periods. The total number of nonconformities reported in the second reassessment of 27 laboratories in 2009 was almost halved compared to their initial assessments. The number of significant nonconformities per laboratory significantly decreased (P = 0.023). Similar nonconformities were reported in the two study periods though the frequency encountered decreased. The significant decrease in number of significant nonconformities encountered in the same group of laboratories in the two periods substantiated that 15015189 contributed to quality improvement of accredited laboratories.

Assessment of WMATA's Automatic Fare Collection Equipment Performance

DOT National Transportation Integrated Search

1981-01-01

The Washington Metropolitan Area Transit Authority (WMATA) has had an Automatic Fare Collection (AFC) system in operation since June 1977. The AFC system, comprised of entry/exit gates, farecard vendors, and addfare machines, initially encountered ma...

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.

Clinical assessment and management of general surgery patients via synchronous telehealth.

PubMed

Cain, Steven M; Moore, Robert; Sturm, Lauren; Mason, Travis; Fuhrman, Caitlin; Smith, Robin; Bojicic, Irfan; Carter, Brandon

2017-02-01

Objective This paper describes how a clinical team at Landstuhl Regional Medical Center (LRMC) successfully integrated synchronous telehealth (TH) into their routine clinical practice. Methods and materials Synchronous TH encounters were performed using Polycom® software on surgeons' computers with high-definition (HD) cameras on monitors at distant sites and PolyCom HDX9000® Telehealth Practitioner Carts at originating sites. Patients provided consented and were presented to general surgeons by nurses and medical technicians at Army health clinics throughout the European Theater. Results In calendar year (CY) 2014, five general surgeons and two surgical physician assistants (PAs) at Landstuhl Regional Medical Center along with registered nurses (RNs) at six originating clinic sites throughout Europe completed 130 synchronous TH encounters for 101 general surgery patients resulting in 73 completed and 16 recommended surgeries. Eighty-eight percent of patients had a completed or recommended surgery. No surgeries or procedures planned after initial TH evaluation were cancelled. Originating site clinics ranged in distance from 68 miles to 517 miles. Acceptance by providers, patients and clinic staff was high. Conclusion Synchronous TH was effective and safe in evaluating common general surgical conditions. We excluded sensitive and complex conditions requiring a nuanced physical examination. The TH efforts of the general surgery staff have resulted in high-quality, seamless and predictable TH activities that continue to expand into other surgical and medical specialties beyond general surgery. Seven surgeons and two PAs use synchronous TH regularly serving patients over a broad geographic area.

The relationship of sex-related alcohol expectancies to alcohol consumption and sexual behavior.

PubMed

Leigh, B C

1990-07-01

Recent psychosocial research on alcohol expectancies--beliefs about the effects of alcohol on behavior, moods and emotions--has suggested that these expectancies mediate not only decisions about drinking but the alcohol effects displayed by those who have been drinking. Results of a study of drinking and sexual behavior showed that individuals of different gender and sexual orientation differed in their beliefs about the effects of alcohol on sexual responding. In addition, expectations of sexual enhancement and disinhibition were related to the initiation of sexual activity and to the proportion of sexual encounters that took place while drinking, and interacted with sex guilt to predict the amount drunk in the most recent sexual encounter. These results suggest that beliefs about the effects of alcohol on sex may affect the characteristics of sexual encounters that involve drinking.

Evaluation of geophysical properties of the lunar regolith for the design of precursor scientific missions for the space exploration initiative

NASA Technical Reports Server (NTRS)

Morgan, Paul

1990-01-01

The following topics are addressed: (1) the frequency of encountering boulders that represent hazards to lunar operations; (2) the ease of lunar soil excavation; (3) the use of explosives in excavation operation; (4) the trafficability of the regolith; (5) problems encountered in mining (probably strip mining) of the regolith; (6) the stable angle(s) of repose in excavation of the regolith; (7) the layering to be encountered in the subsurface; (8) knowledge of the regolith site and the possibility of its general application to any site on the lunar surface; (9) the data needed to characterize a site for a lunar base; (10) the influence of regolith properties on the design of geophysical experiments from the lunar base; and (11) terrestrial analogues for the geophysical properties of the lunar regolith.

Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors’ Responses During Oncology Interviews*

PubMed Central

Beach, Wayne A.; Dozier, David M.

2015-01-01

New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A sub-sampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre-post self-report measures about fears, uncertainties, and hopes as well as post-evaluations of interview satisfaction. Conversation Analysis (CA) was employed to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre-post results it was determined that the higher patients’ reported fears, the higher their post-visit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties following encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: Oncology interviews significantly decreased patients’ fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care. PMID:26134261

Monitoring of the Enzymatic Degradation of Protein Corona and Evaluating the Accompanying Cytotoxicity of Nanoparticles.

PubMed

Ma, Zhifang; Bai, Jing; Jiang, Xiue

2015-08-19

Established nanobio interactions face the challenge that the formation of nanoparticle-protein corona complexes shields the inherent properties of the nanoparticles and alters the manner of the interactions between nanoparticles and biological systems. Therefore, many studies have focused on protein corona-mediated nanoparticle binding, internalization, and intracellular transportation. However, there are a few studies to pay attention to if the corona encounters degradation after internalization and how the degradation of the protein corona affects cytotoxicity. To fill this gap, we prepared three types of off/on complexes based on gold nanoparticles (Au NPs) and dye-labeled serum proteins and studied the extracellular and intracellular proteolytic processes of protein coronas as well as their accompanying effects on cytotoxicity through multiple evaluation mechanisms, including cell viability, adenosine triphosphate (ATP) content, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS). The proteolytic process was confirmed by recovery of the fluorescence of the dye-labeled protein molecules that was initially quenched by Au NPs. Our results indicate that the degradation rate of protein corona is dependent on the type of the protein based on systematical evaluation of the extracellular and intracellular degradation processes of the protein coronas formed by human serum albumin (HSA), γ-globulin (HGG), and serum fibrinogen (HSF). Degradation is the fastest for HSA corona and the slowest for HSF corona. Notably, we also find that the Au NP-HSA corona complex induces lower cell viability, slower ATP production, lower MMP, and higher ROS levels. The cytotoxicity of the nanoparticle-protein corona complex may be associated with the protein corona degradation process. All of these results will enrich the database of cytotoxicity induced by nanomaterial-protein corona complexes.

Critical elements of culturally competent communication in the medical encounter: a review and model.

PubMed

Teal, Cayla R; Street, Richard L

2009-02-01

Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence 'in action.' First, we describe four critical elements of culturally competent communication in the medical encounter--communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.

Evolution of Cometary Dust Particles to the Orbit of the Earth: Particle Size, Shape, and Mutual Collisions

NASA Astrophysics Data System (ADS)

Yang, Hongu; Ishiguro, Masateru

2018-02-01

In this study, we numerically investigated the orbital evolution of cometary dust particles, with special consideration of the initial size–frequency distribution (SFD) and different evolutionary tracks according to the initial orbit and particle shape. We found that close encounters with planets (mostly Jupiter) are the dominating factor determining the orbital evolution of dust particles. Therefore, the lifetimes of cometary dust particles (∼250,000 yr) are shorter than the Poynting–Robertson lifetime, and only a small fraction of large cometary dust particles can be transferred into orbits with small semimajor axes. The exceptions are dust particles from 2P/Encke and, potentially, active asteroids that have little interaction with Jupiter. We also found that the effects of dust shape, mass density, and SFD were not critical in the total mass supply rate to the interplanetary dust particle (IDP) cloud complex when these quantities are confined by observations of zodiacal light brightness and SFD around the Earth’s orbit. When we incorporate a population of fluffy aggregates discovered in the Earth’s stratosphere and the coma of 67P/Churyumov–Gerasimenko within the initial ejection, the initial SFD measured at the comae of comets (67P and 81P/Wild 2) can produce the observed SFD around the Earth’s orbit. Considering the above effects, we derived the probability of mutual collisions among dust particles within the IDP cloud for the first time in a direct manner via numerical simulation and concluded that mutual collisions can mostly be ignored.

Functional Characterization of the Role of the N-terminal Domain of the c/Nip1 Subunit of Eukaryotic Initiation Factor 3 (eIF3) in AUG Recognition*

PubMed Central

Karásková, Martina; Gunišová, Stanislava; Herrmannová, Anna; Wagner, Susan; Munzarová, Vanda; Valášek, Leoš Shivaya

2012-01-01

In eukaryotes, for a protein to be synthesized, the 40 S subunit has to first scan the 5′-UTR of the mRNA until it has encountered the AUG start codon. Several initiation factors that ensure high fidelity of AUG recognition were identified previously, including eIF1A, eIF1, eIF2, and eIF5. In addition, eIF3 was proposed to coordinate their functions in this process as well as to promote their initial binding to 40 S subunits. Here we subjected several previously identified segments of the N-terminal domain (NTD) of the eIF3c/Nip1 subunit, which mediates eIF3 binding to eIF1 and eIF5, to semirandom mutagenesis to investigate the molecular mechanism of eIF3 involvement in these reactions. Three major classes of mutant substitutions or internal deletions were isolated that affect either the assembly of preinitiation complexes (PICs), scanning for AUG, or both. We show that eIF5 binds to the extreme c/Nip1-NTD (residues 1–45) and that impairing this interaction predominantly affects the PIC formation. eIF1 interacts with the region (60–137) that immediately follows, and altering this contact deregulates AUG recognition. Together, our data indicate that binding of eIF1 to the c/Nip1-NTD is equally important for its initial recruitment to PICs and for its proper functioning in selecting the translational start site. PMID:22718758

Future management strategies for state maintained wetlands and stream mitigation sites.

DOT National Transportation Integrated Search

2008-06-01

This study was to identify existing wetland/stream mitigation sites owned by the Kentucky Transportation Cabinet (KYTC) and assess performance of those sites including problems encountered and maintenance costs. Initial work determined that KYTC Dist...

Self-reduction of a copper complex MOD ink for inkjet printing conductive patterns on plastics.

PubMed

Farraj, Yousef; Grouchko, Michael; Magdassi, Shlomo

2015-01-31

Highly conductive copper patterns on low-cost flexible substrates are obtained by inkjet printing a metal complex based ink. Upon heating the ink, the soluble complex, which is composed of copper formate and 2-amino-2-methyl-1-propanol, decomposes under nitrogen at 140 °C and is converted to pure metallic copper. The decomposition process of the complex is investigated and a suggested mechanism is presented. The ink is stable in air for prolonged periods, with no sedimentation or oxidation problems, which are usually encountered in copper nanoparticle based inks.

Predator encounters have spatially extensive impacts on parental behaviour in a breeding bird community

PubMed Central

Moks, Kadri; Thomson, Robert L.; Calhim, Sara; Järvistö, Pauliina E.; Schuett, Wiebke; Velmala, William; Laaksonen, Toni

2016-01-01

Predation risk has negative indirect effects on prey fitness, partly mediated through changes in behaviour. Evidence that individuals gather social information from other members of the population suggests that events in a community may impact the behaviour of distant individuals. However, spatially wide-ranging impacts on individual behaviour caused by a predator encounter elsewhere in a community have not been documented before. We investigated the effect of a predator encounter (hawk model presented at a focal nest) on the parental behaviour of pied flycatchers (Ficedula hypoleuca), both at the focal nest and at nearby nests different distances from the predator encounter. We show that nest visitation of both focal pairs and nearby pairs were affected, up to 3 h and 1 h, respectively. Parents also appeared to compensate initial disrupted feeding by later increasing nest visitation rates. This is the first evidence showing that the behaviour of nearby pairs was affected away from an immediate source of risk. Our results indicate that the impacts of short-term predator encounters may immediately extend spatially to the broader community, affecting the behaviour of distant individuals. Information about predators is probably quickly spread by cues such as intra- and heterospecific alarm calls, in communities of different taxa. PMID:27030411

Survival of extrasolar giant planet moons in planet-planet scattering

NASA Astrophysics Data System (ADS)

CIAN HONG, YU; Lunine, Jonathan; Nicholson, Phillip; Raymond, Sean

2015-12-01

Planet-planet scattering is the best candidate mechanism for explaining the eccentricity distribution of exoplanets. Here we study the survival and dynamics of exomoons under strong perturbations during giant planet scattering. During close encounters, planets and moons exchange orbital angular momentum and energy. The most common outcomes are the destruction of moons by ejection from the system, collision with the planets and the star, and scattering of moons onto perturbed but still planet-bound orbits. A small percentage of interesting moons can remain bound to ejected (free-floating) planets or be captured by a different planet. Moons' survival rate is correlated with planet observables such as mass, semi-major axis, eccentricity and inclination, as well as the close encounter distance and the number of close encounters. In addition, moons' survival rate and dynamical outcomes are predetermined by the moons' initial semi-major axes. The survival rate drops quickly as moons' distances increase, but simulations predict a good chance of survival for the Galilean moons. Moons with different dynamical outcomes occupy different regions of orbital parameter space, which may enable the study of moons' past evolution. Potential effects of planet obliquity evolution caused by close encounters on the satellites’ stability and dynamics will be reported, as well as detailed and systematic studies of individual close encounter events.

Species abundance, sexual encounter and bioluminescent signalling in the deep sea.

PubMed Central

Herring, P J

2000-01-01

The problems faced by deep-sea animals in achieving sexual and other encounters require sensory and effector systems the synergy of which can span the often very substantial distances that separate individuals. Bioluminescent systems provide one of the links between individuals, and the sexual dimorphism of some photophores suggests that they are employed to attract a mate. However, nearest-neighbour values for many deep-sea animals put them beyond the effective range of bioluminescent signals and it is therefore likely that these signals are employed at intermediate ranges, once an initial contact (perhaps olfactory) has been made. PMID:11079413

Fixing Two BSD TCP Bugs

NASA Technical Reports Server (NTRS)

Allman, Mark

1997-01-01

This note outlines two bugs found in the BSD 4.4 Lite TCP implementation, as well as the implications of these bugs and possible ways to correct them. The first problem encountered in this particular TCP implementation is the use of a 2 segment initial congestion window, rather than the standard 1 segment initial window. The second problem is that the receiver delays ACKs in violation of the delayed ACK rules,

Nonlinear Systems.

ERIC Educational Resources Information Center

Seider, Warren D.; Ungar, Lyle H.

1987-01-01

Describes a course in nonlinear mathematics courses offered at the University of Pennsylvania which provides an opportunity for students to examine the complex solution spaces that chemical engineers encounter. Topics include modeling many chemical processes, especially those involving reaction and diffusion, auto catalytic reactions, phase…

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification.

PubMed

Hurst, Dominic; Mickan, Sharon

2017-03-14

Implementation science seeks to promote the uptake of research and other evidence-based findings into practice, but for healthcare professionals, this is complex as practice draws on, in addition to scientific principles, rules of thumb and a store of practical wisdom acquired from a range of informational and experiential sources. The aims of this review were to identify sources of information and professional experiences encountered by healthcare workers and from this to build a classification system, for use in future observational studies, that describes influences on how healthcare professionals acquire and use information in their clinical practice. This was a mixed studies systematic review of observational studies. OVID MEDLINE and Embase and Google Scholar were searched using terms around information, knowledge or evidence and sharing, searching and utilisation combined with terms relating to healthcare groups. Studies were eligible if one of the intentions was to identify information or experiential encounters by healthcare workers. Data was extracted by one author after piloting with another. Studies were assessed using the Mixed Methods Appraisal Tool (MMAT). The primary outcome extracted was the information source or professional experience encounter. Similar encounters were grouped together as single constructs. Our synthesis involved a mixed approach using the top-down logic of the Bliss Bibliographic Classification System (BC2) to generate classification categories and a bottom-up approach to develop descriptive codes (or "facets") for each category, from the data. The generic terms of BC2 were customised by an iterative process of thematic content analysis. Facets were developed by using available theory and keeping in mind the pragmatic end use of the classification. Eighty studies were included from which 178 discreet knowledge encounters were extracted. Six classification categories were developed: what information or experience was encountered; how was the information or experience encountered; what was the mode of encounter; from whom did the information originate or with whom was the experience; how many participants were there; and where did the encounter take place. For each of these categories, relevant descriptive facets were identified. We have sought to identify and classify all knowledge encounters, and we have developed a faceted description of key categories which will support richer descriptions and interrogations of knowledge encounters in healthcare research.

A selective decoy-doxorubicin complex for targeted co-delivery, STAT3 probing and synergistic anti-cancer effect.

PubMed

Wang, Shao-Jen; Hou, Yung-Te; Chen, Lin-Chi

2015-09-04

A novel selective decoy oligodeoxynucleotide (dODN)-doxorubicin (DOX) complex is reported for cancer theranostics. It eliminates the use of a ligand or carrier for targeted delivery and disassembles into therapeutic dODN and DOX upon encountering over-activated STAT3 in cancer cells. Hence, in situ STAT3 probing and synergistic anti-cancer effect are attained at the same time.

An intelligent listening framework for capturing encounter notes from a doctor-patient dialog

PubMed Central

Klann, Jeffrey G; Szolovits, Peter

2009-01-01

Background Capturing accurate and machine-interpretable primary data from clinical encounters is a challenging task, yet critical to the integrity of the practice of medicine. We explore the intriguing possibility that technology can help accurately capture structured data from the clinical encounter using a combination of automated speech recognition (ASR) systems and tools for extraction of clinical meaning from narrative medical text. Our goal is to produce a displayed evolving encounter note, visible and editable (using speech) during the encounter. Results This is very ambitious, and so far we have taken only the most preliminary steps. We report a simple proof-of-concept system and the design of the more comprehensive one we are building, discussing both the engineering design and challenges encountered. Without a formal evaluation, we were encouraged by our initial results. The proof-of-concept, despite a few false positives, correctly recognized the proper category of single-and multi-word phrases in uncorrected ASR output. The more comprehensive system captures and transcribes speech and stores alternative phrase interpretations in an XML-based format used by a text-engineering framework. It does not yet use the framework to perform the language processing present in the proof-of-concept. Conclusion The work here encouraged us that the goal is reachable, so we conclude with proposed next steps. Some challenging steps include acquiring a corpus of doctor-patient conversations, exploring a workable microphone setup, performing user interface research, and developing a multi-speaker version of our tools. PMID:19891797

Do complexity-informed health interventions work? A scoping review.

PubMed

Brainard, Julii; Hunter, Paul R

2016-09-20

The lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks. Systematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting. From 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation. It is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.

The Sun in a Drawer

ERIC Educational Resources Information Center

Anderson, Bruce

1975-01-01

Widespread use of solar energy is unsuccessful with large scale integration required and conservatism of responsible institutions. Rising fuel costs and government promotion may initiate expansion in commercial, environmental, and government establishments, homes, and schools. Difficulties encountered include financing, tax incentives, design,…

"Hi Mommy": Parental Preferences of Greetings by Medical Staff.

PubMed

Wilks-Gallo, Lisa; Aron, Chaim Zev; Messina, Catherine R

2018-04-01

The therapeutic alliance between pediatricians and parents begins at the initial encounter. The manner in which pediatricians greet family members influences this relationship. This study evaluated whether parents are addressed using generic titles and investigated perceptions of parents regarding how they are addressed by medical staff. Written surveys of 137 parents of pediatric inpatients collected opinions about greetings during medical encounters. Parents were asked if they have been addressed as Mom/Dad/Mommy/Daddy during past medical encounters and which generic titles they would prefer. Using a Likert-type scale, the parents' perceptions of various salutations were assessed and compared. In this sample, 86% of parents were previously called Mom/Dad/Mommy/Daddy. Parents preferred to be addressed as Mom or Dad over other generic titles. Many disliked being addressed as Mommy/Daddy, Ma'am/Sir, or without a name, suggesting that providers should avoid the use of these salutations.

Capture and quality control mechanisms for ATP binding

PubMed Central

Li, Li; Martinis, Susan A.

2013-01-01

The catalytic events in members of the nucleotidylyl transferase superfamily are initiated by a millisecond binding of ATP in the active site. Through metadynamics simulations on a class I aminoacyl-tRNA synthetase (aaRSs), the largest group in the superfamily, we calculate the free energy landscape of ATP selection and binding. Mutagenesis studies and fluorescence spectroscopy validated the identification of the most populated intermediate states. The rapid first binding step involves formation of encounter complexes captured through a fly-casting mechanism that acts up on the triphosphate moiety of ATP. In the slower nucleoside binding step, a conserved histidine in the HxxH motif orients the incoming ATP through base-stacking interactions resulting in a deep minimum in the free energy surface. Mutation of this histidine significantly decreases the binding affinity measured experimentally and computationally. The metadynamics simulations further reveal an intermediate quality control state that the synthetases and most likely other members of the superfamily use to select ATP over other nucleoside triphosphates. PMID:23276298

Application of powder densification models to the consolidation processing of composites

NASA Technical Reports Server (NTRS)

Wadley, H. N. G.; Elzey, D. M.

1991-01-01

Unidirectional fiber reinforced metal matrix composite tapes (containing a single layer of parallel fibers) can now be produced by plasma deposition. These tapes can be stacked and subjected to a thermomechanical treatment that results in a fully dense near net shape component. The mechanisms by which this consolidation step occurs are explored, and models to predict the effect of different thermomechanical conditions (during consolidation) upon the kinetics of densification are developed. The approach is based upon a methodology developed by Ashby and others for the simpler problem of HIP of spherical powders. The complex problem is devided into six, much simpler, subproblems, and then their predicted contributions are added to densification. The initial problem decomposition is to treat the two extreme geometries encountered (contact deformation occurring between foils and shrinkage of isolated, internal pores). Deformation of these two geometries is modelled for plastic, power law creep and diffusional flow. The results are reported in the form of a densification map.

Continued investigation of LDEF's structural frame and thermal blankets by the Meteoroid and Debris Special Investigation Group

NASA Technical Reports Server (NTRS)

See, Thomas H.; Mack, Kimberly S.; Warren, Jack L.; Zolensky, Michael E.; Zook, Herbert A.

1993-01-01

This report focuses on the data acquired by detailed examination of LDEF intercostals, 68 of which are now in possession of the Meteoroid and Debris Special Investigation Group (M&D SIG) at JSC. In addition, limited data will be presented for several small sections from the A0178 thermal control blankets that were examined/counted prior to being shipped to Principal Investigators (PI's) for scientific study. The data presented here are limited to measurements of crater and penetration-hole diameters and their frequency of occurrence which permits, yet also constrains, more model-dependent, interpretative efforts. Such efforts will focus on the conversion of crater and penetration-hole sizes to projectile diameters (and masses), on absolute particle fluxes, and on the distribution of particle-encounter velocities. These are all complex issues that presently cannot be pursued without making various assumptions which relate, in part, to crater-scaling relationships, and to assumed trajectories of natural and man-made particle populations in LEO that control the initial impact conditions.

A Review of Chronic Musculoskeletal Pain: Central and Peripheral Effects of Diclofenac.

PubMed

Atzeni, Fabiola; Masala, Ignazio Francesco; Sarzi-Puttini, Piercarlo

2018-06-05

Diclofenac is widely used to manage chronic inflammatory and degenerative joint diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, and extra-articular rheumatism. Its various mechanisms of action make it particularly effective in treating nociceptive pain, but it is also an alternative for treating spinal and chronic central pain. Osteoarthritis and rheumatoid arthritis are the most frequently encountered arthritic conditions in adults. The management of nociceptive pain requires a sequential hierarchical approach, with the initial NSAID treatment being characterized by the replacement of one drug with another, or complete discontinuation usually because of insufficient pain control. OA- and RA-related pain is complex and multifactorial, and due to physiological interactions between the signaling of the central and peripheral nervous systems. The mechanisms of action of diclofenac make it particularly effective in treating both nociceptive pain and chronic central pain. This review underlines the mechanisms of diclofenac involved in chronic and acute joint pain, the most relevant adverse events.

Specialty Task Force: A Strategic Component to Electronic Health Record (EHR) Optimization.

PubMed

Romero, Mary Rachel; Staub, Allison

2016-01-01

Post-implementation stage comes after an electronic health record (EHR) deployment. Analyst and end users deal with the reality that some of the concepts and designs initially planned and created may not be complementary to the workflow; creating anxiety, dissatisfaction, and failure with early adoption of system. Problems encountered during deployment are numerous and can vary from simple to complex. Redundant ticket submission creates backlog for Information Technology personnel resulting in delays in resolving concerns with EHR system. The process of optimization allows for evaluation of system and reassessment of users' needs. A solid and well executed optimization infrastructure can help minimize unexpected end-user disruptions and help tailor the system to meet regulatory agency goals and practice standards. A well device plan to resolve problems during post implementation is necessary for cost containment and to streamline communication efforts. Creating a specialty specific collaborative task force is efficacious and expedites resolution of users' concerns through a more structured process.

Capture and quality control mechanisms for adenosine-5'-triphosphate binding.

PubMed

Li, Li; Martinis, Susan A; Luthey-Schulten, Zaida

2013-04-24

The catalytic events in members of the nucleotidylyl transferase superfamily are initiated by a millisecond binding of ATP in the active site. Through metadynamics simulations on a class I aminoacyl-tRNA synthetase (aaRSs), the largest group in the superfamily, we calculate the free energy landscape of ATP selection and binding. Mutagenesis studies and fluorescence spectroscopy validated the identification of the most populated intermediate states. The rapid first binding step involves formation of encounter complexes captured through a fly casting mechanism that acts upon the triphosphate moiety of ATP. In the slower nucleoside binding step, a conserved histidine in the HxxH motif orients the incoming ATP through base-stacking interactions resulting in a deep minimum in the free energy surface. Mutation of this histidine significantly decreases the binding affinity measured experimentally and computationally. The metadynamics simulations further reveal an intermediate quality control state that the synthetases and most likely other members of the superfamily use to select ATP over other nucleoside triphosphates.

A School for Complex Needs.

ERIC Educational Resources Information Center

Leisner, Hava

2001-01-01

Presents a case study showing the role specialty materials and finishes play in the design of a school for autistic students. Use of incandescent lighting, muted colors and contrast, and padded flooring are examined as are classroom features and construction challenges encountered. (GR)

Recognizing dying in terminal illness.

PubMed

Taylor, Paul M; Johnson, Miriam

2011-08-01

Recognizing dying in terminally ill patients is a complex clinical skill. This article outlines the approach to the decision, common difficulties encountered in patients with both malignant and non-malignant disease, and a simple approach to considering the question 'Is this patient dying?'

