The Baltimore Youth Ammunition Initiative: A Model Application of Local Public Health Authority in Preventing Gun Violence

PubMed Central

Lewin, Nancy L.; Vernick, Jon S.; Beilenson, Peter L.; Mair, Julie S.; Lindamood, Melisa M.; Teret, Stephen P.; Webster, Daniel W.

2005-01-01

In 2002, the Baltimore City Health Department, in collaboration with the Baltimore Police Department and the Johns Hopkins Center for Gun Policy and Research, launched the Youth Ammunition Initiative. The initiative addressed Baltimore’s problem of youth gun violence by targeting illegal firearm ammunition sales to the city’s young people. The initiative included undercover “sting” investigations of local businesses and issuance of health department violation and abatement notices. Intermediate results included the passage of 2 Baltimore city council ordinances regulating ammunition sales and reducing the number of outlets eligible to sell ammunition. Although it is too early to assess effects on violent crime, the intervention could theoretically reduce youth violence by interrupting one source of ammunition to youths. More important, the initiative can serve as a policy model for health commissioners seeking to become more active in gun violence prevention efforts. PMID:15855448

The Baltimore Youth Ammunition Initiative: a model application of local public health authority in preventing gun violence.

PubMed

Lewin, Nancy L; Vernick, Jon S; Beilenson, Peter L; Mair, Julie S; Lindamood, Melisa M; Teret, Stephen P; Webster, Daniel W

2005-05-01

In 2002, the Baltimore City Health Department, in collaboration with the Baltimore Police Department and the Johns Hopkins Center for Gun Policy and Research, launched the Youth Ammunition Initiative. The initiative addressed Baltimore's problem of youth gun violence by targeting illegal firearm ammunition sales to the city's young people. The initiative included undercover "sting" investigations of local businesses and issuance of health department violation and abatement notices. Intermediate results included the passage of 2 Baltimore city council ordinances regulating ammunition sales and reducing the number of outlets eligible to sell ammunition. Although it is too early to assess effects on violent crime, the intervention could theoretically reduce youth violence by interrupting one source of ammunition to youths. More important, the initiative can serve as a policy model for health commissioners seeking to become more active in gun violence prevention efforts.

Cerebral network deficits in post-acute catatonic schizophrenic patients measured by fMRI.

PubMed

Scheuerecker, J; Ufer, S; Käpernick, M; Wiesmann, M; Brückmann, H; Kraft, E; Seifert, D; Koutsouleris, N; Möller, H J; Meisenzahl, E M

2009-03-01

Twelve patients with catatonic schizophrenia and 12 matched healthy controls were examined with functional MRI while performing a motor task. The aim of our study was to identify the intracerebral pathophysiological correlates of motor symptoms in catatonic patients. The motor task included three conditions: a self-initiated (SI), an externally triggered (ET) and a rest condition. Statistical analysis was performed with SPM5. During the self-initiated movements patients showed significantly less activation than healthy controls in the supplementary motor area (SMA), the prefrontal and parietal cortex. Our results suggest a dysfunction of the "medial motor system" in catatonic patients. Self-initiated and externally triggered movements are mediated by different motor loops. The "medial loop" includes the SMA, thalamus and basal ganglia, and is necessary for self-initiated movements. The "lateral loop" includes parts of the cerebellum, lateral premotor cortex, thalamus and parietal association areas. It is involved in the execution of externally triggered movements. Our findings are in agreement with earlier behavioral data, which show deficits in self-initiated movements in catatonic patients but no impairment of externally triggered movements.

The Wisconsin Early Childhood Obesity Prevention Initiative: An Example of Statewide Collective Impact.

PubMed

Meinen, Amy; Hilgendorf, Amy; Korth, Amy L; Christens, Brian D; Breuer, Catherine; Joyner, Hilary; Polzin, Molle; Adams, Alexandra; Wolfe, Daithi; Braun, Abbe; Hoiting, Jill; Paulson, Jeanette; Cullen, Bridget; Stader, Kelli

2016-11-01

The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of “backbone” staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative’s impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state’s quality rating improvement system for child care centers is one of its outcomes. This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the value of establishing a clear common agenda among partners, the roles of backbone staff, and time and partner relationships in collective impact.

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.

Educational Technology: Effective Leadership and Current Initiatives

ERIC Educational Resources Information Center

Courville, Keith

2011-01-01

(Purpose) This article describes the basis for effective educational technology leadership and a few of the current initiatives and impacts that are a result of the aforementioned effective leadership. (Findings) Topics addressed in this paper include: (1) the role of the educational technology leader in an educational setting; (2) an examination…

Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

PubMed Central

Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

2016-01-01

Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

What is an integrable quench?

NASA Astrophysics Data System (ADS)

Piroli, Lorenzo; Pozsgay, Balázs; Vernier, Eric

2017-12-01

Inspired by classical results in integrable boundary quantum field theory, we propose a definition of integrable initial states for quantum quenches in lattice models. They are defined as the states which are annihilated by all local conserved charges that are odd under space reflection. We show that this class includes the states which can be related to integrable boundary conditions in an appropriate rotated channel, in loose analogy with the picture in quantum field theory. Furthermore, we provide an efficient method to test integrability of given initial states. We revisit the recent literature of global quenches in several models and show that, in all of the cases where closed-form analytical results could be obtained, the initial state is integrable according to our definition. In the prototypical example of the XXZ spin-s chains we show that integrable states include two-site product states but also larger families of matrix product states with arbitrary bond dimension. We argue that our results could be practically useful for the study of quantum quenches in generic integrable models.

Cloud Physics Lidar: Instrument Description and Initial Measurement Results

NASA Technical Reports Server (NTRS)

McGill, Matthew; Hlavka, Dennis; Hart, William; Scott, V. Stanley; Spinhirne, James; Schmid, Beat

2002-01-01

The Cloud Physics Lidar (CPL) is a new custom-built instrument for the NASA ER-2 high-altitude aircraft. The CPL can provide multiwavelength measurements of cirrus, subvisual cirrus, and aerosols with high temporal and spatial resolution. Its state-of-the-art technology gives it a high repetition rate, and photon-counting detection, and includes a low-pulse-energy laser. The CPL was first deployed at the Southern African Regional Science Initiative's 2000 field campaign during August and September 2000. This paper provides an overview of the instrument and initial data results to illustrate the measurement capability of the CPL.

Longitudinal Investigation of Smoking Initiation and Relapse Among Younger and Older US Military Personnel

PubMed Central

Trone, Daniel W.; Peterson, Arthur V.; Jacobson, Isabel G.; Littman, Alyson J.; Maynard, Charles; Seelig, Amber D.; Crum-Cianflone, Nancy F.; Bricker, Jonathan B.

2015-01-01

Objectives. We examined whether military service, including deployment and combat experience, were related to smoking initiation and relapse. Methods. We included older (panel 1) and younger (panel 2) participants in the Millennium Cohort Study. Never smokers were followed for 3 to 6 years for smoking initiation, and former smokers were followed for relapse. Complementary log-log regression models estimated the relative risk (RR) of initiation and relapse by military exposure while adjusting for demographic, health, and lifestyle factors. Results. Deployment with combat experience predicted higher initiation rate (panel 1: RR = 1.44; 95% confidence interval [CI] = 1.28, 1.62; panel 2: RR = 1.26; 95% CI = 1.04, 1.54) and relapse rate (panel 1 only: RR = 1.48; 95% CI = 1.36, 1.62). Depending on the panel, previous mental health disorders, life stressors, and other military and nonmilitary characteristics independently predicted initiation and relapse. Conclusions. Deployment with combat experience and previous mental disorder may identify military service members in need of intervention to prevent smoking initiation and relapse. PMID:25880953

Skewness in large-scale structure and non-Gaussian initial conditions

NASA Technical Reports Server (NTRS)

Fry, J. N.; Scherrer, Robert J.

1994-01-01

We compute the skewness of the galaxy distribution arising from the nonlinear evolution of arbitrary non-Gaussian intial conditions to second order in perturbation theory including the effects of nonlinear biasing. The result contains a term identical to that for a Gaussian initial distribution plus terms which depend on the skewness and kurtosis of the initial conditions. The results are model dependent; we present calculations for several toy models. At late times, the leading contribution from the initial skewness decays away relative to the other terms and becomes increasingly unimportant, but the contribution from initial kurtosis, previously overlooked, has the same time dependence as the Gaussian terms. Observations of a linear dependence of the normalized skewness on the rms density fluctuation therefore do not necessarily rule out initially non-Gaussian models. We also show that with non-Gaussian initial conditions the first correction to linear theory for the mean square density fluctuation is larger than for Gaussian models.

Selected Aspects of Markovian and Non-Markovian Quantum Master Equations

NASA Astrophysics Data System (ADS)

Lendi, K.

A few particular marked properties of quantum dynamical equations accounting for general relaxation and dissipation are selected and summarized in brief. Most results derive from the universal concept of complete positivity. The considerations mainly regard genuinely irreversible processes as characterized by a unique asymptotically stationary final state for arbitrary initial conditions. From ordinary Markovian master equations and associated quantum dynamical semigroup time-evolution, derivations of higher order Onsager coefficients and related entropy production are discussed. For general processes including non-faithful states a regularized version of quantum relative entropy is introduced. Further considerations extend to time-dependent infinitesimal generators of time-evolution and to a possible description of propagation of initial states entangled between open system and environment. In the coherence-vector representation of the full non-Markovian equations including entangled initial states, first results are outlined towards identifying mathematical properties of a restricted class of trial integral-kernel functions suited to phenomenological applications.

Evaluation of the "Foundations in Knowledge Translation" training initiative: preparing end users to practice KT.

PubMed

Park, Jamie S; Moore, Julia E; Sayal, Radha; Holmes, Bev J; Scarrow, Gayle; Graham, Ian D; Jeffs, Lianne; Timmings, Caitlyn; Rashid, Shusmita; Johnson, Alekhya Mascarenhas; Straus, Sharon E

2018-04-25

Current knowledge translation (KT) training initiatives are primarily focused on preparing researchers to conduct KT research rather than on teaching KT practice to end users. Furthermore, training initiatives that focus on KT practice have not been rigorously evaluated and have focused on assessing short-term outcomes and participant satisfaction only. Thus, there is a need for longitudinal training evaluations that assess the sustainability of training outcomes and contextual factors that may influence outcomes. We evaluated the KT training initiative "Foundations in KT" using a mixed-methods longitudinal design. "Foundations in KT" provided training in KT practice and included three tailored in-person workshops, coaching, and an online platform for training materials and knowledge exchange. Two cohorts were included in the study (62 participants, including 46 "Foundations in KT" participants from 16 project teams and 16 decision-maker partners). Participants completed self-report questionnaires, focus groups, and interviews at baseline and at 6, 12, 18, and 24 months after the first workshop. Participant-level outcomes include survey results which indicated that participants' self-efficacy in evidence-based practice (F(1,8.9) = 23.7, p = 0.001, n = 45), KT activities (F(1,23.9) = 43.2, p < 0.001, n = 45), and using evidence to inform practice increased over time (F(1,11.0) = 6.0, p = 0.03, n = 45). Interviews and focus groups illustrated that participants' understanding of and confidence in using KT increased from baseline to 24 months after the workshop. Interviews and focus groups suggested that the training initiative helped participants achieve their KT project objectives, plan their projects, and solve problems over time. Contextual factors include teams with high self-reported organizational capacity and commitment to implement at the start of their project had buy-in from upper management that resulted in secured funding and resources for their project. Training initiative outcomes include participants who applied the KT knowledge and skills they learned to other projects by sharing their knowledge informally with coworkers. Sustained spread of KT practice was observed with five teams at 24 months. We completed a longitudinal evaluation of a KT training initiative. Positive participant outcomes were sustained until 24 months after the initial workshop. Given the emphasis on implementing evidence and the need to train implementers, these findings are promising for future KT training.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Ciclovía initiatives: engaging communities, partners and policymakers along the route to success

PubMed Central

Hipp, Aaron; Eyler, Amy A.; Kim, Mi-Sook

2015-01-01

Context Recent efforts to increase physical activity through changes to the built environment have led to strategies and programs that use existing public space including bicycle lanes, temporary parks and the ciclovia initiative (scheduled events in which streets are closed to motorized vehicles and opened for recreational activities) popularized in South America. Objective The current paper describes and compares the processes and structures involved in developing and implementing a ciclovia-type program in two U.S. urban contexts: San Francisco, California, and St. Louis, Missouri. Considering the current growth of and interest in ciclovia initiatives, important outcomes, lessons learned are offered for application in other, similar settings. Design Primary sources from both initiatives and from published research on ciclovias constitute the body of evidence and include: year-end reports, grant applications, meeting minutes, budgets, published ciclovia guidelines, evaluation studies and websites, media sources and interviews and personal communication with the organizers. Main Outcome Measures Primary source documents were reviewed and included in this analysis if they offered information on three grounded questions: What processes were used in developing the initiative? What are the current structures and practices used in implementation of initiatives? What are important lessons learned and best practices from initiatives for recommendations to stakeholders and policy-makers in other contexts? Results Among the categories compared, the structures and processes for implementation regarding buy-in and city department collaboration, route selection, programming, partnerships, media promotion, community outreach and merchant support were relatively similar among the two initiatives. The categories that differed included staffing and volunteer engagement and funding. Conclusion Buy-in from community partners, merchants, residents and city agencies are critical for a positive experience in developing and implementing ciclovia-type initiatives in urban environments. When funding and staffing are inconsistent or limited, the quality and sustainability of the initiative is less certain. PMID:23529059

Variable frequency iteration MPPT for resonant power converters

DOEpatents

Zhang, Qian; Bataresh, Issa; Chen, Lin

2015-06-30

A method of maximum power point tracking (MPPT) uses an MPPT algorithm to determine a switching frequency for a resonant power converter, including initializing by setting an initial boundary frequency range that is divided into initial frequency sub-ranges bounded by initial frequencies including an initial center frequency and first and second initial bounding frequencies. A first iteration includes measuring initial powers at the initial frequencies to determine a maximum power initial frequency that is used to set a first reduced frequency search range centered or bounded by the maximum power initial frequency including at least a first additional bounding frequency. A second iteration includes calculating first and second center frequencies by averaging adjacent frequent values in the first reduced frequency search range and measuring second power values at the first and second center frequencies. The switching frequency is determined from measured power values including the second power values.

The Collaboration Readiness of Transdisciplinary Research Teams and Centers

PubMed Central

Hall, Kara L.; Stokols, Daniel; Moser, Richard P.; Taylor, Brandie K.; Thornquist, Mark D.; Nebeling, Linda C.; Ehret, Carolyn C.; Barnett, Matthew J.; McTiernan, Anne; Berger, Nathan A.; Goran, Michael I.; Jeffery, Robert W.

2009-01-01

Growing interest in promoting cross-disciplinary collaboration among health scientists has prompted several federal agencies, including the NIH, to establish large, multicenter initiatives intended to foster collaborative research and training. In order to assess whether these initiatives are effective in promoting scientific collaboration that ultimately results in public health improvements, it is necessary to develop new strategies for evaluating research processes and products as well as the longer-term societal outcomes associated with these programs. Ideally, evaluative measures should be administered over the entire course of large initiatives, including their near-term and later phases. The present study focuses on the development of new tools for assessing the readiness for collaboration among health scientists at the outset (during Year One) of their participation in the National Cancer Institute’s Transdisciplinary Research on Energetics and Cancer (TREC) initiative. Indexes of collaborative readiness, along with additional measures of near-term collaborative processes, were administered as part of the TREC Year-One evaluation survey. Additionally, early progress toward scientific collaboration and integration was assessed, using a protocol for evaluating written research products. Results from the Year-One survey and the ratings of written products provide evidence of cross-disciplinary collaboration among participants during the first year of the initiative, and also reveal opportunities for enhancing collaborative processes and outcomes during subsequent phases of the project. The implications of these findings for future evaluations of team science initiatives are discussed. PMID:18619396

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion.

PubMed

Ellis, Michael J; Cordingley, Dean M; Vis, Sara; Reimer, Karen M; Leiter, Jeff; Russell, Kelly

2017-01-01

OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.

Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule.

PubMed

Angell, Trevor E; Vyas, Chirag M; Barletta, Justine A; Cibas, Edmund S; Cho, Nancy L; Doherty, Gerard M; Gawande, Atul A; Howitt, Brooke E; Krane, Jeffrey F; Marqusee, Ellen; Strickland, Kyle C; Alexander, Erik K; Moore, Francis D; Nehs, Matthew A

2018-05-01

Diagnostic hemithyroidectomy (HT) is the most widely recommended surgical procedure for a nodule with indeterminate cytology; however, additional details may make initial total thyroidectomy (TT) preferable. We sought to identify patient-specific factors (PSFs) associated with initial TT in patients with indeterminate thyroid nodules. Retrospective analysis of all patients with a thyroid nodule ≥ 1 cm and initial cytology of atypia of undetermined significance or suspicious for follicular neoplasm between 2012 and 2015 who underwent thyroidectomy. Medical records were reviewed for patient demographics, neck symptoms, nodule size, cytology, molecular test results, final histopathology, and additional PSFs influencing surgical management. Variables were analyzed to determine associations with the use of initial TT. Logistic regression analyses were performed to identify independent associations. Of 325 included patients, 182/325 (56.0%) had HT and 143/325 (44.0%) had TT. While patient age and sex, nodule size, and cytology result were not associated with initial treatment, five PSFs were associated with initial TT (p < 0.0001). These included contralateral nodules, hypothyroidism, fluorodeoxyglucose avidity on positron emission tomography scan, family history of thyroid cancer, and increased surgical risk. At least one PSF was present in 126/143 (88.1%) TT patients versus 47/182 (25.8%) HT patients (p < 0.0001). Multivariate logistic regression analysis demonstrated that these variables were the strongest independent predictor of TT (odds ratio 45.93, 95% confidence interval 18.80-112.23, p < 0.001). When surgical management of an indeterminate cytology thyroid nodule was performed, several PSFs were associated with a preference by surgeons and patients for initial TT, which may be useful to consider in making decisions on initial operative extent.

Interventions to increase initial appointment attendance in mental health services: a systematic review.

PubMed

Schauman, Oliver; Aschan, Lisa Ellinor; Arias, Nicole; Beards, Stephanie; Clement, Sarah

2013-12-01

OBJECTIVE Although nonattendance at initial appointments in mental health services is a substantial problem, the phenomenon is poorly understood. This review synthesized findings of randomized controlled trials (RCTs) of interventions to increase initial appointment attendance and determined whether theories or models contributed to intervention design. METHODS Six electronic databases were systematically searched, and reference lists of identified studies were also examined. Studies included were RCTs (including "quasi-randomized" controlled trials) that compared standard practice with an intervention to increase attendance at initial appointments in a sample of adults who had a scheduled initial appointment in a mental health or substance abuse service setting. RESULTS Of 144 potentially relevant studies, 21 met inclusion criteria. These studies were reported in 20 different research papers. Of these, 16 studies (N=3,673 participants) were included in the analyses (five were excluded because they reported only nonattendance at the initial appointment). Separate analyses were conducted for each intervention type (opt-in systems, telephone reminders and prompts, orientation and reminder letters, accelerated intake, preappointment completion of psychodynamic questionnaires, and "other"). Narrative synthesis was used for analysis because the high level of heterogeneity between studies precluded a meta-analysis. The results were mixed for all types of intervention. Some isolated high-quality studies of opt-in systems, orientation and reminder letters, and more novel interventions demonstrated a beneficial effect. CONCLUSIONS The synthesized findings indicated that orientation and reminder letters may have a small beneficial effect. Consistent evidence for the efficacy of other types of common interventions is lacking. More novel interventions, such as asking clients to formulate plans to deal with obstacles to attendance and giving clients a choice of therapist style, showed some promise, but studies require replication.

Access to Oral Osteoporosis Drugs among Female Medicare Part D Beneficiaries

PubMed Central

Lin, Chia-Wei; Karaca-Mandic, Pinar; McCullough, Jeffrey S.; Weaver, Lesley

2014-01-01

Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies. PMID:24837398

Building upon the Great Waters Initiative: Scoping study for potential polyaromatic hydrocarbon deposition into San Diego Bay

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

Koehler, J.; Sylte, W.W.

1997-12-31

The deposition of atmospheric polyaromatic hydrocarbons (PAHs) into San Diego Bay was evaluated at an initial study level. This study was part of an overall initial estimate of PAH waste loading to San Diego Bay from all environmental pathways. The study of air pollutant deposition to water bodies has gained increased attention both as a component of Total Maximum Daily Load (TMDL) determinations required under the Clean Water Act and pursuant to federal funding authorized by the 1990 Clean Air Act Amendments to study the atmospheric deposition of hazardous air pollutants to the Great Waters, which includes coastal waters. Tomore » date, studies under the Clean Air Act have included the Great Lakes, Chesapeake Bay, Lake Champlain, and Delaware Bay. Given the limited resources of this initial study for San Diego Bay, the focus was on maximizing the use of existing data and information. The approach developed included the statistical evaluation of measured atmospheric PAH concentrations in the San Diego area, the extrapolation of EPA study results of atmospheric PAH concentrations above Lake Michigan to supplement the San Diego data, the estimation of dry and wet deposition with published calculation methods considering local wind and rainfall data, and the comparison of resulting PAH deposition estimates for San Diego Bay with estimated PAH emissions from ship and commercial boat activity in the San Diego area. The resulting PAH deposition and ship emission estimates were within the same order of magnitude. Since a significant contributor to the atmospheric deposition of PAHs to the Bay is expected to be from shipping traffic, this result provides a check on the order of magnitude on the PAH deposition estimate. Also, when compared against initial estimates of PAH loading to San Diego Bay from other environmental pathways, the atmospheric deposition pathway appears to be a significant contributor.« less

Initiation devices, initiation systems including initiation devices and related methods

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

Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki

Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materialsmore » include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.« less

Newborn screening for metabolic disorders: parental perceptions of the initial communication of results.

PubMed

Buchbinder, Mara; Timmermans, Stefan

2012-08-01

Positive newborn screening (NBS) results cause significant parental distress, but little is known about how parents find out about children's screening results and what they are told. This qualitative, exploratory study reports on parents' perceptions of the initial communication of NBS results. Participants included the parents of 75 infants referred to a metabolic clinic in California over a 3-year period (2007-2010). Parents provided information about the initial communication of NBS results during audiotaped clinical encounters and open-ended interviews. Transcripts were analyzed inductively using thematic coding. Responses fell into 3 primary themes: sources of news delivery, providing information, and mitigation strategies. The findings suggest that health care providers have access to a range of communicative resources to buffer the impact of positive screening results that may be mobilized in future interventions. Recommendations for improving the communication process and future research directions are discussed.

The School Counseling Program Implementation Survey: Initial Instrument Development and Exploratory Factor Analysis

ERIC Educational Resources Information Center

Clemens, Elysia V.; Carey, John C.; Harrington, Karen M.

2010-01-01

This article details the initial development of the School Counseling Program Implementation Survey and psychometric results including reliability and factor structure. An exploratory factor analysis revealed a three-factor model that accounted for 54% of the variance of the intercorrelation matrix and a two-factor model that accounted for 47% of…

Measuring Quality beyond Test Scores: The Impact of Regional Context on Curriculum Implementation (in Northern Uganda)

ERIC Educational Resources Information Center

Spreen, Carol Anne; Knapczyk, Jillian J.

2017-01-01

Although global initiatives have brought attention to the lack of quality in education systems worldwide; the question remains, how do we implement quality education? Teachers, a vital component of the education process, are not usually included in these global conversations; this results in government initiatives missing key obstacles faced by…

Mayor de Blasio: Comprehensive Homeless Services Plan Increases Focus on

Science.gov Websites

HRA management structure based on the veterans move out initiative will focus on finding permanent structure based on the veterans move out initiative to promote move outs to reduce the shelter census Focus on Prevention & Rehousing Result of 90-day review includes streamlined management structure

Initial results of the Global Thermospheric Mapping Study (GTMS)

NASA Technical Reports Server (NTRS)

Oliver, W. L.; Salah, J. E.; Musgrove, R. G.; Holt, J. M.; Wickwar, V. B.; Hernandez, G. J.; Roble, R. G.

1986-01-01

The Global Thermospheric Mapping Study (GTMS) is a multi-technique experimental study of the thermosphere designed to map simultaneously its spatial and temporal morphology with a thoroughness and diversity of measurement techniques heretofore unachieved. The GTMS is designed around the Incoherent Scatter Radar Chain in the western hemisphere. The European incoherent scatter radars and the worldwide communities of Fabry-Perot interferometers, meteor wind radars, partial reflection drifts radars, MST radars, and satellite probes are included to extend the spatial coverage and types of measurements available. Theoretical and modeling support in the areas of thermospheric and ionospheric structure, tides, and electric fields are included to aid in program planning and data interpretation. Solar activity was low on the three observation days (F10.7 = 97, 98, 96) and magnetic conditions were unsettled to active (A = 10, 12, 20). All six incoherent scatter radar facilities collected data. Each collected F region data day and night while Saint Santin and Millstone Hill additionally collected E region data during daylight hours. Initial results from Sondrestrom and Millstone Hill are presented. Good quality Fabry Perot data were collected at Fritz Peak and San Jose dos Campos. Weather conditions produced poor results at Arequipa and Arecibo. Initial results from Fritz Peak are presented. Mesosphere/lower-thermosphere observations were conducted under the ATMAP organization. The magnetometer chains also were operational during this campaign. Initial thermospheric general circulation model predictions were made for assumed solar-geophysical conditions, and selected results are presented.

40 CFR 1033.320 - Calculation and reporting of test results.

Code of Federal Regulations, 2012 CFR

2012-07-01

... results. 1033.320 Section 1033.320 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Production Line Testing and Audit Programs § 1033.320 Calculation and reporting of test results. (a) Calculate initial test results using the applicable test procedure specified in § 1033.315(a). Include...

40 CFR 1033.320 - Calculation and reporting of test results.

Code of Federal Regulations, 2011 CFR

2011-07-01

... results. 1033.320 Section 1033.320 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Production Line Testing and Audit Programs § 1033.320 Calculation and reporting of test results. (a) Calculate initial test results using the applicable test procedure specified in § 1033.315(a). Include...

Integrated hydrologic modeling: Effects of spatial scale, discretization and initialization

NASA Astrophysics Data System (ADS)

Seck, A.; Welty, C.; Maxwell, R. M.

2011-12-01

Groundwater discharge contributes significantly to the annual flows of Chesapeake Bay tributaries and is presumed to contribute to the observed lag time between the implementation of management actions and the environmental response in the Chesapeake Bay. To investigate groundwater fluxes and flow paths and interaction with surface flow, we have developed a fully distributed integrated hydrologic model of the Chesapeake Bay Watershed using ParFlow. Here we present a comparison of model spatial resolution and initialization methods. We have studied the effect of horizontal discretization on overland flow processes at a range of scales. Three nested model domains have been considered: the Monocacy watershed (5600 sq. km), the Potomac watershed (92000 sq. km) and the Chesapeake Bay watershed (400,000 sq. km). Models with homogeneous subsurface and topographically-derived slopes were evaluated at 500-m, 1000-m, 2000-m, and 4000-m grid resolutions. Land surface slopes were derived from resampled DEMs and corrected using stream networks. Simulation results show that the overland flow processes are reasonably well represented with a resolution up to 2000 m. We observe that the effects of horizontal resolution dissipate with larger scale models. Using a homogeneous model that includes subsurface and surface terrain characteristics, we have evaluated various initialization methods for the integrated Monocacy watershed model. This model used several options for water table depths and two rainfall forcing methods including (1) a synthetic rainfall-recession cycle corresponding to the region's average annual rainfall rate, and (2) an initial shut-off of rainfall forcing followed by a rainfall-recession cycling. Results show the dominance of groundwater generated runoff during a first phase of the simulation followed by a convergence towards more balanced runoff generation mechanisms. We observe that the influence of groundwater runoff increases in dissected relief areas characterized by high slope magnitudes. This is due to the increase in initial water table gradients in these regions. As a result, in the domain conditions for this study, an initial shut-off of rainfall forcing proved to be the more efficient initialization method. The initialized model is then coupled with a Land Surface Model (CLM). Ongoing work includes coupling a heterogeneous subsurface field with spatially variable meteorological forcing using the National Land Data Assimilation System (NLDAS) data products. Seasonal trends of groundwater levels for current and pre-development conditions of the basin will be compared.

Initiatives promoting seamless care in medication management: an international review of the grey literature.

PubMed

Claeys, Coraline; Foulon, Veerle; de Winter, Sabrina; Spinewine, Anne

2013-12-01

Patients' transition between hospital and community is a high-risk period for the occurrence of medication-related problems. The objective was to review initiatives, implemented at national and regional levels in seven selected countries, aiming at improving continuity in medication management upon admission and hospital discharge. We performed a structured search of grey literature, mainly through relevant websites (scientific, professional and governmental organizations). Regional or national initiatives were selected. For each initiative data on the characteristics, impact, success factors and barriers were extracted. National experts were asked to validate the initiatives identified and the data extracted. Most initiatives have been implemented since the early 2000 and are still ongoing. The principal actions include: development and implementation of guidelines for healthcare professionals, national information campaigns, education of healthcare professionals and development of information technologies to share data across settings of care. Positive results have been partially reported in terms of intake into practice or process measures. Critical success factors identified included: leadership and commitment to convey national and local forces, tailoring to local settings, development of a regulatory framework and information technology support. Barriers identified included: lack of human and financial resources, questions relative to responsibility and accountability, lack of training and lack of agreement on privacy issues. Although not all initiatives are applicable as such to a particular healthcare setting, most of them convey very interesting data that should be used when drawing recommendations and implementing approaches to optimize continuity of care.

Lead paint removal with high-intensity light pulses.

PubMed

Grapperhaus, Michael J; Schaefer, Raymond B

2006-12-15

This paper presents the results of an initial investigation into using high-intensity incoherent light pulses to strip paint. Measurements of light pulse characteristics, the reflectivity of different paints and initial experiments on the threshold for paint removal, and paint removal are presented, along with an approximate model consistent with experimental results. Paint removal tests include lead paint, the reduction of lead levels to below levels required for lead abatement, as well as air and light emissions measurements that are within regulatory guidelines.

Initial animal studies of a wireless, batteryless, MEMS implant for cardiovascular applications.

PubMed

Najafi, Nader; Ludomirsky, Achiau

2004-03-01

This paper reports the results of the initial animal studies of a wireless, batteryless, implantable pressure sensor using microelectromechanical systems (MEMS) technology. The animal studies were acute and proved the functional feasibility of using MEMS technology for wireless bio sensing. The results are very encouraging and surpassed the majority of the application's requirements, including high sampling speed and high resolution. Based on the lessons learned, second generation wireless sensors are being developed that will provide total system solution.

Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome

PubMed Central

Bin rsheed, Abdulaziz; Chenoweth, Ian

2017-01-01

AIM To explore primary care physicians’ perspectives on possible barriers to the use of insulin. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers’ perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients’ perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians’ known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number. PMID:28138362

Promoting pre-conceptional use of folic acid to Hispanic women: a social marketing approach.

PubMed

Quinn, Gwendolyn P; Hauser, Kimberlea; Bell-Ellison, Bethany A; Rodriguez, Nydia Y; Frías, Jaime L

2006-09-01

To develop a culturally appropriate communication initiative in an effort to promote the use of pre-conceptional folic acid among Hispanic women of childbearing age. The materials were designed to communicate information about the risks of neural tube defects and the value of folic acid supplementation before conception. The initiative was developed using a social marketing approach. A series of focus groups were conducted with Hispanic women, particularly Mexican and Mexican-American women, to gain an understanding of their knowledge, attitudes, and behaviors regarding birth defects and folic acid. Additionally focus groups assessed women's preferences for existing folic acid education materials. Qualitative analysis of coded transcripts revealed key themes which were incorporated into a multi-media initiative. Critical themes of the research highlighted the need to include the role of partners and a sense of family in the promotions aimed at these groups. Another key component was the need to dispel myths which act as barriers to pre-conceptional folic acid use. Other important elements included in the media products were the need for Spanish and English versions, an explanation of neural tube defects, and a reference to the cost of the supplements. The final products of the initiative included Spanish and English versions of a brochure, photo-novella, and radio public service announcement. Pre-testing results showed women understood the message, thought the message was for women like them, and expected to begin taking a folic acid supplement. Results of the overall evaluation of the initiative are on-going.

Pediatric Emergency Research Canada (PERC): Patient/Family-Informed Research Priorities for Pediatric Emergency Medicine.

PubMed

Bialy, Liza; Plint, Amy C; Freedman, Stephen B; Johnson, David W; Curran, Janet A; Stang, Antonia S

2018-06-06

A growing body of literature supports patient and public involvement in the design, prioritization and dissemination of research and evidence based medicine. The objectives of this project were to engage patients and families in developing a prioritized list of research topics for Pediatric Emergency Medicine (PEM) and to compare results with prior research prioritization initiatives in the ED (emergency department) setting. We utilized a systematic process to combine administrative data on frequency of patient presentations to the ED with multiple stakeholder input including an initial stakeholder survey followed by a modified Delphi consensus methodology consisting of two web-based surveys and a face-to-face meeting. The prioritization process resulted in a ranked list of 15 research priorities. The top five priorities were mental health presentations, pain and sedation, practice tools, quality of care delivery and resource utilization. Mental health, pain and sedation, clinical prediction rules, respiratory illnesses /wheeze, patient safety/medication error and sepsis were identified as shared priorities with prior initiatives. Topics identified in our process that were not identified in prior work included resource utilization, ED communication, antibiotic stewardship and patient/family adherence with recommendations. This work identifies key priorities for research in PEM. Comparing our results with prior initiatives in the ED setting identified shared research priorities and opportunities for collaboration among PEM research networks. This work in particular makes an important contribution to the existing literature by including the patient/family perspective missing from prior work. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients.

PubMed

Ford, Diana C; Schroeder, Mary C; Ince, Dilek; Ernst, Erika J

2018-06-14

The cost-effectiveness of initial treatment strategies for mild-to-moderate Clostridium difficile infection (CDI) in hospitalized patients was evaluated. Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective. The primary outcome was the incremental cost-effective ratio (ICER) between initial treatment strategies. In the primary model, the overall percentage of patients cured was 94.23%, 95.19%, and 96.53% with metronidazole, vancomycin, and fidaxomicin, respectively. Expected costs per case were $1,553.01, $1,306.62, and $5,095.70, respectively. In both models, vancomycin was more effective and less costly than metronidazole, resulting in negative ICERs. The ICERs for fidaxomicin compared with those for metronidazole and vancomycin in the primary model were $1,540.23 and $2,828.69 per 1% gain in cure, respectively. Using these models, a hospital currently treating initial episodes of mild-to-moderate CDI with metronidazole could expect to save $246.39-$388.37 per case treated by using vancomycin for initial therapy. A decision-analytic model revealed vancomycin to be cost-effective, compared with metronidazole, for treatment of initial episodes of mild-to-moderate CDI in adult inpatients. From the hospital perspective, initial treatment with vancomycin resulted in a higher probability of cure and a lower probability of colectomy, recurrence, persistent recurrence, and cost per case treated, compared with metronidazole. Use of fidaxomicin was associated with an increased probability of cure compared with metronidazole and vancomycin, but at a substantially increased cost. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Improved survival in HIV treatment programs in Asia

PubMed Central

De La Mata, Nicole L; Kumarasamy, Nagalingeswaran; Khol, Vohith; Ng, Oon Tek; Van Nguyen, Kinh; Merati, Tuti Parwati; Pham, Thuy Thanh; Lee, Man Po; Durier, Nicolas; Law, Matthew

2016-01-01

Background Antiretroviral treatment (ART) for HIV-positive patients has expanded rapidly in Asia over the last ten years. Our study aimed to describe the time trends and risk factors for overall survival in patients receiving first-line ART in Asia. Methods We included HIV-positive adult patients who initiated ART between 2003–2013 (n=16 546), from seven sites across six Asia-Pacific countries. Patient follow-up was to May 2014. We compared survival for each country and overall by time period of ART initiation using Kaplan-Meier curves. Factors associated with mortality were assessed using Cox regression, stratified by site. We also summarized first-line ART regimens, CD4 count at ART initiation, and CD4 and HIV viral load testing frequencies. Results There were 880 deaths observed over 54 532 person-years of follow-up, a crude rate of 1.61 (1.51, 1.72) per 100 person-years. Survival significantly improved in more recent years of ART initiation. The survival probabilities at 4 years follow-up for those initiating ART in 2003–05 was 92.1%, 2006–09 was 94.3% and 2010–2013 was 94.5% (p<0.001). Factors associated with higher mortality risk included initiating ART in earlier time periods, older age, male sex, injecting drug use as HIV exposure and lower pre-ART CD4 count. Concurrent with improved survival was increased tenofovir use, ART initiation at higher CD4 counts, and greater monitoring of CD4 and HIV viral load. Conclusions Our results suggest that HIV-positive patients from Asia have improved survival in more recent years of ART initiation. This is likely a consequence of improvements in treatment and, patient management and monitoring over time. PMID:26961354

TREC Initiative with Cheshire II.

ERIC Educational Resources Information Center

Larson, Ray R.

2001-01-01

Describes the University of California at Berkeley's participation in the TREC (Text Retrieval Conference) interactive track experiments. Highlights include results of searches on two systems, Cheshire II and ZPRISE; system design goals and implementation; precision and recall results; search questions by topic and system; and results of…

Overview of Additive Manufacturing Initiatives at NASA Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Clinton, R. G., Jr.

2018-01-01

NASA's In Space Manufacturing Initiative (ISM) includes: The case for ISM - why; ISM path to exploration - results from the 3D Printing In Zero-G Technology Demonstration - ISM challenges; In space Robotic Manufacturing and Assembly (IRMA); Additive construction. Additively Manufacturing (AM) development for liquid rocket engine space flight hardware. MSFC standard and specification for additively manufactured space flight hardware. Summary.

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.

From a lunar outpost to Mars - Science, policy and the U.S. Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Pilcher, Carl B.

1992-01-01

The technological developments required for the Space Exploration Initiative (SEI) objectives are discussed in terms of scientific investigation and present U.S. space policy. The results of the 90-Day Study are listed which include explicit suggestions for the successful exploration of the moon and Mars. The Outreach/Synthesis program is described which provides four methods for eliciting ideas, technologies, and research venues for lunar and Martian missions. The results of the studies include 5 scientific objectives such as the relationship between the sun, planetary atmospheres, and climate. The protection of human life from potential extraterrestrial hazards such as radiation is also found to be a key objective of SEI as are the theoretical and practical issues of scientific research.

Reduction of initial shock in decadal predictions using a new initialization strategy

NASA Astrophysics Data System (ADS)

He, Yujun; Wang, Bin

2017-04-01

Initial shock is a well-known problem occurring in the early years of a decadal prediction when assimilating full-field observations into a coupled model, which directly affects the prediction skill. For the purpose to alleviate this problem, we propose a novel full-field initialization method based on dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar). Different from the available solution strategies including anomaly assimilation and bias correction, it substantially reduces the initial shock through generating more consistent initial conditions for the coupled model, which, along with the model trajectory in one-month windows, best fit the monthly mean analysis data of oceanic temperature and salinity. We evaluate the performance of initialized hindcast experiments according to three proposed indices to measure the intensity of the initial shock. The results indicate that this strategy can obviously reduce the initial shock in decadal predictions by FGOALS-g2 (the Flexible Global Ocean-Atmosphere-Land System model, Grid-point Version 2) compared with the commonly-used nudging full-field initialization for the same model as well as the different full-field initialization strategies for other CMIP5 (the fifth phase of the Coupled Model Intercomparison Project) models whose decadal prediction results are available. It is also comparable to or even better than the anomaly initialization methods. Better hindcasts of global mean surface air temperature anomaly are obtained due to the reduction of initial shock by the new initialization scheme.

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco

PubMed Central

2011-01-01

Background Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Methods Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. Results 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Conclusions Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups. PMID:21356062

Laser diode initiated detonators for space applications

NASA Technical Reports Server (NTRS)

Ewick, David W.; Graham, J. A.; Hawley, J. D.

1993-01-01

Ensign Bickford Aerospace Company (EBAC) has over ten years of experience in the design and development of laser ordnance systems. Recent efforts have focused on the development of laser diode ordnance systems for space applications. Because the laser initiated detonators contain only insensitive secondary explosives, a high degree of system safety is achieved. Typical performance characteristics of a laser diode initiated detonator are described in this paper, including all-fire level, function time, and output. A finite difference model used at EBAC to predict detonator performance, is described and calculated results are compared to experimental data. Finally, the use of statistically designed experiments to evaluate performance of laser initiated detonators is discussed.

Implications of DRG Classification in a Bundled Payment Initiative for COPD

PubMed Central

PAREKH, TRISHA M.; BHATT, SURYA P.; WESTFALL, ANDREW O.; WELLS, JAMES M.; KIRKPATRICK, DENAY; IYER, ANAND S.; MUGAVERO, MICHAEL; WILLIG, JAMES H.; DRANSFIELD, MARK T.

2018-01-01

OBJECTIVES Institutions participating in the Medicare Bundled Payments for Care Improvement (BPCI) initiative invest significantly in efforts to reduce readmissions and costs for patients who are included in the program. Eligibility for the BPCI initiative is determined by diagnosis-related group (DRG) classification. The implications of this methodology for chronic diseases are not known. We hypothesized that patients included in a BPCI initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. STUDY DESIGN Retrospective observational study. METHODS We sought to determine the clinical characteristics and outcomes of Medicare patients admitted to the University of Alabama at Birmingham Hospital with acute exacerbations of COPD between 2012 and 2014 who were included and excluded in a BPCI initiative. Patients were included in the analysis if they were discharged with a COPD DRG or with a non-COPD DRG but with an International Classification of Diseases, Ninth Revision code for COPD exacerbation. RESULTS Six hundred and ninety-eight unique patients were discharged for an acute exacerbation of COPD; 239 (34.2%) were not classified into a COPD DRG and thus were excluded from the BPCI initiative. These patients were more likely to have intensive care unit (ICU) admissions (63.2% vs 4.4%, respectively; P <.001) and require noninvasive (46.9% vs 6.5%; P <.001) and invasive mechanical ventilation (41.4% vs 0.7%; P <.001) during their hospitalization than those in the initiative. They also had a longer ICU length of stay (5.2 vs 1.8 days; P = .011), longer hospital length of stay (10.3 days vs 3.9 days; P <.001), higher in-hospital mortality (14.6% vs 0.7%; P <.001), and greater hospitalization costs (median = $13,677 [interquartile range = $7489-$23,054] vs $4281 [$2718-$6537]; P <.001). CONCLUSIONS The use of DRGs to identify patients with COPD for inclusion in the BPCI initiative led to the exclusion of more than one-third of patients with acute exacerbations who had more severe illness and worse outcomes and who may benefit most from the additional interventions provided by the initiative. PMID:29623307

Marshall Space Flight Center Propulsion Systems Department (PSD) KM Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnadoe, Tom; McCarter, Mike

2006-01-01

NASA Marshall Space Flight Center s Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities with in the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center Of Excellence (AISCE), Intergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KM implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to support the planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have been performed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural/KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level systems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

2006-01-01

NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level svstems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, - evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Deuterium fractionation and H2D+ evolution in turbulent and magnetized cloud cores

NASA Astrophysics Data System (ADS)

Körtgen, Bastian; Bovino, Stefano; Schleicher, Dominik R. G.; Giannetti, Andrea; Banerjee, Robi

2017-08-01

High-mass stars are expected to form from dense prestellar cores. Their precise formation conditions are widely discussed, including their virial condition, which results in slow collapse for supervirial cores with strong support by turbulence or magnetic fields, or fast collapse for subvirial sources. To disentangle their formation processes, measurements of the deuterium fractions are frequently employed to approximately estimate the ages of these cores and to obtain constraints on their dynamical evolution. We here present 3D magnetohydrodynamical simulations including for the first time an accurate non-equilibrium chemical network with 21 gas-phase species plus dust grains and 213 reactions. With this network we model the deuteration process in fully depleted prestellar cores in great detail and determine its response to variations in the initial conditions. We explore the dependence on the initial gas column density, the turbulent Mach number, the mass-to-magnetic flux ratio and the distribution of the magnetic field, as well as the initial ortho-to-para ratio (OPR) of H2. We find qualitatively good agreement with recent observations of deuterium fractions in quiescent sources. Our results show that deuteration is rather efficient, even when assuming a conservative OPR of 3 and highly subvirial initial conditions, leading to large deuterium fractions already within roughly a free-fall time. We discuss the implications of our results and give an outlook to relevant future investigations.

Sexual Risk Behavior in Young Adulthood: Broadening the Scope Beyond Early Sexual Initiation

PubMed Central

Epstein, Marina; Bailey, Jennifer A.; Manhart, Lisa E.; Hill, Karl G.; Hawkins, J. David

2013-01-01

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation is a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10–15) and sexual risk-taking (ages 21–24 and 30–33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk-taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood. PMID:24423058

The effects of work engagement and self-efficacy on personal initiative and performance.

PubMed

Lisbona, Ana; Palaci, Francisco; Salanova, Marisa; Frese, Michael

2018-02-01

Two popular concepts, work engagement and personal initiative, are different but related constructs. This study is based on and extends the Frese and Fay (2001) model of personal initiative (PI) by including work engagement (WE) and self-efficacy as antecedents of PI, and performance as a consequence. Two studies (study 1, with a cross-sectional design using N = 396 participants from 22 organizations, and study 2, with a longitudinal design conducted in two waves with N = 118 participants from 15 organizations) test the hypotheses. Structural equation modeling and the PROCESS SPSS Macro were used to test the hypothesized mediating role of personal initiative in work engagement and performance, and the results show the indirect effect of WE on performance through PI. The results of these two studies confirmed our hypotheses: WE and self-efficacy lead to higher PI, which, in turn, leads to higher performance. In addition to considering WE as an antecedent of PI, the results lead to considering PI as an antecedent of performance.

Critical energy for shock initiation of fuze train explosives

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

Walker, F.E.; Wasley, R.J.; Green, L.G.

1973-01-01

Results of shock initiation experiments conducted for tetryl and A-5 are presented, along with some data on the shock initiation of other explosives. The experiments were conducted using a gun system. An equation which has been useful in correlating these shock data is given. Some applications of the critical energy concept (represented by the above equation), to explosive train designs for NASA space systems are included. The concept's usefulness to DOD ordnance agencies now replacing tetryl in fuze trains with A-5 is also indicated. (auth)

Initial development of a patient-reported outcome measure of experience with cognitive impairment associated with schizophrenia.

PubMed

Welch, Lisa C; Trudeau, Jeremiah J; Silverstein, Steven M; Sand, Michael; Henderson, David C; Rosen, Raymond C

2017-01-01

Cognitive impairment is a serious, often distressing aspect of schizophrenia that affects patients' day-to-day lives. Although several interview-based instruments exist to assess cognitive functioning, a reliable measure developed based on the experiences of patients facing cognitive difficulties is needed to complement the objective performance-based assessments. The present article describes the initial development of a patient-reported outcome (PRO) measure to assess the subjective experience of cognitive impairment among patients with schizophrenia, the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS). The phases of development included the construction of a conceptual model based on the existing knowledge and two sets of qualitative interviews with patients: 1) concept elicitation interviews to ensure face and content validity from the perspective of people with schizophrenia and 2) cognitive debriefing of the initial item pool. Input from experts was elicited throughout the process. The initial conceptual model included seven domains. The results from concept elicitation interviews (n=80) supported these domains but yielded substantive changes to concepts within domains and to terminology. Based on these results, an initial pool of 53 items was developed to reflect the most common descriptions and languages used by the study participants. Cognitive debriefing interviews (n=22) resulted in the removal of 18 items and modification of 22 other items. The remaining 35 items represented 23 concepts within six domains plus two items assessing bother. The draft PRO measure is currently undergoing psychometric testing as a precursor to broad-based clinical and research use.

Coactivation of response initiation processes with redundant signals.

PubMed

Maslovat, Dana; Hajj, Joëlle; Carlsen, Anthony N

2018-05-14

During reaction time (RT) tasks, participants respond faster to multiple stimuli from different modalities as compared to a single stimulus, a phenomenon known as the redundant signal effect (RSE). Explanations for this effect typically include coactivation arising from the multiple stimuli, which results in enhanced processing of one or more response production stages. The current study compared empirical RT data with the predictions of a model in which initiation-related activation arising from each stimulus is additive. Participants performed a simple wrist extension RT task following either a visual go-signal, an auditory go-signal, or both stimuli with the auditory stimulus delayed between 0 and 125 ms relative to the visual stimulus. Results showed statistical equivalence between the predictions of an additive initiation model and the observed RT data, providing novel evidence that the RSE can be explained via a coactivation of initiation-related processes. It is speculated that activation summation occurs at the thalamus, leading to the observed facilitation of response initiation. Copyright © 2018 Elsevier B.V. All rights reserved.

The New Jersey Nursing Initiative: building sustainable collaboration.

PubMed

Bakewell-Sachs, Susan; Mertz, Lynn M; Egreczky, Dana; Ladden, Maryjoan

2011-01-01

The New Jersey Nursing Initiative was publically launched in 2009 as a 5-year, $22 million program of the Robert Wood Johnson Foundation based at the New Jersey Chamber of Commerce Foundation. It was reauthorized in 2011 through 2016 for an additional $8.5 million. The initiative includes a faculty preparation program and strategic tracks of work focusing on building education capacity, increasing current faculty capacity, making nurse faculty a preferred career, leading policy initiatives, creating sustainable funding in support of nursing education, and ultimately, building local, regional, and statewide collaborative networks. The tagline, "So a Nurse will be there for You," emphasizes both the reality of an aging nursing workforce needing replacement and the expected health care transformation that will result in the need for new knowledge and skills in the future nursing workforce. The purpose of this article was to describe the New Jersey Nursing Initiative, emphasizing the partnerships that have resulted from the project to date. Copyright © 2011 Elsevier Inc. All rights reserved.

National Nanotechnology Initiative: The Initiative and Its Implementation Plan

DTIC Science & Technology

2000-07-01

precisely controlled size and composition and then to assemble them into larger structures with unique properties and functions will revolutionize...thousand pounds could be stripped from a pilotless fighter aircraft , resulting in longer missions, and fighter agility could be dramatically improved...societal impact: $12 million. e. Major themes and new programs in FY 2001 include : • Nano-biotechnology: biosystems, bio-mimetics and composites (priority

The Impact of a School Board's One-To-One iPad Initiative on Equity and Inclusion

ERIC Educational Resources Information Center

Kirkpatrick, Lori C.; Brown, Heather M.; Searle, Michelle J.; Sauder, Adrienne E.; Smiley, Eric

2017-01-01

This paper examines the impact of a school board's one-to-one iPad initiative on equity and inclusion. Data include: questionnaires from Grade 7-9 students, teachers, and administrators; focus groups with inclusion coaches; and interviews with classroom teachers. The results show that the iPads have supported equity among students in the district;…

Subtyping of Toddlers with ASD Based on Patterns of Social Attention Deficits

DTIC Science & Technology

2015-10-30

autism spectrum . Initial major tasks of the research project included regulatory review and approval and preparation of the eye tracking experiment...situation, we need to discover how to better classify and categorize patterns of behavior and development within the autism spectrum . Our subgrouping...and clinically relevant subgroups within the autism spectrum . Summary of Results, Progress, and Accomplishments with Discussion: Initial major

Improving Human Milk and Breastfeeding Practices in the NICU.

PubMed

Fugate, Karen; Hernandez, Ivonne; Ashmeade, Terri; Miladinovic, Branko; Spatz, Diane L

2015-01-01

To determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mother's own milk (MOM) at initiation of feedings and at hospital discharge. Continuous quality improvement (QI) process. Urban, 82-bed, Level-III NICU. Very- low-birth-weight (VLBW) infants weighing fewer than 1500 grams. The Ten Step method was implemented during a 3-year period. Process measurements included percentage of VLBW infants receiving MOM at initiation of feeds, number of mothers of VLBW infants with hospital-grade electric breast pump at hospital discharge, and number of mothers of VLBW infants initiating pumping within 6 hours of delivery. Outcome measurements included percentage of VLBW infants with any human milk at discharge to home and parent satisfaction with nurses' support of mother's efforts to breastfeed. Balancing measurements included percentage of VLBW infants at less than the third percentile for growth on the Fenton growth chart at discharge and receiving pasteurized donor milk (PDM). Significant improvements were achieved in the percentages of mothers expressing their milk within 6 hours of delivery, infants receiving MOM at initiation of feeds, and mothers with a hospital-grade pump at discharge. Improvements in these processes resulted in increased parent satisfaction with nurses' support of breastfeeding and a 3.1-fold greater odds of the VLBW infant receiving MOM at discharge in 2013 compared to 2010 (odds ratio [OR]= 3.01, 95% confidence interval [CI] [1.75, 5.17], p < .001). Despite an increase in the use of MOM, there was not a significant increase in VLBW infants discharged at less than the third percentile for growth, and initiation of PDM did not negatively affect the percentage of VLBW infants with any human milk at discharge. Implementation of the Ten Steps method using QI methodology resulted in significantly improved rates of use of MOM at initiation of feeds and at hospital discharge. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure.

PubMed

Cooper, Lauren B; Hammill, Bradley G; Peterson, Eric D; Pitt, Bertram; Maciejewski, Matthew L; Curtis, Lesley H; Hernandez, Adrian F

2017-01-01

Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to setting of drug initiation is poorly characterized. We conducted a retrospective cohort study of Medicare beneficiaries linked to laboratory data in 10 states with prevalent heart failure as of July 1, 2011, and incident MRA use between May 1 and September 30, 2011. Outcomes included laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periods, based on setting of drug initiation and the presence of renal insufficiency. Additional outcomes included abnormal laboratory results and adverse events proximate to MRA initiation. Of 10 443 Medicare beneficiaries with heart failure started on an MRA, 19.7% were initiated during a hospitalization. Appropriate follow-up laboratory testing across all time periods occurred in 25.2% of patients with inpatient initiation compared with 2.8% of patients begun as an outpatient. Patients with chronic kidney disease had higher rates of both hyperkalemia and acute kidney failure in the early (1.3% and 2.7%, respectively) and extended (5.6% and 9.8%, respectively) post-initiation periods compared with those without chronic kidney disease. Patients initiated on MRA therapy as an outpatient had extremely poor rates of guideline indicated follow-up laboratory monitoring after drug initiation. In particular, patients with chronic kidney disease are at high risk for adverse events after MRA initiation. Quality improvement initiatives focused on systems to improve appropriate laboratory monitoring are needed. © 2017 American Heart Association, Inc.

75 FR 71072 - Initiation and Preliminary Results of Antidumping Duty Changed Circumstances Review: Certain...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... factors including, but not limited to: (1) Management; (2) production facilities; (3) supplier relationships; and (4) customer base. See Brass Sheet and Strip from Canada: Final Results of Antidumping Duty... y Placa resulted in little or no change in management, production facilities, supplier relationships...

Mobile Health Initiatives in Vietnam: Scoping Study

PubMed Central

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong

2018-01-01

Background Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. PMID:29691214

Mapping of medical acronyms and initialisms to Medical Subject Headings (MeSH) across selected systems

PubMed Central

Shultz, Mary

2006-01-01

Introduction: Given the common use of acronyms and initialisms in the health sciences, searchers may be entering these abbreviated terms rather than full phrases when searching online systems. The purpose of this study is to evaluate how various MEDLINE Medical Subject Headings (MeSH) interfaces map acronyms and initialisms to the MeSH vocabulary. Methods: The interfaces used in this study were: the PubMed MeSH database, the PubMed Automatic Term Mapping feature, the NLM Gateway Term Finder, and Ovid MEDLINE. Acronyms and initialisms were randomly selected from 2 print sources. The test data set included 415 randomly selected acronyms and initialisms whose related meanings were found to be MeSH terms. Each acronym and initialism was entered into each MEDLINE MeSH interface to determine if it mapped to the corresponding MeSH term. Separately, 46 commonly used acronyms and initialisms were tested. Results: While performance differed widely, the success rates were low across all interfaces for the randomly selected terms. The common acronyms and initialisms tested at higher success rates across the interfaces, but the differences between the interfaces remained. Conclusion: Online interfaces do not always map medical acronyms and initialisms to their corresponding MeSH phrases. This may lead to inaccurate results and missed information if acronyms and initialisms are used in search strategies. PMID:17082832

STS-1 operational flight profile. Volume 6: Abort analysis

NASA Technical Reports Server (NTRS)

1980-01-01

The abort analysis for the cycle 3 Operational Flight Profile (OFP) for the Space Transportation System 1 Flight (STS-1) is defined, superseding the abort analysis previously presented. Included are the flight description, abort analysis summary, flight design groundrules and constraints, initialization information, general abort description and results, abort solid rocket booster and external tank separation and disposal results, abort monitoring displays and discussion on both ground and onboard trajectory monitoring, abort initialization load summary for the onboard computer, list of the key abort powered flight dispersion analysis.

Initial Data Analysis Results for ATD-2 ISAS HITL Simulation

NASA Technical Reports Server (NTRS)

Lee, Hanbong

2017-01-01

To evaluate the operational procedures and information requirements for the core functional capabilities of the ATD-2 project, such as tactical surface metering tool, APREQ-CFR procedure, and data element exchanges between ramp and tower, human-in-the-loop (HITL) simulations were performed in March, 2017. This presentation shows the initial data analysis results from the HITL simulations. With respect to the different runway configurations and metering values in tactical surface scheduler, various airport performance metrics were analyzed and compared. These metrics include gate holding time, taxi-out in time, runway throughput, queue size and wait time in queue, and TMI flight compliance. In addition to the metering value, other factors affecting the airport performance in the HITL simulation, including run duration, runway changes, and TMI constraints, are also discussed.

Analysis of strategic plans to assess planning for sustainability of comprehensive community initiatives.

PubMed

Sridharan, Sanjeev; Go, Sodam; Zinzow, Heidi; Gray, Aracelis; Barrett, Melissa Gutierrez

2007-02-01

In order to achieve the intended impact on a community, comprehensive community initiatives must sustain programs once they have been implemented. However, planning for sustainability is challenging and is rarely incorporated in the planning process of an initiative. The current study examined 19 5-year plans developed during the planning phase of the Comprehensive Strategy for Serious, Violent and Chronic Juvenile Offenders. Quantitative and qualitative methods were employed to assess the extent to which the construct of sustainability was incorporated. The plan analysis was supplemented with results from other components of the complex evaluation design implemented as part of the process evaluation of Comprehensive Strategy. Results suggested that sustainability was not accounted for during the planning phase of this initiative. The implications of these findings, including the importance of planning for sustainability in order to achieve sustainability, are discussed.

Simple estimation of linear 1+1 D tsunami run-up

NASA Astrophysics Data System (ADS)

Fuentes, M.; Campos, J. A.; Riquelme, S.

2016-12-01

An analytical expression is derived concerning the linear run-up for any given initial wave generated over a sloping bathymetry. Due to the simplicity of the linear formulation, complex transformations are unnecessay, because the shoreline motion is directly obtained in terms of the initial wave. This analytical result not only supports maximum run-up invariance between linear and non-linear theories, but also the time evolution of shoreline motion and velocity. The results exhibit good agreement with the non-linear theory. The present formulation also allows computing the shoreline motion numerically from a customised initial waveform, including non-smooth functions. This is useful for numerical tests, laboratory experiments or realistic cases in which the initial disturbance might be retrieved from seismic data rather than using a theoretical model. It is also shown that the real case studied is consistent with the field observations.

Charts Depicting Kinematic and Heating Parameters for a Ballistic Reentry at Speeds of 26,000 to 45,000 Feet Per Second

NASA Technical Reports Server (NTRS)

Lovelace, Uriel M.

1961-01-01

Reentry trajectories, including computations of convective and radiative stagnation-point heat transfer, have been calculated by using equations for a point-mass reentry vehicle entering the atmosphere of a rotating, oblate earth. Velocity was varied from 26,000 to 45,000 feet per second; reentry angle, from the skip limit to -20 deg; ballistic drag parameter, from 50 to 200. Initial altitude was 400,000 feet. Explicit results are presented in charts which were computed for an initial latitude of 38 deg N and an azimuth of 90 deg from north. A method is presented whereby these results may be made valid for a range of initial latitude and azimuth angles.

Calling the Doctor: A Qualitative Study of Patient-Initiated Physician Consultation among rural older adults

PubMed Central

Grzywacz, Joseph G.; Quandt, Sara A.; Bell, Ronny A.; Chapman, Christine; Altizer, Kathryn P.; Arcury, Thomas A.

