Implementation of Joint Multi-Segment Training

NASA Technical Reports Server (NTRS)

Reagan, Marc; Smith, Wyatt; Bugrova, Skella; Silkov, Sergei

2000-01-01

The highest level of training for ISS flight is Joint Multi-Segment Training (JMST) simulations. These simulations allow two or more partners to conduct multi-segment training for their respective Mission Control Centers (MCC), include actual crew members, and usually include training facilities in each of the participating International Partner (IP) locations. It is the dress rehearsal for those events that exercise the interface between different IP modules and/or the decision making process between the different MCCs involved. This presentation will describe the challenge of successfully implementing JMST. It will start with a brief overview of who is involved, where they are located, and when JMSTs are required. Finally, it will illustrate many of the complications involved in just running a JMST between MCC-M and MCC-H. The viewer will leave with a much better appreciation for the complexities involved in successfully conducting a JMST of this nature, as well as an idea of how the picture will change as the other partners and payloads become involved.

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

NASA Astrophysics Data System (ADS)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

Characteristics of solder joints under fatigue loads using piezomechanical actuation

NASA Astrophysics Data System (ADS)

Shim, Dong-Jin; Spearing, S. Mark

2003-07-01

Crack initiation and growth characteristics of solder joints under fatigue loads are investigated using piezomechanical actuation. Cracks in solder joints, which can cause failure in microelectronics components, are induced via piezoelectricity in piezo-ceramic bonded joints. Lead-zirconate-titanate ceramic plates and eutectic Sn-Pb solder bonded in a double-lap shear configuration are used in the investigation. Electric field across each piezo-ceramic plate is applied such that shear stresses/strains are induced in the solder joints. The experiments show that cracks initiate in the solder joints around defects such as voids and grow in length until they coalesce with other cracks from adjacent voids. These observations are compared with the similar thermal cycling tests from the literature to show feasibility and validity of the current method in investigating the fatigue characteristics of solder joints. In some specimens, cracks in the piezo-ceramic plates are observed, and failure in the specimens generally occurred due to piezo-ceramic plate fracture. The issues encountered in implementing this methodology such as low actuation and high processing temperatures are further discussed.

Is Infant Initiation of Joint Attention by Pointing Affected by Type of Interaction?

ERIC Educational Resources Information Center

Franco, Fabia; Perucchini, Paola; March, Barbara

2009-01-01

This article reports the results of two experiments studying the effects of type of interaction on infant production of declarative pointing. In Experiment 1, intensity of social presence was manipulated in adult-infant interaction with 12-19-month-olds (no social presence; adult responding only; adult also initiating joint attentional bids).…

Disentangling the initiation from the response in joint attention: an eye-tracking study in toddlers with autism spectrum disorders.

PubMed

Billeci, L; Narzisi, A; Campatelli, G; Crifaci, G; Calderoni, S; Gagliano, A; Calzone, C; Colombi, C; Pioggia, G; Muratori, F

2016-05-17

Joint attention (JA), whose deficit is an early risk marker for autism spectrum disorder (ASD), has two dimensions: (1) responding to JA and (2) initiating JA. Eye-tracking technology has largely been used to investigate responding JA, but rarely to study initiating JA especially in young children with ASD. The aim of this study was to describe the differences in the visual patterns of toddlers with ASD and those with typical development (TD) during both responding JA and initiating JA tasks. Eye-tracking technology was used to monitor the gaze of 17 children with ASD and 15 age-matched children with TD during the presentation of short video sequences involving one responding JA and two initiating JA tasks (initiating JA-1 and initiating JA-2). Gaze accuracy, transitions and fixations were analyzed. No differences were found in the responding JA task between children with ASD and those with TD, whereas, in the initiating JA tasks, different patterns of fixation and transitions were shown between the groups. These results suggest that children with ASD and those with TD show different visual patterns when they are expected to initiate joint attention but not when they respond to joint attention. We hypothesized that differences in transitions and fixations are linked to ASD impairments in visual disengagement from face, in global scanning of the scene and in the ability to anticipate object's action.

Calcium plus vitamin D supplementation and joint symptoms in postmenopausal women in the women's health initiative randomized trial.

PubMed

Chlebowski, Rowan T; Pettinger, Mary; Johnson, Karen C; Wallace, Robert; Womack, Catherine; Mossavar-Rahmani, Yasmin; Stefanick, Marcia; Wactawski-Wende, Jean; Carbone, Laura; Lu, Bing; Eaton, Charles; Walitt, Brian; Kooperberg, Charles L

2013-10-01

Low vitamin D intake and levels have been associated with increased joint symptoms in some observational studies but the findings are mixed and evidence from randomized trials sparse. To evaluate the influence of supplemental calcium and vitamin D on joint symptoms in the Women's Health Initiative randomized, placebo-controlled, clinical trial. In post hoc analyses, the results of the Women's Health Initiative randomized clinical trial in which 36,282 postmenopausal women were randomized to receive calcium carbonate (1,000 mg as elemental calcium) with vitamin D-3 (400 IU) daily or placebo were examined in the 6% subgroup of 1,911 participants, oversampled for minorities, who had serial joint symptom assessment. Qualitative information on joint pain and joint swelling was collected by questionnaire before entry and 2 years after randomization. Logistic regression models were used to compare the occurrence and severity of joint symptoms across randomization groups. At baseline, total calcium and vitamin D intakes from diet and supplements were similar in the two randomization groups. In addition, both joint pain (reported by 73%) and joint swelling (reported by 34%) were commonly reported and comparable in the supplement and placebo groups. Two years after randomization, no statistically significant differences between supplement and placebo groups were seen for joint pain frequency (74.6% compared with 75.1% [P=0.79] for supplement and placebo groups, respectively) or joint swelling frequency (34.6% compared with 32.4% [P=0.29], respectively) or in severity scores for either outcome. Subgroup analyses suggested study participants also using nonprotocol calcium supplements at study entry may have less joint pain with supplement group randomization (interaction P=0.02). Joint symptoms are relatively common in postmenopausal women. However, daily supplementation with 1,000 mg calcium carbonate and 400 IU vitamin D-3 in a randomized, placebo-controlled clinical trial

Ankle Dorsiflexion Displacement During Landing is Associated With Initial Contact Kinematics but not Joint Displacement.

PubMed

Begalle, Rebecca L; Walsh, Meghan C; McGrath, Melanie L; Boling, Michelle C; Blackburn, J Troy; Padua, Darin A

2015-08-01

The ankle, knee, and hip joints work together in the sagittal plane to absorb landing forces. Reduced sagittal plane motion at the ankle may alter landing strategies at the knee and hip, potentially increasing injury risk; however, no studies have examined the kinematic relationships between the joints during jump landings. Healthy adults (N = 30; 15 male, 15 female) performed jump landings onto a force plate while three-dimensional kinematic data were collected. Joint displacement values were calculated during the loading phase as the difference between peak and initial contact angles. No relationship existed between ankle dorsiflexion displacement during landing and three-dimensional knee and hip displacements. However, less ankle dorsiflexion displacement was associated with landing at initial ground contact with larger hip flexion, hip internal rotation, knee flexion, knee varus, and smaller plantar flexion angles. Findings of the current study suggest that restrictions in ankle motion during landing may contribute to contacting the ground in a more flexed position but continuing through little additional motion to absorb the landing. Transverse plane hip and frontal plane knee positioning may also occur, which are known to increase the risk of lower extremity injury.