Protein Structure Initiative Material Repository: an open shared public resource of structural genomics plasmids for the biological community

PubMed Central

Cormier, Catherine Y.; Mohr, Stephanie E.; Zuo, Dongmei; Hu, Yanhui; Rolfs, Andreas; Kramer, Jason; Taycher, Elena; Kelley, Fontina; Fiacco, Michael; Turnbull, Greggory; LaBaer, Joshua

2010-01-01

The Protein Structure Initiative Material Repository (PSI-MR; http://psimr.asu.edu) provides centralized storage and distribution for the protein expression plasmids created by PSI researchers. These plasmids are a resource that allows the research community to dissect the biological function of proteins whose structures have been identified by the PSI. The plasmid annotation, which includes the full length sequence, vector information and associated publications, is stored in a freely available, searchable database called DNASU (http://dnasu.asu.edu). Each PSI plasmid is also linked to a variety of additional resources, which facilitates cross-referencing of a particular plasmid to protein annotations and experimental data. Plasmid samples can be requested directly through the website. We have also developed a novel strategy to avoid the most common concern encountered when distributing plasmids namely, the complexity of material transfer agreement (MTA) processing and the resulting delays this causes. The Expedited Process MTA, in which we created a network of institutions that agree to the terms of transfer in advance of a material request, eliminates these delays. Our hope is that by creating a repository of expression-ready plasmids and expediting the process for receiving these plasmids, we will help accelerate the accessibility and pace of scientific discovery. PMID:19906724

Agents for Change: Nonphysician Medical Providers and Health Care Quality

PubMed Central

Boucher, Nathan A; McMillen, Marvin A; Gould, James S

2015-01-01

Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213

Reaction Mechanisms of Metals with Hydrogen Sulfide and Thiols in Model Wine. Part 1: Copper-Catalyzed Oxidation.

PubMed

Kreitman, Gal Y; Danilewicz, John C; Jeffery, David W; Elias, Ryan J

2016-05-25

Sulfidic off-odors as a result of hydrogen sulfide (H2S) and low-molecular-weight thiols are commonly encountered in wine production. These odors are usually removed by the process of Cu(II) fining, a process that remains poorly understood. The present study aims to elucidate the underlying mechanisms by which Cu(II) interacts with H2S and thiol compounds (RSH) under wine-like conditions. Copper complex formation was monitored along with H2S, thiol, oxygen, and acetaldehyde concentrations after the addition of Cu(II) (50 or 100 μM) to air-saturated model wine solutions containing H2S, cysteine, 6-sulfanylhexan-1-ol, or 3-sulfanylhexan-1-ol (300 μM each). The presence of H2S and thiols in excess to Cu(II) led to the rapid formation of ∼1.4:1 H2S/Cu and ∼2:1 thiol/Cu complexes, resulting in the oxidation of H2S and thiols and reduction of Cu(II) to Cu(I), which reacted with oxygen. H2S was observed to initially oxidize rather than form insoluble copper sulfide. The proposed reaction mechanisms provide insight into the extent to which H2S can be selectively removed in the presence of thiols in wine.

Marshall Space Flight Center Technology Capabilities for Use in Space Situational Awareness Activities

NASA Technical Reports Server (NTRS)

Gagliano, Larry; McLeod, Todd; Hovater, Mary A.

2017-01-01

Marshall performs research, integrates information, matures technologies, and enhances science to bring together a diverse portfolio of products and services of interest for Space Situational Awareness (SSA) and Space Asset Management (SAM), all of which can be accessed through partnerships with Marshall. Integrated Space Situational Awareness and Asset Management (ISSAAM) is an initiative of NASA's Marshall Space Flight Center to improve space situational awareness and space asset management through technical innovation, collaboration, and cooperation with U.S. Government agencies and the global space community. Marshall Space Flight Center provides solutions for complex issues with in-depth capabilities, a broad range of experience, and expertise unique in the world, and all available in one convenient location. NASA has longstanding guidelines that are used to assess space objects. Specifically, Marshall Space Flight Center has the capabilities, facilities and expertise to address the challenges that space objects, such as near-Earth objects (NEO) or Orbital Debris pose. ISSAAM's three pronged approach brings together vital information and in-depth tools working simultaneously toward examining the complex problems encountered in space situational awareness. Marshall's role in managing, understanding and planning includes many projects grouped under each prong area: Database/Analyses/Visualization; Detection/Tracking/ Mitigation/Removal. These are not limited to those listed below.

Estimating the costs of VA ambulatory care.

PubMed

Phibbs, Ciaran S; Bhandari, Aman; Yu, Wei; Barnett, Paul G

2003-09-01

This article reports how we matched Common Procedure Terminology (CPT) codes with Medicare payment rates and aggregate Veterans Affairs (VA) budget data to estimate the costs of every VA ambulatory encounter. Converting CPT codes to encounter-level costs was more complex than a simple match of Medicare reimbursements to CPT codes. About 40 percent of the CPT codes used in VA, representing about 20 percent of procedures, did not have a Medicare payment rate and required other cost estimates. Reconciling aggregated estimated costs to the VA budget allocations for outpatient care produced final VA cost estimates that were lower than projected Medicare reimbursements. The methods used to estimate costs for encounters could be replicated for other settings. They are potentially useful for any system that does not generate billing data, when CPT codes are simpler to collect than billing data, or when there is a need to standardize cost estimates across data sources.

Voyager Saturn encounter attitude and articulation control experience

NASA Technical Reports Server (NTRS)

Carlisle, G.; Hill, M.

1981-01-01

The Voyager attitude and articulation control system is designed for a three-axis stabilized spacecraft; it uses a biasable sun sensor and a Canopus Star Tracker (CST) for celestial control, as well as a dry inertial reference unit, comprised of three dual-axis dry gryos, for inertial control. A series of complex maneuvers was required during the first of two Voyager spacecraft encounters with Saturn (November 13, 1980); these maneuvers involved rotating the spacecraft simultaneously about two or three axes while maintaining accurate pointing of the scan platform. Titan and Saturn earth occulation experiments and a ring scattering experiment are described. Target motion compensation and the effects of celestial sensor interference are also considered. Failure of the CST, which required an extensive reevaluation of the star reference and attitude control mode strategy, is discussed. Results analyzed thus far show that the system performed with high accuracy, gathering data deeper into Saturn's atmosphere than on any previous planetary encounter.

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

Spurzem, R.; Giersz, M.; Heggie, D. C.

At least 10%-15% of nearby Sunlike stars have known Jupiter-mass planets. In contrast, very few planets are found in mature open and globular clusters such as the Hyades and 47 Tuc. We explore here the possibility that this dichotomy is due to the postformation disruption of planetary systems associated with the stellar encounters in long-lived clusters. One supporting piece of evidence for this scenario is the discovery of freely floating low-mass objects in star forming regions. We use two independent numerical approaches, a hybrid Monte Carlo and a direct N-body method, to simulate the impact of the encounters. We showmore » that the results of numerical simulations are in reasonable agreement with analytical determinations in the adiabatic and impulsive limits. They indicate that distant stellar encounters generally do not significantly modify the compact and nearly circular orbits. However, moderately close stellar encounters, which are likely to occur in dense clusters, can excite planets' orbital eccentricity and induce dynamical instability in systems that are closely packed with multiple planets. The disruption of planetary systems occurs primarily through occasional nearly parabolic, nonadiabatic encounters, though eccentricity of the planets evolves through repeated hyperbolic adiabatic encounters that accumulate small-amplitude changes. The detached planets are generally retained by the potential of their host clusters as free floaters in young stellar clusters such as {sigma} Orionis. We compute effective cross sections for the dissolution of planetary systems and show that, for all initial eccentricities, dissolution occurs on timescales that are longer than the dispersion of small stellar associations, but shorter than the age of typical open and globular clusters. Although it is much more difficult to disrupt short-period planets, close encounters can excite modest eccentricity among them, such that subsequent tidal dissipation leads to orbital decay, tidal inflation, and even disruption of the close-in planets.« less

Young people with depression and their experience accessing an enhanced primary care service for youth with emerging mental health problems: a qualitative study.

PubMed

McCann, Terence V; Lubman, Dan I

2012-08-01

Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace) that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process. Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data. Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service's funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic. Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people's consciousness, while the appointment system would benefit from providing more timely appointments with therapists. The service's funding model is important in enabling access initially to young people from low socioeconomic backgrounds, but the government needs to reassess the model for those who require additional support.

Space Exploration Initiative set as a national priority - Responding to national policies and needs

NASA Technical Reports Server (NTRS)

Henn, Jay M.; Reeves, Richard A.

1992-01-01

NASA's Space Exploration Initiative (SEI), through its complementary robotic and human exploration activities, offers a unique opportunity for the establishment of American preeminence in scientific research and technology development, as well as in their educational and economic spinoffs. Attention is given to the preclusion of the problem encountered in space exploration activities in the past by leaving the discovery and development of their various 'spinoffs' to chance.

[Body, autonomy and responsibility of the individual].

PubMed

Bastiani, Flora

The question 'Who does my body belong to?' may at first seem strange. However, it highlights the complexity concealed by the very fact of corporeity, the place of existence and encounter between others and oneself. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain.

PubMed

Patel, Pina M; Goodman, Lauren F; Knepel, Sheri A; Miller, Charles C; Azimi, Asma; Phillips, Gary; Gustin, Jillian L; Hartman, Amber

2017-10-01

There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use. We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated. Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001). Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Role of Electrostatic Interactions in Binding of Peptides and Intrinsically Disordered Proteins to Their Folded Targets: 2. The Model of Encounter Complex Involving the Double Mutant of the c-Crk N-SH3 Domain and Peptide Sos.

PubMed

Yuwen, Tairan; Xue, Yi; Skrynnikov, Nikolai R

2016-03-29

In the first part of this work (paper 1, Xue, Y. et al. Biochemistry 2014 , 53 , 6473 ), we have studied the complex between the 10-residue peptide Sos and N-terminal SH3 domain from adaptor protein c-Crk. In the second part (this paper), we designed the double mutant of the c-Crk N-SH3 domain, W169F/Y186L, with the intention to eliminate the interactions responsible for tight peptide-protein binding, while retaining the interactions that create the initial electrostatic encounter complex. The resulting system was characterized experimentally by measuring the backbone and side-chain (15)N relaxation rates, as well as binding shifts and (1)H(N) temperature coefficients. In addition, it was also modeled via a series of ∼5 μs molecular dynamics (MD) simulations recorded in a large water box under an Amber ff99SB*-ILDN force field. Similar to paper 1, we have found that the strength of arginine-aspartate and arginine-glutamate salt bridges is overestimated in the original force field. To address this problem we have applied the empirical force-field correction described in paper 1. Specifically, the Lennard-Jones equilibrium distance for the nitrogen-oxygen pair across Arg-to-Asp/Glu salt bridges has been increased by 3%. This modification led to MD models in good agreement with the experimental data. The emerging picture is that of a fuzzy complex, where the peptide "dances" over the surface of the protein, making transient contacts via salt-bridge interactions. Every once in a while the peptide assumes a certain more stable binding pose, assisted by a number of adventitious polar and nonpolar contacts. On the other hand, occasionally Sos flies off the protein surface; it is then guided by electrostatic steering to quickly reconnect with the protein. The dynamic interaction between Sos and the double mutant of c-Crk N-SH3 gives rise to only small binding shifts. The peptide retains a high degree of conformational mobility, although it is appreciably slowed down due to its (loose) association with the protein. Note that spin relaxation data are indispensable in determining the dynamic status of the peptide. Such data can be properly modeled only on a basis of bona fide MD simulations, as shown in our study. We anticipate that in future the field will move away from the ensemble view of protein disorder and toward more sophisticated MD models. This will require further optimization of force fields, aimed specifically at disordered systems. Efforts in this direction have been recently initiated by several research groups; the empirical salt-bridge correction proposed in our work falls in the same category. MD models obtained with the help of suitably refined force fields and guided by experimental NMR data will provide a powerful insight into an intricate world of disordered biomolecules.

Evidence of a dominance hierarchy in captive Caribbean flamingos and its relation to pair bonding and physiological measures of health.

PubMed

Royer, Erica A; Anderson, Matthew J

2014-06-01

Caribbean flamingo social structure, how pair bonds affect the structure of the flock, and how social stress affects health measured by heterophil to lymphocyte ratios (H/L) were investigated at the Philadelphia Zoo. It was hypothesized that a hierarchy may become apparent by analyzing agonistic interactions and that paired individuals would share similar places within the hierarchy. Furthermore, it was hypothesized that a negative relationship between H/L ratio and dominance would exist. Forty observations were conducted and in 70% of interactions instigating bird(s) won the encounter, suggesting either some advantage for instigating birds or a prior expectation of an encounter's outcome based upon an understanding of the flock's hierarchy. The flock possessed a semi-linear hierarchy (in terms of wins/losses) and birds with higher pair-bond strengths maintained dominant positions, suggesting that pair-bonding may help individuals become more successful in agonistic encounters. Birds who won more often had higher lymphocytes percentages and analyses suggested a trend indicating dominant birds may be less stressed. A semi-linear hierarchy was also found in terms of initiation/being targeted, and a bird's rank on the dominance (wins/losses) and initiate/target hierarchies were positively correlated, suggesting that subdominant birds were targeted by dominant birds more frequently than vice versa. Copyright © 2014 Elsevier B.V. All rights reserved.

Development of a browser application to foster research on linking climate and health datasets: Challenges and opportunities.

PubMed

Hajat, Shakoor; Whitmore, Ceri; Sarran, Christophe; Haines, Andy; Golding, Brian; Gordon-Brown, Harriet; Kessel, Anthony; Fleming, Lora E

2017-01-01

Improved data linkages between diverse environment and health datasets have the potential to provide new insights into the health impacts of environmental exposures, including complex climate change processes. Initiatives that link and explore big data in the environment and health arenas are now being established. To encourage advances in this nascent field, this article documents the development of a web browser application to facilitate such future research, the challenges encountered to date, and how they were addressed. A 'storyboard approach' was used to aid the initial design and development of the application. The application followed a 3-tier architecture: a spatial database server for storing and querying data, server-side code for processing and running models, and client-side browser code for user interaction and for displaying data and results. The browser was validated by reproducing previously published results from a regression analysis of time-series datasets of daily mortality, air pollution and temperature in London. Data visualisation and analysis options of the application are presented. The main factors that shaped the development of the browser were: accessibility, open-source software, flexibility, efficiency, user-friendliness, licensing restrictions and data confidentiality, visualisation limitations, cost-effectiveness, and sustainability. Creating dedicated data and analysis resources, such as the one described here, will become an increasingly vital step in improving understanding of the complex interconnections between the environment and human health and wellbeing, whilst still ensuring appropriate confidentiality safeguards. The issues raised in this paper can inform the future development of similar tools by other researchers working in this field. Copyright © 2016 Elsevier B.V. All rights reserved.

Wake Encounter Analysis for a Closely Spaced Parallel Runway Paired Approach Simulation

NASA Technical Reports Server (NTRS)

Mckissick,Burnell T.; Rico-Cusi, Fernando J.; Murdoch, Jennifer; Oseguera-Lohr, Rosa M.; Stough, Harry P, III; O'Connor, Cornelius J.; Syed, Hazari I.

2009-01-01

A Monte Carlo simulation of simultaneous approaches performed by two transport category aircraft from the final approach fix to a pair of closely spaced parallel runways was conducted to explore the aft boundary of the safe zone in which separation assurance and wake avoidance are provided. The simulation included variations in runway centerline separation, initial longitudinal spacing of the aircraft, crosswind speed, and aircraft speed during the approach. The data from the simulation showed that the majority of the wake encounters occurred near or over the runway and the aft boundaries of the safe zones were identified for all simulation conditions.

The Tenacious Nature of Memory Binding for Arousing Negative Items

PubMed Central

Novak, Deanna L.; Mather, Mara

2009-01-01

In two experiments, we investigated whether people are better or worse at updating memory for the location of emotional pictures than neutral pictures. We measured participants' memories for the locations of both arousing negative pictures and neutral pictures while manipulating practice (encountering the same event repeatedly) and interference (encountering the same picture in a different location). Memory for the context of emotional items was less likely to be corrected when erroneous and less likely to be correctly updated when the context changed. These results suggest that initial item-context binding is more tenacious for emotional items than for neutral items, even when such binding is incorrect. PMID:19744934

Community Nursing Care of Chinese-Australian Cancer Patients: A Qualitative Study.

PubMed

McKenzie, Heather; Kwok, Cannas; Tsang, Heidi; Moreau, Elizabeth

2015-01-01

Providing quality care and support to cancer patients from minority cultures can challenge community nurses when language barriers and cultural complexities intersect with the need for complex care. This article reports on a qualitative study that explores interactions between community nurses and Chinese-Australian cancer patients. The research method focused on particular nurse-patient encounters and involved preencounter and postencounter interviews with the nurse, postencounter interviews with the patient, and observation of the encounters. Participants included community nurses, Chinese cancer patients being cared for at home, and their carers if present. Four themes were conceptualized: (1) the impact of language barriers on nurse-patient interactions, (2) patient understandings of the scope and objectives of healthcare services, (3) cultural complexities and sensitivities, and (4) valued care and support. The study demonstrates that, although many nurses do provide comprehensive, culturally competent care, language barriers can lead to task-oriented rather than comprehensive approaches, and other cultural complexities do have an impact on patient experiences and on the quality of nurse-patient interactions. Nevertheless, most patient participants experienced a feeling of security as a result of regular contact with a community nursing service. Cancer patients with complex care needs but limited English proficiency require support to negotiate complicated community services networks. Culturally competent community nurses can provide this support. The study highlights the need for continuing cultural competence education for community nurses and the importance of careful discharge planning to ensure continuity of care for this vulnerable patient group.

Team physicians in college athletics.

PubMed

Steiner, Mark E; Quigley, D Bradford; Wang, Frank; Balint, Christopher R; Boland, Arthur L

2005-10-01

There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Descriptive epidemiology study. For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P < .05). Four percent of musculoskeletal injuries required surgery. Most general medical evaluations were single visits for upper respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P < .05). Per capita, men and women sought care at an equal rate. In contrast, 10% of physician encounters with the general pool of undergraduates were for musculoskeletal diagnoses. Student athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

A Role for Ultrasonic Vocalisation in Social Communication and Divergence of Natural Populations of the House Mouse (Mus musculus domesticus)

PubMed Central

von Merten, Sophie; Hoier, Svenja

2014-01-01

It has long been known that rodents emit signals in the ultrasonic range, but their role in social communication and mating is still under active exploration. While inbred strains of house mice have emerged as a favourite model to study ultrasonic vocalisation (USV) patterns, studies in wild animals and natural situations are still rare. We focus here on two wild derived mouse populations. We recorded them in dyadic encounters for extended periods of time to assess possible roles of USVs and their divergence between allopatric populations. We have analysed song frequency and duration, as well as spectral features of songs and syllables. We show that the populations have indeed diverged in several of these aspects and that USV patterns emitted in a mating context differ from those emitted in same sex encounters. We find that females vocalize not less, in encounters with another female even more than males. This implies that the current focus of USVs being emitted mainly by males within the mating context needs to be reconsidered. Using a statistical syntax analysis we find complex temporal sequencing patterns that could suggest that the syntax conveys meaningful information to the receivers. We conclude that wild mice use USV for complex social interactions and that USV patterns can diverge fast between populations. PMID:24816836

14 CFR 135.293 - Initial and recurrent pilot testing requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., high altitude weather; (7) Procedures for— (i) Recognizing and avoiding severe weather situations; (ii) Escaping from severe weather situations, in case of inadvertent encounters, including low-altitude windshear (except that rotorcraft pilots are not required to be tested on escaping from low-altitude...

14 CFR 135.293 - Initial and recurrent pilot testing requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., high altitude weather; (7) Procedures for— (i) Recognizing and avoiding severe weather situations; (ii) Escaping from severe weather situations, in case of inadvertent encounters, including low-altitude windshear (except that rotorcraft pilots are not required to be tested on escaping from low-altitude...

Delta Project Planning and Implementation in the Netherlands.

ERIC Educational Resources Information Center

Dutt, Ashok K.; Heal, Stephen

1979-01-01

Describes a water management project in the Netherlands which is intended to protect the people, land, and property in the Delta Region from abnormally high floods. Presents background for initiation of the Delta Project and discusses problems encountered in the project to date. (Author/DB)

Developing a Simulated-Person Methodology Workshop: An Experiential Education Initiative for Educators and Simulators

ERIC Educational Resources Information Center

Peisachovich, Eva Hava; Nelles, L. J.; Johnson, Samantha; Nicholson, Laura; Gal, Raya; Kerr, Barbara; Celia, Popovic; Epstein, Iris; Da Silva, Celina

2017-01-01

Numerous forecasts suggest that professional-competence development depends on human encounters. Interaction between organizations, tasks, and individual providers influence human behaviour, affect organizations' or systems' performance, and are a key component of professional-competence development. Further, insufficient or ineffective…

Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum

PubMed Central

Brand, Elizabeth; Kothari, Catherine; Stark, Mary Ann

2011-01-01

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women’s reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding. PMID:22211058

Web-based triage in a college health setting.

PubMed

Sole, Mary Lou; Stuart, Patricia L; Deichen, Michael

2006-01-01

The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (kappa = .94), between chief complaint and student health center diagnosis (kappa = .91), and between 24/7 WebMed classification and student health center diagnosis (kappa = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.

Recording medical students' encounters with standardized patients using Google Glass: providing end-of-life clinical education.

PubMed

Tully, Jeffrey; Dameff, Christian; Kaib, Susan; Moffitt, Maricela

2015-03-01

Medical education today frequently includes standardized patient (SP) encounters to teach history-taking, physical exam, and communication skills. However, traditional wall-mounted cameras, used to record video for faculty and student feedback and evaluation, provide a limited view of key nonverbal communication behaviors during clinical encounters. In 2013, 30 second-year medical students participated in an end-of-life module that included SP encounters in which the SPs used Google Glass to record their first-person perspective. Students reviewed the Google Glass video and traditional videos and then completed a postencounter, self-evaluation survey and a follow-up survey about the experience. Google Glass was used successfully to record 30 student/SP encounters. One temporary Google Glass hardware failure was observed. Of the 30 students, 7 (23%) reported a "positive, nondistracting experience"; 11 (37%) a "positive, initially distracting experience"; 5 (17%) a "neutral experience"; and 3 (10%) a "negative experience." Four students (13%) opted to withhold judgment until they reviewed the videos but reported Google Glass as "distracting." According to follow-up survey responses, 16 students (of 23; 70%) found Google Glass "worth including in the [clinical skills program]," whereas 7 (30%) did not. Google Glass can be used to video record students during SP encounters and provides a novel perspective for the analysis and evaluation of their interpersonal communication skills and nonverbal behaviors. Next steps include a larger, more rigorous comparison of Google Glass versus traditional videos and expanded use of this technology in other aspects of the clinical skills training program.

Encounter success of free-ranging marine predator movements across a dynamic prey landscape.

PubMed

Sims, David W; Witt, Matthew J; Richardson, Anthony J; Southall, Emily J; Metcalfe, Julian D

2006-05-22

Movements of wide-ranging top predators can now be studied effectively using satellite and archival telemetry. However, the motivations underlying movements remain difficult to determine because trajectories are seldom related to key biological gradients, such as changing prey distributions. Here, we use a dynamic prey landscape of zooplankton biomass in the north-east Atlantic Ocean to examine active habitat selection in the plankton-feeding basking shark Cetorhinus maximus. The relative success of shark searches across this landscape was examined by comparing prey biomass encountered by sharks with encounters by random-walk simulations of 'model' sharks. Movements of transmitter-tagged sharks monitored for 964 days (16754 km estimated minimum distance) were concentrated on the European continental shelf in areas characterized by high seasonal productivity and complex prey distributions. We show movements by adult and sub-adult sharks yielded consistently higher prey encounter rates than 90% of random-walk simulations. Behavioural patterns were consistent with basking sharks using search tactics structured across multiple scales to exploit the richest prey areas available in preferred habitats. Simple behavioural rules based on learned responses to previously encountered prey distributions may explain the high performances. This study highlights how dynamic prey landscapes enable active habitat selection in large predators to be investigated from a trophic perspective, an approach that may inform conservation by identifying critical habitat of vulnerable species.

Beauty is distractive: particle production during multifield inflation

NASA Astrophysics Data System (ADS)

Battefeld, Diana; Battefeld, Thorsten; Byrnes, Christian; Langlois, David

2011-08-01

We consider a two-dimensional model of inflation, where the inflationary trajectory is ``deformed'' by a grazing encounter with an Extra Species/Symmetry Point (ESP) after the observable cosmological scales have left the Hubble radius. The encounter entails a sudden production of particles, whose backreaction causes a bending of the trajectory and a temporary decrease in speed, both of which are sensitive to initial conditions. This ``modulated'' effect leads to an additional contribution to the curvature perturbation, which can be dominant if the encounter is close. We compute associated non-Gaussianities, the bispectrum and its scale dependence as well as the trispectrum, which are potentially detectable in many cases. In addition, we consider a direct modulation of the coupling to the light field at the ESP via a modulaton field, a mixed scenario whereby the modulaton is identified with a second inflaton, and an extended Extra Species Locus (ESL); all of these scenarios lead to similar additional contributions to observables. We conclude that inflaton interactions throughout inflation are strongly constrained if primordial non-Gaussianities remain unobserved in current experiments such as PLANCK. If they are observed, an ESP encounter leaves additional signatures on smaller scales which may be used to identify the model.

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.

PubMed

Rooke, G Alec; Lombaard, Stefan A; Van Norman, Gail A; Dziersk, Jörg; Natrajan, Krishna M; Larson, Lyle W; Poole, Jeanne E

2015-11-01

Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study

PubMed Central

Clark, Michael; Semple, Martin J; Ivins, Nicola; Mahoney, Kirsten; Harding, Keith

2017-01-01

Objective The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Methods Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Results Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. Conclusions This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales. PMID:28827240

Muscular subaortic stenosis: the initial left ventricular inflow tract pressure as evidence of outflow tract obstruction.

PubMed

Wigle, E D; Auger, P; Marquis, Y

1966-10-15

Two types of intraventricular pressure differences within the left ventricle of man are described. The first is encountered in cases of muscular (or fibrous) subaortic stenosis, in which the outflow tract pressure distal to the stenosis (and proximal to the aortic valve) is low, whereas all pressures recorded in the left ventricle proximal to the stenosis, including that just inside the mitral valve (the initial inflow tract pressure) are high.The second type of intraventricular pressure difference may be recorded in patients without muscular subaortic stenosis when a heart catheter is advanced to the left ventricular wall in such a manner that it becomes imbedded or entrapped by cardiac muscle in systole. Such an entrapped catheter records a high intraventricular pressure that is believed to reflect intramyocardial tissue pressure, which normally exceeds intracavitary pressure. In such cases the initial inflow tract pressure is not high and is precisely equal to the outflow tract systolic pressure, i.e. both are recording intracavity pressure. This type of intramyocardial to intracavitary pressure difference may also be encountered in the left ventricle of dogs.The recent suggestion that intraventricular pressure differences in the left ventricle of cases of muscular subaortic stenosis are due to catheter entrapment by cardiac muscle is refuted by using the initial inflow tract pressure as the means of differentiation between the two types of intraventricular pressure differences outlined.

EXTRAPOLATION MODELING: ADVANCEMENTS AND RESEARCH ISSUES IN LUNG DOSIMETRY

EPA Science Inventory

Many of the environmental pollutants to which humans are exposed are increasing rapidly, in terms of number, complexity, and concentration. ne of the great challenges in environmental medicine is to define more accurately the adverse health effects likely to be encountered by exp...

An Exploratory Study of Pharmacists Professional Learning

ERIC Educational Resources Information Center

Wittstrom, Kristina M.