2011-01-01

Objectives Guided by Leventhal’s Self-regulatory Model and Cockerham’s theory of health lifestyles, we explore 2 questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants’ accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time? Methods We analyze data from semi-structured in-depth interviews with 62 older rural adults. Results Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment. Discussion We characterize participants’ responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham’s emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal’s conceptualization of illness behavior, including patient-initiated physician consultation. PMID:21311048

PhoneSat: Ground Testing of a Phone-Based Prototype Bus

NASA Technical Reports Server (NTRS)

Felix, Carmen; Howard, Benjamin; Reyes, Matthew; Snarskiy, Fedor; Hickman, Ryan; Boshuizen, Christopher; Marshall, William

2010-01-01

Most of the key capabilities that are requisite of a satellite bus are housed in today's smart phones. PhoneSat refers to an initiative to build a ground-based prototype vehicle that could all the basic functionality of a satellite, including attitude control, using a smart Phone as its central hardware. All components used were also low cost Commercial off the Shelf (COTS). In summer 2009, an initial prototype was created using the LEGO Mindstorm toolkit demonstrating simple attitude control. Here we report on a follow up initiative to design, build and test a vehicle based on the Google s smart phone Nexus One. The report includes results from initial thermal-vacuum chamber tests and low altitude sub-orbital rocket flights which show that, at least for short durations, the Nexus One phone is able to withstand key aspects of the space environment without failure. We compare the sensor data from the Phone's accelerometers and magnetometers with that of an external microelectronic inertial measurement unit.

Architecture of human translation initiation factor 3

PubMed Central

Querol-Audi, Jordi; Sun, Chaomin; Vogan, Jacob M.; Smith, Duane; Gu, Yu; Cate, Jamie; Nogales, Eva

2013-01-01

SUMMARY Eukaryotic translation initiation factor 3 (eIF3) plays a central role in protein synthesis by organizing the formation of the 43S preinitiation complex. Using genetic tag visualization by electron microscopy, we reveal the molecular organization of ten human eIF3 subunits, including an octameric core. The structure of eIF3 bears a close resemblance to that of the proteasome lid, with a conserved spatial organization of eight core subunits containing PCI and MPN domains that coordinate functional interactions in both complexes. We further show that eIF3 subunits a and c interact with initiation factors eIF1 and eIF1A, which control the stringency of start codon selection. Finally, we find that subunit j, which modulates messenger RNA interactions with the small ribosomal subunit, makes multiple independent interactions with the eIF3 octameric core. These results highlight the conserved architecture of eIF3 and how it scaffolds key factors that control translation initiation in higher eukaryotes, including humans. PMID:23623729

Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth

PubMed Central

Sullivan, Brittney J.; Esmaili, B. Emily; Cunningham, Coleen K.

2017-01-01

ABSTRACT Background: Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood. Objective: Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature. Design: This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0–24 years of age. Results: A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children. Conclusions: Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes. PMID:28598771

Progress towards a laser produced relativistic electron-positron pair plasma

DOE PAGES

Chen, Hui; Bonlie, J.; Cauble, R.; ...

2016-04-01

Here, a set of experiments has been performed exploring unique characteristics of pair jets and plasmas at several energetic short-pulse laser facilities including Titan at Livermore and OMEGA EP in Rochester, as well as the Osaka LFEX and AWE Orion lasers. New results are summarized, including positron beam emittance, scaling of pair production vs. laser energy, and initial results on the pair jet collimation using electromagnetic fields.

The successful implementation of STEM initiatives in lower income schools

NASA Astrophysics Data System (ADS)

Bakshi, Leena

The purpose of this study was to examine the leadership strategies utilized by superintendents, district administrators and school principals and the impact of these identified strategies on implementing STEM initiatives specifically for lower-income students. This study set out to determine (a) What role does district leadership play in the implementation of STEM initiatives in lower income secondary schools; (b) What internal systems of accountability exist in successful lower income secondary schools' STEM programs; (c) What leadership strategies are used to implement STEM curriculum initiatives; (d) How do school and district leadership support staff in order to achieve student engagement in STEM Initiative curriculum. This study used a mixed-methods approach to determine the impact of leadership strategies utilized by superintendents, district administrators and school principals on implementing STEM initiatives. Quantitative data analyzed survey questionnaires to determine the degree of correlation between the school districts that have demonstrated the successful implementation of STEM initiatives at the school and district levels. Qualitative data was collected using highly structured participant interviews and purposeful sampling of four district superintendents, one district-level administrator and five school leaders to capture the key strategies in implementing STEM initiatives in lower income secondary schools. Through the process of triangulation, the results of the study revealed that superintendents and principals should consider the characteristics of effective STEM initiatives that have shown a considerable degree of correlation with positive outcomes for lower income students. These included the leadership strategies of personnel's making decisions about the district's and school's instructional direction and an emphasis on the conceptual development of scientific principles using the Next Generation Science Standards coupled with the Common Core State Standards across the grade levels. It also emphasized the importance of establishing community partnerships as a primary resource. This study highlighted the criteria district and school leadership should include in implementing STEM initiatives and designing professional development models that result in meaningful instructional practices of STEM curriculum for secondary lower income students. Overall, this study provides insight for superintendents, district leaders and school administrators that can play an integral role in implementing STEM initiatives with access for socioeconomically disadvantaged students.

Measuring the cost implications of the Collaborative Accountable Care initiative in Texas.

PubMed

Ho, Vivian; Allen, Timothy K; Kim, Urie; Keenan, William P; Ku-Goto, Meei-Hsiang; Sanderson, Mark

2016-09-01

We analyzed changes in healthcare spending associated with the implementation of Cigna's Collaborative Accountable Care (CAC) initiative in a large multi-clinic physician practice. We compared claims from 2009, prior to the CAC initiative, against claims for 2010 to 2011, contrasting the patients covered by Cigna's CAC initiative with patients in other practices in the same geographic area covered by Cigna's medical plan. We used a propensity weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the CAC. The CAC initiative resulted in a 5.7% reduction in net spending per patient for 2010 to 2011, relative to what spending would have been without the initiative. This reduced spending was evident in multiple service categories: evaluation and management, procedures, imaging, tests, and durable medical equipment. Professional payments, inpatient facility, and outpatient facility payments for Medical Clinic of North Texas enrollees all experienced significant cost savings relative to the control group. About half of the savings resulted from using lower-priced sources. The CAC initiative, which includes an embedded care coordinator and a list of recommended providers, was associated with cost savings similar to those reported by other initiatives, such as global budgets and risk-based contracts.

ADDRESSING REGIONAL DISPARITIES IN PEDIATRIC ONCOLOGY: RESULTS OF A COLLABORATIVE INITIATIVE ACROSS THE MEXICAN-NORTH AMERICAN BORDER

PubMed Central

Aristizabal, Paula; Fuller, Spencer; Rivera-Gomez, Rebeca; Ornelas, Mario; Nuno, Laura; Rodriguez-Galindo, Carlos; Ribeiro, Raul; Roberts, William

2017-01-01

Background Cancer is emerging as a major cause of childhood mortality in low-income and middle-income countries. In Mexico, cancer is the number one cause of death in children aged 5–14. Until recently, many children with cancer from Baja California, Mexico went untreated. We reasoned that an initiative inspired by the St. Jude Children’s Research Hospital (SJCRH) “twinning” model could successfully be applied to the San Diego–Tijuana border region. In 2008, a twinning project was initiated by Rady Children’s Hospital, SJCRH and the General Hospital Tijuana (GHT). Our aim was to establish a pediatric oncology unit in a culturally sensitive manner, adapted to the local health care system. Procedure An initial assessment revealed that despite existence of basic hospital infrastructure at the GHT, the essential elements of a pediatric cancer unit were lacking, including dedicated space, trained staff, and uniform treatment. A 5-year action plan was designed to offer training, support the staff financially, and improve the infrastructure. Results After seven years, accomplishments include the opening of a new inpatient unit with updated technology, fully-trained staff and a dedicated, interdisciplinary team. Over 700 children have benefited from accurate diagnosis and treatment. Conclusions Initiatives that implement long-term partnerships between institutions along the Mexican-North American border can be highly effective in establishing successful pediatric cancer control programs. The geographic proximity facilitated accelerated training and close monitoring of project development. Similar initiatives across other disciplines may benefit additional patients and synergize with pediatric oncology programs to reduce health disparities in underserved areas. PMID:28000395

Clinical and Organizational Factors in the Initial Evaluation of Patients With Lung Cancer

PubMed Central

Jim Yeung, Sai-Ching; Tanoue, Lynn T.; Gould, Michael K.

2013-01-01

Background: This guideline is intended to provide an evidence-based approach to the initial evaluation of patients with known or suspected lung cancer. It also includes an assessment of the impact of timeliness of care and multidisciplinary teams on outcome. Methods: The applicable current medical literature was identified by a computerized search and evaluated using standardized methods. Recommendations were framed using the approach described by the Guidelines Oversight Committee of the American College of Chest Physicians. Data sources included MEDLINE and the Cochrane Database of Systematic Reviews. Results: Initial evaluation should include a thorough history and physical examination; CT imaging; pulmonary function tests; and hemoglobin, electrolyte, liver function, and calcium levels. Additional testing for distant metastases and paraneoplastic syndromes should be determined on the basis of these results. Paraneoplastic syndromes may have an adverse impact on cancer treatment, so they should be controlled rapidly with the goal of proceeding with definitive cancer treatment in a timely manner. Although the relationship between timeliness of care and survival is difficult to quantify, efforts to deliver timely care are reasonable and should be balanced with the need to attend to other dimensions of health-care quality (eg, safety, effectiveness, efficiency, equality, consistency with patient values and preferences). Quality care will require multiple disciplines. Although it is difficult to assess the impact, we suggest that a multidisciplinary team approach to care be used, particularly for patients requiring multimodality therapy. Conclusions: The initial evaluation of patients with lung cancer should include a thorough history and physical examination, pulmonary function tests, CT imaging, basic laboratory tests, and selective testing for distant metastases and paraneoplastic syndromes. PMID:23649435

Normal aging affects movement execution but not visual motion working memory and decision-making delay during cue-dependent memory-based smooth-pursuit.

PubMed

Fukushima, Kikuro; Barnes, Graham R; Ito, Norie; Olley, Peter M; Warabi, Tateo

2014-07-01

Aging affects virtually all functions including sensory/motor and cognitive activities. While retinal image motion is the primary input for smooth-pursuit, its efficiency/accuracy depends on cognitive processes. Elderly subjects exhibit gain decrease during initial and steady-state pursuit, but reports on latencies are conflicting. Using a cue-dependent memory-based smooth-pursuit task, we identified important extra-retinal mechanisms for initial pursuit in young adults including cue information priming and extra-retinal drive components (Ito et al. in Exp Brain Res 229:23-35, 2013). We examined aging effects on parameters for smooth-pursuit using the same tasks. Elderly subjects were tested during three task conditions as previously described: memory-based pursuit, simple ramp-pursuit just to follow motion of a single spot, and popping-out of the correct spot during memory-based pursuit to enhance retinal image motion. Simple ramp-pursuit was used as a task that did not require visual motion working memory. To clarify aging effects, we then compared the results with the previous young subject data. During memory-based pursuit, elderly subjects exhibited normal working memory of cue information. Most movement-parameters including pursuit latencies differed significantly between memory-based pursuit and simple ramp-pursuit and also between young and elderly subjects. Popping-out of the correct spot motion was ineffective for enhancing initial pursuit in elderly subjects. However, the latency difference between memory-based pursuit and simple ramp-pursuit in individual subjects, which includes decision-making delay in the memory task, was similar between the two groups. Our results suggest that smooth-pursuit latencies depend on task conditions and that, although the extra-retinal mechanisms were functional for initial pursuit in elderly subjects, they were less effective.

Domain epitaxy for thin film growth

DOEpatents

Narayan, Jagdish

2005-10-18

A method of forming an epitaxial film on a substrate includes growing an initial layer of a film on a substrate at a temperature T.sub.growth, said initial layer having a thickness h and annealing the initial layer of the film at a temperature T.sub.anneal, thereby relaxing the initial layer, wherein said thickness h of the initial layer of the film is greater than a critical thickness h.sub.c. The method further includes growing additional layers of the epitaxial film on the initial layer subsequent to annealing. In some embodiments, the method further includes growing a layer of the film that includes at least one amorphous island.

Surgical Missteps in the Management of Venous Thoracic Outlet Syndrome Which Lead to Reoperation.

PubMed

Archie, Meena M; Rollo, Johnathon C; Gelabert, Hugh A

2018-05-01

Surgical management of spontaneous subclavian thrombosis due to venous thoracic outlet syndrome (vTOS) results in durable relief of symptoms. The need to reoperate is rare. We report our experience with reoperation for vTOS. Patients evaluated for vTOS between 1996 and 2016 were identified in a prospective database. Data recorded included demographics, initial presentation, initial surgery, recurrent presentation, reoperation, and final outcomes. In all, 261 patients were evaluated for vTOS, of these, 246 patients underwent first rib resections. Ten (3.8%) patients required evaluation for recurrent vTOS symptoms. Prior management included thrombolysis (4) and anticoagulation alone (6). Prior surgical approaches included infraclavicular (2), supraclavicular (2) and transaxillary (6). One operation was complicated by a hemothorax, and one a brachial plexus injury. Indication for reoperation included congestive symptoms (6) and recurrent thrombosis (4). Evaluation included chest X-rays (10), venogram (8), intra-venous ultrasound (2), and computed tomography venography (3). Significant compression by remaining rib segments were identified in all: inadequate resection of the anterior first rib (7), inadequate resection of posterior rib segment (1), and erroneous resection of second rib (2). Reoperations include 7 transaxillary approaches, 1 medial claviculectomy, and 1 paraclavicular decompression. One phrenic nerve palsy occurred following paraclavicular decompression. All underwent postoperative venography and angioplasty. At final evaluation, 8 veins are patent and congestive symptoms resolved, and 1 crushed stent could not be reopened despite decompression. The incidence of reoperation for first rib resection in cases of vTOS is low and appears largely due to missteps during the initial operation. Awareness of potential errors including inadequacy of resection, intraoperative disorientation, and misunderstanding of the limitations of surgical approaches will result in fewer reoperations. Published by Elsevier Inc.

Residual Stresses and Critical Initial Flaw Size Analyses of Welds

NASA Technical Reports Server (NTRS)

Brust, Frederick W.; Raju, Ivatury, S.; Dawocke, David S.; Cheston, Derrick

2009-01-01

An independent assessment was conducted to determine the critical initial flaw size (CIFS) for the flange-to-skin weld in the Ares I-X Upper Stage Simulator (USS). A series of weld analyses are performed to determine the residual stresses in a critical region of the USS. Weld residual stresses both increase constraint and mean stress thereby having an important effect on the fatigue life. The purpose of the weld analyses was to model the weld process using a variety of sequences to determine the 'best' sequence in terms of weld residual stresses and distortions. The many factors examined in this study include weld design (single-V, double-V groove), weld sequence, boundary conditions, and material properties, among others. The results of this weld analysis are included with service loads to perform a fatigue and critical initial flaw size evaluation.

Use of drinking water treatment solids for arsenate removal from desalination concentrate.

PubMed

Xu, Xuesong; Lin, Lu; Papelis, Charalambos; Myint, Maung; Cath, Tzahi Y; Xu, Pei

2015-05-01

Desalination of impaired water can be hindered by the limited options for concentrate disposal. Selective removal of specific contaminants using inexpensive adsorbents is an attractive option to address the challenges of concentrate management. In this study, two types of ferric-based drinking water treatment solids (DWTS) were examined for arsenate removal from reverse osmosis concentrate during continuous-flow once-through column experiments. Arsenate sorption was investigated under different operating conditions including pH, arsenate concentration, hydraulic retention time, loading rate, temperature, and moisture content of the DWTS. Arsenate removal by the DWTS was affected primarily by surface complexation, electrostatic interactions, and arsenate speciation. Results indicated that arsenate sorption was highly dependent on initial pH and initial arsenate concentration. Acidic conditions enhanced arsenate sorption as a result of weaker electrostatic repulsion between predominantly monovalent H2AsO4(-) and negatively charged particles in the DWTS. High initial arsenate concentration increased the driving force for arsenate sorption to the DWTS surface. Tests revealed that the potential risks associated with the use of DWTS include the leaching of organic contaminants and ammonia, which can be alleviated by using wet DWTS or discarding the initially treated effluent that contains high organic concentration. Copyright © 2015 Elsevier Inc. All rights reserved.

Michigan's forest resources in 2003

Treesearch

Earl C. Leatherberry; David Haugen; Gary J. Brand

2005-01-01

Reports the initial results of the first four annual panels (2000-2003) of the sixth forest inventory of Michigan. Includes information on forest area; volume; biomass; growth, removals, and mortality; and forest health.

Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality Improvement Initiative.

PubMed

Klatte, J Michael; Selvarangan, Rangaraj; Jackson, Mary Anne; Myers, Angela L

2016-01-01

Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing. A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A p-chart was generated to evaluate the percentage of these submitted specimens tested biweekly over a 12-month period. Cost savings for patients and the laboratory were assessed at the study period's conclusion. Run chart analysis revealed an initial shift after the interventions, suggesting a temporary decrease in testing submission; however, no sustained differences in numbers of specimens submitted biweekly were observed over time. On the p-chart, the mean percentage of specimens tested before the intervention was 100%. After the intervention, the average percentage of specimens tested dropped to 53.8%. Resultant laboratory cost savings totaled nearly $3600, and patient savings on testing charges were ∼$32 000. Automatic laboratory declination of nondiarrheal stools submitted for CDI testing resulted in a sustained decrease in the number of specimens tested, resulting in significant laboratory and patient cost savings. Despite multiple educational efforts, no sustained changes in physician ordering practices were observed. Copyright © 2016 by the American Academy of Pediatrics.

Carcinogenicity and Mutagenicity Data: New Initiatives to ...

EPA Pesticide Factsheets

Currents models for prediction of chemical carcinogenicity and mutagenicity rely upon a relatively small number of publicly available data resources, where the data being modeled are highly summarized and aggregated representations of the actual experimental results. A number of new initiatives are underway to improve access to existing public carcinogenicity and mutagenicity data for use in modeling, as well as to encourage new approaches to the use of data in modeling. Rodent bioassay results from the NIEHS National Toxicology Program (NTP) and the Berkeley Carcinogenic Potency Database (CPDB) have provided the largest public data resources for building carcinogenicity prediction models to date. However, relatively few and limited representations of these data have actually informed existing models. Initiatives, such as EPA's DSSTox Database Network, offer elaborated and quality reviewed presentations of the CPDB and expanded data linkages and coverage of chemical space for carcinogenicity and mutagenicity. In particular the latest published DSSTox CPDBAS structure-data file includes a number of species-specific and summary activity fields, including a species-specific normalized score for carcinogenic potency (TD50) and various weighted summary activities. These data are being incorporated into PubChem to provide broad

Decoupled and linear quadratic regulator control of a large, flexible space antenna with an observer in the control loop

NASA Technical Reports Server (NTRS)

Hamer, H. A.; Johnson, K. G.; Young, J. W.

1985-01-01

An analysis is performed to compare decoupled and linear quadratic regulator (LQR) procedures for the control of a large, flexible space antenna. Control objectives involve: (1) commanding changes in the rigid-body modes, (2) nulling initial disturbances in the rigid-body modes, or (3) nulling initial disturbances in the first three flexible modes. Control is achieved with two three-axis control-moment gyros located on the antenna column. Results are presented to illustrate various effects on control requirements for the two procedures. These effects include errors in the initial estimates of state variables, variations in the type, number, and location of sensors, and deletions of state-variable estimates for certain flexible modes after control activation. The advantages of incorporating a time lag in the control feedback are also illustrated. In addition, the effects of inoperative-control situations are analyzed with regard to control requirements and resultant modal responses. Comparisons are included which show the effects of perfect state feedback with no residual modes (ideal case). Time-history responses are presented to illustrate the various effects on the control procedures.

The IMI PROTECT project: purpose, organizational structure, and procedures.

PubMed

Reynolds, Robert F; Kurz, Xavier; de Groot, Mark C H; Schlienger, Raymond G; Grimaldi-Bensouda, Lamiae; Tcherny-Lessenot, Stephanie; Klungel, Olaf H

2016-03-01

The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) initiative was a collaborative European project that sought to address limitations of current methods in the field of pharmacoepidemiology and pharmacovigilance. Initiated in 2009 and ending in 2015, PROTECT was part of the Innovative Medicines Initiative, a joint undertaking by the European Union and pharmaceutical industry. Thirty-five partners including academics, regulators, small and medium enterprises, and European Federation of Pharmaceuticals Industries and Associations companies contributed to PROTECT. Two work packages within PROTECT implemented research examining the extent to which differences in the study design, methodology, and choice of data source can contribute to producing discrepant results from observational studies on drug safety. To evaluate the effect of these differences, the project applied different designs and analytic methodology for six drug-adverse event pairs across several electronic healthcare databases and registries. This papers introduces the organizational structure and procedures of PROTECT, including how drug-adverse event and data sources were selected, study design and analyses documents were developed, and results managed centrally. Copyright © 2016 John Wiley & Sons, Ltd.

Delay of Treatment Initiation Does Not Adversely Affect Survival Outcome in Breast Cancer.

PubMed

Yoo, Tae-Kyung; Han, Wonshik; Moon, Hyeong-Gon; Kim, Jisun; Lee, Jun Woo; Kim, Min Kyoon; Lee, Eunshin; Kim, Jongjin; Noh, Dong-Young

2016-07-01

Previous studies examining the relationship between time to treatment and survival outcome in breast cancer have shown inconsistent results. The aim of this study was to analyze the overall impact of delay of treatment initiation on patient survival and to determine whether certain subgroups require more prompt initiation of treatment. This study is a retrospective analysis of stage I-III patients who were treated in a single tertiary institution between 2005 and 2008. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of interval between diagnosis and treatment initiation in breast cancer and various subgroups. A total of 1,702 patients were included. Factors associated with longer delay of treatment initiation were diagnosis at another hospital, medical comorbidities, and procedures performed before admission for surgery. An interval between diagnosis and treatment initiation as a continuous variable or with a cutoff value of 15, 30, 45, and 60 days had no impact on disease-free survival (DFS). Subgroup analyses for hormone-responsiveness, triple-negative breast cancer, young age, clinical stage, and type of initial treatment showed no significant association between longer delay of treatment initiation and DFS. Our results show that an interval between diagnosis and treatment initiation of 60 days or shorter does not appear to adversely affect DFS in breast cancer.

75 FR 61702 - Notice of Initiation and Preliminary Results of Antidumping Duty Changed Circumstances Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... from Thailand. See Notice of Amended Final Determination of Sales at Less Than Fair Value and...-caught warmwater species include, but are not limited to, whiteleg shrimp (Penaeus vannemei), banana... are packed with marinade, spices or sauce are included in the scope of this order. In addition, food...

78 FR 15048 - SGL Carbon, LLC Including Leased On-Site Worker of Reflex Staffing Services and Manpower, St...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,113] SGL Carbon, LLC Including Leased On-Site Worker of Reflex Staffing Services and Manpower, St. Marys, Pennsylvania; Notice of... of graphite parts. The initial investigation resulted in a negative determination based on the...

Teacher Involvement as a Protective Factor from the Association between Race-Based Bullying and Smoking Initiation.

PubMed

Earnshaw, Valerie A; Rosenthal, Lisa; Carroll-Scott, Amy; Peters, Susan M; McCaslin, Catherine; Ickovics, Jeannette R

2014-06-01

Experiencing bullying as a victim is associated with negative health and health behavior outcomes, including substance use, among adolescents. However, understandings of protective factors - factors that enhance adolescents' resilience to the negative consequences of bullying - remain limited. The current study investigates whether teacher involvement protects adolescent students from the association between being bullied due to race and smoking initiation. Students were recruited from 12 Kindergarten through 8 th grade schools in an urban school district in the Northeast United States. The analytic sample included 769 students who responded to surveys in 5 th or 6 th grade (2009), and two years later in 7 th or 8 th grade (2011). Students primarily identified as Latino and/or Black, and 90% were eligible for free or reduced lunch. Fifty-four (7%) students initiated smoking between survey time points. Among students reporting lower teacher involvement, race-based bullying was associated with higher likelihood of smoking initiation (OR = 1.69, p = .03). In contrast, among students reporting higher teacher involvement, racebased bullying was not associated with higher likelihood of smoking initiation (OR = 0.95, p = .81). Results suggest that teacher involvement may protect students from the association between race-based bullying and smoking initiation. Enhancing teacher involvement among students experiencing race-based bullying in schools may limit smoking initiation.

Protocols for the Initial Treatment of Moderately Severe Juvenile Dermatomyositis: Results of a Children's Arthritis and Rheumatology Research Alliance Consensus Conference

PubMed Central

Huber, Adam M.; Giannini, Edward H.; Bowyer, Suzanne L.; Kim, Susan; Lang, Bianca; Lindsley, Carol B.; Pachman, Lauren M.; Pilkington, Clarissa; Reed, Ann M.; Rennebohm, Robert M.; Rider, Lisa G.; Wallace, Carol A.; Feldman, Brian M.

2010-01-01

Objective To use juvenile dermatomyositis (JDM) survey data and expert opinion to develop a small number of consensus treatment protocols which reflect current initial treatment of moderately severe JDM. Methods A consensus meeting was held in Toronto, Ontario, Canada on December 1-2, 2007. Nominal group technique was used to achieve consensus on treatment protocols which represented typical management of moderately severe JDM. Consensus was also reached on which patients these protocols would be applicable to (inclusion and exclusion criteria), initial investigations which should be done prior to initiating one of these protocols, data which should be collected to evaluate these protocols, concomitant interventions that would be required or recommended. Results Three protocols were developed which described the first 2 months of treatment. All protocols included corticosteroids and methotrexate. One protocol also included intravenous gammaglobulin. Consensus was achieved for all issues that were addressed by conference participants, although there were some areas of controversy Conclusions This study shows that it is possible to achieve consensus on the initial treatment of JDM, despite considerable variation in clinical practice. Once these protocols are extended beyond 2 months, these protocols will be available for clinical use. By using methods which account for differences between patients (confounding by indication), the comparative effectiveness of the protocols will be evaluated. In the future, the goal will be to identify the optimal treatment of moderately severe JDM. PMID:20191521

Calculation of the Initial Magnetic Field for Mercury's Magnetosphere Hybrid Model

NASA Astrophysics Data System (ADS)

Alexeev, Igor; Parunakian, David; Dyadechkin, Sergey; Belenkaya, Elena; Khodachenko, Maxim; Kallio, Esa; Alho, Markku

2018-03-01

Several types of numerical models are used to analyze the interactions of the solar wind flow with Mercury's magnetosphere, including kinetic models that determine magnetic and electric fields based on the spatial distribution of charges and currents, magnetohydrodynamic models that describe plasma as a conductive liquid, and hybrid models that describe ions kinetically in collisionless mode and represent electrons as a massless neutralizing liquid. The structure of resulting solutions is determined not only by the chosen set of equations that govern the behavior of plasma, but also by the initial and boundary conditions; i.e., their effects are not limited to the amount of computational work required to achieve a quasi-stationary solution. In this work, we have proposed using the magnetic field computed by the paraboloid model of Mercury's magnetosphere as the initial condition for subsequent hybrid modeling. The results of the model have been compared to measurements performed by the Messenger spacecraft during a single crossing of the magnetosheath and the magnetosphere. The selected orbit lies in the terminator plane, which allows us to observe two crossings of the bow shock and the magnetopause. In our calculations, we have defined the initial parameters of the global magnetospheric current systems in a way that allows us to minimize paraboloid magnetic field deviation along the trajectory of the Messenger from the experimental data. We have shown that the optimal initial field parameters include setting the penetration of a partial interplanetary magnetic field into the magnetosphere with a penetration coefficient of 0.2.

Transverse kinetics of a charged drop in an external electric field

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

Bondarenko, S.; Komoshvili, K.

2016-01-22

We investigate a non-equilibrium behavior of a small, dense and charged drop in the transverse plane. A collective motion of the drop’s particles with constant entropy is described. Namely, we solve Vlasov’s equation with non-isotropic initial conditions. Thereby a non-equilibrium distribution function of the process of the droplet evolution in the transverse plane is calculated. An external electric field is included in the initial conditions of the equation that affects on the form of the obtained solution. Applicability of the results to the description of initial states of quark-gluon plasma is also discussed.

TESSX: A Mission for Space Exploration with Tethers

NASA Technical Reports Server (NTRS)

Cosmo, Mario L.; Lorenzini, Enrico C.; Gramer, Daniel J.; Hoffman, John H.; Mazzoleni, Andre P.

2005-01-01

Tethers offer significant potential for substantially increasing payload mass fraction, increasing spacecraft lifetime, enhancing long-term space travel, and enabling the understanding and development of gravity-dependent technologies required for Moon and Mars exploration. The development of the Tether Electrodynamic Spin-up and Survivability Experiment (TESSX) will support applications relevant to NASA's new exploration initiative, including: artificial gravity generation, formation flying, electrodynamic propulsion, momentum exchange, and multi-amp current collection and emission. Under the broad term TESSX, we are currently evaluating several different tether system configurations and operational modes. The initial results of this work are presented, including hardware development, orbital dynamics simulations, and electrodynamics design and analysis.

Marketing physical activity: lessons learned from a statewide media campaign.

PubMed

Peterson, Michael; Abraham, Avron; Waterfield, Allan

2005-10-01

Steps taken to create, implement, and initially assess a statewide physical activity social marketing campaign targeted to 18-to 30-year-olds are presented. Included is a summary demonstration of the application of the associative group analysis in formative market research and message development. Initial postcampaign questionnaire (n = 363) results indicated that 39.1% of respondents had seen the television ad, of which 31.2% indicated they intended to be more active, and 62.5% of respondents had been exposed to either the television or outdoor media ads. Lessons learned through the social marketing process including media channel effectiveness, message development and assessment, and marketing firm relationships are provided.

Enabling the space exploration initiative: NASA's exploration technology program in space power

NASA Technical Reports Server (NTRS)

Bennett, Gary L.; Cull, Ronald C.

1991-01-01

Space power requirements for Space Exploration Initiative (SEI) are reviewed, including the results of a NASA 90-day study and reports by the National Research Council, the American Institute of Aeronautics and Astronautics (AIAA), NASA, the Advisory Committee on the Future of the U.S. Space Program, and the Synthesis Group. The space power requirements for the SEI robotic missions, lunar spacecraft, Mars spacecraft, and human missions are summarized. Planning for exploration technology is addressed, including photovoltaic, chemical and thermal energy conversion; high-capacity power; power and thermal management for the surface, Earth-orbiting platform and spacecraft; laser power beaming; and mobile surface systems.

Technical Advisory Team (TAT) report on the rocket sled test accident of October 9, 2008.

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

Stofleth, Jerome H.; Dinallo, Michael Anthony; Medina, Anthony J.

2009-01-01

This report summarizes probable causes and contributing factors that led to a rocket motor initiating prematurely while employees were preparing instrumentation for an AIII rocket sled test at SNL/NM, resulting in a Type-B Accident. Originally prepared by the Technical Advisory Team that provided technical assistance to the NNSA's Accident Investigation Board, the report includes analyses of several proposed causes and concludes that the most probable source of power for premature initiation of the rocket motor was the independent battery contained in the HiCap recorder package. The report includes data, evidence, and proposed scenarios to substantiate the analyses.

Exponential Sensitivity and its Cost in Quantum Physics

PubMed Central

Gilyén, András; Kiss, Tamás; Jex, Igor

2016-01-01

State selective protocols, like entanglement purification, lead to an essentially non-linear quantum evolution, unusual in naturally occurring quantum processes. Sensitivity to initial states in quantum systems, stemming from such non-linear dynamics, is a promising perspective for applications. Here we demonstrate that chaotic behaviour is a rather generic feature in state selective protocols: exponential sensitivity can exist for all initial states in an experimentally realisable optical scheme. Moreover, any complex rational polynomial map, including the example of the Mandelbrot set, can be directly realised. In state selective protocols, one needs an ensemble of initial states, the size of which decreases with each iteration. We prove that exponential sensitivity to initial states in any quantum system has to be related to downsizing the initial ensemble also exponentially. Our results show that magnifying initial differences of quantum states (a Schrödinger microscope) is possible; however, there is a strict bound on the number of copies needed. PMID:26861076

Exponential Sensitivity and its Cost in Quantum Physics.

PubMed

Gilyén, András; Kiss, Tamás; Jex, Igor

2016-02-10

State selective protocols, like entanglement purification, lead to an essentially non-linear quantum evolution, unusual in naturally occurring quantum processes. Sensitivity to initial states in quantum systems, stemming from such non-linear dynamics, is a promising perspective for applications. Here we demonstrate that chaotic behaviour is a rather generic feature in state selective protocols: exponential sensitivity can exist for all initial states in an experimentally realisable optical scheme. Moreover, any complex rational polynomial map, including the example of the Mandelbrot set, can be directly realised. In state selective protocols, one needs an ensemble of initial states, the size of which decreases with each iteration. We prove that exponential sensitivity to initial states in any quantum system has to be related to downsizing the initial ensemble also exponentially. Our results show that magnifying initial differences of quantum states (a Schrödinger microscope) is possible; however, there is a strict bound on the number of copies needed.

Factors Associated with Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department

PubMed Central

Miller, Melissa K.; Randell, Kimberly A.; Barral, Romina; Sherman, Ashley K.; Miller, Elizabeth

2015-01-01

Purpose The purpose was to describe interest in hormonal contraception initiation among female adolescent in the emergency department and to assess for associations with factors known to increase pregnancy risk such as violence victimization. Methods We used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually-experienced females aged 14–19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the Chi-square test. Results 168 adolescents participated (82% of approached; mean age 16.6 years; 41% White, 48% Black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n=96). Among those using non-LARC contraception (n=59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p < .06), and concerns about cost (p < .01), privacy (p=0.03), and where to obtain contraception (p<0.01). Nearly all planned on avoiding pregnancy, though many (23%) used no contraception at last intercourse. One-third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost). Conclusions Many reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of non-traditional sites such as EDs. PMID:26802990

Curricular initiatives that enhance student knowledge and perceptions of sexual and gender minority groups: a critical interpretive synthesis

PubMed Central

Desrosiers, Jennifer; Wilkinson, Tim; Abel, Gillian; Pitama, Suzanne

2016-01-01

Background There is no accepted best practice for optimizing tertiary student knowledge, perceptions, and skills to care for sexual and gender diverse groups. The objective of this research was to synthesize the relevant literature regarding effective curricular initiatives designed to enhance tertiary level student knowledge, perceptions, and skills to care for sexual and gender diverse populations. Methods A modified Critical Interpretive Synthesis using a systematic search strategy was conducted in 2015. This method was chosen to synthesize the relevant qualitative and quantitative literature as it allows for the depth and breadth of information to be captured and new constructs to be illuminated. Databases searched include AMED, CINAHL EBM Reviews, ERIC, Ovid MEDLINE, Ovid Nursing Database, PsychInfo, and Google Scholar. Results Thirty-one articles were included in this review. Curricular initiatives ranging from discrete to multimodal approaches have been implemented. Successful initiatives included discrete sessions with time for processing, and multi-modal strategies. Multi-modal approaches that encouraged awareness of one’s lens and privilege in conjunction with facilitated communication seemed the most effective. Conclusions The literature is limited to the evaluation of explicit curricula. The wider cultural competence literature offers further insight by highlighting the importance of broad and embedded forces including social influences, the institutional climate, and the implicit, or hidden, curriculum. A combined interpretation of the complementary cultural competence and sexual and gender diversity literature provides a novel understanding of the optimal content and context for the delivery of a successful curricular initiative. PMID:28344699

Mapping of initiatives to increase membership in mutual health organizations in Benin

PubMed Central

2012-01-01

Introduction Mutual health organizations (MHO) have been implemented across Africa to increase access to healthcare and improve financial protection. Despite efforts to develop MHOs, low levels of both initial enrolment and membership renewals continue to threaten their financial viability. The purpose of this study was to map initiatives implemented to increase the pool of MHO members in Benin. Methods A multiple case study was conducted to assess MHOs supported by five major promoters in Benin. Three months of fieldwork resulted in 23 semi-structured interviews and two focus groups with MHO promoters, technicians, elected members, and health professionals affiliated with the MHOs. Fifteen non-structured interviews provided additional information and a valuable source of triangulation. Results MHOs have adopted a wide range of initiatives targeting different entry points and involving a variety of stakeholders. Initiatives have included new types of collective health insurance packages and efforts to raise awareness by going door-to-door and organizing health education workshops. Different types of partnerships have been established to strengthen relationships with healthcare professionals and political leaders. However, the selection and implementation of these initiatives have been limited by insufficient financial and human resources. Conclusions The study highlights the importance of prioritizing sustainable strategies to increase MHO membership. No single MHO initiative has been able to resolve the issue of low membership on its own. If combined, existing initiatives could provide a comprehensive and inclusive approach that would target all entry points and include key stakeholders such as household decision-makers, MHO elected members, healthcare professionals, community leaders, governmental authorities, medical advisors, and promoters. There is a need to evaluate empirically the implementation of these interventions. Mechanisms to promote dialogue between MHO stakeholders would be useful to devise innovative strategies, avoid repeating unsuccessful ones, and develop a coordinated plan to promote MHOs. PMID:23217438

Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study.

PubMed

Janz, N K; Wren, P A; Lichter, P R; Musch, D C; Gillespie, B W; Guire, K E

2001-05-01

The Collaborative Initial Glaucoma Treatment Study (CIGTS) was designed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery. This paper describes the quality-of-life (QOL) measurement approach, instruments included, and the CIGTS participants' QOL findings at the time of diagnosis. Baseline results from a randomized, controlled clinical trial. Six hundred seven patients from 14 clinical centers were enrolled. Patients randomized to initial medication received a stepped medical regimen (n = 307). Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treatment initiation. All baseline and posttreatment QOL assessments were conducted by telephone from a centralized interviewing center. The primary outcome measure described in this paper was QOL. The QOL instrument is multidimensional and incorporates both disease-specific and generic measures, including the Visual Activities Questionnaire, Sickness Impact Profile, and a Symptom and Health Problem CHECKLIST: The correlations between QOL measures and clinical outcomes were in the expected direction, but relatively weak. At initial diagnosis, difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function, whereas visual distortion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within the Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression analyses controlling for sociodemographics and nonocular comorbidities, increased visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05). Newly diagnosed glaucoma patients reported experiencing some visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing. Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern. These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma.

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

PubMed Central

Meyer, Johanna C.; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research. PMID:29163151

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study.

PubMed

Meyer, Johanna C; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

PubMed Central

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-01-01

Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. PMID:29179292

African media coverage of tobacco industry corporate social responsibility initiatives.

PubMed

McDaniel, Patricia A; Cadman, Brie; Malone, Ruth E

2018-02-01

Guidelines for implementing the World Health Organization's Framework Convention on Tobacco Control (FCTC) recommend prohibiting tobacco industry corporate social responsibility (CSR) initiatives, but few African countries have done so. We examined African media coverage of tobacco industry CSR initiatives to understand whether and how such initiatives were presented to the public and policymakers. We searched two online media databases (Lexis Nexis and Access World News) for all news items published from 1998 to 2013, coding retrieved items through a collaborative, iterative process. We analysed the volume, type, provenance, slant and content of coverage, including the presence of tobacco control or tobacco interest themes. We found 288 news items; most were news stories published in print newspapers. The majority of news stories relied solely on tobacco industry representatives as news sources, and portrayed tobacco industry CSR positively. When public health voices and tobacco control themes were included, news items were less likely to have a positive slant. This suggests that there is a foundation on which to build media advocacy efforts. Drawing links between implementing the FCTC and prohibiting or curtailing tobacco industry CSR programmes may result in more public dialogue in the media about the negative impacts of tobacco company CSR initiatives.

Adolescent drinking and brain morphometry: A co-twin control analysis.

PubMed

Wilson, Sylia; Malone, Stephen M; Thomas, Kathleen M; Iacono, William G

2015-12-01

Developmental changes in structure and functioning are thought to make the adolescent brain particularly sensitive to the negative effects of alcohol. Although alcohol use disorders are relatively rare in adolescence, the initiation of alcohol use, including problematic use, becomes increasingly prevalent during this period. The present study examined associations between normative drinking (alcohol initiation, binge drinking, intoxication) and brain morphometry in a sample of 96 adolescent monozygotic twins. A priori regions of interest included 11 subcortical and 20 cortical structures implicated in the existing empirical literature as associated with normative alcohol use in adolescence. In addition, co-twin control analyses were used to disentangle risk for alcohol use from consequences of alcohol exposure on the developing brain. Results indicated significant associations reflecting preexisting vulnerability toward problematic alcohol use, including reduced volume of the amygdala, increased volume of the cerebellum, and reduced cortical volume and thickness in several frontal and temporal regions, including the superior and middle frontal gyri, pars triangularis, and middle and inferior temporal gyri. Results also indicated some associations consistent with a neurotoxic effect of alcohol exposure, including reduced volume of the ventral diencephalon and the middle temporal gyrus. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Numerical simulation of the compressible Orszag-Tang vortex. Interim report, June 1988-February 1989

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

Dahlburg, R.B.; Picone, J.M.

Results of fully compressible, Fourier collocation, numerical simulations of the Orszag-Tang vortex system are presented. Initial conditions consist of a nonrandom, periodic field in which the magnetic and velocity fields contain X-points but differ in modal structure along one spatial direction. The velocity field is initially solenoidal, with the total initial pressure-field consisting of the superposition of the appropriate incompressible pressure distribution upon a flat pressure field corresponding to the initial, average flow Mach number of the flow. In the numerical simulations, this initial Mach number is varied from 0.2 to 0.6. These values correspond to average plasma beta valuesmore » ranging from 30.0 to 3.3, respectively. Compressible effects develop within one or two Alfven transit times, as manifested in the spectra of compressible quantities such as mass density and nonsolenoidal flow field. These effects include (1) retardation of growth of correlation between the magnetic field and the velocity field, (2) emergence of compressible small-scale structure such as massive jets, and (3) bifurcation of eddies in the compressible-flow field. Differences between the incompressible and compressible results tend to increase with increasing initial average Mach number.« less

Collaboration and conquest: MTD as viewed by voice teacher (singing voice specialist) and speech-language pathologist.

PubMed

Goffi-Fynn, Jeanne C; Carroll, Linda M

2013-05-01

This study was designed as a qualitative case study to demonstrate the process of diagnosis and treatment between a voice team to manage a singer diagnosed with muscular tension dysphonia (MTD). Traditionally, literature suggests that MTD is challenging to treat and little in the literature directly addresses singers with MTD. Data collected included initial medical screening with laryngologist, referral to speech-language pathologist (SLP) specializing in voice disorders among singers, and adjunctive voice training with voice teacher trained in vocology (singing voice specialist or SVS). Initial target goals with SLP included reducing extrinsic laryngeal tension, using a relaxed laryngeal posture, and effective abdominal-diaphragmatic support for all phonation events. Balance of respiratory forces, laryngeal coordination, and use of optimum filtering of the source signal through resonance and articulatory awareness was emphasized. Further work with SVS included three main goals including a lowered breathing pattern to aid in decreasing subglottic air pressure, vertical laryngeal position to lower to allow for a relaxed laryngeal position, and a top-down singing approach to encourage an easier, more balanced registration, and better resonance. Initial results also emphasize the retraining of subject toward a sensory rather than auditory mode of monitoring. Other areas of consideration include singers' training and vocal use, the psychological effects of MTD, the personalities potentially associated with it, and its relationship with stress. Finally, the results emphasize that a positive rapport with the subject and collaboration between all professionals involved in a singer's care are essential for recovery. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

SRB Environment Evaluation and Analysis. Volume 3: ASRB Plume Induced Environments

NASA Technical Reports Server (NTRS)

Bender, R. L.; Brown, J. R.; Reardon, J. E.; Everson, J.; Coons, L. W.; Stuckey, C. I.; Fulton, M. S.

1991-01-01

Contract NAS8-37891 was expanded in late 1989 to initiate analysis of Shuttle plume induced environments as a result of the substitution of the Advanced Solid Rocket Booster (ASRB) for the Redesigned Solid Rocket Booster (RSRB). To support this analysis, REMTECH became involved in subscale and full-scale solid rocket motor test programs which further expanded the scope of work. Later contract modifications included additional tasks to produce initial design cycle environments and to specify development flight instrumentation. Volume 3 of the final report describes these analyses and contains a summary of reports resulting from various studies.

Advanced Mechanistic 3D Spatial Modeling and Analysis Methods to Accurately Represent Nuclear Facility External Event Scenarios

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

Sezen, Halil; Aldemir, Tunc; Denning, R.

Probabilistic risk assessment of nuclear power plants initially focused on events initiated by internal faults at the plant, rather than external hazards including earthquakes and flooding. Although the importance of external hazards risk analysis is now well recognized, the methods for analyzing low probability external hazards rely heavily on subjective judgment of specialists, often resulting in substantial conservatism. This research developed a framework to integrate the risk of seismic and flooding events using realistic structural models and simulation of response of nuclear structures. The results of four application case studies are presented.

Evolution of the Orszag-Tang vortex system in a compressible medium. I - Initial average subsonic flow

NASA Technical Reports Server (NTRS)

Dahlburg, R. B.; Picone, J. M.

1989-01-01

The results of fully compressible, Fourier collocation, numerical simulations of the Orszag-Tang vortex system are presented. The initial conditions for this system consist of a nonrandom, periodic field in which the magnetic and velocity field contain X points but differ in modal structure along one spatial direction. The velocity field is initially solenoidal, with the total initial pressure field consisting of the superposition of the appropriate incompressible pressure distribution upon a flat pressure field corresponding to the initial, average Mach number of the flow. In these numerical simulations, this initial Mach number is varied from 0.2-0.6. These values correspond to average plasma beta values ranging from 30.0 to 3.3, respectively. It is found that compressible effects develop within one or two Alfven transit times, as manifested in the spectra of compressible quantities such as the mass density and the nonsolenoidal flow field. These effects include (1) a retardation of growth of correlation between the magnetic field and the velocity field, (2) the emergence of compressible small-scale structure such as massive jets, and (3) bifurcation of eddies in the compressible flow field. Differences between the incompressible and compressible results tend to increase with increasing initial average Mach number.

Evolution of the Orszag--Tang vortex system in a compressible medium. I. Initial average subsonic flow

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

Dahlburg, R.B.; Picone, J.M.

In this paper the results of fully compressible, Fourier collocation, numerical simulations of the Orszag--Tang vortex system are presented. The initial conditions for this system consist of a nonrandom, periodic field in which the magnetic and velocity field contain X points but differ in modal structure along one spatial direction. The velocity field is initially solenoidal, with the total initial pressure field consisting of the superposition of the appropriate incompressible pressure distribution upon a flat pressure field corresponding to the initial, average Mach number of the flow. In these numerical simulations, this initial Mach number is varied from 0.2--0.6. Thesemore » values correspond to average plasma beta values ranging from 30.0 to 3.3, respectively. It is found that compressible effects develop within one or two Alfven transit times, as manifested in the spectra of compressible quantities such as the mass density and the nonsolenoidal flow field. These effects include (1) a retardation of growth of correlation between the magnetic field and the velocity field, (2) the emergence of compressible small-scale structure such as massive jets, and (3) bifurcation of eddies in the compressible flow field. Differences between the incompressible and compressible results tend to increase with increasing initial average Mach number.« less

Promoting clinical and laboratory interaction by harmonization.

PubMed

Plebani, Mario; Panteghini, Mauro

2014-05-15

The lack of interchangeable results in current practice among clinical laboratories has underpinned greater attention to standardization and harmonization projects. Although the focus was mainly on the standardization and harmonization of measurement procedures and their results, the scope of harmonization goes beyond method and analytical results: it includes all other aspects of laboratory testing, including terminology and units, report formats, reference limits and decision thresholds, as well as test profiles and criteria for the interpretation of results. In particular, as evidence collected in last decades demonstrates that pre-pre- and post-post-analytical steps are more vulnerable to errors, harmonization initiatives should be performed to improve procedures and processes at the laboratory-clinical interface. Managing upstream demand, down-stream interpretation of laboratory results, and subsequent appropriate action through close relationships between laboratorians and clinicians remains a crucial issue of the laboratory testing process. Therefore, initiatives to improve test demand management from one hand and to harmonize procedures to improve physicians' acknowledgment of laboratory data and their interpretation from the other hand are needed in order to assure quality and safety in the total testing process. © 2013.

Gravitational Waves from Known Pulsars: Results from the Initial Detector Era

NASA Astrophysics Data System (ADS)

Aasi, J.; Abadie, J.; Abbott, B. P.; Abbott, R.; Abbott, T.; Abernathy, M. R.; Accadia, T.; Acernese, F.; Adams, C.; Adams, T.; Adhikari, R. X.; Affeldt, C.; Agathos, M.; Aggarwal, N.; Aguiar, O. D.; Ajith, P.; Allen, B.; Allocca, A.; Amador Ceron, E.; Amariutei, D.; Anderson, R. A.; Anderson, S. B.; Anderson, W. G.; Arai, K.; Araya, M. C.; Arceneaux, C.; Areeda, J.; Ast, S.; Aston, S. M.; Astone, P.; Aufmuth, P.; Aulbert, C.; Austin, L.; Aylott, B. E.; Babak, S.; Baker, P. T.; Ballardin, G.; Ballmer, S. W.; Barayoga, J. C.; Barker, D.; Barnum, S. H.; Barone, F.; Barr, B.; Barsotti, L.; Barsuglia, M.; Barton, M. A.; Bartos, I.; Bassiri, R.; Basti, A.; Batch, J.; Bauchrowitz, J.; Bauer, Th. S.; Bebronne, M.; Behnke, B.; Bejger, M.; Beker, M. G.; Bell, A. S.; Bell, C.; Belopolski, I.; Bergmann, G.; Berliner, J. M.; Bersanetti, D.; Bertolini, A.; Bessis, D.; Betzwieser, J.; Beyersdorf, P. T.; Bhadbhade, T.; Bilenko, I. A.; Billingsley, G.; Birch, J.; Bitossi, M.; Bizouard, M. A.; Black, E.; Blackburn, J. K.; Blackburn, L.; Blair, D.; Blom, M.; Bock, O.; Bodiya, T. P.; Boer, M.; Bogan, C.; Bond, C.; Bondu, F.; Bonelli, L.; Bonnand, R.; Bork, R.; Born, M.; Boschi, V.; Bose, S.; Bosi, L.; Bowers, J.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brannen, C. A.; Brau, J. E.; Breyer, J.; Briant, T.; Bridges, D. O.; Brillet, A.; Brinkmann, M.; Brisson, V.; Britzger, M.; Brooks, A. F.; Brown, D. A.; Brown, D. D.; Brückner, F.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Buskulic, D.; Buy, C.; Byer, R. L.; Cadonati, L.; Cagnoli, G.; Calderón Bustillo, J.; Calloni, E.; Camp, J. B.; Campsie, P.; Cannon, K. C.; Canuel, B.; Cao, J.; Capano, C. D.; Carbognani, F.; Carbone, L.; Caride, S.; Castiglia, A.; Caudill, S.; Cavaglià, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C.; Cesarini, E.; Chakraborty, R.; Chalermsongsak, T.; Chao, S.; Charlton, P.; Chassande-Mottin, E.; Chen, X.; Chen, Y.; Chincarini, A.; Chiummo, A.; Cho, H. S.; Chow, J.; Christensen, N.; Chu, Q.; Chua, S. S. Y.; Chung, S.; Ciani, G.; Clara, F.; Clark, D. E.; Clark, J. A.; Cleva, F.; Coccia, E.; Cohadon, P.-F.; Colla, A.; Colombini, M.; Constancio, M., Jr.; Conte, A.; Conte, R.; Cook, D.; Corbitt, T. R.; Cordier, M.; Cornish, N.; Corsi, A.; Costa, C. A.; Coughlin, M. W.; Coulon, J.-P.; Countryman, S.; Couvares, P.; Coward, D. M.; Cowart, M.; Coyne, D. C.; Craig, K.; Creighton, J. D. E.; Creighton, T. D.; Crowder, S. G.; Cumming, A.; Cunningham, L.; Cuoco, E.; Dahl, K.; Dal Canton, T.; Damjanic, M.; Danilishin, S. L.; D'Antonio, S.; Danzmann, K.; Dattilo, V.; Daudert, B.; Daveloza, H.; Davier, M.; Davies, G. S.; Daw, E. J.; Day, R.; Dayanga, T.; De Rosa, R.; Debreczeni, G.; Degallaix, J.; Del Pozzo, W.; Deleeuw, E.; Deléglise, S.; Denker, T.; Dent, T.; Dereli, H.; Dergachev, V.; DeRosa, R.; DeSalvo, R.; Dhurandhar, S.; Di Fiore, L.; Di Lieto, A.; Di Palma, I.; Di Virgilio, A.; Díaz, M.; Dietz, A.; Dmitry, K.; Donovan, F.; Dooley, K. L.; Doravari, S.; Drago, M.; Drever, R. W. P.; Driggers, J. C.; Du, Z.; Dumas, J.-C.; Dwyer, S.; Eberle, T.; Edwards, M.; Effler, A.; Ehrens, P.; Eichholz, J.; Eikenberry, S. S.; Endrőczi, G.; Essick, R.; Etzel, T.; Evans, K.; Evans, M.; Evans, T.; Factourovich, M.; Fafone, V.; Fairhurst, S.; Fang, Q.; Farinon, S.; Farr, B.; Farr, W.; Favata, M.; Fazi, D.; Fehrmann, H.; Feldbaum, D.; Ferrante, I.; Ferrini, F.; Fidecaro, F.; Finn, L. S.; Fiori, I.; Fisher, R.; Flaminio, R.; Foley, E.; Foley, S.; Forsi, E.; Fotopoulos, N.; Fournier, J.-D.; Franco, S.; Frasca, S.; Frasconi, F.; Frede, M.; Frei, M.; Frei, Z.; Freise, A.; Frey, R.; Fricke, T. T.; Fritschel, P.; Frolov, V. V.; Fujimoto, M.-K.; Fulda, P.; Fyffe, M.; Gair, J.; Gammaitoni, L.; Garcia, J.; Garufi, F.; Gehrels, N.; Gemme, G.; Genin, E.; Gennai, A.; Gergely, L.; Ghosh, S.; Giaime, J. A.; Giampanis, S.; Giardina, K. D.; Giazotto, A.; Gil-Casanova, S.; Gill, C.; Gleason, J.; Goetz, E.; Goetz, R.; Gondan, L.; González, G.; Gordon, N.; Gorodetsky, M. L.; Gossan, S.; Goßler, S.; Gouaty, R.; Graef, C.; Graff, P. B.; Granata, M.; Grant, A.; Gras, S.; Gray, C.; Greenhalgh, R. J. S.; Gretarsson, A. M.; Griffo, C.; Groot, P.; Grote, H.; Grover, K.; Grunewald, S.; Guidi, G. M.; Guido, C.; Gushwa, K. E.; Gustafson, E. K.; Gustafson, R.; Hall, B.; Hall, E.; Hammer, D.; Hammond, G.; Hanke, M.; Hanks, J.; Hanna, C.; Hanson, J.; Harms, J.; Harry, G. M.; Harry, I. W.; Harstad, E. D.; Hartman, M. T.; Haughian, K.; Hayama, K.; Heefner, J.; Heidmann, A.; Heintze, M.; Heitmann, H.; Hello, P.; Hemming, G.; Hendry, M.; Heng, I. S.; Heptonstall, A. W.; Heurs, M.; Hild, S.; Hoak, D.; Hodge, K. A.; Holt, K.; Holtrop, M.; Hong, T.; Hooper, S.; Horrom, T.; Hosken, D. J.; Hough, J.; Howell, E. J.; Hu, Y.; Hua, Z.; Huang, V.; Huerta, E. A.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh, M.; Huynh-Dinh, T.; Iafrate, J.; Ingram, D. R.; Inta, R.; Isogai, T.; Ivanov, A.; Iyer, B. R.; Izumi, K.; Jacobson, M.; James, E.; Jang, H.; Jang, Y. J.; Jaranowski, P.; Jiménez-Forteza, F.; Johnson, W. W.; Jones, D.; Jones, D. I.; Jones, R.; Jonker, R. J. G.; Ju, L.; K, Haris; Kalmus, P.; Kalogera, V.; Kandhasamy, S.; Kang, G.; Kanner, J. B.; Kasprzack, M.; Kasturi, R.; Katsavounidis, E.; Katzman, W.; Kaufer, H.; Kaufman, K.; Kawabe, K.; Kawamura, S.; Kawazoe, F.; Kéfélian, F.; Keitel, D.; Kelley, D. B.; Kells, W.; Keppel, D. G.; Khalaidovski, A.; Khalili, F. Y.; Khazanov, E. A.; Kim, B. K.; Kim, C.; Kim, K.; Kim, N.; Kim, W.; Kim, Y.-M.; King, E. J.; King, P. J.; Kinzel, D. L.; Kissel, J. S.; Klimenko, S.; Kline, J.; Koehlenbeck, S.; Kokeyama, K.; Kondrashov, V.; Koranda, S.; Korth, W. Z.; Kowalska, I.; Kozak, D.; Kremin, A.; Kringel, V.; Krishnan, B.; Królak, A.; Kucharczyk, C.; Kudla, S.; Kuehn, G.; Kumar, A.; Kumar, P.; Kumar, R.; Kurdyumov, R.; Kwee, P.; Landry, M.; Lantz, B.; Larson, S.; Lasky, P. D.; Lawrie, C.; Lazzarini, A.; Le Roux, A.; Leaci, P.; Lebigot, E. O.; Lee, C.-H.; Lee, H. K.; Lee, H. M.; Lee, J.; Lee, J.; Leonardi, M.; Leong, J. R.; Leroy, N.; Letendre, N.; Levine, B.; Lewis, J. B.; Lhuillier, V.; Li, T. G. F.; Lin, A. C.; Littenberg, T. B.; Litvine, V.; Liu, F.; Liu, H.; Liu, Y.; Liu, Z.; Lloyd, D.; Lockerbie, N. A.; Lockett, V.; Lodhia, D.; Loew, K.; Logue, J.; Lombardi, A. L.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Lough, J.; Luan, J.; Lubinski, M. J.; Lück, H.; Lundgren, A. P.; Macarthur, J.; Macdonald, E.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Magana-Sandoval, F.; Mageswaran, M.; Mailand, K.; Majorana, E.; Maksimovic, I.; Malvezzi, V.; Man, N.; Manca, G. M.; Mandel, I.; Mandic, V.; Mangano, V.; Mantovani, M.; Marchesoni, F.; Marion, F.; Márka, S.; Márka, Z.; Markosyan, A.; Maros, E.; Marque, J.; Martelli, F.; Martin, I. W.; Martin, R. M.; Martinelli, L.; Martynov, D.; Marx, J. N.; Mason, K.; Masserot, A.; Massinger, T. J.; Matichard, F.; Matone, L.; Matzner, R. A.; Mavalvala, N.; May, G.; Mazumder, N.; Mazzolo, G.; McCarthy, R.; McClelland, D. E.; McGuire, S. C.; McIntyre, G.; McIver, J.; Meacher, D.; Meadors, G. D.; Mehmet, M.; Meidam, J.; Meier, T.; Melatos, A.; Mendell, G.; Mercer, R. A.; Meshkov, S.; Messenger, C.; Meyer, M. S.; Miao, H.; Michel, C.; Mikhailov, E. E.; Milano, L.; Miller, J.; Minenkov, Y.; Mingarelli, C. M. F.; Mitra, S.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Moe, B.; Mohan, M.; Mohapatra, S. R. P.; Mokler, F.; Moraru, D.; Moreno, G.; Morgado, N.; Mori, T.; Morriss, S. R.; Mossavi, K.; Mours, B.; Mow-Lowry, C. M.; Mueller, C. L.; Mueller, G.; Mukherjee, S.; Mullavey, A.; Munch, J.; Murphy, D.; Murray, P. G.; Mytidis, A.; Nagy, M. F.; Nanda Kumar, D.; Nardecchia, I.; Nash, T.; Naticchioni, L.; Nayak, R.; Necula, V.; Nelemans, G.; Neri, I.; Neri, M.; Newton, G.; Nguyen, T.; Nishida, E.; Nishizawa, A.; Nitz, A.; Nocera, F.; Nolting, D.; Normandin, M. E.; Nuttall, L. K.; Ochsner, E.; O'Dell, J.; Oelker, E.; Ogin, G. H.; Oh, J. J.; Oh, S. H.; Ohme, F.; Oppermann, P.; O'Reilly, B.; Ortega Larcher, W.; O'Shaughnessy, R.; Osthelder, C.; Ottaway, D. J.; Ottens, R. S.; Ou, J.; Overmier, H.; Owen, B. J.; Padilla, C.; Pai, A.; Palomba, C.; Pan, Y.; Pankow, C.; Paoletti, F.; Paoletti, R.; Papa, M. A.; Paris, H.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Pedraza, M.; Peiris, P.; Penn, S.; Perreca, A.; Phelps, M.; Pichot, M.; Pickenpack, M.; Piergiovanni, F.; Pierro, V.; Pinard, L.; Pindor, B.; Pinto, I. M.; Pitkin, M.; Poeld, J.; Poggiani, R.; Poole, V.; Poux, C.; Predoi, V.; Prestegard, T.; Price, L. R.; Prijatelj, M.; Principe, M.; Privitera, S.; Prix, R.; Prodi, G. A.; Prokhorov, L.; Puncken, O.; Punturo, M.; Puppo, P.; Quetschke, V.; Quintero, E.; Quitzow-James, R.; Raab, F. J.; Rabeling, D. S.; Rácz, I.; Radkins, H.; Raffai, P.; Raja, S.; Rajalakshmi, G.; Rakhmanov, M.; Ramet, C.; Rapagnani, P.; Raymond, V.; Re, V.; Reed, C. M.; Reed, T.; Regimbau, T.; Reid, S.; Reitze, D. H.; Ricci, F.; Riesen, R.; Riles, K.; Robertson, N. A.; Robinet, F.; Rocchi, A.; Roddy, S.; Rodriguez, C.; Rodruck, M.; Roever, C.; Rolland, L.; Rollins, J. G.; Romano, J. D.; Romano, R.; Romanov, G.; Romie, J. H.; Rosińska, D.; Rowan, S.; Rüdiger, A.; Ruggi, P.; Ryan, K.; Salemi, F.; Sammut, L.; Sandberg, V.; Sanders, J.; Sannibale, V.; Santiago-Prieto, I.; Saracco, E.; Sassolas, B.; Sathyaprakash, B. S.; Saulson, P. R.; Savage, R.; Schilling, R.; Schnabel, R.; Schofield, R. M. S.; Schreiber, E.; Schuette, D.; Schulz, B.; Schutz, B. F.; Schwinberg, P.; Scott, J.; Scott, S. M.; Seifert, F.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sergeev, A.; Shaddock, D.; Shah, S.; Shahriar, M. S.; Shaltev, M.; Shapiro, B.; Shawhan, P.; Shoemaker, D. H.; Sidery, T. L.; Siellez, K.; Siemens, X.; Sigg, D.; Simakov, D.; Singer, A.; Singer, L.; Sintes, A. M.; Skelton, G. R.; Slagmolen, B. J. J.; Slutsky, J.; Smith, J. R.; Smith, M. R.; Smith, R. J. E.; Smith-Lefebvre, N. D.; Soden, K.; Son, E. J.; Sorazu, B.; Souradeep, T.; Sperandio, L.; Staley, A.; Steinert, E.; Steinlechner, J.; Steinlechner, S.; Steplewski, S.; Stevens, D.; Stochino, A.; Stone, R.; Strain, K. A.; Straniero, N.; Strigin, S.; Stroeer, A. S.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Susmithan, S.; Sutton, P. J.; Swinkels, B.; Szeifert, G.; Tacca, M.; Talukder, D.; Tang, L.; Tanner, D. B.; Tarabrin, S. P.; Taylor, R.; ter Braack, A. P. M.; Thirugnanasambandam, M. P.; Thomas, M.; Thomas, P.; Thorne, K. A.; Thorne, K. S.; Thrane, E.; Tiwari, V.; Tokmakov, K. V.; Tomlinson, C.; Toncelli, A.; Tonelli, M.; Torre, O.; Torres, C. V.; Torrie, C. I.; Travasso, F.; Traylor, G.; Tse, M.; Ugolini, D.; Unnikrishnan, C. S.; Vahlbruch, H.; Vajente, G.; Vallisneri, M.; van den Brand, J. F. J.; Van Den Broeck, C.; van der Putten, S.; van der Sluys, M. V.; van Heijningen, J.; van Veggel, A. A.; Vass, S.; Vasúth, M.; Vaulin, R.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P. J.; Venkateswara, K.; Verkindt, D.; Verma, S.; Vetrano, F.; Viceré, A.; Vincent-Finley, R.; Vinet, J.-Y.; Vitale, S.; Vlcek, B.; Vo, T.; Vocca, H.; Vorvick, C.; Vousden, W. D.; Vrinceanu, D.; Vyachanin, S. P.; Wade, A.; Wade, L.; Wade, M.; Waldman, S. J.; Walker, M.; Wallace, L.; Wan, Y.; Wang, J.; Wang, M.; Wang, X.; Wanner, A.; Ward, R. L.; Was, M.; Weaver, B.; Wei, L.-W.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Welborn, T.; Wen, L.; Wessels, P.; West, M.; Westphal, T.; Wette, K.; Whelan, J. T.; Whitcomb, S. E.; White, D. J.; Whiting, B. F.; Wibowo, S.; Wiesner, K.; Wilkinson, C.; Williams, L.; Williams, R.; Williams, T.; Willis, J. L.; Willke, B.; Wimmer, M.; Winkelmann, L.; Winkler, W.; Wipf, C. C.; Wittel, H.; Woan, G.; Worden, J.; Yablon, J.; Yakushin, I.; Yamamoto, H.; Yancey, C. C.; Yang, H.; Yeaton-Massey, D.; Yoshida, S.; Yum, H.; Yvert, M.; Zadrożny, A.; Zanolin, M.; Zendri, J.-P.; Zhang, F.; Zhang, L.; Zhao, C.; Zhu, H.; Zhu, X. J.; Zotov, N.; Zucker, M. E.; Zweizig, J.; Buchner, S.; Cognard, I.; Corongiu, A.; D'Amico, N.; Espinoza, C. M.; Freire, P. C. C.; Gotthelf, E. V.; Guillemot, L.; Hessels, J. W. T.; Hobbs, G. B.; Kramer, M.; Lyne, A. G.; Marshall, F. E.; Possenti, A.; Ransom, S. M.; Ray, P. S.; Roy, J.; Stappers, B. W.; LIGO Scientific Collaboration; Virgo Collaboration

2014-04-01

We present the results of searches for gravitational waves from a large selection of pulsars using data from the most recent science runs (S6, VSR2 and VSR4) of the initial generation of interferometric gravitational wave detectors LIGO (Laser Interferometric Gravitational-wave Observatory) and Virgo. We do not see evidence for gravitational wave emission from any of the targeted sources but produce upper limits on the emission amplitude. We highlight the results from seven young pulsars with large spin-down luminosities. We reach within a factor of five of the canonical spin-down limit for all seven of these, whilst for the Crab and Vela pulsars we further surpass their spin-down limits. We present new or updated limits for 172 other pulsars (including both young and millisecond pulsars). Now that the detectors are undergoing major upgrades, and, for completeness, we bring together all of the most up-to-date results from all pulsars searched for during the operations of the first-generation LIGO, Virgo and GEO600 detectors. This gives a total of 195 pulsars including the most recent results described in this paper.