Superintendents' Perceptions of 1:1 Initiative Implementation and Sustainability

ERIC Educational Resources Information Center

Cole, Bobby Virgil, Jr.; Sauers, Nicholas J.

2018-01-01

One of the fastest growing, most discussed, and most expensive technology initiatives over the last decade has been one-to-one (1:1) computing initiatives. The purpose of this study was to examine key factors that influenced implementing and sustaining 1:1 computing initiatives from the perspective of school superintendents. Nine superintendents…

The passage and initial implementation of Oregon's Measure 44

PubMed Central

Goldman, L.; Glantz, S.

1999-01-01

OBJECTIVE—To prepare a history of the passage and early implementation of Ballot Measure 44, "An Act to Support the Oregon Health Plan", and tobacco control policymaking in Oregon. Measure 44 raised cigarette taxes in Oregon by US$0.30 per pack, and dedicated 10% of the revenues to tobacco control.
METHODS—Data were gathered from interviews with members of the Committee to Support the Oregon Health Plan, Measure 44's campaign committee, as well as with state and local officials, and tobacco control advocates. Additional information was obtained from public documents, internal memoranda, and news reports.
RESULTS—Although the tobacco industry outspent Measure 44's supporters 7 to 1, the initiative passed with 56% of the vote. Even before the election, tobacco control advocates were working to develop an implementation plan for the tobacco control programme. They mounted a successful lobbying campaign to see that the legislature did not divert tobacco control funds to other uses. They also stopped industry efforts to limit the scope of the programme. The one shortcoming of the tobacco control forces was not getting involved in planning the initiative early enough to influence the amount of money that was devoted to tobacco control. Although public health groups provided 37% of the money it cost to pass Measure 44, only 10% of revenues were devoted to tobacco control.
CONCLUSIONS—Proactive planning and aggressive implementation can secure passage of tobacco control initiatives and see that the associated implementing legislation follows good public health practice.


Keywords: advocacy; legislation; implementation; tobacco tax PMID:10599577

Child-Friendly School Initiative in Jordan: A Sharing Experience

ERIC Educational Resources Information Center

Weshah, Hani A.; Al-Faori, Oraib; Sakal, Reham M.

2012-01-01

The purpose of this research was to report on a Child-Friendly School (CFS) initiative pilot project in Jordan, which aims at initiating the creation of CFS and to raise stakeholders' awareness of the importance of this project in promoting and implementing Child Rights Conviction (CRC) in Jordan. The study was conducted by a joint team selected…

Cabo Verde telemedicine program: initial results of nationwide implementation.

PubMed

Latifi, Rifat; Dasho, Erion; Merrell, Ronald C; Lopes, Miguel; Azevedo, Vanda; Bekteshi, Flamur; Osmani, Kalterina L; Qesteri, Orland; Kucani, Julian; Lecaj, Ismet

2014-11-01

Telemedicine and e-health have been suggested as one solution for closing the health disparity gap between the developed world and the developing world. Yet evidence is lacking from current successful programs in the developing world and, in particular, from sub-Saharan Africa. The primary objective of our study was to present the preliminary results of our efforts in building the Integrated Telemedicine and e-Health Program for Cabo Verde (ITeHP-CV), with an emphasis on initial utilization and results. This is a prospective study of data collected while we worked to establish a fully functional, integrated national telemedicine network and virtual education network in Cabo Verde. We used the International Virtual e-Hospital Foundation strategic approach known as "initiate-build-operate-transfer" over a 26-month period (November 2011-December 2013). We describe herein the five main pillars of this process that have been implemented: (1) capacity building; (2) network development and deployment of equipment; (3) implementation of clinical telemedicine; (4) implementation of activities related to continuing medical education, delivered from within the country and from abroad; and (5) establishment and use of the electronic virtual library. Based on comprehensive technical and medical assessment of the country's needs, 10 fully functional telemedicine centers in all nine inhabited islands of the Republic of Cabo Verde have been established. RESULTS are presented under the five main pillars of capacity building, network deployment, implementation of clinical telemedicine, implementation of continuing medical education activities, and establishment of the electronic virtual library. The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure

Effect of Initial Microstructure on the Microstructural Evolution and Joint Efficiency of a WE43 Alloy During Friction Stir Welding

DTIC Science & Technology

2013-04-01

to maximize joint efficiency. 15. SUBJECT TERMS friction stir welding, strain rate, dynamic recrystallization , joint efficiency, stir zone (SZ...stir welding, Strain rate, Dynamic recrystallization , Joint efficiency, Stir Zone (SZ) Abstract The initial microstructure plays an important role in... eutectic Mg17Al12 phase. Park et al. [7] demonstrated the importance of texture and related it to the mechanical properties of an AZ61 alloy

Progressive Damage Analysis of Bonded Composite Joints

NASA Technical Reports Server (NTRS)

Leone, Frank A., Jr.; Girolamo, Donato; Davila, Carlos G.

2012-01-01

The present work is related to the development and application of progressive damage modeling techniques to bonded joint technology. The joint designs studied in this work include a conventional composite splice joint and a NASA-patented durable redundant joint. Both designs involve honeycomb sandwich structures with carbon/epoxy facesheets joined using adhesively bonded doublers.Progressive damage modeling allows for the prediction of the initiation and evolution of damage within a structure. For structures that include multiple material systems, such as the joint designs under consideration, the number of potential failure mechanisms that must be accounted for drastically increases the complexity of the analyses. Potential failure mechanisms include fiber fracture, intraply matrix cracking, delamination, core crushing, adhesive failure, and their interactions. The bonded joints were modeled using highly parametric, explicitly solved finite element models, with damage modeling implemented via custom user-written subroutines. Each ply was discretely meshed using three-dimensional solid elements. Layers of cohesive elements were included between each ply to account for the possibility of delaminations and were used to model the adhesive layers forming the joint. Good correlation with experimental results was achieved both in terms of load-displacement history and the predicted failure mechanism(s).

Brief report: High and low level initiations of joint attention, and response to joint attention: differential relationships with language and imitation.

PubMed

Pickard, Katherine E; Ingersoll, Brooke R

2015-01-01

Frequency of high-level (showing/pointing) and low-level (coordinated gaze shifts) behaviors on the Early Social Communication Scales are often used as a measure of joint attention initiations (IJA). This study examined the degree to which these skills and response to joint attention (RJA; e.g. gaze following) were differentially related to measures of language and imitation in 53 children with autism spectrum disorder between the ages of 22 and 93 months. High-level and low-level IJA were not associated with each other, and only high-level IJA was associated with RJA, and language and imitation measures. High-level IJA and RJA were unique predictors of imitation, while RJA was a unique predictor of language. Findings indicate that IJA involves distinct skills, with high-level behaviors more closely related to social-communication skills.

Implementation of the IHR Joint External Evaluation: Taiwan's Experiences.

PubMed

Lo, Yi-Chun

In February 2016, the World Health Organization developed the Joint External Evaluation (JEE) tool to independently assess country capacity to prevent, detect, and respond to public health threats as part of the International Health Regulations (IHR) (2005) monitoring and evaluation framework. In light of this, the Taiwan government actively engaged at least 19 government agencies or institutions and voluntarily implemented the JEE. An External Assessment Team consisting of 6 US subject matter experts conducted the external evaluation, including site visits, from June 21 to July 1, 2016. The results, published on October 18, 2016, are useful and will be translated into actions and change in the system. Based on Taiwan's experiences, early stakeholder engagement and an experts' pre-JEE pilot visit would contribute to a successful JEE process.

Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies.

PubMed

Menear, Matthew; Briand, Catherine

2014-04-01

Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.