2012-01-01

Today's healthcare professional is challenged to stay current with increasingly complex therapeutic challenges, greater societal needs and expectations, and a public demand for the best possible care. Professional learning opportunities are needed to develop new knowledge, skills, or abilities to address specific matters encountered during…

Guidelines for Psychological Practice with Girls and Women

ERIC Educational Resources Information Center

American Psychologist, 2007

2007-01-01

During recent decades, women and girls of diverse ethnicities, social classes, sexual orientations, and life experiences have encountered dramatic and complex changes in education, health, work, reproductive and caregiving roles, and personal relationships. Although many of these changes have resulted in increased equality, opportunity, and…

Organizational Effectiveness in Higher Education: Faculty Informal Structure as Social Capital

ERIC Educational Resources Information Center

Dose, Jennifer J.

2012-01-01

Higher education institutions encounter complex external environments, requiring increasing responsiveness and innovation. Research on social capital has demonstrated that highly connected employee relational networks are more creative, effective, and exhibit higher member satisfaction. The present study examines one college to demonstrate how…

Encounter complexes and dimensionality reduction in protein-protein association.

PubMed

Kozakov, Dima; Li, Keyong; Hall, David R; Beglov, Dmitri; Zheng, Jiefu; Vakili, Pirooz; Schueler-Furman, Ora; Paschalidis, Ioannis Ch; Clore, G Marius; Vajda, Sandor

2014-04-08

An outstanding challenge has been to understand the mechanism whereby proteins associate. We report here the results of exhaustively sampling the conformational space in protein-protein association using a physics-based energy function. The agreement between experimental intermolecular paramagnetic relaxation enhancement (PRE) data and the PRE profiles calculated from the docked structures shows that the method captures both specific and non-specific encounter complexes. To explore the energy landscape in the vicinity of the native structure, the nonlinear manifold describing the relative orientation of two solid bodies is projected onto a Euclidean space in which the shape of low energy regions is studied by principal component analysis. Results show that the energy surface is canyon-like, with a smooth funnel within a two dimensional subspace capturing over 75% of the total motion. Thus, proteins tend to associate along preferred pathways, similar to sliding of a protein along DNA in the process of protein-DNA recognition. DOI: http://dx.doi.org/10.7554/eLife.01370.001.

Encounter complexes and dimensionality reduction in protein–protein association

PubMed Central

Kozakov, Dima; Li, Keyong; Hall, David R; Beglov, Dmitri; Zheng, Jiefu; Vakili, Pirooz; Schueler-Furman, Ora; Paschalidis, Ioannis Ch; Clore, G Marius; Vajda, Sandor

2014-01-01

An outstanding challenge has been to understand the mechanism whereby proteins associate. We report here the results of exhaustively sampling the conformational space in protein–protein association using a physics-based energy function. The agreement between experimental intermolecular paramagnetic relaxation enhancement (PRE) data and the PRE profiles calculated from the docked structures shows that the method captures both specific and non-specific encounter complexes. To explore the energy landscape in the vicinity of the native structure, the nonlinear manifold describing the relative orientation of two solid bodies is projected onto a Euclidean space in which the shape of low energy regions is studied by principal component analysis. Results show that the energy surface is canyon-like, with a smooth funnel within a two dimensional subspace capturing over 75% of the total motion. Thus, proteins tend to associate along preferred pathways, similar to sliding of a protein along DNA in the process of protein-DNA recognition. DOI: http://dx.doi.org/10.7554/eLife.01370.001 PMID:24714491

Bypass of a Nick by the Replisome of Bacteriophage T7*

PubMed Central

Zhu, Bin; Lee, Seung-Joo; Richardson, Charles C.

2011-01-01

DNA polymerase and DNA helicase are essential components of DNA replication. The helicase unwinds duplex DNA to provide single-stranded templates for DNA synthesis by the DNA polymerase. In bacteriophage T7, movement of either the DNA helicase or the DNA polymerase alone terminates upon encountering a nick in duplex DNA. Using a minicircular DNA, we show that the helicase·polymerase complex can bypass a nick, albeit at reduced efficiency of 7%, on the non-template strand to continue rolling circle DNA synthesis. A gap in the non-template strand cannot be bypassed. The efficiency of bypass synthesis depends on the DNA sequence downstream of the nick. A nick on the template strand cannot be bypassed. Addition of T7 single-stranded DNA-binding protein to the complex stimulates nick bypass 2-fold. We propose that the association of helicase with the polymerase prevents dissociation of the helicase upon encountering a nick, allowing the helicase to continue unwinding of the duplex downstream of the nick. PMID:21701044

Bypass of a nick by the replisome of bacteriophage T7.

PubMed

Zhu, Bin; Lee, Seung-Joo; Richardson, Charles C

2011-08-12

DNA polymerase and DNA helicase are essential components of DNA replication. The helicase unwinds duplex DNA to provide single-stranded templates for DNA synthesis by the DNA polymerase. In bacteriophage T7, movement of either the DNA helicase or the DNA polymerase alone terminates upon encountering a nick in duplex DNA. Using a minicircular DNA, we show that the helicase · polymerase complex can bypass a nick, albeit at reduced efficiency of 7%, on the non-template strand to continue rolling circle DNA synthesis. A gap in the non-template strand cannot be bypassed. The efficiency of bypass synthesis depends on the DNA sequence downstream of the nick. A nick on the template strand cannot be bypassed. Addition of T7 single-stranded DNA-binding protein to the complex stimulates nick bypass 2-fold. We propose that the association of helicase with the polymerase prevents dissociation of the helicase upon encountering a nick, allowing the helicase to continue unwinding of the duplex downstream of the nick.

Anomalous viscosity effect in the early stages of the ion-assisted adhesion/fusion event between lipid bilayers: A theoretical and computational study

NASA Astrophysics Data System (ADS)

Raudino, Antonio; Marrink, Siewert J.; Pannuzzo, Martina

2013-06-01

The effect of viscosity on the encounter rate of two interacting membranes was investigated by combining a non-equilibrium Fokker-Planck model together with extensive Molecular Dynamics (MD) calculations. The encounter probability and stabilization of transient contact points represent the preliminary steps toward short-range adhesion and fusion of lipid leaflets. To strengthen our analytical model, we used a Coarse Grained MD method to follow the behavior of two charged palmitoyl oleoyl phosphatidylglycerol membranes embedded in a electrolyte-containing box at different viscosity regimes. Solvent friction was modulated by varying the concentration of a neutral, water-soluble polymer, polyethylene glycol, while contact points were stabilized by divalent ions that form bridges among juxtaposed membranes. While a naïve picture foresees a monotonous decrease of the membranes encounter rate with solvent viscosity, both the analytical model and MD simulations show a complex behavior. Under particular conditions, the encounter rate could exhibit a maximum at a critical viscosity value or for a critical concentration of bridging ions. These results seem to be confirmed by experimental observations taken from the literature.

Secular dynamics of hierarchical multiple systems composed of nested binaries, with an arbitrary number of bodies and arbitrary hierarchical structure - II. External perturbations: flybys and supernovae

NASA Astrophysics Data System (ADS)

Hamers, Adrian S.

2018-05-01

We extend the formalism of a previous paper to include the effects of flybys and instantaneous perturbations such as supernovae on the long-term secular evolution of hierarchical multiple systems with an arbitrary number of bodies and hierarchy, provided that the system is composed of nested binary orbits. To model secular encounters, we expand the Hamiltonian in terms of the ratio of the separation of the perturber with respect to the barycentre of the multiple system, to the separation of the widest orbit. Subsequently, we integrate over the perturber orbit numerically or analytically. We verify our method for secular encounters and illustrate it with an example. Furthermore, we describe a method to compute instantaneous orbital changes to multiple systems, such as asymmetric supernovae and impulsive encounters. The secular code, with implementation of the extensions described in this paper, is publicly available within AMUSE, and we provide a number of simple example scripts to illustrate its usage for secular and impulsive encounters and asymmetric supernovae. The extensions presented in this paper are a next step towards efficiently modelling the evolution of complex multiple systems embedded in star clusters.

Influence of changes in hydrodynamic conditions on cadmium transport in tidal river network of the Pearl River Delta, China.

PubMed

Dou, Ming; Zuo, Qiting; Zhang, Jinping; Li, Congying; Li, Guiqiu

2013-09-01

With rapid economic development, the Pearl River Delta (PRD) of China has experienced a series of serious heavy metal pollution events. Considering complex hydrodynamic and pollutants transport process, one-dimensional hydrodynamic model and heavy metal transport model were developed for tidal river network of the PRD. Then, several pollution emergency scenarios were designed by combining with the upper inflow, water quality and the lower tide level boundary conditions. Using this set of models, the temporal and spatial change process of cadmium (Cd) concentration was simulated. The influence of change in hydrodynamic conditions on Cd transport in tidal river network was assessed, and its transport laws were summarized. The result showed the following: Flow changes in the tidal river network were influenced remarkably by tidal backwater action, which further influenced the transport process of heavy metals; Cd concentrations in most sections while encountering high tide were far greater than those while encountering middle or low tides; and increased inflows from upper reaches could intensify water pollution in the West River (while encountering high tide) or the North River (while encountering middle or low tides).

Shape of initial portion of boundary of supersonic axisymmetric free jets at large jet pressure ratios

NASA Technical Reports Server (NTRS)

Love, Eugene S; Lee, Louise P

1958-01-01

Calculations have been made of the initial portion of the boundary of axisymmetric free jets exhausting at large pressure ratios from a conically divergent nozzle having a jet exit Mach number of 2.5 and a semidivergence angle of 15 degrees. The results of the calculations indicate the size and shape of the jet to be expected at large pressure ratios, the effects of ratio of specific heats, and the large initial inclinations of the boundary that are likely to be encountered by hypersonic vehicles at high altitude.

Introduction: Nipah virus--discovery and origin.

PubMed

Chua, Kaw Bing

2012-01-01

Until the Nipah outbreak in Malaysia in 1999, knowledge of human infections with the henipaviruses was limited to the small number of cases associated with the emergence of Hendra virus in Australia in 1994. The Nipah outbreak in Malaysia alerted the global public health community to the severe pathogenic potential and widespread distribution of these unique paramyxoviruses. This chapter briefly describes the initial discovery of Nipah virus and the challenges encountered during the initial identification and characterisation of the aetiological agent responsible for the outbreak of febrile encephalitis. The initial attempts to isolate Nipah virus from the bat reservoir host are also described.

Semiclassical modelling of finite-pulse effects on non-adiabatic photodynamics via initial condition filtering: The predissociation of NaI as a test case

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

Martínez-Mesa, Aliezer; Institut für Chemie, Universität Potsdam, Karl-Liebknecht-Strasse 24-25, D-14476 Potsdam-Golm; Saalfrank, Peter

2015-05-21

Femtosecond-laser pulse driven non-adiabatic spectroscopy and dynamics in molecular and condensed phase systems continue to be a challenge for theoretical modelling. One of the main obstacles is the “curse of dimensionality” encountered in non-adiabatic, exact wavepacket propagation. A possible route towards treating complex molecular systems is via semiclassical surface-hopping schemes, in particular if they account not only for non-adiabatic post-excitation dynamics but also for the initial optical excitation. One such approach, based on initial condition filtering, will be put forward in what follows. As a simple test case which can be compared with exact wavepacket dynamics, we investigate the influencemore » of the different parameters determining the shape of a laser pulse (e.g., its finite width and a possible chirp) on the predissociation dynamics of a NaI molecule, upon photoexcitation of the A(0{sup +}) state. The finite-pulse effects are mapped into the initial conditions for semiclassical surface-hopping simulations. The simulated surface-hopping diabatic populations are in qualitative agreement with the quantum mechanical results, especially concerning the subpicosend photoinduced dynamics, the main deviations being the relative delay of the non-adiabatic transitions in the semiclassical picture. Likewise, these differences in the time-dependent electronic populations calculated via the semiclassical and the quantum methods are found to have a mild influence on the overall probability density distribution. As a result, the branching ratios between the bound and the dissociative reaction channels and the time-evolution of the molecular wavepacket predicted by the semiclassical method agree with those computed using quantum wavepacket propagation. Implications for more challenging molecular systems are given.« less

Statistical complex fatigue data for SAE 4340 steel and its use in design by reliability

NASA Technical Reports Server (NTRS)

Kececioglu, D.; Smith, J. L.

1970-01-01

A brief description of the complex fatigue machines used in the test program is presented. The data generated from these machines are given and discussed. Two methods of obtaining strength distributions from the data are also discussed. Then follows a discussion of the construction of statistical fatigue diagrams and their use in designing by reliability. Finally, some of the problems encountered in the test equipment and a corrective modification are presented.

Mast cells contribute to the mucosal adjuvant effect of CTA1-DD after IgG-complex formation.

PubMed

Fang, Yu; Larsson, Lisa; Mattsson, Johan; Lycke, Nils; Xiang, Zou

2010-09-01

Mast cell activation is one of the most dramatic immune-mediated responses the body can encounter. In the worst scenario (i.e., anaphylaxis), this response is fatal. However, the importance of mast cells as initiators and effectors of both innate and adaptive immunity in healthy individuals has recently been appreciated. It was reported that mast cell activation can be used as an adjuvant to promote Ag-specific humoral immune responses upon vaccination. In this study, we have used a clinically relevant mucosal adjuvant, cholera toxin A1 subunit (CTA1)-DD, which is a fusion protein composed of CTA1, the ADP-ribosylating part of cholera toxin, and DD, two Ig-binding domains derived from Staphylococcus aureus protein A. CTA1-DD in combination with polyclonal IgG induced degranulation and production of TNF-alpha from mouse mast cells. Furthermore, CTA1-DD and polyclonal IgG complex induced mast cell degranulation in mouse skin tissue and nasal mucosa. We also found that intranasal immunization with hapten (4-hydroxy-3-nitrophenyl) acetyl (NP) coupled to chicken gammaglobulin admixed with CTA1-DD complexed with polyclonal IgG greatly enhanced serum IgG anti-NP Ab responses and stimulated higher numbers of NP-specific plasma cells in the bone marrow as compared with that observed in mice immunized with NP-chicken gammaglobulin with CTA1-DD alone. This CTA1-DD/IgG complex-mediated enhancement was mast cell dependent because it was absent in mast cell-deficient Kit(W-sh/W-sh) mice. In conclusion, our data suggest that a clinically relevant adjuvant, CTA1-DD, exerts additional augmenting effects through activation of mucosal mast cells, clearly demonstrating that mast cells could be further exploited for improving the efficacy of mucosal vaccines.

Kinetics of binding of chicken cystatin to papain.

PubMed

Björk, I; Alriksson, E; Ylinenjärvi, K

1989-02-21

The kinetics of binding of chicken cystatin to papain were studied by stopped-flow fluorometry under pseudo-first-order conditions, i.e., with an excess of inhibitor. All reactions showed first-order behavior, and the observed pseudo-first-order rate constant increased linearly with the cystatin concentration up to the highest concentration that could be studied, 35 microM. The analyses thus provided no evidence for a limiting rate resulting from a conformational change stabilizing an initial encounter complex, in contrast with previous studies of reactions between serine proteinases and their protein inhibitors. The second-order association rate constant for complex formation was 9.9 X 10(6) M-1 s-1 at 25 degrees C, pH 7.4, I = 0.15, for both forms of cystatin, 1 and 2. This value approaches that expected for a diffusion-controlled rate. The temperature dependence of the association rate constant gave an enthalpy of activation at 25 degrees C of 31.5 kJ mol-1 and an entropy of activation at 25 degrees C of -7 J K-1 mol-1, compatible with no appreciable conformational change during the reaction. The association rate constant was independent of pH between pH 6 and 8 but decreased at lower and higher pH in a manner consistent with involvement of an unprotonated acid group with a pKa of 4-4.5 and a protonated basic group with a pKa of 9-9.5 in the interaction. The association rate constant was unaffected by ionic strengths between 0.15 and 1.0 but decreased somewhat at lower ionic strengths. Incubation of the complex between cystatin 2 and papain with an excess of cystatin 1 resulted in slow displacement of cystatin 2 from the complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Clue Insensitivity in Remote Associates Test Problem Solving

ERIC Educational Resources Information Center

Smith, Steven M.; Sifonis, Cynthia M.; Angello, Genna

2012-01-01

Does spreading activation from incidentally encountered hints cause incubation effects? We used Remote Associates Test (RAT) problems to examine effects of incidental clues on impasse resolution. When solution words were seen incidentally 3-sec before initially unsolved problems were retested, more problems were resolved (Experiment 1). When…

Physical activity problem-solving inventory for adolescents: Development and initial validation

USDA-ARS?s Scientific Manuscript database

Youth encounter physical activity barriers, often called problems. The purpose of problem-solving is to generate solutions to overcome the barriers. Enhancing problem-solving ability may enable youth to be more physically active. Therefore, a method for reliably assessing physical activity problem-s...

Education in Liquid Modernity

ERIC Educational Resources Information Center

Bauman, Zygmunt

2005-01-01

The author initially describes several seminal and interconnected departures from the old social order which are currently happening and which are creating a new and indeed unprecedented setting for the educational process, thereby raising a series of never-before-encountered challenges for the educators. He then details how society is being…

Death as a Counseling Concern

ERIC Educational Resources Information Center

Bascue, Loy O.; Krieger, George W.

1974-01-01

This article points out some situations in which counselors are likely to encounter the topic of death as a client concern (in counseling young children and adolescents, in rehabilitation settings, drug crisis clinics, runaway houses, etc.). An initial framework for providing therapeutic services to such clients is outlined. (Author/EAK)

Interdisciplinarity within an Academic Career

ERIC Educational Resources Information Center

Blackmore, Paul; Kandiko, Camille B.

2011-01-01

This project identified academics who have been involved with interdisciplinary leadership initiatives and sought to find out what had motivated them, what issues they had encountered and how they had resolved them. A powerful message emerging is the central importance of motivation in interdisciplinary work. Interviewees spoke of leaving their…

The Congolobe project, a multidisciplinary study of Congo deep-sea fan lobe complex: Overview of methods, strategies, observations and sampling

NASA Astrophysics Data System (ADS)

Rabouille, C.; Olu, K.; Baudin, F.; Khripounoff, A.; Dennielou, B.; Arnaud-Haond, S.; Babonneau, N.; Bayle, C.; Beckler, J.; Bessette, S.; Bombled, B.; Bourgeois, S.; Brandily, C.; Caprais, J. C.; Cathalot, C.; Charlier, K.; Corvaisier, R.; Croguennec, C.; Cruaud, P.; Decker, C.; Droz, L.; Gayet, N.; Godfroy, A.; Hourdez, S.; Le Bruchec, J.; Saout, J.; Le Saout, M.; Lesongeur, F.; Martinez, P.; Mejanelle, L.; Michalopoulos, P.; Mouchel, O.; Noel, P.; Pastor, L.; Picot, M.; Pignet, P.; Pozzato, L.; Pruski, A. M.; Rabiller, M.; Raimonet, M.; Ragueneau, O.; Reyss, J. L.; Rodier, P.; Ruesch, B.; Ruffine, L.; Savignac, F.; Senyarich, C.; Schnyder, J.; Sen, A.; Stetten, E.; Sun, Ming Yi; Taillefert, M.; Teixeira, S.; Tisnerat-Laborde, N.; Toffin, L.; Tourolle, J.; Toussaint, F.; Vétion, G.; Jouanneau, J. M.; Bez, M.; Congolobe Group:

2017-08-01

The presently active region of the Congo deep-sea fan (around 330,000 km2), called the terminal lobes or lobe complex, covers an area of 2500 km2 at 4700-5100 m water depth and 750-800 km offshore. It is a unique sedimentary area in the world ocean fed by a submarine canyon and a channel-levee system which presently deliver large amounts of organic carbon originating from the Congo River by turbidity currents. This particularity is due to the deep incision of the shelf by the Congo canyon, up to 30 km into the estuary, which funnels the Congo River sediments into the deep-sea. The connection between the river and the canyon is unique for major world rivers. In 2011, two cruises (WACS leg 2 and Congolobe) were conducted to simultaneously investigate the geology, organic and inorganic geochemistry, and micro- and macro-biology of the terminal lobes of the Congo deep-sea fan. Using this multidisciplinary approach, the morpho-sedimentary features of the lobes were characterized along with the origin and reactivity of organic matter, the recycling and burial of biogenic compounds, the diversity and function of bacterial and archaeal communities within the sediment, and the biodiversity and functioning of the faunal assemblages on the seafloor. Six different sites were selected for this study: Four distributed along the active channel from the lobe complex entrance to the outer rim of the sediment deposition zone, and two positioned cross-axis and at increasing distance from the active channel, thus providing a gradient in turbidite particle delivery and sediment age. This paper aims to provide the general context of this multidisciplinary study. It describes the general features of the site and the overall sampling strategy and provides the initial habitat observations to guide the other in-depth investigations presented in this special issue. Detailed bathymetry of each sampling site using 0.1-1 m resolution multibeam obtained with a remotely operated vehicle (ROV) shows progressive widening and smoothing of the channel-levees with increasing depth and reveals a complex morphology with channel bifurcations, erosional features and massive deposits. Dense ecosystems surveyed in the study area gather high density clusters of two large-sized species of symbiotic Vesicomyidae bivalves and microbial mats. These assemblages, which are rarely observed in sedimentary zones, resemble those based on chemosynthesis at cold-seep sites, such as the active pockmarks encountered along the Congo margin, and share with these sites the dominant vesicomyid species Christineconcha regab. Sedimentation rates estimated in the lobe complex range between 0.5 and 10 cm yr-1, which is 2-3 orders of magnitude higher than values generally encountered at abyssal depths. The bathymetry, faunal assemblages and sedimentation rates make the Congo lobe complex a highly peculiar deep-sea habitat driven by high inputs of terrigenous material delivered by the Congo channel-levee system.

Introducing Complex Numbers

ERIC Educational Resources Information Center

Trudgian, Timothy

2009-01-01

One of the difficulties in any teaching of mathematics is to bridge the divide between the abstract and the intuitive. Throughout school one encounters increasingly abstract notions, which are more and more difficult to relate to everyday experiences. This article examines a familiar approach to thinking about negative numbers, that is an…

Interdisciplinarity in Adapted Physical Activity

ERIC Educational Resources Information Center

Bouffard, Marcel; Spencer-Cavaliere, Nancy

2016-01-01

It is commonly accepted that inquiry in adapted physical activity involves the use of different disciplines to address questions. It is often advanced today that complex problems of the kind frequently encountered in adapted physical activity require a combination of disciplines for their solution. At the present time, individual research…

The Implications of Literacy Teaching Models

ERIC Educational Resources Information Center

Gunawardena, Maya

2017-01-01

First year students often experience a culture shock as certain literacy practices at the university level are different from their experiences in high schools. Some major challenges that students encounter include students' ability to maintain academic integrity practices in their studies, to comprehend complex academic texts to outline key…

Using a Semi-Realistic Database to Support a Database Course

ERIC Educational Resources Information Center

Yue, Kwok-Bun

2013-01-01

A common problem for university relational database courses is to construct effective databases for instructions and assignments. Highly simplified "toy" databases are easily available for teaching, learning, and practicing. However, they do not reflect the complexity and practical considerations that students encounter in real-world…

Adolescents' Moral Engagement in Urban Settings

ERIC Educational Resources Information Center

Thorkildsen, Theresa A.

2007-01-01

Adolescents who live in urban settings regularly encounter a complex array of people and circumstances that require sophisticated decision-making skills. Using their personal standards, adolescents coordinate moral thoughts and emotions when deciding how to act. After defining what the author refers to as moral engagement, several empirical…

Known-to-Unknown Approach to Teach about Coulomb's Law

ERIC Educational Resources Information Center

Thamburaj, P. K.

2007-01-01

Analogies from life experiences help students understand various relationships presented in an introductory chemistry course. Coulomb's law is a complex relationship encountered in introductory general chemistry. A proper understanding of the relationships between the quantities involved in Coulomb's law is necessary in order for students to…

Chapter 13. Physiology and ecology of host defense against microbial invaders

USDA-ARS?s Scientific Manuscript database

Insects mount a complex hierarchy of defenses that pathogens must overcome before successful infection is achieved. Behavioral avoidance and antiseptic behaviors by host insects reduce the degree of encounters between the insect and pathogens. Any pathogen that contacts or establishes on a potentia...

Managing Curriculum Change and "Ontological Uncertainty" in Tertiary Education

ERIC Educational Resources Information Center

Keesing-Styles, Linda; Nash, Simon; Ayres, Robert

2014-01-01

Curriculum reform at institutional level is a challenging endeavour. Those charged with leading this process will encounter both enthusiasm and multiple obstacles to teacher engagement including the particularly complex issue of confronting existing teacher identities. At Unitec Institute of Technology (Unitec), the "Living Curriculum"…

Occupational and environmental health hazards in the plastics industry.

PubMed Central

Eckardt, R E

1976-01-01

A brief description of the potential occupational health hazards encountered in the manufacture of plastics (polymers) is given. In general, these hazards are due to the monomers used to make the various plastics, to unreacted monomer contained within the finished products, and to the fillers, stabilizers, pigments, inhibitors, and initiators used in fabricating the finished products. They run the gamut from angiosarcomas of the liver due to vinyl chloride, to dermatitis and asthma-like reactions due to the initiators used with epoxy resins. PMID:140799

Keeping Your Cool When the Heat Is On.

ERIC Educational Resources Information Center

Hendrick, Joanne

1987-01-01

Presents techniques that directors of child care facilities can use to deal effectively with angry confrontations from parents and staff members. These techniques include listening to and rephrasing the complaint during the initial encounter; dealing with one's own anger in safe surroundings; and offering explanations or solutions to the…

Paradoxical Effects of Testing: Retrieval Enhances Both Accurate Recall and Suggestibility in Eyewitnesses

ERIC Educational Resources Information Center

Chan, Jason C. K.; Langley, Moses M.

2011-01-01

Although retrieval practice typically enhances memory retention, it can also impair subsequent eyewitness memory accuracy (Chan, Thomas, & Bulevich, 2009). Specifically, participants who had taken an initial test about a witnessed event were more likely than nontested participants to recall subsequently encountered misinformation--an effect we…

Policy Prolepsis in Education: Encounters, Becomings, and Phantasms

ERIC Educational Resources Information Center

Webb, P. Taylor; Gulson, Kalervo N.

2012-01-01

We argue that the concept of a "policy prolepsis" is a category of becoming-policy that actualizes educational practices within spaces of desired policy initiatives and implementations. Policy prolepses represent a range of emergent policy ontologies produced through the interface of educational actors' senses of policy and their estimations of…

Development of an Interdisciplinary Dysphagia Team in the Public Schools.

ERIC Educational Resources Information Center

Homer, Emily M.; Bickerton, Cheryl; Hill, Sherry; Parham, Lisa; Taylor, Darlene

2000-01-01

This article describes the development of a school-based dysphagia team (swallowing action team (SWAT)) in Louisiana. It addresses how the team was initially formed, the process of identifying students who were exhibiting a swallowing disorder, steps taken for staff development, and problems encountered in seeking administrative approval.…

The Columbian Encounter and Land-Use Change.

ERIC Educational Resources Information Center

Turner, B. L. II, Butzer, Karl W.

1992-01-01

Discusses land use patterns in fifteenth-century Europe and in the Americas and the mutual influence (initiated by Columbus's arrival in the Americas) that led to land use change. Presents a historical perspective and categorization of contemporary global land use changes for the purpose of highlighting associations between past and present global…

The Story of Them: Outcomes of Practicing Autoethnography in Undergraduate Writing Courses

ERIC Educational Resources Information Center

Hopkins, Justin B.