Gravitational Waves from Known Pulsars: Results from the Initial Detector Era

NASA Technical Reports Server (NTRS)

Aasi, J.; Abadie, J.; Abbott, B. P.; Abbott, R.; Abbott, T.; Abernathy, M. R.; Accadia, T.; Acernese, F.; Adams, C.; Adams, T.;

Response of Psychiatrically Impaired Inmates to Activity Therapy.

ERIC Educational Resources Information Center

Siberski, James

2001-01-01

This paper describes the results of activity therapy programs with psychiatrically impaired inmates at a maximum security prison. Results include the programs which were felt to be of benefit and enjoyable, and those which prepared them for the future. Recommendations for initiation of a similar program are offered. (Author)

Initial Results of Coupling the Output of a Regional Weather Model and a Localized Computational Fluid Dynamics Model at the Atlantic City International Airport

NASA Astrophysics Data System (ADS)

Trout, Joseph; Manson, J. Russell; Rios, Manny; King, David; Decicco, Nicholas

2015-04-01

Wake Vortex Turbulence is the turbulence generated by an aircraft in flight. This turbulence is created by vortices at the tips of the wing that may decay slowly and persist for several minutes after creation. The strength, formation and lifetime of the turbulence and vortices are effected by many things including the weather. Here we present the preliminary results of an investigation of low level wind fields generated by the Weather Research and Forecasting Model and an analysis of historical data. The simulations are used as inputs for the computational fluid dynamics model (OpenFoam) that will be used to investigate the effect of weather on wake turbulence. The initial results of the OpenFoam model are presented elsewhere. Presented here are the initial results from a research grant, ``A Pilot Project to Investigate Wake Vortex Patterns and Weather Patterns at the Atlantic City Airport by the Richard Stockton College of NJ and the FAA''.

A longitudinal study of cannabis use initiation among high school students: Effects of social anxiety, expectancies, peers and alcohol.

PubMed

Schmits, Emilie; Mathys, Cécile; Quertemont, Etienne

2015-06-01

This study identified protective and risk factors of cannabis use initiation, including expectancies and social anxiety. A questionnaire was completed twice by 877 teenagers. Logistic regressions, mediation and moderation analyses were performed. Significant risk factors were alcohol use, peer users, perceptual enhancement, and craving expectancies. Protective factors were negative behavior expectancies and social anxiety. Social anxiety protected from initiation through the mediating role of perceptual enhancement and craving expectancies, whatever the role of peer users and alcohol use. Findings are discussed in terms of risk and protection, in an overall approach including internalizing factors. Results support the identification of an internalizing profile of adolescents for prevention or treatment and the importance of social anxiety and expectancies in intervention. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

MYCOBACTERIUM ABSCESSUS PNEUMONIA IN AN ATLANTIC BOTTLENOSE DOLPHIN (TURSIOPS TRUNCATUS)

PubMed Central

Clayton, Leigh Ann; Stamper, M. Andrew; Whitaker, Brent R.; Hadfield, Catherine A.; Simons, Brian; Mankowski, Joseph L.

2013-01-01

Mycobacterium abscessus pneumonia was diagnosed antemortem in a 23-yr-old male Atlantic bottlenose dolphin (Tursiops truncatus). Clinical signs included lethargy, hyporexia, coughing, and bloody respiratory discharge. Diagnostic findings included neutrophilic leukocytosis, anemia, elevated erythrocyte sedimentation rate, and repeated forceful exhaled breath (sputum) cytology, with acute inflammatory cells and acid-fast positive beaded rods. The bacteria were initially identified free in the sputum sample and subsequently were seen within neutrophils. A culture was positive for a rapidly growing, white, colony-forming organism confirmed as M. abscessus by polymerase chain reaction and DNA sequencing. Clinical signs initially resolved with multidrug therapy. Concurrent Pseudomonas aeruginosa infection complicated clinical management and contributed to terminal decline. The dolphin was euthanized 5 mo after initial diagnosis. Necropsy results demonstrated acid-fast positive bacteria in lung tissue and supported the diagnosis of M. abscessus pneumonia. Acid-fast stains and mycobacteria cultures should be considered when evaluating ill dolphins. PMID:23272373

Smart hands for the EVA retriever

NASA Technical Reports Server (NTRS)

Hess, Clifford W.; Li, Larry C.

1990-01-01

Dexterous, robotic hands are required for the extravehicular activity retriever (EVAR) system being developed by the NASA Johnson Space Center (JSC). These hands, as part of the EVAR system, must be able to grasp objects autonomously and securely which inadvertently separate from the Space Station. Development of the required hands was initiated in 1987. Outlined here are the hand development activities, including design considerations, progress to date, and future plans. Several types of dexterous hands that were evaluated, along with a proximity-sensing capability that was developed to initiate a reflexive, adaptive grasp, are described. The evaluations resulted in the design and fabrication of a 6-degree-of-freedom (DOF) hand that has two fingers and a thumb arranged in an anthropomorphic configuration. Finger joint force and position sensors are included in the design, as well as infrared proximity sensors which allow initiation of the grasp sequence when an object is detected within the grasp envelope.

Population-level interventions in government jurisdictions for dietary sodium reduction.

PubMed

McLaren, Lindsay; Sumar, Nureen; Barberio, Amanda M; Trieu, Kathy; Lorenzetti, Diane L; Tarasuk, Valerie; Webster, Jacqui; Campbell, Norman Rc

2016-09-16

Excess dietary sodium consumption is a risk factor for high blood pressure, stroke and cardiovascular disease. Currently, dietary sodium consumption in almost every country is too high. Excess sodium intake is associated with high blood pressure, which is common and costly and accounts for significant burden of disease. A large number of jurisdictions worldwide have implemented population-level dietary sodium reduction initiatives. No systematic review has examined the impact of these initiatives. • To assess the impact of population-level interventions for dietary sodium reduction in government jurisdictions worldwide.• To assess the differential impact of those initiatives by social and economic indicators. We searched the following electronic databases from their start date to 5 January 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Public Health Group Specialised Register; MEDLINE; MEDLINE In Process & Other Non-Indexed Citations; EMBASE; Effective Public Health Practice Project Database; Web of Science; Trials Register of Promoting Health Interventions (TRoPHI) databases; and Latin American Caribbean Health Sciences Literature (LILACS). We also searched grey literature, other national sources and references of included studies.This review was conducted in parallel with a comprehensive review of national sodium reduction efforts under way worldwide (Trieu 2015), through which we gained additional information directly from country contacts.We imposed no restrictions on language or publication status. We included population-level initiatives (i.e. interventions that target whole populations, in this case, government jurisdictions, worldwide) for dietary sodium reduction, with at least one pre-intervention data point and at least one post-intervention data point of comparable jurisdiction. We included populations of all ages and the following types of study designs: cluster-randomised, controlled pre-post, interrupted time series and uncontrolled pre-post. We contacted study authors at different points in the review to ask for missing information. Two review authors extracted data, and two review authors assessed risk of bias for each included initiative.We analysed the impact of initiatives by using estimates of sodium consumption from dietary surveys or urine samples. All estimates were converted to a common metric: salt intake in grams per day. We analysed impact by computing the mean change in salt intake (grams per day) from pre-intervention to post-intervention. We reviewed a total of 881 full-text documents. From these, we identified 15 national initiatives, including more than 260,000 people, that met the inclusion criteria. None of the initiatives were provided in lower-middle-income or low-income countries. All initiatives except one used an uncontrolled pre-post study design.Because of high levels of study heterogeneity (I 2 > 90%), we focused on individual initiatives rather than on pooled results.Ten initiatives provided sufficient data for quantitative analysis of impact (64,798 participants). As required by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method, we graded the evidence as very low due to the risk of bias of the included studies, as well as variation in the direction and size of effect across the studies. Five of these showed mean decreases in average daily salt intake per person from pre-intervention to post-intervention, ranging from 1.15 grams/day less (Finland) to 0.35 grams/day less (Ireland). Two initiatives showed mean increase in salt intake from pre-intervention to post-intervention: Canada (1.66) and Switzerland (0.80 grams/day more per person. The remaining initiatives did not show a statistically significant mean change.Seven of the 10 initiatives were multi-component and incorporated intervention activities of a structural nature (e.g. food product reformulation, food procurement policy in specific settings). Of those seven initiatives, four showed a statistically significant mean decrease in salt intake from pre-intervention to post-intervention, ranging from Finland to Ireland (see above), and one showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention (Switzerland; see above).Nine initiatives permitted quantitative analysis of differential impact by sex (men and women separately). For women, three initiatives (China, Finland, France) showed a statistically significant mean decrease, four (Austria, Netherlands, Switzerland, United Kingdom) showed no significant change and two (Canada, United States) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention. For men, five initiatives (Austria, China, Finland, France, United Kingdom) showed a statistically significant mean decrease, three (Netherlands, Switzerland, United States) showed no significant change and one (Canada) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention.Information was insufficient to indicate whether a differential change in mean salt intake occurred from pre-intervention to post-intervention by other axes of equity included in the PROGRESS framework (e.g. education, place of residence).We identified no adverse effects of these initiatives.The number of initiatives was insufficient to permit other subgroup analyses, including stratification by intervention type, economic status of country and duration (or start year) of the initiative.Many studies had methodological strengths, including large, nationally representative samples of the population and rigorous measurement of dietary sodium intake. However, all studies were scored as having high risk of bias, reflecting the observational nature of the research and the use of an uncontrolled study design. The quality of evidence for the main outcome was low. We could perform a sensitivity analysis only for impact. Population-level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population-wide reductions in salt intake from pre-intervention to post-intervention, particularly if they are multi-component (more than one intervention activity) and incorporate intervention activities of a structural nature (e.g. food product reformulation), and particularly amongst men. Heterogeneity across studies was significant, reflecting different contexts (population and setting) and initiative characteristics. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects.

Tumor initiation in human malignant melanoma and potential cancer therapies.

PubMed

Ma, Jie; Frank, Markus H

2010-02-01

Cancer stem cells (CSCs), also known as tumor-initiating cells, have been identified in several human malignancies, including human malignant melanoma. The frequency of malignant melanoma-initiating cells (MMICs), which are identified by their expression of ATP-binding cassette (ABC) family member ABCB5, correlates with disease progression in human patients. Furthermore, targeted MMIC ablation through ABCB5 inhibits tumor initiation and growth in preclinical xenotransplantation models, pointing to potential therapeutic promise of the CSC concept. Recent advances also show that CSCs can exert pro-angiogenic roles in tumor growth and serve immunomodulatory functions related to the evasion of host anti-tumor immunity. Thus, MMICs might initiate and sustain tumorigenic growth not only as a result of CSC-intrinsic self-renewal, differentiation and proliferative capacity, but also based on pro-tumorigenic interactions with the host environment.

Tumor Initiation in Human Malignant Melanoma and Potential Cancer Therapies

PubMed Central

Ma, Jie; Frank, Markus H.

2010-01-01

Cancer stem cells (CSCs), also known as tumor-initiating cells, have been identified in several human malignancies, including human malignant melanoma. The frequency of malignant melanoma-initiating cells (MMICs), which are identified by their expression of ATP-binding cassette (ABC) family member ABCB5, correlates with disease progression in human patients. Furthermore, targeted MMIC ablation through ABCB5 inhibits tumor initiation and growth in preclinical xenotransplantation models, pointing to potential therapeutic promise of the CSC concept. Recent advances also show that CSCs can exert pro-angiogenic roles in tumor growth and serve immunomodulatory functions related to the evasion of host anti-tumor immunity. Thus, MMICs might initiate and sustain tumorigenic growth not only as a result of CSC-intrinsic self-renewal, differentiation and proliferative capacity, but also based on pro-tumorigenic interactions with the host environment. PMID:20184545

Early appendectomy reduces costs in children with perforated appendicitis.

PubMed

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier Inc. All rights reserved.

Disease spread across multiple scales in a spatial hierarchy: effect of host spatial structure and of inoculum quantity and distribution.

PubMed

Gosme, Marie; Lucas, Philippe

2009-07-01

Spatial patterns of both the host and the disease influence disease spread and crop losses. Therefore, the manipulation of these patterns might help improve control strategies. Considering disease spread across multiple scales in a spatial hierarchy allows one to capture important features of epidemics developing in space without using explicitly spatialized variables. Thus, if the system under study is composed of roots, plants, and planting hills, the effect of host spatial pattern can be studied by varying the number of plants per planting hill. A simulation model based on hierarchy theory was used to simulate the effects of large versus small planting hills, low versus high level of initial infections, and aggregated versus uniform distribution of initial infections. The results showed that aggregating the initially infected plants always resulted in slower epidemics than spreading out the initial infections uniformly. Simulation results also showed that, in most cases, disease epidemics were slower in the case of large host aggregates (100 plants/hill) than with smaller aggregates (25 plants/hill), except when the initially infected plants were both numerous and spread out uniformly. The optimal strategy for disease control depends on several factors, including initial conditions. More importantly, the model offers a framework to account for the interplay between the spatial characteristics of the system, rates of infection, and aggregation of the disease.

Sector Activities and Lessons Learned Around Initial Implementation of the United States National Physical Activity Plan

PubMed Central

Evenson, Kelly R.; Satinsky, Sara B.

2016-01-01

Background National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. Methods During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. Results The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. Conclusions These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans. PMID:24176800

Dietary Management of Hyperthyroidism in a Dog.

PubMed

Looney, Andrea; Wakshlag, Joseph

An 8 yr old female spayed golden retriever presented for a routine exam during which ventral cervical soft tissue masses were identified. History included weight loss, increased activity and appetite, gagging, and occasional diarrhea. Exam findings included a body condition score of 4/9 and palpable ventral cervical nodules. A serum thyroxine (T4) value was 8.0 ug/dL (normal = 0.8-3.5ug/dL). Doppler systolic blood pressure readings ranged from 200-210 mmHg (normal systolic blood pressure <150 mmHg). The diagnosis was hyperthyroidism due to active thyroid masses. Due to financial constraints, the owner elected conservative management. Initial treatment with methimazole resulted in a decreased T4 value of 5.0 ug/dL at approximately 4 mo after initiation of treatment. A commercially available iodine-restricted feline diet was fed and this resulted in further reduction in serum T4 levels, improved sleeping cycles, reduced anxiety, and reduced systolic blood pressure. A temporary suspension of iodine-restricted feline diet for 2 mo resulted in increases in serum T4 concentrations, which, subsequently, decreased with re-introduction of the diet. Roughly 10 mo after initiation of the therapeutic diet and 16 mo after intial diagnosis, the dog remains relatively normal clinically despite active growing cervical masses with T4 concentration of 2.3 ug/dL.

Magnetohydrodynamic power generation

NASA Technical Reports Server (NTRS)

Smith, J. L.

1984-01-01

Magnetohydrodynamic (MHD) Power Generation is a concise summary of MHD theory, history, and future trends. Results of the major international MHD research projects are discussed. Data from MHD research is included. Economics of initial and operating costs are considered.

Utility Incentives for Combined Heat and Power

EPA Pesticide Factsheets

This report describes the results of EPA's research and analysis into utility incentives for CHP. It provides information about utility-initiated policies, programs, and incentives for CHP systems, and includes case studies and tools and resources.

The need and approach for characterization - U.S. air force perspectives on materials state awareness

NASA Astrophysics Data System (ADS)

Aldrin, John C.; Lindgren, Eric A.

2018-04-01

This paper expands on the objective and motivation for NDE-based characterization and includes a discussion of the current approach using model-assisted inversion being pursued within the Air Force Research Laboratory (AFRL). This includes a discussion of the multiple model-based methods that can be used, including physics-based models, deep machine learning, and heuristic approaches. The benefits and drawbacks of each method is reviewed and the potential to integrate multiple methods is discussed. Initial successes are included to highlight the ability to obtain quantitative values of damage. Additional steps remaining to realize this capability with statistical metrics of accuracy are discussed, and how these results can be used to enable probabilistic life management are addressed. The outcome of this initiative will realize the long-term desired capability of NDE methods to provide quantitative characterization to accelerate certification of new materials and enhance life management of engineered systems.

Real-Time Transliteration of Speech into Print for Hearing-Impaired Students in Regular Classes.

ERIC Educational Resources Information Center

Stuckless, E. Ross

1983-01-01

A system is described whereby a stenotypist records the classroom instructor's and students' speech which a computer then translates to words on the screen for hearing impaired postsecondary students. Initial results include a high degree of verbatim accuracy, support for real-time operation, and several technical problems including lack of…

Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity

PubMed Central

Wojcicki, Janet M

2014-01-01

While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these initiatives should focus on banning sugar sweetened beverages, including sodas, 100% fruit juice and sports drinks, from hospital cafeterias and vending machines instead of limiting their presence, so as to ensure the success of these programs in reducing the prevalence of childhood obesity. If US hospitals comprehensively remove sugar sweetened beverages from their cafeterias and vending machines, these programs could subsequently become a model for efforts to address childhood obesity in other areas of the world. Conclusion Hospitals should be a model for health care reform in their communities and removing sugar sweetened beverages is a necessary first step. PMID:23445326

Adolescent Online Romantic Relationship Initiation: Differences by Sexual and Gender Identification

PubMed Central

Korchmaros, Josephine D.; Ybarra, Michele L.; Mitchell, Kimberly J.

2015-01-01

Data from the national Teen Health and Technology Study of adolescents 13-18 years old (N = 5,091) were used to examine online formation of romantic relationships. Results show that lesbian, gay, bisexual, transgender, and queer (LGBTQ) and non-LGBTQ adolescents similarly were most likely to have met their most recent boy/girlfriend in the past 12 months at school. However, they differed on many characteristics of romantic relationship initiation, including the extent to which they initiated romantic relationships online. LGBTQ and non-LGBTQ adolescents also differed on level of offline access to potential partners, offline popularity, and numerous other factors possibly related to online relationship initiation (e.g., Internet use and demographic factors). Even after adjusting for differences in these factors, LGBTQ adolescents were more likely than non-LGBTQ adolescents to find boy/girlfriends online in the past 12 months. The results support the rich-get-richer hypothesis as well as the social compensation hypothesis. PMID:25625753

Impact of Targeted Programs on Health Systems: A Case Study of the Polio Eradication Initiative

PubMed Central

Loevinsohn, Benjamin; Aylward, Bruce; Steinglass, Robert; Ogden, Ellyn; Goodman, Tracey; Melgaard, Bjorn

2002-01-01

The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development. PMID:11772750

Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015).

PubMed

Singh, S K; Enzhong, L; Reidpath, D D; Allotey, P

2017-03-01

To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth. The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?' Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review. This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth. This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Characterization of seed nuclei in glucagon aggregation using light scattering methods and field-flow fractionation

PubMed Central

Hoppe, Cindy C; Nguyen, Lida T; Kirsch, Lee E; Wiencek, John M

2008-01-01

Background Glucagon is a peptide hormone with many uses as a therapeutic agent, including the emergency treatment of hypoglycemia. Physical instability of glucagon in solution leads to problems with the manufacture, formulation, and delivery of this pharmaceutical product. Glucagon has been shown to aggregate and form fibrils and gels in vitro. Small oligomeric precursors serve to initiate and nucleate the aggregation process. In this study, these initial aggregates, or seed nuclei, are characterized in bulk solution using light scattering methods and field-flow fractionation. Results High molecular weight aggregates of glucagon were detected in otherwise monomeric solutions using light scattering techniques. These aggregates were detected upon initial mixing of glucagon powder in dilute HCl and NaOH. In the pharmaceutically relevant case of acidic glucagon, the removal of aggregates by filtration significantly slowed the aggregation process. Field-flow fractionation was used to separate aggregates from monomeric glucagon and determine relative mass. The molar mass of the large aggregates was shown to grow appreciably over time as the glucagon solutions gelled. Conclusion The results of this study indicate that initial glucagon solutions are predominantly monomeric, but contain small quantities of large aggregates. These results suggest that the initial aggregates are seed nuclei, or intermediates which catalyze the aggregation process, even at low concentrations. PMID:18613970

Sexual minority women's experiences of sexual pressure: a qualitative investigation of recipients' and initiators' reports.

PubMed

Budge, Stephanie L; Keller, Bethany L; Sherry, Alissa R

2015-05-01

Sexual pressure can have detrimental effects to individuals both physically and emotionally; however, research in this area is lacking regarding the experiences by lesbian, gay, bisexual, queer, and questioning (LGBQ) women. This online study qualitatively examined sexual pressure experienced and explained by LGBQ women (n = 50) using grounded theory methodology. Participants responded to open-ended questions by providing perspectives from both those who were on the receiving end of the sexual pressure (recipients) and from those who pressured their partners (initiators). Results indicated that there were eight overarching themes, 43 higher order categories, and 241 line-by-line codes. The eight overarching themes included: Reasons to Not Want Sex, Reasons for Pressuring, Reasons for Giving In, Actions of Initiators, Expectations, Communication, Negative Outcomes, and Positive Reactions. Negative Outcomes was the most common theme endorsed. Several higher order categories indicated the unique experiences of sexual minority women, namely trying to be "normal" (e.g., engaging in sexual acts as a result of internalized homophobia), experiencing more pressure from men, and self-consciousness (specifically related to lack of knowledge about sex with women). Implications for the current study include the importance of addressing sexual pressure with sexual minority women and creating interventions, such as assertiveness training and communication skills, that could assist both recipients and initiators with engaging in mutually satisfactory sexual practices.

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

PubMed

Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E

2013-01-01

The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation elements of a strategic initiative than to the earlier stages.

Evaluating science return in space exploration initiative architectures

NASA Technical Reports Server (NTRS)

Budden, Nancy Ann; Spudis, Paul D.

1993-01-01

Science is an important aspect of the Space Exploration Initiative, a program to explore the Moon and Mars with people and machines. Different SEI mission architectures are evaluated on the basis of three variables: access (to the planet's surface), capability (including number of crew, equipment, and supporting infrastructure), and time (being the total number of man-hours available for scientific activities). This technique allows us to estimate the scientific return to be expected from different architectures and from different implementations of the same architecture. Our methodology allows us to maximize the scientific return from the initiative by illuminating the different emphases and returns that result from the alternative architectural decisions.

Silicon production process evaluations

NASA Technical Reports Server (NTRS)

1982-01-01

Engineering design of the third distillation column in the process was accomplished. The initial design is based on a 94.35% recovery of dichlorosilane in the distillate and a 99.9% recovery of trichlorosilane in the bottoms. The specified separation is achieved at a reflux ratio of 15 with 20 trays (equilibrium stages). Additional specifications and results are reported including equipment size, temperatures and pressure. Specific raw material requirements necessary to produce the silicon in the process are presented. The primary raw materials include metallurgical grade silicon, silicon tetrachloride, hydrogen, copper (catalyst) and lime (waste treatment). Hydrogen chloride is produced as by product in the silicon deposition. Cost analysis of the process was initiated during this reporting period.

Trends in CD4 cell count response to first-line antiretroviral treatment in HIV-positive patients from Asia, 2003-2013: TREAT Asia HIV Observational Database Low Intensity Transfer.

PubMed

De La Mata, Nicole L; Ly, Penh S; Ng, Oon T; Nguyen, Kinh V; Merati, Tuti P; Pham, Thuy T; Lee, Man P; Choi, Jun Y; Sohn, Annette H; Law, Matthew G; Kumarasamy, Nagalingeswaran

2017-11-01

Antiretroviral treatment (ART) guidelines have changed over the past decade, recommending earlier initiation and more tolerable regimens. The study objective was to examine the CD4 response to ART, depending on the year of ART initiation, in HIV-positive patients in the Asia-Pacific. We included HIV-positive adult patients who initiated ART between 2003 and 2013 in our regional cohort from eight urban referral centres in seven countries within Asia. We used mixed-effects linear regression models to evaluate differences in CD4 response by year of ART initiation during 36 months of follow-up, adjusted a priori for other covariates. Overall, 16,962 patients were included. Patients initiating in 2006-9 and 2010-13 had an estimated mean CD4 cell count increase of 8 and 15 cells/µl, respectively, at any given time during the 36-month follow-up, compared to those in 2003-5. The median CD4 cell count at ART initiation also increased from 96 cells/µl in 2003-5 to 173 cells/µl in 2010-13. Our results suggest that the CD4 response to ART is modestly higher for those initiating ART in more recent years. Moreover, fewer patients are presenting with lower absolute CD4 cell counts over time. This is likely to reduce their risk of opportunistic infections and future non-AIDS defining cancers.

The 12 GHz mixer/local oscillator and parametric amplifier. [considering all solid state circuitry

NASA Technical Reports Server (NTRS)

Dickens, L. E.

1976-01-01

The results of the initial implementation of the proposed design, the design modifications, and limitations are presented. Also included are data on component parts of the breadboard amplifier and the converter.

Iowa's forest resources in 2003

Treesearch

Earl C. Leatherberry; Gary J. Brand; Steve Pennington

2005-01-01

Reports the initial results of all five annual panels (1999-2003) of the fourth inventory of Iowa`s forest resources, the first annual inventory of the State. Includes information on forest area; volume; biomass; growth, mortality, and removals; and health.

Cost-effectiveness analysis of CNG urban taxi operations.

DOT National Transportation Integrated Search

1993-10-01

Increased emphasis on energy efficiency and air quality has resulted in a number of state and federal initiatives : examining the use of alternative fuels for motor vehicles. Texas' program for alternate fuels includes compressed : natural gas (CNG)....

The initiation of boiling during pressure transients. [water boiling on metal surfaces

NASA Technical Reports Server (NTRS)

Weisman, J.; Bussell, G.; Jashnani, I. L.; Hsieh, T.

1973-01-01

The initiation of boiling of water on metal surfaces during pressure transients has been investigated. The data were obtained by a new technique in which light beam fluctuations and a pressure signal were simultaneously recorded on a dual beam oscilloscope. The results obtained agreed with those obtained using high speed photography. It was found that, for water temperatures between 90-150 C, the wall superheat required to initiate boiling during a rapid pressure transient was significantly higher than required when the pressure was slowly reduced. This result is explained by assuming that a finite time is necessary for vapor to fill the cavity at which the bubble originates. Experimental measurements of this time are in reasonably good agreement with calculations based on the proposed theory. The theory includes a new procedure for estimating the coefficient of vaporization.

Effects of model error on control of large flexible space antenna with comparisons of decoupled and linear quadratic regulator control procedures

NASA Technical Reports Server (NTRS)

Hamer, H. A.; Johnson, K. G.

1986-01-01

An analysis was performed to determine the effects of model error on the control of a large flexible space antenna. Control was achieved by employing two three-axis control-moment gyros (CMG's) located on the antenna column. State variables were estimated by including an observer in the control loop that used attitude and attitude-rate sensors on the column. Errors were assumed to exist in the individual model parameters: modal frequency, modal damping, mode slope (control-influence coefficients), and moment of inertia. Their effects on control-system performance were analyzed either for (1) nulling initial disturbances in the rigid-body modes, or (2) nulling initial disturbances in the first three flexible modes. The study includes the effects on stability, time to null, and control requirements (defined as maximum torque and total momentum), as well as on the accuracy of obtaining initial estimates of the disturbances. The effects on the transients of the undisturbed modes are also included. The results, which are compared for decoupled and linear quadratic regulator (LQR) control procedures, are shown in tabular form, parametric plots, and as sample time histories of modal-amplitude and control responses. Results of the analysis showed that the effects of model errors on the control-system performance were generally comparable for both control procedures. The effect of mode-slope error was the most serious of all model errors.

Surgically induced neuropathic pain: understanding the perioperative process.

PubMed

Borsook, David; Kussman, Barry D; George, Edward; Becerra, Lino R; Burke, Dennis W

2013-03-01

Nerve damage takes place during surgery. As a consequence, significant numbers (10%-40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in "peripheral and central sensitization," with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients, these initial events produce chemical, structural, and functional changes in the peripheral and central nervous systems (CNS). The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state-allodynia, sensory loss, shooting pains, etc, that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed "centralization of pain" and affect sensory, emotional, and other (eg, cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (eg, depression). Currently there are no objective measures of nociception and pain in the perioperative period. As such, intermittent or continuous pain may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition, appear to provide initial opportunities for decreasing the burden of SNPP, until treatments with high efficacy and low adverse effects that either prevent or treat pain are discovered.

Disseminated histoplasmosis in an African pygmy hedgehog.

PubMed

Snider, Timothy A; Joyner, Priscilla H; Clinkenbeard, Kenneth D

2008-01-01

A 2-year-old captive-bred sexually intact female African pygmy hedgehog (Atelerix albiventris) was evaluated because of vague signs of illness including inappetence, weakness, lethargy, and weight loss over a 20-day period. Abnormalities detected via initial clinicopathologic analyses included anemia, thrombocytopenia, leukopenia, hypoproteinemia, and hypoglycemia. Results of a fecal flotation test were negative. Three weeks after the initial evaluation, splenomegaly was detected via palpation and ultrasonography. The hedgehog was treated with broad-spectrum antibacterial agents, resulting in an initially favorable response. Fenbendazole was also administered against possible occult parasitic infestation. After 3 weeks of illness, the hedgehog's condition had worsened and supportive care and administration of additional antibacterial agents were instituted. The hedgehog died, and pathologic examinations revealed severe splenomegaly; granulomatous infiltrates were evident in multiple organs, and Histoplasma capsulatum yeasts were detected intralesionally. Histoplasmosis can develop in a wide range of mammalian species. African pygmy hedgehogs are becoming increasingly popular as exotic pets, and vague signs of illness and splenomegaly are often attributed to hemolymphatic malignancies, which are somewhat common in this species. Practitioners should be aware that similar clinical signs may be associated with histoplasmosis in these animals. Although the hedgehog of this report was confined indoors, it originated from an area where histoplasmosis was endemic; this indicates that the disease should be included as a differential diagnosis for hedgehogs that develop vague signs of illness and are known to originate from such geographic regions.

Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking.

PubMed

Seelig, Amber D; Bensley, Kara M; Williams, Emily C; Armenta, Richard F; Rivera, Anna C; Peterson, Arthur V; Jacobson, Isabel G; Littman, Alyson J; Maynard, Charles; Bricker, Jonathan B; Rull, Rudolph P; Boyko, Edward J

2018-06-06

The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.

Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

PubMed

Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

2014-01-01

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

Patient Navigation Improves Subsequent Breast Cancer Screening After a Noncancerous Result: Evidence from the Patient Navigation in Medically Underserved Areas Study.

PubMed

Molina, Yamile; Kim, Sage J; Berrios, Nerida; Glassgow, Anne Elizabeth; San Miguel, Yazmin; Darnell, Julie S; Pauls, Heather; Vijayasiri, Ganga; Warnecke, Richard B; Calhoun, Elizabeth A

2018-03-01

Past efforts to assess patient navigation on cancer screening utilization have focused on one-time uptake, which may not be sufficient in the long term. This is partially due to limited resources for in-person, longitudinal patient navigation. We examine the effectiveness of a low-intensity phone- and mail-based navigation on multiple screening episodes with a focus on screening uptake after receiving noncancerous results during a previous screening episode. The is a secondary analysis of patients who participated in a randomized controlled patient navigation trial in Chicago. Participants include women referred for a screening mammogram, aged 50-74 years, and with a history of benign/normal screening results. Navigation services focused on identification of barriers and intervention via shared decision-making processes. A multivariable logistic regression intent-to-treat model was used to examine differences in odds of obtaining a screening mammogram within 2 years of the initial mammogram (yes/no) between navigated and non-navigated women. Sensitivity analyses were conducted to explore patterns across subsets of participants (e.g., navigated women successfully contacted before the initial appointment; women receiving care at Hospital C). The final sample included 2,536 women (741 navigated, 1,795 non-navigated). Navigated women exhibited greater odds of obtaining subsequent screenings relative to women in the standard care group in adjusted models and analyses including women who received navigation before the initial appointment. Our findings suggest that low-intensity navigation services can improve follow-up screening among women who receive a noncancerous result. Further investigation is needed to confirm navigation's impacts on longitudinal screening.

Late initiation of combination antiretroviral therapy in Canada: a call for a national public health strategy to improve engagement in HIV care

PubMed Central

Cescon, Angela; Patterson, Sophie; Davey, Colin; Ding, Erin; Raboud, Janet M; Chan, Keith; Loutfy, Mona R; Cooper, Curtis; Burchell, Ann N; Palmer, Alexis K; Tsoukas, Christos; Machouf, Nima; Klein, Marina B; Rourke, Sean B; Rachlis, Anita; Hogg, Robert S; Montaner, Julio SG

2015-01-01

Introduction Combination antiretroviral therapy (ART) significantly decreases morbidity, mortality and HIV transmission. We aimed to characterize the timing of ART initiation based on CD4 cell count from 2000 to 2012 and identify factors associated with late initiation of treatment. Methods Participants from the Canadian Observational Cohort (CANOC), a multi-site cohort of HIV-positive adults initiating ART naively after 1 January 2000, in three Canadian provinces (British Columbia, Ontario and Québec) were included. Late initiation was defined as a CD4 count <200 cells/mm3 or an AIDS-defining illness before ART initiation (baseline). Temporal trends were assessed using the Cochran–Armitage test, and independent correlates of late initiation were identified using logistic regression. Results In total, 8942 participants (18% female) of median age 40 years (Q1–Q3 33–47) were included. The median baseline CD4 count increased from 190 cells/mm3 (Q1–Q3 80–320) in 2000 to 360 cells/mm3 (Q1–Q3 220–490) in 2012 (p<0.001). Overall, 4274 participants (48%) initiated ART with a CD4 count <200 cells/mm3 or AIDS-defining illness. Late initiation was more common among women, non-MSM, older individuals, participants from Ontario and BC (vs. Québec), persons with injection drug use (IDU) history and individuals starting ART in earlier calendar years. In sub-analysis exploring recent (2008 to 2012) predictors using an updated CD4 criterion (<350 cells/mm3), IDU and residence in BC (vs. Québec) were no longer significant correlates of late initiation. Conclusions This analysis documents increasing baseline CD4 counts over time among Canadians initiating ART. However, CD4 counts at ART initiation remain below contemporary treatment guidelines, highlighting the need for strategies to improve earlier engagement in HIV care. PMID:26443752

Correlates of Early versus Later Initiation into Sex Work in Two Mexico–U.S. Border Cities

PubMed Central

Loza, Oralia; Strathdee, Steffanie A.; Lozada, Remedios; Staines, Hugo; Ojeda, Victoria D.; Martínez, Gustavo A.; Amaro, Hortensia; Patterson, Thomas L.

2009-01-01

Purpose To examine correlates of early initiation into sex work in two Mexico–U.S. border cities. Methods Female sex workers (FSWs) ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression. Results Of 920 FSWs interviewed in Tijuana (N=474) and Ciudad Juarez (N=446), 9.8% (N=90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6–58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs 9.6%, p=0.002), initiate sex work to pay for alcohol (36.7% vs 18.4%, p<.001), report abuse as a child (42.2% vs 18.7%, p<.0001), and they were less likely to be migrants (47.8% vs 62.3%, p=0.02). Factors independently associated with early initiation included inhalant use (adjOR=2.39), initiating sex work to pay for alcohol (adjOR=1.88) and history of child abuse (adjOR=2.92). Factors associated with later initiation included less education (adjOR=0.43 per 5-year increase), migration (adjOR=0.47), and initiating sex work for better pay (adjOR=0.44) or to support children (adjOR=0.03). Conclusions Different pathways for entering sex work are apparent among younger versus older females in the Mexico–U.S. border region. Among girls, interventions are needed to prevent inhalant use and child abuse and to offer coping skills; among older initiators, income-generating strategies, childcare, and services for migrants may help to delay or prevent entry into sex work. PMID:20123256

Traditional circumcision during manhood initiation rituals in the Eastern Cape, South Africa: a pre-post intervention evaluation

PubMed Central

Peltzer, Karl; Nqeketo, Ayanda; Petros, George; Kanta, Xola

2008-01-01

Background Circumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death. The aim of this study was to test an intervention for safe traditional circumcision in the context of initiation into manhood among the Xhosa, Eastern Cape, South Africa. Methods Traditional surgeons and nurses registered with the health department were trained over five days on ten modules including safe circumcision, infection control, anatomy, post-operative care, detection and early management of complications and sexual health education. Initiates from initiation schools of the trained surgeons and nurses were examined and interviewed on 2nd, 4th, 7th and 14th day after circumcision. Results From 192 initiates physically examined at the 14th day after circumcision by a trained clinical nurse high rates of complications were found: 40 (20.8%) had mild delayed wound healing, 31 (16.2%) had a mild wound infection, 22 (10.5%) mild pain and 20 (10.4%) had insufficient skin removed. Most traditional surgeons and nurses wore gloves during operation and care but did not use the recommended circumcision instrument. Only 12% of the initiates were circumcised before their sexual debut and they reported a great deal of sexual risk behaviour. Conclusion Findings show weak support for scaling up traditional male circumcision. PMID:18284673

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

PubMed Central

MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Background Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. PMID:29668763

A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant.

PubMed

Bixby, Christine; Baker-Fox, Cindy; Deming, Crystal; Dhar, Vijay; Steele, Caroline

2016-03-01

Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population. A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced. To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015. The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.

75 FR 37757 - Frozen Warmwater Shrimp From Vietnam: Initiation and Preliminary Results of Changed-Circumstances...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... including, but not limited to, changes in management, production facilities, supplier relationships, and customer base. See Industrial Phosphoric Acid From Israel: Final Results of Antidumping Duty Changed... Corp. is the successor-in- interest to Phuong Nam Co., Ltd. With respect to management prior to and...

78 FR 16660 - Advisory Committee to the U.S. Section to the International Commission for the Conservation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

... will meet with its Technical Advisors to discuss matters relating to ICCAT, including the 2012 Commission meeting results; research and management activities; global and domestic initiatives related to... ICCAT meeting results and U.S. implementation of ICCAT decisions; NMFS research and monitoring...

Climate Change Professional Development: Design, Implementation, and Initial Outcomes on Teacher Learning, Practice, and Student Beliefs

NASA Astrophysics Data System (ADS)

Shea, Nicole A.; Mouza, Chrystalla; Drewes, Andrea

2016-04-01

In this work, we present the design, implementation, and initial outcomes of the Climate Academy, a hybrid professional development program delivered through a combination of face-to-face and online interactions, intended to prepare formal and informal science teachers (grades 5-16) in teaching about climate change. The Climate Academy was designed around core elements of successful environmental professional development programs and aligned with practices advocated in benchmarked science standards. Data were collected from multiple sources including observations of professional development events, participants' reflections on their learning, and collection of instructional units designed during the Academy. Data were also collected from a focal case study teacher in a middle school setting. Case study data included classroom observations, teacher interviews, and student beliefs toward climate change. Results indicated that the Climate Academy fostered increased learning among participants of both climate science content and pedagogical strategies for teaching about climate change. Additionally, results indicated that participants applied their new learning in the design of climate change instructional units. Finally, results from the case study indicated positive impacts on student beliefs and greater awareness about climate change. Results have implications for the design of professional development programs on climate change, a topic included for the first time in national standards.

Effectiveness of a Model Bundle Payment Initiative for Femur Fracture Patients.

PubMed

Lott, Ariana; Belayneh, Rebekah; Haglin, Jack; Konda, Sanjit; Egol, Kenneth A

2018-05-28

Analyze the effectiveness of a BPCI (Bundle Payments for Care Improvement) initiative for patients who would be included in a future potential Surgical Hip and Femur Fracture Treatment (SHFFT) bundle. Retrospective cohort SETTING:: Single Academic Institution PATIENTS/PARTICIPANTS:: Patients discharged with operative fixation of a hip or femur fracture (DRG codes 480-482) between 1/2015-10/2016 were included. A BPCI initiative based upon an established program for BPCI Total Joint Arthroplasty (TJA) was initiated for patients with hip and femur fractures in January 2016. Patients were divided into non-bundle (care before initiative) and bundle (care with initiative) cohorts. Application of BPCI principles MAIN OUTCOME MEASURES:: Length of stay, location of discharge, readmissions RESULTS:: 116 patients participated in the "institutional bundle," and 126 received care prior to the initiative. There was a trend towards decreased mean length of stay, (7.3 ± 6.3 days vs. 6.8 ± 4.0 days, p=0.457) and decreased readmission within 90 days (22.2% vs. 18.1%, p=0.426). The number of patients discharged home doubled (30.2% vs. 14.3%, p=0.008). There was no difference in readmission rates in bundle vs. non-bundle patients based on discharged home status; however, bundle patients discharged to SNF trended towards less readmissions than non-bundle patients discharged to SNF (37.3% vs. 50.6%, p=0.402). Mean episode cost reduction due to initiative was estimated to be $6,450 using Medicare reimbursement data. This study demonstrates the potential success of a BPCI initiative at one institution in decreasing post-acute care facility utilization and cost of care when used for a hip and femur fracture population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Virologic outcomes in early antiretroviral treatment: HPTN 052

PubMed Central

Eshleman, Susan H.; Wilson, Ethan A.; Zhang, Xinyi C.; Ou, San-San; Piwowar-Manning, Estelle; Eron, Joseph J.; McCauley, Marybeth; Gamble, Theresa; Gallant, Joel E.; Hosseinipour, Mina C.; Kumarasamy, Nagalingeswaran; Hakim, James G.; Kalonga, Ben; Pilotto, Jose H.; Grinsztejn, Beatriz; Godbole, Sheela V.; Chotirosniramit, Nuntisa; Santos, Breno Riegel; Shava, Emily; Mills, Lisa A.; Panchia, Ravindre; Mwelase, Noluthando; Mayer, Kenneth H.; Chen, Ying Q.; Cohen, Myron S.; Fogel, Jessica M.

2017-01-01

INTRODUCTION The HPTN 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. OBJECTIVE To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. METHODS 1,566 participants who had a viral load (VL) >400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350–550 cells/mm3 at ART initiation) and 734 in the delayed ART arm (204 with a CD4 <250 cells/mm3 at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs >1,000 copies/mL >24 weeks after ART initiation. RESULTS Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by 3 months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. CONCLUSIONS Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention. PMID:28385131

Construction and Initial Tests of MAIZE: 1 MA LTD-Driven Z-Pinch *

NASA Astrophysics Data System (ADS)

Gilgenbach, R. M.; Gomez, M. R.; Zier, J. C.; Tang, W.; French, D. M.; Lau, Y. Y.; Mazarakis, M. G.; Cuneo, M. E.; Johnston, M. D.; Oliver, B. V.; Mehlhorn, T. A.; Kim, A. A.; Sinebryukhov, V. A.

2008-11-01

We report construction and initial testing of a 1-MA Linear Transformer Driver (LTD), The Michigan Accelerator for Inductive Z-pinch Experiments, (MAIZE). This machine, the first of its type to reach the USA, is based on the joint HCEI, Sandia Laboratories, and UM development effort. The compact LTD uses 80 capacitors and 40 spark gap switches, in 40 ``bricks'', to deliver 1 MA, 100 kV pulses with 70 ns risetime into a matched resistive load. Test results will be presented for a single brick and the full LTD. Design and construction will be presented of a low-inductance MITL. Experimental research programs under design and construction at UM include: a) Studies of Magneto-Raleigh-Taylor Instability of planar foils, and b) Vacuum convolute studies including cathode and anode plasma. Theory and simulation results will be presented for these planned experiments. Initial experimental designs and moderate-current feasibility experiments will be discussed. *Research supported by U. S. DoE through Sandia National Laboratories award document numbers 240985, 768225, 790791 and 805234 to the UM. MRG supported by NNSA Fellowship and JCZ supported by NPSC Fellowship / Sandia National Labs.

Initial photoinduced dynamics of the photoactive yellow protein.

PubMed

Larsen, Delmar S; van Grondelle, Rienk

2005-05-01

The photoactive yellow protein (PYP) is the photoreceptor protein responsible for initiating the blue-light repellent response of the Halorhodospira halophila bacterium. Optical excitation of the intrinsic chromophore in PYP, p-coumaric acid, leads to the initiation of a photocycle that comprises several distinct intermediates. The dynamical processes responsible for the initiation of the PYP photocycle have been explored with several time-resolved techniques, which include ultrafast electronic and vibrational spectroscopies. Ultrafast electronic spectroscopies, such as pump-visible probe, pump-dump-visible probe, and fluorescence upconversion, are useful in identifying the timescales and connectivity of the transient intermediates, while ultrafast vibrational spectroscopies link these intermediates to dynamic structures. Herein, we present the use of these techniques for exploring the initial dynamics of PYP, and show how these techniques provide the basis for understanding the complex relationship between protein and chromophore, which ultimately results in biological function.

Vulnerability to Peer Influence: A Moderated Mediation Study of Early Adolescent Alcohol Use Initiation

PubMed Central

Trucco, Elisa M.; Colder, Craig R.; Wieczorek, William F.

2011-01-01

Affiliation with deviant peers is a correlate of adolescent alcohol use; however, the mechanism accounting for this association remains unclear, particularly with respect to initiation of alcohol use in early adolescence. This prospective study examines perceived peer attitudes and use as a mediator between peer delinquency and initiation of alcohol use, and how parenting may moderate vulnerability to this risk pathway. Participants included 371 11–13 year-old adolescents (55.5% female, 83.0% Caucasian). Results suggested that high levels of peer delinquency prospectively predicted perceived peer approval and use of alcohol and that peer approval and use of alcohol prospectively predicted initiation of alcohol use. Thus, reinforcement and modeling alcohol use appear to be important mechanisms by which delinquent peers influence the initiation of drinking. There was no support for parental warmth or control as moderators of peer influence. PMID:21420241

Crew and Thermal Systems Division Strategic Communications Initiatives in Support of NASA's Strategic Goals: Fiscal Year 2012 Summary and Initial Fiscal Year 2013 Metrics

NASA Technical Reports Server (NTRS)

Paul, Heather L.

2013-01-01

The NASA strategic plan includes overarching strategies to inspire students through interactions with NASA people and projects, and to expand partnerships with industry and academia around the world. The NASA Johnson Space Center Crew and Thermal Systems Division (CTSD) actively supports these NASA initiatives. At the end of fiscal year 2011, CTSD created a strategic communications team to communicate CTSD capabilities, technologies, and personnel to internal NASA and external technical audiences for collaborative and business development initiatives, and to students, educators, and the general public for education and public outreach efforts. The strategic communications initiatives implemented in fiscal year 2012 resulted in 707 in-reach, outreach, and commercialization events with 39,731 participant interactions. This paper summarizes the CTSD Strategic Communications metrics for fiscal year 2012 and provides metrics for the first nine months of fiscal year 2013.

The Role for Community-Based Participatory Research in Formulating Policy Initiatives: Promoting Safety and Health for In-Home Care Workers and Their Consumers

PubMed Central

Gong, Fang; Ayala, Linda; Stock, Laura; McDevitt, Susannah; Heaney, Cathy

2009-01-01

Although community-based participatory research (CBPR) can be effective in influencing policy, the process of formulating policy initiatives through CBPR is understudied. We describe a case study to illustrate how alliances among various community partners could be united to formulate policy directions. In collaboration with partners, the National Institute for Occupational Safety and Health initiated a project aimed at improving health and safety for low-income elderly and disabled persons and their in-home care workers. Community partners and stakeholders participated in focus groups, stakeholder interviews, and meetings; they played multiple roles including identifying organizational policy changes the partners could initiate immediately, as well as broader public policy goals. Results indicated that a strong community partnership, participation, and shared values contributed to successful formulation of policy initiatives. PMID:19890153

Temperature requirements for initiation of RNA-dependent RNA polymerization.

PubMed

Yang, Hongyan; Gottlieb, Paul; Wei, Hui; Bamford, Dennis H; Makeyev, Eugene V

2003-09-30

To continue the molecular characterization of RNA-dependent RNA polymerases of dsRNA bacteriophages (Cystoviridae), we purified and biochemically characterized the wild-type (wt) and a temperature-sensitive (ts) point mutant of the polymerase subunit (Pol) from bacteriophage phi12. Interestingly, initiation by both wt and the ts phi12 Pol was notably more sensitive to increased temperatures than the elongation step, the absolute value of the nonpermissive temperature being lower for the ts enzyme. Experiments with the Pol subunit of related cystovirus phi6 revealed a similar differential sensitivity of the initiation and elongation steps. This is consistent with the previous result showing that de novo initiation by RdRp from dengue virus is inhibited at elevated temperatures, whereas the elongation phase is relatively thermostable. Overall, these data suggest that de novo RNA-dependent RNA synthesis in many viral systems includes a specialized thermolabile state of the RdRp initiation complex.

Tailoring the Systems Engineering Technical Review Implementation Within Naval Acquisition

DTIC Science & Technology

2017-09-01

additional feedback regarding SETR implementations. Free Text N/A 40 B. SURVEY DATA (1) Question 1 Figure 12 provides the results to the initial...instruction. The complete set of responses provided in the free text field—”Other (please specify)”—are included in Appendix B. Figure 13. Question 2...provided in the free text field— ”Other (please specify)”—are included in Appendix B. Figure 14. Question 3 Survey Results 43 (4) Question 4

Retrospective Analysis of Dose Titration and Serum Testosterone Level Assessments in Patients Treated With Topical Testosterone.

PubMed

Muram, David; Kaltenboeck, Anna; Boytsov, Natalie; Hayes-Larson, Eleanor; Ivanova, Jasmina; Birnbaum, Howard G; Swindle, Ralph

2015-11-01

Patterns of care following topical testosterone agent (TTA) initiation are poorly understood. This study aimed to characterize care following TTA initiation and compare results between patients with and without a serum testosterone (T) assay within 30 days before and including TTA initiation. Adult men (N=4,146) initiating TTAs from January 1, 2011, to March 31, 2012, were identified from a commercially insured database. Patients were included if they initiated at recommended starting dose (RSD) and had ≥12 and ≥6 months of continuous eligibility preinitiation (baseline) and postinitiation (study period), respectively. Patients were stratified by preinitiation T assay. Maintenance dose attainment month was determined using unadjusted generalized estimating equations regression to compare dose relative to RSD month by month. Outcomes included maintenance dose attainment month, time to stopping of index TTA refills or a claim for nonindex testosterone replacement therapy (TRT), and proportion of patients with study period T assay or diagnosis of hypogonadism (HG) or another low testosterone condition, and were compared using chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Maintenance dose was attained in Month 4 postinitiation, at 115.2% of RSD. Approximately 46% of patients had a preinitiation T assay; these men were more likely to receive a diagnosis of HG or another low testosterone condition, to have a follow-up T assay, to continue treatment by filling a nonindex TRT, and less likely to stop refilling treatment with their index TTA. Differences in care following TTA initiation suggest that preinitiation T assays (i.e., guideline-based care) may be helpful in ensuring treatment benefits. © The Author(s) 2014.

Surface Complexation Modeling of Fluoride Adsorption by Soil and the Role of Dissolved Aluminum on Adsorption

NASA Astrophysics Data System (ADS)

Padhi, S.; Tokunaga, T.

2017-12-01

Adsorption of fluoride (F) on soil can control the mobility of F and subsequent contamination of groundwater. Hence, accurate evaluation of adsorption equilibrium is a prerequisite for understanding transport and fate of F in the subsurface. While there have been studies for the adsorption behavior of F with respect to single mineral constituents based on surface complexation models (SCM), F adsorption to natural soil in the presence of complexing agents needs much investigation. We evaluated the adsorption processes of F on a natural granitic soil from Tsukuba, Japan, as a function of initial F concentration, ionic strength, and initial pH. A SCM was developed to model F adsorption behavior. Four possible surface complexation reactions were postulated with and without including dissolved aluminum (Al) and Al-F complex sorption. Decrease in F adsorption with the increase in initial pH was observed in between the initial pH range of 4 to 9, and a decrease in the rate of the reduction of adsorbed F with respect to the increase in the initial pH was observed in the initial pH range of 5 to 7. Ionic strength variation in the range of 0 to 100mM had insignificant effect on F removal. Changes in solution pH were observed by comparing the solution before and after F adsorption experiments. At acidic pH, the solution pH increased, whereas at alkaline pH, the solution pH decreased after equilibrium. The SCM including dissolved Al and the adsorption of Al-F complex can simulate the experimental results quite successfully. Also, including dissolved Al and the adsorption of Al-F complex to the model explained the change in solution pH after F adsorption.

Investigating the Influence of the Initial Biomass Distribution and Injection Strategies on Biofilm-Mediated Calcite Precipitation in Porous Media

DOE PAGES

Hommel, Johannes; Lauchnor, Ellen; Gerlach, Robin; ...