Joint Attention Initiation with and without Positive Affect: Risk Group Differences and Associations with ASD Symptoms

PubMed Central

Gangi, Devon N.; Ibañez, Lisa V.; Messinger, Daniel S.

2014-01-01

Infants at risk for Autism Spectrum Disorders (ASD) may have difficulty integrating smiles into initiating joint attention (IJA) bids. A specific IJA pattern, anticipatory smiling, may communicate preexisting positive affect when an infant smiles at an object and then turns the smile toward the social partner. We compared the development of anticipatory smiling at 8, 10, and 12 months in infant siblings of children with ASD (high-risk siblings) and without ASD (low-risk siblings). High-risk siblings produced less anticipatory smiling than low-risk siblings, suggesting early differences in communicating preexisting positive affect. While early anticipatory smiling distinguished the risk groups, IJA not accompanied by smiling best predicted later severity of ASD-related behavioral characteristics among high-risk siblings. High-risk infants appear to show lower levels of motivation to share positive affect with others. However, facility with initiating joint attention in the absence of a clear index of positive affective motivation appears to be central to the prediction of ASD symptoms. PMID:24281421

Within-Year Fidelity Growth of SWPBIS during Installation and Initial Implementation

ERIC Educational Resources Information Center

Schaper, Andrew; McIntosh, Kent; Hoselton, Robert

2016-01-01

The purpose of this study was to document within-year fidelity growth during installation and initial implementation of School-Wide Positive Behavioral Interventions and Supports (SWPBIS). Participants included school teams from schools throughout the United States that were in years one to four of SWPBIS implementation and routinely evaluated…

Determination of Parachute Joint Factors using Seam and Joint Testing

NASA Technical Reports Server (NTRS)

Mollmann, Catherine

2015-01-01

This paper details the methodology for determining the joint factor for all parachute components. This method has been successfully implemented on the Capsule Parachute Assembly System (CPAS) for the NASA Orion crew module for use in determining the margin of safety for each component under peak loads. Also discussed are concepts behind the joint factor and what drives the loss of material strength at joints. The joint factor is defined as a "loss in joint strength...relative to the basic material strength" that occurs when "textiles are connected to each other or to metals." During the CPAS engineering development phase, a conservative joint factor of 0.80 was assumed for each parachute component. In order to refine this factor and eliminate excess conservatism, a seam and joint testing program was implemented as part of the structural validation. This method split each of the parachute structural joints into discrete tensile tests designed to duplicate the loading of each joint. Breaking strength data collected from destructive pull testing was then used to calculate the joint factor in the form of an efficiency. Joint efficiency is the percentage of the base material strength that remains after degradation due to sewing or interaction with other components; it is used interchangeably with joint factor in this paper. Parachute materials vary in type-mainly cord, tape, webbing, and cloth -which require different test fixtures and joint sample construction methods. This paper defines guidelines for designing and testing samples based on materials and test goals. Using the test methodology and analysis approach detailed in this paper, the minimum joint factor for each parachute component can be formulated. The joint factors can then be used to calculate the design factor and margin of safety for that component, a critical part of the design verification process.

Within-Year Fidelity Growth of SWPBIS during Installation and Initial Implementation

ERIC Educational Resources Information Center

Schaper, Andrew; McIntosh, Kent; Hoselton, Robert

2016-01-01

The purpose of this study was to document within-year fidelity growth during installation and initial implementation of School-Wide Positive Behavioral Interventions and Supports (SWPBIS). Participants included school teams from schools throughout the United States that were in years 1 to 4 of SWPBIS implementation and routinely evaluated their…

Joint Attention Initiation with and without Positive Affect: Risk Group Differences and Associations with ASD Symptoms

ERIC Educational Resources Information Center

Gangi, Devon N.; Ibañez, Lisa V.; Messinger, Daniel S.

2014-01-01

Infants at risk for autism spectrum disorders (ASD) may have difficulty integrating smiles into initiating joint attention (IJA) bids. A specific IJA pattern, anticipatory smiling, may communicate preexisting positive affect when an infant smiles at an object and then turns the smile toward the social partner. We compared the development of…

Initiatives and outcomes of green supply chain management implementation by Chinese manufacturers.

PubMed

Zhu, Qinghua; Sarkis, Joseph; Lai, Kee-hung

2007-10-01

This paper aims to explore the green supply chain management (GSCM) initiatives (implementation) of various manufacturing industrial sectors in China and examine the links between GSCM initiatives and performance outcomes. We conducted a survey to collect data from four typical manufacturing industrial sectors in China, namely, power generating, chemical/petroleum, electrical/electronic and automobile, and received 171 valid organizational responses for data analysis. Analysis of variance (ANOVA) was used to analyze the data. The results are consistent with our prediction that the different manufacturing industry types display different levels of GSCM implementation and outcomes. We specifically found that the electrical/electronic industry has relatively higher levels of GSCM implementation and achieves better performance outcomes than the other three manufacturer types. Implications of the results are discussed and suggestions for further research on the implementation of GSCM are offered.

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

PubMed Central

Whitaker, Daniel J.; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; Lutzker, John R.; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

2013-01-01

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. PMID:22146860

Socio-cultural effects on children's initiation of joint attention

PubMed Central

Gavrilov, Yana; Rotem, Sarit; Ofek, Renana; Geva, Ronny

2012-01-01

Exchanging gazes with a social partner in response to an event in the environment is considered an effective means to direct attention, share affective experiences, and highlight a target in the environment. This behavior appears during infancy and plays an important role in children's learning and in shaping their socio-emotional development. It has been suggested that cultural values of the community affect socio-emotional development through attentional dynamics of social reference (Rogoff et al., 1993). Maturational processes of brain-circuits have been found to mediate socio-cultural learning and the behavioral manifestation of cultural norms starting at preschool age (Nelson and Guyer, 2011). The aim of the current study was to investigate the relations between cultural ecology levels and children's joint attention (JA). Initiation of JA bids was studied empirically as a function of the level of social load of the target toy (3 levels), the community level of adherence to traditional values (3 levels), parental education (2 levels), and gender. Sixty-two kindergarten aged children were enrolled in a structured toy-exploration task, during which they were presented with toys of various social loads, with social agents (i.e., mother and experimenter) present nearby, and non-social distracters presented intermittently. Measurements included the child's number of JA bids and the extent of positive affect. Analysis of variance indicated that the child's initiation of JA toward the social partner was affected by all levels of cultural ecology (i.e., toy's social load, adherence to tradition values, parental education, gender), thus supporting the study's hypotheses. The effects were such that overall, children, particularly girls' JA initiation was augmented in social toys and moderated by the socio-cultural variables. These results suggest that cultural ecology is related to children's JA, thereby scaffolding initiation of social sharing cues between children and

Dual initiation strip charge apparatus and methods for making and implementing the same

DOEpatents

Jakaboski, Juan-Carlos [Albuquerque, NM; Todd,; Steven, N [Rio Rancho, NM; Polisar, Stephen [Albuquerque, NM; Hughs, Chance [Tijeras, NM

2011-03-22

A Dual Initiation Strip Charge (DISC) apparatus is initiated by a single initiation source and detonates a strip of explosive charge at two separate contacts. The reflection of explosively induced stresses meet and create a fracture and breach a target along a generally single fracture contour and produce generally fragment-free scattering and no spallation. Methods for making and implementing a DISC apparatus provide numerous advantages over previous methods of creating explosive charges by utilizing steps for rapid prototyping; by implementing efficient steps and designs for metering consistent, repeatable, and controlled amount of high explosive; and by utilizing readily available materials.