2017-01-01

This study is an examination of the outcomes of practicing autoethnography, specifically in the context of first-year undergraduate, writing-intensive courses. The researcher recounts his initial, inspiring encounter with autoethnography and explores the possibility of its pedagogical application in composition instruction. Autoethnography is a…

REVIEW OF STANISLAUS COUNTY MULTI-OCCUPATIONAL VOCATIONAL TRAINING PROJECT, 1964-1965.

ERIC Educational Resources Information Center

Modesto Junior Coll., CA.

THIS REPORT OUTLINES PROBLEMS ENCOUNTERED AND PROGRESS MADE IN THE STANISLAUS COUNTY, CALIFORNIA, TRAINING PROJECT. INITIAL DIFFICULTY IN SECURING FEDERAL APPROVAL AND FUNDS FOR PREVOCATIONAL OR BASIC EDUCATION WAS ENDED BY THE AMENDED MANPOWER TRAINING AND DEVELOPMENT ACT. HOWEVER, DIFFICULTIES, MAINLY IN REORIENTING PREVOCATIONAL AND VOCATIONAL…

Return Journey: "Snakes in the Swamp"

ERIC Educational Resources Information Center

Beynon, John

2008-01-01

In 1985 Falmer Press published my first book, a classroom ethnography entitled "Initial Encounters in a Secondary School," which helped establish me as an academic. However, it has long concerned me that the decade-long Victoria Road Lower School Project (as it came to be called) contained two resounding "silences": (1)…

Identification of Vigor Related Transcripts in Beta vulgaris When Germinated Under Abiotic Stress

USDA-ARS?s Scientific Manuscript database

Germination is the first opportunity to evaluate vigor for beet breeders. The initial condition a germinating seed encounters affects the speed and success of germination, the amount of stored energy reserves to withstand future stress, and the overall ability of the seedling to flourish. However, s...

Germination Under Stress: A Marker For Inherent Vigor Or An Isolated Event?

USDA-ARS?s Scientific Manuscript database

Seedling vigor and its translation to late-season vigor are, at best, murky for most beet breeders. The initial conditions a germinating seed encounters, and its ability to overcome them, affects stored energy reserves to withstand future adverse environments and the ability of the seedling to survi...

Seedling Vigor in Beta vulgaris: The Artistry of Germination

USDA-ARS?s Scientific Manuscript database

Seedling vigor and stand establishment are two problems that growers have struggled with for decades. The initial conditions that a germinating seed encounters, and its ability to deal with them, affect the rate at which germination occurs, the rate of mobilization of stored energy reserves that the...

Training for Community Development Personnel in India.

ERIC Educational Resources Information Center

Makhija, H. R.

The book traces the development of training schemes in India for community development workers. It is divided into four parts which deal with: origin and growth of the Community Development Training Programme; problems encountered and the process of solutions through trial and error; major reorganization of the initial program and the research…

Barriers to School Restructuring.

ERIC Educational Resources Information Center

Sheane, Kim; Bierlein, Louann

In 1990, the Arizona legislature initiated the Arizona School Restructuring Pilot Project. This report identifies local- and state-level barriers encountered in the first 2 years. Outcomes are presented for the 15 pilot schools--11 elementary and 4 high schools--that were selected in a competitive grant process. Data were collected through school…

Internal States and Behavioral Decision-Making: Toward an Integration of Emotion and Cognition.

PubMed

Kennedy, Ann; Asahina, Kenta; Hoopfer, Eric; Inagaki, Hidehiko; Jung, Yonil; Lee, Hyosang; Remedios, Ryan; Anderson, David J

2014-01-01

Social interactions, such as an aggressive encounter between two conspecific males or a mating encounter between a male and a female, typically progress from an initial appetitive or motivational phase, to a final consummatory phase. This progression involves both changes in the intensity of the animals' internal state of arousal or motivation and sequential changes in their behavior. How are these internal states, and their escalating intensity, encoded in the brain? Does this escalation drive the progression from the appetitive/motivational to the consummatory phase of a social interaction and, if so, how are appropriate behaviors chosen during this progression? Recent work on social behaviors in flies and mice suggests possible ways in which changes in internal state intensity during a social encounter may be encoded and coupled to appropriate behavioral decisions at appropriate phases of the interaction. These studies may have relevance to understanding how emotion states influence cognitive behavioral decisions at higher levels of brain function. Copyright © 2014 Cold Spring Harbor Laboratory Press; all rights reserved.

A Comparison of the Pencil-of-Function Method with Prony’s Method, Wiener Filters and Other Identification Techniques,

DTIC Science & Technology

1977-12-01

exponentials encountered are complex and zhey are approximately at harmonic frequencies. Moreover, the real parts of the complex exponencials are much...functions as a basis for expanding the current distribution on an antenna by the method of moments results in a regularized ill-posed problem with respect...to the current distribution on the antenna structure. However, the problem is not regularized with respect to chaoge because the chaPge distribution

Improved methods of performing coherent optical correlation

NASA Technical Reports Server (NTRS)

Husain-Abidi, A. S.

1972-01-01

Coherent optical correlators are described in which complex spatial filters are recorded by a quasi-Fourier transform method. The high-pass spatial filtering effects (due to the dynamic range of photographic films) normally encountered in Vander Lugt type complex filters are not present in this system. Experimental results for both transmittive as well as reflective objects are presented. Experiments are also performed by illuminating the object with diffused light. A correlator using paraboloidal mirror segments as the Fourier-transforming element is also described.

Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association

PubMed Central

Sarkar, Siddharth; Gupta, Nitin

2017-01-01

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal adverse event associated with the use of antipsychotics. Although atypical antipsychotics were initially considered to carry no risk of NMS, reports have accumulated over time implicating them in NMS causation. Almost all atypical antipsychotics have been reported to be associated with NMS. The clinical profile of NMS caused by certain atypical antipsychotics such as clozapine has been reported to be considerably different from the NMS produced by typical antipsychotics, with diaphoresis encountered more commonly, and rigidity and tremor encountered less frequently. This article briefly discusses the evidence relating to the occurrence, presentation and management of NMS induced by atypical antipsychotics. PMID:28811916

Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association.

PubMed

Sarkar, Siddharth; Gupta, Nitin

2017-08-01

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal adverse event associated with the use of antipsychotics. Although atypical antipsychotics were initially considered to carry no risk of NMS, reports have accumulated over time implicating them in NMS causation. Almost all atypical antipsychotics have been reported to be associated with NMS. The clinical profile of NMS caused by certain atypical antipsychotics such as clozapine has been reported to be considerably different from the NMS produced by typical antipsychotics, with diaphoresis encountered more commonly, and rigidity and tremor encountered less frequently. This article briefly discusses the evidence relating to the occurrence, presentation and management of NMS induced by atypical antipsychotics.

Serotonin and aggressive motivation in crustaceans: altering the decision to retreat.

PubMed

Huber, R; Smith, K; Delago, A; Isaksson, K; Kravitz, E A

1997-05-27

In crustaceans, as in most animal species, the amine serotonin has been suggested to serve important roles in aggression. Here we show that injection of serotonin into the hemolymph of subordinate, freely moving animals results in a renewed willingness of these animals to engage the dominants in further agonistic encounters. By multivariate statistical analysis, we demonstrate that this reversal results principally from a reduction in the likelihood of retreat and an increase in the duration of fighting. Serotonin infusion does not alter other aspects of fighting behavior, including which animal initiates an encounter, how quickly fighting escalates, or which animal eventually retreats. Preliminary studies suggest that serotonin uptake plays an important role in this behavioral reversal.

ICE telemetry performance

NASA Technical Reports Server (NTRS)

Layland, J. W.

1986-01-01

Acquiring telemetry data from the International Cometary Explorer (ICE) at its encounter with the comet Giacobini-Zinner on September 11, 1985 proved to be among the more difficult challenges the DSN has met in recent years. The ICE spacecraft began its life as an Earth orbiting monitor of the Solar Wind. At the comet, ICE was nearly 50 times as distant as in its initial role, with its signal strength diminished nearly 2500 times. Collecting enough of that weak signal to provide meaningful scientific data about the comet required unique new telemetry capabilities and special handling by the DSN. This article describes the development and validation of the DSN telemetry capability for ICE from its early planning stages through the successful comet encounter.

Ion Composition in Titan's Exosphere from the Cassini Plasma Spectrometer

NASA Astrophysics Data System (ADS)

Woodson, A.; Smith, H. T.; Johnson, R. E.

2013-12-01

A primary goal of the Cassini mission has been to characterize the complex interaction between Saturn's magnetosphere and Titan's ionosphere. To this end, the Cassini spacecraft carries two instruments-the Ion and Neutral Mass Spectrometer (INMS) and the Cassini Plasma Spectrometer (CAPS)-capable of energy- and mass-analysis. The Ion Mass Spectrometer (IMS), one of three instruments composing CAPS, is designed to characterize diffuse plasmas throughout the magnetosphere while the INMS is optimized for measurements within Titan's upper atmosphere. As such, mass-resolved ion compositions confirming a variety of hydrocarbons and nitriles have been extracted from INMS data for numerous Titan encounters. Similar analysis of IMS data, however, has largely been resolution-limited to the identification of 'light' and 'heavy' ion groups in the wake. Herein we present a technique for extracting Dalton-resolved ion compositions from IMS spectra acquired below ~5 Titan radii. The method is then applied to data from the T40 encounter and the resulting relative abundances compared with those derived from the INMS data for the same encounter.

Individual and Situational Factors Associated with Social Barriers for Persons with Mobility Impairment

ERIC Educational Resources Information Center

McCaughey, Tiffany

2009-01-01

Decades of research have examined factors involved in complex, and sometimes stressful, interpersonal interactions between individuals with and without disabilities. The present study applies structural equation modeling to test an integrative model of individual and situational factors affecting encounters between able-bodied college students and…

ArcFuels10 system overview

Treesearch

Nicole M. Vaillant; Alan A. Ager; John Anderson

2013-01-01

Fire behavior modeling and geospatial analyses can provide tremendous insight for land managers as they grapple with the complex problems frequently encountered in wildfire risk assessments and fire and fuels management planning. Fuel management often is a particularly complicated process in which the benefits and potential impacts of fuel treatments need to be...

Language Choice in Multilingual Encounters in Transnational Workplaces

ERIC Educational Resources Information Center

Kingsley, Leilarna

2013-01-01

This paper is based on research conducted in banks in the international banking centre of Luxembourg. Operating in the globalised context of international banking and multilingual Luxembourg, financial institutions are an ideal focal point for investigating policy and practices in complex multilingual and transnational work spaces. Two theoretical…

Improving the Design of Workplace E-Learning Research

ERIC Educational Resources Information Center

Dubois, Cathy; Long, Lori

2012-01-01

E-learning researchers face considerable challenges in creating meaningful and generalizable studies due to the complex nature of this dynamic training medium. Our experience in conducting workplace e-learning research led us to create this guide for planning research on e-learning. We share the unanticipated complications we encountered in our…

Impact of Military Deployment and Distance Learning on Soldier-Students

ERIC Educational Resources Information Center

Murray, August T.

2013-01-01

Soldiers face complex challenges, issues, and decisions when pursuing distance learning while deployed. These challenges are encountered frequently while completing undergraduate and graduate degree programs on active duty overseas. Many learning programs and benefits are available and utilized by military online learners in a war zone. Education…

Encountering Complexity: Native Musics in the Curriculum.

ERIC Educational Resources Information Center

Boyea, Andrea

1999-01-01

Describes Native American musics, focusing on issues such as music and the experience of time, metaphor and metaphorical aspects, and spirituality and sounds from nature. Discusses Native American metaphysics and its reflection in the musics. States that an effective curriculum would provide a new receptivity to Native American musics. (CMK)

Case Studies on Educational Administration. Third Edition.

ERIC Educational Resources Information Center

Kowalski, Theodore J.

This book contains 24 case studies selected to demonstrate the different types of challenges in contemporary educational leadership. It is intended to help prospective administrators develop decision-making skills. The cases are quite complex with multiple viewpoints and aspects. They represent a range of problems encountered by practitioners in…

Teaching Listening Skills to JFL Students in Australia.

ERIC Educational Resources Information Center

Danaher, Mike

1996-01-01

Examines issues affecting the teaching and learning of listening skills within the study of Japanese as a Foreign Language. Listening within foreign-language learning is a complex skill, and students encounter several difficulties in learning to listen for comprehension. Teachers face concerns ranging from resource availability to how to teach…

Conceptual Complexity and Apparent Contradictions in Mathematics Language

ERIC Educational Resources Information Center

Gough, John

2007-01-01

Mathematics is like a language, although technically it is not a natural or informal human language, but a formal, that is, artificially constructed language. Importantly, educators use their natural everyday language to teach the formal language of mathematics. At times, however, instructors encounter problems when the technical words they use,…

Enhancing Reflective Practice in Multicultural Counseling through Cultural Auditing

ERIC Educational Resources Information Center

Collins, Sandra; Arthur, Nancy; Wong-Wylie, Gina

2010-01-01

Counselors work in an increasingly complex cultural milieu where every encounter with a client must be considered multicultural in nature. Reflective practice is a central component of professional competence and necessarily involves attention to culture. The cultural auditing model provides an effective and flexible reflective process for…

Reconceptualising Family: Negotiating Sexuality in a Governmental Climate of Neoliberalism

ERIC Educational Resources Information Center

Davies, Cristyn; Robinson, Kerry H.

2013-01-01

Based on qualitative research, this article examines the complex kinship relations involved in constructing queer families. The discussion focuses on the heterogeneity of queer families; the difficulties encountered in association with processes of recognition and how this is negotiated across different contexts within queer families, extended…

Road Signs in Ethical Quicksand.

ERIC Educational Resources Information Center

Jerrell, S. Lee; Jerrell, Jeanette M.

1985-01-01

Some of the major moral and ethical dilemmas illustrated by authors in this special journal issue are highlighted. From an ethical viewpoint, the complexity of evaluation activities is likened to "quicksand" terrain in which directional or warning signs should be erected to aid personal choices when such issues are encountered.…

Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 3.0.

PubMed

Simon, Tamara D; Haaland, Wren; Hawley, Katherine; Lambka, Karen; Mangione-Smith, Rita

2018-02-26

To modify the Pediatric Medical Complexity Algorithm (PMCA) to include both International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) codes for classifying children with chronic disease (CD) by level of medical complexity and to assess the sensitivity and specificity of the new PMCA version 3.0 for correctly identifying level of medical complexity. To create version 3.0, PMCA version 2.0 was modified to include ICD-10-CM codes. We applied PMCA version 3.0 to Seattle Children's Hospital data for children with ≥1 emergency department (ED), day surgery, and/or inpatient encounter from January 1, 2016, to June 30, 2017. Starting with the encounter date, up to 3 years of retrospective discharge data were used to classify children as having complex chronic disease (C-CD), noncomplex chronic disease (NC-CD), and no CD. We then selected a random sample of 300 children (100 per CD group). Blinded medical record review was conducted to ascertain the levels of medical complexity for these 300 children. The sensitivity and specificity of PMCA version 3.0 was assessed. PMCA version 3.0 identified children with C-CD with 86% sensitivity and 86% specificity, children with NC-CD with 65% sensitivity and 84% specificity, and children without CD with 77% sensitivity and 93% specificity. PMCA version 3.0 is an updated publicly available algorithm that identifies children with C-CD, who have accessed tertiary hospital emergency department, day surgery, or inpatient care, with very good sensitivity and specificity when applied to hospital discharge data and with performance to earlier versions of PMCA. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Hospitalist workload influences faculty evaluations by internal medicine clerkship students.

PubMed

Robinson, Robert L

2015-01-01

The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. The results suggest that internal medicine clerkship student evaluations of hospitalist faculty are negatively influenced by high clinical service intensity measured in terms of annual work RVUs, patient encounters, and duty days.

Pharmacy users’ expectations of pharmacy encounters: a Q‐methodological study

PubMed Central

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Åsa; Tully, Mary P.

2010-01-01

Abstract Background  Pharmacy practice is evolving according to general health‐care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under‐explored topic but crucial to understanding how pharmacy practice can evolve efficiently. Objective  To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Methods  Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Setting and participants  Eighty‐five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Results  Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual’s own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health‐care and lifestyle support. Discussion and conclusions  The systematic Q‐methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients’ expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. PMID:21199199

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

Araujo, R. A. N.; Sfair, R.; Winter, O. C., E-mail: ran.araujo@gmail.com, E-mail: rsfair@feg.unesp.br, E-mail: ocwinter@gmail.com

The Centaur population is composed of minor bodies wandering between the giant planets that frequently perform close gravitational encounters with these planets, leading to a chaotic orbital evolution. Recently, the discovery of two well-defined narrow rings was announced around the Centaur 10199 Chariklo. The rings are assumed to be in the equatorial plane of Chariklo and to have circular orbits. The existence of a well-defined system of rings around a body in such a perturbed orbital region poses an interesting new problem. Are the rings of Chariklo stable when perturbed by close gravitational encounters with the giant planets? Our approachmore » to address this question consisted of forward and backward numerical simulations of 729 clones of Chariklo, with similar initial orbits, for a period of 100 Myr. We found, on average, that each clone experiences during its lifetime more than 150 close encounters with the giant planets within one Hill radius of the planet in question. We identified some extreme close encounters that were able to significantly disrupt or disturb the rings of Chariklo. About 3% of the clones lose their rings and about 4% of the clones have their rings significantly disturbed. Therefore, our results show that in most cases (more than 90%), the close encounters with the giant planets do not affect the stability of the rings in Chariklo-like systems. Thus, if there is an efficient mechanism that creates the rings, then these structures may be common among these kinds of Centaurs.« less

Pharmacy users' expectations of pharmacy encounters: a Q-methodological study.

PubMed

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Asa; Tully, Mary P

2011-12-01

Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. © 2010 Blackwell Publishing Ltd.

A mixed methods study of patient-provider communication about opioid analgesics.

PubMed

Hughes, Helen Kinsman; Korthuis, Philip Todd; Saha, Somnath; Eggly, Susan; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Beach, Mary Catherine

2015-04-01

To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients. We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients. 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed. Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients. Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[The heuristics of reaching a diagnosis].

PubMed

Wainstein, Eduardo

2009-12-01

Making a diagnosis in medicine is a complex process in which many cognitive and psychological issues are involved. After the first encounter with the patient, an unconscious process ensues to suspect the presence of a particular disease. Usually, complementary tests are requested to confirm the clinical suspicion. The interpretation of requested tests can be biased by the clinical diagnosis that was considered in the first encounter with the patient. The awareness of these sources of error is essential in the interpretation of the findings that will eventually lead to a final diagnosis. This article discusses some aspects of the heuristics involved in the adjudication of priory probabilities and provides a brief review of current concepts of the reasoning process.

North American paragonimiasis (Caused by Paragonimus kellicotti) in the context of global paragonimiasis.

PubMed

Procop, Gary W

2009-07-01

Paragonimus species are highly evolved parasites with a complex life cycle that involves at least three different hosts, i.e., snails, crustaceans, and mammals. The adult forms of Paragonimus species reside and mate in the lungs of a variety of permissive mammalian hosts, including humans. Although human paragonimiasis is uncommonly encountered in North America, both autochthonous and imported disease may be encountered. Paragonimus kellicotti, the species endemic to North America, is a well-known pathogen in wild and domestic animals. Five patients with North American paragonimiasis have been reported in the recent medical literature. The biologic, clinical, radiologic, and laboratory features of paragonimiasis are reviewed, with emphasis on North American paragonimiasis whenever possible.

History dependence in insect flight decisions during odor tracking.

PubMed

Pang, Rich; van Breugel, Floris; Dickinson, Michael; Riffell, Jeffrey A; Fairhall, Adrienne

2018-02-01

Natural decision-making often involves extended decision sequences in response to variable stimuli with complex structure. As an example, many animals follow odor plumes to locate food sources or mates, but turbulence breaks up the advected odor signal into intermittent filaments and puffs. This scenario provides an opportunity to ask how animals use sparse, instantaneous, and stochastic signal encounters to generate goal-oriented behavioral sequences. Here we examined the trajectories of flying fruit flies (Drosophila melanogaster) and mosquitoes (Aedes aegypti) navigating in controlled plumes of attractive odorants. While it is known that mean odor-triggered flight responses are dominated by upwind turns, individual responses are highly variable. We asked whether deviations from mean responses depended on specific features of odor encounters, and found that odor-triggered turns were slightly but significantly modulated by two features of odor encounters. First, encounters with higher concentrations triggered stronger upwind turns. Second, encounters occurring later in a sequence triggered weaker upwind turns. To contextualize the latter history dependence theoretically, we examined trajectories simulated from three normative tracking strategies. We found that neither a purely reactive strategy nor a strategy in which the tracker learned the plume centerline over time captured the observed history dependence. In contrast, "infotaxis", in which flight decisions maximized expected information gain about source location, exhibited a history dependence aligned in sign with the data, though much larger in magnitude. These findings suggest that while true plume tracking is dominated by a reactive odor response it might also involve a history-dependent modulation of responses consistent with the accumulation of information about a source over multi-encounter timescales. This suggests that short-term memory processes modulating decision sequences may play a role in natural plume tracking.

History dependence in insect flight decisions during odor tracking

PubMed Central

van Breugel, Floris; Dickinson, Michael; Riffell, Jeffrey A.; Fairhall, Adrienne

2018-01-01

Natural decision-making often involves extended decision sequences in response to variable stimuli with complex structure. As an example, many animals follow odor plumes to locate food sources or mates, but turbulence breaks up the advected odor signal into intermittent filaments and puffs. This scenario provides an opportunity to ask how animals use sparse, instantaneous, and stochastic signal encounters to generate goal-oriented behavioral sequences. Here we examined the trajectories of flying fruit flies (Drosophila melanogaster) and mosquitoes (Aedes aegypti) navigating in controlled plumes of attractive odorants. While it is known that mean odor-triggered flight responses are dominated by upwind turns, individual responses are highly variable. We asked whether deviations from mean responses depended on specific features of odor encounters, and found that odor-triggered turns were slightly but significantly modulated by two features of odor encounters. First, encounters with higher concentrations triggered stronger upwind turns. Second, encounters occurring later in a sequence triggered weaker upwind turns. To contextualize the latter history dependence theoretically, we examined trajectories simulated from three normative tracking strategies. We found that neither a purely reactive strategy nor a strategy in which the tracker learned the plume centerline over time captured the observed history dependence. In contrast, “infotaxis”, in which flight decisions maximized expected information gain about source location, exhibited a history dependence aligned in sign with the data, though much larger in magnitude. These findings suggest that while true plume tracking is dominated by a reactive odor response it might also involve a history-dependent modulation of responses consistent with the accumulation of information about a source over multi-encounter timescales. This suggests that short-term memory processes modulating decision sequences may play a role in natural plume tracking. PMID:29432454

Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

PubMed

Carson, Matthew B; Scholtens, Denise M; Frailey, Conor N; Gravenor, Stephanie J; Powell, Emilie S; Wang, Amy Y; Kricke, Gayle Shier; Ahmad, Faraz S; Mutharasan, R Kannan; Soulakis, Nicholas D

2016-11-01

The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment. We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the shared positive outcome ratio, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters. Satisfaction rates seem to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes. © 2016 American Heart Association, Inc.

The Behavior of Regular Satellites during the Nice Model's Planetary Close Encounters

NASA Astrophysics Data System (ADS)

Nogueira, E. C.; Gomes, R. S.; Brasser, R.

2014-10-01

In order to explain the behavior of the regular satellites of the ice planets during the instability phase of the Nice model, we used numerical simulations to investigate the evolution of the satellite systems when these two planets experienced encounters with the gas giants. For the initial conditions we placed an ice planet in between Jupiter and Saturn, according to the evolution of Nice model simulations in a jumping Jupiter scenario (Brasser et al. 2009). We used the MERCURY integrator (Chambers 1999) and we obtained 101 successful runs which kept all planets, of which 24 were jumping Jupiter cases. Subsequently we performed additional numerical integrations in which the ice giant that encountered a gas giant was started on the same orbit but with its regular satellites included. This is done as follows: For each of the 101 basic runs, we save the orbital elements of all objects in the integration at all close encounter events. Then we performed a backward integration to start the system 100 years before the encounter and re-enacted the forward integration with the regular satellites around the ice giant. The final orbital elements of the satellites with respect to the ice planet were used to restart the integration for the next planetary encounter. If we assume that Uranus is the ice planet that had encounters with a gas giant, we considered the satellites Miranda, Ariel, Umbriel, Titania and Oberon with their present orbits. For Neptune we introduced Triton with an orbit with a 15% larger than the actual semi-major axis to account for the tidal decay from the LHB to present time. We also assume that Triton was captured through binary disruption (Agnor and Hamilton 2006, Nogueira et al. 2011) and its orbit was circularized by tides during the 500 million years before the LHB.

Integration of Research Into Science-outreach (IRIS): A Video and Web-based Approach

NASA Astrophysics Data System (ADS)

Clay, P. L.; O'Driscoll, B.

2013-12-01

The development of the IRIS (Integration of Research Into Science-outreach) initiative is aimed at using field- and laboratory- based videos and blog entries to enable a sustained outreach relationship between university researchers and local classrooms. IRIS seeks to communicate complex, cutting-edge scientific research in the Earth and Planetary sciences to school-aged children in a simple and interesting manner, in the hope of ameliorating the overall decline of children entering into science and engineering fields in future generations. The primary method of delivery IRIS utilizes is the media of film, ';webinars' and blog entries. Filmed sequences of laboratory work, field work, science demos and mini webinars on current and relevant material in the Earth and Planetary sciences are ';subscribed' to by local schools. Selected sequences are delivered in 20-30 minute film segments with accompanying written material. The level at which the subject matter is currently geared is towards secondary level school-aged children, with the purpose of inspiring and encouraging curiosity, learning and development in scientific research. The video broadcasts are supplemented by a hands-on visit 1-2 times per year by a group of scientists participating in the filmed sequences to the subscribing class, with the objective of engaging and establishing a natural rapport between the class and the scientists that they see in the broadcasts. This transgresses boundaries that traditional 'one off' outreach platforms often aren't able to achieve. The initial results of the IRIS outreach initiative including successes, problems encountered and classroom feedback will be reported.

The impact of communication barriers on diagnostic confidence and ancillary testing in the emergency department.

PubMed

Garra, Gregory; Albino, Hiram; Chapman, Heather; Singer, Adam J; Thode, Henry C

2010-06-01

Communication barriers (CBs) compromise the diagnostic power of the medical interview and may result in increased reliance on diagnostic tests or incorrect test ordering. The prevalence and degree to which these barriers affect diagnosis, testing, and treatment are unknown. To quantify and characterize CBs encountered in the Emergency Department (ED), and assess the effect of CBs on initial diagnosis and perceived reliance on ancillary testing. This was a prospective survey completed by emergency physicians after initial adult patient encounters. CB severity, diagnostic confidence, and reliance on ancillary testing were quantified on a 100-mm Visual Analog Scale (VAS) from least (0) to most (100). Data were collected on 417 ED patient encounters. CBs were reported in 46%; with a mean severity of 50 mm on a 100-mm VAS with endpoints of "perfect communication and "no communication." Language was the most commonly reported form of CB (28%). More than one CB was identified in 6%. The 100-mm VAS rating of diagnostic confidence was lower in patients with perceived CBs (64 mm) vs. those without CBs (80 mm), p < 0.001. VAS ratings of physician reliance on ancillary testing was higher in patients with perceived CBs (50 mm) vs. patients without a perceived CB (38 mm), p < 0.001. Communication barriers in our ED setting were common, and resulted in lower diagnostic confidence and increased perception that ancillary tests are needed to narrow the diagnosis. Copyright 2010 Elsevier Inc. All rights reserved.