2015-12-16

Attachment of bacteria in porous media is a complex mixture of processes resulting in the transfer and immobilization of suspended cells onto a solid surface within the porous medium. However, quantifying the rate of attachment is difficult due to the many simultaneous processes possibly involved in attachment, including straining, sorption, and sedimentation, and the difficulties in measuring metabolically active cells attached to porous media. Preliminary experiments confirmed the difficulty associated with measuring active Sporosarcina pasteurii cells attached to porous media. However, attachment is a key process in applications of biofilm-mediated reactions in the subsurface such as microbially induced calcite precipitation.more » Independent of the exact processes involved, attachment determines both the distribution and the initial amount of attached biomass and as such the initial reaction rate. As direct experimental investigations are difficult, this study is limited to a numerical investigation of the effect of various initial biomass distributions and initial amounts of attached biomass. This is performed for various injection strategies, changing the injection rate as well as alternating between continuous and pulsed injections. The results of this study indicate that, for the selected scenarios, both the initial amount and the distribution of attached biomass have minor influence on the Ca 2+ precipitation efficiency as well as the distribution of the precipitates compared to the influence of the injection strategy. The influence of the initial biomass distribution on the resulting final distribution of the precipitated calcite is limited, except for the continuous injection at intermediate injection rate. But even for this injection strategy, the Ca 2+ precipitation efficiency shows no significant dependence on the initial biomass distribution.« less

Investigating the Influence of the Initial Biomass Distribution and Injection Strategies on Biofilm-Mediated Calcite Precipitation in Porous Media

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

Hommel, Johannes; Lauchnor, Ellen; Gerlach, Robin

Attachment of bacteria in porous media is a complex mixture of processes resulting in the transfer and immobilization of suspended cells onto a solid surface within the porous medium. However, quantifying the rate of attachment is difficult due to the many simultaneous processes possibly involved in attachment, including straining, sorption, and sedimentation, and the difficulties in measuring metabolically active cells attached to porous media. Preliminary experiments confirmed the difficulty associated with measuring active Sporosarcina pasteurii cells attached to porous media. However, attachment is a key process in applications of biofilm-mediated reactions in the subsurface such as microbially induced calcite precipitation.more » Independent of the exact processes involved, attachment determines both the distribution and the initial amount of attached biomass and as such the initial reaction rate. As direct experimental investigations are difficult, this study is limited to a numerical investigation of the effect of various initial biomass distributions and initial amounts of attached biomass. This is performed for various injection strategies, changing the injection rate as well as alternating between continuous and pulsed injections. The results of this study indicate that, for the selected scenarios, both the initial amount and the distribution of attached biomass have minor influence on the Ca 2+ precipitation efficiency as well as the distribution of the precipitates compared to the influence of the injection strategy. The influence of the initial biomass distribution on the resulting final distribution of the precipitated calcite is limited, except for the continuous injection at intermediate injection rate. But even for this injection strategy, the Ca 2+ precipitation efficiency shows no significant dependence on the initial biomass distribution.« less

Pilot study evaluating the feasibility and initial outcomes of a primary care weight loss intervention with peer coaches.

PubMed

Dutton, Gareth R; Phillips, Janice M; Kukkamalla, Meghana; Cherrington, Andrea L; Safford, Monika M

2015-06-01

The purpose of this single-group pilot study was to evaluate the feasibility, acceptability, and initial outcomes of a novel approach to delivering weight loss treatment in primary care using peer coaches and targeting predominantly African American patients with diabetes or prediabetes. Participants (N = 33) were recruited from a family medicine practice for a 6-month lifestyle intervention. Eligible patients were obese adults (body mass index [BMI] ≥30 kg/m(2)) with ≥1 additional cardiometabolic risk factor(s), including (1) elevated hemoglobin A1C or diagnosed diabetes, (2) elevated blood pressure, (3) elevated triglycerides, and/or (4) low high-density lipoprotein. The intervention included a combination of 12 group-based office visits with health professionals plus 12 individual phone contacts with peer coaches. Outcomes included weight loss, program adherence, and program satisfaction. Participants (mean age = 56 ± 10 years; BMI = 42.9 ± 11.0 kg/m(2)) were predominantly female (88%) and African American (85%). Treatment resulted in a significant mean weight loss of -4.5 ± 7.2 kg, and approximately 27% of participants lost ≥5% of their initial body weight. Participants completed approximately 50% of the group visits and 40% of the telephone calls with peer coaches. Participants rated both components of the intervention favorably. Results of this pilot study indicated that a primary care weight management program including group-based visits and peer-delivered telephone contacts achieved significant weight loss among predominantly African American patients with weight-related comorbidities, including diabetes and prediabetes. Additional research is needed to examine the long-term outcomes of this novel approach and to identify program components supporting patients' success. © 2015 The Author(s).

Low-melting elemental metal or fusible alloy encapsulated polymerization initiator for delayed initiation

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

Hermes, Robert E.

2017-08-15

An encapsulated composition for polymerization includes an initiator composition for initiating a polymerization reaction, and a capsule prepared from an elemental metal or fusible alloy having a melting temperature from about 20.degree. C. to about 200.degree. C. A fluid for polymerization includes the encapsulated composition and a monomer. When the capsule melts or breaks open, the initiator is released.

Hormone replacement therapy: short-term versus long-term use.

PubMed

Rousseau, Mary Ellen

2002-01-01

Midwives manage health care of women throughout the life cycle including prescribing hormone replacement therapy (HRT). This article presents a history of research on the use of HRT, as well as risks and benefits. Older research on the effects of HRT on heart disease, osteoporosis, and breast cancer is included. The results and recommendations of the Women's Health Initiative are examined.

Development of a CFD Code for Analysis of Fluid Dynamic Forces in Seals

NASA Technical Reports Server (NTRS)

Athavale, Mahesh M.; Przekwas, Andrzej J.; Singhal, Ashok K.

1991-01-01

The aim is to develop a 3-D computational fluid dynamics (CFD) code for the analysis of fluid flow in cylindrical seals and evaluation of the dynamic forces on the seals. This code is expected to serve as a scientific tool for detailed flow analysis as well as a check for the accuracy of the 2D industrial codes. The features necessary in the CFD code are outlined. The initial focus was to develop or modify and implement new techniques and physical models. These include collocated grid formulation, rotating coordinate frames and moving grid formulation. Other advanced numerical techniques include higher order spatial and temporal differencing and an efficient linear equation solver. These techniques were implemented in a 2D flow solver for initial testing. Several benchmark test cases were computed using the 2D code, and the results of these were compared to analytical solutions or experimental data to check the accuracy. Tests presented here include planar wedge flow, flow due to an enclosed rotor, and flow in a 2D seal with a whirling rotor. Comparisons between numerical and experimental results for an annular seal and a 7-cavity labyrinth seal are also included.

Development of countermeasures for use in space missions. [to adaptive response to space flight

NASA Technical Reports Server (NTRS)

Nicogossian, A. E. T.; Pool, S.; Huntoon, C. S. L.; Leonard, J. I.

1985-01-01

Several measures used to mitigate the inappropriate adaptive responses of space flight are investigated. Weighlessness results in a cephalic fluid shift, which causes a reduction in the circulating blood volume, and removal of weight bearing forces from musculoskeletal systems. The physiological changes that occur from one-g initiated hypovolemia and zero-g initiated fluild shifts are analyzed and compared. The role of barorecptors on the activation of the adrenergic responses that occurs as a result of hypovolemia is studied. The proper selection and administration of in-flight and post flight countermeasures, which include passive and active physical conditioning techniques, drugs, and vitamins are examined.

Compressive Neuropathy of the Ulnar Nerve: A Perspective on History and Current Controversies.

PubMed

Eberlin, Kyle R; Marjoua, Youssra; Jupiter, Jesse B

2017-06-01

The untoward effects resulting from compression of the ulnar nerve have been recognized for almost 2 centuries. Initial treatment of cubital tunnel syndrome focused on complete transection of the nerve at the level of the elbow, resulting in initial alleviation of pain but significant functional morbidity. A number of subsequent techniques have been described including in situ decompression, subcutaneous transposition, submuscular transposition, and most recently, endoscopic release. This manuscript focuses on the historical aspects of each of these treatments and our current understanding of their efficacy. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Revision of the International Pharmaceutical Federation's Basel Statements on the future of hospital pharmacy: From Basel to Bangkok.

PubMed

Vermeulen, Lee C; Moles, Rebekah J; Collins, Jack C; Gray, Andy; Sheikh, Abdul Latif; Surugue, Jacqueline; Moss, Robert J; Ivey, Marianne F; Stevenson, James G; Takeda, Yasuo; Ranjit, Eurek; Chaar, Betty; Penm, Jonathan

2016-07-15

The processes used to revise the 2008 Basel Statements on the future of hospital pharmacy are summarized, and the revised statements are presented. The process for revising the Basel Statements followed an approach similar to that used during their initial development. The Hospital Pharmacy Section (HPS) of the International Pharmaceutical Federation (FIP) revised the 2008 FIP Basel Statements in four phases, including a survey of hospital pharmacists worldwide, an internal review, online forums, and a face-to-face "World Café" workshop in Bangkok, Thailand. The global survey on the initial Basel Statements included input from 334 respondents from 62 countries. The majority of respondents agreed that most of the initial Basel Statements were acceptable as written and did not require revision. In total, 11 statements were judged by more than 10% of respondents as needing revision or deletion. The FIP HPS executive committee used the survey results to develop 69 initial revised draft statements. After an online discussion with the international hospital pharmacy community, including individuals from 28 countries representing all six World Health Organization regions, a final set of draft statements was prepared for the live discussion involving participants from 20 countries. The final 65 revised Basel Statements were voted on and accepted. Systematic revision of the FIP Basel Statements resulted in an updated reflection of aspirational goals for the future of hospital pharmacy practice. While this revision reflects the development of new goals for hospital pharmacy practice, the core principles of the Basel Statements remain an essential foundation for the discipline. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Evaluative reports on medical malpractice policies in obstetrics: a rapid scoping review.

PubMed

Cardoso, Roberta; Zarin, Wasifa; Nincic, Vera; Barber, Sarah Louise; Gulmezoglu, Ahmet Metin; Wilson, Charlotte; Wilson, Katherine; McDonald, Heather; Kenny, Meghan; Warren, Rachel; Straus, Sharon E; Tricco, Andrea C

2017-09-06

The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary.

Simulation Study on Jet Formability and Damage Characteristics of a Low-Density Material Liner

PubMed Central

Tang, Wenhui; Ran, Xianwen

2018-01-01

The shaped charge tandem warhead is an effective weapon against the ERA (explosive reactive armor). Whether the pre-warhead can reliably initiate the ERA directly determines the entire performance of the tandem warhead. The existing shaped charge pre-warhead mostly adopts a metal shaped jet, which effectively initiates the ERA, but interferes the main shaped jet. This article, on the other hand, explores the possibility of producing a pre-warhead using a low-density material as the liner. The nonlinear dynamic analysis software Autodyn-2D is used to simulate and compare three kinds of low-density shaped jets, including floatglass, Lucite, and Plexiglas, to the copper shaped jet in the effectiveness of impacting ERA. Based on the integrative criteria (including u-d initiation criterion, explosive reactive degree, explosive pressure, and particle velocity of the panels), it can be determined whether the low-density shaped jet can reliably initiate the sandwich charge. The results show that the three kinds of low-density shaped jets can not only initiate the reaction armor, but are also superior to the existing copper shaped jet in ductility, jet tip velocity, jet tip diameter, and the mass; namely, it is feasible to use the low-density material shaped jet to destroy the ERA. PMID:29300351

Assessing personal initiative among vocational training students: development and validation of a new measure.

PubMed

Balluerka, Nekane; Gorostiaga, Arantxa; Ulacia, Imanol

2014-11-14

Personal initiative characterizes people who are proactive, persistent and self-starting when facing the difficulties that arise in achieving goals. Despite its importance in the educational field there is a scarcity of measures to assess students' personal initiative. Thus, the aim of the present study was to develop a questionnaire to assess this variable in the academic environment and to validate it for adolescents and young adults. The sample comprised 244 vocational training students. The questionnaire showed a factor structure including three factors (Proactivity-Prosocial behavior, Persistence and Self-Starting) with acceptable indices of internal consistency (ranging between α = .57 and α =.73) and good convergent validity with respect to the Self-Reported Initiative scale. Evidence of external validity was also obtained based on the relationships between personal initiative and variables such as self-efficacy, enterprising attitude, responsibility and control aspirations, conscientiousness, and academic achievement. The results indicate that this new measure is very useful for assessing personal initiative among vocational training students.

Compression of thick laminated composite beams with initial impact-like damage

NASA Technical Reports Server (NTRS)

Breivik, N. L.; Guerdal, Z.; Griffin, O. H., Jr.

1992-01-01

While the study of compression after impact of laminated composites has been under consideration for many years, the complexity of the damage initiated by low velocity impact has not lent itself to simple predictive models for compression strength. The damage modes due to non-penetrating, low velocity impact by large diameter objects can be simulated using quasi-static three-point bending. The resulting damage modes are less coupled and more easily characterized than actual impact damage modes. This study includes the compression testing of specimens with well documented initial damage states obtained from three-point bend testing. Compression strengths and failure modes were obtained for quasi-isotropic stacking sequences from 0.24 to 1.1 inches thick with both grouped and interspersed ply stacking. Initial damage prior to compression testing was divided into four classifications based on the type, extent, and location of the damage. These classifications are multiple through-thickness delaminations, isolated delamination, damage near the surface, and matrix cracks. Specimens from each classification were compared to specimens tested without initial damage in order to determine the effects of the initial damage on the final compression strength and failure modes. A finite element analysis was used to aid in the understanding and explanation of the experimental results.

[Reasons for not initating HCV treatment in prison: a subanalysis of the EPIBAND study].

PubMed

de Juan, J; Faraco, I; Saiz de la Hoya, P; Marco, A; Yllobre, C; Da Silva, A; del Pozo, E; Veiras, F M

2011-01-01

This sub-analysis was designed within the framework of the EPIBAND study to establish the reasons why prison patients do not initiate HCV treatment. Epidemiological, prospective, multicentre study conducted in 26 centres. We present the results from those patients included in the EPIBAND study who did not initiate HCV treatment for different reasons. A total of 195 patients were evaluated (average age 39 ± 6.6 years, 86.7% male and 96.9% Spanish nationality). The reasons why this population did not initiate HCV treatment were secondary ones relating to the patient (41%), medical reasons (30.8%), and the prison environment (3.6%). 47.5% of patients reported lack of awareness and motivation, and 18.8% did not initiate treatment as a result of adverse events. Immunological status (35%). as well as psychiatric and neurological disorders (28.3%) were the main medical reasons for contraindication. Aspects associated to prison environment such as impending release or change of prison (64.4%) were among the various reasons that influenced treatment initiation. Lack of motivation and awareness in patients as well as adverse events were the main reasons for not initiating therapy. These factors are subjective, modifiable aspects that depend on patient education and adequate medical care.

Missouri's forest resources in 2004

Treesearch

W. Keith Moser; Mark H. Hansen; Thomas Treiman; Bruce Moltzan; Robert Lawrence; Gary J. Brand

2006-01-01

Reports the initial results of five annual panels (2000-2004) of the inventory of Missouri's forest resources and one panel (2004) of growth, removals, and mortality. Includes information on forest area, number of trees, volume, biomass, growth, removals, mortality, and forest health.

Missouri's forest resources in 2003

Treesearch

W. Keith; Moser; Treiman, Thomas Treiman, Thomas; Bruce Moltzan; Robert Lawrence; Gary J. Brand; Gary J. Brand

2005-01-01

Reports the initial results of all five annual panels (1999-2003) of the fifth inventory of Missouri`s forest resources, the first annual inventory of the State. Includes information on forest area; volume; biomass; growth, removals, and mortality; and forest health.

Indiana's forest resources in 2004

Treesearch

Christopher Woodall; Gary Brand; Joey Gallion

2006-01-01

Reports the initial results of five annual panels (2000-2004) of the inventory of Indiana's forest resources and one panel (2004) of growth, removals, and mortality. Includes information on forest area, number of trees, volume, biomass, growth, removals, mortality, and forest health.

Particle Tracking on the BNL Relativistic Heavy Ion Collider

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

Dell, G. F.

1986-08-07

Tracking studies including the effects of random multipole errors as well as the effects of random and systematic multipole errors have been made for RHIC. Initial results for operating at an off diagonal working point are discussed.

Inclusion of Highest Glasgow Coma Scale Motor Component Score in Mortality Risk Adjustment for Benchmarking of Trauma Center Performance.

PubMed

Gomez, David; Byrne, James P; Alali, Aziz S; Xiong, Wei; Hoeft, Chris; Neal, Melanie; Subacius, Harris; Nathens, Avery B

2017-12-01

The Glasgow Coma Scale (GCS) is the most widely used measure of traumatic brain injury (TBI) severity. Currently, the arrival GCS motor component (mGCS) score is used in risk-adjustment models for external benchmarking of mortality. However, there is evidence that the highest mGCS score in the first 24 hours after injury might be a better predictor of death. Our objective was to evaluate the impact of including the highest mGCS score on the performance of risk-adjustment models and subsequent external benchmarking results. Data were derived from the Trauma Quality Improvement Program analytic dataset (January 2014 through March 2015) and were limited to the severe TBI cohort (16 years or older, isolated head injury, GCS ≤8). Risk-adjustment models were created that varied in the mGCS covariates only (initial score, highest score, or both initial and highest mGCS scores). Model performance and fit, as well as external benchmarking results, were compared. There were 6,553 patients with severe TBI across 231 trauma centers included. Initial and highest mGCS scores were different in 47% of patients (n = 3,097). Model performance and fit improved when both initial and highest mGCS scores were included, as evidenced by improved C-statistic, Akaike Information Criterion, and adjusted R-squared values. Three-quarters of centers changed their adjusted odds ratio decile, 2.6% of centers changed outlier status, and 45% of centers exhibited a ≥0.5-SD change in the odds ratio of death after including highest mGCS score in the model. This study supports the concept that additional clinical information has the potential to not only improve the performance of current risk-adjustment models, but can also have a meaningful impact on external benchmarking strategies. Highest mGCS score is a good potential candidate for inclusion in additional models. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Numerical Simulation of Particle Motion in a Curved Channel

NASA Astrophysics Data System (ADS)

Liu, Yi; Nie, Deming

2018-01-01

In this work the lattice Boltzmann method (LBM) is used to numerically study the motion of a circular particle in a curved channel at intermediate Reynolds numbers (Re). The effects of the Reynolds number and the initial particle position are taken into account. Numerical results include the streamlines, particle trajectories and final equilibrium positions. It has been found that the particle is likely to migrate to a similar equilibrium position irrespective of its initial position when Re is large.

Expected Results From Channeling Radiation Experiments at Fast

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

Sen, Tanaji; Broemmelsiek, Daniel; Edstrom, Dean

2016-06-01

The photoinjector at the new Fermilab FAST facility will accelerate electron beams to about 50 GeV. After initial beam commissioning, channeling radiation experiments to generate hard X-rays will be performed. In the initial stage, low bunch charge beams will be used to keep the photon count rate low and avoid pile up in the detector. We report here on the optics solutions, the expected channaling spectrum including background from bremmstrahlung and the use of a Compton scatterer for higher bunch charge operation.

Parallel and orthogonal stimulus in ultradiluted neural networks

NASA Astrophysics Data System (ADS)

Sobral, G. A., Jr.; Vieira, V. M.; Lyra, M. L.; da Silva, C. R.

2006-10-01

Extending a model due to Derrida, Gardner, and Zippelius, we have studied the recognition ability of an extreme and asymmetrically diluted version of the Hopfield model for associative memory by including the effect of a stimulus in the dynamics of the system. We obtain exact results for the dynamic evolution of the average network superposition. The stimulus field was considered as proportional to the overlapping of the state of the system with a particular stimulated pattern. Two situations were analyzed, namely, the external stimulus acting on the initialization pattern (parallel stimulus) and the external stimulus acting on a pattern orthogonal to the initialization one (orthogonal stimulus). In both cases, we obtained the complete phase diagram in the parameter space composed of the stimulus field, thermal noise, and network capacity. Our results show that the system improves its recognition ability for parallel stimulus. For orthogonal stimulus two recognition phases emerge with the system locking at the initialization or stimulated pattern. We confront our analytical results with numerical simulations for the noiseless case T=0 .

Pencil beam characteristics of the next-generation proton scanning gantry of PSI: design issues and initial commissioning results

NASA Astrophysics Data System (ADS)

Pedroni, E.; Meer, D.; Bula, C.; Safai, S.; Zenklusen, S.

2011-07-01

In this paper we report on the main design features, on the realization process and on selected first results of the initial commissioning of the new Gantry 2 of PSI for the delivery of proton therapy with new advanced pencil beam scanning techniques. We present briefly the characteristics of the new gantry system with main emphasis on the beam optics, on the characterization of the pencil beam used for scanning and on the performance of the scanning system. The idea is to give an overview of the major components of the whole system. The main long-term technical goal of the new equipment of Gantry 2 is to expand the use of pencil beam scanning to the whole spectrum of clinical indications including moving targets. We report here on the initial experience and problems encountered in the development of the system with selected preliminary results of the ongoing commissioning of Gantry 2.

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

Sobral, G. A. Jr.; Vieira, V. M.; Lyra, M. L.

Extending a model due to Derrida, Gardner, and Zippelius, we have studied the recognition ability of an extreme and asymmetrically diluted version of the Hopfield model for associative memory by including the effect of a stimulus in the dynamics of the system. We obtain exact results for the dynamic evolution of the average network superposition. The stimulus field was considered as proportional to the overlapping of the state of the system with a particular stimulated pattern. Two situations were analyzed, namely, the external stimulus acting on the initialization pattern (parallel stimulus) and the external stimulus acting on a pattern orthogonalmore » to the initialization one (orthogonal stimulus). In both cases, we obtained the complete phase diagram in the parameter space composed of the stimulus field, thermal noise, and network capacity. Our results show that the system improves its recognition ability for parallel stimulus. For orthogonal stimulus two recognition phases emerge with the system locking at the initialization or stimulated pattern. We confront our analytical results with numerical simulations for the noiseless case T=0.« less

Carpal tunnel syndrome: Investigating the sensitivity of initial-diagnosis with electro-diagnostic tests in 600 cases and associated risk factors especially manual milking.

PubMed

Tunç, Abdulkadir; Güngen, Belma Doğan

2017-01-01

Electro-diagnostic studies are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many risk factors associated with CTS, there are a limited number of studies in the literature indicating that manual milking, which is frequently seen in Turkey, is a risk factor for CTS. The purpose of this study was to evaluate demographic findings of cases referred due to initial diagnosis of CTS as well as aetiological data especially manual milking and to investigate the sensitivity of initial diagnosis of CTS. Six hundred patients, who were referred to our electromyography laboratory due to initial diagnosis of CTS, were included. Demographic findings, duration of complaints, existence of diabetes mellitus, and manual milking histories of all patients were recorded. Sensitivity of initial diagnosis was investigated based on electro-diagnostic test results. According to electro-diagnostic test results, 289 of the patients were diagnosed with CTS (48.17%). 110 (18.3%) of 600 patients had a history of manual milking. In 94 of this group (85.4%), CTS was detected. Statistically significant correlation was found between CTS and age, female gender, duration of complaints, obesity and manual milking. This study confirms that manual milking is an important risk factor for CTS in addition to female gender, age, symptom duration and obesity. The fact that sensitivity of initial diagnosis of CTS was found to be low according to electro-diagnostic test results indicates importance of detailed clinical evaluation.

Effect of heat treatment On Microstructure of steel AISI 01 Tools

NASA Astrophysics Data System (ADS)

Dyanasari Sebayang, Melya; Yudo, Sesmaro Max; Silitonga, Charlie

2018-03-01

This study discusses the influence of quenching, normalizing, and annealing to changes in hardness, tensile, and microstructure of materials tool steel AISI 01 after the material undergo heat treatment process. This heat treatment process includes an initial warming of 600° C and a 5-minute detention time, followed by heating to an austenisation temperature of 850°C. After that a different cooling process, including annealing process, normalizing and quenching oil SAE 40. Tests performed include tensile, hard, and microstructure with shooting using SEM (Scanning Electron Microscope). This is done to see the effect of different heat treatment and cooling process. The result of this research is difference of tensile test value, hard, and micro structure from influence of difference of each process. The quenching process obtains the highest tensile and hard values followed by the normalizing process, annealing, and the lowest is in the starting material, this is because the initial material does not undergo heat treatment process. The resulting microstructure is pearlit and cementite, the difference seen from the shape and size of the grains. The larger the grain size, the greater the hardness.

Factors Associated with Breastfeeding Initiation: A Comparison between France and French-Speaking Canada

PubMed Central

Girard, Lisa-Christine; Côté, Sylvana M.; de Lauzon-Guillain, Blandine; Dubois, Lise; Falissard, Bruno; Forhan, Anne; Doyle, Orla; Bernard, Jonathan Y.; Heude, Barbara; Saurel-Cubizolles, Marie-Josephe; Kaminski, Monique; Boivin, Michel; Tremblay, Richard E.

2016-01-01

Background Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce. Objective The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts. Methods Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation. Results Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having ‘some university’ was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France. Conclusions and Implications for Practice While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors. PMID:27902741

Seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery: selective amygdalohippocampectomy versus anterior temporal lobectomy.

PubMed

Elliott, Cameron A; Broad, Andrew; Narvacan, Karl; Steve, Trevor A; Snyder, Thomas; Urlacher, Jordan; Wheatley, B Matt; Sinclair, D Barry

2018-06-22

OBJECTIVE The aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE). METHODS The authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing. RESULTS A total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1-16 years). The patients' average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher's exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up. CONCLUSIONS SelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.

Cost-effectiveness of lenalidomide plus dexamethasone vs. bortezomib plus melphalan and prednisone in transplant-ineligible U.S. patients with newly-diagnosed multiple myeloma.

PubMed

Usmani, S Z; Cavenagh, J D; Belch, A R; Hulin, C; Basu, S; White, D; Nooka, A; Ervin-Haynes, A; Yiu, W; Nagarwala, Y; Berger, A; Pelligra, C G; Guo, S; Binder, G; Gibson, C J; Facon, T

2016-01-01

To conduct a cost-effectiveness assessment of lenalidomide plus dexamethasone (Rd) vs bortezomib plus melphalan and prednisone (VMP) as initial treatment for transplant-ineligible patients with newly-diagnosed multiple myeloma (MM), from a U.S. payer perspective. A partitioned survival model was developed to estimate expected life-years (LYs), quality-adjusted LYs (QALYs), direct costs and incremental costs per QALY and LY gained associated with use of Rd vs VMP over a patient's lifetime. Information on the efficacy and safety of Rd and VMP was based on data from multinational phase III clinical trials and a network meta-analysis. Pre-progression direct costs included the costs of Rd and VMP, treatment of adverse events (including prophylaxis) and routine care and monitoring associated with MM. Post-progression direct costs included costs of subsequent treatment(s) and routine care and monitoring for progressive disease, all obtained from published literature and estimated from a U.S. payer perspective. Utilities were obtained from the aforementioned trials. Costs and outcomes were discounted at 3% annually. Relative to VMP, use of Rd was expected to result in an additional 2.22 LYs and 1.47 QALYs (discounted). Patients initiated with Rd were expected to incur an additional $78,977 in mean lifetime direct costs (discounted) vs those initiated with VMP. The incremental costs per QALY and per LY gained with Rd vs VMP were $53,826 and $35,552, respectively. In sensitivity analyses, results were found to be most sensitive to differences in survival associated with Rd vs VMP, the cost of lenalidomide and the discount rate applied to effectiveness outcomes. Rd was expected to result in greater LYs and QALYs compared with VMP, with similar overall costs per LY for each regimen. Results of this analysis indicated that Rd may be a cost-effective alternative to VMP as initial treatment for transplant-ineligible patients with MM, with an incremental cost-effectiveness ratio well within the levels for recent advancements in oncology.

Anticipatory Postural Control of Stability during Gait Initiation Over Obstacles of Different Height and Distance Made Under Reaction-Time and Self-Initiated Instructions.

PubMed

Yiou, Eric; Artico, Romain; Teyssedre, Claudine A; Labaune, Ombeline; Fourcade, Paul

2016-01-01

Despite the abundant literature on obstacle crossing in humans, the question of how the central nervous system (CNS) controls postural stability during gait initiation with the goal to clear an obstacle remains unclear. Stabilizing features of gait initiation include anticipatory postural adjustments (APAs) and lateral swing foot placement. To answer the above question, 14 participants initiated gait as fast as possible in three conditions of obstacle height, three conditions of obstacle distance and one obstacle-free (control) condition. Each of these conditions was performed with two levels of temporal pressure: reaction-time (high-pressure) and self-initiated (low-pressure) movements. A mechanical model of the body falling laterally under the influence of gravity and submitted to an elastic restoring force is proposed to assess the effect of initial (foot-off) center-of-mass position and velocity (or "initial center-of-mass set") on the stability at foot-contact. Results showed that the anticipatory peak of mediolateral (ML) center-of-pressure shift, the initial ML center-of-mass velocity and the duration of the swing phase, of gait initiation increased with obstacle height, but not with obstacle distance. These results suggest that ML APAs are scaled with swing duration in order to maintain an equivalent stability across experimental conditions. This statement is strengthened by the results obtained with the mechanical model, which showed how stability would be degraded if there was no adaptation of the initial center-of-mass set to swing duration. The anteroposterior (AP) component of APAs varied also according to obstacle height and distance, but in an opposite way to the ML component. Indeed, results showed that the anticipatory peak of backward center-of-pressure shift and the initial forward center-of-mass set decreased with obstacle height, probably in order to limit the risk to trip over the obstacle, while the forward center-of-mass velocity at foot-off increased with obstacle distance, allowing a further step to be taken. These effects of obstacle height and distance were globally similar under low and high-temporal pressure. Collectively, these findings imply that the CNS is able to predict the potential instability elicited by the obstacle clearance and that it scales the spatiotemporal parameters of APAs accordingly.

Anticipatory Postural Control of Stability during Gait Initiation Over Obstacles of Different Height and Distance Made Under Reaction-Time and Self-Initiated Instructions

PubMed Central

Yiou, Eric; Artico, Romain; Teyssedre, Claudine A.; Labaune, Ombeline; Fourcade, Paul

2016-01-01

Despite the abundant literature on obstacle crossing in humans, the question of how the central nervous system (CNS) controls postural stability during gait initiation with the goal to clear an obstacle remains unclear. Stabilizing features of gait initiation include anticipatory postural adjustments (APAs) and lateral swing foot placement. To answer the above question, 14 participants initiated gait as fast as possible in three conditions of obstacle height, three conditions of obstacle distance and one obstacle-free (control) condition. Each of these conditions was performed with two levels of temporal pressure: reaction-time (high-pressure) and self-initiated (low-pressure) movements. A mechanical model of the body falling laterally under the influence of gravity and submitted to an elastic restoring force is proposed to assess the effect of initial (foot-off) center-of-mass position and velocity (or “initial center-of-mass set”) on the stability at foot-contact. Results showed that the anticipatory peak of mediolateral (ML) center-of-pressure shift, the initial ML center-of-mass velocity and the duration of the swing phase, of gait initiation increased with obstacle height, but not with obstacle distance. These results suggest that ML APAs are scaled with swing duration in order to maintain an equivalent stability across experimental conditions. This statement is strengthened by the results obtained with the mechanical model, which showed how stability would be degraded if there was no adaptation of the initial center-of-mass set to swing duration. The anteroposterior (AP) component of APAs varied also according to obstacle height and distance, but in an opposite way to the ML component. Indeed, results showed that the anticipatory peak of backward center-of-pressure shift and the initial forward center-of-mass set decreased with obstacle height, probably in order to limit the risk to trip over the obstacle, while the forward center-of-mass velocity at foot-off increased with obstacle distance, allowing a further step to be taken. These effects of obstacle height and distance were globally similar under low and high-temporal pressure. Collectively, these findings imply that the CNS is able to predict the potential instability elicited by the obstacle clearance and that it scales the spatiotemporal parameters of APAs accordingly. PMID:27656138

Improving Social Engagement and Initiations between Children with Autism Spectrum Disorder and Their Peers in Inclusive Settings

PubMed Central

Koegel, Lynn Kern; Vernon, Ty; Koegel, Robert L.; Koegel, Brittany L.; Paullin, Anne W.

2013-01-01

Children with Asperger’s Disorder often have difficulty with peer relationships and socialization. The current study assessed whether peer social interactions would improve in school settings if an intervention was designed that incorporated the children with Asperger’s interests. Three children who were fully-included in regular education classes but did not interact with peers prior to intervention participated in this research. Social lunch clubs, open to both the study participants and their typical peers, were implemented twice weekly during regular lunchtime periods. Results showed that all three children increased their time engaged with peers as a result of the clubs. While their initiations greatly improved over baseline levels and approximated their peers, they were often initiating below the level of most of their peers. Implications for improving peer social interactions for children with Asperger’s Disorder are discussed. PMID:25328380

A novel orthoimage mosaic method using the weighted A* algorithm for UAV imagery

NASA Astrophysics Data System (ADS)

Zheng, Maoteng; Zhou, Shunping; Xiong, Xiaodong; Zhu, Junfeng

2017-12-01

A weighted A* algorithm is proposed to select optimal seam-lines in orthoimage mosaic for UAV (Unmanned Aircraft Vehicle) imagery. The whole workflow includes four steps: the initial seam-line network is firstly generated by standard Voronoi Diagram algorithm; an edge diagram is then detected based on DSM (Digital Surface Model) data; the vertices (conjunction nodes) of initial network are relocated since some of them are on the high objects (buildings, trees and other artificial structures); and, the initial seam-lines are finally refined using the weighted A* algorithm based on the edge diagram and the relocated vertices. The method was tested with two real UAV datasets. Preliminary results show that the proposed method produces acceptable mosaic images in both the urban and mountainous areas, and is better than the result of the state-of-the-art methods on the datasets.

Indiana's forest resources in 2005

Treesearch

Christopher Woodall; Gary Brand; Joey Gallion

2006-01-01

Reports the initial results of five annual panels (2001-2005) of the inventory of Indiana's forest resources and two panels (2004 and 2005) of growth, removals, and mortality. Includes information on forest area, number of trees, volume, biomass, growth, removals, mortality, and forest health.

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

Doerr, R.E.

The energy conservation program initiated in 1973 by the Monsanto Corp., its activities, implementation, and results are reviewed. Information is included on program planning, energy accounting, modification of industrial equipment to affect energy savings, waste heat recovery, space heating and cooling, and employee awareness program for energy conservation. (LCL)

Microbial control of the gypsy moth in recently infested states: experiences and expectations

Treesearch

Timothy C. Tigner

1985-01-01

Experiences and expectations concerning microbial control of the gypsy moth in recently infested states are summarized. Initial experience included mixed results, but expectations remain optimistic. Public sentiment assures continued pressure for improvement in microbial control technology.

Multiple degree of freedom optical pattern recognition

NASA Technical Reports Server (NTRS)

Casasent, D.

1987-01-01

Three general optical approaches to multiple degree of freedom object pattern recognition (where no stable object rest position exists) are advanced. These techniques include: feature extraction, correlation, and artificial intelligence. The details of the various processors are advanced together with initial results.

Bayesian analysis of a mastitis control plan to investigate the influence of veterinary prior beliefs on clinical interpretation.

PubMed

Green, M J; Browne, W J; Green, L E; Bradley, A J; Leach, K A; Breen, J E; Medley, G F

2009-10-01

The fundamental objective for health research is to determine whether changes should be made to clinical decisions. Decisions made by veterinary surgeons in the light of new research evidence are known to be influenced by their prior beliefs, especially their initial opinions about the plausibility of possible results. In this paper, clinical trial results for a bovine mastitis control plan were evaluated within a Bayesian context, to incorporate a community of prior distributions that represented a spectrum of clinical prior beliefs. The aim was to quantify the effect of veterinary surgeons' initial viewpoints on the interpretation of the trial results. A Bayesian analysis was conducted using Markov chain Monte Carlo procedures. Stochastic models included a financial cost attributed to a change in clinical mastitis following implementation of the control plan. Prior distributions were incorporated that covered a realistic range of possible clinical viewpoints, including scepticism, enthusiasm and uncertainty. Posterior distributions revealed important differences in the financial gain that clinicians with different starting viewpoints would anticipate from the mastitis control plan, given the actual research results. For example, a severe skeptic would ascribe a probability of 0.50 for a return of < 5 UK pounds per cow in an average herd that implemented the plan, whereas an enthusiast would ascribe this probability for a return of > 20 UK pounds per cow. Simulations using increased trial sizes indicated that if the original study was four times as large, an initial skeptic would be more convinced about the efficacy of the control plan but would still anticipate less financial return than an initial enthusiast would anticipate after the original study. In conclusion, it is possible to estimate how clinicians' prior beliefs influence their interpretation of research evidence. Further research on the extent to which different interpretations of evidence result in changes to clinical practice would be worthwhile.

Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program

ERIC Educational Resources Information Center

Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda

2015-01-01

The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

FIRST RESULTS FROM OPERATIONAL TESTING OF THE U.S. EPA MODELS-3 COMMUNITY MULTISCALE MODEL FOR AIR QUALITY (CMAQ)

EPA Science Inventory

The Models 3 / Community Multiscale Model for Air Quality (CMAQ) has been designed for one-atmosphere assessments for multiple pollutants including ozone (O3), particulate matter (PM10, PM2.5), and acid / nutrient deposition. In this paper we report initial results of our evalu...

The Successful Mobilization of a Campus Community for Student Retention. Report of the University Retention Steering Committee.

ERIC Educational Resources Information Center

Eastern Michigan Univ., Ypsilanti.

Components of a student retention program at Eastern Michigan University are examined; for each effort to improve retention, project objectives and design, results, and recommendations are presented. Retention initiatives, decided upon as a result of a campus-wide mobilization of effort, include: a student-focused orientation system, a fast track…

Is fixed combination therapy appropriate for initial hypertension treatment?

PubMed

Elliott, William J

2002-08-01

Recent clinical trials in hypertension prove how seldom single drug therapy achieves target blood pressure (BP) and reduces cardiovascular morbidity and mortality. A natural response is the testing and marketing of fixed-dose combination products for hypertension, of which 14 have been approved in the United States since 1993. Currently, only five products are indicated by the Food and Drug Administration for initial therapy of hypertension; all include a diuretic. To achieve such an indication, studies must show not only safety and efficacy of the combination, but also BP lowering that is at least additive compared with the two agents given separately, as well as a "synergy" not present when each agent is given alone. Some advantages to initial combination therapy include greater BP reduction, improved adherence to pill taking, fewer side effects, and lower cost. The most likely candidates for initial combination therapy are patients with initial BP higher than 160/100 mm Hg, or those with a BP goal lower than the customary 140/90 mm Hg. These include patients with target organ damage, clinical cardiovascular disease, proteinuria, renal impairment, or diabetes mellitus. In many of these circumstances, an angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist is frequently recommended; adding a diuretic or calcium antagonist to it is much more likely to result in achievement of the BP goal. More research is being done to explore the combination of not only two representatives from classes of conventional agents, but also other drugs that may help address the multiple manifestations of the "metabolic syndrome" that often accompanies hypertension.

LDRD final report :

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

Brost, Randolph C.; McLendon, William Clarence,

2013-01-01

Modeling geospatial information with semantic graphs enables search for sites of interest based on relationships between features, without requiring strong a priori models of feature shape or other intrinsic properties. Geospatial semantic graphs can be constructed from raw sensor data with suitable preprocessing to obtain a discretized representation. This report describes initial work toward extending geospatial semantic graphs to include temporal information, and initial results applying semantic graph techniques to SAR image data. We describe an efficient graph structure that includes geospatial and temporal information, which is designed to support simultaneous spatial and temporal search queries. We also report amore » preliminary implementation of feature recognition, semantic graph modeling, and graph search based on input SAR data. The report concludes with lessons learned and suggestions for future improvements.« less

The Heart of Grinnell: A Community-Wide Rural Health Wellness Initiative: a pilot observational study and a prospective study design.

PubMed

Linden, Todd C; Jackson, Cory; Rutledge, Sheryl; Nath, Chad; Lof, Laura Nelson

2010-01-01

In 2007, the leadership team at Grinnell Regional Medical Center participated in a pilot project with the Institute of HeartMath (IHM) to assess the stress level of individual team members and its effect on the organization. At the beginning of the project, the leadership team completed a Personal and Organizational Quality Assessment (POQA-R). Results showed that a high percentage of the participants were experiencing fatigue, anxiety, difficulty sleeping, and depression. The leadership team participated in a Transforming Stress workshop and began using IHM techniques to deal with the stresses in their personal and professional lives. A 1-month follow up revealed improvement in six of the 10 categories assessed: fatigue, anxiety, depression, anger management, resentfulness, and stress symptoms. Based on this success, GRMC and IHM initiated The Heart of Grinnell: A Community-Wide Rural Health Wellness Initiative to determine if these results could be replicated on a community level. This project is a health and disease promotion, chronic disease prevention, and education wellness initiative. Located in Grinnell and Poweshiek County, Iowa, this initiative is a multicomponent, community-wide intervention that includes Grinnell College, schools, churches, businesses, social service agencies, local government, and Grinnell Regional Medical Center in partnership with IHM and the University of Iowa College of Public Health. At the center of this project is the goal of training community groups on using a scientifically researched program created by the IHM designed to reduce stress and increase coherence. Coherence implies order, structure, harmony, and alignment among systems-whether in cells and organs, entire organisms, or social groups including communities and counties. The primary objective of The Heart of Grinnell project is to measure the results of a community-wide program to increase community coherence and stress reduction in order to improve adherence to positive wellness behaviors; physical biometrics; productivity by reducing absenteeism and improving workplace morale; and coherence in the workplace, schools, homes, and community.

Impact of multiple-dose versus single-dose inhaler devices on COPD patients’ persistence with long-acting β2-agonists: a dispensing database analysis

PubMed Central

van Boven, Job FM; van Raaij, Joost J; van der Galiën, Ruben; Postma, Maarten J; van der Molen, Thys; Dekhuijzen, PN Richard; Vegter, Stefan

2014-01-01

Background: With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients’ persistence with long-acting β2-agonists (LABAs). Aims: To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs. Methods: A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. Results were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities. Results: In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76–1.26, P=0.99). Over 80% re-started or switched medication. Conclusions: There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients’ persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year. PMID:25274453

Mapping of initiatives to increase membership in mutual health organizations in Benin.

PubMed

Turcotte-Tremblay, Anne-Marie; Haddad, Slim; Yacoubou, Ismaïlou; Fournier, Pierre

2012-12-05

Mutual health organizations (MHO) have been implemented across Africa to increase access to healthcare and improve financial protection. Despite efforts to develop MHOs, low levels of both initial enrolment and membership renewals continue to threaten their financial viability. The purpose of this study was to map initiatives implemented to increase the pool of MHO members in Benin. A multiple case study was conducted to assess MHOs supported by five major promoters in Benin. Three months of fieldwork resulted in 23 semi-structured interviews and two focus groups with MHO promoters, technicians, elected members, and health professionals affiliated with the MHOs. Fifteen non-structured interviews provided additional information and a valuable source of triangulation. MHOs have adopted a wide range of initiatives targeting different entry points and involving a variety of stakeholders. Initiatives have included new types of collective health insurance packages and efforts to raise awareness by going door-to-door and organizing health education workshops. Different types of partnerships have been established to strengthen relationships with healthcare professionals and political leaders. However, the selection and implementation of these initiatives have been limited by insufficient financial and human resources. The study highlights the importance of prioritizing sustainable strategies to increase MHO membership. No single MHO initiative has been able to resolve the issue of low membership on its own. If combined, existing initiatives could provide a comprehensive and inclusive approach that would target all entry points and include key stakeholders such as household decision-makers, MHO elected members, healthcare professionals, community leaders, governmental authorities, medical advisors, and promoters. There is a need to evaluate empirically the implementation of these interventions. Mechanisms to promote dialogue between MHO stakeholders would be useful to devise innovative strategies, avoid repeating unsuccessful ones, and develop a coordinated plan to promote MHOs.

Developing a Long-term Monitoring Program with Undergraduate Students in Marine Sciences

NASA Astrophysics Data System (ADS)

Anders, T. M.; Boryta, M. D.

2015-12-01

A goal of our growing marine geoscience program at Mt. San Antonio College is to involve our students in all stages of developing and running an undergraduate research project. During the initial planning phase, students develop and test their proposals. Instructor-set parameters were chosen carefully to help guide students toward manageable projects but to not limit their creativity. Projects should focus on long-term monitoring of a coastal area in southern California. During the second phase, incoming students will critique the initial proposals, modify as necessary and continue to develop the project. We intend for data collection opportunities to grow from geological and oceanographic bases to eventually include other STEM topics in biology, chemistry, math and GIS. Questions we will address include: What makes this a good research project for a community college? What are the costs and time commitments involved? How will the project benefit students and society? Additionally we will share our initial results, challenges, and unexpected pitfalls and benefits.

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.

Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania.

PubMed

Peltzer, Karl; Pengpid, Supa

2015-09-30

This study aimed to investigate the correlations between early initiation (<12 years) of smoking cigarettes, alcohol use, and drug use (cannabis) with suicidal ideation and suicide attempts in school-aged adolescents in four Pacific Island countries in Oceania. The sample included 6540 adolescents (≤13 to ≥16 years old) from Kiribati, Samoa, Solomon Islands, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the association between pre-adolescent substance use initiation and suicidal ideation and suicide attempts. Results indicate a prevalence of 25.8% suicidal ideation in the past 12 months (ranging from 17.2% in Vanuatu to 34.7% in Kiribati) and 34.9% suicide attempts in the past 12 months (ranging from 23.5% in Vanuatu to 62.0% in Samoa). The prevalence of early cigarette smoking initiation was 15.7%, early alcohol initiation 13.8%, and early drug use initiation was 12.9%. Students who reported pre-adolescent substance use initiation, compared with non-substance users, were more likely reporting suicidal ideation and suicide attempts. The concurrent initiation of cigarette smoking, alcohol, and drug use should be targeted in early prevention programmes in order to prevent possible subsequent suicidal behaviours.

Oleic Acid enhances all-trans retinoic Acid loading in nano-lipid emulsions.

PubMed

Chinsriwongkul, Akhayachatra; Opanasopit, Praneet; Ngawhirunpat, Tanasait; Rojanarata, Theerasak; Sila-On, Warisada; Ruktanonchai, Uracha

2010-01-01

The aim of this study was to investigate the enhancement of all-trans retinoic acid (ATRA) loading in nano-lipid emulsions and stability by using oleic acid. The effect of formulation factors including initial ATRA concentration and the type of oil on the physicochemical properties, that is, percentage yield, percentage drug release, and photostability of formulations, was determined. The solubility of ATRA was increased in the order of oleic acid > MCT > soybean oil > water. The physicochemical properties of ATRA-loaded lipid emulsion, including mean particle diameter and zeta potential, were modulated by changing an initial ATRA concentration as well as the type and mixing ratio of oil and oleic acid as an oil phase. The particles of lipid emulsions had average sizes of less than 250 nm and negative zeta potential. The addition of oleic acid in lipid emulsions resulted in high loading capacity. The photodegradation rate was found to be dependent on the initial drug concentration but independent of the type of oily phase used in this study. The release rates were not affected by initial ATRA concentration but were affected by the type of oil, where oleic acid showed the highest release rate of ATRA from lipid emulsions.

Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity.

PubMed

Wojcicki, Janet M

2013-06-01

While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these initiatives should focus on banning sugar sweetened beverages, including sodas, 100% fruit juice and sports drinks, from hospital cafeterias and vending machines instead of limiting their presence, so as to ensure the success of these programs in reducing the prevalence of childhood obesity. If US hospitals comprehensively remove sugar sweetened beverages from their cafeterias and vending machines, these programs could subsequently become a model for efforts to address childhood obesity in other areas of the world. Hospitals should be a model for health care reform in their communities and removing sugar sweetened beverages is a necessary first step. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women

PubMed Central

Reimers, Laura L.; Sotardi, Susan; Daniel, David; Chiu, Lydia G.; Arsdale, Anne Van; Wieland, Daryl L.; Leider, Jason M.; Xue, Xiaonan; Strickler, Howard D.; Garry, David J.; Goldberg, Gary L.; Einstein, Mark H.

2011-01-01

Objective To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15–2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95% CI: 1.55–7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95% CI: 1.90–19.73). Conclusions Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population. PMID:20605046

Assessing Landslide Mobility Using GIS: Application to Kosrae, Micronesia

NASA Astrophysics Data System (ADS)

Reid, M. E.; Brien, D. L.; Godt, J.; Schmitt, R. G.; Harp, E. L.

2015-12-01

Deadly landslides are often mobile landslides, as exemplified by the disastrous landslide that occurred near Oso, Washington in 2014 killing 43. Despite this association, many landslide susceptibility maps do not identify runout areas. We developed a simple, GIS-based method for identifying areas potentially overrun by mobile slides and debris flows. Our method links three processes within a DEM landscape: landslide initiation, transport, and debris-flow inundation (from very mobile slides). Given spatially distributed shear strengths, we first identify initiation areas using an infinite-slope stability analysis. We then delineate transport zones, or regions of potential entrainment and/or deposition, using a height/length runout envelope. Finally, where these transport zones intersect the channel network, we start debris-flow inundation zones. The extent of inundation is computed using the USGS model Laharz, modified to include many debris-flow locations throughout a DEM. Potential debris-flow volumes are computed from upslope initiation areas and typical slide thicknesses. We applied this approach to the main island of Kosrae State, Federated States of Micronesia (FSM). In 2002, typhoon Chata'an triggered numerous landslides on the neighboring islands of Chuuk State, FSM, resulting in 43 fatalities. Using an infinite-slope stability model calibrated to the Chuuk event, we identified potential landslide initiation areas on Kosrae. We then delineated potential transport zones using a 20º runout envelope, based on runout observations from Chuuk. Potential debris-flow inundation zones were then determined using Laharz. Field inspections on Kosrae revealed that our resulting susceptibility map correctly classified areas covered by previous debris-flow deposits and did not include areas covered by fluvial deposits. Our map has the advantage of providing a visual tool to portray initiation, transport, and runout zones from mobile landslides.

Correlating Scatter in Fatigue Life with Fracture Mechanisms in Forged Ti-6242Si Alloy

NASA Astrophysics Data System (ADS)

Sinha, V.; Pilchak, A. L.; Jha, S. K.; Porter, W. J.; John, R.; Larsen, J. M.

2018-04-01

Unlike the quasi-static mechanical properties, such as strength and ductility, fatigue life can vary significantly (by an order of magnitude or more) for nominally identical material and test conditions in many materials, including Ti-alloys. This makes life prediction and management more challenging for components that are subjected to cyclic loading in service. The differences in fracture mechanisms can cause the scatter in fatigue life. In this study, the fatigue fracture mechanisms were investigated in a forged near- α titanium alloy, Ti-6Al-2Sn-4Zr-2Mo-0.1Si, which had been tested under a condition that resulted in life variations by more than an order of magnitude. The crack-initiation and small crack growth processes, including their contributions to fatigue life variability, were elucidated via quantitative characterization of fatigue fracture surfaces. Combining the results from quantitative tilt fractography and electron backscatter diffraction, crystallography of crack-initiating and neighboring facets on the fracture surface was determined. Cracks initiated on the surface for both the shortest and the longest life specimens. The facet plane in the crack-initiating grain was aligned with the basal plane of a primary α grain for both the specimens. The facet planes in grains neighboring the crack-initiating grain were also closely aligned with the basal plane for the shortest life specimen, whereas the facet planes in the neighboring grains were significantly misoriented from the basal plane for the longest life specimen. The difference in the extent of cracking along the basal plane can explain the difference in fatigue life of specimens at the opposite ends of scatter band.

Instructional and Career Guidance in STEM: An Improvement Initiative to Create Opportunities for Female High School Students

NASA Astrophysics Data System (ADS)

Belcher, Aaron Heath

The purpose of this disquisition is to disseminate an improvement initiative in a public high school that addressed female Science, Technology, Engineering and Math (STEM) disparity in STEM classes. In this high school current instructional and career guidance practices were inadequate in providing female STEM students opportunities to experience relevant instruction in STEM through the application of real world practices. The improvement initiative identified four interventions using qualitative research that addressed the question, how do instructional and career guidance practices that emphasize the real world application of STEM impact the academic choices and career aspirations of female STEM students? The interventions include (1) instructional feedback (2) instructional resources, (3) career coaching, and (4) community college partnership. These interventions were chosen as a result of insider research methods that followed a scan, focus, summarize framework for understanding the problem. The aim of the improvement initiative was to develop structured protocols that impact STEM classroom and career guidance practices. An intervention team intended to identify opportunities for female STEM students to experience the real world application of STEM. First, the research context is explained. Then, a review of the literature explains foundation knowledge that led to the conceptual and leadership framework. Next, the research methodology is outlined including design and participants, survey instruments, procedures, timeline, and measures. The research methodology is followed by an analysis of data for instructional and career guidance practice efficacy. Finally, a discussion of the initiative and its outcome are illustrated through the stories of three female STEM students. As a result of these stories, the intervention team developed STEM classroom observation protocols. These protocols can be used by school leaders as a structure for STEM instruction and career guidance.

Impact of nurse-targeted care on HIV outcomes among immunocompromised persons: a before-after study in Uganda

PubMed Central

Kiragga, Agnes N.; Nalintya, Elizabeth; Morawski, Bozena M.; Kigozi, Joanita; Park, Benjamin J.; Kaplan, Jonathan E.; Boulware, David R.; Meya, David B.; Manabe, Yukari C.

2016-01-01

Introduction Improving HIV outcomes among severely immunocompromised HIV-infected persons who have increased morbidity and mortality remains an important issue in sub-Saharan Africa. We sought to evaluate the impact of targeted clinic- based nurse care on ART initiation and retention among severely immunocompromised HIV-infected persons. Methods The study included ART-naïve patients with CD4<100 cells/μL registered in seven urban clinics in Kampala, Uganda. Data were retrospectively collected on patients enrolled from July to December 2011 (routine care cohort). Between July 2012 and September 2013, one additional nurse per clinic was hired (nurse counselor cohort) to identify new patients, expedite ART initiation and trace those loss-to-follow-up. We compared time to ART initiation and 6-month retention in care between cohorts and used a generalized linear model to estimate the relative risk of retention. Results The study included 258 patients in the routine care cohort and 593 in the nurse counselor cohort. The proportion of patients who initiated ART increased from 190 (73.6%) in the routine care cohort to 506 (85.3%) in the nurse counselor cohort (p<0.001). At 6 months, 62% of the routine care cohort were retained in care versus 76% in the nurse counselor cohort (p=0.001). A 21% increase in likelihood of retention in the nurse counselor cohort (relative risk 1.21, 95% CI, 1.09–1.34) compared with the routine care cohort was observed. Conclusion Implementation of targeted nurse–led care of severely immunocompromised HIV-infected patients in public outpatient health care facilities resulted in decreased time to ART initiation and increased retention. PMID:27003494

Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

PubMed Central

Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

2016-01-01

Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

Physicochemical characteristics and microbial community evolution of biofilms during the start-up period in a moving bed biofilm reactor.

PubMed

Zhu, Yan; Zhang, Yan; Ren, Hong-Qiang; Geng, Jin-Ju; Xu, Ke; Huang, Hui; Ding, Li-Li

2015-03-01

This study aimed to investigate biofilm properties evolution coupled with different ages during the start-up period in a moving bed biofilm reactor system. Physicochemical characteristics including adhesion force, extracellular polymeric substances (EPS), morphology as well as volatile solid and microbial community were studied. Results showed that the formation and development of biofilms exhibited four stages, including (I) initial attachment and young biofilm formation, (II) biofilms accumulation, (III) biofilm sloughing and updating, and (IV) biofilm maturation. During the whole start-up period, adhesion force was positively and significantly correlated with the contents of EPS, especially the content of polysaccharide. In addition, increased adhesion force and EPS were beneficial for biofilm retention. Gram-negative bacteria mainly including Sphaerotilus, Zoogloea and Haliscomenobacter were predominant in the initial stage. Actinobacteria was beneficial to resist sloughing. Furthermore, filamentous bacteria were dominant in maturation biofilm. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parametric Study on the Response of Compression-Loaded Composite Shells With Geometric and Material Imperfections

NASA Technical Reports Server (NTRS)

Hilburger, Mark W.; Starnes, James H., Jr.

2004-01-01

The results of a parametric study of the effects of initial imperfections on the buckling and postbuckling response of three unstiffened thinwalled compression-loaded graphite-epoxy cylindrical shells with different orthotropic and quasi-isotropic shell-wall laminates are presented. The imperfections considered include initial geometric shell-wall midsurface imperfections, shell-wall thickness variations, local shell-wall ply-gaps associated with the fabrication process, shell-end geometric imperfections, nonuniform applied end loads, and variations in the boundary conditions including the effects of elastic boundary conditions. A high-fidelity nonlinear shell analysis procedure that accurately accounts for the effects of these imperfections on the nonlinear responses and buckling loads of the shells is described. The analysis procedure includes a nonlinear static analysis that predicts stable response characteristics of the shells and a nonlinear transient analysis that predicts unstable response characteristics.

[WHO Healthy City Initiative in Japan].

PubMed

Yoshizawa, Kazuko

2013-01-01

City environmental conditions are associated with health outcomes in people living there. World Health Organization (WHO) initiated Healthy City in 1986. To promote the networking, Alliance for Healthy Cities (AFHC) was launched in 2003 with local offices including AFHC Japan. As of 2010, 26 cities are members of AFHC Japan. A questionnaire was sent to those member cities. It includes questions on why they became an AFHC member, which section is in charge of the initiatives, what factors are important for promotion, and others. Out of the 26 cities, 13 cities returned the completed questionnaire. As for factors important for promoting the initiatives, 10 (77%) out of the 13 cities answered "consciousness of residents", while five (38%) chose "budget". This result suggests that community participation is a more important factor than budget for promoting and succeeding in the initiatives. Aging is a problem in any of the member cities, and six cities out the 13 falls under the category of superaged society, which is defined as a society with the proportion of aged people < 65 years being greater than 21% of the whole population. Eleven cities (85%) agreed that bicycles are an alternative means of transportation to cars; however, infrastructure for ensuring safety needs further improvement. In the promotion of Healthy City, networking among the member cities in Japan and worldwide should be promoted. Community participation with empowerment from the planning stage should lead to sustainable initiatives. The function of AFHC in collaboration among the members should be strengthened to cope with the rapidly changing city environment.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

Urinary calculi in aviation pilots: what is the best therapeutic approach?

PubMed

Zheng, Wei; Beiko, Darren T; Segura, Joseph W; Preminger, Glenn M; Albala, David M; Denstedt, John D

2002-10-01

We reviewed treatment outcomes in a series of aviation pilots treated in the era of modern surgical techniques and provide recommendations regarding treatment in this unique group. We retrospectively analyzed the records of all aviation pilots surgically treated for urinary calculi at our 4 tertiary stone centers from January 1988 to June 2000. Preoperative data and postoperative results were evaluated. Primary outcome measures included stone-free status after initial therapy, time lost from work and overall stone-free rates. Secondary outcome measures included the need for secondary procedures and complications. Of the 36 patients 17 had renal and 19 had ureteral stones. In 4 patients the stones passed spontaneously, while 17 were initially treated with extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia), 9 were initially treated with ureteroscopy and 6 were treated with percutaneous nephrolithotripsy. There was 1 complication. The stone-free rate for ESWL, percutaneous nephrolithotripsy and ureteroscopy after initial therapy was 35%, 100% and 100%, respectively. All patients were rendered stone-free after secondary therapy. Mean time lost from work for ESWL, percutaneous nephrolithotripsy and ureteroscopy was 4.7, 2.6 and 1.6 weeks, respectively. Aviation pilots with surgical urolithiasis are best treated with an initial endoscopic procedure. Stone-free rates can be maximized, while time lost from work can be minimized when an endoscopic approach is used initially. All pilots with urolithiasis should undergo mandatory metabolic evaluations to institute medical therapy when indicated.

Waste inspection tomography (WIT)

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

Bernardi, R.T.

1996-12-31

WIT is a self-sufficient mobile semitrailer for nondestructive evaluation and nondestructive assay of nuclear waste drums using x-ray and gamma-ray tomography. The recently completed Phase I included the design, fabrication, and initial testing of all WIT subsystems installed on-board the trailer. Initial test results include 2 MeV digital radiography, computed tomography, Anger camera imaging, single photon emission computed tomography, gamma-ray spectroscopy, collimated gamma scanning, and active and passive computed tomography using a 1.4 mCi source of {sup 166}Ho. These techniques were initially demonstrated on a 55-gallon phantom drum with 3 simulated waste matrices of combustibles, heterogeneous metals, and cement usingmore » check sources of gamma active isotopes such as {sup 137}Cs and {sup 133}Ba with 9-250 {mu}Ci activities. Waste matrix identification, isotopic identification, and attenuation-corrected gamma activity determination were demonstrated nondestructively and noninvasively in Phase I. Currently ongoing Phase II involves DOE site field test demonstrations at LLNL, RFETS, and INEL with real nuclear waste drums. Current WIT experience includes 55 gallon drums of cement, graphite, sludge, glass, metals, and combustibles. Thus far WIT has inspected drums with 0-20 gms of {sup 239}Pu.« less

The pediatric studies initiative: after 15 years have we reached the limits of the law?