Exploring the Process of Implementing Healthy Workplace Initiatives: Mapping to Kotter's Leading Change Model.

PubMed

Chappell, Stacie; Pescud, Melanie; Waterworth, Pippa; Shilton, Trevor; Roche, Dee; Ledger, Melissa; Slevin, Terry; Rosenberg, Michael

2016-10-01

The aim of this study was to use Kotter's leading change model to explore the implementation of workplace health and wellbeing initiatives. Qualitative interviews were conducted with 31 workplace representatives with a healthy workplace initiative. None of the workplaces used a formal change management model when implementing their healthy workplace initiatives. Not all of the steps in Kotter model were considered necessary and the order of the steps was challenged. For example, interviewees perceived that communicating the vision, developing the vision, and creating a guiding coalition were integral parts of the process, although there was less emphasis on the importance of creating a sense of urgency and consolidating change. Although none of the workplaces reported using a formal organizational change model when implementing their healthy workplace initiatives, there did appear to be perceived merit in using the steps in Kotter's model.

Implementation of an Algorithm for Prosthetic Joint Infection: Deviations and Problems.

PubMed

Mühlhofer, Heinrich M L; Kanz, Karl-Georg; Pohlig, Florian; Lenze, Ulrich; Lenze, Florian; Toepfer, Andreas; von Eisenhart-Rothe, Ruediger; Schauwecker, Johannes

The outcome of revision surgery in arthroplasty is based on a precise diagnosis. In addition, the treatment varies based on whether the prosthetic failure is caused by aseptic or septic loosening. Algorithms can help to identify periprosthetic joint infections (PJI) and standardize diagnostic steps, however, algorithms tend to oversimplify the treatment of complex cases. We conducted a process analysis during the implementation of a PJI algorithm to determine problems and deviations associated with the implementation of this algorithm. Fifty patients who were treated after implementing a standardized algorithm were monitored retrospectively. Their treatment plans and diagnostic cascades were analyzed for deviations from the implemented algorithm. Each diagnostic procedure was recorded, compared with the algorithm, and evaluated statistically. We detected 52 deviations while treating 50 patients. In 25 cases, no discrepancy was observed. Synovial fluid aspiration was not performed in 31.8% of patients (95% confidence interval [CI], 18.1%-45.6%), while white blood cell counts (WBCs) and neutrophil differentiation were assessed in 54.5% of patients (95% CI, 39.8%-69.3%). We also observed that the prolonged incubation of cultures was not requested in 13.6% of patients (95% CI, 3.5%-23.8%). In seven of 13 cases (63.6%; 95% CI, 35.2%-92.1%), arthroscopic biopsy was performed; 6 arthroscopies were performed in discordance with the algorithm (12%; 95% CI, 3%-21%). Self-critical analysis of diagnostic processes and monitoring of deviations using algorithms are important and could increase the quality of treatment by revealing recurring faults.

[Implementation of joint-crisis plans--a study of health care users and professionals].

PubMed

Grätz, Juliane; Brieger, Peter

2012-11-01

To study effects of the implementation of joint-crisis plans (JCP) on health-care users and professionals. The first 3 years of the implementation of JCP were followed with structured interviews with health-care users and professionals. Legal and administrative complications were documented. 36 of 44 subjects with JCP were assessed. Most of them had learned of JCP through other users or self-help. 55 % had prior experience with compulsory treatment. Better communication and self-determination were main goals of JCP. A relevant change in hospital treatment through JCP was not observed. Only few professionals had made direct experience with JCP. They valued JCP mildly positive. No legal and administrative complications were documented. Only a small minority of users signed JCP. JCP were easily employed and improved communication and self-determination. © Georg Thieme Verlag KG Stuttgart · New York.

Managed care and critical pathway development: the joint replacement experience.

PubMed

Benham, A J

1999-01-01

This article examines the economic, social, ethical, and political issues affecting total joint replacement patients in a managed care environment. Using general systems theory as a framework, it examines the interrelated historical events that have shaped the development of both joint replacement procedures and managed care, and discusses the extent to which these two phenomena have been mutually influential. Specifically, the article examines the initial development, implementation, and continuing evolution of clinical pathways as an easily identified and relatively discrete manifestation of managed care for the joint replacement population. While the overall impact of managed care is beyond the scope of this presentation, it is hoped that a focus on the practical application of clinical pathways to joint replacement will allow some general principles to emerge that may be useful for both patients and practitioners operating in other aspects of the managed care environment.

Implementing a Structured Reporting Initiative Using a Collaborative Multistep Approach.

PubMed

Goldberg-Stein, Shlomit; Walter, William R; Amis, E Stephen; Scheinfeld, Meir H

To describe the successful implementation of a structured reporting initiative in a large urban academic radiology department. We describe our process, compromises, and top 10 lessons learned in overhauling traditional reporting practices and comprehensively implementing structured reporting at our institution. To achieve our goals, we took deliberate steps toward consensus building, undertook multistep template refinement, and achieved close collaboration with the technical staff, department coders, and hospital information technologists. Following institutional review board exemption, we audited radiologist compliance by evaluating 100 consecutive cases of 12 common examination types. Fisher exact test was applied to determine significance of association between trainee initial report drafting and template compliance. We produced and implemented structured reporting templates for 95% of all departmental computed tomography, magnetic resonance, and ultrasound examinations. Structured templates include specialized reports adhering to the American College of Radiology's Reporting and Data Systems (ACR's RADS) recommendations (eg, Lung-RADS and Li-RADS). We attained 94% radiologist compliance within 2 years, without any financial incentives. We provide a blueprint of how to successfully achieve structured reporting using a collaborative multistep approach. Copyright © 2017 Elsevier Inc. All rights reserved.

European Scale Earthquake Data Exchange: ORFEUS-EMSC Joint Initiatives

NASA Astrophysics Data System (ADS)

Bossu, R.; van Eck, T.

2003-04-01

common EC Infrastructure proposal for European seismology. This presentation will provide a systematic overview of our current collaboration and joint initiatives.

Implementation of oral health initiatives by Australian rural communities: Factors for success.

PubMed

Taylor, Judy; Carlisle, Karen; Farmer, Jane; Larkins, Sarah; Dickson-Swift, Virginia; Kenny, Amanda

2018-01-01

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014-2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of "lay" community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university-based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12 months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter-relationship between community motivation to participate with the fortunes of the oral health initiatives, having the "right" people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community. © 2017 John Wiley & Sons Ltd.

How was the UNAIDS drug access initiative implemented in Chile?

PubMed Central

Brousselle, Astrid; Champagne, François

2012-01-01

In 1997, UNAIDS decided to implement Drug Access Initiatives (DAI) in four different pilot-countries. We studied the implementation of the DAI in Chile as part of the evaluation program conducted by the ‘Agence Nationale de Recherche sur le SIDA’ (ANRS/France). The objective was to understand how the politico-organizational dynamic influenced the implementation process of the DAI. Approximately 50 semi-directed interviews and observation activities were conducted with the actors who participated in the implementation of the DAI or who played a role in the HIV/AIDS context. The program theory models were established and their evolution analyzed. This article offers an original analysis of an international HIV/AIDS drug access program that was put in place at a time when such programs were seen as a priority by international and governmental institutions. It also offers some insights for the creation of international projects that will be locally implemented. PMID:23230344

Ohio Route 50 joint sealant experiment : research implementation plan.