Predator-prey pursuit-evasion games in structurally complex environments.

PubMed

Morice, Sylvie; Pincebourde, Sylvain; Darboux, Frédéric; Kaiser, Wilfried; Casas, Jérôme

2013-11-01

Pursuit and evasion behaviors in many predator-prey encounters occur in a geometrically structured environment. The physical structures in the environment impose strong constraints on the perception and behavioral responses of both antagonists. Nevertheless, no experimental or theoretical study has tackled the issue of quantifying the role of the habitat's architecture on the joint trajectories during a predator-prey encounter. In this study, we report the influence of microtopography of forest leaf litter on the pursuit-evasion trajectories of wolf spiders Pardosa sp. attacking the wood cricket Nemobius sylvestris. Fourteen intact leaf litter samples of 1 m × 0.5 m were extracted from an oak-beech forest floor in summer and winter, with later samples having the most recently fallen leaves. Elevation was mapped at a spatial resolution of 0.5 mm using a laser scanner. Litter structuring patterns were identified by height transects and experimental semi-variograms. Detailed analysis of all visible leaf-fragments of one sample enabled us to relate the observed statistical patterns to the underlying geometry of individual elements. Video recording of pursuit-evasion sequences in arenas with flat paper or leaf litter enabled us to estimate attack and fleeing distances as a function of substrate. The compaction index, the length of contiguous flat surfaces, and the experimental variograms showed that the leaf litter was smoother in summer than in winter. Thus, weathering as well as biotic activities compacted and flattened the litter over time. We found good agreement between the size of the structuring unit of leaf litter and the distance over which attack and escape behaviors both were initiated (both ∼3 cm). There was a four-fold topographical effect on pursuit-escape sequences; compared with a flat surface, leaf litter (1) greatly reduced the likelihood of launching a pursuit, (2) reduced pursuit and escape distances by half, (3) put prey and predator on par in terms of pursuit and escape distances, and (4) reduced the likelihood of secondary pursuits, after initial escape of the prey, to nearly zero. Thus, geometry of the habitat strongly modulates the rules of pursuit-evasion in predator-prey interactions in the wild.

Situated clinical encounters in the negotiation of religious and spiritual plurality: a critical ethnography.

PubMed

Pesut, Barbara; Reimer-Kirkham, Sheryl

2010-07-01

Despite increasingly diverse, globalized societies, little attention has been paid to the influence of religious and spiritual diversity on clinical encounters within healthcare. The purpose of the study was to analyze the negotiation of religious and spiritual plurality in clinical encounters, and the social, gendered, cultural, historical, economic and political contexts that shape that negotiation. Qualitative: critical ethnography. The study was conducted in Western Canada between 2006 and 2009. Data collection occurred on palliative, hospice, medical and renal in-patient units at two tertiary level hospitals and seven community hospitals. Participants were recruited through purposive sampling and snowball technique. Twenty healthcare professionals, seventeen spiritual care providers, sixteen patients and families and twelve administrators, representing diverse ethnicities and religious affiliations, took part in the study. Data collection included 65 in-depth interviews and over 150h of participant observation. Clinical encounters between care providers and recipients were shaped by how individual identities in relation to religion and spirituality were constructed. Importantly, these identities did not occur in isolation from other lines of social classification such as gender, race, and class. Negotiating difference was a process of seeing spirituality as a point of connection, eliciting the meaning systems of patients and creating safe spaces for the expression of that meaning. The complexity of religious and spiritual identity construction and negotiation raises important questions about language and about professional competence and boundaries in clinical encounters where religion and spirituality are relevant concerns. Copyright 2009 Elsevier Ltd. All rights reserved.

Air-flow distortion and turbulence statistics near an animal facility

NASA Astrophysics Data System (ADS)

Prueger, J. H.; Eichinger, W. E.; Hipps, L. E.; Hatfield, J. L.; Cooper, D. I.

The emission and dispersion of particulates and gases from concentrated animal feeding operations (CAFO) at local to regional scales is a current issue in science and society. The transport of particulates, odors and toxic chemical species from the source into the local and eventually regional atmosphere is largely determined by turbulence. Any models that attempt to simulate the dispersion of particles must either specify or assume various statistical properties of the turbulence field. Statistical properties of turbulence are well documented for idealized boundary layers above uniform surfaces. However, an animal production facility is a complex surface with structures that act as bluff bodies that distort the turbulence intensity near the buildings. As a result, the initial release and subsequent dispersion of effluents in the region near a facility will be affected by the complex nature of the surface. Previous Lidar studies of plume dispersion over the facility used in this study indicated that plumes move in complex yet organized patterns that would not be explained by the properties of turbulence generally assumed in models. The objective of this study was to characterize the near-surface turbulence statistics in the flow field around an array of animal confinement buildings. Eddy covariance towers were erected in the upwind, within the building array and downwind regions of the flow field. Substantial changes in turbulence intensity statistics and turbulence-kinetic energy (TKE) were observed as the mean wind flow encountered the building structures. Spectra analysis demonstrated unique distribution of the spectral energy in the vertical profile above the buildings.

Estimating Preferences for Complex Health Technologies: Lessons Learned and Implications for Personalized Medicine.

PubMed

Marshall, Deborah A; Gonzalez, Juan Marcos; MacDonald, Karen V; Johnson, F Reed

2017-01-01

We examine key study design challenges of using stated-preference methods to estimate the value of whole-genome sequencing (WGS) as a specific example of genomic testing. Assessing the value of WGS is complex because WGS provides multiple findings, some of which can be incidental in nature and unrelated to the specific health concerns that motivated the test. In addition, WGS results can include actionable findings (variants considered to be clinically useful and can be acted on), findings for which evidence for best clinical action is not available (variants considered clinically valid but do not meet as high of a standard for clinical usefulness), and findings of unknown significance. We consider three key challenges encountered in designing our national study on the value of WGS-layers of uncertainty, potential downstream consequences with endogenous aspects, and both positive and negative utility associated with testing information-and potential solutions as strategies to address these challenges. We conceptualized the decision to acquire WGS information as a series of sequential choices that are resolved separately. To determine the value of WGS information at the initial decision to undergo WGS, we used contingent valuation questions, and to elicit respondent preferences for reducing risks of health problems and the consequences of taking the steps to reduce these risks, we used a discrete-choice experiment. We conclude by considering the implications for evaluating the value of other complex health technologies that involve multiple forms of uncertainty. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Medical support for law enforcement-extended operations incidents.

PubMed

Levy, Matthew J; Tang, Nelson

2014-01-01

As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. This study retrospectively examined the clinical encounters of the Maryland State Police (MSP) Tactical Medical Unit (TMU) during law enforcement extended operations incidents lasting 8 or more hours. In addition, a qualitative analysis was performed on clinical data collected by federal law enforcement agencies during their extended operations. Forty-four percent of missions (455/1,047) supported by the MSP TMU lasted 8 or more hours. Twenty-six percent of these missions (117/455) resulted in at least one patient encounter. Nineteen percent of patient chief complaints (45/238) were related to heat illness/ dehydration. Fifteen percent of encounters (36/238) were for musculoskeletal injury/pain. Eight percent of patients (19/238) had nonspecific sick call (minor illness) complaints. The next most common occurring complaints were cold-related injuries, headache, sinus congestion, and wound/laceration, each of which accounted for 7 percent of patients (16/238), respectively. Analysis of federal law enforcement agencies' response to such events yielded similar clinical encounters. A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints reported during extended operations involves the deployment of a well-trained medical support team using the core concepts of tactical emergency medical support.

Limitations of Medical Research and Evidence at the Patient-Clinician Encounter Scale

PubMed Central

Ioannidis, John P. A.

2013-01-01

We explore some philosophical and scientific underpinnings of clinical research and evidence at the patient-clinician encounter scale. Insufficient evidence and a common failure to use replicable and sound research methods limit us. Both patients and health care may be, in part, complex nonlinear chaotic systems, and predicting their outcomes is a challenge. When trustworthy (credible) evidence is lacking, making correct clinical choices is often a low-probability exercise. Thus, human (clinician) error and consequent injury to patients appear inevitable. Individual clinician decision-makers operate under the philosophical influence of Adam Smith’s “invisible hand” with resulting optimism that they will eventually make the right choices and cause health benefits. The presumption of an effective “invisible hand” operating in health-care delivery has supported a model in which individual clinicians struggle to practice medicine, as they see fit based on their own intuitions and preferences (and biases) despite the obvious complexity, errors, noise, and lack of evidence pervading the system. Not surprisingly, the “invisible hand” does not appear to produce the desired community health benefits. Obtaining a benefit at the patient-clinician encounter scale requires human (clinician) behavior modification. We believe that serious rethinking and restructuring of the clinical research and care delivery systems is necessary to assure the profession and the public that we continue to do more good than harm. We need to evaluate whether, and how, detailed decision-support tools may enable reproducible clinician behavior and beneficial use of evidence. PMID:23546485

Limitations of medical research and evidence at the patient-clinician encounter scale.

PubMed

Morris, Alan H; Ioannidis, John P A

2013-04-01

We explore some philosophical and scientific underpinnings of clinical research and evidence at the patient-clinician encounter scale. Insufficient evidence and a common failure to use replicable and sound research methods limit us. Both patients and health care may be, in part, complex nonlinear chaotic systems, and predicting their outcomes is a challenge. When trustworthy (credible) evidence is lacking, making correct clinical choices is often a low-probability exercise. Thus, human (clinician) error and consequent injury to patients appear inevitable. Individual clinician decision-makers operate under the philosophical influence of Adam Smith's "invisible hand" with resulting optimism that they will eventually make the right choices and cause health benefits. The presumption of an effective "invisible hand" operating in health-care delivery has supported a model in which individual clinicians struggle to practice medicine, as they see fit based on their own intuitions and preferences (and biases) despite the obvious complexity, errors, noise, and lack of evidence pervading the system. Not surprisingly, the "invisible hand" does not appear to produce the desired community health benefits. Obtaining a benefit at the patient-clinician encounter scale requires human (clinician) behavior modification. We believe that serious rethinking and restructuring of the clinical research and care delivery systems is necessary to assure the profession and the public that we continue to do more good than harm. We need to evaluate whether, and how, detailed decision-support tools may enable reproducible clinician behavior and beneficial use of evidence.

MPA in Labor: Securing the Pearl Cays of Nicaragua

NASA Astrophysics Data System (ADS)

Gonzalez, Clarence; Jentoft, Svein

2011-04-01

Implementation of Marine Protected Areas (MPAs) has always a step-zero, i.e., an initial phase when the idea is incepted, communicated and negotiated among stakeholders. What happens during this phase is likely to have an impact later on. If not done right, the management of the MPA may encounter problems at later stage that will be difficult to correct. Inspired by this working theory, this article describes the effort to establish the Pearl Cays off the Caribbean coast of Nicaragua as a protected area. This case-study illustrates the critical actions to be taken during step-zero, i.e., what needs to be considered and done before an MPA is formally declared. The area investigated consists of a number of small islands (cays) and coral reefs, fishing grounds and marine turtle nesting areas. Throughout history, the cays have played an important role in sustaining livelihoods of nearby communities. Although the idea of an MPA was originally conservation, the communities saw it as an opportunity to regain ownership and control of the cays. By Nicaraguan law, in order to establish protected areas, consultation and approval from local people is required. In the case of the Pearl Cays, this has proved difficult. The article demonstrates how MPA initiatives must sometimes relate to already ongoing complex social processes in the area where they are to be instigated.

MPA in labor: securing the Pearl Cays of Nicaragua.

PubMed

Gonzalez, Clarence; Jentoft, Svein

2011-04-01

Implementation of Marine Protected Areas (MPAs) has always a step-zero, i.e., an initial phase when the idea is incepted, communicated and negotiated among stakeholders. What happens during this phase is likely to have an impact later on. If not done right, the management of the MPA may encounter problems at later stage that will be difficult to correct. Inspired by this working theory, this article describes the effort to establish the Pearl Cays off the Caribbean coast of Nicaragua as a protected area. This case-study illustrates the critical actions to be taken during step-zero, i.e., what needs to be considered and done before an MPA is formally declared. The area investigated consists of a number of small islands (cays) and coral reefs, fishing grounds and marine turtle nesting areas. Throughout history, the cays have played an important role in sustaining livelihoods of nearby communities. Although the idea of an MPA was originally conservation, the communities saw it as an opportunity to regain ownership and control of the cays. By Nicaraguan law, in order to establish protected areas, consultation and approval from local people is required. In the case of the Pearl Cays, this has proved difficult. The article demonstrates how MPA initiatives must sometimes relate to already ongoing complex social processes in the area where they are to be instigated.

Active listening for spatial orientation in a complex auditory scene.

PubMed

Moss, Cynthia F; Bohn, Kari; Gilkenson, Hannah; Surlykke, Annemarie

2006-04-01

To successfully negotiate a complex environment, an animal must control the timing of motor behaviors in coordination with dynamic sensory information. Here, we report on adaptive temporal control of vocal-motor behavior in an echolocating bat, Eptesicus fuscus, as it captured tethered insects close to background vegetation. Recordings of the bat's sonar vocalizations were synchronized with high-speed video images that were used to reconstruct the bat's three-dimensional flight path and the positions of target and vegetation. When the bat encountered the difficult task of taking insects as close as 10-20 cm from the vegetation, its behavior changed significantly from that under open room conditions. Its success rate decreased by about 50%, its time to initiate interception increased by a factor of ten, and its high repetition rate "terminal buzz" decreased in duration by a factor of three. Under all conditions, the bat produced prominent sonar "strobe groups," clusters of echolocation pulses with stable intervals. In the final stages of insect capture, the bat produced strobe groups at a higher incidence when the insect was positioned near clutter. Strobe groups occurred at all phases of the wingbeat (and inferred respiration) cycle, challenging the hypothesis of strict synchronization between respiration and sound production in echolocating bats. The results of this study provide a clear demonstration of temporal vocal-motor control that directly impacts the signals used for perception.

Active Listening for Spatial Orientation in a Complex Auditory Scene

PubMed Central

Bohn, Kari; Gilkenson, Hannah; Surlykke, Annemarie

2006-01-01

To successfully negotiate a complex environment, an animal must control the timing of motor behaviors in coordination with dynamic sensory information. Here, we report on adaptive temporal control of vocal–motor behavior in an echolocating bat, Eptesicus fuscus, as it captured tethered insects close to background vegetation. Recordings of the bat's sonar vocalizations were synchronized with high-speed video images that were used to reconstruct the bat's three-dimensional flight path and the positions of target and vegetation. When the bat encountered the difficult task of taking insects as close as 10–20 cm from the vegetation, its behavior changed significantly from that under open room conditions. Its success rate decreased by about 50%, its time to initiate interception increased by a factor of ten, and its high repetition rate “terminal buzz” decreased in duration by a factor of three. Under all conditions, the bat produced prominent sonar “strobe groups,” clusters of echolocation pulses with stable intervals. In the final stages of insect capture, the bat produced strobe groups at a higher incidence when the insect was positioned near clutter. Strobe groups occurred at all phases of the wingbeat (and inferred respiration) cycle, challenging the hypothesis of strict synchronization between respiration and sound production in echolocating bats. The results of this study provide a clear demonstration of temporal vocal–motor control that directly impacts the signals used for perception. PMID:16509770

An Enriched Environment Promotes Shelter-Seeking Behaviour and Survival of Hatchery-Produced Juvenile European Lobster (Homarus gammarus)

PubMed Central

Aspaas, Stian; Grefsrud, Ellen Sofie; Fernö, Anders; Jensen, Knut Helge; Trengereid, Henrik; Agnalt, Ann-Lisbeth

2016-01-01

The high loss of newly released hatchery-reared European lobster (Homarus gammarus) juveniles for stock enhancement is believed to be the result of maladaptive anti-predator behaviour connected to deprived stimuli in the hatchery environment. Our objective was to learn if an enriched hatchery environment enhances shelter-seeking behaviour and survival. In the “naïve” treatment, the juveniles were raised in single compartments without substrate and shelter whereas juveniles in the “exposed” treatment experienced substrate, shelter and interactions with conspecifics. Three experiments with increasing complexity were conducted. Few differences in shelter-seeking behaviour were found between treatments when one naïve or one exposed juvenile were observed alone. When observing interactions between one naïve and one exposed juvenile competing for shelter, naïve juveniles more often initiated the first aggressive encounter. The third experiment was set up to simulate a release for stock enhancement. Naïve and exposed juveniles were introduced to a semi-natural environment including substrate, a limited number of shelters and interactions with conspecifics. Shelter occupancy was recorded three times during a period of 35 days. Exposed juveniles occupied more shelters, grew larger and had higher survival compared with naïve juveniles. Our results demonstrate that experience of environmental complexity and social interactions increase shelter-seeking ability and survival in hatchery reared lobster juveniles. PMID:27560932

An Enriched Environment Promotes Shelter-Seeking Behaviour and Survival of Hatchery-Produced Juvenile European Lobster (Homarus gammarus).

PubMed

Aspaas, Stian; Grefsrud, Ellen Sofie; Fernö, Anders; Jensen, Knut Helge; Trengereid, Henrik; Agnalt, Ann-Lisbeth

2016-01-01

The high loss of newly released hatchery-reared European lobster (Homarus gammarus) juveniles for stock enhancement is believed to be the result of maladaptive anti-predator behaviour connected to deprived stimuli in the hatchery environment. Our objective was to learn if an enriched hatchery environment enhances shelter-seeking behaviour and survival. In the "naïve" treatment, the juveniles were raised in single compartments without substrate and shelter whereas juveniles in the "exposed" treatment experienced substrate, shelter and interactions with conspecifics. Three experiments with increasing complexity were conducted. Few differences in shelter-seeking behaviour were found between treatments when one naïve or one exposed juvenile were observed alone. When observing interactions between one naïve and one exposed juvenile competing for shelter, naïve juveniles more often initiated the first aggressive encounter. The third experiment was set up to simulate a release for stock enhancement. Naïve and exposed juveniles were introduced to a semi-natural environment including substrate, a limited number of shelters and interactions with conspecifics. Shelter occupancy was recorded three times during a period of 35 days. Exposed juveniles occupied more shelters, grew larger and had higher survival compared with naïve juveniles. Our results demonstrate that experience of environmental complexity and social interactions increase shelter-seeking ability and survival in hatchery reared lobster juveniles.

Young people with depression and their experience accessing an enhanced primary care service for youth with emerging mental health problems: a qualitative study

PubMed Central

2012-01-01

Background Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace) that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process. Method Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data. Results Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service’s funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic. Conclusions Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people’s consciousness, while the appointment system would benefit from providing more timely appointments with therapists. The service’s funding model is important in enabling access initially to young people from low socioeconomic backgrounds, but the government needs to reassess the model for those who require additional support. PMID:22853550

Some Observations on the Current Status of Performing Finite Element Analyses

NASA Technical Reports Server (NTRS)

Raju, Ivatury S.; Knight, Norman F., Jr; Shivakumar, Kunigal N.

2015-01-01

Aerospace structures are complex high-performance structures. Advances in reliable and efficient computing and modeling tools are enabling analysts to consider complex configurations, build complex finite element models, and perform analysis rapidly. Many of the early career engineers of today are very proficient in the usage of modern computers, computing engines, complex software systems, and visualization tools. These young engineers are becoming increasingly efficient in building complex 3D models of complicated aerospace components. However, the current trends demonstrate blind acceptance of the results of the finite element analysis results. This paper is aimed at raising an awareness of this situation. Examples of the common encounters are presented. To overcome the current trends, some guidelines and suggestions for analysts, senior engineers, and educators are offered.

Improving adherence to the Epic Beacon ambulatory workflow.

PubMed

Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

2017-06-01

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

PubMed

Langenau, Erik; Kachur, Elizabeth; Horber, Dot

2014-07-01

Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Development of a Shared Decision Making coding system for analysis of patient-healthcare provider encounters

PubMed Central

Clayman, Marla L.; Makoul, Gregory; Harper, Maya M.; Koby, Danielle G.; Williams, Adam R.

2012-01-01

Objectives Describe the development and refinement of a scheme, Detail of Essential Elements and Participants in Shared Decision Making (DEEP-SDM), for coding Shared Decision Making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. Methods The Evidence-Based Patient Choice instrument was modified to reflect Makoul and Clayman’s Integrative Model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding. Results The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations. Conclusion DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the Essential Elements of Shared Decision Making. Further work should include application of DEEP-SDM to non-cancer encounters. Practice Implications: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. PMID:22784391

A clinically useful diabetes electronic medical record: lessons from the past; pointers toward the future.

PubMed

Gorman, C; Looker, J; Fisk, T; Oelke, W; Erickson, D; Smith, S; Zimmerman, B

1996-01-01

We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats.

Control of Initialized Fractional-Order Systems

NASA Technical Reports Server (NTRS)

Hartley, Tom T.; Lorenzo, Carl F.

2004-01-01

Fractional-Order systems, or systems containing fractional derivatives and integrals, have been studied by many in the engineering area. Additionally, very readable discussions, devoted specifically to the subject, are presented by Oldham and Spanier, Miller and Ross, and Pudlubny (1999a). It should be noted that there are a growing number of physical systems whose behavior can be compactly described using fractional system theory. Of specific interest to electrical engineers are long lines, electrochemical processes, dielectric polarization, colored noise, viscoelastic materials, and chaos. With the growing number of applications, it is important to establish a theory of control for these fractional-order systems, and for the potential use of fractional-order systems as feedback compensators. This topic is addressed in this paper. The first section discusses the control of fractional-order systems using a vector space representation, where initialization is included in the discussion. It should be noted that Bagley and Calico and Padovan and Sawicki both present a fractional state-space representation, which do not include the important historic effects. Incorporation of these effects based on the initialized fractional calculus is presented . The control methods presented in this paper are based on the initialized fractional order system theory. The second section presents an input-output approach. Some of the problems encountered in these sections are: a) the need to introduce a new complex plane to study the dynamics of fractional-order systems, b) the need to properly define the Laplace transform of the fractional derivative, and c) the proper inclusion of the initialization response in the system and control formulation. Following this, the next section generalizes the proportional-plus-integral-control (PI-control) and PID-control (PI-plus- derivative) concepts using fractional integrals. This is then further generalized using general fractional- order compensators. Finally the compensator concept is generalized by the use of a continuum of fractions in the compensator via the concept of order-distributions. The last section introduces fractional feedback in discrete-time.

Feasibility for direct rapid energy dispersive X-ray fluorescence (EDXRF) and scattering analysis of complex matrix liquids by partial least squares.

PubMed

Angeyo, K H; Gari, S; Mustapha, A O; Mangala, J M

2012-11-01

The greatest challenge to material characterization by XRF technique is encountered in direct trace analysis of complex matrices. We exploited partial least squares (PLS) in conjunction with energy dispersive X-ray fluorescence and scattering (EDXRFS) spectrometry to rapidly (200 s) analyze lubricating oils. The PLS-EDXRFS method affords non-invasive quality assurance (QA) analysis of complex matrix liquids as it gave optimistic results for both heavy- and low-Z metal additives. Scatter peaks may further be used for QA characterization via the light elements. Copyright © 2012 Elsevier Ltd. All rights reserved.

Improving police interventions during mental health-related encounters: Past, present and future

PubMed Central

Wood, Jennifer D.; Watson, Amy C.

2017-01-01

There are calls across America for police to re-imagine themselves as “guardians” rather than “warriors” in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a “case-based” focus with a “place-based” focus. PMID:29200799

Ofsted--"Brief Encounters of a Second Kind"?!

ERIC Educational Resources Information Center

Cale, Lorraine; Harris, Jo

2009-01-01

Background: Since 1995, the Office for Standards in Education (Ofsted) has inspected the quality of all Initial Teacher Training (ITT) provision in England on behalf of the Training and Development Agency for Schools (TDA). Ofsted inspection results are published and are highly significant because the TDA has a statutory duty to take account of…

Evaluation of the technical feasibility and effective cost of various wafer thicknesses for the manufacture of solar cells

NASA Technical Reports Server (NTRS)

1978-01-01

Three wafering demonstration runs were completed on the Yasunaga wire saw. Wafer thickness/taper uniformity is excellent. Many small problems were encountered with Yasunaga accessories, slowing the effort. A wafer characterization cycle was defined and will be initiated during the next period.

Techo Tensions in an Athabascan Indian Classroom.

ERIC Educational Resources Information Center

Brown, Stephen G.

A compositionist teaching high school on an Athabascan Indian Reservation near Anchorage, Alaska, encountered considerable resistance from his students when attempting to see them through a college-prep program. Their initial hostility toward him masked their deep need for an adult role model who was not abusive, neglectful, or alcoholic. It was a…

Lagrange Multipliers, Adjoint Equations, the Pontryagin Maximum Principle and Heuristic Proofs

ERIC Educational Resources Information Center

Ollerton, Richard L.

2013-01-01

Deeper understanding of important mathematical concepts by students may be promoted through the (initial) use of heuristic proofs, especially when the concepts are also related back to previously encountered mathematical ideas or tools. The approach is illustrated by use of the Pontryagin maximum principle which is then illuminated by reference to…

Work Values, Cognitive Strategies, and Applicant Reactions in a Structured Pre-Employment Interview for Ethical Integrity.

ERIC Educational Resources Information Center

Pawlowski, Donna R.; Hollwitz, John

2000-01-01

Notes that companies emphasize ethical behavior, and schools and professional groups devote many resources to applied ethics training. Describes initial construct validation of a structured ethical integrity pre-employment interview. Reviews evidence relating to cognitive and impression management strategies used when college students encounter an…

Strategies and Students: Beginning Teachers' Early Encounters with National Policy

ERIC Educational Resources Information Center

Rosowsky, Andrey

2006-01-01

The 1-year Postgraduate Certificate in Education Secondary English method course at the University of Sheffield's School of Education has, since 2001, asked its students to write an essay of around 4000 words on their initial understanding and experience of the National Strategies promoted by the United Kingdom's Department for Education and…

Navigating Past and Present Accountability Measures in Search of an Effective Principal Professional Development Model

ERIC Educational Resources Information Center

Martin, Patrick M.

2012-01-01

This study was designed to investigate the perceived experiences encountered by principals in the state of Illinois regarding professional development sessions offered through the Illinois Administrator Academy. The fundamental value of the Illinois Administrator Academy was designed as one of 169 specific initiatives in association with the…

Changing Ourselves, Changing Our Programs

ERIC Educational Resources Information Center

Carter, Margie

2011-01-01

The author is fascinated about the notion of "the changer and the changed." Having change imposed upon everyone can be difficult and one can become resistant. On the other hand, having an inspirational encounter can excite one about making change. When people initiate some new actions, what drives that change? How do they become changed in the…

Program Planning: The Embryonic Stage.