PubMed

Milne, Christopher-Paul; Davis, Jonathan

2014-02-01

Despite considerable disincentives for conducting drug studies in children, 15 years ago the Food and Drug Administration, pediatric health advocates and congressional sponsors created a carrot-and-stick policy approach of voluntary and mandatory programs to encourage the pharmaceutical industry to include children in the drug development process. After several rounds of reauthorization of the laws on a temporary basis, the enabling statutes have been made permanent. The purpose of this analysis is to review the advances that resulted from the law and the areas where further progress is needed. A brief review of the history and results of the pediatric studies initiative was conducted by the authors and a determination made about the accomplishments of the law and remaining challenges. Indicators of the changes that resulted from this pediatric studies initiative are both indirect, such as the increase in the number of indication supplements for new populations, and direct, such as the decrease in the percentage of medicines used off-label in children. Although the pediatric studies initiative has significantly improved therapeutic options for children, concern still exists that drug companies are reluctant to include children in drug development unless continuously incentivized, whether positively or negatively. Two challenges are particularly problematic: neonatal studies and child-friendly formulations. Although the latest round of legislation should provide opportunities to address these problems, significantly more effort will be needed to achieve real culture change. Ultimately, the solution will require full program implementation by the Food and Drug Administration and close collaboration by many key stakeholders to ensure that pediatric studies become a routine part of the drug development process. © 2013 Elsevier HS Journals, Inc. All rights reserved.

Building analytic capacity, facilitating partnerships, and promoting data use in state health agencies: a distance-based workforce development initiative applied to maternal and child health epidemiology.

PubMed

Rankin, Kristin M; Kroelinger, Charlan D; Rosenberg, Deborah; Barfield, Wanda D

2012-12-01

The purpose of this article is to summarize the methodology, partnerships, and products developed as a result of a distance-based workforce development initiative to improve analytic capacity among maternal and child health (MCH) epidemiologists in state health agencies. This effort was initiated by the Centers for Disease Control's MCH Epidemiology Program and faculty at the University of Illinois at Chicago to encourage and support the use of surveillance data by MCH epidemiologists and program staff in state agencies. Beginning in 2005, distance-based training in advanced analytic skills was provided to MCH epidemiologists. To support participants, this model of workforce development included: lectures about the practical application of innovative epidemiologic methods, development of multidisciplinary teams within and across agencies, and systematic, tailored technical assistance The goal of this initiative evolved to emphasize the direct application of advanced methods to the development of state data products using complex sample surveys, resulting in the articles published in this supplement to MCHJ. Innovative methods were applied by participating MCH epidemiologists, including regional analyses across geographies and datasets, multilevel analyses of state policies, and new indicator development. Support was provided for developing cross-state and regional partnerships and for developing and publishing the results of analytic projects. This collaboration was successful in building analytic capacity, facilitating partnerships and promoting surveillance data use to address state MCH priorities, and may have broader application beyond MCH epidemiology. In an era of decreasing resources, such partnership efforts between state and federal agencies and academia are essential for promoting effective data use.

A Comprehensive Quality Assurance Program for Personnel and Procedures in Radiation Oncology: Value of Voluntary Error Reporting and Checklists

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

Kalapurakal, John A., E-mail: j-kalapurakal@northwestern.edu; Zafirovski, Aleksandar; Smith, Jeffery

Purpose: This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy. Methods and Materials: A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impactmore » of these and other QA initiatives was analyzed. Results: From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radiation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P<.001). These and other QA measures resulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose. Conclusions: A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era.« less

Does universal active MRSA surveillance influence anti-MRSA antibiotic use? A retrospective analysis of the treatment of patients admitted with suspicion of infection at Veterans Affairs Medical Centers between 2005 and 2010

PubMed Central

Jones, Makoto; Huttner, Benedikt; Leecaster, Molly; Huttner, Angela; Damal, Kavitha; Tanner, Windy; Nielson, Christopher; Rubin, Michael A.; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew H.

2014-01-01

Objectives After the implementation of an active surveillance programme for MRSA in US Veterans Affairs (VA) Medical Centers, there was an increase in vancomycin use. We investigated whether positive MRSA admission surveillance tests were associated with MRSA-positive clinical admission cultures and whether the availability of surveillance tests influenced prescribers' ability to match initial anti-MRSA antibiotic use with anticipated MRSA results from clinical admission cultures. Methods Analyses were based on barcode medication administration data, microbiology data and laboratory data from 129 hospitals between January 2005 and September 2010. Hospitalized patient admissions were included if clinical cultures were obtained and antibiotics started within 2 days of admission. Mixed-effects logistic regression was used to examine associations between positive MRSA admission cultures and (i) admission MRSA surveillance test results and (ii) initial anti-MRSA therapy. Results Among 569 815 included admissions, positive MRSA surveillance tests were strong predictors of MRSA-positive admission cultures (OR 8.5; 95% CI 8.2–8.8). The negative predictive value of MRSA surveillance tests was 97.6% (95% CI 97.5%–97.6%). The diagnostic OR between initial anti-MRSA antibiotics and MRSA-positive admission cultures was 3.2 (95% CI 3.1–3.4) for patients without surveillance tests and was not significantly different for admissions with surveillance tests. Conclusions The availability of nasal MRSA surveillance tests in VA hospitals did not seem to improve the ability of prescribers to predict the necessity of initial anti-MRSA treatment despite the high negative predictive value of MRSA surveillance tests. Prospective trials are needed to establish the safety and effectiveness of using MRSA surveillance tests to guide antibiotic therapy. PMID:25103488

An augmented SMS intervention to improve access to antenatal CD4 testing and ART initiation in HIV-infected pregnant women: a cluster randomized trial.

PubMed

Dryden-Peterson, Scott; Bennett, Kara; Hughes, Michael D; Veres, Adrian; John, Oaitse; Pradhananga, Rosina; Boyer, Matthew; Brown, Carolyn; Sakyi, Bright; van Widenfelt, Erik; Keapoletswe, Koona; Mine, Madisa; Moyo, Sikhulile; Asmelash, Aida; Siedner, Mark; Mmalane, Mompati; Shapiro, Roger L; Lockman, Shahin

2015-01-01

Less than one-third of HIV-infected pregnant women eligible for combination antiretroviral therapy (ART) globally initiate treatment prior to delivery, with lack of access to timely CD4 results being a principal barrier. We evaluated the effectiveness of an SMS-based intervention to improve access to timely antenatal ART. We conducted a stepped-wedge cluster randomized trial of a low-cost programmatic intervention in 20 antenatal clinics in Gaborone, Botswana. From July 2011-April 2012, 2 clinics were randomly selected every 4 weeks to receive an ongoing clinic-based educational intervention to improve CD4 collection and to receive CD4 results via an automated SMS platform with active patient tracing. CD4 testing before 26 weeks gestation and ART initiation before 30 weeks gestation were assessed. Three-hundred-sixty-six ART-naïve women were included, 189 registering for antenatal care under Intervention and 177 under Usual Care periods. Of CD4-eligible women, 100 (59.2%) women under Intervention and 79 (50.6%) women under Usual Care completed CD4 phlebotomy before 26 weeks gestation, adjusted odds ratio (aOR, adjusted for time that a clinic initiated Intervention) 0.87 (95% confidence interval [CI]0.47-1.63, P = 0.67). The SMS-based platform reduced time to clinic receipt of CD4 test result from median of 16 to 6 days (P<0.001), was appreciated by clinic staff, and was associated with reduced operational cost. However, rates of ART initiation remained low, with 56 (36.4%) women registering under Intervention versus 37 (24.2%) women under Usual Care initiating ART prior to 30 weeks gestation, aOR 1.06 (95%CI 0.53-2.13, P = 0.87). The augmented SMS-based intervention delivered CD4 results more rapidly and efficiently, and this type of SMS-based results delivery platform may be useful for a variety of tests and settings. However, the intervention did not appear to improve access to timely antenatal CD4 testing or ART initiation, as obstacles other than CD4 impeded ART initiation during pregnancy.

Exploring the cause of initially reactive bovine brains on rapid tests for BSE

PubMed Central

Dudas, Sandor; James, Jace; Anderson, Renee; Czub, Stefanie

2015-01-01

ABSTRACT Bovine spongiform encephalopathy (BSE) is an invariably fatal prion disease of cattle. The identification of the zoonotic potential of BSE prompted safety officials to initiate surveillance testing for this disease. In Canada, BSE surveillance is primarily focused on high risk cattle including animals which are dead, down and unable to rise, diseased or distressed. This targeted surveillance results in the submission of brain samples with a wide range of tissue autolysis and associated contaminants. These contaminants have the potential to interfere with important steps of surveillance tests resulting in initially positive test results requiring additional testing to confirm the disease status of the animal. The current tests used for BSE screening in Canada utilize the relative protease resistance of the prion protein gained when it misfolds from PrPC to PrPSc as part of the disease process. Proteinase K completely digests PrPC in normal brains, but leaves most of the PrPSc in BSE positive brains intact which is detected using anti-prion antibodies. These tests are highly reliable but occasionally give rise to initially reactive/false positive results. Test results for these reactive samples were close to the positive/negative cut-off on a sub set of test platforms. This is in contrast to all of the previous Canadian positive samples whose numeric values on these same test platforms were 10 to 100 fold greater than the test positive/negative cut-off. Here we explore the potential reason why a sample is repeatedly positive on a sub-set of rapid surveillance tests, but negative on other test platforms. In order to better understand and identify what might cause these initial reactions, we have conducted a variety of rapid and confirmatory assays as well as bacterial isolation and identification on BSE positive, negative and initially reactive samples. We observed high levels of viable bacterial contamination in initially reactive samples suggesting that the reactivity may be related to bacterial factors. Several bacteria isolated from the initially reactive samples have characteristics of biofilm forming bacteria and this extracellular matrix might play a role in preventing complete digestion of PrPC in these samples. PMID:26689488

Data assimilation method based on the constraints of confidence region

NASA Astrophysics Data System (ADS)

Li, Yong; Li, Siming; Sheng, Yao; Wang, Luheng

2018-03-01

The ensemble Kalman filter (EnKF) is a distinguished data assimilation method that is widely used and studied in various fields including methodology and oceanography. However, due to the limited sample size or imprecise dynamics model, it is usually easy for the forecast error variance to be underestimated, which further leads to the phenomenon of filter divergence. Additionally, the assimilation results of the initial stage are poor if the initial condition settings differ greatly from the true initial state. To address these problems, the variance inflation procedure is usually adopted. In this paper, we propose a new method based on the constraints of a confidence region constructed by the observations, called EnCR, to estimate the inflation parameter of the forecast error variance of the EnKF method. In the new method, the state estimate is more robust to both the inaccurate forecast models and initial condition settings. The new method is compared with other adaptive data assimilation methods in the Lorenz-63 and Lorenz-96 models under various model parameter settings. The simulation results show that the new method performs better than the competing methods.

Identification of spatially-localized initial conditions via sparse PCA

NASA Astrophysics Data System (ADS)

Dwivedi, Anubhav; Jovanovic, Mihailo

2017-11-01

Principal Component Analysis involves maximization of a quadratic form subject to a quadratic constraint on the initial flow perturbations and it is routinely used to identify the most energetic flow structures. For general flow configurations, principal components can be efficiently computed via power iteration of the forward and adjoint governing equations. However, the resulting flow structures typically have a large spatial support leading to a question of physical realizability. To obtain spatially-localized structures, we modify the quadratic constraint on the initial condition to include a convex combination with an additional regularization term which promotes sparsity in the physical domain. We formulate this constrained optimization problem as a nonlinear eigenvalue problem and employ an inverse power-iteration-based method to solve it. The resulting solution is guaranteed to converge to a nonlinear eigenvector which becomes increasingly localized as our emphasis on sparsity increases. We use several fluids examples to demonstrate that our method indeed identifies the most energetic initial perturbations that are spatially compact. This work was supported by Office of Naval Research through Grant Number N00014-15-1-2522.

Evolution of the Orszag-Tang vortex system in a compressible medium. II - Supersonic flow

NASA Technical Reports Server (NTRS)

Picone, J. Michael; Dahlburg, Russell B.

1991-01-01

A study is presented on the effect of embedded supersonic flows and the resulting emerging shock waves on phenomena associated with MHD turbulence, including reconnection, the formation of current sheets and vortex structures, and the evolution of spatial and temporal correlations among physical variables. A two-dimensional model problem, the Orszag-Tang (1979) vortex system, is chosen, which involves decay from nonrandom initial conditions. The system is doubly periodic, and the initial conditions consist of single-mode solenoidal velocity and magnetic fields, each containing X points and O points. The initial mass density is flat, and the initial pressure fluctuations are incompressible, balancing the local forces for a magnetofluid of unit mass density. Results on the evolution of the local structure of the flow field, the global properties of the system, and spectral correlations are presented. The important dynamical properties and observational consequences of embedded supersonic regions and emerging shocks in the Orszag-Tang model of an MHD system undergoing reconnection are discussed. Conclusions are drawn regarding the effects of local supersonic regions on MHD turbulence.

Convection of Plasmaspheric Plasma into the Outer Magnetosphere and Boundary Layer Region: Initial Results

NASA Technical Reports Server (NTRS)

Ober, Daniel M.; Horwitz, J. L.

1998-01-01

We present initial results on the modeling of the circulation of plasmaspheric-origin plasma into the outer magnetosphere and low-latitude boundary layer (LLBL), using a dynamic global core plasma model (DGCPM). The DGCPM includes the influences of spatially and temporally varying convection and refilling processes to calculate the equatorial core plasma density distribution throughout the magnetosphere. We have developed an initial description of the electric and magnetic field structures in the outer magnetosphere region. The purpose of this paper is to examine both the losses of plasmaspheric-origin plasma into the magnetopause boundary layer and the convection of this plasma that remains trapped on closed magnetic field lines. For the LLBL electric and magnetic structures we have adopted here, the plasmaspheric plasma reaching the outer magnetosphere is diverted anti-sunward primarily along the dusk flank. These plasmas reach X= -15 R(sub E) in the LLBL approximately 3.2 hours after the initial enhancement of convection and continues to populate the LLBL for 12 hours as the convection electric field diminishes.

Surgically-Induced Neuropathic Pain (SNPP): Understanding the Perioperative Process

PubMed Central

Borsook, David; Kussman, Barry D.; George, Edward; Becerra, Lino R.; Burke, Dennis W.

2012-01-01

Objective Nerve damage takes place during surgery. As a consequence, significant numbers (10–40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). Background The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in ‘peripheral’ and ‘central sensitization’, with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients these initial events produce chemical, structural and functional changes in the peripheral (PNS) and central nervous (CNS) systems. The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state – allodynia, sensory loss, shooting pains etc., that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed ‘centralization of pain’ and affect sensory, emotional and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Conclusions Currently there are no objective measures of pain in the peri-operative period. As such intermittent pain or continuous may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition appear to provide initial opportunities for decreasing the burden of SNPP until treatments with high efficacy and low side effects that either prevent or treat pain are discovered. PMID:23059501

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco.

PubMed

Dooley, Kelly E; Lahlou, Ouafae; Ghali, Iraqi; Knudsen, Janine; Elmessaoudi, My Driss; Cherkaoui, Imad; El Aouad, Rajae

2011-02-28

Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups.

Oahu Wind Integration and Transmission Study (OWITS): Hawaiian Islands Transmission Interconnection Project

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

Woodford, D.

This report provides an independent review included an initial evaluation of the technical configuration and capital costs of establishing an undersea cable system and examining impacts to the existing electric transmission systems as a result of interconnecting the islands.

Accelerating hydrodynamic description of pseudorapidity density and the initial energy density in p +p , Cu + Cu, Au + Au, and Pb + Pb collisions at energies available at the BNL Relativistic Heavy Ion Collider and the CERN Large Hadron Collider

NASA Astrophysics Data System (ADS)

Ze-Fang, Jiang; Chun-Bin, Yang; Csanád, Máté; Csörgő, Tamás

2018-06-01

A known class of analytic, exact, accelerating solutions of prefect relativistic hydrodynamics with longitudinal acceleration is utilized to describe results on the pseudorapidity distributions for different collision systems. These results include d N /d η measured in p +p , Cu+Cu, Au+Au, and Pb+Pb collisions at the BNL Relativistic Heavy Ion Collider and the CERN Large Hadron Collider, in a broad centrality range. Going beyond the traditional Bjorken model, from the accelerating hydrodynamic description we determine the initial energy density and other thermodynamic quantities in those collisions.

The benchmark aeroelastic models program: Description and highlights of initial results

NASA Technical Reports Server (NTRS)

Bennett, Robert M.; Eckstrom, Clinton V.; Rivera, Jose A., Jr.; Dansberry, Bryan E.; Farmer, Moses G.; Durham, Michael H.

1991-01-01

An experimental effort was implemented in aeroelasticity called the Benchmark Models Program. The primary purpose of this program is to provide the necessary data to evaluate computational fluid dynamic codes for aeroelastic analysis. It also focuses on increasing the understanding of the physics of unsteady flows and providing data for empirical design. An overview is given of this program and some results obtained in the initial tests are highlighted. The tests that were completed include measurement of unsteady pressures during flutter of rigid wing with a NACA 0012 airfoil section and dynamic response measurements of a flexible rectangular wing with a thick circular arc airfoil undergoing shock boundary layer oscillations.

Study of Plasma Flows Generated in Plasma Focus Discharge in Different Regimes of Working Gas Filling

NASA Astrophysics Data System (ADS)

Voitenko, D. A.; Ananyev, S. S.; Astapenko, G. I.; Basilaia, A. D.; Markolia, A. I.; Mitrofanov, K. N.; Myalton, V. V.; Timoshenko, A. P.; Kharrasov, A. M.; Krauz, V. I.

2017-12-01

Results are presented from experimental studies of the plasma flows generated in the KPF-4 Phoenix Mather-type plasma focus device (Sukhum Physical Technical Institute). In order to study how the formation and dynamics of the plasma flow depend on the initial distribution of the working gas, a system of pulsed gas puffing into the discharge volume was developed. The system allows one to create profiled gas distributions, including those with a reduced gas density in the region of plasma flow propagation. Results of measurements of the magnetic field, flow profile, and flow deceleration dynamics at different initial distributions of the gas pressure are presented.

Some Landing Studies Pertinent to Glider-Reentry Vehicles

NASA Technical Reports Server (NTRS)

Houbolt, John C.; Batterson, Sidney A.

1960-01-01

Results are presented of some landing studies that may serve as guidelines in the consideration of landing problems of glider-reentry configurations. The effect of the initial conditions of sinking velocity, angle of attack, and pitch rate on impact severity and the effect of locating the rear gear in various positions are discussed. Some information is included regarding the influence of landing-gear location on effective masses. Preliminary experimental results on the slideout phase of landing include sliding and rolling friction coefficients that have been determined from tests of various skids and all-metal wheels.

Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children aged 1–5 Years: A Causal Modelling Analysis

PubMed Central

Schomaker, Michael; Davies, Mary-Ann; Malateste, Karen; Renner, Lorna; Sawry, Shobna; N’Gbeche, Sylvie; Technau, Karl-Günter; Eboua, François; Tanser, Frank; Sygnaté-Sy, Haby; Phiri, Sam; Amorissani-Folquet, Madeleine; Cox, Vivian; Koueta, Fla; Chimbete, Cleophas; Lawson-Evi, Annette; Giddy, Janet; Amani-Bosse, Clarisse; Wood, Robin; Egger, Matthias; Leroy, Valeriane

2017-01-01

Background There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modelling analysis in children aged 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups and regions. Methods ART-naïve children of age 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. Results About one quarter of the 5826 included children was from West Africa (24.6%). The median (first; third quartile) CD4% at the first visit was 16% (11%;23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count<750 cells/mm3 or CD4%<25% was 0.2% (95%CI: −0.2%;0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95%CI: −0.04;0.01). Younger children aged 1–2 and children in West Africa had worse outcomes. Conclusions Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, though we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below750/25%. PMID:26479876

Trends in CD4 counts in HIV-infected patients with HIV viral load monitoring while on combination antiretroviral treatment: results from The TREAT Asia HIV Observational Database

PubMed Central

2010-01-01

Background The aim of this study was to examine the relationship between trends in CD4 counts (slope) and HIV viral load (VL) after initiation of combination antiretroviral treatment (cART) in Asian patients in The TREAT Asia HIV Observational Database (TAHOD). Methods Treatment-naive HIV-infected patients who started cART with three or more and had three or more CD4 count and HIV VL tests were included. CD4 count slopes were expressed as changes of cells per microliter per year. Predictors of CD4 count slopes from 6 months after initiation were assessed by random-effects linear regression models. Results A total of 1676 patients (74% male) were included. The median time on cART was 4.2 years (IQR 2.5-5.8 years). In the final model, CD4 count slope was associated with age, concurrent HIV VL and CD4 count, disease stage, hepatitis B or C co-infection, and time since cART initiation. CD4 count continues to increase with HIV VL up to 20 000 copies/mL during 6-12 months after cART initiation. However, the HIV VL has to be controlled below 5 000, 4 000 and 500 copies/mL for the CD4 count slope to remain above 20 cells/microliter per year during 12-18, 18-24, and beyond 24 months after cART initiation. Conclusions After cART initiation, CD4 counts continued to increase even when the concurrent HIV VL was detectable. However, HIV VL needed to be controlled at a lower level to maintain a positive CD4 count slope when cART continues. The effect on long-term outcomes through the possible development of HIV drug resistance remains uncertain. PMID:21182796

Characterization, Monitoring, and Risk Assessment at the IEA GHG Weyburn-Midale CO2 Monitoring and Storage Project, Saskatchewan, Canada.

NASA Astrophysics Data System (ADS)

Ben, R.; Chalaturnyk, R.; Gardner, C.; Hawkes, C.; Johnson, J.; White, D.; Whittaker, S.

2008-12-01

In July 2000, a major research project was initiated to study the geological storage of CO2 as part of a 5000 tonnes/day EOR project planned for the Weyburn Field in Saskatchewan, Canada. Major objectives of the IEA GHG Weyburn CO2 monitoring and storage project included: assessing the integrity of the geosphere encompassing the Weyburn oil pool for effective long-term storage of CO2; monitoring the movement of the injected CO2, and assessing the risk of migration of CO2 from the injection zone (approximately 1500 metres depth) to the surface. Over the period 2000-2004, a diverse group of 80+ researchers worked on: geological, geophysical, and hydrogeological characterizations at both the regional (100 km beyond the field) and detailed scale (10 km around the field); conducted time-lapse geophysical surveys; carried out surface and subsurface geochemical surveys; and undertook numerical reservoir simulations. Results of the characterization were used for a performance assessment that concluded the risk of CO2 movement to the biosphere was very small. By September 2007, more than 14 Mtonnes of CO2 had been injected into the Weyburn reservoir, including approximately 3 Mtonnes recycled from oil production. A "Final Phase" research project was initiated (2007- 2011) to contribute to a "Best Practices" guide for long-term CO2 storage in EOR settings. Research objectives include: improving the geoscience characterization; further detailed analysis and data collection on the role of wellbores; additional geochemical and geophysical monitoring activities; and an emphasis on quantitative risk assessments using multiple analysis techniques. In this talk a review of results from Phase I will be presented followed by plans and initial results for the Final Phase.

Six Sigma in healthcare delivery.

PubMed

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

Processes that initiate turbidity currents and their influence on turbidites: A marine geology perspective

USGS Publications Warehouse

Piper, David J.W.; Normark, William R.

2009-01-01

How the processes that initiate turbidity currents influence turbidite deposition is poorly understood, and many discussions in the literature rely on concepts that are overly simplistic. Marine geological studies provide information on the initiation and flow path of turbidity currents, including their response to gradient. In case studies of late Quaternary turbidites on the eastern Canadian and western U.S. margins, initiation processes are inferred either from real-time data for historical flows or indirectly from the age and contemporary paleogeography, erosional features, and depositional record. Three major types of initiation process are recognized: transformation of failed sediment, hyperpycnal flow from rivers or ice margins, and resuspension of sediment near the shelf edge by oceanographic processes. Many high-concentration flows result from hyperpycnal supply of hyperconcentrated bedload, or liquefaction failure of coarse-grained sediment, and most tend to deposit in slope conduits and on gradients < 0.5° at the base of slope and on the mid fan. Highly turbulent flows, from transformation of retrogressive failures and from ignitive flows that are triggered by oceanographic processes, tend to cannibalize these more proximal sediments and redeposit them on lower gradients on the basin plain. Such conduit flushing provides most of the sediment in large turbidites. Initiation mechanism exerts a strong control on the duration of turbidity flows. In most basins, there is a complex feedback between different types of turbidity-current initiation, the transformation of the flows, and the associated slope morphology. As a result, there is no simple relationship between initiating process and type of deposit.

Towards adjoint-based inversion of time-dependent mantle convection with nonlinear viscosity

NASA Astrophysics Data System (ADS)

Li, Dunzhu; Gurnis, Michael; Stadler, Georg

2017-04-01

We develop and study an adjoint-based inversion method for the simultaneous recovery of initial temperature conditions and viscosity parameters in time-dependent mantle convection from the current mantle temperature and historic plate motion. Based on a realistic rheological model with temperature-dependent and strain-rate-dependent viscosity, we formulate the inversion as a PDE-constrained optimization problem. The objective functional includes the misfit of surface velocity (plate motion) history, the misfit of the current mantle temperature, and a regularization for the uncertain initial condition. The gradient of this functional with respect to the initial temperature and the uncertain viscosity parameters is computed by solving the adjoint of the mantle convection equations. This gradient is used in a pre-conditioned quasi-Newton minimization algorithm. We study the prospects and limitations of the inversion, as well as the computational performance of the method using two synthetic problems, a sinking cylinder and a realistic subduction model. The subduction model is characterized by the migration of a ridge toward a trench whereby both plate motions and subduction evolve. The results demonstrate: (1) for known viscosity parameters, the initial temperature can be well recovered, as in previous initial condition-only inversions where the effective viscosity was given; (2) for known initial temperature, viscosity parameters can be recovered accurately, despite the existence of trade-offs due to ill-conditioning; (3) for the joint inversion of initial condition and viscosity parameters, initial condition and effective viscosity can be reasonably recovered, but the high dimension of the parameter space and the resulting ill-posedness may limit recovery of viscosity parameters.

Application of Interface Technology in Progressive Failure Analysis of Composite Panels

NASA Technical Reports Server (NTRS)

Sleight, D. W.; Lotts, C. G.

2002-01-01

A progressive failure analysis capability using interface technology is presented. The capability has been implemented in the COMET-AR finite element analysis code developed at the NASA Langley Research Center and is demonstrated on composite panels. The composite panels are analyzed for damage initiation and propagation from initial loading to final failure using a progressive failure analysis capability that includes both geometric and material nonlinearities. Progressive failure analyses are performed on conventional models and interface technology models of the composite panels. Analytical results and the computational effort of the analyses are compared for the conventional models and interface technology models. The analytical results predicted with the interface technology models are in good correlation with the analytical results using the conventional models, while significantly reducing the computational effort.

Initial state with shear in peripheral heavy ion collisions

NASA Astrophysics Data System (ADS)

Magas, V. K.; Gordillo, J.; Strottman, D.; Xie, Y. L.; Csernai, L. P.

2018-06-01

In the present work we propose a new way of constructing the initial state for further hydrodynamic simulation of relativistic heavy ion collisions based on Bjorken-like solution applied streak by streak in the transverse plane. Previous fluid dynamical calculations in Cartesian coordinates with an initial state based on a streak by streak Yang-Mills field led for peripheral higher energy collisions to large angular momentum, initial shear flow and significant local vorticity. Recent experiments verified the existence of this vorticity via the resulting polarization of emitted Λ and Λ ¯ particles. At the same time parton cascade models indicated the existence of more compact initial state configurations, which we are going to simulate in our approach. The proposed model satisfies all the conservation laws, including conservation of a strong initial angular momentum, which is present in noncentral collisions. As a consequence of this large initial angular momentum we observe the rotation of the whole system as well as the fluid shear in the initial state, which leads to large flow vorticity. Another advantage of the proposed model is that the initial state can be given in both [t,x,y,z] and [τ ,x ,y ,η ] coordinates and thus can be tested by all 3+1D hydrodynamical codes which exist in the field.

Sector activities and lessons learned around initial implementation of the United States national physical activity plan.

PubMed

Evenson, Kelly R; Satinsky, Sara B

2014-08-01

National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans.

Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents.

PubMed

Voorhees, Carolyn C; Ye, Cong; Carter-Pokras, Olivia; MacPherson, Laura; Kanamori, Mariano; Zhang, Guangyu; Chen, Lu; Fiedler, Robert

2011-01-01

Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey. Cross-sectional, multistage, probability sample survey. Schools (308 middle and high schools) in Maryland. Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n  =  57,072). Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region. Chi-square and multiple logistic regression analyses controlling for clustering. Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation. Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

Universal Surface-initiated Polymerization of Antifouling Zwitterionic Brushes Using A Mussel-Mimetic Peptide Initiator

PubMed Central

Kuang, Jinghao; Messersmith, Phillip B.

2012-01-01

We report a universal method for the surface-initated polymerization (SIP) of a antifouling polymer brush on various classes of surfaces, including noble metals, metal oxides and inert polymers. Inspired by the versatility of mussel adhesive proteins, we synthesized a novel bifunctional tripeptide bromide (BrYKY) which combines an atom transfer radical polymerization (ATRP) initiating alkyl bromide with l-3,4-dihydroxyphenylalanine (DOPA) and lysine. Simple dip-coating of substrates with variable wetting properties and compositions, including Teflon®, in a BrYKY solution at pH 8.5 led to formation of a thin film of cross-linked BrYKY. Subsequently, we showed that the BrYKY layer initiated the ATRP of a zwitterionic monomer, sulfobetaine methacrylate (SBMA) on all substrates, resulting in high density antifouling pSBMA brushes. Both BrYKY deposition and pSBMA grafting were unambiguously confirmed by ellipsometry, X-ray photoelectron spectroscopy and goniometry. All substrates that were coated with BrYKY/pSBMA dramatically reduced bacterial adhesion for 24 h and also resisted mammalian cell adhesion for at least 4 months, demonstrating the long-term stability of the BrYKY anchoring and antifouling properties of pSBMA. The use of BrYKY as a primer and polymerization initiator has the potential to be widely employed in surface grafted polymer brush modifications for biomedical and other applications. PMID:22506651

Initiation-promotion model of tumor prevalence in mice from space radiation exposures

NASA Technical Reports Server (NTRS)

Cucinotta, F. A.; Wilson, J. W.

1995-01-01

Exposures in space consist of low-level background components from galactic cosmic rays (GCR), occasional intense-energetic solar-particle events, periodic passes through geomagnetic-trapped radiation, and exposure from possible onboard nuclear-propulsion engines. Risk models for astronaut exposure from such diverse components and modalities must be developed to assure adequate protection in future NASA missions. The low-level background exposures (GCR), including relativistic heavy ions (HZE), will be the ultimate limiting factor for astronaut career exposure. We consider herein a two-mutation, initiation-promotion, radiation-carcinogenesis model in mice in which the initiation stage is represented by a linear kinetics model of cellular repair/misrepair, including the track-structure model for heavy ion action cross-sections. The model is validated by comparison with the harderian gland tumor experiments of Alpen et al. for various ion beams. We apply the initiation-promotion model to exposures from galactic cosmic rays, using models of the cosmic-ray environment and heavy ion transport, and consider the effects of the age of the mice prior to and after the exposure and of the length of time in space on predictions of relative risk. Our results indicate that biophysical models of age-dependent radiation hazard will provide a better understanding of GCR risk than models that rely strictly on estimates of the initial slopes of these radiations.

Veterans' experiences initiating VA-based mental health care.

PubMed

Bovin, Michelle J; Miller, Christopher J; Koenig, Christopher J; Lipschitz, Jessica M; Zamora, Kara A; Wright, Patricia B; Pyne, Jeffrey M; Burgess, James F

2018-05-21

Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) physical health-care appointments; (b) the service connection disability system; (c) non-VA care; and (d) being mandated to care. Taken together, these data lend themselves to a model that describes both modifiers of, and pathways to, VA mental health care. The model suggests that interventions aimed at the identified pathways, in concert with efforts designed to reduce barriers, may increase initiation of VA mental health-care services by veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Compelling Evidence of the Need for Corporate Work/Life Balance Initiatives: Results from a National Survey of Stressful Life-Events.

ERIC Educational Resources Information Center

Hobson, Charles J.; Delunas, Linda; Kesic, Dawn

2001-01-01

Considers how failure to balance excessive work and life/family demands can lead to negative consequences for both individuals and organizations, including higher stress levels, increased absenteeism, and lower productivity. Discusses results of a survey on stressful life events that offers an explanation of why work/life balance programs are so…

Linking Resources to Results: The Chicago Public Education Fund's Master Teacher Initiative. Principles for Effective Education Grantmaking. Case in Brief Number 1

ERIC Educational Resources Information Center

Grantmakers for Education, 2012

2012-01-01

"Linking Resources to Results" explores the deliberate approach--including specific goals, a clearly articulated grantmaking strategy and benchmarks for measuring progress--the Chicago Public Education Fund used to help the Chicago Public Schools recognize, reward and deploy high-quality teachers. The case study is intended to help…

Time's arrow: A numerical experiment

NASA Astrophysics Data System (ADS)

Fowles, G. Richard

1994-04-01

The dependence of time's arrow on initial conditions is illustrated by a numerical example in which plane waves produced by an initial pressure pulse are followed as they are multiply reflected at internal interfaces of a layered medium. Wave interactions at interfaces are shown to be analogous to the retarded and advanced waves of point sources. The model is linear and the calculation is exact and demonstrably time reversible; nevertheless the results show most of the features expected of a macroscopically irreversible system, including the approach to the Maxwell-Boltzmann distribution, ergodicity, and concomitant entropy increase.

Magnetohydrodynamic modelling of exploding foil initiators

NASA Astrophysics Data System (ADS)

Neal, William

2015-06-01

Magnetohydrodynamic (MHD) codes are currently being developed, and used, to predict the behaviour of electrically-driven flyer-plates. These codes are of particular interest to the design of exploding foil initiator (EFI) detonators but there is a distinct lack of comparison with high-fidelity experimental data. This study aims to compare a MHD code with a collection of temporally and spatially resolved diagnostics including PDV, dual-axis imaging and streak imaging. The results show the code's excellent representation of the flyer-plate launch and highlight features within the experiment that the model fails to capture.

Pathways into mental health care for UK veterans: a qualitative study.

PubMed

Mellotte, Harriet; Murphy, Dominic; Rafferty, Laura; Greenberg, Neil

2017-01-01

Background : It is well established that veterans suffering from mental health difficulties under use mental health services. Objective : This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans' help-seeking and pathways to care. Method : The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results : Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans' help-seeking in future; these focussed on enhancing both veterans and health professionals' knowledge regarding mental health difficulties. Conclusions : This study identified a number of barriers and enablers that may impact a veteran's journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours.

Pathways into mental health care for UK veterans: a qualitative study

PubMed Central

Mellotte, Harriet; Murphy, Dominic; Rafferty, Laura; Greenberg, Neil

2017-01-01

ABSTRACT Background: It is well established that veterans suffering from mental health difficulties under use mental health services. Objective: This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans’ help-seeking and pathways to care. Method: The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results: Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans’ help-seeking in future; these focussed on enhancing both veterans and health professionals’ knowledge regarding mental health difficulties. Conclusions: This study identified a number of barriers and enablers that may impact a veteran’s journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours. PMID:29163864

Climate Change Impacts on Water Resources and Water Supply Security through Adaptation

EPA Science Inventory

This presentation is to describe the water resources adaptation program (WRAP) at the U.S.EPA National Risk Management Research Laboratory, and to highlight initial research results on hydroclimatic periodicity and changes and on adaptation measures including sustainable water in...

The psychodynamic treatment of combat neuroses (PTSD) with hypnosis during World War II.

PubMed

Watkins, J G

2000-07-01

In a large Army hospital during World War II, a full-time program in hypnotherapy for battle trauma cases was developed. Symptoms included severe anxiety, phobias, conversions, hysterias, and dissociations. Many hypnoanalytic techniques were used, especially including abreactions. Good therapeutic results were frequent, as demonstrated by typical cases. There was no evidence that the abreactive procedure tended to retraumatize patients or initiate psychotic reactions.

The faint intergalactic-medium red-shifted emission balloon: future UV observations with EMCCDs

NASA Astrophysics Data System (ADS)

Kyne, Gillian; Hamden, Erika T.; Lingner, Nicole; Morrissey, Patrick; Nikzad, Shouleh; Martin, D. Christopher

2016-08-01

We present the latest developments in our joint NASA/CNES suborbital project. This project is a balloon-borne UV multi-object spectrograph, which has been designed to detect faint emission from the circumgalactic medium (CGM) around low redshift galaxies. One major change from FIREBall-1 has been the use of a delta-doped Electron Multiplying CCD (EMCCD). EMCCDs can be used in photon-counting (PC) mode to achieve extremely low readout noise (¡ 1e-). Our testing initially focused on reducing clock-induced-charge (CIC) through wave shaping and well depth optimisation with the CCD Controller for Counting Photons (CCCP) from Nüvü. This optimisation also includes methods for reducing dark current, via cooling and substrate voltage adjustment. We present result of laboratory noise measurements including dark current. Furthermore, we will briefly present some initial results from our first set of on-sky observations using a delta-doped EMCCD on the 200 inch telescope at Palomar using the Palomar Cosmic Web Imager (PCWI).

Advanced Space Suit Insulation Feasibility Study

NASA Technical Reports Server (NTRS)

Trevino, Luis A.; Orndoff, Evelyne S.

2000-01-01

For planetary applications, the space suit insulation has unique requirements because it must perform in a dynamic mode to protect humans in the harsh dust, pressure and temperature environments. Since the presence of a gaseous planetary atmosphere adds significant thermal conductance to the suit insulation, the current multi-layer flexible insulation designed for vacuum applications is not suitable in reduced pressure planetary environments such as that of Mars. Therefore a feasibility study has been conducted at NASA to identify the most promising insulation concepts that can be developed to provide an acceptable suit insulation. Insulation concepts surveyed include foams, microspheres, microfibers, and vacuum jackets. The feasibility study includes a literature survey of potential concepts, an evaluation of test results for initial insulation concepts, and a development philosophy to be pursued as a result of the initial testing and conceptual surveys. The recommended focus is on microfibers due to the versatility of fiber structure configurations, the wide choice of fiber materials available, the maturity of the fiber processing industry, and past experience with fibers in insulation applications

Status of a Power Processor for the Prometheus-1 Electric Propulsion System

NASA Technical Reports Server (NTRS)

Pinero, Luis R.; Hill, Gerald M.; Aulisio, Michael; Gerber, Scott; Griebeler, Elmer; Hewitt, Frank; Scina, Joseph

2006-01-01

NASA is developing technologies for nuclear electric propulsion for proposed deep space missions in support of the Exploration initiative under Project Prometheus. Electrical power produced by the combination of a fission-based power source and a Brayton power conversion and distribution system is used by a high specific impulse ion propulsion system to propel the spaceship. The ion propulsion system include the thruster, power processor and propellant feed system. A power processor technology development effort was initiated under Project Prometheus to develop high performance and lightweight power-processing technologies suitable for the application. This effort faces multiple challenges including developing radiation hardened power modules and converters with very high power capability and efficiency to minimize the impact on the power conversion and distribution system as well as the heat rejection system. This paper documents the design and test results of the first version of the beam supply, the design of a second version of the beam supply and the design and test results of the ancillary supplies.

Initial design and performance of the near surface unmanned aircraft system sensor suite in support of the GOES-R field campaign

NASA Astrophysics Data System (ADS)

Pearlman, Aaron J.; Padula, Francis; Shao, Xi; Cao, Changyong; Goodman, Steven J.

2016-09-01

One of the main objectives of the Geostationary Operational Environmental Satellite R-Series (GOES-R) field campaign is to validate the SI traceability of the Advanced Baseline Imager. The campaign plans include a feasibility demonstration study for new near surface unmanned aircraft system (UAS) measurement capability that is being developed to meet the challenges of validating geostationary sensors. We report our progress in developing our initial systems by presenting the design and preliminary characterization results of the sensor suite. The design takes advantage of off-the-shelf technologies and fiber-based optical components to make hemispheric directional measurements from a UAS. The characterization results - including laboratory measurements of temperature effects and polarization sensitivity - are used to refine the radiometric uncertainty budget towards meeting the validation objectives for the campaign. These systems will foster improved validation capabilities for the GOES-R field campaign and other next generation satellite systems.

Structure of a bacterial RNA polymerase holoenzyme open promoter complex

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

Bae, Brian; Feklistov, Andrey; Lass-Napiorkowska, Agnieszka

2015-09-08

Initiation of transcription is a primary means for controlling gene expression. In bacteria, the RNA polymerase (RNAP) holoenzyme binds and unwinds promoter DNA, forming the transcription bubble of the open promoter complex (RPo). We have determined crystal structures, refined to 4.14 Å-resolution, of RPo containing Thermus aquaticus RNAP holoenzyme and promoter DNA that includes the full transcription bubble. The structures, combined with biochemical analyses, reveal key features supporting the formation and maintenance of the double-strand/single-strand DNA junction at the upstream edge of the -10 element where bubble formation initiates. The results also reveal RNAP interactions with duplex DNA just upstreammore » of the -10 element and potential protein/DNA interactions that direct the DNA template strand into the RNAP active site. Addition of an RNA primer to yield a 4 base-pair post-translocated RNA:DNA hybrid mimics an initially transcribing complex at the point where steric clash initiates abortive initiation and σA dissociation.« less

Structure of a bacterial RNA polymerase holoenzyme open promoter complex

DOE PAGES

Bae, Brian; Feklistov, Andrey; Lass-Napiorkowska, Agnieszka; ...

2015-09-08

Initiation of transcription is a primary means for controlling gene expression. In bacteria, the RNA polymerase (RNAP) holoenzyme binds and unwinds promoter DNA, forming the transcription bubble of the open promoter complex (RPo). We have determined crystal structures, refined to 4.14 Å-resolution, of RPo containing Thermus aquaticus RNAP holoenzyme and promoter DNA that includes the full transcription bubble. The structures, combined with biochemical analyses, reveal key features supporting the formation and maintenance of the double-strand/single-strand DNA junction at the upstream edge of the -10 element where bubble formation initiates. The results also reveal RNAP interactions with duplex DNA just upstreammore » of the -10 element and potential protein/DNA interactions that direct the DNA template strand into the RNAP active site. Additionally a RNA primer to yield a 4 base-pair post-translocated RNA:DNA hybrid mimics an initially transcribing complex at the point where steric clash initiates abortive initiation and σ A dissociation.« less

Administering an epoch initiated for remote memory access

DOEpatents

Blocksome, Michael A; Miller, Douglas R

2014-03-18

Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

Administering an epoch initiated for remote memory access

DOEpatents

Blocksome, Michael A; Miller, Douglas R

2012-10-23

Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

Administering an epoch initiated for remote memory access

DOEpatents

Blocksome, Michael A.; Miller, Douglas R.

2013-01-01

Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

Linear and non-linear flow mode in Pb-Pb collisions at √{sNN} = 2.76 TeV

NASA Astrophysics Data System (ADS)

Acharya, S.; Adamová, D.; Adolfsson, J.; Aggarwal, M. M.; Aglieri Rinella, G.; Agnello, M.; Agrawal, N.; Ahammed, Z.; Ahmad, N.; Ahn, S. U.; Aiola, S.; Akindinov, A.; Alam, S. N.; Alba, J. L. B.; Albuquerque, D. S. D.; Aleksandrov, D.; Alessandro, B.; Alfaro Molina, R.; Alici, A.; Alkin, A.; Alme, J.; Alt, T.; Altenkamper, L.; Altsybeev, I.; Alves Garcia Prado, C.; An, M.; Andrei, C.; Andreou, D.; Andrews, H. A.; Andronic, A.; Anguelov, V.; Anson, C.; Antičić, T.; Antinori, F.; Antonioli, P.; Anwar, R.; Aphecetche, L.; Appelshäuser, H.; Arcelli, S.; Arnaldi, R.; Arnold, O. W.; Arsene, I. C.; Arslandok, M.; Audurier, B.; Augustinus, A.; Averbeck, R.; Azmi, M. D.; Badalà, A.; Baek, Y. W.; Bagnasco, S.; Bailhache, R.; Bala, R.; Baldisseri, A.; Ball, M.; Baral, R. C.; Barbano, A. M.; Barbera, R.; Barile, F.; Barioglio, L.; Barnaföldi, G. G.; Barnby, L. S.; Barret, V.; Bartalini, P.; Barth, K.; Bartsch, E.; Basile, M.; Bastid, N.; Basu, S.; Bathen, B.; Batigne, G.; Batista Camejo, A.; Batyunya, B.; Batzing, P. C.; Bearden, I. G.; Beck, H.; Bedda, C.; Behera, N. K.; Belikov, I.; Bellini, F.; Bello Martinez, H.; Bellwied, R.; Beltran, L. G. E.; Belyaev, V.; Bencedi, G.; Beole, S.; Bercuci, A.; Berdnikov, Y.; Berenyi, D.; Bertens, R. A.; Berzano, D.; Betev, L.; Bhasin, A.; Bhat, I. R.; Bhati, A. K.; Bhattacharjee, B.; Bhom, J.; Bianchi, L.; Bianchi, N.; Bianchin, C.; Bielčík, J.; Bielčíková, J.; Bilandzic, A.; Biro, G.; Biswas, R.; Biswas, S.; Blair, J. T.; Blau, D.; Blume, C.; Boca, G.; Bock, F.; Bogdanov, A.; Boldizsár, L.; Bombara, M.; Bonomi, G.; Bonora, M.; Book, J.; Borel, H.; Borissov, A.; Borri, M.; Botta, E.; Bourjau, C.; Braun-Munzinger, P.; Bregant, M.; Broker, T. A.; Browning, T. A.; Broz, M.; Brucken, E. J.; Bruna, E.; Bruno, G. E.; Budnikov, D.; Buesching, H.; Bufalino, S.; Buhler, P.; Buncic, P.; Busch, O.; Buthelezi, Z.; Butt, J. B.; Buxton, J. T.; Cabala, J.; Caffarri, D.; Caines, H.; Caliva, A.; Calvo Villar, E.; Camerini, P.; Capon, A. A.; Carena, F.; Carena, W.; Carnesecchi, F.; Castillo Castellanos, J.; Castro, A. J.; Casula, E. A. R.; Ceballos Sanchez, C.; Cerello, P.; Chandra, S.; Chang, B.; Chapeland, S.; Chartier, M.; Charvet, J. L.; Chattopadhyay, S.; Chattopadhyay, S.; Chauvin, A.; Cherney, M.; Cheshkov, C.; Cheynis, B.; Chibante Barroso, V.; Chinellato, D. D.; Cho, S.; Chochula, P.; Choi, K.; Chojnacki, M.; Choudhury, S.; Chowdhury, T.; Christakoglou, P.; Christensen, C. H.; Christiansen, P.; Chujo, T.; Chung, S. U.; Cicalo, C.; Cifarelli, L.; Cindolo, F.; Cleymans, J.; Colamaria, F.; Colella, D.; Collu, A.; Colocci, M.; Concas, M.; Conesa Balbastre, G.; Conesa Del Valle, Z.; Connors, M. E.; Contreras, J. G.; Cormier, T. M.; Corrales Morales, Y.; Cortés Maldonado, I.; Cortese, P.; Cosentino, M. R.; Costa, F.; Costanza, S.; Crkovská, J.; Crochet, P.; Cuautle, E.; Cunqueiro, L.; Dahms, T.; Dainese, A.; Danisch, M. C.; Danu, A.; Das, D.; Das, I.; Das, S.; Dash, A.; Dash, S.; de, S.; de Caro, A.; de Cataldo, G.; de Conti, C.; de Cuveland, J.; de Falco, A.; de Gruttola, D.; De Marco, N.; de Pasquale, S.; de Souza, R. D.; Degenhardt, H. F.; Deisting, A.; Deloff, A.; Deplano, C.; Dhankher, P.; di Bari, D.; di Mauro, A.; di Nezza, P.; di Ruzza, B.; Diaz Corchero, M. A.; Dietel, T.; Dillenseger, P.; Divià, R.; Djuvsland, Ø.; Dobrin, A.; Domenicis Gimenez, D.; Dönigus, B.; Dordic, O.; Doremalen, L. V. V.; Drozhzhova, T.; Dubey, A. K.; Dubla, A.; Ducroux, L.; Duggal, A. K.; Dupieux, P.; Ehlers, R. J.; Elia, D.; Endress, E.; Engel, H.; Epple, E.; Erazmus, B.; Erhardt, F.; Espagnon, B.; Esumi, S.; Eulisse, G.; Eum, J.; Evans, D.; Evdokimov, S.; Fabbietti, L.; Faivre, J.; Fantoni, A.; Fasel, M.; Feldkamp, L.; Feliciello, A.; Feofilov, G.; Ferencei, J.; Fernández Téllez, A.; Ferreiro, E. G.; Ferretti, A.; Festanti, A.; Feuillard, V. J. G.; Figiel, J.; Figueredo, M. A. S.; Filchagin, S.; Finogeev, D.; Fionda, F. M.; Fiore, E. M.; Floris, M.; Foertsch, S.; Foka, P.; Fokin, S.; Fragiacomo, E.; Francescon, A.; Francisco, A.; Frankenfeld, U.; Fronze, G. G.; Fuchs, U.; Furget, C.; Furs, A.; Fusco Girard, M.; Gaardhøje, J. J.; Gagliardi, M.; Gago, A. M.; Gajdosova, K.; Gallio, M.; Galvan, C. D.; Ganoti, P.; Gao, C.; Garabatos, C.; Garcia-Solis, E.; Garg, K.; Garg, P.; Gargiulo, C.; Gasik, P.; Gauger, E. F.; Gay Ducati, M. B.; Germain, M.; Ghosh, J.; Ghosh, P.; Ghosh, S. K.; Gianotti, P.; Giubellino, P.; Giubilato, P.; Gladysz-Dziadus, E.; Glässel, P.; Goméz Coral, D. M.; Gomez Ramirez, A.; Gonzalez, A. S.; Gonzalez, V.; González-Zamora, P.; Gorbunov, S.; Görlich, L.; Gotovac, S.; Grabski, V.; Graczykowski, L. K.; Graham, K. L.; Greiner, L.; Grelli, A.; Grigoras, C.; Grigoriev, V.; Grigoryan, A.; Grigoryan, S.; Grion, N.; Gronefeld, J. M.; Grosa, F.; Grosse-Oetringhaus, J. F.; Grosso, R.; Gruber, L.; Guber, F.; Guernane, R.; Guerzoni, B.; Gulbrandsen, K.; Gunji, T.; Gupta, A.; Gupta, R.; Guzman, I. B.; Haake, R.; Hadjidakis, C.; Hamagaki, H.; Hamar, G.; Hamon, J. C.; Harris, J. W.; Harton, A.; Hassan, H.; Hatzifotiadou, D.; Hayashi, S.; Heckel, S. T.; Hellbär, E.; Helstrup, H.; Herghelegiu, A.; Herrera Corral, G.; Herrmann, F.; Hess, B. A.; Hetland, K. F.; Hillemanns, H.; Hills, C.; Hippolyte, B.; Hladky, J.; Hohlweger, B.; Horak, D.; Hornung, S.; Hosokawa, R.; Hristov, P.; Hughes, C.; Humanic, T. J.; Hussain, N.; Hussain, T.; Hutter, D.; Hwang, D. S.; Iga Buitron, S. A.; Ilkaev, R.; Inaba, M.; Ippolitov, M.; Irfan, M.; Isakov, V.; Ivanov, M.; Ivanov, V.; Izucheev, V.; Jacak, B.; Jacazio, N.; Jacobs, P. M.; Jadhav, M. B.; Jadlovska, S.; Jadlovsky, J.; Jaelani, S.; Jahnke, C.; Jakubowska, M. J.; Janik, M. A.; Jayarathna, P. H. S. Y.; Jena, C.; Jena, S.; Jercic, M.; Jimenez Bustamante, R. T.; Jones, P. G.; Jusko, A.; Kalinak, P.; Kalweit, A.; Kang, J. H.; Kaplin, V.; Kar, S.; Karasu Uysal, A.; Karavichev, O.; Karavicheva, T.; Karayan, L.; Karpechev, E.; Kebschull, U.; Keidel, R.; Keijdener, D. L. D.; Keil, M.; Ketzer, B.; Khabanova, Z.; Khan, P.; Khan, S. A.; Khanzadeev, A.; Kharlov, Y.; Khatun, A.; Khuntia, A.; Kielbowicz, M. M.; Kileng, B.; Kim, D.; Kim, D. W.; Kim, D. J.; Kim, H.; Kim, J. S.; Kim, J.; Kim, M.; Kim, M.; Kim, S.; Kim, T.; Kirsch, S.; Kisel, I.; Kiselev, S.; Kisiel, A.; Kiss, G.; Klay, J. L.; Klein, C.; Klein, J.; Klein-Bösing, C.; Klewin, S.; Kluge, A.; Knichel, M. L.; Knospe, A. G.; Kobdaj, C.; Kofarago, M.; Kollegger, T.; Kolojvari, A.; Kondratiev, V.; Kondratyeva, N.; Kondratyuk, E.; Konevskikh, A.; Konyushikhin, M.; Kopcik, M.; Kour, M.; Kouzinopoulos, C.; Kovalenko, O.; Kovalenko, V.; Kowalski, M.; Koyithatta Meethaleveedu, G.; Králik, I.; Kravčáková, A.; Krivda, M.; Krizek, F.; Kryshen, E.; Krzewicki, M.; Kubera, A. M.; Kučera, V.; Kuhn, C.; Kuijer, P. G.; Kumar, A.; Kumar, J.; Kumar, L.; Kumar, S.; Kundu, S.; Kurashvili, P.; Kurepin, A.; Kurepin, A. B.; Kuryakin, A.; Kushpil, S.; Kweon, M. J.; Kwon, Y.; La Pointe, S. L.; La Rocca, P.; Lagana Fernandes, C.; Lai, Y. S.; Lakomov, I.; Langoy, R.; Lapidus, K.; Lara, C.; Lardeux, A.; Lattuca, A.; Laudi, E.; Lavicka, R.; Lazaridis, L.; Lea, R.; Leardini, L.; Lee, S.; Lehas, F.; Lehner, S.; Lehrbach, J.; Lemmon, R. C.; Lenti, V.; Leogrande, E.; León Monzón, I.; Lévai, P.; Li, S.; Li, X.; Lien, J.; Lietava, R.; Lim, B.; Lindal, S.; Lindenstruth, V.; Lindsay, S. W.; Lippmann, C.; Lisa, M. A.; Litichevskyi, V.; Ljunggren, H. M.; Llope, W. J.; Lodato, D. F.; Loenne, P. I.; Loginov, V.; Loizides, C.; Loncar, P.; Lopez, X.; López Torres, E.; Lowe, A.; Luettig, P.; Lunardon, M.; Luparello, G.; Lupi, M.; Lutz, T. H.; Maevskaya, A.; Mager, M.; Mahajan, S.; Mahmood, S. M.; Maire, A.; Majka, R. D.; Malaev, M.; Malinina, L.; Mal'Kevich, D.; Malzacher, P.; Mamonov, A.; Manko, V.; Manso, F.; Manzari, V.; Mao, Y.; Marchisone, M.; Mareš, J.; Margagliotti, G. V.; Margotti, A.; Margutti, J.; Marín, A.; Markert, C.; Marquard, M.; Martin, N. A.; Martinengo, P.; Martinez, J. A. L.; Martínez, M. I.; Martínez García, G.; Martinez Pedreira, M.; Mas, A.; Masciocchi, S.; Masera, M.; Masoni, A.; Masson, E.; Mastroserio, A.; Mathis, A. M.; Matyja, A.; Mayer, C.; Mazer, J.; Mazzilli, M.; Mazzoni, M. A.; Meddi, F.; Melikyan, Y.; Menchaca-Rocha, A.; Meninno, E.; Mercado Pérez, J.; Meres, M.; Mhlanga, S.; Miake, Y.; Mieskolainen, M. M.; Mihaylov, D.; Mihaylov, D. L.; Mikhaylov, K.; Milano, L.; Milosevic, J.; Mischke, A.; Mishra, A. N.; Miśkowiec, D.; Mitra, J.; Mitu, C. M.; Mohammadi, N.; Mohanty, B.; Mohisin Khan, M.; Montes, E.; Moreira de Godoy, D. A.; Moreno, L. A. P.; Moretto, S.; Morreale, A.; Morsch, A.; Muccifora, V.; Mudnic, E.; Mühlheim, D.; Muhuri, S.; Mukherjee, M.; Mulligan, J. D.; Munhoz, M. G.; Münning, K.; Munzer, R. H.; Murakami, H.; Murray, S.; Musa, L.; Musinsky, J.; Myers, C. J.; Myrcha, J. W.; Naik, B.; Nair, R.; Nandi, B. K.; Nania, R.; Nappi, E.; Narayan, A.; Naru, M. U.; Natal da Luz, H.; Nattrass, C.; Navarro, S. R.; Nayak, K.; Nayak, R.; Nayak, T. K.; Nazarenko, S.; Nedosekin, A.; Negrao de Oliveira, R. A.; Nellen, L.; Nesbo, S. V.; Ng, F.; Nicassio, M.; Niculescu, M.; Niedziela, J.; Nielsen, B. S.; Nikolaev, S.; Nikulin, S.; Nikulin, V.; Nobuhiro, A.; Noferini, F.; Nomokonov, P.; Nooren, G.; Noris, J. C. C.; Norman, J.; Nyanin, A.; Nystrand, J.; Oeschler, H.; Oh, S.; Ohlson, A.; Okubo, T.; Olah, L.; Oleniacz, J.; Oliveira da Silva, A. C.; Oliver, M. H.; Onderwaater, J.; Oppedisano, C.; Orava, R.; Oravec, M.; Ortiz Velasquez, A.; Oskarsson, A.; Otwinowski, J.; Oyama, K.; Pachmayer, Y.; Pacik, V.; Pagano, D.; Pagano, P.; Paić, G.; Palni, P.; Pan, J.; Pandey, A. K.; Panebianco, S.; Papikyan, V.; Pappalardo, G. S.; Pareek, P.; Park, J.; Parmar, S.; Passfeld, A.; Pathak, S. P.; Paticchio, V.; Patra, R. N.; Paul, B.; Pei, H.; Peitzmann, T.; Peng, X.; Pereira, L. G.; Pereira da Costa, H.; Peresunko, D.; Perez Lezama, E.; Peskov, V.; Pestov, Y.; Petráček, V.; Petrov, V.; Petrovici, M.; Petta, C.; Pezzi, R. P.; Piano, S.; Pikna, M.; Pillot, P.; Pimentel, L. O. D. L.; Pinazza, O.; Pinsky, L.; Piyarathna, D. B.; Płoskoń, M.; Planinic, M.; Pliquett, F.; Pluta, J.; Pochybova, S.; Podesta-Lerma, P. L. M.; Poghosyan, M. G.; Polichtchouk, B.; Poljak, N.; Poonsawat, W.; Pop, A.; Poppenborg, H.; Porteboeuf-Houssais, S.; Porter, J.; Pozdniakov, V.; Prasad, S. K.; Preghenella, R.; Prino, F.; Pruneau, C. A.; Pshenichnov, I.; Puccio, M.; Puddu, G.; Pujahari, P.; Punin, V.; Putschke, J.; Rachevski, A.; Raha, S.; Rajput, S.; Rak, J.; Rakotozafindrabe, A.; Ramello, L.; Rami, F.; Rana, D. B.; Raniwala, R.; Raniwala, S.; Räsänen, S. S.; Rascanu, B. T.; Rathee, D.; Ratza, V.; Ravasenga, I.; Read, K. F.; Redlich, K.; Rehman, A.; Reichelt, P.; Reidt, F.; Ren, X.; Renfordt, R.; Reolon, A. R.; Reshetin, A.; Reygers, K.; Riabov, V.; Ricci, R. A.; Richert, T.; Richter, M.; Riedler, P.; Riegler, W.; Riggi, F.; Ristea, C.; Rodríguez Cahuantzi, M.; Røed, K.; Rogochaya, E.; Rohr, D.; Röhrich, D.; Rokita, P. S.; Ronchetti, F.; Rosas, E. D.; Rosnet, P.; Rossi, A.; Rotondi, A.; Roukoutakis, F.; Roy, A.; Roy, C.; Roy, P.; Rubio Montero, A. J.; Rueda, O. V.; Rui, R.; Russo, R.; Rustamov, A.; Ryabinkin, E.; Ryabov, Y.; Rybicki, A.; Saarinen, S.; Sadhu, S.; Sadovsky, S.; Šafařík, K.; Saha, S. K.; Sahlmuller, B.; Sahoo, B.; Sahoo, P.; Sahoo, R.; Sahoo, S.; Sahu, P. K.; Saini, J.; Sakai, S.; Saleh, M. A.; Salzwedel, J.; Sambyal, S.; Samsonov, V.; Sandoval, A.; Sarkar, D.; Sarkar, N.; Sarma, P.; Sas, M. H. P.; Scapparone, E.; Scarlassara, F.; Scharenberg, R. P.; Scheid, H. S.; Schiaua, C.; Schicker, R.; Schmidt, C.; Schmidt, H. R.; Schmidt, M. O.; Schmidt, M.; Schuchmann, S.; Schukraft, J.; Schutz, Y.; Schwarz, K.; Schweda, K.; Scioli, G.; Scomparin, E.; Scott, R.; Šefčík, M.; Seger, J. E.; Sekiguchi, Y.; Sekihata, D.; Selyuzhenkov, I.; Senosi, K.; Senyukov, S.; Serradilla, E.; Sett, P.; Sevcenco, A.; Shabanov, A.; Shabetai, A.; Shahoyan, R.; Shaikh, W.; Shangaraev, A.; Sharma, A.; Sharma, A.; Sharma, M.; Sharma, M.; Sharma, N.; Sheikh, A. I.; Shigaki, K.; Shou, Q.; Shtejer, K.; Sibiriak, Y.; Siddhanta, S.; Sielewicz, K. M.; Siemiarczuk, T.; Silvermyr, D.; Silvestre, C.; Simatovic, G.; Simonetti, G.; Singaraju, R.; Singh, R.; Singhal, V.; Sinha, T.; Sitar, B.; Sitta, M.; Skaali, T. B.; Slupecki, M.; Smirnov, N.; Snellings, R. J. M.; Snellman, T. W.; Song, J.; Song, M.; Soramel, F.; Sorensen, S.; Sozzi, F.; Spiriti, E.; Sputowska, I.; Srivastava, B. K.; Stachel, J.; Stan, I.; Stankus, P.; Stenlund, E.; Stocco, D.; Strmen, P.; Suaide, A. A. P.; Sugitate, T.; Suire, C.; Suleymanov, M.; Suljic, M.; Sultanov, R.; Šumbera, M.; Sumowidagdo, S.; Suzuki, K.; Swain, S.; Szabo, A.; Szarka, I.; Szczepankiewicz, A.; Tabassam, U.; Takahashi, J.; Tambave, G. J.; Tanaka, N.; Tarhini, M.; Tariq, M.; Tarzila, M. G.; Tauro, A.; Tejeda Muñoz, G.; Telesca, A.; Terasaki, K.; Terrevoli, C.; Teyssier, B.; Thakur, D.; Thakur, S.; Thomas, D.; Tieulent, R.; Tikhonov, A.; Timmins, A. R.; Toia, A.; Tripathy, S.; Trogolo, S.; Trombetta, G.; Tropp, L.; Trubnikov, V.; Trzaska, W. H.; Trzeciak, B. A.; Tsuji, T.; Tumkin, A.; Turrisi, R.; Tveter, T. S.; Ullaland, K.; Umaka, E. N.; Uras, A.; Usai, G. L.; Utrobicic, A.; Vala, M.; van der Maarel, J.; van Hoorne, J. W.; van Leeuwen, M.; Vanat, T.; Vande Vyvre, P.; Varga, D.; Vargas, A.; Vargyas, M.; Varma, R.; Vasileiou, M.; Vasiliev, A.; Vauthier, A.; Vázquez Doce, O.; Vechernin, V.; Veen, A. M.; Velure, A.; Vercellin, E.; Vergara Limón, S.; Vernet, R.; Vértesi, R.; Vickovic, L.; Vigolo, S.; Viinikainen, J.; Vilakazi, Z.; Villalobos Baillie, O.; Villatoro Tello, A.; Vinogradov, A.; Vinogradov, L.; Virgili, T.; Vislavicius, V.; Vodopyanov, A.; Völkl, M. A.; Voloshin, K.; Voloshin, S. A.; Volpe, G.; von Haller, B.; Vorobyev, I.; Voscek, D.; Vranic, D.; Vrláková, J.; Wagner, B.; Wagner, J.; Wang, H.; Wang, M.; Watanabe, D.; Watanabe, Y.; Weber, M.; Weber, S. G.; Weiser, D. F.; Wenzel, S. C.; Wessels, J. P.; Westerhoff, U.; Whitehead, A. M.; Wiechula, J.; Wikne, J.; Wilk, G.; Wilkinson, J.; Willems, G. A.; Williams, M. C. S.; Willsher, E.; Windelband, B.; Witt, W. E.; Yalcin, S.; Yamakawa, K.; Yang, P.; Yano, S.; Yin, Z.; Yokoyama, H.; Yoo, I.-K.; Yoon, J. H.; Yurchenko, V.; Zaccolo, V.; Zaman, A.; Zampolli, C.; Zanoli, H. J. C.; Zardoshti, N.; Zarochentsev, A.; Závada, P.; Zaviyalov, N.; Zbroszczyk, H.; Zhalov, M.; Zhang, H.; Zhang, X.; Zhang, Y.; Zhang, C.; Zhang, Z.; Zhao, C.; Zhigareva, N.; Zhou, D.; Zhou, Y.; Zhou, Z.; Zhu, H.; Zhu, J.; Zhu, X.; Zichichi, A.; Zimmermann, A.; Zimmermann, M. B.; Zinovjev, G.; Zmeskal, J.; Zou, S.; Alice Collaboration

2017-10-01

The second and the third order anisotropic flow, V2 and V3, are mostly determined by the corresponding initial spatial anisotropy coefficients, ε2 and ε3, in the initial density distribution. In addition to their dependence on the same order initial anisotropy coefficient, higher order anisotropic flow, Vn (n > 3), can also have a significant contribution from lower order initial anisotropy coefficients, which leads to mode-coupling effects. In this Letter we investigate the linear and non-linear modes in higher order anisotropic flow Vn for n = 4, 5, 6 with the ALICE detector at the Large Hadron Collider. The measurements are done for particles in the pseudorapidity range | η | < 0.8 and the transverse momentum range 0.2

Wavelength dependence of nanosecond infrared laser-induced breakdown in water: Evidence for multiphoton initiation via an intermediate state

NASA Astrophysics Data System (ADS)

Linz, Norbert; Freidank, Sebastian; Liang, Xiao-Xuan; Vogelmann, Hannes; Trickl, Thomas; Vogel, Alfred

2015-04-01

Investigation of the wavelength dependence (725-1025 nm) of the threshold for nanosecond optical breakdown in water revealed steps consistent with breakdown initiation by multiphoton ionization, with an initiation energy of about 6.6 eV. This value is considerably smaller than the autoionization threshold of about 9.5 eV, which can be regarded as band gap relevant for avalanche ionization. Breakdown initiation is likely to occur via excitation of a valence band electron into a solvated state, followed by rapid excitation into the conduction band. Theoretical analysis based on these assumptions suggests that the seed electron density required for initiating avalanche ionization amounts to 2.5 ×1015c m-3 at 725 nm and drops to 1.1 ×1012c m-3 at 1025 nm. These results demand changes of future breakdown modeling for water, including the use of a larger band gap than previously employed, the introduction of an intermediate energy level for initiation, and consideration of the wavelength dependence of seed electron density.