DOT National Transportation Integrated Search

2005-05-01

Research in the state of Wisconsin over the past forty years has found no noticeable difference in : performance between jointed concrete pavement (JCP) constructed with a sealed contraction joint and : JCP constructed with a single, narrow, unsealed...

A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.

PubMed

Nelson, Amanda E; Allen, Kelli D; Golightly, Yvonne M; Goode, Adam P; Jordan, Joanne M

2014-06-01

Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementing a One-to-One Technology Initiative in Higher Education

ERIC Educational Resources Information Center

Fridley, Daryl; Rogers-Adkinson, Diana

2015-01-01

This paper describes the process of conceptualizing and implementing a one-to-one technology initiative at a regional comprehensive university. Organized around the principle that sustainable change requires attention to clear, justifiable goals, attention to key decisions, the development of stakeholder investment, adequate training, building…

Administrators and Principals and the Implementation Process of the Leader in Me Initiative

ERIC Educational Resources Information Center

Bryant, Naarah

2016-01-01

Principals and administrators are crucial to the success of an initiative such as the Leader in Me. The purpose of this basic qualitative study was to identify the strategies, practices, and processes utilized by elementary school principals to initiate and implement initiatives or programs such as the Leader in Me. Eight elementary school…

Joint Center Estimation Using Single-Frame Optimization: Part 1: Numerical Simulation.

PubMed

Frick, Eric; Rahmatalla, Salam

2018-04-04

The biomechanical models used to refine and stabilize motion capture processes are almost invariably driven by joint center estimates, and any errors in joint center calculation carry over and can be compounded when calculating joint kinematics. Unfortunately, accurate determination of joint centers is a complex task, primarily due to measurements being contaminated by soft-tissue artifact (STA). This paper proposes a novel approach to joint center estimation implemented via sequential application of single-frame optimization (SFO). First, the method minimizes the variance of individual time frames’ joint center estimations via the developed variance minimization method to obtain accurate overall initial conditions. These initial conditions are used to stabilize an optimization-based linearization of human motion that determines a time-varying joint center estimation. In this manner, the complex and nonlinear behavior of human motion contaminated by STA can be captured as a continuous series of unique rigid-body realizations without requiring a complex analytical model to describe the behavior of STA. This article intends to offer proof of concept, and the presented method must be further developed before it can be reasonably applied to human motion. Numerical simulations were introduced to verify and substantiate the efficacy of the proposed methodology. When directly compared with a state-of-the-art inertial method, SFO reduced the error due to soft-tissue artifact in all cases by more than 45%. Instead of producing a single vector value to describe the joint center location during a motion capture trial as existing methods often do, the proposed method produced time-varying solutions that were highly correlated ( r > 0.82) with the true, time-varying joint center solution.

Harmonization in preclinical epilepsy research: A joint AES/ILAE translational initiative.

PubMed

Galanopoulou, Aristea S; French, Jacqueline A; O'Brien, Terence; Simonato, Michele

2017-11-01

Among the priority next steps outlined during the first translational epilepsy research workshop in London, United Kingdom (2012), jointly organized by the American Epilepsy Society (AES) and the International League Against Epilepsy (ILAE), are the harmonization of research practices used in preclinical studies and the development of infrastructure that facilitates multicenter preclinical studies. The AES/ILAE Translational Task Force of the ILAE has been pursuing initiatives that advance these goals. In this supplement, we present the first reports of the working groups of the Task Force that aim to improve practices of performing rodent video-electroencephalography (vEEG) studies in experimental controls, generate systematic reviews of preclinical research data, and develop preclinical common data elements (CDEs) for epilepsy research in animals. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region.

PubMed

Al-Jawaldeh, Ayoub; Abul-Fadl, Azza

2018-03-11

The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity ( p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.

76 FR 23221 - Joint Public Roundtable on Issues Related to the Schedule for Implementing Final Rules for Swaps...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-26

... submissions will be reviewed jointly by the Agencies. All comments must be in English or be accompanied by an English translation. All submissions provided to either Agency in any electronic form or on paper will be... of CFTC Commissioner Scott D. O'Malia; Implementation Roundtable Seriatim; Certainty & Transparency I...

Capacity Building and Districts' Decision to Implement Coaching Initiatives

ERIC Educational Resources Information Center

Mangin, Melinda M.

2014-01-01

The United States has experienced tremendous growth in the development of coaching initiatives including professional training programs, state endorsements and resources for coaches. These developments bring attention to the potential for coaching to improve education. They also raise the question of how best to facilitate implementation in local…

HMA Longitudinal Joint Evaluation and Construction

DOT National Transportation Integrated Search

2011-02-01

Longitudinal joint quality is essential to the successful performance of asphalt pavements. A number of states have begun to implement longitudinal joint specifications, and most are based on determinations of density. However, distress at the joint ...

A Modelling Method of Bolt Joints Based on Basic Characteristic Parameters of Joint Surfaces

NASA Astrophysics Data System (ADS)

Yuansheng, Li; Guangpeng, Zhang; Zhen, Zhang; Ping, Wang

2018-02-01

Bolt joints are common in machine tools and have a direct impact on the overall performance of the tools. Therefore, the understanding of bolt joint characteristics is essential for improving machine design and assembly. Firstly, According to the experimental data obtained from the experiment, the stiffness curve formula was fitted. Secondly, a finite element model of unit bolt joints such as bolt flange joints, bolt head joints, and thread joints was constructed, and lastly the stiffness parameters of joint surfaces were implemented in the model by the secondary development of ABAQUS. The finite element model of the bolt joint established by this method can simulate the contact state very well.

Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management

PubMed Central

Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R.; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

2014-01-01

This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea–Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year’s meeting was hosted for the first time in Korea which has recently established its own national database–K-CaP–to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable ‘template’ for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving

Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management.

PubMed

Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

2014-01-01

This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea-Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year's meeting was hosted for the first time in Korea which has recently established its own national database-K-CaP-to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable 'template' for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving the

A Contextual Factors Framework to Inform Implementation and Evaluation of Public Health Initiatives

ERIC Educational Resources Information Center

Vanderkruik, Rachel; McPherson, Marianne E.

2017-01-01

Evaluating initiatives implemented across multiple settings can elucidate how various contextual factors may influence both implementation and outcomes. Understanding context is especially critical when the same program has varying levels of success across settings. We present a framework for evaluating contextual factors affecting an initiative…

AFOSR Indo-UK -US Joint Physics Initiative for Study of Angular Optical Mode Fiber Amplification

DTIC Science & Technology

2017-02-20

AFRL -AFOSR-UK-TR-2017-0011 AFOSR Indo-UK -US Joint Physics Initiative for study of angular optical mode fiber amplification Johan Nilsson UNIVERSITY...ES) EOARD Unit 4515 APO AE 09421-4515 10. SPONSOR/MONITOR’S ACRONYM(S) AFRL /AFOSR IOE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) AFRL -AFOSR-UK-TR-2017-0011...this travel, he had the opportunity to visit the Kirtland Air Force Base and interact with Dr Leanne Henry as well as Dr Iyad Dajani to discuss

Building a Quality Workforce. A Joint Initiative.

ERIC Educational Resources Information Center

Department of Commerce, Washington, DC.

For this joint effort among three Cabinet Agencies, studies by a variety of organizations were reviewed and 134 business leaders and 34 education leaders in many communities throughout the United States were interviewed to determine what businesses find lacking among new entrants into the labor force and what employers' work force needs will be in…

The JOVE initiative - A NASA/university Joint Venture in space science

NASA Technical Reports Server (NTRS)

Six, F.; Chappell, R.