ERIC Educational Resources Information Center

Stone, Gwen

The document examines a number of sex education programs and reviews some of the problems and issues educators encounter in planning and initiating sex education programs. Included is a discussion of population background of Polk County, Iowa and a presentation by school administrators of five reasons which favor the teaching of sex education: (1)…

A Self-Ethnographic Investigation of Continuing Education Program in Engineering Arising from Economic Structural Change

ERIC Educational Resources Information Center

Kaihlavirta, Auri; Isomöttönen, Ville; Kärkkäinen, Tommi

2015-01-01

This paper provides a self-ethnographic investigation of a continuing education program in engineering in Central Finland. The program was initiated as a response to local economic structural change, in order to offer re-education possibilities for a higher educated workforce currently under unemployment threat. We encountered considerable…

Talking with the "Enemy": Firing Enthusiasm for History through International Conversation and Collaboration

ERIC Educational Resources Information Center

Kerridge, Richard; Cinnamond, Sacha

2012-01-01

Richard Kerridge and Sacha Cinnamond explain how their history department built a culture of international dialogue and collaboration that enriches their students' historical learning. Video-conferencing is at the centre of these activities. Their story begins with an initial, moving encounter with the First World War battlefields that soon turned…

The New ERA of Journal Ranking: The Consequences of Australia's Fraught Encounter with "Quality"

ERIC Educational Resources Information Center

Cooper, Simon; Poletti, Anna

2011-01-01

Ranking scholarly journals forms a major feature of the Excellence in Research for Australia (ERA) initiative. We argue this process is not only a flawed system of measurement, but more significantly erodes the very contexts that produce "quality" research. We argue that collegiality, networks of international research, the…

A Professional Experience Model for Primary Pre-Service Teachers Specialising in Mathematics

ERIC Educational Resources Information Center

McMaster, Heather; Cavanagh, Michael

2016-01-01

Many primary pre-service teachers (PSTs) who are enthused by tertiary courses that espouse and model a socio-constructivist approach to teaching mathematics, revert to a traditional approach when they encounter mathematics teaching during professional experience. An intervention was designed to translate the initial pedagogical intent of four…

High-Five Fridays: (Mis)Trust-Building in One White Liberal Community

ERIC Educational Resources Information Center

Ives, Denise; Cammack, Camille

2017-01-01

The shocking election of President Donald Trump following a campaign characterized by hateful and divisive rhetoric has left many people fearful. In this essay the authors recount their story about the difficulties they encountered trying to disrupt the normalization of white experience through a local community policing initiative in their…

Real fuel effects on flame extinction and re-ignition

NASA Astrophysics Data System (ADS)

Zhao, Xinyu; Wu, Bifen; Xu, Chao; Lu, Tianfeng; Chen, Jacqueline H.

2016-11-01

Flame-vortex interactions have significant implications in studying combustion in practical aeronautical engines, and can be used to facilitate the model development in capturing local extinction and re-ignition. To study the interactions between the complex fuel and the intense turbulence that are commonly encountered in engines, direct numerical simulations of the interactions between a flame and a vortex pair are carried out using a recently-developed 24-species reduced chemistry for n-dodecane. Both non-premixed and premixed flames with different initial and inlet thermochemical conditions are studied. Parametric studies of different vortex strengths and orientations are carried out to induce maximum local extinction and re-ignition. Chemical-explosive-mode-analysis based flame diagnostic tools are used to identify different modes of combustion, including auto-ignition and extinction. Results obtained from the reduced chemistry are compared with those obtained from one-step chemistry to quantify the effect of fuel pyrolysis on the extinction limit. Effects of flame curvature, heat loss and unsteadiness on flame extinction are also explored. Finally, the validity of current turbulent combustion models to capture the local extinction and re-ignition will be discussed.

Novel Antitubercular 6-Dialkylaminopyrimidine Carboxamides from Phenotypic Whole-Cell High Throughput Screening of a SoftFocus Library: Structure–Activity Relationship and Target Identification Studies

PubMed Central

2017-01-01

A BioFocus DPI SoftFocus library of ∼35 000 compounds was screened against Mycobacterium tuberculosis (Mtb) in order to identify novel hits with antitubercular activity. The hits were evaluated in biology triage assays to exclude compounds suggested to function via frequently encountered promiscuous mechanisms of action including inhibition of the QcrB subunit of the cytochrome bc1 complex, disruption of cell–wall homeostasis, and DNA damage. Among the hits that passed this screening cascade, a 6-dialkylaminopyrimidine carboxamide series was prioritized for hit to lead optimization. Compounds from this series were active against clinical Mtb strains, while no cross-resistance to conventional antituberculosis drugs was observed. This suggested a novel mechanism of action, which was confirmed by chemoproteomic analysis leading to the identification of BCG_3193 and BCG_3827 as putative targets of the series with unknown function. Initial structure–activity relationship studies have resulted in compounds with moderate to potent antitubercular activity and improved physicochemical properties. PMID:29148755

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings.

PubMed

Ewashen, Carol; Lane, Annette

2007-09-01

Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between 'counselor', and 'caring educator'? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.

Showing Your Students You Care: Seeing the Individual Trees in the Classroom Forest

ERIC Educational Resources Information Center

Philipp, Randolph A.; Thanheiser, Eva

2010-01-01

Teaching is a complex profession, and although every context is unique, teachers face common challenges. The authors have identified two challenges that nearly every teacher encounters: (1) managing a classroom of students; and (2) addressing the needs of individual students. Although these are not teachers' only challenges, the authors highlight…

Exploring Perspectives and Identifying Potential Challenges Encountered with Crime Scene Investigations When Developing Chemistry Curricula

ERIC Educational Resources Information Center

Kanu, A. Bakarr; Pajski, Megan; Hartman, Machelle; Kimaru, Irene; Marine, Susan

2015-01-01

In today's complex world, there is a continued demand for recently graduated forensic chemists (criminalists) who have some background in forensic experimental techniques. This article describes modern forensic experimental approaches designed and implemented from a unique instructional perspective to present certain facets of crime scene…

E-Learning in a Large Organization: A Study of the Critical Role of Information Sharing

ERIC Educational Resources Information Center

Netteland, Grete; Wasson, Barbara; Morch, Anders I

2007-01-01

Purpose: The purpose of this paper is to provide new insights into the implementation of large-scale learning projects; thereby better understanding the difficulties, frustrations, and obstacles encountered when implementing enterprise-wide e-learning as a tool for training and organization transformation in a complex organization.…

Methodological Complications of Matching Designs under Real World Constraints: Lessons from a Study of Deeper Learning

ERIC Educational Resources Information Center

Zeiser, Kristina; Rickles, Jordan; Garet, Michael S.

2014-01-01

To help researchers understand potential issues one can encounter when conducting propensity matching studies in complex settings, this paper describes methodological complications faced when studying schools using deeper learning practices to improve college and career readiness. The study uses data from high schools located in six districts…

The Complexities of Engagement: Chinese Undergraduate Students Encountering U.S. Higher Education

ERIC Educational Resources Information Center

Chen, Yajing

2017-01-01

This dissertation investigates Chinese undergraduate student engagement at U.S. universities. Over the past decade, the number of Chinese students studying in the United States has increased dramatically, but scholars have yet to concentrate on these student experiences or on the dynamics of their interaction with host institutions. Dominant media…

Reflection and Reflexivity in Practice versus in Theory: Challenges of Conceptualization, Complexity, and Competence

ERIC Educational Resources Information Center

Alexander, Patricia A.

2017-01-01

In this commentary, theoretical principles pertaining to the role of epistemic cognition in teaching and professional development, synthesized from the content of this special issue on reflection and reflexivity, are proffered. These theoretical notions are then followed with a critical analysis of specific challenges encountered in enacting these…

Nahuatl as a Classical, Foreign, and Additional Language: A Phenomenological Study

ERIC Educational Resources Information Center

De Felice, Dustin

2012-01-01

In this study, participants learning an endangered language variety shared their experiences, thoughts, and feelings about the often complex and diverse language-learning process. I used phenomenological interviews in order to learn more about these English or Spanish language speakers' journey with the Nahuatl language. From first encounter to…

Onwards and Upwards: Space, Placement, and Liminality in Adult ESOL Classes

ERIC Educational Resources Information Center

Baynham, Mike; Simpson, James

2010-01-01

The extensive literature on classroom-based second language learning makes little attempt to situate the classroom itself in social and multilingual sociolinguistic space, in the complex and iterative networks of encounters and interactions that make up daily life. Daily life is routinely evoked and "brought into" the classroom as a…

From Symptom Recognition to Services: How South Asian Muslim Immigrant Families Navigate Autism

ERIC Educational Resources Information Center

Jegatheesan, Brinda; Fowler, Susan; Miller, Peggy J.

2010-01-01

This study examined the experiences of three South Asian Muslim immigrant families who have a young child with autism. It describes the early period of their child's disability as the families encountered four critical issues in their lives: a complex disability, the culturally diverse conceptualizations of the disability, family-professional…

Testing Effect and Complex Comprehension in a Large Introductory Undergraduate Biology Course

ERIC Educational Resources Information Center

Pagliarulo, Christopher L.

2011-01-01

Traditional undergraduate biology courses are content intensive, requiring students to understand and remember large amounts of information in short periods of time. Yet most students maintain little of the material encountered during their education. Poor knowledge retention is a main cause of academic failure and high undergraduate attrition…

The STIN in the Tale: A Socio-Technical Interaction Perspective on Networked Learning

ERIC Educational Resources Information Center

Walker, Steve; Creanor, Linda

2009-01-01

In this paper, we go beyond what have been described as "mechanistic" accounts of e-learning to explore the complexity of relationships between people and technology as encountered in cases of networked learning. We introduce from the social informatics literature the concept of sociotechnical interaction networks which focus on the…

Comprehension Strategies for Reading Historical Fiction Picturebooks

ERIC Educational Resources Information Center

Youngs, Suzette; Serafini, Frank

2011-01-01

As the texts readers encounter in and out of school grow in complexity, the strategies that teachers demonstrate and encourage students to employ need to expand to accommodate the changing nature of these texts. In this article, the authors present a three-part framework for utilizing historical fiction picturebooks as instructional resources.…

Motivating Adolescent Readers: A Middle School Reading Fluency and Prosody Intervention

ERIC Educational Resources Information Center

Whittington, Marta

2012-01-01

Adolescent learners face a complexity of reading content they have never before encountered as they enter middle school and become independent in structuring their own academic frameworks. Some students become disconnected and unmotivated readers as school competes with their multiple reading lives. This study examined the use of choice along with…

A Summary of Some Biochemistry and Thermal Aspects of Intelligence.

ERIC Educational Resources Information Center

Harmon, Darell Boyd

Because of the intensity factors involved in school tasks, and the importance of schooling in determining the child's future in this complex civilization, the energy organizations and physical limits of the classroom are probably the most significant of all the factors encountered in shaping the child's ultimate social form. Very little is known…

Have Words, Will Understand?

ERIC Educational Resources Information Center

James, Jon

2013-01-01

Shifting the focus from words to concepts--does it work? The author shares his findings from such a project with three primary schools in the UK. Many children aged 7-10 find mastering the language of science difficult and do not make the progress that they could. Encountering complex terminology in the science language causes students to become…

The oak (Quercus) biodiversity of California and adjacent regions

Treesearch

Kevin C. Nixon

2002-01-01

Twenty species of oak (Quercus) are known from California. The white oak group is the most diverse, and includes a complex of scrub oak species that are often encountered in chaparral, mixed forest and desert margin habitats. The Protobalanus group (e.g., Quercus chrysolepis) is a unique and distinctive clade of western North...

"What Happened to Their Pets?": Third Graders Encounter the Holocaust

ERIC Educational Resources Information Center

Schweber, Simone

2008-01-01

Background/Context: Though widely believed to contain moral lessons of import for audiences of all ages, the Holocaust is often considered too complex, too appalling, too impenetrable, or too emotionally disturbing a subject to be taught to young children, even if taught only in its most "preparatory version," to use Jerome Bruner's famous…

Commentary: Is the Air Pollution Health Research Community Prepared to Support a Multipollutant Air Quality Management Framework?

EPA Science Inventory

Ambient air pollution is always encountered as a complex mixture, but past regulatory and research strategies largely focused on single pollutants, pollutant classes, and sources one-at-a-time. There is a trend toward managing air quality in a progressively “multipollutant” manne...

The Most Frequent Metacognitive Strategies Used in Reading Comprehension among ESP Learners

ERIC Educational Resources Information Center

Khoshsima, Hooshang; Samani, Elham Amiri

2015-01-01

Reading strategies are plans for solving problems encountered during reading while learners are deeply engage with the text. So, comprehension is not a simple decoding of symbols, but a complex multidimensional process in which the leaner draws on previous schemata applying strategies consciously. In fact, metacognitive strategies are accessible…

A Physician/Psychologist Team Approach to Children and Adolescents with Recurrent Somatic Complaints.

ERIC Educational Resources Information Center

Greene, John W.; Thompson, Warren

1984-01-01

Children and adolescents with recurrent somatic complaints represent some of the most complex school health-related problems encountered by school officials and physicians. These complaints account for missed days and are often the primary reason for prolonged absences. A collaborative approach involving a school psychologist and physician team is…

Statistics and Data Interpretation for Social Work

ERIC Educational Resources Information Center

Rosenthal, James A.

2011-01-01

Written by a social worker for social work students, this is a nuts and bolts guide to statistics that presents complex calculations and concepts in clear, easy-to-understand language. It includes numerous examples, data sets, and issues that students will encounter in social work practice. The first section introduces basic concepts and terms to…

Gifts of the Magi: "Chef," "Million Dollar Arm," and Cultural Mixtures

ERIC Educational Resources Information Center

Beck, Bernard

2014-01-01

When groups using different cultural systems encounter one another in diverse societies, their previous cultures are transformed into a merged, complex cultural picture. Some culture areas are preserved while others are adjusted, exchanged, and merged. In our society, introducing groups to the cooking of other groups is a form of contact which…

Order and Disorder in Conversation: Encounters with Dementia of the Alzheimer's Type

ERIC Educational Resources Information Center

Muller, Nicole; Guendouzi, Jacqueline A.

2005-01-01

After a brief introduction to Dementia of the Alzheimer's Type (DAT), its behavioral diagnostic symptom complex and a summary of communicative implications, we present data from two conversations involving participants with and without DAT. We discuss the concept of "order" in conversation, and the central importance of interactional monitoring.…

Decision support for sustainable forestry: enhancing the basic rational model.

Treesearch

H.R. Ekbia; K.M. Reynolds

2007-01-01

Decision-support systems (DSS) have been extensively used in the management of natural resources for nearly two decades. However, practical difficulties with the application of DSS in real-world situations have become increasingly apparent. Complexities of decisionmaking, encountered in the context of ecosystem management, are equally present in sustainable forestry....

The Tentative Nature of Scientific Knowledge: Why Should We Teach More about Diabetes Mellitus?

ERIC Educational Resources Information Center

Biermann, Carol A.

1993-01-01

Almost 70 years of scientific research leaves many unanswered questions concerning diabetes mellitus. This disease can be viewed as an illustration of the complexity of biological systems. Textbooks stress normal rather than abnormal physiology and rarely share the difficulties encountered in understanding those abnormal conditions (PR)

Complexities of Vietnamese Femininities: A Resource for Rethinking Women's University Leadership Practices

ERIC Educational Resources Information Center

Do, Van Hanh Thi; Brennan, Marie

2015-01-01

This paper develops a dialogical encounter between northern-inspired theorisations of gender and Vietnam's historical and cultural differentiation identified through the presence of matriarchy in ancient societies and its popularity in folklore and contemporary politics. The article draws on interviews with 12 senior women from 8 universities in…

Prose and Cons: Theatrical Encounters with Students and Prisoners in Ma'asiyahu, Israel

ERIC Educational Resources Information Center

Kuftinec, Sonja; Alon, Chen

2007-01-01

This article details how a unique educational project conducted through Tel Aviv University's Community Theatre program tackled the complex dynamics of the prison-political system over nine months in 2005-2006. The program focused on theatrical facilitations between mainly female students and male prisoners - two more or less homogeneous groups…

Approximate Value of Buoyant Force: A Water-Filled Balloon Demonstration

ERIC Educational Resources Information Center

Radovanovic, Jelena; Slisko, Josip

2012-01-01

Floating and sinking might be common phenomena, encountered on a daily basis, but still represent conceptually complex scientific topics. Research has shown that most students have certain experiences and their own "theories" that explain why objects sink or float. Unfortunately, many of these "theories" are either misconceptions or are valid only…

Living Together in European Intercultural Schools: The Case of the Catalan School System (Spain)

ERIC Educational Resources Information Center

Molina, Fidel; Casado, Núria

2014-01-01

There are practical difficulties in making intercultural education a substantial element of inclusion in both primary and compulsory secondary education in Europe. The Spanish education system and, in particular, the Catalan education system, have developed a series of strategies in response to the new multicultural complexity encountered in both…

Mature Zionism: Education and the Scholarly Study of Israel

ERIC Educational Resources Information Center

Alexander, Hanan A.

2015-01-01

A new approach to Israel education has emerged to counteract what has been a tendency to romanticize Israel by avoiding criticism; it presumes that Israel engagement has much to offer a meaningful Jewish identity, but only when encountered critically, taking into account Israel's many complexities. However, prevailing scholarly trends may not…

The Machines Are Coming: Future Directions in Instructional Communication Research. Forum: The Future of Instructional Communication

ERIC Educational Resources Information Center

Edwards, Autumn; Edwards, Chad

2017-01-01

Educational encounters of the future (and increasingly, of the present) will involve a complex collaboration of human and machine intelligences and agents, partnering to enhance learning and growth. Increasingly, "students and instructors are not only talking 'through' machines, but also [talking] 'to them', and 'within them'" (Edwards…

Improving Communication Is Everyone's Responsibility

ERIC Educational Resources Information Center

Warner, Fara

2008-01-01

In 2003, Terrence Martell, a finance professor at the City University of New York's Baruch College, encountered a classroom of 80 seniors who could navigate the complex intricacies of the futures markets and commodities trading. But when he asked them to write a report explaining to a commodity pool operator why he or she should retain the student…

National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study.

PubMed

Clark, Michael; Semple, Martin J; Ivins, Nicola; Mahoney, Kirsten; Harding, Keith

2017-08-21

The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Project-based learning with international collaboration for training biomedical engineers.

PubMed

Krishnan, Shankar

2011-01-01

Training biomedical engineers while effectively keeping up with the fast paced scientific breakthroughs and the growth in technical innovations poses arduous challenges for educators. Traditional pedagogical methods are employed for coping with the increasing demands in biomedical engineering (BME) training and continuous improvements have been attempted with some success. Project-based learning (PBL) is an academic effort that challenges students by making them carry out interdisciplinary projects aimed at accomplishing a wide range of student learning outcomes. PBL has been shown to be effective in the medical field and has been adopted by other fields including engineering. The impact of globalization in healthcare appears to be steadily increasing which necessitates the inclusion of awareness of relevant international activities in the curriculum. Numerous difficulties are encountered when the formation of a collaborative team is tried, and additional difficulties occur as the collaboration team is extended to international partners. Understanding and agreement of responsibilities becomes somewhat complex and hence the collaborative project has to be planned and executed with clear understanding by all partners and participants. A model for training BME students by adopting PBL with international collaboration is proposed. The results of previous BME project work with international collaboration fit partially into the model. There were many logistic issues and constraints; however, the collaborative projects themselves greatly enhanced the student learning outcomes. This PBL type of learning experience tends to promote long term retention of multidisciplinary material and foster high-order cognitive activities such as analysis, synthesis and evaluation. In addition to introducing the students to experiences encountered in the real-life workforce, the proposed approach enhances developing professional contracts and global networking. In conclusion, despite initial challenges, adopting project-based learning with international collaboration has strong potentials to be valuable in the training of biomedical engineering students.

Geomorphic factors related to the persistence of subsurface oil from the Exxon Valdez oil spill

USGS Publications Warehouse

Nixon, Zachary; Michel, Jacqueline; Hayes, Miles O.; Irvine, Gail V.; Short, Jeffrey

2013-01-01

Oil from the 1989 Exxon Valdez oil spill has persisted along shorelines of Prince William Sound, Alaska, for more than two decades as both surface and subsurface oil residues. To better understand the distribution of persistent subsurface oil and assess the potential need for further restoration, a thorough and quantitative understanding of the geomorphic factors controlling the presence or absence of subsurface oil is required. Data on oiling and geomorphic features were collected at 198 sites in Prince William Sound to identify and quantify the relationships among these geomorphic factors and the presence and absence of persistent subsurface oil. Geomorphic factors associated with the presence of subsurface oil were initial oil exposure, substrate permeability, topographic slope, low exposure to waves, armoring on gravel beaches, tombolos, natural breakwaters, and rubble accumulations. Geomorphic factors associated with the absence of subsurface oil were impermeable bedrock; platforms with thin sediment veneer; fine-grained, well-sorted gravel beaches with no armor; and low-permeability, raised bay-bottom beaches. Relationships were found between the geomorphic and physical site characteristics and the likelihood of encountering persistent subsurface oiling at those sites. There is quantitative evidence of more complex interactions between the overall wave energy incident at a site and the presence of fine-scale geomorphic features that may have provided smaller, local wave energy sheltering of oil. Similarly, these data provide evidence for interactions between the shoreline slope and the presence of angular rubble, with decreased likelihood for encountering subsurface oil at steeply sloped sites except at high-angle sheltered rubble shoreline locations. These results reinforce the idea that the interactions of beach permeability, stability, and site-specific wave exposure are key drivers for subsurface oil persistence in exposed and intermittently exposed mixed gravel beach and rocky shoreline environments.

Tiltrotor Research Aircraft composite blade repairs - Lessons learned

NASA Technical Reports Server (NTRS)

Espinosa, Paul S.; Groepler, David R.

1992-01-01

The XV-15, N703NA Tiltrotor Research Aircraft located at the NASA Ames Research Center, Moffett Field, California, currently uses a set of composite rotor blades of complex shape known as the advanced technology blades (ATBs). The main structural element of the blades is a D-spar constructed of unidirectional, angled fiberglass/graphite, with the aft fairing portion of the blades constructed of a fiberglass cross-ply skin bonded to a Nomex honeycomb core. The blade tip is a removable laminate shell that fits over the outboard section of the spar structure, which contains a cavity to retain balance weights. Two types of tip shells are used for research. One is highly twisted (more than a conventional helicopter blade) and has a hollow core constructed of a thin Nomex-honeycomb-and-fiberglass-skin sandwich; the other is untwisted with a solid Nomex honeycomb core and a fiberglass cross-ply skin. During initial flight testing of the blades, a number of problems in the composite structure were encountered. These problems included debonding between the fiberglass skin and the honeycomb core, failure of the honeycomb core, failures in fiberglass splices, cracks in fiberglass blocks, misalignment of mated composite parts, and failures of retention of metal fasteners. Substantial time was spent in identifying and repairing these problems. Discussed here are the types of problems encountered, the inspection procedures used to identify each problem, the repairs performed on the damaged or flawed areas, the level of criticality of the problems, and the monitoring of repaired areas. It is hoped that this discussion will help designers, analysts, and experimenters in the future as the use of composites becomes more prevalent.

Tiltrotor research aircraft composite blade repairs: Lessons learned

NASA Technical Reports Server (NTRS)

Espinosa, Paul S.; Groepler, David R.

1991-01-01

The XV-15, N703NA Tiltrotor Research Aircraft located at the NASA Ames Research Center, Moffett Field, California, currently uses a set of composite rotor blades of complex shape known as the advanced technology blades (ATBs). The main structural element of the blades is a D-spar constructed of unidirectional, angled fiberglass/graphite, with the aft fairing portion of the blades constructed of a fiberglass cross-ply skin bonded to a Nomex honeycomb core. The blade tip is a removable laminate shell that fits over the outboard section of the spar structure, which contains a cavity to retain balance weights. Two types of tip shells are used for research. One is highly twisted (more than a conventional helicopter blade) and has a hollow core constructed of a thin Nomex-honeycomb-and-fiberglass-skin sandwich; the other is untwisted with a solid Nomex honeycomb core and a fiberglass cross-ply skin. During initial flight testing of the blades, a number of problems in the composite structure were encountered. These problems included debonding between the fiberglass skin and the honeycomb core, failure of the honeycomb core, failures in fiberglass splices, cracks in fiberglass blocks, misalignment of mated composite parts, and failures of retention of metal fasteners. Substantial time was spent in identifying and repairing these problems. Discussed here are the types of problems encountered, the inspection procedures used to identify each problem, the repairs performed on the damaged or flawed areas, the level of criticality of the problems, and the monitoring of repaired areas. It is hoped that this discussion will help designers, analysts, and experimenters in the future as the use of composites becomes more prevalent.

The Use of Electronic Medical Records

PubMed Central

Makoul, Gregory; Curry, Raymond H.; Tang, Paul C.

2001-01-01

Objective: To assess physician–patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. Design: An exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews. Setting: General internal medicine practice at an academic medical center. Participants: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician). Main Outcome Measures: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart. Results: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians. Summary: An EMR system may enhance the ability of physicians to complete informationintensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified. PMID:11687567

Chilled to the bone: embodied countertransference and unspoken traumatic memories.

PubMed

Zoppi, Luisa

2017-11-01

Starting from a deeply challenging experience of early embodied countertransference in a first encounter with a new patient, the author explores the issues it raised. Such moments highlight projective identification as well as what Stone (2006) has described as 'embodied resonance in the countertransference'. In these powerful experiences linear time and subject boundaries are altered, and this leads to central questions about analytic work. As well as discussing the uncanny experience at the very beginning of an analytic encounter and its challenges for the analytic field, the author considers 'the time horizon of analytic process' (Hogenson ), the relationship between 'moments of complexity and analytic boundaries' (Cambray ) and the role of mirror neurons in intersubjective experience. © 2017, The Society of Analytical Psychology.

North American Paragonimiasis (Caused by Paragonimus kellicotti) in the Context of Global Paragonimiasis

PubMed Central

Procop, Gary W.

2009-01-01

Summary: Paragonimus species are highly evolved parasites with a complex life cycle that involves at least three different hosts, i.e., snails, crustaceans, and mammals. The adult forms of Paragonimus species reside and mate in the lungs of a variety of permissive mammalian hosts, including humans. Although human paragonimiasis is uncommonly encountered in North America, both autochthonous and imported disease may be encountered. Paragonimus kellicotti, the species endemic to North America, is a well-known pathogen in wild and domestic animals. Five patients with North American paragonimiasis have been reported in the recent medical literature. The biologic, clinical, radiologic, and laboratory features of paragonimiasis are reviewed, with emphasis on North American paragonimiasis whenever possible. PMID:19597007

Meteorology Associated with Turbulence Encounters During NASA's Fall-2000 Flight Experiments

NASA Technical Reports Server (NTRS)

Hamilton, David W.; Proctor, Fred H.