Linear and non-linear flow mode in Pb–Pb collisions at s NN = 2.76  TeV

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

Acharya, S.; Adamová, D.; Adolfsson, J.

The second and the third order anisotropic flow, V 2 and V 3, are mostly determined by the corresponding initial spatial anisotropy coefficients, and , in the initial density distribution. In addition to their dependence on the same order initial anisotropy coefficient, higher order anisotropic flow, V n (n > 3), can also have a significant contribution from lower order initial anisotropy coefficients, which leads to mode-coupling effects. In this Letter we investigate the linear and non-linear modes in higher order anisotropic flow V n for n = 4, 5, 6 with the ALICE detector at the Large Hadron Collider.more » The measurements are done for particles in the pseudorapidity range |η| < 0.8 and the transverse momentum range 0.2 < p T < 5.0 GeV/c as a function of collision centrality. The results are compared with theoretical calculations and provide important constraints on the initial conditions, including initial spatial geometry and its fluctuations, as well as the ratio of the shear viscosity to entropy density of the produced system.« less

Linear and non-linear flow mode in Pb–Pb collisions at s NN = 2.76  TeV

DOE PAGES

Acharya, S.; Adamová, D.; Adolfsson, J.; ...

2017-08-04

The second and the third order anisotropic flow, V 2 and V 3, are mostly determined by the corresponding initial spatial anisotropy coefficients, and , in the initial density distribution. In addition to their dependence on the same order initial anisotropy coefficient, higher order anisotropic flow, V n (n > 3), can also have a significant contribution from lower order initial anisotropy coefficients, which leads to mode-coupling effects. In this Letter we investigate the linear and non-linear modes in higher order anisotropic flow V n for n = 4, 5, 6 with the ALICE detector at the Large Hadron Collider.more » The measurements are done for particles in the pseudorapidity range |η| < 0.8 and the transverse momentum range 0.2 < p T < 5.0 GeV/c as a function of collision centrality. The results are compared with theoretical calculations and provide important constraints on the initial conditions, including initial spatial geometry and its fluctuations, as well as the ratio of the shear viscosity to entropy density of the produced system.« less

A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women

PubMed Central

Hodgson, Ian; Plummer, Mary L.; Konopka, Sarah N.; Colvin, Christopher J.; Jonas, Edna; Albertini, Jennifer; Amzel, Anouk; Fogg, Karen P.

2014-01-01

Background Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. Methods Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. Results Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. Conclusions To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation. PMID:25372479

Azathioprine Intolerance in Japanese Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis

PubMed Central

Morishita, Michiko; Watanabe, Haruki; Yan, Minglu; Zeggar, Sonia; Hiramatsu, Sumie; Ohashi, Keiji; Miyawaki, Yoshia; Katsuyama, Eri; Katsuyama, Takayuki; Takano Narazaki, Mariko; Toyota Tatebe, Noriko; Sunahori Watanabe, Katsue; Kawabata, Tomoko; Sada, Ken-Ei; Wada, Jun

2017-01-01

Objective To assess the safety of azathioprine (AZA) in Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods We retrospectively enrolled 67 consecutive AAV patients who had initiated AZA treatment from January 2006 to August 2014 at Okayama University Hospital. We evaluated the development of severe adverse events (AEs), AZA discontinuation due to total AEs (severe AEs included) within 1 year, and AZA-associated risk factors. Results The patients' median age was 70 years old. Forty-nine women and 18 men participated at the initiation of the study. Fifty-eight (87%) patients experienced AEs, and 36 experienced severe AEs (21 hepatic and 11 cytopenic severe AEs). Thirty-one (46%) patients discontinued treatment because of AEs. Abnormal hepatic laboratory test results at the treatment initiation were more frequent in patients with hepatic severe AEs and were associated with treatment discontinuation. The leukocyte and neutrophil counts at the treatment initiation were lower in the patients who discontinued treatment because of cytopenic AEs than in those who continued treatment. Only two patients experienced flare-ups during treatment. Conclusion The AE-associated AZA discontinuation rate in Japanese AAV patients was relatively high. AZA use warrants caution in patients with abnormal hepatic laboratory test results or low leukocyte or neutrophil counts. PMID:28674351

Identification and initial response to children's exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals.

PubMed

Lewis, Natalia V; Feder, Gene S; Howarth, Emma; Szilassy, Eszter; McTavish, Jill R; MacMillan, Harriet L; Wathen, Nadine

2018-04-28

To synthesise evidence on the acceptable identification and initial response to children's exposure to intimate partner violence (IPV) from the perspectives of providers and recipients of healthcare and social services. We conducted a thematic synthesis of qualitative research, appraised the included studies with the modified Critical Appraisal Skills Programme checklist and undertook a sensitivity analysis of the studies scored above 15. We searched eight electronic databases, checked references and citations and contacted authors of the included studies. We included qualitative studies with children, parents and providers of healthcare or social services about their experiences of identification or initial responses to children's exposure to IPV. Papers that have not been peer-reviewed were excluded as well as non-English papers. Searches identified 2039 records; 11 studies met inclusion criteria. Integrated perspectives of 42 children, 212 mothers and 251 professionals showed that sufficient training and support for professionals, good patient-professional relationship and supportive environment for patient/clients need to be in place before enquiry/disclosure of children's exposure to IPV should occur. Providers and recipients of care favour a phased enquiry about IPV initiated by healthcare professionals, which focuses on 'safety at home' and is integrated into the context of the consultation or visit. Participants agreed that an acceptable initial response prioritises child safety and includes emotional support, education about IPV and signposting to IPV services. Participants had conflicting perspectives on what constitutes acceptable engagement with children and management of safety. Sensitivity analysis produced similar results. Healthcare and social service professionals should receive sufficient training and ongoing individual and system-level support to provide acceptable identification of and initial response to children's exposure to IPV. Ideal identification and responses should use a phased approach to enquiry and the WHO Listen, Inquire about needs and concerns, Validate, Enhance safety and Support principles integrated into a trauma-informed and violence-informed model of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Thyroid nodules with benign findings at cytologic examination: results of long-term follow-up with US.

PubMed

Kim, Soo-Yeon; Han, Kyung Hwa; Moon, Hee Jung; Kwak, Jin Young; Chung, Woong Youn; Kim, Eun-Kyung

2014-04-01

To investigate the natural history of thyroid nodules found to be benign at initial fine-needle aspiration biopsy (FNAB) to determine the percentage of nodules that increased in volume by more than 50% as being an indicator of malignancy. This retrospective observational cohort study was approved by the institutional review board, and the need to obtain informed consent was waived. The study included 854 FNAB-confirmed benign thyroid nodules. Suspicious ultrasonographic (US) features included marked hypoechogenicity, irregular or microlobulated margin, microcalcification, and taller-than-wide shape. Univariate and multivariate generalized linear mixed models were used to assess the association with nodule growth greater than 50% in volume. For the 854 nodules, the initial mean diameter was 19.92 mm (range, 3.10-60.00 mm), and the initial mean volume was 3.19 cm(3) (range, 0.01-4.64 cm(3)). The majority (682 [79.9%] of 854) of thyroid nodules with benign cytologic results at initial FNAB did not grow more than 50% in volume during 4 years of mean follow-up (range, 7-101 months). More than 4 years of follow-up time versus less than 2 years, younger age, a cystic component of less than 25%, and nodule size 1 cm or larger versus less than 1 cm were independently associated with growth. There was only one malignant nodule (0.6%) among 172 thyroid nodules with a volume increase of 50% or greater during the entire follow-up time. Ten malignant nodules (overall malignancy rate: 1.2%) were detected among the 854 total nodules, and eight of these 10 nodules showed suspicious features at US. Repeat FNAB for nodules showing more than 50% growth in volume is unlikely to result in a diagnosis of malignancy. A positive FNAB result for malignancy is significantly more likely in the presence of suspicious US features. RSNA, 2014

Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

PubMed Central

Groen-van de Ven, Leontine; Smits, Carolien; de Graaff, Fuusje; Span, Marijke; Eefsting, Jan; Jukema, Jan; Vernooij-Dassen, Myrra

2017-01-01

Objective To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. Design A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. Setting Community settings and nursing homes in the Netherlands. Participants 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). Results The participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. Conclusion Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period. PMID:29133329

Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies

PubMed Central

Hawk, Kathryn F.; Vaca, Federico E.; D’Onofrio, Gail

2015-01-01

The opioid overdose epidemic is a major threat to the public’s health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose [1-3]. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose [4-7]. PMID:26339206

Evolution of Rotor Wake in Swirling Flow

NASA Technical Reports Server (NTRS)

El-Haldidi, Basman; Atassi, Hafiz; Envia, Edmane; Podboy, Gary

2000-01-01

A theory is presented for modeling the evolution of rotor wakes as a function of axial distance in swirling mean flows. The theory, which extends an earlier work to include arbitrary radial distributions of mean swirl, indicates that swirl can significantly alter the wake structure of the rotor especially at large downstream distances (i.e., for moderate to large rotor-stator spacings). Using measured wakes of a representative scale model fan stage to define the mean swirl and initial wake perturbations, the theory is used to predict the subsequent evolution of the wakes. The results indicate the sensitivity of the wake evolution to the initial profile and the need to have complete and consistent initial definition of both velocity and pressure perturbations.

Understanding violence: a school initiative for violence prevention.

PubMed

Nikitopoulos, Christina E; Waters, Jessica S; Collins, Erin; Watts, Caroline L

2009-01-01

The present study evaluates Understanding Violence, a violence prevention initiative implemented in a Boston-area elementary school whose students experience high rates of community violence. Understanding Violence draws on the educational and personal skills of youths and allows them to practice positive alternatives to violence. Participating 5th graders (n = 123) completed a survey that included rating scale items and open-ended questions to assess the program. Results indicate high levels of satisfaction with and learning from the program. Participants responded positively to the program's use of diverse components and community engagement. Developed as part of a larger community mental health outreach program, Understanding Violence offers an example of a school-based initiative to mitigate the effects of community violence.

An Augmented SMS Intervention to Improve Access to Antenatal CD4 Testing and ART Initiation in HIV-Infected Pregnant Women: A Cluster Randomized Trial

PubMed Central

Dryden-Peterson, Scott; Bennett, Kara; Hughes, Michael D.; Veres, Adrian; John, Oaitse; Pradhananga, Rosina; Boyer, Matthew; Brown, Carolyn; Sakyi, Bright; van Widenfelt, Erik; Keapoletswe, Koona; Mine, Madisa; Moyo, Sikhulile; Asmelash, Aida; Siedner, Mark; Mmalane, Mompati; Shapiro, Roger L.; Lockman, Shahin

2015-01-01

Background Less than one-third of HIV-infected pregnant women eligible for combination antiretroviral therapy (ART) globally initiate treatment prior to delivery, with lack of access to timely CD4 results being a principal barrier. We evaluated the effectiveness of an SMS-based intervention to improve access to timely antenatal ART. Methods We conducted a stepped-wedge cluster randomized trial of a low-cost programmatic intervention in 20 antenatal clinics in Gaborone, Botswana. From July 2011-April 2012, 2 clinics were randomly selected every 4 weeks to receive an ongoing clinic-based educational intervention to improve CD4 collection and to receive CD4 results via an automated SMS platform with active patient tracing. CD4 testing before 26 weeks gestation and ART initiation before 30 weeks gestation were assessed. Results Three-hundred-sixty-six ART-naïve women were included, 189 registering for antenatal care under Intervention and 177 under Usual Care periods. Of CD4-eligible women, 100 (59.2%) women under Intervention and 79 (50.6%) women under Usual Care completed CD4 phlebotomy before 26 weeks gestation, adjusted odds ratio (aOR, adjusted for time that a clinic initiated Intervention) 0.87 (95% confidence interval [CI]0.47–1.63, P = 0.67). The SMS-based platform reduced time to clinic receipt of CD4 test result from median of 16 to 6 days (P<0.001), was appreciated by clinic staff, and was associated with reduced operational cost. However, rates of ART initiation remained low, with 56 (36.4%) women registering under Intervention versus 37 (24.2%) women under Usual Care initiating ART prior to 30 weeks gestation, aOR 1.06 (95%CI 0.53–2.13, P = 0.87). Conclusions The augmented SMS-based intervention delivered CD4 results more rapidly and efficiently, and this type of SMS-based results delivery platform may be useful for a variety of tests and settings. However, the intervention did not appear to improve access to timely antenatal CD4 testing or ART initiation, as obstacles other than CD4 impeded ART initiation during pregnancy. PMID:25693050

A retrospective case-cohort study comparing treatment outcomes in abacavir versus stavudine containing first line antiretroviral treatment regimens in children <3yrs old, at a paediatric programme based in Soweto, South Africa

PubMed Central

Otwombe, Kennedy; Lazarus, Erica; Liberty, Afaaf; Gray, Glenda E.; Greeff, Oppel B. W.; Violari, Avy

2017-01-01

Introduction The current World Health Organization guideline for first line antiretroviral therapy (ART) in HIV-infected children recommends the use of abacavir and lamivudine as nucleoside backbones and no longer includes stavudine. We compared treatment outcomes with abacavir (ABC) versus stavudine (d4T) in a cohort of HIV-1 infected children 6 and 12 months after antiretroviral therapy was initiated. Methods This was a retrospective case-cohort study, using programmatic data from children enrolled in the Paediatric Wellness Programme at the Perinatal HIV Research Unit in Soweto, South Africa between 2005 and 2013. Children on abacavir/stavudine who had initiated ART at age <3 years with a regimen including lamivudine and lopinavir/ritonavir and had at least one 6 or 12 month viral load result were eligible. All ABC cases identified were matched for age at ART initiation and gender to eligible d4T controls (1:2). Outcomes analysed at 6 and 12 months post ART initiation included virological failure, mortality, immunological failure and anthropometry. Chi-square tests compared categorical measures while Kruskal-Wallis compared continuous measures. Results We identified 57 eligible ABC cases and selected 114 matched d4T controls. Overall, 57% were females and 89% started treatment at age <1year. The median age at ART initiation was 3.11 (IQR: 1.98–6.05) months. There was no difference in the proportion of children virologically suppressed between the groups at 6 (ABC 54.5% vs. d4T 67.0%, p = 0.125) and 12 (ABC 66.7% vs. d4T 71.6%, p = 0.53) months post ART-initiation. The proportion of children with adherence levels >90% for ABC and d4T were similar too (95% in ABC vs. 86% in d4T, p = 0.10). The proportion of children who died over 12 months was 3.5% in the ABC and 7.9% in the d4T group (p = 0.27). Similarly, the anthropometric measures were comparable. Conclusions It is reassuring that in the short term, in this group of patients, the treatment outcomes were similar. PMID:28686654

Is Follow-Up Testing with the FilmArray Gastrointestinal Multiplex PCR Panel Necessary?

PubMed Central

Park, Sholhui; Hitchcock, Matthew M.; Gomez, Carlos A.

2017-01-01

ABSTRACT The FilmArray gastrointestinal (GI) panel (BioFire Diagnostics, Salt Lake City, UT) is a simple, sample-to-answer, on-demand, multiplex, nucleic acid amplification test for syndromic diagnosis of infectious gastroenteritis. The aim of this study was to measure the yield of follow-up testing with FilmArray GI panel within 4 weeks of an initial test. Consecutive adult and pediatric patients tested at an academic institution between August 2015 and June 2016 were included in this study. Of 145 follow-up tests in 106 unique patients with an initial negative result, 134 (92.4%) tests and 98 (92.5%) patients remained negative upon follow-up testing. Excluding targets that are not reported at this institution (Clostridium difficile, enteroaggregative Escherichia coli, enteropathogenic E. coli, and enterotoxigenic E. coli), 137 (94.5%) follow-up tests and 101 (95.3%) patients remained negative. Weekly conversion rates were not significantly different across the 4-week follow-up interval. No epidemiological or clinical factors were significantly associated with a negative to positive conversion. Of 80 follow-up tests in patients with an initial positive result, 43 (53.8%) remained positive for the same target, 34 (42.5%) were negative, and 3 were positive for a different target (3.8%). Follow-up testing with FilmArray GI panel within 4 weeks of a negative result rarely changed the initial result, and the follow-up test reverted to negative less than half the time after an initial positive result. In the absence of clinical or epidemiological evidence for a new infection, follow-up testing should be limited and FilmArray GI panel should not be used as a test of cure. PMID:28122874

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

Frenkel, G.; Paterson, T.S.; Smith, M.E.

The Institute for Defense Analyses (IDA) has collected and analyzed information on battle management algorithm technology that is relevant to Battle Management/Command, Control and Communications (BM/C3). This Memorandum Report represents a program plan that will provide the BM/C3 Directorate of the Strategic Defense Initiative Organization (SDIO) with administrative and technical insight into algorithm technology. This program plan focuses on current activity in algorithm development and provides information and analysis to the SDIO to be used in formulating budget requirements for FY 1988 and beyond. Based upon analysis of algorithm requirements and ongoing programs, recommendations have been made for research areasmore » that should be pursued, including both the continuation of current work and the initiation of new tasks. This final report includes all relevant material from interim reports as well as new results.« less

Development of direct-inverse 3-D methods for applied transonic aerodynamic wing design and analysis

NASA Technical Reports Server (NTRS)

Carlson, Leland A.

1989-01-01

Progress in the direct-inverse wing design method in curvilinear coordinates has been made. This includes the remedying of a spanwise oscillation problem and the assessment of grid skewness, viscous interaction, and the initial airfoil section on the final design. It was found that, in response to the spanwise oscillation problem that designing at every other spanwise station produced the best results for the cases presented, a smoothly varying grid is especially needed for the accurate design at the wing tip, the boundary layer displacement thicknesses must be included in a successful wing design, the design of high and medium aspect ratio wings is possible with this code, and the final airfoil section designed is fairly independent of the initial section.

Creep fatigue life prediction for engine hot section materials (isotropic)

NASA Technical Reports Server (NTRS)

Moreno, V.

1983-01-01

The Hot Section Technology (HOST) program, creep fatigue life prediction for engine hot section materials (isotropic), is reviewed. The program is aimed at improving the high temperature crack initiation life prediction technology for gas turbine hot section components. Significant results include: (1) cast B1900 and wrought IN 718 selected as the base and alternative materials respectively; (2) fatigue test specimens indicated that measurable surface cracks appear early in the specimen lives, i.e., 15% of total life at 871 C and 50% of life at 538 c; (3) observed crack initiation sites are all surface initiated and are associated with either grain boundary carbides or local porosity, transgrannular cracking is observed at the initiation site for all conditions tested; and (4) an initial evaluation of two life prediction models, representative of macroscopic (Coffin-Mason) and more microscopic (damage rate) approaches, was conducted using limited data generated at 871 C and 538 C. It is found that the microscopic approach provides a more accurate regression of the data used to determine crack initiation model constants, but overpredicts the effect of strain rate on crack initiation life for the conditions tested.

A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.

PubMed

Kelly, Allison A; Jones, Makoto M; Echevarria, Kelly L; Kralovic, Stephen M; Samore, Matthew H; Goetz, Matthew B; Madaras-Kelly, Karl J; Simbartl, Loretta A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

2017-05-01

OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.

Multiphysics Simulations of Hot-Spot Initiation in Shocked Insensitive High-Explosive

NASA Astrophysics Data System (ADS)

Najjar, Fady; Howard, W. M.; Fried, L. E.

2010-11-01

Solid plastic-bonded high-explosive materials consist of crystals with micron-sized pores embedded. Under mechanical or thermal insults, these voids increase the ease of shock initiation by generating high-temperature regions during their collapse that might lead to ignition. Understanding the mechanisms of hot-spot initiation has significant research interest due to safety, reliability and development of new insensitive munitions. Multi-dimensional high-resolution meso-scale simulations are performed using the multiphysics software, ALE3D, to understand the hot-spot initiation. The Cheetah code is coupled to ALE3D, creating multi-dimensional sparse tables for the HE properties. The reaction rates were obtained from MD Quantum computations. Our current predictions showcase several interesting features regarding hot spot dynamics including the formation of a "secondary" jet. We will discuss the results obtained with hydro-thermo-chemical processes leading to ignition growth for various pore sizes and different shock pressures.

Implementation of a University-wide Retention Model

NASA Astrophysics Data System (ADS)

Davis, E. J.; Campbell, A.

2006-12-01

Eleven years ago, Bowie State University and NASA Goddard Space Flight Center entered into an agreement to enhance the science, mathematics, engineering and technology /(SMET/) domains. A Model Institutions for Excellence Award provided the financial basis for a number of initiatives that have led to increased retention and graduation rates. Initiatives such as a scholarship program, tutoring center, Summer Academy, safety-net program, research focus and mentoring have had a significant impact on students entering graduate and professional school and SMET related employment. Successes documented through various assessment activities and tracking of student progress, have led to implementation of the `retention model' urilized by the SMET MIE Initiatives throughout the University. The MIE retention efforts include each of the aforementioned initiatives plus pre-college and second-year experience programs. It is anticipated that the University-wide application of the `retention model' will provide the incentives necessary to obtain similar results throughout the student body.

On the line: worker democracy and the struggle over occupational health and safety.

PubMed

Granzow, Kara; Theberge, Nancy

2009-01-01

In this article we present a qualitative analysis of worker involvement in a participatory project to improve occupational health and safety at a Canadian manufacturing site. Based on interviews with workers in the plant, we consider the manner and degree to which workers experienced meaningful participation in the intervention process and some of the main barriers to worker participation. Findings emphasize the importance of the social and political context in conditioning the dynamics of joint management labor ventures specifically in relation to health initiatives. Interviews revealed few instances in which workers felt included in the participatory initiative; most often they felt marginalized. In the absence of structural change in the plant, workers described the health initiative as seriously limited in its ability to render meaningful worker participation. These results extend beyond this analysis of a participatory workplace health initiative, offering insights into the dynamics of institutional participatory process, and into participatory research practice generally.

Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting.

PubMed

Haga, Susanne B; LaPointe, Nancy M Allen; Cho, Alex; Reed, Shelby D; Mills, Rachel; Moaddeb, Jivan; Ginsburg, Geoffrey S

2014-09-01

To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.

Progressive Failure Studies of Stiffened Panels Subjected to Shear Loading

NASA Technical Reports Server (NTRS)

Ambur, Damodar R.; Jaunky, Navin; Hilburger, Mark W.; Bushnell, Dennis M. (Technical Monitor)

2002-01-01

Experimental and analytical results are presented for progressive failure of stiffened composite panels with and without a notch and subjected to in plane shear loading well into their postbuckling regime. Initial geometric imperfections are included in the finite element models. Ply damage modes such as matrix cracking, fiber-matrix shear, and fiber failure are modeled by degrading the material properties. Experimental results from the test include strain field data from video image correlation in three dimensions in addition to other strain and displacement measurements. Results from nonlinear finite element analyses are compared with experimental data. Good agreement between experimental data and numerical results are observed for the stitched stiffened composite panels studied.

Practical recommendations for the evaluation of improvement initiatives

PubMed Central

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

Strengthening the evidence and action on multi-sectoral partnerships in public health: an action research initiative

PubMed Central

Willis, C. D.; Greene, J. K.; Abramowicz, A.; Riley, B. L.

2016-01-01

Abstract Introduction: The Public Health Agency of Canada’s Multi-sectoral Partnerships Initiative, administered by the Centre for Chronic Disease Prevention (CCDP), brings together diverse partners to design, implement and advance innovative approaches for improving population health. This article describes the development and initial priorities of an action research project (a learning and improvement strategy) that aims to facilitate continuous improvement of the CCDP’s partnership initiative and contribute to the evidence on multi-sectoral partnerships. Methods: The learning and improvement strategy for the CCDP’s multi-sectoral partnership initiative was informed by (1) consultations with CCDP staff and senior management, and (2) a review of conceptual frameworks to do with multi-sectoral partnerships. Consultations explored the development of the multi-sectoral initiative, barriers and facilitators to success, and markers of effectiveness. Published and grey literature was reviewed using a systematic search strategy with findings synthesized using a narrative approach. Results: Consultations and the review highlighted the importance of understanding partnership impacts, developing a shared vision, implementing a shared measurement system and creating opportunities for knowledge exchange. With that in mind, we propose a six-component learning and improvement strategy that involves (1) prioritizing learning needs, (2) mapping needs to evidence, (3) using relevant data-collection methods, (4) analyzing and synthesizing data, (5) feeding data back to CCDP staff and teams and (6) taking action. Initial learning needs include investigating partnership reach and the unanticipated effects of multi-sectoral partnerships for individuals, groups, organizations or communities. Conclusion: While the CCDP is the primary audience for the learning and improvement strategy, it may prove useful for a range of audiences, including other government departments and external organizations interested in capturing and sharing new knowledge generated from multi-sectoral partnerships. PMID:27284702

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Incidence and Predictors of Pregnancy among a Cohort of HIV-Positive Women Initiating Antiretroviral Therapy in Mbarara, Uganda

PubMed Central

Kaida, Angela; Matthews, Lynn T.; Kanters, Steve; Kabakyenga, Jerome; Muzoora, Conrad; Mocello, A. Rain; Martin, Jeffrey N.; Hunt, Peter; Haberer, Jessica; Hogg, Robert S.; Bangsberg, David R.

2013-01-01

Objective Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility. Methods Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18–49 years) who enrolled between 2005–2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation. Results At baseline (pre-ART initiation), median age was 33 years [IQR: 27–37] and median prior livebirths was four [IQR: 2–6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81–207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86–0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29–4.63). Conclusions Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling. PMID:23704906

A Large-Scale Initiative Inviting Patients to Share Personal Fitness Tracker Data with Their Providers: Initial Results

PubMed Central

Pevnick, Joshua M.; Fuller, Garth; Duncan, Ray; Spiegel, Brennan M. R.

2016-01-01

Background Personal fitness trackers (PFT) have substantial potential to improve healthcare. Objective To quantify and characterize early adopters who shared their PFT data with providers. Methods We used bivariate statistics and logistic regression to compare patients who shared any PFT data vs. patients who did not. Results A patient portal was used to invite 79,953 registered portal users to share their data. Of 66,105 users included in our analysis, 499 (0.8%) uploaded data during an initial 37-day study period. Bivariate and regression analysis showed that early adopters were more likely than non-adopters to be younger, male, white, health system employees, and to have higher BMIs. Neither comorbidities nor utilization predicted adoption. Conclusion Our results demonstrate that patients had little intrinsic desire to share PFT data with their providers, and suggest that patients most at risk for poor health outcomes are least likely to share PFT data. Marketing, incentives, and/or cultural change may be needed to induce such data-sharing. PMID:27846287

Deciphering landslide behavior using large-scale flume experiments

USGS Publications Warehouse

Reid, Mark E.; Iverson, Richard M.; Iverson, Neal R.; LaHusen, Richard G.; Brien, Dianne L.; Logan, Matthew

2008-01-01

Landslides can be triggered by a variety of hydrologic events and they can exhibit a wide range of movement dynamics. Effective prediction requires understanding these diverse behaviors. Precise evaluation in the field is difficult; as an alternative we performed a series of landslide initiation experiments in the large-scale, USGS debris-flow flume. We systematically investigated the effects of three different hydrologic triggering mechanisms, including groundwater exfiltration from bedrock, prolonged rainfall infiltration, and intense bursts of rain. We also examined the effects of initial soil porosity (loose or dense) relative to the soil’s critical-state porosity. Results show that all three hydrologic mechanisms can instigate landsliding, but water pathways, sensor response patterns, and times to failure differ. Initial soil porosity has a profound influence on landslide movement behavior. Experiments using loose soil show rapid soil contraction during failure, with elevated pore pressures liquefying the sediment and creating fast-moving debris flows. In contrast, dense soil dilated upon shearing, resulting in slow, gradual, and episodic motion. These results have fundamental implications for forecasting landslide behavior and developing effective warning systems.

Derivation of a Levelized Cost of Coating (LCOC) metric for evaluation of solar selective absorber materials

DOE PAGES

Ho, C. K.; Pacheco, J. E.

2015-06-05

A new metric, the Levelized Cost of Coating (LCOC), is derived in this paper to evaluate and compare alternative solar selective absorber coatings against a baseline coating (Pyromark 2500). In contrast to previous metrics that focused only on the optical performance of the coating, the LCOC includes costs, durability, and optical performance for more comprehensive comparisons among candidate materials. The LCOC is defined as the annualized marginal cost of the coating to produce a baseline annual thermal energy production. Costs include the cost of materials and labor for initial application and reapplication of the coating, as well as the costmore » of additional or fewer heliostats to yield the same annual thermal energy production as the baseline coating. Results show that important factors impacting the LCOC include the initial solar absorptance, thermal emittance, reapplication interval, degradation rate, reapplication cost, and downtime during reapplication. The LCOC can also be used to determine the optimal reapplication interval to minimize the levelized cost of energy production. As a result, similar methods can be applied more generally to determine the levelized cost of component for other applications and systems.« less

Turbine engine rotor health monitoring evaluation by means of finite element analyses and spin tests data

NASA Astrophysics Data System (ADS)

Abdul-Aziz, Ali; Woike, Mark R.; Clem, Michelle; Baaklini, George Y.

2014-04-01

Generally, rotating engine components undergo high centrifugal loading environment which subject them to various types of failure initiation mechanisms. Health monitoring of these components is a necessity and is often challenging to implement. This is primarily due to numerous factors including the presence of scattered loading conditions, flaw sizes, component geometry and materials properties, all which hinder the simplicity of applying health monitoring applications. This paper represents a summary work of combined experimental and analytical modeling that included data collection from a spin test experiment of a rotor disk addressing the aforementioned durability issues. It further covers presentation of results obtained from a finite element modeling study to characterize the structural durability of a cracked rotor as it relates to the experimental findings. The experimental data include blade tip clearance, blade tip timing and shaft displacement measurements. The tests were conducted at the NASA Glenn Research Center's Rotordynamics Laboratory, a high precision spin rig. The results are evaluated and examined to determine their significance on the development of a health monitoring system to pre-predict cracks and other anomalies and to assist in initiating a supplemental physics based fault prediction analytical model.

Should tsunami simulations include a nonzero initial horizontal velocity?

NASA Astrophysics Data System (ADS)

Lotto, Gabriel C.; Nava, Gabriel; Dunham, Eric M.

2017-08-01

Tsunami propagation in the open ocean is most commonly modeled by solving the shallow water wave equations. These equations require initial conditions on sea surface height and depth-averaged horizontal particle velocity or, equivalently, horizontal momentum. While most modelers assume that initial velocity is zero, Y.T. Song and collaborators have argued for nonzero initial velocity, claiming that horizontal displacement of a sloping seafloor imparts significant horizontal momentum to the ocean. They show examples in which this effect increases the resulting tsunami height by a factor of two or more relative to models in which initial velocity is zero. We test this claim with a "full-physics" integrated dynamic rupture and tsunami model that couples the elastic response of the Earth to the linearized acoustic-gravitational response of a compressible ocean with gravity; the model self-consistently accounts for seismic waves in the solid Earth, acoustic waves in the ocean, and tsunamis (with dispersion at short wavelengths). Full-physics simulations of subduction zone megathrust ruptures and tsunamis in geometries with a sloping seafloor confirm that substantial horizontal momentum is imparted to the ocean. However, almost all of that initial momentum is carried away by ocean acoustic waves, with negligible momentum imparted to the tsunami. We also compare tsunami propagation in each simulation to that predicted by an equivalent shallow water wave simulation with varying assumptions regarding initial velocity. We find that the initial horizontal velocity conditions proposed by Song and collaborators consistently overestimate the tsunami amplitude and predict an inconsistent wave profile. Finally, we determine tsunami initial conditions that are rigorously consistent with our full-physics simulations by isolating the tsunami waves from ocean acoustic and seismic waves at some final time, and backpropagating the tsunami waves to their initial state by solving the adjoint problem. The resulting initial conditions have negligible horizontal velocity.[Figure not available: see fulltext.

Nutrient enrichment, biodiversity loss, and consequent declines in ecosystem productivity.

PubMed

Isbell, Forest; Reich, Peter B; Tilman, David; Hobbie, Sarah E; Polasky, Stephen; Binder, Seth

2013-07-16

Anthropogenic drivers of environmental change often have multiple effects, including changes in biodiversity, species composition, and ecosystem functioning. It remains unknown whether such shifts in biodiversity and species composition may, themselves, be major contributors to the total, long-term impacts of anthropogenic drivers on ecosystem functioning. Moreover, although numerous experiments have shown that random losses of species impact the functioning of ecosystems, human-caused losses of biodiversity are rarely random. Here we use results from long-term grassland field experiments to test for direct effects of chronic nutrient enrichment on ecosystem productivity, and for indirect effects of enrichment on productivity mediated by resultant species losses. We found that ecosystem productivity decreased through time most in plots that lost the most species. Chronic nitrogen addition also led to the nonrandom loss of initially dominant native perennial C4 grasses. This loss of dominant plant species was associated with twice as great a loss of productivity per lost species than occurred with random species loss in a nearby biodiversity experiment. Thus, although chronic nitrogen enrichment initially increased productivity, it also led to loss of plant species, including initially dominant species, which then caused substantial diminishing returns from nitrogen fertilization. In contrast, elevated CO2 did not decrease grassland plant diversity, and it consistently promoted productivity over time. Our results support the hypothesis that the long-term impacts of anthropogenic drivers of environmental change on ecosystem functioning can strongly depend on how such drivers gradually decrease biodiversity and restructure communities.

Frequency Spectrum for New Aviation Data Links: Initial Study Results

NASA Technical Reports Server (NTRS)

Matolak, David W.; Branstetter, James R.

2004-01-01

We describe results from an initial study to assess the suitability of various spectral bands for supporting the deployment of new aviation data links (ADL). The study focused on systems and spectral bands that can deliver VHF data link (VDL)-or-higher data rates in a two-way communication setting, including air-ground, ground-air, and air-air modes of operation. In the first part of our paper, we briefly discuss the current situation regarding communications, navigation, and surveillance (CNS) links and existing spectrum, and the well-known need for new aviation data links. We next provide an overview of related systems, and discuss key factors involved in the use of spectrum in various bands for any future integrated CNS data link, addressing primarily the lower few layers of the communications protocol stack. Desired attributes of a new ADL system are discussed, and the beneficial aspects of a particular transmission technique spread spectrum are summarized. We also provide a short list of several example potential spectral regions, and note that while none of the existing systems will likely meet the full range of desired features of a new ADL, several systems and spectral regions offer promise in terms of one or more characteristics. A detailed discussion and evaluation of these spectral regions is proposed as future work. We include a few brief examples to illustrate initial technical results regarding spread spectrum overlay, also a subject for future work.

Factors affecting patient compliance with compressive brace therapy for pectus carinatum.

PubMed

Kang, Du-Young; Jung, Junho; Chung, Sangho; Cho, Jinkyung; Lee, Sungsoo

2014-12-01

The aim of this study was to identify factors affecting patient compliance with brace therapy for pectus carinatum. Eighty-six pectus carinatum patients who started brace therapy from August 2008 to November 2011 were included in this study. Patients were divided into two groups: patients who wore the brace for ≥6 months (compliance group) or patients who wore the brace for <6 months (non-compliance group). Factors affecting patient compliance were assessed at the last day of follow-up with a multiple-choice questionnaire. The questionnaire comprised seven items: pain at compression site, skin problems on compression area, confidence in brace treatment, shame, discomfort, initial result of bracing treatment and total number of factors affecting patient compliance. Eighty-six patients completed the survey, including seven (8.1%) female patients and 79 (91.9%) male patients, with a mean age of 12.0 years at the time of treatment (range, 3-20 years). The initial result of the compression period (P <0.001) and total number of factors affecting patient compliance (P <0.05) were significant predictors of patient compliance. An initial successful result of the compression period may increase patient compliance during treatment for pectus carinatum. Additional efforts to decrease pain, skin problems, shame and discomfort, and to give confidence may be beneficial in increasing compliance with bracing treatment. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

24 CFR 248.173 - Resident homeownership program.

Code of Federal Regulations, 2013 CFR

2013-04-01

... or a public body, including an agency or instrumentality thereof. Such organization shall have..., and moderate income persons at initial occupancy are of the same proportion of very low, low, and... date results in the higher proportion of very low income families, except that the resident council may...

24 CFR 248.173 - Resident homeownership program.

Code of Federal Regulations, 2012 CFR

2012-04-01

... or a public body, including an agency or instrumentality thereof. Such organization shall have..., and moderate income persons at initial occupancy are of the same proportion of very low, low, and... date results in the higher proportion of very low income families, except that the resident council may...

24 CFR 248.173 - Resident homeownership program.

Code of Federal Regulations, 2011 CFR

2011-04-01

... or a public body, including an agency or instrumentality thereof. Such organization shall have..., and moderate income persons at initial occupancy are of the same proportion of very low, low, and... date results in the higher proportion of very low income families, except that the resident council may...

24 CFR 248.173 - Resident homeownership program.

Code of Federal Regulations, 2014 CFR

2014-04-01

... or a public body, including an agency or instrumentality thereof. Such organization shall have..., and moderate income persons at initial occupancy are of the same proportion of very low, low, and... date results in the higher proportion of very low income families, except that the resident council may...

241-AZ-101 Waste Tank Color Video Camera System Shop Acceptance Test Report

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

WERRY, S.M.

2000-03-23

This report includes shop acceptance test results. The test was performed prior to installation at tank AZ-101. Both the camera system and camera purge system were originally sought and procured as a part of initial waste retrieval project W-151.

The Application of Gestalt Principles in Classroom Teaching

ERIC Educational Resources Information Center

Phillips, Mark

1976-01-01

Discusses the application of principles and techniques derived from Gestalt therapy to education. Initial investigations of the results of these applications have noted significant benefits to both teachers and students, including personal control, self-knowledge and self-esteem. For journal availability, see SO 504 730. (Author/DB)

78 FR 60256 - Initial Patent Applications

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

... patent statutes and regulations to be issued as a patent. Most applications for patent, including new.../process/fiie/efs/guidance/New legal framework.jsp, provides a listing of patent applications and documents... declaration forms that were created to comply with the changes resulting from the Leahy-Smith America Invents...

Phase 2 Report: Oahu Wind Integration and Transmission Study (OWITS); Hawaiian Islands Transmission Interconnection Project

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

Woodford, D.

This report provides an independent review including an initial evaluation of the technical configuration and capital costs of establishing an undersea cable system and examining impacts to the existing electric transmission systems as a result of interconnecting the islands

Animal-vehicle crash mitigation using advanced technology : phase II, system effectiveness and system acceptance.

DOT National Transportation Integrated Search

2009-03-01

This project was initiated in the fall of 1999. The results through the fall of 2005 (Phase I) have been documented in detail in an earlier report. The accomplishments of Phase I included the following: the identification of existing animal detection...

Creating a Learning Organization: A Case Study of Outcomes and Lessons Learned.

ERIC Educational Resources Information Center

Bierema, Laura L.; Berdish, David M.

1999-01-01

Discusses how organizations are gaining a competitive edge in a global business environment through learning and highlights a learning organization implementation case study of a division of Ford Motor Company. Examines the strategic initiative; performance improvement results; individual learning, including interpersonal development and…

Micro-Mechanical Analysis About Kink Band in Carbon Fiber/Epoxy Composites Under Longitudinal Compression

NASA Astrophysics Data System (ADS)

Zhang, Mi; Guan, Zhidong; Wang, Xiaodong; Du, Shanyi

2017-10-01

Kink band is a typical phenomenon for composites under longitudinal compression. In this paper, theoretical analysis and finite element simulation were conducted to analyze kink angle as well as compressive strength of composites. Kink angle was considered to be an important character throughout longitudinal compression process. Three factors including plastic matrix, initial fiber misalignment and rotation due to loading were considered for theoretical analysis. Besides, the relationship between kink angle and fiber volume fraction was improved and optimized by theoretical derivation. In addition, finite element models considering fiber stochastic strength and Drucker-Prager constitutive model for matrix were conducted in ABAQUS to analyze kink band formation process, which corresponded with the experimental results. Through simulation, the loading and failure procedure can be evidently divided into three stages: elastic stage, softening stage, and fiber break stage. It also shows that kink band is a result of fiber misalignment and plastic matrix. Different values of initial fiber misalignment angle, wavelength and fiber volume fraction were considered to explore the effects on compressive strength and kink angle. Results show that compressive strength increases with the decreasing of initial fiber misalignment angle, the decreasing of initial fiber misalignment wavelength and the increasing of fiber volume fraction, while kink angle decreases in these situations. Orthogonal array in statistics was also built to distinguish the effect degree of these factors. It indicates that initial fiber misalignment angle has the largest impact on compressive strength and kink angle.

Inhaled corticosteroids and the occurrence of oral candidiasis: a prescription sequence symmetry analysis.

PubMed

van Boven, Job F M; de Jong-van den Berg, Lolkje T W; Vegter, Stefan

2013-04-01

The primary aim of the study was to gain insight into the relative risk of clinically relevant oral candidiasis following inhaled corticosteroid (ICS) initiation over time. A secondary aim was to analyse the influence of patient characteristics and co-medication on the occurrence of this adverse effect. Drug prescription data from 1994 to 2011 were retrieved from the IADB.nl database. To study the influence of ICS use on occurrence of oral candidiasis, a prescription symmetry analysis was used, including patients using medication for oral candidiasis up to 1 year before or after ICS initiation. The relative risk was calculated by dividing the number of patients receiving medication for oral candidiasis after ICS initiation by the number of patients receiving the same medication before ICS initiation. Sub-analyses were conducted to compare the relative risks at several time points after ICS initiation and to account for therapy persistence by only including chronic users of ICS. A multivariate logistic regression model was used to identify predictive factors. A total of 52,279 incident users of ICS therapy were identified, of which 1,081 received medication for oral candidiasis up to 1 year before or after ICS initiation. A total of 701 patients received medication for oral candidiasis after ICS initiation, while 361 received these medications in the reversed sequence, resulting in a sequence ratio (SR) of 1.94 (95 % CI 1.71-2.21). In the first 3 months after ICS initiation, the SR was 2.72 (95 % CI 2.19-3.38) and then decreased to 1.47 (95 % CI 1.11-1.95) 9-12 months after ICS initiation. Predictive factors were higher daily dose of ICS and concomitant use of oral corticosteroids. This study found a significant and clinically relevant increased number of patients receiving medication for oral candidiasis in the first year after therapy initiation with ICS. Relative risk is highest in the first 3 months, but remains increased up to at least 1 year after ICS initiation. This study stresses the need for patient education and inhalation instruction.

Comparison of cross sections from the quasi-classical trajectory method and the j(z)-conserving centrifugal sudden approximation with accurate quantum results for an atom-rigid nonlinear polyatomic collision

NASA Technical Reports Server (NTRS)

Schwenke, David W.

1993-01-01

We report the results of a series of calculations of state-to-state integral cross sections for collisions between O and nonvibrating H2O in the gas phase on a model nonreactive potential energy surface. The dynamical methods used include converged quantum mechanical scattering calculations, the j(z) conserving centrifugal sudden (j(z)-CCS) approximation, and quasi-classical trajectory (QCT) calculations. We consider three total energies 0.001, 0.002, and 0.005 E(h) and the nine initial states with rotational angular momentum less than or equal to 2 (h/2 pi). The j(z)-CCS approximation gives good results, while the QCT method can be quite unreliable for transitions to specific rotational sublevels. However, the QCT cross sections summed over final sublevels and averaged over initial sublevels are in better agreement with the quantum results.

Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances.

PubMed

Jian, Fan; Lai, Wenli; Furness, Susan; McIntyre, Grant T; Millett, Declan T; Hickman, Joy; Wang, Yan

2013-04-30

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review 'Initial arch wires for alignment of crooked teeth with fixed orthodontic braces' first published in the Cochrane Database of Systematic Reviews 2010, Issue 4. To assess the effects of initial arch wires for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 2 August 2012), CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE via OVID (1950 to 2 August 2012) and EMBASE via OVID (1980 to 2 August 2012). We also searched the reference lists of relevant articles. There was no restriction with regard to publication status or language of publication. We contacted all authors of included studies to identify additional studies. We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. Only studies involving participants with upper and/or lower full arch fixed orthodontic appliances were included. Two review authors were responsible for study selection, validity assessment and data extraction. All disagreements were resolved by discussion amongst the review team. Corresponding authors of included studies were contacted to obtain missing information. Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias and a number of methodological limitations were identified. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption.Three groups of comparisons were made.(1) Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.(2) Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over 6 months and the other reporting pain over 1 week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch wires with regard to either alignment or pain.(3) Single-strand superelastic NiTi initial arch wires compared to other NiTi (coaxial, copper NiTi (CuNiTi) or thermoelastic) initial arch wires. The three trials in this comparison each compared a different product against single-strand superelastic NiTi. There is very weak unreliable evidence, based on one very small study (n = 24) at high risk of bias, that coaxial superelastic NiTi may produce greater tooth movement over 12 weeks, but no information on associated pain or root resorption. This result should be interpreted with caution until further research evidence is available. There is insufficient evidence to determine whether or not there is a difference between either thermoelastic or CuNiTi and superelastic NiTi initial arch wires. There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered, RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.

Leishmania Antigenuria to Predict Initial Treatment Failure and Relapse in Visceral Leishmaniasis/HIV Coinfected Patients: An Exploratory Study Nested Within a Clinical Trial in Ethiopia.

PubMed

van Griensven, Johan; Mengesha, Bewketu; Mekonnen, Tigist; Fikre, Helina; Takele, Yegnasew; Adem, Emebet; Mohammed, Rezika; Ritmeijer, Koert; Vogt, Florian; Adriaensen, Wim; Diro, Ermias

2018-01-01

Background: Biomarkers predicting the risk of VL treatment failure and relapse in VL/HIV coinfected patients are needed. Nested within a two-site clinical trial in Ethiopia (2011-2015), we conducted an exploratory study to assess whether (1) levels of Leishmania antigenuria measured at VL diagnosis were associated with initial treatment failure and (2) levels of Leishmania antigenuria at the end of treatment (parasitologically-confirmed cure) were associated with subsequent relapse. Methods: Leishmania antigenuria at VL diagnosis and cure was determined using KAtex urine antigen test and graded as negative (0), weak/moderate (grade 1+/2+) or strongly-positive (3+). Logistic regression and Kaplan-Meier methods were used to assess the association between antigenuria and (1) initial treatment failure, and (2) relapse over the 12 months after cure, respectively. Results: The analysis to predict initial treatment failure included sixty-three coinfected adults [median age: 30 years interquartile range (IQR) 27-35], median CD4 count: 56 cells/μL (IQR 38-113). KAtex results at VL diagnosis were negative in 11 (17%), weak/moderate in 17 (27%) and strongly-positive in 35 (36%). Twenty (32%) patients had parasitologically-confirmed treatment failure, with a risk of failure of 9% (1/11) with KAtex-negative results, 0% (0/17) for KAtex 1+/2+ and 54% (19/35) for KAtex 3+ results. Compared to KAtex-negative patients, KAtex 3+ patients were at increased risk of treatment failure [odds ratio 11.9 (95% CI 1.4-103.0); P : 0.025]. Forty-four patients were included in the analysis to predict relapse [median age: 31 years (IQR 28-35), median CD4 count: 116 cells/μL (IQR 95-181)]. When achieving VL cure, KAtex results were negative in 19 (43%), weak/moderate (1+/2+) in 10 (23%), and strongly positive (3+) in 15 patients (34%). Over the subsequent 12 months, eight out of 44 patients (18%) relapsed. The predicted 1-year relapse risk was 6% for KAtex-negative results, 14% for KAtex 1+/2+ and 42% for KAtex 3+ results [hazard ratio of 2.2 (95% CI 0.1-34.9) for KAtex 1+/2+ and 9.8 (95% CI 1.8-82.1) for KAtex 3+, compared to KAtex negative patients; P : 0.03]. Conclusion: A simple field-deployable Leishmania urine antigen test can be used for risk stratification of initial treatment failure and VL relapse in HIV-patients. A dipstick-format would facilitate field implementation.

Addressing regional disparities in pediatric oncology: Results of a collaborative initiative across the Mexican-North American border.

PubMed

Aristizabal, Paula; Fuller, Spencer; Rivera-Gomez, Rebeca; Ornelas, Mario; Nuno, Laura; Rodriguez-Galindo, Carlos; Ribeiro, Raul; Roberts, William

2017-06-01

Cancer is emerging as a major cause of childhood mortality in low- and middle-income countries. In Mexico, cancer is the number one cause of death in children aged 5-14. Until recently, many children with cancer from Baja California, Mexico, went untreated. We reasoned that an initiative inspired by the St. Jude Children's Research Hospital (SJCRH) "twinning" model could successfully be applied to the San Diego-Tijuana border region. In 2008, a twinning project was initiated by Rady Children's Hospital, SJCRH, and the General Hospital Tijuana (GHT). Our aim was to establish a pediatric oncology unit in a culturally sensitive manner, adapted to the local healthcare system. An initial assessment revealed that despite existence of basic hospital infrastructure at the GHT, the essential elements of a pediatric cancer unit were lacking, including dedicated space, trained staff, and uniform treatment. A 5-year action plan was designed to offer training, support the staff financially, and improve the infrastructure. After 7 years, accomplishments include the opening of a new inpatient unit with updated technology, fully trained staff, and a dedicated, interdisciplinary team. Over 700 children have benefited from accurate diagnosis and treatment. Initiatives that implement long-term partnerships between institutions along the Mexican-North American border can be highly effective in establishing successful pediatric cancer control programs. The geographic proximity facilitated accelerated training and close monitoring of project development. Similar initiatives across other disciplines may benefit additional patients and synergize with pediatric oncology programs to reduce health disparities in underserved areas. © 2016 Wiley Periodicals, Inc.

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence: Problem for Young Women.

PubMed

Smolina, Kate; Ball, Laura; Humphries, Karin H; Khan, Nadia; Morgan, Steven G

2015-11-01

The prevalence of the use of secondary prevention cardiovascular medications is lower among women than men, but it is unclear if this is a result of lower treatment initiation among women or lower treatment adherence. We aimed to map the treatment pathway for survivors of acute myocardial infarction (AMI) by sex and age. This retrospective population-based cohort study used linked administrative data sets in British Columbia (2004-2011), which include health care, prescription drugs, sociodemographic, and mortality information. The study cohort included all individuals admitted to hospital for AMI in 2007-2009 and survived for 1 year after hospital discharge. Patients were evaluated for whether they initiated and then subsequently filled prescriptions angiotensin-converting enzyme inhibitors, β-blockers, and statins. More than two thirds of AMI survivors initiated treatment on all appropriate medications, given their contraindications, within 2 months of discharge. Younger men were significantly more likely than younger women to initiate appropriate treatment (adjusted odds ratio, 1.38; 95% confidence interval, 1.10-1.75). By the end of 1 year after discharge, only one third of all AMI survivors filled all appropriate prescriptions for at least 80% of the year. There was no significant difference in adherence to medication therapy between women and men. The majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently. Women <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence. © 2015 American Heart Association, Inc.

Replication RCT of Early Universal Prevention Effects on Young Adult Substance Misuse

PubMed Central

Spoth, Richard; Trudeau, Linda; Redmond, Cleve; Shin, Chungyeol

2014-01-01

Objective For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood. Method Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program plus Life Skills Training (SFP 10–14 + LST), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including four during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19–22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a two-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction. Results Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with intervention by risk interaction effects favoring the higher-risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher-risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects. Conclusions Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems, into young adulthood. PMID:24821095

Evaluation of Pharmacist Impact on Culture Review Process for Patients Discharged From the Emergency Department.

PubMed

Santiago, Ruben D; Bazan, Jose A; Brown, Nicole V; Adkins, Eric J; Shirk, Mary Beth

2016-10-01

Background: Accurate and timely review of microbiological test results is a core component of antimicrobial stewardship. There is documented success of these programs in the inpatient setting; however, emergency department (ED) patients are typically not included in these initiatives. Objectives: To assess the impact of an emergency medicine pharmacist (EMP)-facilitated review process of positive microbiological test results from patients discharged from the ED as measured by time to positive result review and number of indicated interventions completed. Methods: This was a retrospective study that compared EMP-facilitated to ED charge nurse (CN)-facilitated physician review of randomly selected positive microbiological test results. Groups were compared concurrently within the time frame of July 1, 2012 through December 31, 2012. Results: One hundred seventy-eight positive microbiological test results were included (EMP, n = 91; CN, n = 87). The median (IQR) time to initial review was 3 (1.0-6.3) hours for the EMP and 2 (0.3-5.5) hours for the CN group ( p = .35). Four percent (1/25) of indicated interventions were not completed in the EMP group versus 47% (14/30) in the CN group ( p = .0004). Conclusion: An EMP was significantly less likely to miss an intervention when indicated with no difference in time to review of positive microbiological results. These findings support the role of the EMP in antimicrobial stewardship in the ED.

Modeling surface-water flow and sediment mobility with the Multi-Dimensional Surface-Water Modeling System (MD_SWMS)

USGS Publications Warehouse

McDonald, Richard; Nelson, Jonathan; Kinzel, Paul; Conaway, Jeffrey S.

2006-01-01

The Multi-Dimensional Surface-Water Modeling System (MD_SWMS) is a Graphical User Interface for surface-water flow and sediment-transport models. The capabilities of MD_SWMS for developing models include: importing raw topography and other ancillary data; building the numerical grid and defining initial and boundary conditions; running simulations; visualizing results; and comparing results with measured data.

First results from a large, multi-platform study of trace gas and particle emissions from biomass burning

Treesearch

I. R. Burling; R. J. Yokelson; S. K. Akagi; T. J. Johnson; D. W. Griffith; Shawn Urbanski; J. W. Taylor; J. S. Craven; G. R. McMeeking; J. M. Roberts; C. Warneke; P. R. Veres; J. A. de Gouw; J. B. Gilman; W. C. Kuster; WeiMin Hao; D. Weise; H. Coe; J. Seinfeld

2010-01-01

We report preliminary results from a large, multi-component study focused on North American biomass burning that measured both initial emissions and post-emission processing. Vegetation types burned were from the relatively less-studied temperate region of the US and included chaparral, oak savanna, and mixed conifer forest from the southwestern US, and pine understory...