1990-01-01

The JOVE (NASA/university Joint Venture in space science) initiative is a point program between NASA and institutions of higher education whose aim is to bring about an extensive merger between these two communities. The project is discussed with emphasis on suggested contributions of partnership members, JOVE process timeline, and project schedules and costs. It is suggested that NASA provide a summer resident research associateship (one ten week stipend); scientific on-line data from space missions; an electronic network and work station, providing a link to the data base and to other scientists; matching student support, both undergraduate and graduate; matching summer salary for up to three faculty participants; and travel funds. The universities will be asked to provide research time for faculty participants, matching student support, matching summer salary for faculty participants, an instructional unit in space science, and an outreach program to pre-college students.

Do joints initiate as sharp mode I fractures or finite thickness dilatancy bands? Insights from laboratory experiments and field data

NASA Astrophysics Data System (ADS)

Petit, J.; Chemenda, A. I.; Jorand, C.

2011-12-01

Terminology on fracture and discontinuities in geological objects mainly relies on distinguishing between tabular and sharp forms of deformation localization/failure structures (Aydin et al, JSG 2006; Shultz and Fossen, AAPG, 2009). On this basis joints (considered as mode I fractures) and dilation bands (very rarely observed) are distinguished among extension discontinuities. The former propagate with the separation of the fracture walls due to strong stress concentration at the fracture tips. The plumose features or hackles typical of joints (these terms cover a wide variety of diverging fractographic features) are believed to result from the fracture front breakdown due to the loading mode change (the origin of this change remains unclear). This view is called into question by recent experimental results of extension tests conducted on a synthetic physical rock analogue (granular, frictional, cohesive and dilatant) material (GRAM1) and by field observations of embryonic (not yet open) joints in highly jointed dolomicrite Chemenda et al., JGR, 2011). The initial porosity and grain size of both materials are very different, but at SEM scale, both experimental and natural unopened discontinuities reveal a comparable dilatancy (dilation) band structure with a porosity increase over a width of several grains. This suggests that the distinction between tabular and sharp is a matter of observation scale. Both axisymetric and poly-axial extension tests show that dilatancy bands form at elevated mean stress and have plumose morphology. Mode I cracking occurs only at very low mean stres and the forming fractures do not bear plumose features. Thus the absence of plumose structures can be considered as the signature of mode I fracturing. Consequently, we propose that non- plumose bearing natural joints (provided their fractography is not eroded) could originate as mode I fractures and call them "mode I joints". We call the joints formed as closed dilatancy bands propagating

78 FR 61743 - Revisions to the Export Administration Regulations: Initial Implementation of Export Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

... ``attachments'' that are ``specially designed'' for a commodity subject to control in this ECCN or a defense... Implementation of Export Control Reform; Correction; Final Rule #0;#0;Federal Register / Vol. 78 , No. 192... Administration Regulations: Initial Implementation of Export Control Reform; Correction AGENCY: Bureau of...

Airborne laser topographic mapping results from initial joint NASA/US Army Corps of Engineers experiment

NASA Technical Reports Server (NTRS)

Krabill, W. B.; Collins, J. G.; Swift, R. N.; Butler, M. L.

1980-01-01

Initial results from a series of joint NASA/US Army Corps of Engineers experiments are presented. The NASA Airborne Oceanographic Lidar (AOL) was exercised over various terrain conditions, collecting both profile and scan data from which river basin cross sections are extracted. Comparisons of the laser data with both photogrammetry and ground surveys are made, with 12 to 27 cm agreement observed over open ground. Foliage penetration tests, utilizing the unique time-waveform sampling capability of the AOL, indicate 50 cm agreement with photogrammetry (known to have difficulty in foliage covered terrain).

Health technology assessment to optimize health technology utilization: using implementation initiatives and monitoring processes.

PubMed

Frønsdal, Katrine B; Facey, Karen; Klemp, Marianne; Norderhaug, Inger Natvig; Mørland, Berit; Røttingen, John-Arne

2010-07-01

The way in which a health technology is used in any particular health system depends on the decisions and actions of a variety of stakeholders, the local culture, and context. In 2009, the HTAi Policy Forum considered how health technology assessment (HTA) could be improved to optimize the use of technologies (in terms of uptake, change in use, or disinvestment) in such complex systems. In scoping, it was agreed to focus on initiatives to implement evidence-based guidance and monitoring activities. A review identified systematic reviews of implementation initiatives and monitoring activities. A two-day deliberative workshop was held to discuss key papers, members' experiences, and collectively address key questions. This consensus paper was developed by email and finalized at a postworkshop meeting. Evidence suggests that the impact and use of HTA could be increased by ensuring timely delivery of relevant reports to clearly determined policy receptor (decision-making) points. To achieve this, the breadth of assessment, implementation initiatives such as incentives and targeted, intelligent dissemination of HTA result, needs to be considered. HTA stakeholders undertake a variety of monitoring activities, which could inform optimal use of a technology. However, the quality of these data varies and is often not submitted to an HTA. Monitoring data should be sufficiently robust so that they can be used in HTA to inform optimal use of technology. Evidence-based implementation initiatives should be developed for HTA, to better inform decision makers at all levels in a health system about the optimal use of technology.

Institutionalizing Blended Learning into Joint Training: A Case Study and Ten Recommendations

DTIC Science & Technology

2014-12-01

mail.mil pbockelman@mesh.dsci.com ABSTRACT In 2011, the Joint Staff J7 (Joint Training) directorate initiated the Continuum of eLearning project in...Orlando, FL. 14. ABSTRACT In 2011, the Joint Staff J7 (Joint Training) directorate initiated the Continuum of eLearning project in order to integrate...dispersed organizations still poses significant challenges. The Joint Staff J7, Deputy Director for Joint Training initiated the Continuum of eLearning

Joint reconstruction of the initial pressure and speed of sound distributions from combined photoacoustic and ultrasound tomography measurements

NASA Astrophysics Data System (ADS)

Matthews, Thomas P.; Anastasio, Mark A.

2017-12-01

The initial pressure and speed of sound (SOS) distributions cannot both be stably recovered from photoacoustic computed tomography (PACT) measurements alone. Adjunct ultrasound computed tomography (USCT) measurements can be employed to estimate the SOS distribution. Under the conventional image reconstruction approach for combined PACT/USCT systems, the SOS is estimated from the USCT measurements alone and the initial pressure is estimated from the PACT measurements by use of the previously estimated SOS. This approach ignores the acoustic information in the PACT measurements and may require many USCT measurements to accurately reconstruct the SOS. In this work, a joint reconstruction method where the SOS and initial pressure distributions are simultaneously estimated from combined PACT/USCT measurements is proposed. This approach allows accurate estimation of both the initial pressure distribution and the SOS distribution while requiring few USCT measurements.

Joint modelling of repeated measurement and time-to-event data: an introductory tutorial.