2002-01-01

Initial flight experiments have been conducted to investigate convectively induced turbulence and to test technologies for its airborne detection. Turbulence encountered during the experiments is described with sources of data measured from in situ sensors, groundbased and airborne Doppler radars, and aircraft video. Turbulence measurements computed from the in situ system were quantified in terms of RMS normal loads (sigma(sub Delta n)), where 0.20 g is less than or equal to sigma(sub Delta n) is less than or equal to 0.30 g is considered moderate and sigma(sub Delta n) is greater than 0.30 g is severe. During two flights, 18 significant turbulence encounters (sigma(sub Delta) is greater than or equal to 0.20 g) occurred in the vicinity of deep convection; 14 moderate and 4 severe. In all cases, the encounters with turbulence occurred along the periphery of cumulus convection. These events were associated with relatively low values of radar reflectivity, i.e. RRF is less than 35 dBz, with most levels being below 20 dBz. The four cases of severe turbulence occurred in precipitation and were centered at the interface between a cumulus updraft turret and a downwind downdraft. Horizontal gradients of vertical velocity at this interface were found to be strongest on the downwind side of the cumulus turrets. Furthermore, the greatest loads to the aircraft occurred while flying along, not orthogonal to, the ambient environmental wind vector. During the two flights, no significant turbulence was encountered in the clear air (visual meteorological conditions), not even in the immediate vicinity of the deep convection.

Formation of Tidally Induced Bars in Galactic Flybys: Prograde versus Retrograde Encounters

NASA Astrophysics Data System (ADS)

Łokas, Ewa L.

2018-04-01

Bars in disk galaxies can be formed by interactions with other systems, including those of comparable mass. It has long been established that the effect of such interactions on galaxy morphology depends strongly on the orbital configuration, in particular the orientation of the intrinsic spin of the galactic disk with respect to its orbital angular momentum. Prograde encounters modify the morphology strongly, including the formation of tidally induced bars, while retrograde flybys should have little effect on morphology. Recent works on the subject reached conflicting conclusions, one using the impulse approximation and claiming no dependence on this angle in the properties of tidal bars. To resolve the controversy, we performed self-consistent N-body simulations of hyperbolic encounters between two identical Milky Way-like galaxies assuming different velocities and impact parameters, with one of the galaxies on a prograde and the other on a retrograde orbit. The galaxies were initially composed of an exponential stellar disk and an NFW dark halo, and they were stable against bar formation in isolation for 3 Gyr. We find that strong tidally induced bars form only in galaxies on prograde orbits. For smaller impact parameters and lower relative velocities, the bars are stronger and have lower pattern speeds. Stronger bars undergo extended periods of buckling instability that thicken their vertical structure. The encounters also lead to the formation of two-armed spirals with strength inversely proportional to the strength of the bars. We conclude that proper modeling of prograde and retrograde encounters cannot rely on the simplest impulse approximation.

Toward a Definition of Complexity for Quantum Field Theory States.

PubMed

Chapman, Shira; Heller, Michal P; Marrochio, Hugo; Pastawski, Fernando

2018-03-23

We investigate notions of complexity of states in continuous many-body quantum systems. We focus on Gaussian states which include ground states of free quantum field theories and their approximations encountered in the context of the continuous version of the multiscale entanglement renormalization ansatz. Our proposal for quantifying state complexity is based on the Fubini-Study metric. It leads to counting the number of applications of each gate (infinitesimal generator) in the transformation, subject to a state-dependent metric. We minimize the defined complexity with respect to momentum-preserving quadratic generators which form su(1,1) algebras. On the manifold of Gaussian states generated by these operations, the Fubini-Study metric factorizes into hyperbolic planes with minimal complexity circuits reducing to known geodesics. Despite working with quantum field theories far outside the regime where Einstein gravity duals exist, we find striking similarities between our results and those of holographic complexity proposals.

Toward a Definition of Complexity for Quantum Field Theory States

NASA Astrophysics Data System (ADS)

Chapman, Shira; Heller, Michal P.; Marrochio, Hugo; Pastawski, Fernando

2018-03-01

We investigate notions of complexity of states in continuous many-body quantum systems. We focus on Gaussian states which include ground states of free quantum field theories and their approximations encountered in the context of the continuous version of the multiscale entanglement renormalization ansatz. Our proposal for quantifying state complexity is based on the Fubini-Study metric. It leads to counting the number of applications of each gate (infinitesimal generator) in the transformation, subject to a state-dependent metric. We minimize the defined complexity with respect to momentum-preserving quadratic generators which form s u (1 ,1 ) algebras. On the manifold of Gaussian states generated by these operations, the Fubini-Study metric factorizes into hyperbolic planes with minimal complexity circuits reducing to known geodesics. Despite working with quantum field theories far outside the regime where Einstein gravity duals exist, we find striking similarities between our results and those of holographic complexity proposals.

Innate defensive behaviour and panic-like reactions evoked by rodents during aggressive encounters with Brazilian constrictor snakes in a complex labyrinth: behavioural validation of a new model to study affective and agonistic reactions in a prey versus predator paradigm.

PubMed

Guimarães-Costa, Raquel; Guimarães-Costa, Maria Beatriz; Pippa-Gadioli, Leonardo; Weltson, Alfredo; Ubiali, Walter Adriano; Paschoalin-Maurin, Tatiana; Felippotti, Tatiana Tocchini; Elias-Filho, Daoud Hibrahim; Laure, Carlos Júlio; Coimbra, Norberto Cysne

2007-09-15

Defensive behaviour has been extensively studied, and non-invasive methodologies may be interesting approaches to analyzing the limbic system function as a whole. Using experimental models of animals in the state of anxiety has been fundamental in the search for new anxiolytic and antipanic compounds. The aim of this present work is to examine a new model for the study of affective behaviour, using a complex labyrinth consisting of an arena and galleries forming a maze. Furthermore, it aims to compare the defensive behaviour of Wistar rats, Mongolian gerbils and golden hamsters in a complex labyrinth, as well as the defensive behaviour of Meriones unguiculatus in aggressive encounters with either Epicrates cenchria assisi or Boa constrictor amarali in this same model. Among species presently studied, the Mongolian gerbils showed better performance in the exploration of both arena and galleries of the labyrinth, also demonstrating less latency in finding exits of the galleries. This increases the possibility of survival, as well as optimizes the events of encounter with the predator. The duration of alertness and freezing increased during confrontation with living Epicrates, as well as the duration of exploratory behaviour in the labyrinth. There was an increase in the number of freezing and alertness behaviours, as well as in duration of alertness during confrontations involving E.c. assisi, compared with behavioural reactions elicited by jirds in presence of B.c. amarali. Interestingly, the aggressive behaviour of Mongolian gerbils was more prominent against B.c. amarali compared with the other Boidae snake. E.c. assisi elicited more offensive attacks and exhibited a greater time period of body movement than B.c. amarali, which spent more time in the arena and in defensive immobility than the E.c. assisi. Considering that jirds evoked more fear-like reaction in contact with E.c. assisi, a fixed E.c. assisi kept in a hermetically closed acrylic box was used as control. In these prey/predator encounter-based experiments, there was an increase in the number of alertness and freezing behaviours exhibited by gerbils, and a decrease in the number of crossing elicited by them, when comparing confrontations between the living E.c. assisi and the control. The experiments were performed at 7.0 p.m. In the labyrinth, the snakes showed in confrontation similar performance to that observed in nature (organizing hunting behaviour, offensive/defensive attack, constriction, prey inspection and feeding behaviour), which were essential to the validity of the experiments and gave behavioural validation within the complex labyrinth.

Management of complex femoral nonunion with monorail external fixator: A prospective study.

PubMed

Agrawal, Hemendra Kumar; Garg, Mohit; Singh, Balvinder; Jaiman, Ashish; Khatkar, Vipin; Khare, Shailender; Batra, Sumit; Sharma, Vinod Kumar

2016-01-01

To evaluate 30 patients who underwent distraction osteogenesis with monorail external fixator for complex femoral nonunion. Complex femoral nonunion includes infective non-union, gap nonunion, and limb-length discrepancy secondary to traumatic bone loss, which needs specialized treatment to ensure the functional integrity of femoral bone. 30 patients, including 28 male and 2 female (aged 22-62 years) patients, underwent surgical debridement followed by bone transport with monorail fixator. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles, and complications encountered during the treatment were assessed. Patients underwent a mean of 2.2 (range 1-4) surgeries before presentation. The mean bone defect after surgical debridement was 5.83 cm (range 2-16 cm). The mean treatment duration was 204.7 days (range 113-543 days). The mean lengthening index was 13.06 days/cm with range from 12 to 16 days/cm. Mean maturation index was 23.51 days/cm with range from 17 to 45.5 days/cm. In our study, bone result was excellent in 17, good in 9, fair in 3, and poor in 1 patient. In our study functional outcome is excellent in 9 [30%], good in 14 [46.67%], fair in 5, and poor in 2 patients. In our study, we encountered 34 problems, 17 obstacles, and 8 complications. We concluded that monorail external fixator is an effective treatment option for complex nonunion femoral shaft fracture and its functional outcome is comparable with any other treatment options. Lack of complications and its effectiveness makes monorail external fixator the treatment of choice for complex nonunion femoral shaft.

Structure, dynamics and biophysics of the cytoplasmic protein–protein complexes of the bacterial phosphoenolpyruvate: Sugar phosphotransferase system

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

Clore, G. Marius; Venditti, Vincenzo

2013-10-01

The bacterial phosphotransferase system (PTS) couples phosphoryl transfer, via a series of bimolecular protein–protein interactions, to sugar transport across the membrane. The multitude of complexes in the PTS provides a paradigm for studying protein interactions, and for understanding how the same binding surface can specifically recognize a diverse array of targets. Fifteen years of work aimed at solving the solution structures of all soluble protein–protein complexes of the PTS has served as a test bed for developing NMR and integrated hybrid approaches to study larger complexes in solution and to probe transient, spectroscopically invisible states, including encounter complexes. We reviewmore » these approaches, highlighting the problems that can be tackled with these methods, and summarize the current findings on protein interactions.« less

Stability of hierarchical triples - I. Dependence on inner eccentricity and inclination

NASA Astrophysics Data System (ADS)

Mylläri, A.; Valtonen, M.; Pasechnik, A.; Mikkola, S.

2018-05-01

In simulations it is often important to decide if a given hierarchical triple star system is stable over an extended period of time. We introduce a stability criterion, modified from earlier work, where we use the closest approach ratio Q of the third star to the inner binary centre of mass in their initial osculating orbits. We study by numerical integration the orbits of over 1000 000 triple systems of the fixed masses and outer eccentricities eout, but varying inner eccentricities ein and inclinations i. 12 primary combinations of masses have been tried, representing the range encountered in stellar systems. The definition of the instability is either the escape of one of the bodies, or the exchange of the members between the inner and outer systems. An analytical approximation is derived using the energy change in a single close encounter between the inner and outer systems, assuming that the orbital phases in subsequent encounters occur randomly. The theory provides a fairly good description of the typical Qst, the smallest Q value that allows the system to be stable over N = 10 000 revolutions of the initial outer orbit. The final stability limit formula is Qst = 101/3A[( f g)2/(1 - eout)]1/6, where the coefficient A ˜ 1 should be used in N-body experiments, and A = 2.4 when the absolute long-term stability is required. The functions f (ein, cos i) and g(m1, m2, m3) are derived in the paper. At the limit of ein = i = m3 = 0, f g = 1.

Definition of boundary and initial conditions in the analysis of saturated ground-water flow systems - An introduction

USGS Publications Warehouse

Franke, O. Lehn; Reilly, Thomas E.; Bennett, Gordon D.

1987-01-01

Accurate definition of boundary and initial conditions is an essential part of conceptualizing and modeling ground-water flow systems. This report describes the properties of the seven most common boundary conditions encountered in ground-water systems and discusses major aspects of their application. It also discusses the significance and specification of initial conditions and evaluates some common errors in applying this concept to ground-water-system models. An appendix is included that discusses what the solution of a differential equation represents and how the solution relates to the boundary conditions defining the specific problem. This report considers only boundary conditions that apply to saturated ground-water systems.

Risk for physical restraint or seclusion in the psychiatric emergency service (PES).

PubMed

Simpson, Scott A; Joesch, Jutta M; West, Imara I; Pasic, Jagoda

2014-01-01

We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES). We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed. Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion. Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation. © 2014.

Flight-management strategies for escape from microburst encounters. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Hinton, David A.

1988-01-01

An effort is underway by NASA, FAA, and industry to reduce the threat of convective microburst wind shear phenomena to aircraft. The goal is to develop and test a candidate set of strategies for recovery from inadvertent microburst encounters during takeoff. Candidate strategies were developed and evaluated using a fast-time simulation consisting of a simple point-mass performance model of a transport-category airplane and an analytical microburst model. The results indicate that the recovery strategy characteristics that best utilize available airplane energy include an initial reduction in pitch attitude to reduce the climb rate, followed by an increase in pitch up to the stick shaker angle of attack. The stick shaker angle of attack should be reached just as the airplane is exiting the microburst. The shallowest angle of climb necessary for obstacle clearance should be used. If the altitude is higher than necessary, an intentional descent to reduce the airspeed deceleration should be used. Of the strategies tested, two flight-path-angle based strategies had the highest recovery altitudes and the least sensitivity to variations in the encounter scenarios.

Implementing Reform Curriculum: Voicing the Experiences of an ESL/Mathematics Teacher

ERIC Educational Resources Information Center

Celedon-Pattichis, Sylvia

2010-01-01

The purpose of this 18-month case study is to highlight the successes and challenges that an ESL/mathematics teacher encountered as she made a shift from traditional mathematics curriculum to a standards-based curriculum as part of a statewide systemic initiative. The study was conducted in an urban, public middle school in Central Texas that…

Exposure to Novelty Weakens Conditioned Fear in Long-Evans Rats

ERIC Educational Resources Information Center

Anderson, Matthew J.; Burpee, Tara E.; Wall, Matthew J.; McGraw, Justin J.

2013-01-01

The present study sought to determine whether post-training exposure to a novel or familiar object, encountered in either the location of the original fear conditioning (black compartment of a passive avoidance {PA} chamber) or in a neutral setting (open field where initial object training had occurred) would prove capable of reducing fear at…

Aesthetic Response: An Overview of Selected Theories and the Postulation of a Model.

ERIC Educational Resources Information Center

King, Alison

In response to a growing interest among educators in improving aesthetic education, this paper explores aesthetic response, defined as what happens in the mind and body of a person who encounters an aesthetic object or phenomenon. An initial section overviews the major theories of aesthetic response, including the work of Plato, Aristotle, Freud,…

"Are You a Computer?" Opening Exchanges in Virtual Reference Shape the Potential for Teaching

ERIC Educational Resources Information Center

Dempsey, Paula R.

2016-01-01

Academic reference librarians frequently work with students who are not aware of their professional roles. In online interactions, a student might not even realize that the librarian is a person. The ways students initiate conversations reveal their understanding of the mutual roles involved in reference encounters. Conversation analysis of live…

An Encounter with Fleeting Moments through Transitional Space

ERIC Educational Resources Information Center

Ryoo, Anna

2016-01-01

This paper is based on a phenomenologically oriented exploratory case study. It focuses on Bea, one of the many fascinating individuals the author met at a unique educational site who had an invaluable impact not only on the refinement of the initial guiding question of inquiry, but also on the author as an educator and educational researcher.…

Intercultural Communication Competence through Experiential Learning: The Importance of Student-Initiated Strategies and Dialogic Encounters

ERIC Educational Resources Information Center

Taylor, Josephine Ann

2007-01-01

Approaches to intercultural communication competence (ICC) generally argue the need for objective knowledge about another culture as well as knowledge about and the ability to achieve appropriate behaviors of that target culture. Most of these approaches continue to base themselves on a conception of culture as comprehensive but static.…

Asian Americans and Pacific Peoples: A Case of Mistaken Identity.

ERIC Educational Resources Information Center

Ishikawa, Michael; And Others

This report prepared by the California Advisory Committee for the U.S. Commission on Civil Rights is said to constitute an initial attempt to present a demographic sketch of Asian Americans and Pacific Peoples and to describe generally the areas in which they encounter significant problems. In order to destroy existing stereotypes about Asian…

The Unreliability of Data in the California Community College System. AIR Forum 1979 Paper.

ERIC Educational Resources Information Center

Turner, John D.; Booth, Mary W.

A chronicle of the problems faced in an attempt to collect data on sociology curriculum trends in California's community college system is presented. The project was initiated in an effort to determine if other colleges in the system were experiencing the same difficulties with curriculum and enrollment in sociology courses being encountered by…

Encountering the Past in the Present: An Exploratory Study of Educational Heritage Tourism

ERIC Educational Resources Information Center

Gross, Magdalena H.; Kelman, Ari Y.

2017-01-01

This article presents an educational programme designed to explore the multicultural history of Poland. Targeting Jewish and non-Jewish students of Polish heritage, the "Polonia Programme" (PP) was conceptualised with the aim of applying the tools of experiential education to initiate a new approach to examining one of the world's most…

Fitting species-accumulation functions and assessing regional land use impacts on avian diversity

Treesearch

Curtis H. Flather

1996-01-01

As one samples species from a particular assemblage, the initial rapid rate with which new species are encountered declines with increasing effort. Nine candidate models to characterize species-accumulation functions were compared in a search for a model that consistently fit geographically extensive avian survey data from a wide range of environmental conditions....

An Analysis of Problems in College Students' Participation in the Western China Program

ERIC Educational Resources Information Center

Yumei, Yi

2008-01-01

Since its initiation in 2003, the College Student Western China Program has had several satisfying achievements. At the same time, however, problems exist in the project. This article gives a brief analysis of problems encountered in the project from the aspects of publicity and campaign work, plans and schedules, student participation, voluntary…

Life's Little Problems: An Intensive Look at the Daily Experiences of Young Children. Informal Paper.

ERIC Educational Resources Information Center

Wolfson, Bernice J.; Jackson, Philip W.

Three studies were conducted in an initial attempt to investigate the psychological importance of trivial everyday frustrations encountered by preschool children. Study 1 analyzed the frequency and quality of experiences that could be interpreted as interfering in some way with children's natural pursuit of their desires. In a nursery school…

Initial Attempts at Developing Appropriate Human Relations Experiences for Potential Teachers.

ERIC Educational Resources Information Center

Calliotte, James A.

This paper traces the development of a human relations program as part of the teacher education curriculum at the University of Maryland Baltimore County. Four approaches are presented--a basic encounter model, a cognitive model, a programed unit, and a final integrated model that is now being employed in the teacher education program. Each model…

The Intercultural and Non-Formal Learning Processes of Children in Primary School Exchange Programmes in France and Germany

ERIC Educational Resources Information Center

Melin, Valérie; Wagner, Bernd

2015-01-01

This paper is based on educational anthropology, and presents the initial findings of a three-year international comparative study of primary school children's learning-processes during travel and cross-cultural encounters. A French-German research team investigated and here reports on primary school exchange programmes. Open coding of the…

Moving from Good Ideas in Educational Systems Change to Sustainable Program Implementation: Coming to Terms with Some of the Realities

ERIC Educational Resources Information Center

Noell, George H.; Gansle, Kristin A.

2009-01-01

Proponents of systemic changes in education commonly encounter ethical, theoretical, and pragmatic challenges in moving from possibility to implementation of their vision of change. Although ethical and theoretical issues are critically important to a successful change initiative, pragmatic issues relevant to assuring program implementation have…

Observations and reinterpretation of kingfisher-raptor interactions

USGS Publications Warehouse

Kirby, Ronald E.; Fuller, Mark R.

1978-01-01

Reported observations of Belted Kingfisher (Megaceryle alcyon)-raptor interactions have ranged from brief encounters where the kingfisher escaped the raptor and the hawk subsequently flew away to repeated chases (Johnson 1925, McCabe and McCabe 1928, Skinner 1928, Smith 1963). In some repetitive chases, kingfishers appeared to initiate the interaction (McCabe and McCabe 1928, Skinner 1928).

For Love or Money: Patterns of Resource Commutation in Social Interchange.

ERIC Educational Resources Information Center

Turner, Jim L.; Foa, Uriel G.

The notion of particularism is used in this study to relate the choice of reciprocal action to the previous exchange situation. Initial encounters were manipulated by exposing 80 female subjects to affective and monetary outcomes provided by 2 male peers. Treatment conditions varyed in feedback level (high vs. low) and mode of interaction…

Muscular Subaortic Stenosis

PubMed Central

Wigle, E. Douglas; Auger, Pierre; Marquis, Yves

1966-01-01

Two types of intraventricular pressure differences within the left ventricle of man are described. The first is encountered in cases of muscular (or fibrous) subaortic stenosis, in which the outflow tract pressure distal to the stenosis (and proximal to the aortic valve) is low, whereas all pressures recorded in the left ventricle proximal to the stenosis, including that just inside the mitral valve (the initial inflow tract pressure) are high. The second type of intraventricular pressure difference may be recorded in patients without muscular subaortic stenosis when a heart catheter is advanced to the left ventricular wall in such a manner that it becomes imbedded or entrapped by cardiac muscle in systole. Such an entrapped catheter records a high intraventricular pressure that is believed to reflect intramyocardial tissue pressure, which normally exceeds intracavitary pressure. In such cases the initial inflow tract pressure is not high and is precisely equal to the outflow tract systolic pressure, i.e. both are recording intracavity pressure. This type of intramyocardial to intracavitary pressure difference may also be encountered in the left ventricle of dogs. The recent suggestion that intraventricular pressure differences in the left ventricle of cases of muscular subaortic stenosis are due to catheter entrapment by cardiac muscle is refuted by using the initial inflow tract pressure as the means of differentiation between the two types of intraventricular pressure differences outlined. PMID:5951625

Orbit classification in an equal-mass non-spinning binary black hole pseudo-Newtonian system

NASA Astrophysics Data System (ADS)

Zotos, Euaggelos E.; Dubeibe, Fredy L.; González, Guillermo A.

2018-07-01

The dynamics of a test particle in a non-spinning binary black hole system of equal masses is numerically investigated. The binary system is modelled in the context of the pseudo-Newtonian circular restricted three-body problem, such that the primaries are separated by a fixed distance and move in a circular orbit around each other. In particular, the Paczyński-Wiita potential is used for describing the gravitational field of the two non-Newtonian primaries. The orbital properties of the test particle are determined through the classification of the initial conditions of the orbits, using several values of the Jacobi constant, in the Hill's regions of possible motion. The initial conditions are classified into three main categories: (i) bounded, (ii) escaping, and (iii) displaying close encounters. Using the smaller alignment index chaos indicator, we further classify bounded orbits into regular, sticky, or chaotic. To gain a complete view of the dynamics of the system, we define grids of initial conditions on different types of two-dimensional planes. The orbital structure of the configuration plane, along with the corresponding distributions of the escape and collision/close encounter times, allow us to observe the transition from the classical Newtonian to the pseudo-Newtonian regime. Our numerical results reveal a strong dependence of the properties of the considered basins with the Jacobi constant as well as with the Schwarzschild radius of the black holes.

The Kuwait Oil Fire Health Risk Assessment Biological Surveillance Initiative.

PubMed

Deeter, David P

2011-07-01

An important environmental concern during the first Gulf War (Operation Desert Storm) was assessing exposures and potential health effects in U.S. forces exposed to the Kuwait oil fires. With only 3 weeks for planning, a Biological Surveillance Initiative (BSI) was developed and implemented for a U.S. Army unit. The BSI included blood and urine collections, questionnaire administration, and other elements during the predeployment, deployment, and post-deployment phases. Many BSI objectives were accomplished. Difficulties encountered included planning failures, loss of data and information, and difficulty in interpreting laboratory results. In order for biological surveillance initiatives to provide useful information for future deployments where environmental exposures may be a concern, meaningful, detailed, and realistic planning and preparation must occur long before the deployment is initiated.

Computational Prediction of Pressure and Thermal Environments in the Flame Trench With Launch Vehicles

NASA Technical Reports Server (NTRS)

Brehm, Christoph; Sozer, Emre; Barad, Michael F.; Housman, Jeffrey A.; Kiris, Cetin C.; Moini-Yekta, Shayan; Vu, Bruce T.; Parlier, Christopher R.

2014-01-01

One of the key objectives for the development of the 21st Century Space Launch Com- plex is to provide the exibility needed to support evolving launch vehicles and spacecrafts with enhanced range capacity. The launch complex needs to support various proprietary and commercial vehicles with widely di erent needs. The design of a multi-purpose main ame de ector supporting many di erent launch vehicles becomes a very challenging task when considering that even small geometric changes may have a strong impact on the pressure and thermal environment. The physical and geometric complexity encountered at the launch site require the use of state-of-the-art Computational Fluid Dynamics (CFD) tools to predict the pressure and thermal environments. Due to harsh conditions encountered in the launch environment, currently available CFD methods which are frequently employed for aerodynamic and ther- mal load predictions in aerospace applications, reach their limits of validity. This paper provides an in-depth discussion on the computational and physical challenges encountered when attempting to provide a detailed description of the ow eld in the launch environ- ment. Several modeling aspects, such as viscous versus inviscid calculations, single-species versus multiple-species ow models, and calorically perfect gas versus thermally perfect gas, are discussed. The Space Shuttle and the Falcon Heavy launch vehicles are used to study di erent engine and geometric con gurations. Finally, we provide a discussion on traditional analytical tools which have been used to provide estimates on the expected pressure and thermal loads.

Outpatient virtual clinical encounters after complex surgery for cancer: a prospective pilot study of "TeleDischarge".

PubMed

Katz, Matthew H G; Slack, Rebecca; Bruno, Morgan; McMillan, Jermaine; Fleming, Jason B; Lee, Jeffrey E; Bednarski, Brian; Papadopoulos, John; Matin, Surena F

2016-05-01

Outpatient clinical encounters are used to promote recovery after complex surgical procedures for cancer. These care episodes are resource intensive. Virtual clinical encounters (VCEs) can now be conducted using widely available videoconferencing technologies. However, whether these technologies may be used to monitor postoperative recovery is unknown. In this pilot study, we provided care using a comprehensive "TeleDischarge" protocol to 15 patients after pancreatectomy. In addition to routine follow-up, all patients participated in two scheduled and an unlimited number of unscheduled VCEs using mobile hardware and secure videoconferencing software. We evaluated feasibility, patient satisfaction, postoperative adverse events, and health care human resource utilization. The median age of enrolled patients was 63 y (range, 52-83 y) and 93% underwent pancreatoduodenectomy. Twenty-eight scheduled VCEs (93%) were completed successfully, and only one unscheduled VCE was requested. Twelve patients (80%) felt their postoperative care was enhanced by VCEs and 14 (93%) felt that VCEs should be a regular part of postoperative care. Minor interventions in four patients (27%) were performed on the basis of clinical data gathered during a VCE. On a per patient basis, the TeleDischarge pathway was estimated to take 36 min longer and to have a direct labor cost $39 greater than the standard pathway. Secure VCEs can be conducted using widely available hardware and software solutions. Although cancer patients support the introduction of mobile technology into postoperative care, further studies are needed to identify ways in which such technology can be used most effectively and efficiently to reduce barriers to recovery. Copyright © 2016 Elsevier Inc. All rights reserved.