CALiPER Report 24: OLED Luminaires

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

Miller, N. J.; Leon, F. A.; Davis, J. L.

2017-08-01

This report documents an initial investigation of OLED luminaires and summarizes the key features of those products. In addition to photometric testing of four commercial products in independent laboratories, PNNL examined many of the products through teardown testing (disassemblies to identify parts and functionality) in PNNL laboratories. Results of these tests as well as results of stress testing of several OLED luminaires at RTI International have been included.

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

Hermes, Robert E.

An encapsulated composition for polymerization includes an initiator composition for initiating a polymerization reaction, and a capsule prepared from an elemental metal or fusible alloy having a melting temperature from about 20.degree. C. to about 200.degree. C. A fluid for polymerization includes the encapsulated composition and a monomer. When the capsule melts or breaks open, the initiator is released.

Mesoscale Modeling, Forecasting and Remote Sensing Research.

DTIC Science & Technology

remote sensing , cyclonic scale diagnostic studies and mesoscale numerical modeling and forecasting are summarized. Mechanisms involved in the release of potential instability are discussed and simulated quantitatively, giving particular attention to the convective formulation. The basic mesoscale model is documented including the equations, boundary condition, finite differences and initialization through an idealized frontal zone. Results of tests including a three dimensional test with real data, tests of convective/mesoscale interaction and tests with a detailed

The potential impact of accountable care organizations with respect to cost and quality with special attention to imaging.

PubMed

Mukherji, Suresh K

2014-04-01

An accountable care organization is a form of a managed care organization in which a group of networked health care providers, which may include hospitals, group practices, networks of practices, hospital-provider partnerships, or joint ventures, are accountable for the health care of a defined group of patients. Initial results of the institutions participating in CMS's Physician Group Demonstration Project did not demonstrate a substantial reduction in imaging that could be directly attributed to the accountable care organization model. However, the initial results suggest that incentive-based methodology appears to be successful for increasing compliance for measuring quality metrics. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Report on the Development of the Advanced Encryption Standard (AES).

PubMed

Nechvatal, J; Barker, E; Bassham, L; Burr, W; Dworkin, M; Foti, J; Roback, E

2001-01-01

In 1997, the National Institute of Standards and Technology (NIST) initiated a process to select a symmetric-key encryption algorithm to be used to protect sensitive (unclassified) Federal information in furtherance of NIST's statutory responsibilities. In 1998, NIST announced the acceptance of 15 candidate algorithms and requested the assistance of the cryptographic research community in analyzing the candidates. This analysis included an initial examination of the security and efficiency characteristics for each algorithm. NIST reviewed the results of this preliminary research and selected MARS, RC™, Rijndael, Serpent and Twofish as finalists. Having reviewed further public analysis of the finalists, NIST has decided to propose Rijndael as the Advanced Encryption Standard (AES). The research results and rationale for this selection are documented in this report.

Mathematical modeling of damage in unidirectional composites

NASA Technical Reports Server (NTRS)

Goree, J. G.; Dharani, L. R.; Jones, W. F.

1983-01-01

Extending the work of Goree and Gross (1979), solutions are given for a two-dimensional region of unidirectional fibers embedded in an elastic matrix whose initial flaw may take the form of a transverse notch, a rectangular cutout, or a circular hole. Subsequent flaw-induced damage is generated by remote stresses acting parallel to the fibers. For the case of such ductile matrix composites as boron/aluminum, present results indicate that both longitudinal matrix yielding and transverse notch extension must be included in order for the model to agree with experimental results. Little difference is found for the three types of initial damage considered. In all cases, the presence of additional damage changes the nature of stress distribution through the unbroken fibers.

Equipment. [for testing human space perception

NASA Technical Reports Server (NTRS)

1974-01-01

A discussion is presented on the problems encountered in designing and constructing a simulator to determine human vestibular response to a range of linear accelerations from 0 to 0.3 g's. Starting with a set of initial performance specifications, the designers combined an array of commercially available components into a system which, altough requiring further refinement before completion, shows considerable promise of fulfilling the initial requirements. The resulting system consists of a wheeled vehicle driven by a cable and drum arrangement, powered by a hydraulic-electric servo-valve. Technical design considerations are presented along with a discussion of the trade-offs between various component options. A description of the system characteristics as well as an analysis of preliminary test results and recommendations for future system improvements are included.

Initial Results From The Chandra High Energy Transmission Grating Spectrometer

NASA Technical Reports Server (NTRS)

Canizares, C. R.; Davis, D. S.; Dewey, D.; Flanagan, K. A.; Houck, J.; Huenemoerder, D. P.; Marshall, H. L.; Schattenburg, M. L.; Schulz, N. S.; Wise, M.

2000-01-01

The High Energy Transmission Grating Spectrometer (HETGS) on the Chandra X-ray Observatory provides spectral resolving powers of 200-1000 over the range 0.4-8.0 keV (1.5-30 A) with effective area of 2-200 square centimeters. Initial observations during the activation and calibration phases of the mission show that the HETGS is performing as predicted prior to Chandra launch. The talk presented very preliminary results that illustrate the power of the HETGS for performing detailed studies of a wide range of celestial sources, including plasma diagnostics. This written version gives a brief summary of that talk with examples of preliminary spectra of Capella, the Crab pulsar, SS433 and the SNR E0102-72.

The role local initiatives in community based disaster risk management in Kemijen, Semarang City

NASA Astrophysics Data System (ADS)

Fauzie, W. Z.; Sariffudin, S.

2017-06-01

Community-based disaster risk reduction is one of the homegrown initiatives efforts and community empowerment oriented in disaster management. This approach is very important because no one can understand the conditions in a region better than the local communities. Therefore, the implementation of CBDRM always emphasize local initiatives in decision making. The existence of local initiative is necessary specially to anticipate the impact of climate change which is increasingly affecting towns in coastal areas, including settlements in Semarang. Kemijen Urban Village is one of the informal settlements in Semarang, which has the highest intensity of flood that is 12 times during 5 years (2011-2015). The research question is how the level of local initiatives in flood disaster management in Kemijen, Semarang? This study aims to assess the level of local initiatives in Kemijen as the community adaptive capacity of flood prevention in pre-disaster, emergency response, and post-disaster. Local initiatives assessed on water supply, sanitation, food, shelter, health, drainage maintenance and waste management. This study shows the level of local initiatives in pre-disaster and post-disaster is almost same and bigger than the response phase. Scoring results showed that pre-disaster is 35.002, 27.9577 for emergency response, and post-disaster is 34.9862 with each category that is independent, empowered, and independent. This study also shows that local initiatives in Kemijen largely formed by individual initiative and only a few were formed by a collective initiative.

Clinician Descriptions of Communication Strategies to Improve Treatment Engagement by Racial/Ethnic Minorities in Mental Health Services: A Systematic Review

PubMed Central

Aggarwal, Neil Krishan; Pieh, Matthew C.; Dixon, Lisa; Guarnaccia, Peter; Alegría, Margarita; Lewis-Fernández, Roberto

2015-01-01

Objective To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Methods Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Results Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. Conclusion Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. Practice implications Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations. PMID:26365436

Building the field of population health intervention research: The development and use of an initial set of competencies.

PubMed

Riley, Barbara; Harvey, Jean; Di Ruggiero, Erica; Potvin, Louise

2015-01-01

Population health intervention research (PHIR) is a relatively new research field that studies interventions that can improve health and health equity at a population level. Competencies are one way to give legitimacy and definition to a field. An initial set of PHIR competencies was developed with leadership from a multi-sector group in Canada. This paper describes the development process for these competencies and their possible uses. Methods to develop the competencies included key informant interviews; a targeted review of scientific and gray literature; a 2-round, online adapted Delphi study with a 24-member panel; and a focus group with 9 international PHIR experts. The resulting competencies consist of 25 items grouped into 6 categories. They include principles of good science applicable though not exclusive to PHIR, and more suitable for PHIR teams rather than individuals. This initial set of competencies, released in 2013, may be used to develop graduate student curriculum, recruit trainees and faculty to academic institutions, plan non-degree professional development, and develop job descriptions for PHIR-related research and professional positions. The competencies provide some initial guideposts for the field and will need to be adapted as the PHIR field matures and to meet unique needs of different jurisdictions.

Building the field of population health intervention research: The development and use of an initial set of competencies

PubMed Central

Riley, Barbara; Harvey, Jean; Di Ruggiero, Erica; Potvin, Louise

2015-01-01

Population health intervention research (PHIR) is a relatively new research field that studies interventions that can improve health and health equity at a population level. Competencies are one way to give legitimacy and definition to a field. An initial set of PHIR competencies was developed with leadership from a multi-sector group in Canada. This paper describes the development process for these competencies and their possible uses. Methods to develop the competencies included key informant interviews; a targeted review of scientific and gray literature; a 2-round, online adapted Delphi study with a 24-member panel; and a focus group with 9 international PHIR experts. The resulting competencies consist of 25 items grouped into 6 categories. They include principles of good science applicable though not exclusive to PHIR, and more suitable for PHIR teams rather than individuals. This initial set of competencies, released in 2013, may be used to develop graduate student curriculum, recruit trainees and faculty to academic institutions, plan non-degree professional development, and develop job descriptions for PHIR-related research and professional positions. The competencies provide some initial guideposts for the field and will need to be adapted as the PHIR field matures and to meet unique needs of different jurisdictions. PMID:26844160

Making Initial Earthquake Catalogs from a Temporary Seismic Network for Monitoring Aftershocks

NASA Astrophysics Data System (ADS)

Park, J.; Kang, T. S.; Kim, K. H.; Rhie, J.; Kim, Y.

2017-12-01

The ML 5.1 foreshock and the ML 5.8 mainshock earthquakes occurred consecutively in Gyeongju, the southeastern part of the Korean Peninsula, on September 12, 2016. A temporary seismic network was installed quickly to observe aftershocks followed this mainshock event in the vicinity of the epicenter. The network was consisting of 27 stations equipped with broadband sensors initially and it has been operated in off-line system which required a periodic manual backup of the recorded data. We detected P-triggers and associated events by using SeisComP3 to make an initial catalogue of aftershock events rapidly. If necessary, manual picking was performed to obtain precise P- and S-arrival times from a module, scolv, included in SeisComP3. For cross-checking of reliable identification of seismic phases, a seismic python package, PhasePApy, was applied in parallel with SeisComP3. Then we get the precise relocated coordinates and depth of the aftershock events using the velellipse algorithm. The resulting dataset comprises of an initial aftershock catalog. The catalog will provide the means to address some important questions and issues on seismogenesis in this intraplate seismicity region including the 2016 Gyeongju earthquake sequence and to improve seismic hazard estimation of the region.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

PubMed

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

2012-09-01

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research. © 2012 John Wiley & Sons A/S.

Pretest analysis document for Test S-FS-6

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

Shaw, R.A.; Hall, D.G.

This report documents the pretest analyses completed for Semiscale Test S-FS-6. This test will simulate a transient initiated by a 100% break in a steam generator bottom feedwater line downstream of the check valve. The initial conditions represent normal operating conditions for a C-E System 80 nuclear power plant. Predictions of transients resulting from feedwater line breaks in these plants have indicated that significant primary system overpressurization may occur. The enclosed analyses include a RELAP5/MOD2/CY21 code calculation and preliminary results from a facility hot, integrated test which was conducted to near S-FS-6 specifications. The results of these analyses indicate thatmore » the test objectives for Test S-FS-6 can be achieved. The primary system overpressurization will pose no threat to personnel or plant integrity.« less

Practical implementation of a particle filter data assimilation approach to estimate initial hydrologic conditions and initialize medium-range streamflow forecasts

NASA Astrophysics Data System (ADS)

Clark, Elizabeth; Wood, Andy; Nijssen, Bart; Mendoza, Pablo; Newman, Andy; Nowak, Kenneth; Arnold, Jeffrey

2017-04-01

In an automated forecast system, hydrologic data assimilation (DA) performs the valuable function of correcting raw simulated watershed model states to better represent external observations, including measurements of streamflow, snow, soil moisture, and the like. Yet the incorporation of automated DA into operational forecasting systems has been a long-standing challenge due to the complexities of the hydrologic system, which include numerous lags between state and output variations. To help demonstrate that such methods can succeed in operational automated implementations, we present results from the real-time application of an ensemble particle filter (PF) for short-range (7 day lead) ensemble flow forecasts in western US river basins. We use the System for Hydromet Applications, Research and Prediction (SHARP), developed by the National Center for Atmospheric Research (NCAR) in collaboration with the University of Washington, U.S. Army Corps of Engineers, and U.S. Bureau of Reclamation. SHARP is a fully automated platform for short-term to seasonal hydrologic forecasting applications, incorporating uncertainty in initial hydrologic conditions (IHCs) and in hydrometeorological predictions through ensemble methods. In this implementation, IHC uncertainty is estimated by propagating an ensemble of 100 temperature and precipitation time series through conceptual and physically-oriented models. The resulting ensemble of derived IHCs exhibits a broad range of possible soil moisture and snow water equivalent (SWE) states. The PF selects and/or weights and resamples the IHCs that are most consistent with external streamflow observations, and uses the particles to initialize a streamflow forecast ensemble driven by ensemble precipitation and temperature forecasts downscaled from the Global Ensemble Forecast System (GEFS). We apply this method in real-time for several basins in the western US that are important for water resources management, and perform a hindcast experiment to evaluate the utility of PF-based data assimilation on streamflow forecasts skill. This presentation describes findings, including a comparison of sequential and non-sequential particle weighting methods.

A Track Initiation Method for the Underwater Target Tracking Environment

NASA Astrophysics Data System (ADS)

Li, Dong-dong; Lin, Yang; Zhang, Yao

2018-04-01

A novel efficient track initiation method is proposed for the harsh underwater target tracking environment (heavy clutter and large measurement errors): track splitting, evaluating, pruning and merging method (TSEPM). Track initiation demands that the method should determine the existence and initial state of a target quickly and correctly. Heavy clutter and large measurement errors certainly pose additional difficulties and challenges, which deteriorate and complicate the track initiation in the harsh underwater target tracking environment. There are three primary shortcomings for the current track initiation methods to initialize a target: (a) they cannot eliminate the turbulences of clutter effectively; (b) there may be a high false alarm probability and low detection probability of a track; (c) they cannot estimate the initial state for a new confirmed track correctly. Based on the multiple hypotheses tracking principle and modified logic-based track initiation method, in order to increase the detection probability of a track, track splitting creates a large number of tracks which include the true track originated from the target. And in order to decrease the false alarm probability, based on the evaluation mechanism, track pruning and track merging are proposed to reduce the false tracks. TSEPM method can deal with the track initiation problems derived from heavy clutter and large measurement errors, determine the target's existence and estimate its initial state with the least squares method. What's more, our method is fully automatic and does not require any kind manual input for initializing and tuning any parameter. Simulation results indicate that our new method improves significantly the performance of the track initiation in the harsh underwater target tracking environment.

Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation Among Adolescent Girls in the United States

PubMed Central

Henry, Kevin A.; Stroup, Antoinette M.; Warner, Echo L; Kepka, Deanna

2015-01-01

Background This study is among the first to explore geographic factors that may be associated with HPV vaccine uptake in the United States. Methods Data from the 2011 and 2012 National Immunization Survey-Teen for 20,565 female adolescents aged 13-17 years were analyzed to examine associations of HPV vaccine initiation (receipt of at least one dose) with ZIP code-level geographic factors. Logistic regression including individual and geographic factors was used to estimate the odds of HPV vaccine initiation. Results Approximately 53% of girls initiated the HPV vaccine in both years. Girls in high poverty communities had higher HPV vaccine initiation compared to those in low poverty communities (61.1% vs .52.4%; Adjusted Odds Ratio [AOR] 1.18,95%CI 1.04-1.33). Initiation was higher among girls in communities where the majority of the population was Hispanic (69.0% vs. 49.9%;AOR 1.64, 95%CI 1.43-1.87) or non-Hispanic mixed race (60.4% vs. 49.9%; AOR 1.30, 95%CI 1.17-1.44) compared to majority non-Hispanic white communities. Interactions between individual-level race/ethnicity and community racial–ethnic composition indicated significantly higher odds of initiation among Hispanic girls living in Hispanic communities compared to Hispanic girls living in predominately NHW (AOR 2.23;95%CI 1.87-2.65) or NHB (AOR 1.90; 95%CI 1.20-3.04)communities, respectively Conclusion Initiation rates of HPV vaccination among teen girls were highest in the poorest communities and among Hispanics living in communities where the racial–ethnic composition was predominantly Hispanic or mixed race. Impact Given low HPV vaccination rates in the United States, these results provide important evidence to inform public health interventions to increase HPV vaccination. PMID:26768989

Tuning of Recombinant Protein Expression in Escherichia coli by Manipulating Transcription, Translation Initiation Rates, and Incorporation of Noncanonical Amino Acids.

PubMed

Schlesinger, Orr; Chemla, Yonatan; Heltberg, Mathias; Ozer, Eden; Marshall, Ryan; Noireaux, Vincent; Jensen, Mogens Høgh; Alfonta, Lital

2017-06-16

Protein synthesis in cells has been thoroughly investigated and characterized over the past 60 years. However, some fundamental issues remain unresolved, including the reasons for genetic code redundancy and codon bias. In this study, we changed the kinetics of the Eschrichia coli transcription and translation processes by mutating the promoter and ribosome binding domains and by using genetic code expansion. The results expose a counterintuitive phenomenon, whereby an increase in the initiation rates of transcription and translation lead to a decrease in protein expression. This effect can be rescued by introducing slow translating codons into the beginning of the gene, by shortening gene length or by reducing initiation rates. On the basis of the results, we developed a biophysical model, which suggests that the density of co-transcriptional-translation plays a role in bacterial protein synthesis. These findings indicate how cells use codon bias to tune translation speed and protein synthesis.

Cosmological perturbation theory and the spherical collapse model - II. Non-Gaussian initial conditions

NASA Astrophysics Data System (ADS)

Gaztanaga, Enrique; Fosalba, Pablo

1998-12-01

In Paper I of this series, we introduced the spherical collapse (SC) approximation in Lagrangian space as a way of estimating the cumulants xi_J of density fluctuations in cosmological perturbation theory (PT). Within this approximation, the dynamics is decoupled from the statistics of the initial conditions, so we are able to present here the cumulants for generic non-Gaussian initial conditions, which can be estimated to arbitrary order including the smoothing effects. The SC model turns out to recover the exact leading-order non-linear contributions up to terms involving non-local integrals of the J-point functions. We argue that for the hierarchical ratios S_J, these non-local terms are subdominant and tend to compensate each other. The resulting predictions show a non-trivial time evolution that can be used to discriminate between models of structure formation. We compare these analytic results with non-Gaussian N-body simulations, which turn out to be in very good agreement up to scales where sigma<~1.

Planning an organizational wellness initiative at a multi-state social service agency.

PubMed

Miller, J Jay; Grise-Owens, Erlene; Addison, Donia; Marshall, Midaya; Trabue, Donna; Escobar-Ratliff, Laura

2016-06-01

Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Economics of Structured Continuing Education in Selected Professional Journals.

ERIC Educational Resources Information Center

Sasmor, James C.

A study determined what business administration considerations were elements in the managerial decision making process to include structured continuing education in a professional journal and what the positive or negative results have been in terms of operating benefits and profits. An initial literature review showed the need for exploratory…

A Profile of Bullying at School.

ERIC Educational Resources Information Center

Olweus, Dan

2003-01-01

Describes basic facts and common myths about bullying. Covers the key principles of the Olweus Bulling Prevention Program. Discusses the results of research-based evaluations of the Olweus Program. Describes Norway's recent national initiative against bullying, which includes the use of the Olweus Program in a large number of elementary and junior…

Concept of Tone in Mandarin Revisited: A Perceptual Study on Tonal Coarticulation.

ERIC Educational Resources Information Center

Shen, Xiaonan Susan; Lin, Maocan

1991-01-01

Examination of the perceptibility of carryover coarticulatory perturbations occurring at syllabic vowels in Mandarin Chinese suggests that, in connected speech, a portion of fundamental frequency at intertonemic onset is perturbed, including initial voiced consonants and vowels, and that the perturbations result from preservative as well as…

21st Century Library Initiative.

ERIC Educational Resources Information Center

Utah State Library Div., Salt Lake City. Dept. of Community and Economic Development.

This document reports results of a study of Utah's public libraries that included four specific tasks: (1) analysis of demographic data, library use patterns, and projected demand for the next 10 years; (2) a statewide public opinion survey to determine the level of knowledge of and support for Utah's libraries; (3) facilities review, assessment…

Vocational Guidance Institutes 1966. Evaluation.

ERIC Educational Resources Information Center

Plans for Progress, Washington, DC.

Presented here is a detailed summation of the evaluation of 17 Vocational Guidance Institutes initiated, promoted, and supported by Plans for Progress. The data used for evaluation included an analysis of proposals and other pre-institute material, survey data from trainers and participants in the institute, and material resulting from on-site…

Blueprint for Missouri Higher Education: Reporting the Results. 1999 Annual Report.

ERIC Educational Resources Information Center

Missouri Coordinating Board for Higher Education, Jefferson City.

This annual report highlights the actions of the Missouri Coordinating Board for Higher Education and the activities of the Missouri higher education committee. It examines several strategic initiatives undertaken by the state, including: (1) the institutional mission review and enhancement process; (2) MOSTARS (which provides resources and…

40 CFR 1033.320 - Calculation and reporting of test results.

Code of Federal Regulations, 2010 CFR

2010-07-01

... applicable non-deterioration adjustments such as a Green Engine Factor or regeneration adjustment factor... following are true: (1) The catalyst was in a green condition when tested initially. (2) The locomotive met... locomotive, including: (A) Configuration and engine family identification. (B) Year, make, and build date. (C...

The Pennsylvania Phosphorus Index and TopoSWAT: A comparison of transport components and approaches

USDA-ARS?s Scientific Manuscript database

The regional Chesapeake Bay Conservation Innovation Grant Initiative includes comparison of TopoSWAT results and Phosphorus Index (P Index) evaluations of eight study watersheds throughout the Chesapeake Bay watershed. While similarities exist between the P Index and TopoSWAT, further comparison of ...

Fostering Reading Excellence at Every Level of School through Reading Clinics

ERIC Educational Resources Information Center

Ortlieb, Evan; Grandstaff-Beckers, Gerlinde; Cheek, Earl H., Jr.

2012-01-01

With the increased emphasis on standardized testing from state and federal mandates, the need for reading remediation has intensified. Programs directed toward increasing student test scores have been put in place nationwide with mixed results. These initiatives include response to intervention (RTI), direct instruction, and individualized…

Recycling evaluation of new-generation environmentally benign pressure sensitive adhesives

Treesearch

Said M. Abubakr; Carl Houtman; Dave Bormett; Nancy Ross Sutherland; Joe Peng

1999-01-01

As a result of a United States Postal Service (USPS) initiative, a work team was formed consisting of representatives from USPS, Forest Products Laboratory (FPL), Specialized Technology Resources, Inc. (STR), and industry. The industries represented included papermakers, paper recyclers, paper collectors, equipment manufacturers, paper users, adhesive manufacturers and...

Why Dose Frequency Affects Spoken Vocabulary in Preschoolers with Down Syndrome

ERIC Educational Resources Information Center

Yoder, Paul J.; Woynaroski, Tiffany; Fey, Marc E.; Warren, Steven F.; Gardner, Elizabeth

2015-01-01

In an earlier randomized clinical trial, daily communication and language therapy resulted in more favorable spoken vocabulary outcomes than weekly therapy sessions in a subgroup of initially nonverbal preschoolers with intellectual disabilities that included only children with Down syndrome (DS). In this reanalysis of the dataset involving only…

78 FR 774 - Joy Global, Inc., Also Known as Joy Technologies, Inc., Including On-Site Leased Workers From All...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-04

... Manpower, Franklin, PA; Notice of Affirmative Determination Regarding Application for Reconsideration By... All Seasons Temporaries and Manpower, Franklin, Pennsylvania (Joy Global). The determination was... product. The initial investigation resulted in a negative determination based on the findings that, with...

The Tides of Talent.

ERIC Educational Resources Information Center

Taylor, Craig R.

2003-01-01

Results of recent studies on why people leave or stay with an employer identified organizational, job, and leadership issues. Factors included job satisfaction, organizational climate, salary and benefits, loyalty, and anxiety about the economy and job market. Research showed three periods of highest risk of turnover: after the initial 30-60 days,…

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2013 CFR

2013-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2011 CFR

2011-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2014 CFR

2014-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2010 CFR

2010-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2012 CFR

2012-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

Tree mortality risk of oak due to gypsy moth

Treesearch

K.W. Gottschalk; J.J. Colbert; D.L. Feicht

1998-01-01

We present prediction models for estimating tree mortality resulting from gypsy moth, Lymantria dispar, defoliation in mixed oak, Quercus sp., forests. These models differ from previous work by including defoliation as a factor in the analysis. Defoliation intensity, initial tree crown condition (crown vigour), crown position, and...

Physical Education and Physical Activity: Results from the School Health Policies and Programs Study 2006

ERIC Educational Resources Information Center

Lee, Sarah M.; Burgeson, Charlene R.; Fulton, Janet E.; Spain, Christine G.

2007-01-01

Background: Comprehensive school-based physical activity programs consist of physical education and other physical activity opportunities including recess and other physical activity breaks, intramurals, interscholastic sports, and walk and bike to school initiatives. This article describes the characteristics of school physical education and…

Functional Analysis and Treatment of Aggression Maintained by Preferred Conversational Topics

ERIC Educational Resources Information Center

Roscoe, Eileen M.; Kindle, Arianne E.; Pence, Sacha T.

2010-01-01

After an initial functional analysis of a participant's aggression showed unclear outcomes, we conducted preference and reinforcer assessments to identify preferred forms of attention that may maintain problem behavior. Next, we conducted an extended functional analysis that included a modified attention condition. Results showed that the…

Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti

PubMed Central

Koenig, Serena P.; Bernard, Daphne; Dévieux, Jessy G.; Atwood, Sidney; McNairy, Margaret L.; Severe, Patrice; Marcelin, Adias; Julma, Pierrot; Apollon, Alexandra; Pape, Jean W.

2016-01-01

Background High attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions. Methods We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART. Results 24,925 patients (61% female, median age 35 years) were included, and 15,008 (60%) had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding transfers, the proportion of patients who were retained in pre-ART care or initiated ART within the first year after HIV testing was 84%, 82%, 64%, and 64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB) at HIV testing were associated with retention in care. Conclusions The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts. PMID:26901795

Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

PubMed

Medford, Andrew Rl; Pepperell, Justin Ct

2007-10-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

An Analysis of the Climate Data Initiative's Data Collection

NASA Astrophysics Data System (ADS)

Ramachandran, R.; Bugbee, K.

2015-12-01

The Climate Data Initiative (CDI) is a broad multi-agency effort of the U.S. government that seeks to leverage the extensive existing federal climate-relevant data to stimulate innovation and private-sector entrepreneurship to support national climate-change preparedness. The CDI project is a systematic effort to manually curate and share openly available climate data from various federal agencies. To date, the CDI has curated seven themes, or topics, relevant to climate change resiliency. These themes include Coastal Flooding, Food Resilience, Water, Ecosystem Vulnerability, Human Health, Energy Infrastructure, and Transportation. Each theme was curated by subject matter experts who selected datasets relevant to the topic at hand. An analysis of the entire Climate Data Initiative data collection and the data curated for each theme offers insights into which datasets are considered most relevant in addressing climate resiliency. Other aspects of the data collection will be examined including which datasets were the most visited or popular and which datasets were the most sought after for curation by the theme teams. Results from the analysis of the CDI collection will be presented in this talk.

The corporate role in reducing disparities: initiatives under way at Verizon.

PubMed

Izlar, Audrietta C

2011-10-01

Major US employers have great influence on the health care system because of the large number of employees for whom they provide health benefits and the billions of dollars they spend on health care. These companies must find ways to promote and improve health and health care, including by addressing racial and ethnic disparities. The communications company Verizon 38 percent of whose workforce is made up of racial and ethnic minorities, does so through a variety of initiatives to educate employees and to partner with health plans to increase screenings, care management, and other interventions. These initiatives include on-site mammography screening for employees; mailings that describe heightened breast cancer risks for minority populations; and data analysis to determine whether special programs should be put in place to target cardiovascular and other disease risks for racial and ethnic minorities. Between 200 and 300 female employees each year for the past three years have been screened at Verizon for breast cancer as a result, and the company is carrying out additional analyses to determine the impact on morbidity, mortality, and spending for that and other programs.

Nuclear thermal propulsion transportation systems for lunar/Mars exploration

NASA Technical Reports Server (NTRS)

Clark, John S.; Borowski, Stanley K.; Mcilwain, Melvin C.; Pellaccio, Dennis G.

1992-01-01

Nuclear thermal propulsion technology development is underway at NASA and DoE for Space Exploration Initiative (SEI) missions to Mars, with initial near-earth flights to validate flight readiness. Several reactor concepts are being considered for these missions, and important selection criteria will be evaluated before final selection of a system. These criteria include: safety and reliability, technical risk, cost, and performance, in that order. Of the concepts evaluated to date, the Nuclear Engine for Rocket Vehicle Applications (NERVA) derivative (NDR) is the only concept that has demonstrated full power, life, and performance in actual reactor tests. Other concepts will require significant design work and must demonstrate proof-of-concept. Technical risk, and hence, development cost should therefore be lowest for the concept, and the NDR concept is currently being considered for the initial SEI missions. As lighter weight, higher performance systems are developed and validated, including appropriate safety and astronaut-rating requirements, they will be considered to support future SEI application. A space transportation system using a modular nuclear thermal rocket (NTR) system for lunar and Mars missions is expected to result in significant life cycle cost savings. Finally, several key issues remain for NTR's, including public acceptance and operational issues. Nonetheless, NTR's are believed to be the 'next generation' of space propulsion systems - the key to space exploration.

International models of investigator-initiated trials: implications for Japan

PubMed Central

Trimble, E. L.; Ledermann, J.; Law, K.; Miyata, T.; Imamura, C. K.; Nam, B.-H.; Kim, Y.H.; Bang, Y.-J.; Michaels, M.; Ardron, D.; Amano, S.; Ando, Y.; Tominaga, T.; Kurokawa, K.; Takebe, N.

2012-01-01

Background Academic/institutional investigator-initiated clinical trials benefit individuals and society by supplementing gaps in industry-sponsored clinical trials. Materials In May 2010, experts from Japan, the Republic of Korea, the UK, and the United States, met at a symposium in Tokyo, Japan, to discuss how policies related to the conduct of clinical trials, which have been shown to be effective, may be applied to other regions of the world. Results In order to increase the availability of anticancer drugs world-wide, nations including Japan should examine the benefits of increasing the number of investigator-initiated clinical trials. These trials represent one of the most effective ways to translate basic scientific knowledge into clinical practice. These trials should be conducted under GCP guidelines and include Investigational New Drug application submissions with the ultimate goal of future drug approval. Conclusions To maximize the effectiveness of these trials, a policy to educate health care professionals, cancer patients and their families, and the public in general on the benefits of clinical trials should be strengthened. Finally, policies that expedite the clinical development of novel cancer drugs which have already been shown to be effective in other countries are needed in many nations including Japan to accelerate drug approval. PMID:22843420

Operation, Modeling and Analysis of the Reverse Water Gas Shift Process

NASA Technical Reports Server (NTRS)

Whitlow, Jonathan E.

2001-01-01

The Reverse Water Gas Shift process is a candidate technology for water and oxygen production on Mars under the In-Situ Propellant Production project. This report focuses on the operation and analysis of the Reverse Water Gas Shift (RWGS) process, which has been constructed at Kennedy Space Center. A summary of results from the initial operation of the RWGS, process along with an analysis of these results is included in this report. In addition an evaluation of a material balance model developed from the work performed previously under the summer program is included along with recommendations for further experimental work.

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2012 CFR

2012-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2014 CFR

2014-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

40 CFR 63.9565 - What definitions apply to this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... limitation (including any operating limit) in this subpart during startup, shutdown, or malfunction.... Examples include hexane, toluene, and trichloroethylene. Initial startup means the first time that equipment is put into operation. Initial startup does not include operation solely for testing equipment...

Three-Dimensional Viscous Alternating Direction Implicit Algorithm and Strategies for Shape Optimization

NASA Technical Reports Server (NTRS)

Pandya, Mohagna J.; Baysal, Oktay

1997-01-01

A gradient-based shape optimization based on quasi-analytical sensitivities has been extended for practical three-dimensional aerodynamic applications. The flow analysis has been rendered by a fully implicit, finite-volume formulation of the Euler and Thin-Layer Navier-Stokes (TLNS) equations. Initially, the viscous laminar flow analysis for a wing has been compared with an independent computational fluid dynamics (CFD) code which has been extensively validated. The new procedure has been demonstrated in the design of a cranked arrow wing at Mach 2.4 with coarse- and fine-grid based computations performed with Euler and TLNS equations. The influence of the initial constraints on the geometry and aerodynamics of the optimized shape has been explored. Various final shapes generated for an identical initial problem formulation but with different optimization path options (coarse or fine grid, Euler or TLNS), have been aerodynamically evaluated via a common fine-grid TLNS-based analysis. The initial constraint conditions show significant bearing on the optimization results. Also, the results demonstrate that to produce an aerodynamically efficient design, it is imperative to include the viscous physics in the optimization procedure with the proper resolution. Based upon the present results, to better utilize the scarce computational resources, it is recommended that, a number of viscous coarse grid cases using either a preconditioned bi-conjugate gradient (PbCG) or an alternating-direction-implicit (ADI) method, should initially be employed to improve the optimization problem definition, the design space and initial shape. Optimized shapes should subsequently be analyzed using a high fidelity (viscous with fine-grid resolution) flow analysis to evaluate their true performance potential. Finally, a viscous fine-grid-based shape optimization should be conducted, using an ADI method, to accurately obtain the final optimized shape.

Cue-dependent memory-based smooth-pursuit in normal human subjects: importance of extra-retinal mechanisms for initial pursuit.

PubMed

Ito, Norie; Barnes, Graham R; Fukushima, Junko; Fukushima, Kikuro; Warabi, Tateo

2013-08-01

Using a cue-dependent memory-based smooth-pursuit task previously applied to monkeys, we examined the effects of visual motion-memory on smooth-pursuit eye movements in normal human subjects and compared the results with those of the trained monkeys. These results were also compared with those during simple ramp-pursuit that did not require visual motion-memory. During memory-based pursuit, all subjects exhibited virtually no errors in either pursuit-direction or go/no-go selection. Tracking eye movements of humans and monkeys were similar in the two tasks, but tracking eye movements were different between the two tasks; latencies of the pursuit and corrective saccades were prolonged, initial pursuit eye velocity and acceleration were lower, peak velocities were lower, and time to reach peak velocities lengthened during memory-based pursuit. These characteristics were similar to anticipatory pursuit initiated by extra-retinal components during the initial extinction task of Barnes and Collins (J Neurophysiol 100:1135-1146, 2008b). We suggest that the differences between the two tasks reflect differences between the contribution of extra-retinal and retinal components. This interpretation is supported by two further studies: (1) during popping out of the correct spot to enhance retinal image-motion inputs during memory-based pursuit, pursuit eye velocities approached those during simple ramp-pursuit, and (2) during initial blanking of spot motion during memory-based pursuit, pursuit components appeared in the correct direction. Our results showed the importance of extra-retinal mechanisms for initial pursuit during memory-based pursuit, which include priming effects and extra-retinal drive components. Comparison with monkey studies on neuronal responses and model analysis suggested possible pathways for the extra-retinal mechanisms.

Exact solution of the Lifshitz equations governing the growth of fluctuations in cosmology

NASA Technical Reports Server (NTRS)

Adams, P. J.; Canuto, V.

1975-01-01

The exact solution of the Lifshitz equations governing the cosmological evolution of an initial fluctuation is presented. Lifshitz results valid for squares of the sound velocity equal to zero and 1/3 are extended in closed form to any equation of state where the pressure equals the total energy density times the square of the sound velocity. The solutions embody all the results found previously for special cases of the square of the sound velocity. It is found that the growth of any initial fluctuation is only an exponential function of time with an exponent of not more than 4/3 and is insufficient to produce galaxies unless the initial fluctuation is very large. A possible way to produce very large initial fluctuations by modifying the equation of state by including gravitational interactions is also examined. It is found that a phase transition can occur at baryonic density of 1 nucleon per cubic Planck length or equivalently, at a time of about 10 to the -43rd power sec. At those early times, the masses allowed by causality requirements are too small to be of interest in galaxy formation.

Short-term results of physiotherapy in patients with newly diagnosed degenerative cervical spine disease.

PubMed

Hey, H W; Lau, P H; Hee, H T

2012-03-01

Degenerative cervical spine diseases are common, and physiotherapy is widely used as an initial form of treatment. We aimed to analyse the effects of the initial sessions of physiotherapy for patients who were newly diagnosed with degenerative cervical spine disorders. A prospective series of 30 patients with newly diagnosed degenerative cervical spine disease were referred to our department and followed up for the initial two sessions of physiotherapy. The patients were assessed after each session. Outcome parameters studied included pain using a visual analogue scale (VAS), neck range of movements and activities of daily living (ADL). Our study subjects comprised mainly females (60%) in their fifties (46.7%) who worked as clerks or secretaries (53.3%). There was an improvement in the patients' pain score (VAS) from a median of 8 to 4 after two visits to the physiotherapists. Slight improvement in the neck range of movements was also observed. Marked improvement was seen in ADL, especially in the ability to carry heavy objects. Physiotherapy is an effective initial option for patients with newly presented degenerative cervical spine disease. The results of this study can be used to advise patients on the short-term benefits of physiotherapy.

New approaches to the diagnosis and management of laser eye injury

NASA Astrophysics Data System (ADS)

Hacker, Henry D.; Brown, Jeremiah, Jr.; Cheramie, Rachel; Stuck, Bruce E.

2007-02-01

The emergence of high resolution optical coherence tomography (OCT) along with evidence showing beneficial effects of anti-inflammatory drugs for retinal edema and neovascularization suggests a rational plan for the diagnosis and management of patients with acute laser eye injury. We review the results of recent experiments we conducted to evaluate treatment of laser lesions followed by reports of two cases of acute laser eye injury with foveal involvement. The initial presentation of these cases was notable for the lack of significant abnormalities on fluorescein angiography whereas OCT readily disclosed the size and extent of retinal involvement from exposure to laser energy. Prompt referral of these cases resulted in rapid initiation of medical therapy which included a 10-14 day combined course of steroid and non-steroidal anti-inflammatory medication. An initial decrease in Snellen visual acuity of approximately two lines (20/25- to 20/30) was noted on presentation. In both cases, a measurable improvement of visual acuity was noted by two weeks post injury. The use of anti-inflammatory medication may enhance the initial recovery of vision and reduce the likelihood of longer term retinal complications from scarring and neovascularization.

Bioavailability of dissolved organic nitrogen (DON) in wastewaters from animal feedlots and storage lagoons.

PubMed

Sun, Jingyi; Khan, Eakalak; Simsek, Senay; Ohm, Jae-Bom; Simsek, Halis

2017-11-01

Dissolved organic nitrogen (DON) from animal wastes can contribute to pollution of surface waters. Bioavailable DON (ABDON) is a portion of DON utilized by algae with or without bacteria. This study determined DON and ABDON levels in animal wastewater collected from two different sources: an animal feedlot wastewater storage tank and a sheep wastewater storage lagoon. Inocula for the ABDON bioassays were comprised of individual species and several combinations involving two algae (Chlamydomonas reinhardtii and Chlorella vulgaris) and a mixed liquor suspended solids (MLSS) bacterial culture. The ratio of initial DON to initial total dissolved nitrogen was 18% in the feedlot wastewater samples and 70% in the lagoon wastewater samples. The results showed that between 1.6 and 4.5 mg-NL-1 DON (45-79% of initial DON) in the feedlot samples and between 3.4 and 7.5 mg-NL-1 DON (36%-79% of initial DON) in the lagoon samples were bioavailable with the inocula tested. These results suggest that when considering eutrophication potential of livestock wastewater, organic nitrogen should be included in addition to the obvious culprits, ammonia and nitrate. Copyright © 2017 Elsevier Ltd. All rights reserved.

Addressing the coming radiology crisis-the Society for Computer Applications in Radiology transforming the radiological interpretation process (TRIP) initiative.

PubMed

Andriole, Katherine P; Morin, Richard L; Arenson, Ronald L; Carrino, John A; Erickson, Bradley J; Horii, Steven C; Piraino, David W; Reiner, Bruce I; Seibert, J Anthony; Siegel, Eliot

2004-12-01

The Society for Computer Applications in Radiology (SCAR) Transforming the Radiological Interpretation Process (TRIP) Initiative aims to spearhead research, education, and discovery of innovative solutions to address the problem of information and image data overload. The initiative will foster interdisciplinary research on technological, environmental and human factors to better manage and exploit the massive amounts of data. TRIP will focus on the following basic objectives: improving the efficiency of interpretation of large data sets, improving the timeliness and effectiveness of communication, and decreasing medical errors. The ultimate goal of the initiative is to improve the quality and safety of patient care. Interdisciplinary research into several broad areas will be necessary to make progress in managing the ever-increasing volume of data. The six concepts involved are human perception, image processing and computer-aided detection (CAD), visualization, navigation and usability, databases and integration, and evaluation and validation of methods and performance. The result of this transformation will affect several key processes in radiology, including image interpretation; communication of imaging results; workflow and efficiency within the health care enterprise; diagnostic accuracy and a reduction in medical errors; and, ultimately, the overall quality of care.

Fuel Optimal, Finite Thrust Guidance Methods to Circumnavigate with Lighting Constraints

NASA Astrophysics Data System (ADS)

Prince, E. R.; Carr, R. W.; Cobb, R. G.

This paper details improvements made to the authors' most recent work to find fuel optimal, finite-thrust guidance to inject an inspector satellite into a prescribed natural motion circumnavigation (NMC) orbit about a resident space object (RSO) in geosynchronous orbit (GEO). Better initial guess methodologies are developed for the low-fidelity model nonlinear programming problem (NLP) solver to include using Clohessy- Wiltshire (CW) targeting, a modified particle swarm optimization (PSO), and MATLAB's genetic algorithm (GA). These initial guess solutions may then be fed into the NLP solver as an initial guess, where a different NLP solver, IPOPT, is used. Celestial lighting constraints are taken into account in addition to the sunlight constraint, ensuring that the resulting NMC also adheres to Moon and Earth lighting constraints. The guidance is initially calculated given a fixed final time, and then solutions are also calculated for fixed final times before and after the original fixed final time, allowing mission planners to choose the lowest-cost solution in the resulting range which satisfies all constraints. The developed algorithms provide computationally fast and highly reliable methods for determining fuel optimal guidance for NMC injections while also adhering to multiple lighting constraints.

Design and Development of a Real-Time Model Attitude Measurement System for Hypersonic Facilities

NASA Technical Reports Server (NTRS)

Jones, Thomas W.; Lunsford, Charles B.

2005-01-01

A series of wind tunnel tests have been conducted to evaluate a multi-camera videogrammetric system designed to measure model attitude in hypersonic facilities. The technique utilizes processed video data and applies photogrammetric principles for point tracking to compute model position including pitch, roll and yaw variables. A discussion of the constraints encountered during the design, development, and testing process, including lighting, vibration, operational range and optical access is included. Initial measurement results from the NASA Langley Research Center (LaRC) 31-Inch Mach 10 tunnel are presented.

Design and Development of a Real-Time Model Attitude Measurement System for Hypersonic Facilities

NASA Technical Reports Server (NTRS)

Jones, Thomas W.; Lunsford, Charles B.

2004-01-01

A series of wind tunnel tests have been conducted to evaluate a multi-camera videogrammetric system designed to measure model attitude in hypersonic facilities. The technique utilizes processed video data and applies photogrammetric principles for point tracking to compute model position including pitch, roll and yaw variables. A discussion of the constraints encountered during the design, development, and testing process, including lighting, vibration, operational range and optical access is included. Initial measurement results from the NASA Langley Research Center (LaRC) 31-Inch Mach 10 tunnel are presented.

Acoustic Beam Forming Array Using Feedback-Controlled Microphones for Tuning and Self-Matching of Frequency Response

NASA Technical Reports Server (NTRS)

Radcliffe, Eliott (Inventor); Naguib, Ahmed (Inventor); Humphreys, Jr., William M. (Inventor)

2014-01-01

A feedback-controlled microphone includes a microphone body and a membrane operatively connected to the body. The membrane is configured to be initially deflected by acoustic pressure such that the initial deflection is characterized by a frequency response. The microphone also includes a sensor configured to detect the frequency response of the initial deflection and generate an output voltage indicative thereof. The microphone additionally includes a compensator in electric communication with the sensor and configured to establish a regulated voltage in response to the output voltage. Furthermore, the microphone includes an actuator in electric communication with the compensator, wherein the actuator is configured to secondarily deflect the membrane in opposition to the initial deflection such that the frequency response is adjusted. An acoustic beam forming microphone array including a plurality of the above feedback-controlled microphones is also disclosed.

Dispersion relations of elastic waves in one-dimensional piezoelectric/piezomagnetic phononic crystal with initial stresses.

PubMed

Guo, Xiao; Wei, Peijun

2016-03-01

The dispersion relations of elastic waves in a one-dimensional phononic crystal formed by periodically repeating of a pre-stressed piezoelectric slab and a pre-stressed piezomagnetic slab are studied in this paper. The influences of initial stress on the dispersive relation are considered based on the incremental stress theory. First, the incremental stress theory of elastic solid is extended to the magneto-electro-elasto solid. The governing equations, constitutive equations, and boundary conditions of the incremental stresses in a magneto-electro-elasto solid are derived with consideration of the existence of initial stresses. Then, the transfer matrices of a pre-stressed piezoelectric slab and a pre-stressed piezomagnetic slab are formulated, respectively. The total transfer matrix of a single cell in the phononic crystal is obtained by the multiplication of two transfer matrixes related with two adjacent slabs. Furthermore, the Bloch theorem is used to obtain the dispersive equations of in-plane and anti-plane Bloch waves. The dispersive equations are solved numerically and the numerical results are shown graphically. The oblique propagation and the normal propagation situations are both considered. In the case of normal propagation of elastic waves, the analytical expressions of the dispersion equation are derived and compared with other literatures. The influences of initial stresses, including the normal initial stresses and shear initial stresses, on the dispersive relations are both discussed based on the numerical results. Copyright © 2015 Elsevier B.V. All rights reserved.

[Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

PubMed

Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

2016-07-07

The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit.

Working with community partners to implement and evaluate the Chicago Park District's 100% Healthier Snack Vending Initiative.

PubMed

Mason, Maryann; Zaganjor, Hatidza; Bozlak, Christine T; Lammel-Harmon, Colleen; Gomez-Feliciano, Lucy; Becker, Adam B

2014-08-07

The objective of this case study was to evaluate the acceptability, sales impact, and implementation barriers for the Chicago Park District's 100% Healthier Snack Vending Initiative to strengthen and support future healthful vending efforts. The Chicago Park District is the largest municipal park system in the United States, serving almost 200,000 children annually through after-school and summer programs. Chicago is one of the first US cities to improve park food environments through more healthful snack vending. A community-based participatory evaluation engaged community and academic partners, who shared in all aspects of the research. From spring 2011 to fall 2012, we collected data through observation, surveys, and interviews on staff and patron acceptance of snack vending items, purchasing behaviors, and machine operations at a sample of 10 Chicago parks. A new snack vending contract included nutrition standards for serving sizes, calories, sugar, fat, and sodium for all items. Fifteen months of snack vending sales data were collected from all 98 snack vending machines in park field houses. Staff (100%) and patrons (88%) reacted positively to the initiative. Average monthly per-machine sales increased during 15 months ($84 to $371). Vendor compliance issues included stocking noncompliant items and delayed restocking. The initiative resulted in improved park food environments. Diverse partner engagement, participatory evaluation, and early attention to compliance can be important supports for healthful vending initiatives. Consumer acceptance and increasing revenues can help to counter fears of revenue loss that can pose barriers to adoption.

Different Effects of Oral Contraceptive and Dydrogesterone Treatment on Oxidative Stress Levels in Premenopausal Women

PubMed Central

Chen, Jui-Tung; Kotani, Kazuhiko

2018-01-01

Background The aim of the study was to observe the changes in blood oxidative stress levels by oral contraceptive (OC) and/or dydrogesterone (DG) treatment. Methods A retrospective cohort of 27 premenopausal women with primary dysmenorrhea consisted of the OC treatment group (N = 17) and the DG treatment group (N = 10) by choice of the initial treatment. The OC group included two subgroups: patients with continuous OC treatment (treated for at least 15 months, N = 10) and patients with discontinuous OC treatment (switched to DG treatment after approximately 6 months of initial OC treatment: N = 7). The DG group had 15 months of continuous DG treatment. Blood parameters, including diacron-reactive oxygen metabolites (d-ROMs: an oxidative stress marker), were measured. Results The d-ROMs level was elevated in the OC group 3 months after initial treatment (mean: from 321 (at baseline) to 512 Carratelli Units (Carr U); P < 0.01), while such changes were not observed in the DG group. The d-ROMs level was reduced in the discontinuous OC subgroup 15 months after initial treatment (from 508 (3 months after initial treatment) to 372 Carr U; P < 0.01), while such changes were not observed in the continuous OC subgroup. The DG group displayed unchanged the d-ROMs level. Conclusion Replacing OC with DG can attenuate oxidative stress as elevated by OC, thereby alleviating the possible vascular risks with OC treatment. PMID:29317960

Development and Implementation of an International Counseling Outreach Effort in Bhutan: A Group Stage Conceptualization

ERIC Educational Resources Information Center

Guth, Lorraine J.; Lorelle, Sonya; Hinkle, J. Scott; Remley, Theodore P.

2015-01-01

This article highlights the development and implementation of an international counseling outreach program in Bhutan using a group stage conceptualization that includes the initial, transition, working, and final stages. The initial stage included a counseling initiative started by one of the queens as well as meetings with key leaders from the…

Interaction of N-vortex structures in a continuum, including atmosphere, hydrosphere and plasma

NASA Astrophysics Data System (ADS)

Belashov, Vasily Yu.

2017-10-01

The results of analysis and numerical simulation of evolution and interaction of the N-vortex structures of various configuration and different vorticities in the continuum including atmosphere, hydrosphere and plasma are presented. It is found that in dependence on initial conditions the regimes of weak interaction with quasi-stationary evolution and active interaction with the "phase intermixing", when the evolution can lead to formation of complex forms of vorticity regions, are realized in the N-vortex systems. For the 2-vortex interaction the generalized critical parameter determining qualitative character of interaction of vortices is introduced. It is shown that for given initial conditions its value divides modes of active interaction and quasi-stationary evolution. The results of simulation of evolution and interaction of the two-dimensional and three-dimensional vortex structures, including such phenomena as dynamics of the atmospheric synoptic vortices of cyclonic types and tornado, hydrodynamic 4-vortex interaction and also interaction in the systems of a type of "hydrodynamic vortex - dust particles" are presented. The applications of undertaken approach to the problems of such plasma systems as streams of charged particles in a uniform magnetic field B and plasma clouds in the ionosphere are considered. It is shown that the results obtained have obvious applications in studies of the dynamics of the vortex structures dynamics in atmosphere, hydrosphere and plasma.

Does information available at admission for delivery improve prediction of vaginal birth after cesarean?

PubMed Central

Grobman, William A.; Lai, Yinglei; Landon, Mark B.; Spong, Catherine Y.; Leveno, Kenneth J.; Rouse, Dwight J.; Varner, Michael W.; Moawad, Atef H.; Simhan, Hyagriv N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; O'sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

2010-01-01

Objective To construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care. Study design Using multivariable modeling, we constructed a predictive model for VBAC that included patient factors known at the initial prenatal visit as well as those that only became evident as the pregancy progressed to the admission for delivery. Results 9616 women were analyzed. The regression equation for VBAC success included multiple factors that could not be known at the first prenatal visit. The area under the curve for this model was significantly greater (P < .001) than that of a model that included only factors available at the first prenatal visit. Conclusion A prediction model for VBAC success that incorporates factors that can be ascertained only as the pregnancy progresses adds to the predictive accuracy of a model that uses only factors available at a first prenatal visit. PMID:19813165

Scientific Cooperation Between the U.S. and the Republic of South Africa Funds 7 Cancer-Specific Pro

Cancer.gov

The NIH has recently awarded its first round of grants in a parallel U.S.-South Africa funding opportunity. Initiatives funded through this program will advance biomedical research for tuberculosis and HIV/AIDS in not only the US and South Africa, but will contribute to the global wealth of knowledge of these diseases. The scope of this initiative includes HIV/AIDS co-morbidities, and resulting malignancies. This opportunity was further targeted at expanding basic, translational, behavioral and applied research that will stimulate scientific discovery, and engage U.S. and South African researcher collaboration.

Experimental study of the penetrating of plates by projectile at low initial speeds

NASA Astrophysics Data System (ADS)

Orlov, M. Yu; Orlova, Yu N.; Smakotin, Ig L.; Glazyrin, V. P.; Orlov, Yu N.

2017-11-01

The research of the penetration process of lightweight plates by a projectile in the range of initial velocities up to 325 m/s was attempted. The projectile was a shell bullet and the barriers were of ice, MDF-panels and plexiglas barriers. The response of barriers to impact loading is studied. High-speed shooting of each experiment is obtained, including photos of the front and rear sides of the barriers. An attempt was made to reproduce the scenario of the destruction of barriers. The results of experiments can be interpreted only as qualitative tests. Projectile was not destroyed.

Electronic delay ignition module for single bridgewire Apollo standard initiator

NASA Technical Reports Server (NTRS)

Ward, R. D.

1975-01-01

An engineering model and a qualification model of the EDIM were constructed and tested to Scout flight qualification criteria. The qualification model incorporated design improvements resulting from the engineering model tests. Compatibility with single bridgewire Apollo standard initiator (SBASI) was proven by test firing forty-five (45) SBASI's with worst case voltage and temperature conditions. The EDIM was successfully qualified for Scout flight application with no failures during testing of the qualification unit. Included is a method of implementing the EDIM into Scout vehicle hardware and the ground support equipment necessary to check out the system.

Terminal navigation analysis for the 1980 comet Encke slow flyby mission

NASA Technical Reports Server (NTRS)

Jacobson, R. A.; Mcdanell, J. P.; Rinker, G. C.

1973-01-01

The initial results of a terminal navigation analysis for the proposed 1980 solar electric slow flyby mission to the comet Encke are presented. The navigation technique employs onboard optical measurements with the scientific television camera, groundbased observations of the spacecraft and comet, and groundbased orbit determination and thrust vector update computation. The knowledge and delivery accuracies of the spacecraft are evaluated as a function of the important parameters affecting the terminal navigation. These include optical measurement accuracy, thruster noise level, duration of the planned terminal coast period, comet ephemeris uncertainty, guidance initiation time, guidance update frequency, and optical data rate.

Research on plasma-puff initiation of high Coulomb transfer switches

NASA Technical Reports Server (NTRS)

Venable, Demetrius D.; Han, Kwang S.

1993-01-01

The plasma-puff triggering mechanism based on hypocycloidal pinch geometry was investigated to determine the optimal operating conditions for an azimuthally uniform surface flashover which initiates plasma-puff under wide ranges of fill gas pressures of Ar, He and N2. Research is presented and resulting conference papers are attached. These papers include 'Characteristics of Plasma-Puff Trigger for an Inverse-Pinch Plasma Switch'; 'Ultra-High-Power Plasma Switch INPUTS for Pulse Power Systems'; 'Characteristics of Switching Plasma in an Inverse-Pinch Switch'; 'Comparative Study of INPIStron and Spark Gap'; and 'INPIStron Switched Pulsed Power for Dense Plasma Pinches.'

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule.

PubMed

Chambers, Georgina M; Randall, Sean; Hoang, Van Phuong; Sullivan, Elizabeth A; Highet, Nicole; Croft, Maxine; Mihalopoulos, Cathrine; Morgan, Vera A; Reilly, Nicole; Austin, Marie-Paule

2016-03-01

To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships.

PubMed

Tevendale, Heather D; Fuller, Taleria R; House, L Duane; Dee, Deborah L; Koumans, Emilia H

2017-03-01

Seeking to reduce teen pregnancy and births in communities with rates above the national average, the Centers for Disease Control and Prevention, in partnership with the U.S. Department of Health and Human Services Office of Adolescent Health Teen Pregnancy Prevention Program, developed a joint funding opportunity through which grantees worked to implement and test an approach involving community-wide teen pregnancy prevention initiatives. Once these projects had been in the field for 2.5 years, Centers for Disease Control and Prevention staff developed plans for a supplemental issue of the Journal of Adolescent Health to present findings from and lessons learned during implementation of the community-wide initiatives. When the articles included in the supplemental issue are considered together, common themes emerge, particularly those related to initiating, building, and maintaining strong partnerships. Themes seen across articles include the importance of (1) sharing local data with partners to advance initiative implementation, (2) defining partner roles from the beginning of the initiatives, (3) developing teams that include community partners to provide direction to the initiatives, and (4) addressing challenges to maintaining strong partnerships including partner staff turnover and delays in implementation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Smart roadside initiative : user manual.

DOT National Transportation Integrated Search

2015-09-01

This document provides the user instructions for the Smart Roadside Initiative (SRI) applications including mobile and web-based SRI applications. These applications include smartphone-enabled information exchange and notification, and software compo...

Patient engagement in clinical trials: The Clinical Trials Transformation Initiative's leadership from theory to practical implementation.

PubMed

Patrick-Lake, Bray

2018-02-01

Patient engagement is an increasingly important aspect of successful clinical trials. Over the past decade, as patient group involvement in clinical trials has continued to increase and diversify, the Clinical Trials Transformation Initiative has not only recognized the crucial role patients play in improving the clinical trial enterprise but also made a deep commitment to help grow and shape the emerging field of patient engagement. This article describes the evolution of patient engagement including the origins of the patient engagement movement; barriers to successful engagement and remaining challenges to full and valuable collaboration between patient groups and trial sponsors; and Clinical Trials Transformation Initiative's role in influencing the field through organizational practices, formal project work and resulting recommendations, and external advocacy efforts.

Silicon production process evaluations

NASA Technical Reports Server (NTRS)

1981-01-01

Chemical engineering analysis of the HSC process (Hemlock Semiconductor Corporation) for producing silicon from dichlorosilane in a 1,000 MT/yr plant was continued. Progress and status for the chemical engineering analysis of the HSC process are reported for the primary process design engineering activities: base case conditions (85%), reaction chemistry (85%), process flow diagram (60%), material balance (60%), energy balance (30%), property data (30%), equipment design (20%) and major equipment list (10%). Engineering design of the initial distillation column (D-01, stripper column) in the process was initiated. The function of the distillation column is to remove volatile gases (such as hydrogen and nitrogen) which are dissolved in liquid chlorosilanes. Initial specifications and results for the distillation column design are reported including the variation of tray requirements (equilibrium stages) with reflux ratio for the distillation.

Ignitability test method and apparatus

NASA Technical Reports Server (NTRS)

Bement, Laurence J. (Inventor); Bailey, James W. (Inventor); Schimmel, Morry L. (Inventor)

1989-01-01

An apparatus for testing ignitability of an initiator includes a body with a central cavity, initiator holder for holding the initiator over the central cavity of the body, an ignition material holder disposed in the central cavity of the body and a cavity facing the initiator holder which receives a measured quantity of ignition material to be ignited by the initiator and a chamber in communication with the cavity of the ignition material holder and the central cavity of the body. A measuring system for analyzing pressure characteristics is generated by ignition material by the initiator. The measuring system includes at least one transducer coupled to an oscillograph for recording pressure traces generated by ignition.

Ignitability test method and apparatus

NASA Technical Reports Server (NTRS)

Bement, Laurence J. (Inventor); Bailey, James W. (Inventor); Schimmel, Morry L. (Inventor)

1991-01-01

An apparatus for testing ignitability of an initiator includes a body having a central cavity, an initiator holder for holding the initiator over the central cavity of the body, an ignition material holder disposed in the central cavity of the body and having a cavity facing the initiator holder which receives a measured quantity of ignition material to be ignited by the initiator. It contains a chamber in communication with the cavity of the ignition material and the central cavity of the body, and a measuring system for analyzing pressure characteristics generated by ignition of the ignition material by the initiator. The measuring system includes at least one transducer coupled with an oscillograph for recording pressure traces generated by ignition.

Divorce transition differences of midlife women.