PubMed

Asar, Özgür; Ritchie, James; Kalra, Philip A; Diggle, Peter J

2015-02-01

The term 'joint modelling' is used in the statistical literature to refer to methods for simultaneously analysing longitudinal measurement outcomes, also called repeated measurement data, and time-to-event outcomes, also called survival data. A typical example from nephrology is a study in which the data from each participant consist of repeated estimated glomerular filtration rate (eGFR) measurements and time to initiation of renal replacement therapy (RRT). Joint models typically combine linear mixed effects models for repeated measurements and Cox models for censored survival outcomes. Our aim in this paper is to present an introductory tutorial on joint modelling methods, with a case study in nephrology. We describe the development of the joint modelling framework and compare the results with those obtained by the more widely used approaches of conducting separate analyses of the repeated measurements and survival times based on a linear mixed effects model and a Cox model, respectively. Our case study concerns a data set from the Chronic Renal Insufficiency Standards Implementation Study (CRISIS). We also provide details of our open-source software implementation to allow others to replicate and/or modify our analysis. The results for the conventional linear mixed effects model and the longitudinal component of the joint models were found to be similar. However, there were considerable differences between the results for the Cox model with time-varying covariate and the time-to-event component of the joint model. For example, the relationship between kidney function as measured by eGFR and the hazard for initiation of RRT was significantly underestimated by the Cox model that treats eGFR as a time-varying covariate, because the Cox model does not take measurement error in eGFR into account. Joint models should be preferred for simultaneous analyses of repeated measurement and survival data, especially when the former is measured with error and the association

The Implementation Challenge and the Learning Health System for SCI Initiative.

PubMed

Stucki, Gerold; Bickenbach, Jerome

2017-02-01

The paper introduces the special issue by linking the International Spinal Cord Injury (InSCI) Community Survey study to the Learning Health System for SCI Initiative (LHS-SCI). The LHS-SCI was designed to respond to the implementation challenge of bringing about policy reform in light of the targeted policy recommendations of World Health Organization's International Perspectives on SCI report as well as the call for action of WHO's Global Disability Action Plan. The paper reviews the components of LHS-SCI relevant to internationally comparable information, a theory of change to guide for action, and the tools for evidence-informed policy. The interplay between persons, their health needs, and the societal response to those needs provides the foundation for the organization of the LHS-SCI Initiative. Moreover, as the other articles in this special issue describe in detail, the rationale, conceptualization, and study design of the InSCI study are also informed by the rationale, and mission, of the LHS for SCI Initiative. The LHS-SCI, and the implementation challenge that motivates it, is responsible for the design of the InSCI study and the overall mission of LHS-SCI to continuously improve the lived experience of people living with SCI around the world through an international evidence- and rights-informed research and policy reform effort.

Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

PubMed

Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

2015-10-01

Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability.

PubMed

Hoffman, Martin D; Agnish, Vikram

2018-04-01

Examine the effectiveness of sacroiliac (SI) joint prolotherapy for SI joint instability, and characterize the patients most likely to benefit from this treatment. Retrospective cohort study. Department of Veterans Affairs outpatient physical medicine clinic. Patients referred for low back pain and diagnosed with SI joint instability received a series of three SI joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval. The outcome of those completing treatment was retrospectively examined, and characteristics were compared between those with at least a minimum clinically important improvement and those without improvement. Patients completed the Oswestry Disability Index (ODI) before treatment was initiated, immediately preceding each prolotherapy injection, and at 3-4 month follow-up. Of 103 treated patients returning for post-treatment follow-up at a median of 117 days, 24 (23%) showed a minimum clinically important improvement despite a median of 2 years with low back pain and a mean (±SD) pre-intervention ODI of 54 ± 15 points. Much of the improvement was evident after the initial prolotherapy injection, and a 15-point improvement in ODI prior to the second prolotherapy injection had a sensitivity of 92% and specificity of 80% for determining which patients would improve. A satisfactory proportion of patients with symptomatic SI joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection. Published by Elsevier Ltd.

Early detection and progression of decay in L-joints and lap-joints in a moderate decay hazard zone

Treesearch

Carol A. Clausen; Terry L. Highley; Daniel L. Lindner

2006-01-01

Accelerated test methods are needed to evaluate the initiation and progression of decay in wood exposed aboveground. The relationship between test conditions and initiation of decay, however, is poorly understood. Southern pine and maple L-joints and lap-joints were exposed aboveground in a configuration that encouraged water entrapment at the Valley View Experimental...

Dynamic optical imaging of vascular and metabolic reactivity in rheumatoid joints.

PubMed

Lasker, Joseph M; Fong, Christopher J; Ginat, Daniel T; Dwyer, Edward; Hielscher, Andreas H

2007-01-01

Dynamic optical imaging is increasingly applied to clinically relevant areas such as brain and cancer imaging. In this approach, some external stimulus is applied and changes in relevant physiological parameters (e.g., oxy- or deoxyhemoglobin concentrations) are determined. The advantage of this approach is that the prestimulus state can be used as a reference or baseline against which the changes can be calibrated. Here we present the first application of this method to the problem of characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system together with previously implemented model-based iterative image reconstruction schemes, we have performed initial dynamic imaging case studies on a limited number of healthy volunteers and patients diagnosed with RA. Focusing on three cases studies, we illustrated our major finds. These studies support our hypothesis that differences in the vascular reactivity exist between affected and unaffected joints.

Exploring Readiness, Motivation, and Capacity for Implementing an iPad Campus Initiative: A Rural Community College Case Study

ERIC Educational Resources Information Center

Smith, Douglas A.; Coleman, Dawn

2018-01-01

This intrinsic case study explored organizational readiness to implement a campus-wide technology initiative. Specifically, this research examined a rural community college's implementation of an "iPad campus" initiative in which all students, faculty, and staff were required to adopt iPad technology. We apply a heuristic for…

The Early Childhood Educator Preparation Innovation Grant: Lessons from Initial Implementation. Policy Research: IERC 2015-2

ERIC Educational Resources Information Center

Lichtenberger, Eric J.; Klostermann, Brenda K.; Duffy, Daniel Q.

2015-01-01

The main goals of this implementation study were to: (1) examine how the grant recipients were implementing the changes set forth in their grant proposals; (2) identify initial barriers to implementation of grant activities; (3) identify catalysts that aided in goal attainment and/or partnership development; and (4) consider the sustainability of…

The Joint Military Medical Executive Skills initiative: an impressive response to changing human resource management rules of engagement.

PubMed

Kerr, Bernard J

2007-01-01

Confronted with a sudden and substantial change in the rules regarding who could command a military medical treatment facility (MTF), the Military Health System (MHS) responded to the challenge with an impressive human resource management solution-the Joint Medical Executive Skills Program. The history, emergence, and continuing role of this initiative exemplifies the MHS's capacity to fulfill the spirit and intent of an arduous Congressional mandate while enhancing professional development and sustaining the career opportunities of medical officers. The MHS response to the Congressional requirement that candidates for MTF command demonstrate professional administrative skills was decisive, creative, and consistent with the basic principles of human resource management. The Joint Medical Executive Skills Program is a management success story that demonstrates how strategic planning, well-defined skills requirements, and structured training can assure a ready supply of qualified commanders for the military's MTFs.

Implementing the Regular Education Initiative in Secondary Schools: A Different Ball Game.

ERIC Educational Resources Information Center

Schumaker, Jean B.; Deshler, Donald D.

1988-01-01

The article reviews potential barriers to implementing the Regular Education Initiative (REI) in secondary schools and then discusses a set of factors central to developing a workable partnership, one that is compatible with the goals of the REI but that also responds to the unique parameters of secondary schools. (Author/DB)

75 FR 2013 - Health Information Technology: Initial Set of Standards, Implementation Specifications, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-13

...The Department of Health and Human Services (HHS) is issuing this interim final rule with a request for comments to adopt an initial set of standards, implementation specifications, and certification criteria, as required by section 3004(b)(1) of the Public Health Service Act. This interim final rule represents the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology and to support its meaningful use. The certification criteria adopted in this initial set establish the capabilities and related standards that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support the achievement of the proposed meaningful use Stage 1 (beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.