Charge carrier concentration dependence of encounter-limited bimolecular recombination in phase-separated organic semiconductor blends

NASA Astrophysics Data System (ADS)

Heiber, Michael C.; Nguyen, Thuc-Quyen; Deibel, Carsten

2016-05-01

Understanding how the complex intermolecular configurations and nanostructure present in organic semiconductor donor-acceptor blends impacts charge carrier motion, interactions, and recombination behavior is a critical fundamental issue with a particularly major impact on organic photovoltaic applications. In this study, kinetic Monte Carlo (KMC) simulations are used to numerically quantify the complex bimolecular charge carrier recombination behavior in idealized phase-separated blends. Recent KMC simulations have identified how the encounter-limited bimolecular recombination rate in these blends deviates from the often used Langevin model and have been used to construct the new power mean mobility model. Here, we make a challenging but crucial expansion to this work by determining the charge carrier concentration dependence of the encounter-limited bimolecular recombination coefficient. In doing so, we find that an accurate treatment of the long-range electrostatic interactions between charge carriers is critical, and we further argue that many previous KMC simulation studies have used a Coulomb cutoff radius that is too small, which causes a significant overestimation of the recombination rate. To shed more light on this issue, we determine the minimum cutoff radius required to reach an accuracy of less than ±10 % as a function of the domain size and the charge carrier concentration and then use this knowledge to accurately quantify the charge carrier concentration dependence of the recombination rate. Using these rigorous methods, we finally show that the parameters of the power mean mobility model are determined by a newly identified dimensionless ratio of the domain size to the average charge carrier separation distance.

Shared presence in physician-patient communication: A graphic representation.

PubMed

Ventres, William B; Frankel, Richard M

2015-09-01

Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care--all deceptive in their simplicity but, in fact, highly complex--or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients. (c) 2015 APA, all rights reserved).

Management of Acute Upper Gastrointestinal Disease While at Sea.

PubMed

Carr, Matthew J; Oxner, Christopher; Elster, Eric A; Ritter, Eric M; Vicente, Diego

2018-02-06

Management of complex acute surgical pathology in austere environments necessitates rapid evaluation and resource appropriate management to avoid time-associated morbidity and potentially mortality. Obstructive upper gastrointestinal (UGI) pathologies can be particularly challenging and associated with significant morbidity. Herein, we present six patients with UGI obstructions encountered over the course of an 8-mo deployment onboard a US Navy Aircraft Carrier. Each patient presented to our medical department with signs and symptoms of obstructive UGI pathology including one gastric volvulus requiring operative management at sea, one with a new diagnosis of achalasia requiring transportation and continental United States outpatient evaluation, and four patients with food impaction requiring urgent endoscopic management. Although UGI pathology is seldom encountered at sea, definitive surgical interventions, including prompt evaluation and management of these acute pathologies, can be performed in an austere environment. We wish to call attention to these potential encounters in order that underway deployed medical units and supporting resources ashore are prepared and equipped to intervene on acute UGI obstructive pathology. © Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study.

PubMed

Silverman, Julie; Krieger, James; Sayre, George; Nelson, Karin

2018-03-01

To describe community health workers (CHWs) roles in a diabetes self-management intervention. Retrospective qualitative inductive analysis of open text home visit encounter form from Peer Support for Achieving Independence in Diabetes (Peer AID), a randomized controlled trial in which low-income individuals with poorly controlled diabetes received either CHW home visits or usual care. Following visits, CHWs completed encounter forms documenting the health goal of the visit, the self-management strategies discussed and participant concerns. 634 encounter reports were completed for the 145 intervention participants. CHW notes revealed three main obstacles to optimal disease control: gaps in diabetes knowledge and self-management skills; socioeconomic conditions; and the complexity of the healthcare system. CHWs helped participants overcome these obstacles through extensive, hands-on education, connecting participants to community resources, and assistance navigating the medical system. In addition, the CHWs offered uncomplicated accessibility and availability to their clients. CHWs can be a valuable asset for low-income patients with chronic health conditions who may require more support than what can provided in a typical primary care visit.

USMC Ground Surveillance Robot (GSR): Lessons Learned

NASA Astrophysics Data System (ADS)

Harmon, S. Y.

1987-02-01

This paper describes the design of an autonomous vehicle and the lessons learned during the implementation of that complex robot. The major problems encountered to which solutions were found include sensor processing bandwidth limitations, coordination of the interactions between major subsystems, sensor data fusion and system knowledge representation. Those problems remaining unresolved include system complexity management, the lack of powerful system monitoring and debugging tools, exploratory implementation of a complex system and safety and testing issues. Many of these problems arose from working with underdeveloped and continuously evolving technology and will probably be resolved as the technological resources mature and stabilize. Unfortunately, other problems will continue to plague developers throughout the evolution of autonomous system technology.

Problem Solving in Technology Rich Contexts: Mathematics Sense Making in Out-of-School Environments

ERIC Educational Resources Information Center

Lowrie, Tom

2005-01-01

This investigation describes the way in which a case study participant (aged 7) represented, posed and solved problems in a technology game-based environment. The out-of-school problem-solving context placed numeracy demands on the participant that were more complex and sophisticated than the type of mathematics experiences he encountered in…

Not Silent, Invisible: Literature's Chance Encounters with Deaf Heroes and Heroines

ERIC Educational Resources Information Center

McDonald, Donna M.

2010-01-01

Literatures is both a rich resource and a blunt instrument in conveying the complexities of identity, in particular, the elusive "deaf identity". The rarity of the fully realized deaf person in memoir and fiction shapes the way readers regard deaf people and throws up fresh challenges in redesigning stories of deafness free of the taint of…

Use of Multimedia in an Introductory College Biology Course to Improve Comprehension of Complex Material

ERIC Educational Resources Information Center

Rhodes, Ashley; Rozell, Tim; Shroyer, Gail

2014-01-01

Many students who have the ability to succeed in science, technology, engineering and math (STEM) disciplines are often alienated by the traditional instructional methods encountered within introductory courses; as a result, attrition from STEM fields is highest after completion of these courses. This is especially true for females. The present…

Students transcribing tasks: Noticing Fluency, Accuracy, and Complexity

ERIC Educational Resources Information Center

Stillwell, Christopher; Curabba, Brad; Alexander, Kamsin; Kidd, Andrew; Kim, Euna; Stone, Paul; Wyle, Christopher

2010-01-01

Student self-transcription can greatly enhance the power of tasks to promote language learning, for it allows students to re-examine their experience freed from the pressure of performing the task itself, so they can notice and reflect on the language used and encountered. This is a powerful step in language development because it allows for…

Complex Problem Solving in Radiologic Technology: Understanding the Roles of Experience, Reflective Judgment, and Workplace Culture

ERIC Educational Resources Information Center

Yates, Jennifer L.

2011-01-01

The purpose of this research study was to explore the process of learning and development of problem solving skills in radiologic technologists. The researcher sought to understand the nature of difficult problems encountered in clinical practice, to identify specific learning practices leading to the development of professional expertise, and to…

The Representation of Anatomical Structures through Computer Animation for Scientific, Educational and Artistic Applications.

ERIC Educational Resources Information Center

Stredney, Donald Larry

An overview of computer animation and the techniques involved in its creation is provided in the introduction to this masters thesis, which focuses on the problems encountered by students in learning the forms and functions of complex anatomical structures and ways in which computer animation can address these problems. The objectives for,…

Palladium-catalyzed three-component reaction of N-tosyl hydrazones, isonitriles and amines leading to amidines.

PubMed

Dai, Qiang; Jiang, Yan; Yu, Jin-Tao; Cheng, Jiang

2015-12-04

A palladium-catalyzed three-component reaction between N-tosyl hydrazones, aryl isonitriles and amines was developed, leading to amidines in moderate to good yields. This procedure features the rapid construction of amidine frameworks with high diversity and complexity. Ketenimines serve as intermediates, which encounter nucleophilic attack by amines to produce amidines.

The problem of site variation within red pine provenance experiments

Treesearch

Mark J. Holst

1966-01-01

In spite of care taken in the selection of site and experimental design of provenance experiments, site heterogenity within the experimental area may be more complex than was anticipated when the experiment was established. The present paper describes a problem of this nature encountered in a red pine (Pinus resinosa Ait.) provenance experiment at...

A Portal into Biology Education: An Annotated List of Commonly Encountered Terms

ERIC Educational Resources Information Center

Miller, Sarah; Tanner, Kimberly D.

2015-01-01

In an introductory biology course, undergraduate students are expected to become familiar with, and be able to use, hundreds of new terms to navigate the complex ideas in biology. And this is just in the introductory course! Juxtapose this student situation with the common frustration expressed by biologists that there is "just too much…

Measuring Science Teachers' Stress Level Triggered by Multiple Stressful Conditions

ERIC Educational Resources Information Center

Halim, Lilia; Samsudin, Mohd Ali; Meerah, T. Subahan M.; Osman, Kamisah

2006-01-01

The complexity of science teaching requires science teachers to encounter a range of tasks. Some tasks are perceived as stressful while others are not. This study aims to investigate the extent to which different teaching situations lead to different stress levels. It also aims to identify the easiest and most difficult conditions to be regarded…

When Districts Encounter Teacher Shortages: The Challenges of Recruiting and Retaining Mathematics Teachers in Urban Districts

ERIC Educational Resources Information Center

Liu, Edward; Rosenstein, Joseph G.; Swan, Aubrie E.; Khalil, Deena

2008-01-01

Administrators in six urban districts were interviewed to understand the nature and extent of their problems with recruiting and retaining high quality mathematics teachers. Findings suggest that the math staffing challenge is quite complex, and administrators have had to make difficult compromises because of deficiencies in the quantity and…

Striatal and Hippocampal Entropy and Recognition Signals in Category Learning: Simultaneous Processes Revealed by Model-Based fMRI

ERIC Educational Resources Information Center

Davis, Tyler; Love, Bradley C.; Preston, Alison R.

2012-01-01

Category learning is a complex phenomenon that engages multiple cognitive processes, many of which occur simultaneously and unfold dynamically over time. For example, as people encounter objects in the world, they simultaneously engage processes to determine their fit with current knowledge structures, gather new information about the objects, and…

Teacher Inquiry and English Learners: The Tensions of Inquiry, Direct Instruction, and Learning

ERIC Educational Resources Information Center

Capitelli, Sarah

2015-01-01

This article explores the tensions surrounding teaching linguistically diverse students that are illuminated during a teacher inquiry group that has an explicit focus on working with English learners (ELs). The discussion is focused on the tensions teachers encounter when trying to make sense of the complexity of working with large numbers of ELs…

Teaching Movable "Du": Guidelines for Developing Enrhythmic Reading Skills

ERIC Educational Resources Information Center

Dalby, Bruce

2015-01-01

Reading music notation with fluency is a complex skill requiring well-founded instruction by the music teacher and diligent practice on the part of the learner. The task is complicated by the fact that there are multiple ways to notate a given rhythm. Beginning music students typically have their first encounter with enrhythmic notation when they…

An Improved Decision Tree for Predicting a Major Product in Competing Reactions

ERIC Educational Resources Information Center

Graham, Kate J.

2014-01-01

When organic chemistry students encounter competing reactions, they are often overwhelmed by the task of evaluating multiple factors that affect the outcome of a reaction. The use of a decision tree is a useful tool to teach students to evaluate a complex situation and propose a likely outcome. Specifically, a decision tree can help students…

The Role of Domain-Specific Knowledge in Generative Reasoning about Complicated Multileveled Phenomena

ERIC Educational Resources Information Center

Duncan, Ravit Golan

2007-01-01

Promoting the ability to reason generatively about novel phenomena and problems students may encounter in their everyday lives is a major goal of science education. This goal proves to be a formidable challenge in domains, such as molecular genetics, for which the accumulated scientific understandings are daunting in both amount and complexity. To…

Women and Women of Color in Leadership: Complexity, Identity, and Intersectionality

ERIC Educational Resources Information Center

Sanchez-Hucles, Janis V.; Davis, Donald D.

2010-01-01

This article describes the challenges that women and women of color face in their quest to achieve and perform in leadership roles in work settings. We discuss the barriers that women encounter and specifically address the dimensions of gender and race and their impact on leadership. We identify the factors associated with gender evaluations of…

Guidelines for a Training Course in Noise Survey Techniques.

ERIC Educational Resources Information Center

Shadley, John; And Others

The course is designed to train noise survey technicians during a 3-5 day period to make reliable measurements of 75 percent of the noise problems encountered in the community. The more complex noise problems remaining will continue to be handled by experienced specialists. These technicians will be trained to assist State and local governments in…

The Research Potential of the Electronic OED Database at the University of Waterloo: A Case Study.

ERIC Educational Resources Information Center

Berg, Donna Lee

1991-01-01

Discusses the history and structure of the online database of the second edition of the Oxford English Dictionary (OED) and the software tools developed at the University of Waterloo to manipulate the unusually complex database. Four sample searches that indicate some types of problems that might be encountered are appended. (DB)

Raising the Bar: Challenging Students in a Capstone Project Course with an Android and Mobile Web Parallel Development Team Project

ERIC Educational Resources Information Center

Wong, Wilson; Pepe, James; Englander, Irv

2017-01-01

Information systems capstone projects aim to prepare students for what they will encounter in the industry after graduation. Corporate application development is often a complex endeavor that requires coordination between related products. For example, software development in the mobile application sector may require a coordinated parallel…

Is Acculturation a Dynamic Construct?: The Influence of Method of Priming Culture on Acculturation

ERIC Educational Resources Information Center

Lechuga, Julia

2008-01-01

Recent evidence suggests that culture is a dynamic construct activated in response to cues encountered in a given situation. Research on acculturation indicates that this is a complex construct that might be domain specific. Two studies were undertaken to investigate the effect of two ways of priming culture on acculturation and enculturation…

Collaboration The Key To: Defining Entry Level Competencies for Public Child Welfare Workers Serving Indian Communities.

ERIC Educational Resources Information Center

Gonzalez-Santin, Edwin; And Others

The rural environment in which most Indian tribal human service personnel work impedes the access of paraprofessional staff to professional education programs that will enable them to expand their theoretical knowledge, enhance their practical skills, and advance their careers. Each day, child welfare workers encounter complex tasks that require…

"Promiscuous Crowd of English Smatterers": The "Poor" in the Colonial and Nationalist Discourse on Education in India, 1835-1912

ERIC Educational Resources Information Center

Rao, Parimala V.

2013-01-01

The encounter between the pre-colonial education system in India, dominated by poor teachers and students, and the British education system, which defended and perpetuated the "English class system", created a complex and problematic relationship. This article explores this problematic relationship between poverty and education in the…

Improving Student Assessments of Elections: The Use of Information Literacy and a Course-Embedded Librarian

ERIC Educational Resources Information Center

Booke, Paula; Wiebe, Todd J.

2017-01-01

The study of U.S. elections as a part of introductory political science courses has become an increasingly difficult endeavour as students encounter the ever-changing landscape of electoral politics. Instructors seeking to equip students with the skills needed to navigate this complex terrain may look for partnerships with library faculty and…

Separating the Problem and the Person: Insights from Narrative Therapy with People Who Stutter

ERIC Educational Resources Information Center

Ryan, Fiona; O'Dwyer, Mary; Leahy, Margaret M.

2015-01-01

Stuttering is a complex disorder of speech that encompasses motor speech and emotional and cognitive factors. The use of narrative therapy is described here, focusing on the stories that clients tell about the problems associated with stuttering that they have encountered in their lives. Narrative therapy uses these stories to understand, analyze,…

The objective structured clinical examination revisited for postgraduate trainees in general practice.

PubMed

Schoenmakers, Birgitte; Wens, Johan

2014-03-04

To investigate if the psychometric qualities of an OSCE consisting of more complex simulated patient encounters remain valid and reliable in the assessment of postgraduate trainees in general practice. In this intervention study without control group, the traditional OSCE was formally replaced by the new, complex version. The study population was composed by all postgraduate trainees (second and third phase) in general practice during the ongoing academic year. Data were handled and collected as part of the formal assessment program. Univariate analyses, the variance of scores and multivariate analyses were performed to assess the test qualities. A total of 340 students participated. Average final scores were slightly higher for third-phase students (t-test, p =0.05). Overall test scores were equally distributed on station level, circuit level and phase level. A multiple regression analysis revealed that test scores were dependent on the stations and circuits, but not on the master phase. In a changing learning environment, assessment and evaluation strategies require reorientation. The reliability and validity of the OSCE remain subject to discussion. In particular, when it comes to content and design, the traditional OSCE might underestimate the performance level of postgraduate trainees in general practice. A reshaping of this OSCE to a more sophisticated design with more complex patient encounters appears to restore the validity of the test results.

PubMed Central

Perreault, C

1981-01-01

Human leukocyte antigens (HLA) are transmembrane bicatenar glycoproteins; their heavy chain is coded by chromosome 6 and carries allotypic determinants. These molecules are present in nearly every cell, tissue and biologic fluid. Their congenital absence from fibroblasts is associated with progeria, while their absence from lymphocytes is associated with immunodeficiency. HLA antigens are usually studied microlymphocytotoxicity tests. The numerous cross-reactions encountered make the interpretation of results quite difficult. To clearly understand these reactions a complex-complex model is mandatory. The antigen, the HLA molecule, is complex since it carries many antigenic determinants; some of them are private ("subtypic"), while others are public ("subtypic"). Anti-HLA antibodies are also complex since they are heterogeneous, reacting with variable affinity with different antigenic determinants. The in vitro cross-reactions represent a partial explanation for varying cross-immunogenicity in vivo. PMID:7008927

Developing a unified list of physicians' reasoning tasks during clinical encounters.

PubMed

Goldszmidt, Mark; Minda, John Paul; Bordage, Georges

2013-03-01

The clinical reasoning literature focuses on how physicians reason while making decisions, rather than on what they reason about while performing their clinical tasks. In an attempt to provide a common language for discussing, teaching, and researching clinical reasoning, the authors undertook the task of developing a unified list of physicians' reasoning tasks, or what they reason about, during clinical encounters. The authors compiled an initial list of 20 reasoning tasks based on the literature from four content areas--clinical reasoning, communications, medical errors, and clinical guidelines. In the summer and fall of 2010, they surveyed a purposive sample of 46 international experts in clinical reasoning and communications. From the results of the first survey, the authors refined their list of reasoning tasks, then resurveyed 22 of the original participants. From the results of the second survey, they further refined their list and validated the inclusion of the reasoning tasks. Twenty-four of 46 (52%) and 15 of 22 (65%) participants completed the first- and second-round surveys, respectively. Following the second-round survey, the authors' list included 24 reasoning tasks, and a clinical example corresponding to each, that fell into four broad categories: framing the encounter (3), diagnosis (8), management (11), and self-reflection (2). The development of this unified list represents a first step in offering a vocabulary for discussing, reflecting on, teaching, and studying physicians' reasoning tasks during clinical encounters.

Voyager: Neptune Encounter Highlights

NASA Technical Reports Server (NTRS)

1989-01-01

Voyager encounter data are presented in computer animation (CA) and real (R) animation. The highlights include a view of 2 full rotations of Neptune. It shows spacecraft trajectory 'diving' over Neptune and intercepting Triton's orbit, depicting radiation and occulation zones. Also shown are a renegade orbit of Triton and Voyager's encounter with Neptune's Magnetopause. A model of the spacecraft's complex maneuvers during close encounters of Neptune and Triton is presented. A view from Earth of Neptune's occulation experiment is is shown as well as a recreation of Voyager's final pass. There is detail of Voyager's Image Compensation technique which produces Voyager images. Eighteen images were produced on June 22 - 23, 1989, from 57 million miles away. A 68 day sequence which provides a stroboscopic view - colorization approximates what is seen by the human eye. Real time images recorded live from Voyager on 8/24/89 are presented. Photoclinometry produced the topography of Triton. Three images are used to create a sequence of Neptune's rings. The globe of Neptune and 2 views of the south pole are shown as well as Neptune rotating. The rotation of a scooter is frozen in images showing differential motion. There is a view of rotation of the Great Dark Spot about its own axis. Photoclinometry provides a 3-dimensional perspective using a color mosaic of Triton images. The globe is used to indicate the orientation of Neptune's crescent. The east and west plumes on Triton are shown.

Neptune encounter highlights

NASA Astrophysics Data System (ADS)

1989-11-01

Voyager encounter data are presented in computer animation (CA) and real (R) animation. The highlights include a view of 2 full rotations of Neptune. It shows spacecraft trajectory 'diving' over Neptune and intercepting Triton's orbit, depicting radiation and occulation zones. Also shown are a renegade orbit of Triton and Voyager's encounter with Neptune's Magnetopause. A model of the spacecraft's complex maneuvers during close encounters of Neptune and Triton is presented. A view from Earth of Neptune's occulation experiment is is shown as well as a recreation of Voyager's final pass. There is detail of Voyager's Image Compensation technique which produces Voyager images. Eighteen images were produced on June 22 - 23, 1989, from 57 million miles away. A 68 day sequence which provides a stroboscopic view - colorization approximates what is seen by the human eye. Real time images recorded live from Voyager on 8/24/89 are presented. Photoclinometry produced the topography of Triton. Three images are used to create a sequence of Neptune's rings. The globe of Neptune and 2 views of the south pole are shown as well as Neptune rotating. The rotation of a scooter is frozen in images showing differential motion. There is a view of rotation of the Great Dark Spot about its own axis. Photoclinometry provides a 3-dimensional perspective using a color mosaic of Triton images. The globe is used to indicate the orientation of Neptune's crescent. The east and west plumes on Triton are shown.

Top-down, Bottom-up and Sideways: The Multilayered Complexities of Multi-level Actors Shaping Forest Governance and REDD+ Arrangements in Madre de Dios, Peru.

PubMed

Rodriguez-Ward, Dawn; Larson, Anne M; Ruesta, Harold Gordillo

2018-01-03

This study examines the role multilevel governance plays in the adoption of sustainable landscape management initiatives in emerging arrangements aimed at reducing emissions from deforestation and forest degradation (REDD+). It sheds light on the challenges these multiple layers of actors and interests encounter around such alternatives in a subnational jurisdiction. Through transcript analysis of 93 interviews with institutional actors in the region of Madre de Dios, Peru, particularly with regard to five sites of land-use change, we identified the multiple actors who are included and excluded in the decision-making process and uncovered their complex interactions in forest and landscape governance and REDD+ arrangements. Madre de Dios is a useful case for studying complex land-use dynamics, as it is home to multiple natural resources, a large mix of actors and interests, and a regional government that has recently experienced the reverberations of decentralization. Findings indicate that multiple actors shaped REDD+ to some extent, but REDD+ and its advocates were unable to shape land-use dynamics or landscape governance, at least in the short term. In the absence of strong and effective regional regulation for sustainable land use alternatives and the high value of gold on the international market, illegal gold mining proved to be a more profitable land-use choice. Although REDD+ created a new space for multilevel actor interaction and communication and new alliances to emerge, the study questions the prevailing REDD+ discourse suggesting that better coordination and cooperation will lead to integrated landscape solutions. For REDD+ to be able to play a role in integrated landscape governance, greater attention needs to be paid to grassroots actors, power and authority over territory and underlying interests and incentives for land-use change.

Complex proximal humeral fractures: a prospective study of 22 cases treated using the "Bilboquet" device.

PubMed

Doursounian, L; Kilinc, A; Cherrier, B; Nourissat, G

2011-02-01

Despite recent improvements in surgical devices, complex proximal humerus fractures internal fixation still encounters frequent mechanical failures. The aim of this study was to confirm that the Bilboquet device (a design mimicking the cup-and-ball game) helps solving mechanical difficulties associated with these fractures internal fixation and to present a simplified version of the original surgical procedure. This non-randomised prospective study included 22 fractures in 22 patients, mean age: 70 years. According to the Neer classification there were three-part fractures in seven cases and four-part fractures in 15 cases. Fractures were all reduced and treated by internal fixation in a simplified surgical procedure using the Bilboquet device. Mean postoperative follow-up was 34 months. The mean Constant score was 66 and the weighted Constant score was 86. Mean active forward elevation was 108° and mean active external rotation was 28°. No per- or postoperative complications occurred. Initial reduction of the tuberosity was incomplete in four cases. Union was obtained in all fractures. There was no secondary tilting of the head, and no migration or pseudarthrosis of the tuberosities. Five patients developed postoperative avascular necrosis of the humeral head. The Bilboquet staple component provides a supporting platform for the entire humeral head area. This peripheral stabilization associated with tension band wiring explains the lack of secondary displacement in these cases. Although the Bilboquet device provides a solution to the mechanical problems of complex fractures of the proximal humerus, it does not solve the problem of secondary avascular necrosis of the humeral head, which occurred in 23% of the patients in this series and in 33% of patients in the four-part fractures subgroup. IV (non-randomised prospective study). Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Who Treats Patients with Diabetes and Compensated Cirrhosis

PubMed Central

Barritt IV, A. Sidney; Weinberger, Morris; Paul, John E.; Fried, Bruce; Trogdon, Justin G.

2016-01-01

Background Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. Objective We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. Design Retrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases. Patients We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded. Main Measures Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories. Key Results Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%). Conclusions This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination. PMID:27783702

Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients.

PubMed

Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C

2016-03-01

The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface-to-face, nonbillable encounters performed by perioperative nursing staff. The care coordination activities integrated into the preoperative process include elaboration of care plans and identification and remediation of discrepancies. Capturing the activities and outcomes of care coordination for preoperative care provides a framework for quality improvement and enables documentation of the value of nonface-to-face perioperative nursing encounters that comprise care coordination.

The postural control can be optimized by the first movement initiation condition encountered when submitted to muscle fatigue.

PubMed

Monjo, Florian; Forestier, Nicolas

2017-08-01

We investigated whether and how the movement initiation condition (IC) encountered during the early movements performed following focal muscle fatigue affects the postural control of discrete ballistic movements. For this purpose, subjects performed shoulder flexions in a standing posture at maximal velocity under two movement IC, i.e., in self-paced conditions and submitted to a Stroop-like task in which participants had to trigger fast shoulder flexions at the presentation of incongruent colors. Shoulder flexion kinematics, surface muscle activity of focal and postural muscles as well as center-of-pressure kinematics were recorded. The initial IC and the order in which subjects were submitted to these two conditions were varied within two separate experimental sessions. IC schedule was repeated before and after fatigue protocols involving shoulder flexors. The aim of this fatigue procedure was to affect acceleration-generating capacities of focal muscles. In such conditions, the postural muscle activity preceding and accompanying movement execution is expected to decrease. Following fatigue, when subjects initially moved in self-paced conditions, postural muscle activity decreased and scaled to the lower focal peak acceleration. This postural strategy then transferred to the Stroop-like task. In contrast, when subjects initially moved submitted to the Stroop-like task, postural muscle activity did not decrease and this transferred to self-paced movements. Regarding the center-of-pressure peak velocity, which is indicative of the efficiency of the postural actions generated in stabilizing posture, no difference appeared between the two sessions post-fatigue. This highlights an optimization of the postural actions when subjects first moved in self-paced conditions, smaller postural muscle activation levels resulting in similar postural consequences. In conclusion, the level of neuromuscular activity associated with the postural control is affected and can be optimized by the initial movement IC experienced post-fatigue. Beyond the fundamental contributions arising from these results, we point out potential applications for trainers and sports instructors. Copyright © 2017 Elsevier B.V. All rights reserved.