PubMed

Sakraida, Teresa J

2005-01-01

Divorce transition experienced by and its influence upon midlife women's health is not fully understood. Interviews were conducted with 24 divorced women who self-classified into decider status groups: initiator (who first decided to end marriage), non-initiator (recipient of end of marriage decision), and mutual decider (shared decision to end marriage). Interpretive content analysis involving pattern coding was conducted. The divorce transition by initiators (n=8) included self-focused growth, optimism, and social support losses and opportunities, while the divorce transition by non-initiators (n=8) included being left, ruminating, vulnerability, and spiritual comfort. No profile emerged for the mutual-decider group (n=8). This study supports that differences in divorce transition exist for initiators and non-initiators.

Electronic Cigarette Use among Current Smokers: A Pilot Qualitative Study

PubMed Central

Majeed, Ban A.; Stanton, Cassandra A.; Dube, Shanta R.; Sterling, Kymberle L.; Burns, Joy D.; Eriksen, Michael P.

2016-01-01

Objective This pilot study explored psychosocial influences of e-cigarette use among dual users. Methods Two focus groups among adult current smokers who had ever used e-cigarettes were conducted in Georgia. Discussions were audio-recorded. Principles of grounded theory and thematic analysis were employed. Results Reasons for initial use included curiosity and social influence. Themes related to regular use included enjoyment of sensory experiences and perception of reduced harm. Nicotine craving, social image, and convenience were reasons for initial and regular dual use. Two patterns of use emerged – (1) using e-cigarettes to supplement combustible cigarettes; and (2) to replace combustible cigarettes. Conclusions Reasons for dual use were related to nicotine dependence, social influence, product appeal, and perception of reduced harm. Understanding contextual nuances of dual use can inform policy and communication. PMID:28393082

High neuroticism at age 20 predicts history of mental disorders and low self-esteem at age 35.

PubMed

Lönnqvist, Jan-Erik; Verkasalo, Markku; Mäkinen, Seppo; Henriksson, Markus

2009-07-01

The authors assessed whether neuroticism in emerging adulthood predicts mental disorders and self-esteem in early adulthood after controlling for possible confounding variables. A sample of 69 male military conscripts was initially assessed at age 20 and again as civilians at age 35. The initial assessment included a psychiatric interview, objective indicators of conscript competence, an intellectual performance test, and neuroticism questionnaires. The follow-up assessment included a Structured Clinical Interview for DSM-IV (SCID; First, Spitzer, Gibbon, & Williams, 1996) and the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Neuroticism predicted future mental disorders and low self-esteem beyond more objective indicators of adjustment. The results support the use of neuroticism as a predictor of future mental disorders, even over periods of time when personality is subject to change.

Rapid Assessment of the HIV/AIDS Crisis in Racial and Ethnic Minority Communities: An Approach for Timely Community Interventions

PubMed Central

Needle, Richard H.; Trotter, Robert T.; Singer, Merrill; Bates, Christopher; Page, J. Bryan; Metzger, David; Marcelin, Louis H.

2003-01-01

Objectives. The US Department of Health and Human Services, in collaboration with the Congressional Black Caucus, created a new initiative to address the disproportionate ongoing HIV/AIDS crisis in racial/ethnic minority populations. Methods. This initiative included deploying technical assistance teams through the Office of HIV/AIDS Policy. The teams introduced rapid assessment and response methodologies and trained minority communities in their use. Results. The first 3 eligible cities (Detroit, Miami, and Philadelphia) focused assessments in small geographic areas, using multiple methodologies to obtain data. Conclusions. Data from the first 3 eligible cities provided critical information about changing the dynamics of the HIV/AIDS epidemic at the local level, including program and policy changes and infrastructure redeployment targeted at the most serious social and environmental conditions. PMID:12773364

An initial look at the quality of life of Malaysian families that include children with disabilities.

PubMed

Clark, M; Brown, R; Karrapaya, R

2012-01-01

While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual disabilities. Dynamics characterising Malaysian society are described as developments in social policy and service delivery that support persons with disabilities and their families. Questionnaire data were collected using the Family Quality of Life Survey - Short Version. Members of 52 families that included one or two children with disabilities were interviewed. Their responses provided their perceptions within six dimensions of family quality of life across the nine life domains assessed. Findings showed a consistent pattern of relatively strong perceived 'importance' ratings in each of life domains as compared to mean ratings for other family quality of life dimensions. Some dimensions of family quality of life, in particular 'opportunities', 'initiative' and 'attainment', demonstrated particularly strong associations with each other. Overall means of satisfaction with and attainment of family quality of life as well as global evaluations of quality of life and satisfaction all demonstrated significant associations, although each of these correlations accounted for less than 50% of the common variance. The importance rating can be viewed as a determining factor in terms of quality of life, and it played a critical role in supporting attainment of, and satisfaction with, family quality of life, assuming opportunities, initiative and stability are adequate. The need for a broader sample including families that were not receiving services was noted. Future research questions based on the results of the current study and some of the dynamics impacting Malaysian society are also suggested. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.

Control of Initialized Fractional-Order Systems. Revised

NASA Technical Reports Server (NTRS)

Hartley, Tom T.; Lorenzo, Carl F.

2002-01-01

Due to the importance of historical effects in fractional-order systems, this paper presents a general fractional-order control theory that includes the time-varying initialization response. Previous studies have not properly accounted for these historical effects. The initialization response, along with the forced response, for fractional-order systems is determined. Stability properties of fractional-order systems are presented in the complex w-plane, which is a transformation of the s-plane. Time responses are discussed with respect to pole positions in the complex w-plane and frequency response behavior is included. A fractional-order vector space representation, which is a generalization of the state space concept, is presented including the initialization response. Control methods for vector representations of initialized fractional-order systems are shown. Nyquist, root-locus, and other input-output control methods are adapted to the control of fractional-order systems. Finally, the fractional-order differintegral is generalized to continuous order-distributions that have the possibility of including a continuum of fractional orders in a system element.

Control of Initialized Fractional-Order Systems

NASA Technical Reports Server (NTRS)

Hartly, Tom T.; Lorenzo, Carl F.

2002-01-01

Due to the importance of historical effects in fractional-order systems, this paper presents a general fractional-order control theory that includes the time-varying initialization response. Previous studies have not properly accounted for these historical effects. The initialization response, along with the forced response, for fractional-order systems is determined. Stability properties of fractional-order systems are presented in the complex Airplane, which is a transformation of the s-plane. Time responses are discussed with respect to pole positions in the complex Airplane and frequency response behavior is included. A fractional-order vector space representation, which is a generalization of the state space concept, is presented including the initialization response. Control methods for vector representations of initialized fractional-order systems are shown. Nyquist, root-locus, and other input-output control methods are adapted to the control of fractional-order systems. Finally, the fractional-order differintegral is generalized to continuous order-distributions that have the possibility of including a continuum of fractional orders in a system element.

Cascade model of gamma-ray bursts: Power-law and annihilation-line components

NASA Technical Reports Server (NTRS)

Harding, A. K.; Sturrock, P. A.; Daugherty, J. K.

1988-01-01

If, in a neutron star magnetosphere, an electron is accelerated to an energy of 10 to the 11th or 12th power eV by an electric field parallel to the magnetic field, motion of the electron along the curved field line leads to a cascade of gamma rays and electron-positron pairs. This process is believed to occur in radio pulsars and gamma ray burst sources. Results are presented from numerical simulations of the radiation and photon annihilation pair production processes, using a computer code previously developed for the study of radio pulsars. A range of values of initial energy of a primary electron was considered along with initial injection position, and magnetic dipole moment of the neutron star. The resulting spectra was found to exhibit complex forms that are typically power law over a substantial range of photon energy, and typically include a dip in the spectrum near the electron gyro-frequency at the injection point. The results of a number of models are compared with data for the 5 Mar., 1979 gamma ray burst. A good fit was found to the gamma ray part of the spectrum, including the equivalent width of the annihilation line.

The role of DNA repair in herpesvirus pathogenesis.

PubMed

Brown, Jay C

2014-10-01

In cells latently infected with a herpesvirus, the viral DNA is present in the cell nucleus, but it is not extensively replicated or transcribed. In this suppressed state the virus DNA is vulnerable to mutagenic events that affect the host cell and have the potential to destroy the virus' genetic integrity. Despite the potential for genetic damage, however, herpesvirus sequences are well conserved after reactivation from latency. To account for this apparent paradox, I have tested the idea that host cell-encoded mechanisms of DNA repair are able to control genetic damage to latent herpesviruses. Studies were focused on homologous recombination-dependent DNA repair (HR). Methods of DNA sequence analysis were employed to scan herpesvirus genomes for DNA features able to activate HR. Analyses were carried out with a total of 39 herpesvirus DNA sequences, a group that included viruses from the alpha-, beta- and gamma-subfamilies. The results showed that all 39 genome sequences were enriched in two or more of the eight recombination-initiating features examined. The results were interpreted to indicate that HR can stabilize latent herpesvirus genomes. The results also showed, unexpectedly, that repair-initiating DNA features differed in alpha- compared to gamma-herpesviruses. Whereas inverted and tandem repeats predominated in alpha-herpesviruses, gamma-herpesviruses were enriched in short, GC-rich initiation sequences such as CCCAG and depleted in repeats. In alpha-herpesviruses, repair-initiating repeat sequences were found to be concentrated in a specific region (the S segment) of the genome while repair-initiating short sequences were distributed more uniformly in gamma-herpesviruses. The results suggest that repair pathways are activated differently in alpha- compared to gamma-herpesviruses. Copyright © 2014. Published by Elsevier Inc.

Workplace antistigma initiatives: a scoping study.

PubMed

Malachowski, Cindy; Kirsh, Bonnie

2013-07-01

The purpose of this scoping study was to identify and describe the principles and characteristics embedded in workplace mental health antistigma initiatives. Research in this area is diffuse and not well synthesized. Therefore, a scoping study is useful in generating a breadth of coverage and identifying all relevant literature on the topic regardless of study design. Results will inform evaluation strategies and can be used to distinguish the effectiveness of particular elements in future research. The "York Framework," a five-stage methodological design (with an optional sixth stage) was used as the structure for this study. Eleven peer-reviewed and gray-literature databases were searched (2000-2011), and an extensive Internet review was also conducted. Two reviewers independently reviewed all abstracts to determine study selection. A data chart consisting of key issues and themes was utilized to extract data from the included studies. Preliminary results were used to inform a stakeholder consultation with seven international experts. Twenty-two antistigma interventions were included in the study. Most of the initiatives have appeared in the past four years and across geographic boundaries, reflecting the growing international interest in mental health in the workplace. A large proportion of the interventions utilize educational approaches to reducing stigma, and a substantial number target military personnel. Stronger evidence for effective practices needs to be established through the use of standardized workplace-specific interventions, reliable and valid evaluation tools, and overall enhanced scientific rigor.

The importance of fluctuations in fluid mixing.

PubMed

Kadau, Kai; Rosenblatt, Charles; Barber, John L; Germann, Timothy C; Huang, Zhibin; Carlès, Pierre; Alder, Berni J

2007-05-08

A ubiquitous example of fluid mixing is the Rayleigh-Taylor instability, in which a heavy fluid initially sits atop a light fluid in a gravitational field. The subsequent development of the unstable interface between the two fluids is marked by several stages. At first, each interface mode grows exponentially with time before transitioning to a nonlinear regime characterized by more complex hydrodynamic mixing. Unfortunately, traditional continuum modeling of this process has generally been in poor agreement with experiment. Here, we indicate that the natural, random fluctuations of the flow field present in any fluid, which are neglected in continuum models, can lead to qualitatively and quantitatively better agreement with experiment. We performed billion-particle atomistic simulations and magnetic levitation experiments with unprecedented control of initial interface conditions. A comparison between our simulations and experiments reveals good agreement in terms of the growth rate of the mixing front as well as the new observation of droplet breakup at later times. These results improve our understanding of many fluid processes, including interface phenomena that occur, for example, in supernovae, the detachment of droplets from a faucet, and ink jet printing. Such instabilities are also relevant to the possible energy source of inertial confinement fusion, in which a millimeter-sized capsule is imploded to initiate nuclear fusion reactions between deuterium and tritium. Our results suggest that the applicability of continuum models would be greatly enhanced by explicitly including the effects of random fluctuations.

Inhomogeneous anisotropic cosmology

DOE PAGES

Kleban, Matthew; Senatore, Leonardo

2016-10-12

In homogeneous and isotropic Friedmann-Robertson-Walker cosmology, the topology of the universe determines its ultimate fate. If the Weak Energy Condition is satisfied, open and flat universes must expand forever, while closed cosmologies can recollapse to a Big Crunch. A similar statement holds for homogeneous but anisotropic (Bianchi) universes. Here in this paper, we prove that arbitrarily inhomogeneous and anisotropic cosmologies with "flat'' (including toroidal) and "open'' (including compact hyperbolic) spatial topology that are initially expanding must continue to expand forever at least in some region at a rate bounded from below by a positive number, despite the presence of arbitrarilymore » large density fluctuations and/or the formation of black holes. Because the set of 3-manifold topologies is countable, a single integer determines the ultimate fate of the universe, and, in a specific sense, most 3-manifolds are "flat" or "open". Our result has important implications for inflation: if there is a positive cosmological constant (or suitable inflationary potential) and initial conditions for the inflaton, cosmologies with "flat'' or "open" topology must expand forever in some region at least as fast as de Sitter space, and are therefore very likely to begin inflationary expansion eventually, regardless of the scale of the inflationary energy or the spectrum and amplitude of initial inhomogeneities and gravitational waves. Our result is also significant for numerical general relativity, which often makes use of periodic (toroidal) boundary conditions.« less

Inhomogeneous anisotropic cosmology

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

Kleban, Matthew; Senatore, Leonardo

In homogeneous and isotropic Friedmann-Robertson-Walker cosmology, the topology of the universe determines its ultimate fate. If the Weak Energy Condition is satisfied, open and flat universes must expand forever, while closed cosmologies can recollapse to a Big Crunch. A similar statement holds for homogeneous but anisotropic (Bianchi) universes. Here in this paper, we prove that arbitrarily inhomogeneous and anisotropic cosmologies with "flat'' (including toroidal) and "open'' (including compact hyperbolic) spatial topology that are initially expanding must continue to expand forever at least in some region at a rate bounded from below by a positive number, despite the presence of arbitrarilymore » large density fluctuations and/or the formation of black holes. Because the set of 3-manifold topologies is countable, a single integer determines the ultimate fate of the universe, and, in a specific sense, most 3-manifolds are "flat" or "open". Our result has important implications for inflation: if there is a positive cosmological constant (or suitable inflationary potential) and initial conditions for the inflaton, cosmologies with "flat'' or "open" topology must expand forever in some region at least as fast as de Sitter space, and are therefore very likely to begin inflationary expansion eventually, regardless of the scale of the inflationary energy or the spectrum and amplitude of initial inhomogeneities and gravitational waves. Our result is also significant for numerical general relativity, which often makes use of periodic (toroidal) boundary conditions.« less

Inhomogeneous anisotropic cosmology

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

Kleban, Matthew; Senatore, Leonardo; Kavli Institute for Particle Astrophysics and Cosmology, Stanford University and SLAC,2575 Sand Hill Road, M/S 29, Menlo Park, CA 94025

In homogeneous and isotropic Friedmann-Robertson-Walker cosmology, the topology of the universe determines its ultimate fate. If the Weak Energy Condition is satisfied, open and flat universes must expand forever, while closed cosmologies can recollapse to a Big Crunch. A similar statement holds for homogeneous but anisotropic (Bianchi) universes. Here, we prove that arbitrarily inhomogeneous and anisotropic cosmologies with “flat” (including toroidal) and “open” (including compact hyperbolic) spatial topology that are initially expanding must continue to expand forever at least in some region at a rate bounded from below by a positive number, despite the presence of arbitrarily large density fluctuationsmore » and/or the formation of black holes. Because the set of 3-manifold topologies is countable, a single integer determines the ultimate fate of the universe, and, in a specific sense, most 3-manifolds are “flat” or “open”. Our result has important implications for inflation: if there is a positive cosmological constant (or suitable inflationary potential) and initial conditions for the inflaton, cosmologies with “flat” or “open” topology must expand forever in some region at least as fast as de Sitter space, and are therefore very likely to begin inflationary expansion eventually, regardless of the scale of the inflationary energy or the spectrum and amplitude of initial inhomogeneities and gravitational waves. Our result is also significant for numerical general relativity, which often makes use of periodic (toroidal) boundary conditions.« less

Clinical pharmacogenetics implementation: approaches, successes, and challenges.

PubMed

Weitzel, Kristin W; Elsey, Amanda R; Langaee, Taimour Y; Burkley, Benjamin; Nessl, David R; Obeng, Aniwaa Owusu; Staley, Benjamin J; Dong, Hui-Jia; Allan, Robert W; Liu, J Felix; Cooper-Dehoff, Rhonda M; Anderson, R David; Conlon, Michael; Clare-Salzler, Michael J; Nelson, David R; Johnson, Julie A

2014-03-01

Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. © 2014 Wiley Periodicals, Inc.

Initial Development of a Spatially Separated Speech-in-Noise and Localization Training Program

PubMed Central

Tyler, Richard S.; Witt, Shelley A.; Dunn, Camille C.; Wang, Wenjun

2010-01-01

Objective This article describes the initial development of a novel approach for training hearing-impaired listeners to improve their ability to understand speech in the presence of background noise and to also improve their ability to localize sounds. Design Most people with hearing loss, even those well fit with hearing devices, still experience significant problems understanding speech in noise. Prior research suggests that at least some subjects can experience improved speech understanding with training. However, all training systems that we are aware of have one basic, critical limitation. They do not provide spatial separation of the speech and noise, therefore ignoring the potential benefits of training binaural hearing. In this paper we describe our initial experience with a home-based training system that includes spatially separated speech-in-noise and localization training. Results Throughout the development of this system patient input, training and preliminary pilot data from individuals with bilateral cochlear implants were utilized. Positive feedback from subjective reports indicated that some individuals were engaged in the treatment, and formal testing showed benefit. Feedback and practical issues resulted from the reduction of an eight-loudspeaker to a two-loudspeaker system. Conclusions These preliminary findings suggest we have successfully developed a viable spatial hearing training system that can improve binaural hearing in noise and localization. Applications include, but are not limited to, hearing with hearing aids and cochlear implants. PMID:20701836

12 CFR 1071.202 - Documentation of fees and expenses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... initiation of the adversary adjudication, including the cost of any study, engineering report, test, or... incurred after initiation of the adversary adjudication, including the cost of any study, engineering...

New techniques for modeling the reliability of reactor pressure vessels

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

Johnson, K.I.; Simonen, F.A.; Liebetrau, A.M.

1985-12-01

In recent years several probabilistic fracture mechanics codes, including the VISA code, have been developed to predict the reliability of reactor pressure vessels. This paper describes new modeling techniques used in a second generation of the VISA code entitled VISA-II. Results are presented that show the sensitivity of vessel reliability predictions to such factors as inservice inspection to detect flaws, random positioning of flaws within the vessel walls thickness, and fluence distributions that vary through-out the vessel. The algorithms used to implement these modeling techniques are also described. Other new options in VISA-II are also described in this paper. Themore » effect of vessel cladding has been included in the heat transfer, stress, and fracture mechanics solutions in VISA-II. The algorithm for simulating flaws has been changed to consider an entire vessel rather than a single flaw in a single weld. The flaw distribution was changed to include the distribution of both flaw depth and length. A menu of several alternate equations has been included to predict the shift in RTNDT. For flaws that arrest and later re-initiate, an option was also included to allow correlating the current arrest thoughness with subsequent initiation toughnesses. 21 refs.« less

The economic and clinical burden of early versus late initiation of celecoxib among patients with osteoarthritis

PubMed Central

Shelbaya, Ahmed; Solem, Caitlyn T; Walker, Chris; Wan, Yin; Johnson, Courtney; Cappelleri, Joseph C

2018-01-01

Objective This study aimed to evaluate the characteristics associated with early versus late initiation of celecoxib treatment after osteoarthritis (OA) diagnosis and whether economic and safety outcomes differ between patients with early versus late initiation of celecoxib. Methods Adults (≥18 years) with a confirmed OA diagnosis (International Classification of Diseases, 9th Edition, Clinical Modifications code: 715.XX), ≥12 months of continuous pre- and post-index enrollment, and ≥1 post-index claim for celecoxib were included from the MarketScan® Commercial Claims and Encounter Database (2009–2013). Index date was defined as initial OA diagnosis. Patients were categorized as initiating celecoxib early (within 6 months of index date) or late (≥6 months after index date). Logistic regressions were used to assess characteristics associated with early versus late celecoxib initiation. Key outcomes included health care resource utilization (HCRU) and costs post-index, and adverse event incidence post-celecoxib initiation. Unadjusted and adjusted comparisons (using generalized linear models with a gamma distribution for costs and Poisson distribution for event and resource utilization) were made between early and late celecoxib initiators. Results Of the 62,434 OA patients identified, 27,402 were early and 35,032 were late initiators. Post-index hospital admissions and length of stay did not differ statistically between early versus late initiators after controlling for pre-index event rates and covariates, but early patients had significantly fewer outpatient (incidence rate ratio [IRR]: 0.96; 95% confidence interval [CI]: 0.95, 0.97) and emergency room visits (IRR: 0.89; 95% CI: 0.84, 0.95). After adjustment for key covariates, early initiators (versus late initiators) had lower all-cause (US$12,909 versus US$13,781, P<0.001) and OA-related (US$4,988 versus US$5,178, P=0.015) costs per person-year. Early initiators had no statistically significant difference in the incidence of post-celecoxib cardiovascular (IRR: 0.92; 95% CI: 0.73, 1.14), gastrointestinal (IRR: 1.25; 95% CI: 0.81, 1.92), or renal (IRR: 1.19; 95% CI: 0.65, 2.18) events, controlling for pre-index event rates and covariates when compared to late initiators. Conclusion In this real-world cohort, patients initiated on celecoxib early (versus late) had significantly lower costs and HCRU; this may warrant consideration when making treatment decisions for OA patients. PMID:29670383

75 FR 12497 - Carbazole Violet Pigment 23 from India and the People's Republic of China: Final Results of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... formula of C 34 H 22 Cl 2 N 4 O 2 . The subject merchandise includes the crude pigment in any form (e.g... (PRC) pursuant to section 751(c) of the Tariff Act of 1930, as amended (the Act). See Initiation of...)(C)(2). As a result of these sunset reviews, the Department finds that revocation of the antidumping...

Models for integrated pest control and their biological implications.

PubMed

Tang, Sanyi; Cheke, Robert A

2008-09-01

Successful integrated pest management (IPM) control programmes depend on many factors which include host-parasitoid ratios, starting densities, timings of parasitoid releases, dosages and timings of insecticide applications and levels of host-feeding and parasitism. Mathematical models can help us to clarify and predict the effects of such factors on the stability of host-parasitoid systems, which we illustrate here by extending the classical continuous and discrete host-parasitoid models to include an IPM control programme. The results indicate that one of three control methods can maintain the host level below the economic threshold (ET) in relation to different ET levels, initial densities of host and parasitoid populations and host-parasitoid ratios. The effects of host intrinsic growth rate and parasitoid searching efficiency on host mean outbreak period can be calculated numerically from the models presented. The instantaneous pest killing rate of an insecticide application is also estimated from the models. The results imply that the modelling methods described can help in the design of appropriate control strategies and assist management decision-making. The results also indicate that a high initial density of parasitoids (such as in inundative releases) and high parasitoid inter-generational survival rates will lead to more frequent host outbreaks and, therefore, greater economic damage. The biological implications of this counter intuitive result are discussed.

An Evaluation of the Navy Family Advocacy Program at Naval Regional Medical Center, Camp Pendleton, California.

DTIC Science & Technology

1982-08-01

to d suggest that health system intervention varies from simply providing initial physical examination to coordinating long term care and follow-up...developed with item numbers 3, 4, and 6 utilized to score the local program in terms of professional awareness. The cover 1 49 letter and questionnaire...Congress. HARM: Includes, but not limited to: ( 1 ) Physical , emo- tional, or mental injury, including physical injury resulting from otherwise lawful

Metrical expectations from preceding prosody influence perception of lexical stress

PubMed Central

Brown, Meredith; Salverda, Anne Pier; Dilley, Laura C.; Tanenhaus, Michael K.

2015-01-01

Two visual-world experiments tested the hypothesis that expectations based on preceding prosody influence the perception of suprasegmental cues to lexical stress. The results demonstrate that listeners’ consideration of competing alternatives with different stress patterns (e.g., ‘jury/gi’raffe) can be influenced by the fundamental frequency and syllable timing patterns across material preceding a target word. When preceding stressed syllables distal to the target word shared pitch and timing characteristics with the first syllable of the target word, pictures of alternatives with primary lexical stress on the first syllable (e.g., jury) initially attracted more looks than alternatives with unstressed initial syllables (e.g., giraffe). This effect was modulated when preceding unstressed syllables had pitch and timing characteristics similar to the initial syllable of the target word, with more looks to alternatives with unstressed initial syllables (e.g., giraffe) than to those with stressed initial syllables (e.g., jury). These findings suggest that expectations about the acoustic realization of upcoming speech include information about metrical organization and lexical stress, and that these expectations constrain the initial interpretation of suprasegmental stress cues. These distal prosody effects implicate on-line probabilistic inferences about the sources of acoustic-phonetic variation during spoken-word recognition. PMID:25621583

Translation of the first upstream ORF in the hepatitis B virus pregenomic RNA modulates translation at the core and polymerase initiation codons

PubMed Central

Chen, Augustine; Kao, Y. F.; Brown, Chris M.

2005-01-01

The human hepatitis B virus (HBV) has a compact genome encoding four major overlapping coding regions: the core, polymerase, surface and X. The polymerase initiation codon is preceded by the partially overlapping core and four or more upstream initiation codons. There is evidence that several mechanisms are used to enable the synthesis of the polymerase protein, including leaky scanning and ribosome reinitiation. We have examined the first AUG in the pregenomic RNA, it precedes that of the core. It initiates an uncharacterized short upstream open reading frame (uORF), highly conserved in all HBV subtypes, we designated the C0 ORF. This arrangement suggested that expression of the core and polymerase may be affected by this uORF. Initiation at the C0 ORF was confirmed in reporter constructs in transfected cells. The C0 ORF had an inhibitory role in downstream expression from the core initiation site in HepG2 cells and in vitro, but also stimulated reinitiation at the polymerase start when in an optimal context. Our results indicate that the C0 ORF is a determinant in balancing the synthesis of the core and polymerase proteins. PMID:15731337

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg.

PubMed

Fleming, Geoffrey M; Remenapp, Robert T; Bartlett, Robert H; Annich, Gail M

2006-05-01

To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. Retrospective cohort study of all neonatal and pediatric patients < 10 kg placed on ECLS from May 1998 to April 2001. Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. Initiation of ECLS in infants < 10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

Preferences for the Return of Individual Results From Research on Pediatric Biobank Samples.

PubMed

Christensen, Kurt D; Savage, Sarah K; Huntington, Noelle L; Weitzman, Elissa R; Ziniel, Sonja I; Bacon, Phoebe L; Cacioppo, Cara N; Green, Robert C; Holm, Ingrid A

2017-04-01

Discussions about disclosing individual genetic research results include calls to consider participants' preferences. In this study, parents of Boston Children's Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0 to 10 scales increased from 4.7 to 7.2 ( p < .001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants' desires for information.

Preferences for the return of individual results from research on pediatric biobank samples

PubMed Central

Christensen, Kurt D.; Savage, Sarah K.; Huntington, Noelle L.; Weitzman, Elissa R.; Ziniel, Sonja I.; Bacon, Phoebe L.; Cacioppo, Cara N.; Green, Robert C.; Holm, Ingrid A.

2016-01-01

Discussions about disclosing individual genetic research results include calls to consider participants’ preferences. In this study, parents of Boston Children’s Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0–10 scales increased from 4.7 to 7.2 (p<0.001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants’ desires for information. PMID:28421887

Ciclovía initiatives: engaging communities, partners, and policy makers along the route to success.

PubMed

Zieff, Susan G; Hipp, J Aaron; Eyler, Amy A; Kim, Mi-Sook

2013-01-01

Recent efforts to increase physical activity through changes to the built environment have led to strategies and programs that use existing public space, including bicycle lanes, temporary parks, and the ciclovia initiative (scheduled events in which streets are closed to motorized vehicles and opened for recreational activities) popularized in South America. This article describes and compares the processes and structures involved in developing and implementing a ciclovia-type program in 2 US urban contexts: San Francisco, California, and St Louis, Missouri. Considering the current growth of and interest in ciclovia initiatives, important outcomes, lessons learned are offered for application in other, similar settings. Primary sources from both initiatives and from published research on ciclovias constitute the body of evidence and include year-end reports, grant applications, meeting minutes, budgets, published ciclovia guidelines, evaluation studies and Web sites, media sources, and interviews and personal communication with the organizers. Primary source documents were reviewed and included in this analysis if they offered information on 3 grounded questions: What processes were used in developing the initiative? What are the current structures and practices used in implementation of initiatives? What are important lessons learned and best practices from initiatives for recommendations to stakeholders and policy makers in other contexts? Among the categories compared, the structures and processes for implementation regarding buy-in and city department collaboration, route selection, programming, partnerships, media promotion, community outreach, and merchant support were relatively similar among the 2 initiatives. The categories that differed included staffing and volunteer engagement and funding. Buy-in from community partners, merchants, residents, and city agencies is critical for a positive experience in developing and implementing ciclovia-type initiatives in urban environments. When funding and staffing are inconsistent or limited, the quality and sustainability of the initiative is less certain.

Substance Use among Male Sex Workers in Vietnam: Prevalence, Onset, and Interactions with Sexual Risk

PubMed Central

Yu, Gary; Clatts, Michael C.; Goldsamt, Lloyd A.; Giang, Le Minh

2014-01-01

Background HIV research in Vietnam has focused primarily on its large heroin injector population. Data on men who have sex with men [MSM], particularly the large and growing population of men who exchange sex for money or other material rewards, male sex workers [MSWs], is very limited. Methods Data derive from a cross-sectional study of MSW, age 16-35, recruited using community sampling methods in three cities in 2010-2011, including Hanoi, Ho Chi Minh City [HCMC], and Nha Trang City (n=710). Assessments included demographic characteristics, substance use, sexual risk, and use of health services. A series of “event” questions were used to assess the influence of alcohol and drugs on sexual risk. Results Both tobacco and alcohol are initiated at a young age and most participants currently use both substances overall across all three cities. While alcohol and tobacco use precede the initiation of sex work, stimulant and opiate use are initiated following the initiation of sex work. There was substantial overlap between substance use and sexual risk, and this overlap was strongest in sexual events involving male and female elective partners rather than sex work clients. Conclusion Although rates of HIV infection in this group are low, this may be an artifact of the young age of the sample. High rates of drug use, including alcohol, tobacco and illicit drugs, coupled with high rates of ulcerative STIs such as HPV, suggest the potential for rapid amplification of STI/HIV risk among MSW and their complex sex partnering networks. PMID:25488636

Overview of Initial NSTX-U Experimental Operations

NASA Astrophysics Data System (ADS)

Battaglia, Devon; the NSTX-U Team

2016-10-01

Initial operation of the National Spherical Torus Experiment Upgrade (NSTX-U) has satisfied a number of commissioning milestones, including demonstration of discharges that exceed the field and pulse length of NSTX. ELMy H-mode operation at the no-wall βN limit is obtained with Boronized wall conditioning. Peak H-mode parameters include: Ip = 1 MA, BT0 = 0.63 T, WMHD = 330 kJ, βN = 4, βN/li = 6, κ = 2.3, τE , tot >50 ms. Access to high-performance H-mode scenarios with long MHD-quiescent periods is enabled by the resilient timing of the L-H transition via feedback control of the diverting time and shape, and correction of the dominant n =1 error fields during the Ip ramp. Stationary L-mode discharges have been realized up to 1 MA with 2 s discharges achieved at Ip = 650 kA. The long-pulse L-mode discharges enabled by the new central solenoid supported initial experiments on error field measurements and correction, plasma shape control, controlled discharge ramp-down, L-mode transport and fast ion physics. Increased off-axis current drive and reduction of fast ion instabilities has been observed with the new, more tangential neutral beamline. The initial results support that access to increased field, current and heating at low-aspect-ratio expands the regimes available to develop scenarios, diagnostics and predictive models that inform the design and optimization of future burning plasma tokamak devices, including ITER. Work Supported by U.S. DOE Contract No. DE-AC02-09CH11466.

Condom use: exploring verbal and non-verbal communication strategies among Latino and African American men and women.

PubMed

Zukoski, Ann P; Harvey, S Marie; Branch, Meredith

2009-08-01

A growing body of literature provides evidence of a link between communication with sexual partners and safer sexual practices, including condom use. More research is needed that explores the dynamics of condom communication including gender differences in initiation, and types of communication strategies. The overall objective of this study was to explore condom use and the dynamics surrounding condom communication in two distinct community-based samples of African American and Latino heterosexual couples at increased risk for HIV. Based on 122 in-depth interviews, 80% of women and 74% of men reported ever using a condom with their primary partner. Of those who reported ever using a condom with their current partner, the majority indicated that condom use was initiated jointly by men and women. In addition, about one-third of the participants reported that the female partner took the lead and let her male partner know she wanted to use a condom. A sixth of the sample reported that men initiated use. Although over half of the respondents used bilateral verbal strategies (reminding, asking and persuading) to initiate condom use, one-fourth used unilateral verbal strategies (commanding and threatening to withhold sex). A smaller number reported using non-verbal strategies involving condoms themselves (e.g. putting a condom on or getting condoms). The results suggest that interventions designed to improve condom use may need to include both members of a sexual dyad and focus on improving verbal and non-verbal communication skills of individuals and couples.

Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

PubMed

Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

2016-10-01

To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists. Pan-Canadian environmental scan. Canada. Individuals representing the various initiatives provided data for the analysis. Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation. The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care. The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance. Copyright© the College of Family Physicians of Canada.

Online Friendship, Romance, and Sex: Properties and Associations of the Online Relationship Initiation Scale.

PubMed

Harris, Keith M; Aboujaoude, Elias

2016-08-01

Online relationships are increasingly central to many people's lives. As a result, there is a growing need to scientifically examine their psychosocial implications. This study developed and tested the Online Relationship Initiation Scale (ORIS) through classical and item response theory analyses to address this need. An anonymous online survey included 713 adults, aged 18-71 years. The ORIS was tested on psychometric properties and examined for associations with gender and several standardized psychosocial measures. Results demonstrated unidimensionality of nine items, strong factor loadings, and high internal consistency (α = 0.90, ωt = 0.94). All items captured significant information on the latent trait and none showed differential item functioning by sex, age group, or ethnicity. General linear modeling confirmed hypotheses that men were more likely than women to initiate online relationships. Online relationship initiation was not strongly associated with perceived social support, but was positively related to financial distress, and willingness to engage in infidelity or unprotected sex. The ORIS was negatively associated with age and satisfaction with life and showed modest interactions with ethnicity and hours online. This study provided empirical evidence for an interpersonal relationship initiation construct. The ORIS was shown to be a psychometrically sound instrument for evaluating online interpersonal behaviors and their associations with psychosocial and demographic factors. Such psychometrically sound instruments can be useful in exploring online interpersonal behaviors and their significance.

A discrete-time survival analysis of the relationship between truancy and the onset of marijuana use.

PubMed

Henry, Kimberly L; Thornberry, Terence P; Huizinga, David H

2009-01-01

Despite truancy being a common behavior among teenagers, little research has assessed its deleterious effects. In this study, the effect of truancy on the initiation of marijuana use was examined. Using data from the Rochester Youth Development Study (a longitudinal sample of predominantly minority youth), discrete time survival analyses were estimated to assess the effect of truancy on the subsequent initiation of marijuana use. The current analyses used 5 years of panel data collected from youth and their primary caregiver every 6 months throughout adolescence. Truancy was a significant predictor of the initiation of marijuana use during each subsequent 6-month period. The effect was more robust in earlier compared with later adolescence. These effects persisted after controlling for potential risk factors that are shared by both truancy and drug use, including commitment to school, grade-point average, delinquent values, prior involvement in delinquency, peer reactions to delinquency, parental monitoring, affective ties to the child, and positive parenting. We argue that the effect is, in part, the result of reduced social control (i.e., disengagement from pro-social entities such as school) and, in part, the result of the unsupervised, unmonitored time afforded by truancy. Prevention initiatives aimed at reducing truancy also may have a beneficial impact on preventing the initiation of drug use among adolescents.

Categorizing accident sequences in the external radiotherapy for risk analysis

PubMed Central

2013-01-01

Purpose This study identifies accident sequences from the past accidents in order to help the risk analysis application to the external radiotherapy. Materials and Methods This study reviews 59 accidental cases in two retrospective safety analyses that have collected the incidents in the external radiotherapy extensively. Two accident analysis reports that accumulated past incidents are investigated to identify accident sequences including initiating events, failure of safety measures, and consequences. This study classifies the accidents by the treatments stages and sources of errors for initiating events, types of failures in the safety measures, and types of undesirable consequences and the number of affected patients. Then, the accident sequences are grouped into several categories on the basis of similarity of progression. As a result, these cases can be categorized into 14 groups of accident sequence. Results The result indicates that risk analysis needs to pay attention to not only the planning stage, but also the calibration stage that is committed prior to the main treatment process. It also shows that human error is the largest contributor to initiating events as well as to the failure of safety measures. This study also illustrates an event tree analysis for an accident sequence initiated in the calibration. Conclusion This study is expected to provide sights into the accident sequences for the prospective risk analysis through the review of experiences. PMID:23865005

Prospective trial of pelvic floor retraining in patients with fecal incontinence.

PubMed

Rieger, N A; Wattchow, D A; Sarre, R G; Cooper, S J; Rich, C A; Saccone, G T; Schloithe, A C; Toouli, J; McCall, J L

1997-07-01

Our aim was to prospectively evaluate pelvic floor retraining (PFR) in improving symptomatic fecal incontinence. PFR was used to treat 30 patients with fecal incontinence (28 women; age range, 29-85 (median, 68) years). PFR was performed by a physiotherapist in the outpatient department according to a strict protocol and included biofeedback using an anal plug electromyometer. Manometry (24 patients), pudendal nerve terminal motor latency (PNTML, 16 patients), and anal ultrasound (14 patients) were done before commencing therapy. Independent assessment of symptoms was done at the commencement of therapy, at 6 weeks, and at 6 and 12 months posttherapy. Twenty patients (67 percent) had improved incontinence scores, with eight patients (27 percent) being completely or nearly free of symptoms. Of 28 patients followed up longer than six months, 14 achieved a 25 percent or greater improvement at six weeks, which was sustained in all cases. Fourteen had an initial improvement of less than 25 percent, with only four (29 percent) showing later improvement (P < 0.0001). There was no relationship between results of the therapy and patient age, initial severity of symptoms, etiology of incontinence, and results of anal manometry, PNTML, and anal ultrasound. PFR is a physical therapy that should be considered as the initial treatment in patients with fecal incontinence. An improvement can be expected in up to 67 percent of patients. Initial good results can predict overall outcome.

HPV literacy and its link to initiation and completion of HPV vaccine among young adults in Minnesota.

PubMed

Lee, H Y; Lee, J; Henning-Smith, C; Choi, J

2017-11-01

This study identifies whether, and how, human papillomavirus (HPV) literacy and predisposing, enabling, and need factors are associated with HPV vaccine initiation and completion among young adults in Minnesota. Cross-sectional survey design. Using a sample of 170 young adults (aged 18-26 years), we used logistic regression models to identify factors associated with HPV vaccination initiation and completion, including HPV literacy, adjusting for relevant predisposing, enabling, and need factors. Consistent with national estimates, we found relatively low rates of HPV vaccination initiation (46%) and completion (36%). Better HPV literacy was significantly associated with higher rates of both initiation and completion, as was being female and having an annual check-up. Being married/partnered was significantly associated with lower odds of HPV vaccination. Public health programs, policy-makers, and healthcare providers can use these results to increase HPV vaccination rates by making concerted efforts to improve HPV vaccination literacy through individual and public education campaigns and by improving access to annual check-ups. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Challenges to Breastfeeding Initiation and Duration for Teen Mothers.

PubMed

Cota-Robles, Sonia; Pedersen, Laura; LeCroy, Craig Winston

The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program. We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped. Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood. We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.

Prediction of fracture initiation in square cup drawing of DP980 using an anisotropic ductile fracture criterion

NASA Astrophysics Data System (ADS)

Park, N.; Huh, H.; Yoon, J. W.

2017-09-01

This paper deals with the prediction of fracture initiation in square cup drawing of DP980 steel sheet with the thickness of 1.2 mm. In an attempt to consider the influence of material anisotropy on the fracture initiation, an uncoupled anisotropic ductile fracture criterion is developed based on the Lou—Huh ductile fracture criterion. Tensile tests are carried out at different loading directions of 0°, 45°, and 90° to the rolling direction of the sheet using various specimen geometries including pure shear, dog-bone, and flat grooved specimens so as to calibrate the parameters of the proposed fracture criterion. Equivalent plastic strain distribution on the specimen surface is computed using Digital Image Correlation (DIC) method until surface crack initiates. The proposed fracture criterion is implemented into the commercial finite element code ABAQUS/Explicit by developing the Vectorized User-defined MATerial (VUMAT) subroutine which features the non-associated flow rule. Simulation results of the square cup drawing test clearly show that the proposed fracture criterion is capable of predicting the fracture initiation with sufficient accuracy considering the material anisotropy.

Optimization of γ-aminobutyric acid production by Lactobacillus plantarum Taj-Apis362 from honeybees.

PubMed

Tajabadi, Naser; Ebrahimpour, Afshin; Baradaran, Ali; Rahim, Raha Abdul; Mahyudin, Nor Ainy; Manap, Mohd Yazid Abdul; Bakar, Fatimah Abu; Saari, Nazamid

2015-04-15

Dominant strains of lactic acid bacteria (LAB) isolated from honey bees were evaluated for their γ-aminobutyric acid (GABA)-producing ability. Out of 24 strains, strain Taj-Apis362 showed the highest GABA-producing ability (1.76 mM) in MRS broth containing 50 mM initial glutamic acid cultured for 60 h. Effects of fermentation parameters, including initial glutamic acid level, culture temperature, initial pH and incubation time on GABA production were investigated via a single parameter optimization strategy. The optimal fermentation condition for GABA production was modeled using response surface methodology (RSM). The results showed that the culture temperature was the most significant factor for GABA production. The optimum conditions for maximum GABA production by Lactobacillus plantarum Taj-Apis362 were an initial glutamic acid concentration of 497.97 mM, culture temperature of 36 °C, initial pH of 5.31 and incubation time of 60 h, which produced 7.15 mM of GABA. The value is comparable with the predicted value of 7.21 mM.

AtaT blocks translation initiation by N-acetylation of the initiator tRNAfMet.

PubMed

Jurėnas, Dukas; Chatterjee, Sneha; Konijnenberg, Albert; Sobott, Frank; Droogmans, Louis; Garcia-Pino, Abel; Van Melderen, Laurence

2017-06-01

Toxin-antitoxin (TA) loci are prevalent in bacterial genomes. They are suggested to play a central role in dormancy and persister states. Under normal growth conditions, TA toxins are neutralized by their cognate antitoxins, and under stress conditions, toxins are freed and inhibit essential cellular processes using a variety of mechanisms. Here we characterize ataR-ataT, a novel TA system, from enterohemorrhagic Escherichia coli. We show that the toxin AtaT is a GNAT family enzyme that transfers an acetyl group from acetyl coenzyme A to the amine group of the methionyl aminoacyl moiety of initiator tRNA. AtaT specifically modifies Met-tRNA fMet , but no other aminoacyl-tRNAs, including the elongator Met-tRNA Met . We demonstrate that once acetylated, AcMet-tRNA fMet fails to interact with initiation factor-2 (IF2), resulting in disruption of the translation initiation complex. This work reveals a new mechanism of translation inhibition and confirms Met-tRNA fMet as a prime target to efficiently block cell growth.

Self-esteem and the initiation of substance use among adolescents.

PubMed

Richardson, Chris G; Kwon, Jae-Young; Ratner, Pamela A

2012-11-08

To investigate differences in the relationship between self-esteem and the initiation of substance use (tobacco, alcohol and marijuana) among male and female secondary school students in British Columbia. The data were collected in the 2010 fall and 2011 spring cycles of the British Columbia Adolescent Substance Use Survey (BASUS). The sample consisted of 1,267 adolescents (57% female) in Grades 8 and 9. Multivariate logistic regression models were used to examine the extent to which self-esteem and gender, and their interaction, influenced the odds of having initiated substance use at baseline and at follow-up 6 months later. For each one-point increase on the Rosenberg Self-Esteem Scale, there was a reduction in the odds of initiating substance use by up to 9% for tobacco, 3% for alcohol, and 7% for marijuana. The relationships between self-esteem and the initiation of tobacco and alcohol use varied by gender, with boys having slightly less robust associations at the baseline assessment. The results suggest that self-esteem is protective against the initiation of tobacco, alcohol, and marijuana use. Researchers are advised to consider the interactive effects of gender in future longitudinal research examining the relationship between self-esteem and the initiation of substance use, including implications related to the development of substance use prevention programs.

Establishing a regional network of academic centers to support decision making for new vaccine introduction in Latin America and the Caribbean: the ProVac experience.

PubMed

Toscano, C M; Jauregui, B; Janusz, C B; Sinha, A; Clark, A D; Sanderson, C; Resch, S; Ruiz Matus, C; Andrus, J K

2013-07-02

The Pan American Health Organization's ProVac Initiative, designed to strengthen national decision making regarding the introduction of new vaccines, was initiated in 2004. Central to realizing ProVac's vision of regional capacity building, the ProVac Network of Centers of Excellence (CoEs) was established in 2010 to provide research support to the ProVac Initiative, leveraging existing capacity at Latin American and Caribbean (LAC) universities. We describe the process of establishing the ProVac Network of CoEs and its initial outcomes and challenges. A survey was sent to academic, not-for-profit institutions in LAC that had recently published work in the areas of clinical decision sciences and health economic analysis. Centers invited to join the Network were selected by an international committee on the basis of the survey results. Selection criteria included academic productivity in immunization-related work, team size and expertise, successful collaboration with governmental agencies and international organizations, and experience in training and education. The Network currently includes five academic institutions across LAC. Through open dialog and negotiation, specific projects were assigned to centers according to their areas of expertise. Collaboration among centers was highly encouraged. Faculty from ProVac's technical partners were assigned as focal points for each project. The resulting work led to the development and piloting of tools, methodological guides, and training materials that support countries in assessing existing evidence and generating new evidence on vaccine introduction. The evidence generated is shared with country-level decision makers and the scientific community. As the ProVac Initiative expands to other regions of the world with support from immunization and public health partners, the establishment of other regional and global networks of CoEs will be critical. The experience of LAC in creating the current network could benefit the formation of similar structures that support evidence-based decisions regarding new public health interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Surgical aspects of Operation Bali Assist: initial wound surgery on the tarmac and in flight.

PubMed

Read, David; Ashford, Bruce

2004-11-01

The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin. A descriptive report is provided of the event and includes; resuscitation, anaesthesia, initial burns surgery management including escharotomy and fasciotomy, head injury management and importance of supplies and medical records with a description of the evacuation to Darwin. Operation Bali Assist involved five C130 Hercules aircraft and aeromedical evacuation medical and nursing teams managing 66 casualties in the Denpasar area and their evacuation to Royal Darwin Hospital with ketamine the most useful anaesthetic agent and cling film the most useful burns dressing. Twelve procedures were performed at the ASF including seven escharotomies, three fasciotomies and two closed reductions. One escharotomy was performed in flight. The important lessons learnt from the exercise is the inclusion of a surgeon in the aeromedical evacuation team, the importance of debridement and delayed primary closure, the usefulness of cling film as a burns dressing and the importance of continuous assessment. Future disaster planning exercises need to consider a patient age mix that might be expected in a shopping mall, rather than the young adult encountered in Bali, a more familiar age mix for Australian Defence Force medical staff.

Effect of closed-loop order processing on the time to initial antimicrobial therapy.

PubMed

Panosh, Nicole; Rew, Richardd; Sharpe, Michelle

2012-08-15

The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported. A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration. The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis). Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.

Impact of Initial Vancomycin Trough Concentration on Clinical and Microbiological Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children.

PubMed

Yoo, Ree Nar; Kim, Seo Hee; Lee, Jina

2017-01-01

It is important to use vancomycin in a proper manner to ensure optimal drug exposure. Despite extensive use of vancomycin in children, studies on its optimal trough concentration (Ctrough) in the pediatric population remained rare. This retrospective study included children < 18 years old with culture-confirmed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia who were hospitalized in our institute from January 2010 to April 2014. Clinical characteristics, initial vancomycin dose, Ctrough and clinical/microbiological outcomes were retrospectively collected from medical records. Forty-six MRSA bacteremia cases occurring to the patients with a mean age of 22.0 ± 46.9 months were included and all of them were healthcare-associated. Severe diseases requiring intensive care unit (ICU) stay, mechanical ventilation and/or resulting in death were observed in 57.8% (26/45); all-cause 30-day fatality was 11.1% (5/45). An initial Ctrough ≥ 15 μg/mL was achieved in only 4 (8.7%) cases with an average vancomycin dosage of 40.6 ± 7.9 mg/kg/day. Persistent bacteremia at 48 hours after initiation of vancomycin was observed more frequently in children with initial Ctrough < 10 μg/mL than in those with Ctrough ≥ 10 μg/mL (P = 0.032). However, there was no statistically significant difference between the two groups in terms of 30-day mortality and recurrent bacteremia (P = 0.899, and P = 0.754, respectively). Although initial Ctrough may be a useful parameter for minimizing early microbiological failure, it does not predict 30-day fatality or recurrence in pediatric MRSA bacteremia. Further prospective data on vancomycin dosing are needed to find the optimal drug exposure and clarify its impact on clinical outcomes in pediatric populations.

Incidence and predictors of herpes zoster among antiretroviral therapy-naïve patients initiating HIV treatment in Johannesburg, South Africa

PubMed Central

Maskew, Mhairi; Ajayi, Toyin; Berhanu, Rebecca; Majuba, Pappie; Sanne, Ian; Fox, Matthew P.

2014-01-01

Summary Objectives To describe the characteristics of HIV-infected patients experiencing herpes zoster after antiretroviral therapy (ART) initiation and to describe the incidence and predictors of a herpes zoster diagnosis. Methods Adult patients initiating ART from April 2004 to September 2011 at the Themba Lethu Clinic in Johannesburg, South Africa were included. Patients were followed from ART initiation until the date of first herpes zoster diagnosis, or death, transfer, loss to follow-up, or dataset closure. Herpes zoster is described using incidence rates (IR) and predictors of herpes zoster are presented as subdistribution hazard ratios (sHR) and 95% confidence intervals (95% CI). Results Fifteen thousand and twenty-five patients were included; 62% were female, the median age was 36.6 years, and the median baseline CD4 count was 98 cells/mm3. Three hundred and forty patients (2.3%) experienced herpes zoster in a median of 26.1 weeks after ART initiation. Most (71.5%) occurred within 1 year of initiation, for a 1-year IR of 18.1/1000 person-years. In an adjusted model, patients with low CD4 counts (<50 vs. ≥200 cells/mm3; sHR: 1.71, 95% CI: 1.21–2.47) and with a prior episode of herpes zoster (sHR: 1.53, 95% CI: 0.97–2.28) were at increased risk of incident herpes zoster. Conclusions While only 2% of patients were diagnosed with herpes zoster in this cohort, patients with low CD4 counts and those with prior episodes of herpes zoster were at higher risk for a herpes zoster diagnosis. PMID:24680820

Roles and competencies of the Support Facilitator in Australia's recovery-oriented mental health initiative: a qualitative study from Gippsland, Victoria.

PubMed

Sutton, Keith; Isaacs, Anton N; Dalziel, Kim; Maybery, Darryl

2017-03-01

Objective This study explored the roles and competencies of Support Facilitators (SFs) engaged in the implementation of the Partners in Recovery initiative in a rural region of Victoria. Methods Semi-structured interviews were conducted with 32 stakeholders involved in the initiative, of which 15 were SFs. Results Two main themes and 10 subthemes emerged from the data: (1) SF competencies (which included an understanding of local services as well as administrative and social skills); and (2) the SF role (which included them being a single point of contact, providing care coordination, assisting the client to become self-reliant, achieving good outcomes for clients with confronting behaviours, judiciously using flexible funding, clearly outlining their role with clients and maintaining boundaries and performing a different role from that of the mental health case manager). Conclusions The roles and competencies of the SF in the Partners in Recovery initiative in Gippsland were congruent with the defined characteristics of a care coordination approach. The results highlight how the SF role differs from that of traditional clinical case managers. These findings are important for future mental health service policy development, education and training of mental health practitioners and recruitment of personnel to care coordination roles. What is known about the topic? There is a growing body of literature highlighting the importance of care coordination in delivery of positive outcomes for people with chronic and complex health problems. However, little is documented about the care coordination role of SFs as part of the Partners in Recovery initiative in Australia. What does this paper add? This paper identifies the roles and competencies of SFs in the Partners in Recovery initiative in a rural region of Victoria. The paper highlights that the emergent competencies and role functions are congruent with the defined characteristics of a care coordination approach but differ from that of mental health case managers. What are the implications for practitioners? These findings are important for future mental health service policy development, education and training of mental health practitioners and recruitment of personnel to care coordination roles.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

PubMed

Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

2016-12-07

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study.

PubMed

Schuetz, Philipp; Hausfater, Pierre; Amin, Devendra; Amin, Adina; Haubitz, Sebastian; Faessler, Lukas; Kutz, Alexander; Conca, Antoinette; Reutlinger, Barbara; Canavaggio, Pauline; Sauvin, Gabrielle; Bernard, Maguy; Huber, Andreas; Mueller, Beat

2015-10-29

Early risk stratification in the emergency department (ED) is vital to reduce time to effective treatment in high-risk patients and to improve patient flow. Yet, there is a lack of investigations evaluating the incremental usefulness of multiple biomarkers measured upon admission from distinct biological pathways for predicting fatal outcome and high initial treatment urgency in unselected ED patients in a multicenter and multinational setting. We included consecutive, adult, medical patients seeking ED care into this observational, cohort study in Switzerland, France and the USA. We recorded initial clinical parameters and batch-measured prognostic biomarkers of inflammation (pro-adrenomedullin [ProADM]), stress (copeptin) and infection (procalcitonin). During a 30-day follow-up, 331 of 7132 (4.6 %) participants reached the primary endpoint of death within 30 days. In logistic regression models adjusted for conventional risk factors available at ED admission, all three biomarkers strongly predicted the risk of death (AUC 0.83, 0.78 and 0.75), ICU admission (AUC 0.67, 0.69 and 0.62) and high initial triage priority (0.67, 0.66 and 0.58). For the prediction of death, ProADM significantly improved regression models including (a) clinical information available at ED admission (AUC increase from 0.79 to 0.84), (b) full clinical information at ED discharge (AUC increase from 0.85 to 0.88), and (c) triage information (AUC increase from 0.67 to 0.83) (p <0.01 for each comparison). Similarly, ProADM also improved clinical models for prediction of ICU admission and high initial treatment urgency. Results were robust in regard to predefined patient subgroups by center, main diagnosis, presenting symptoms, age and gender. Combination of clinical information with results of blood biomarkers measured upon ED admission allows early and more adequate risk stratification in individual unselected medical ED patients. A randomized trial is needed to answer the question whether biomarker-guided initial patient triage reduces time to initial treatment of high-risk patients in the ED and thereby improves patient flow and clinical outcomes. ClinicalTrials.gov NCT01768494 . Registered January 9, 2013.

Interactions Between Energy Drink Consumption and Sleep Problems: Associations with Alcohol Use Among Young Adolescents.

PubMed

Marmorstein, Naomi R

2017-09-01

Background: Energy drink consumption and sleep problems are both associated with alcohol use among adolescents. In addition, caffeine consumption (including energy drinks) is associated with sleep problems. However, information about how these three constructs may interact is limited. The goal of this study was to examine potential interactions between energy drink consumption and sleep problems in the concurrent prediction of alcohol use among young adolescents. Coffee and soda consumption were also examined for comparison. Methods: Participants from the Camden Youth Development Study were included ( n  = 127; mean age = 13.1; 68% Hispanic, 29% African American) and questionnaire measures of frequency of caffeinated beverage consumption (energy drinks, coffee, and soda), sleep (initial insomnia, sleep disturbances, daytime fatigue, and sleep duration), and alcohol consumption were used. Regression analyses were conducted to examine interactions between caffeinated beverage consumption and sleep in the concurrent prediction of alcohol use. Results: Energy drink consumption interacted with initial insomnia and daytime fatigue to concurrently predict particularly frequent alcohol use among those with either of these sleep-related problems and energy drink consumption. The pattern of results for coffee consumption was similar for insomnia but reached only a trend level of significance. Results of analyses examining soda consumption were nonsignificant. Conclusions: Young adolescents who both consume energy drinks and experience initial insomnia and/or daytime fatigue are at particularly high risk for alcohol use. Coffee consumption appears to be associated with similar patterns. Longitudinal research is needed to explain the developmental pathways by which these associations emerge, as well as mediators and moderators of these associations.

Effect of Parental Age on Treatment Response in Adolescents with Schizophrenia

PubMed Central

Opler, Mark; Malaspina, Dolores; Gopal, Srihari; Nuamah, Isaac; Savitz, Adam J; Singh, Jaskaran; Hough, David

2013-01-01

Background Advanced paternal age (APA) is associated with increased risk for schizophrenia, but its effect on treatment response has not been longitudinally studied. Methods Association of parental ages at the time of the child's birth with age of onset, initial symptom severity and treatment response (to placebo and three different weight-based doses of paliperidone ER) in adolescents with schizophrenia was assessed in a post-hoc analysis using data from a 6-week double-blind study, the primary results of which are published (NCT 00518323). Results The mean (SD) paternal age was 29.2 (6.2) years, range (16-50) and maternal age was 26.8 (5.7) years, range (17-42) at childbirth for the 201 adolescents (ages 12-17 years) included in the analysis. While parental ages were uncorrelated with age of onset or initial symptom severity, both maternal and paternal age showed significant effects on treatment response (p < 0.03) of all paliperidone ER arms versus placebo. Paternal age was significantly correlated to improvement in positive symptoms and maternal age significantly related to negative symptoms, although only paternal age remained significantly associated with the treatment response in analyses that included both parents’ ages. Conclusions APA was associated with greater treatment response to both paliperidone ER and placebo, but not to age of onset or initial symptom severity in adolescents with schizophrenia. The results support the contention that APA-related schizophrenia has distinct underpinnings from other cases. Further studies are required to explore the role of genetic and environmental factors, and their interactions, in treatment response in this complex disorder. PMID:24144440

Deaf College Students' Representation of Image and Verbal Information.

ERIC Educational Resources Information Center

Epstein, Kenneth; And Others

This paper discusses the results of a study of 27 college students with deafness that investigated whether cognitive processes are modality dependent in individuals with deafness. The experiment included two separate parts, one composed of shape trials and the other composed of word trials. An initial stimulus was shown on a computer screen for…

Defining Child Exposure to Domestic Violence as Neglect: Minnesota's Difficult Experience

ERIC Educational Resources Information Center

Edleson, Jeffrey L.; Gassman-Pines, Jenny; Hill, Marissa B.

2006-01-01

Policymakers are increasingly focusing on children exposed to domestic violence. The 1999 Minnesota legislature amended the definition of child neglect to include a child's exposure to family violence. What was initially seen as a simple change to bring more attention to children exposed to domestic violence resulted in great turmoil across…

FIELD ACTIVITIES AND PRELIMINARY RESULTS FROM THE INVESTIGATION OF WESTERN AIRBORNE CONTAMINANTS IN TWO HIGH ELEVATION WATERSHEDS OF ROCKY MOUNTAIN NATIONAL PARK

EPA Science Inventory

The National Park Service initiated the Western Airborne Contaminants Assessment Project (WACAP) in 2002 to determine if airborne contaminants from long-range transport and/or regional sources are having an impact on remote western ecosystems, including AK. Rocky Mountain Nation...

Law Student Wellbeing: A Neoliberal Conundrum

ERIC Educational Resources Information Center

Thornton, Margaret

2016-01-01

The discourse around student wellness is a marked feature of the 21st century Australian legal academy. It has resulted in various initiatives on the part of law schools, including the development of a national forum. The phenomenon relates to psychological distress reported by students through surveys. Proposed remedies tend to focus on improving…