In-field implementation of impedance-based structural health monitoring for insulated rail joints

NASA Astrophysics Data System (ADS)

Albakri, Mohammad I.; Malladi, V. V. N. Sriram; Woolard, Americo G.; Tarazaga, Pablo A.

2017-04-01

Track defects are a major safety concern for the railroad industry. Among different track components, insulated rail joints, which are widely used for signaling purposes, are considered a weak link in the railroad track. Several joint-related defects have been identified by the railroad community, including rail wear, torque loss, and joint bar breakage. Current track inspection techniques rely on manual and visual inspection or on specially equipped testing carts, which are costly, timeconsuming, traffic disturbing, and prone to human error. To overcome the aforementioned limitations, the feasibility of utilizing impedance-based structural health monitoring for insulated rail joints is investigated in this work. For this purpose, an insulated joint, provided by Koppers Inc., is instrumented with piezoelectric transducers and assembled with 136 AREA rail plugs. The instrumented joint is then installed and tested at the Facility for Accelerated Service Testing, Transportation Technology Center Inc. The effects of environmental and operating conditions on the measured impedance signatures are investigated through a set of experiments conducted at different temperatures and loading conditions. The capabilities of impedance-based SHM to detect several joint-related damage types are also studied by introducing reversible mechanical defects to different joint components.

Prediction of corrosion fatigue crack initiation behavior of A7N01P-T4 aluminum alloy welded joints

NASA Astrophysics Data System (ADS)

An, J.; Chen, J.; Gou, G.; Chen, H.; Wang, W.

2017-07-01

Through investigating the corrosion fatigue crack initiation behavior of A7N01P-T4 aluminum alloy welded joints in 3.5 wt.% NaCl solution, corrosion fatigue crack initiation life is formulated as Ni = 6.97 × 1012[Δσeqv1.739 - 491.739]-2 and the mechanism of corrosion fatigue crack initiation is proposed. SEM and TEM tests revealed that several corrosion fatigue cracks formed asynchronously and the first crack does not necessarily develop into the leading crack. The uneven reticular dislocations produced by fatigue loading are prone to piling up and tangling near the grain boundaries or the second phases and form the “high dislocation-density region” (HDDR), which acts as an anode in microbatteries and dissolved to form small crack. Thus the etching pits, HDDR near the grain boundaries and second phases are confirmed as the main causes inducing the initiation of fatigue crack.

Improved Automatically Locking/Unlocking Orthotic Knee Joint

NASA Technical Reports Server (NTRS)

Weddendorf, Bruce

1995-01-01

Proposed orthotic knee joint improved version of one described in "Automatically Locking/Unlocking Orthotic Knee Joint" (MFS-28633). Locks automatically upon initial application of radial force (wearer's weight) and unlocks automatically, but only when all loads (radial force and bending) relieved. Joints lock whenever wearer applies weight to knee at any joint angle between full extension and 45 degree bend. Both devices offer increased safety and convenience relative to conventional orthotic knee joints.

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

Joint NASA-ESA Outer Planet Mission study overview

NASA Astrophysics Data System (ADS)

Lebreton, J.-P.; Niebur, C.; Cutts, J.; Falkner, P.; Greeley, R.; Lunine, J.; Blanc, M.; Coustenis, A.; Pappalardo, R.; Matson, D.; Clark, K.; Reh, K.; Stankov, A.; Erd, C.; Beauchamp, P.

2009-04-01

evaluated by each agency between November 2008 and January 2009, and a joint decision as to which destination has been selected is expected to be announced in February 2009. The ESA Cosmic Vision selection process includes two additional competitive steps (that include two competing astronomy missions) before its contribution to the selected Outer Planet Mission is confirmed in 2012. NASA expects to proceed with the initial implementation of the mission in FY2009, while full implementation will start in FY2013, in line with ESA Cosmic Vision schedule. Should ESA select an astronomy mission instead, NASA would proceed in 2013 with the implementation of a NASA-only mission concept. This presentation will provide an overview of the selected Outer Planet Mission and outline the next steps towards its implementation.

78 FR 65621 - Implementation of Title I/II Program Initiatives; Extension of Public Comment Period; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... DEPARTMENT OF EDUCATION Implementation of Title I/II Program Initiatives; Extension of Public Comment Period; Correction AGENCY: Department of Education. ACTION: Correction notice. SUMMARY: On October... Title I/II Program Initiatives,'' Docket ID ED- 2013-ICCD-0090. The comment period for this information...

Adaptive independent joint control of manipulators - Theory and experiment

NASA Technical Reports Server (NTRS)

Seraji, H.

1988-01-01

The author presents a simple decentralized adaptive control scheme for multijoint robot manipulators based on the independent joint control concept. The proposed control scheme for each joint consists of a PID (proportional integral and differential) feedback controller and a position-velocity-acceleration feedforward controller, both with adjustable gains. The static and dynamic couplings that exist between the joint motions are compensated by the adaptive independent joint controllers while ensuring trajectory tracking. The proposed scheme is implemented on a MicroVAX II computer for motion control of the first three joints of a PUMA 560 arm. Experimental results are presented to demonstrate that trajectory tracking is achieved despite strongly coupled, highly nonlinear joint dynamics. The results confirm that the proposed decentralized adaptive control of manipulators is feasible, in spite of strong interactions between joint motions. The control scheme presented is computationally very fast and is amenable to parallel processing implementation within a distributed computing architecture, where each joint is controlled independently by a simple algorithm on a dedicated microprocessor.

RSRM Nozzle-to-Case Joint J-leg Development

NASA Technical Reports Server (NTRS)

Albrechtsen, Kevin U.; Eddy, Norman F.; Ewing, Mark E.; McGuire, John R.

2003-01-01

Since the beginning of the Space Shuttle Reusable Solid Rocket Motor (RSRM) program, nozzle-to-case joint polysulfide adhesive gas paths have occurred on several flight motors. These gas paths have allowed hot motor gases to reach the wiper O-ring. Even though these motors continue to fly safely with this condition, a desire was to reduce such occurrences. The RSRM currently uses a J-leg joint configuration on case field joints and igniter inner and outer joints. The J-leg joint configuration has been successfully demonstrated on numerous RSRM flight and static test motors, eliminating hot gas intrusion to the critical O-ring seals on these joints. Using the proven technology demonstrated on the case field joints and igniter joints, a nozzle-to-case joint J-leg design was developed for implementation on RSRM flight motors. This configuration provides an interference fit with nozzle fixed housing phenolics at assembly, with a series of pressurization gaps incorporated outboard of the joint mating surface to aid in joint pressurization and to eliminate any circumferential flow in this region. The joint insulation is bonded to the nozzle phenolics using the same pressure sensitive adhesive used in the case field joints and igniter joints. An enhancement to the nozzle-to-case joint J-leg configuration is the implementation of a carbon rope thermal barrier. The thermal barrier is located downstream of the joint bondline and is positioned within the joint in a manner where any hot gas intrusion into the joint passes through the thermal barrier, reducing gas temperatures to a level that would not affect O-rings downstream of the thermal barrier. This paper discusses the processes used in reaching a final nozzle-to-case joint J-leg design, provides structural and thermal results in support of the design, and identifies fabrication techniques and demonstrations used in arriving at the final configuration.

"Bill is now singing": joint engagement and the emergence of social communication of three young children with autism.

PubMed

Vaiouli, Potheini; Grimmet, Kharon; Ruich, Lawrence J

2015-01-01

Young children with autism spectrum disorder meet significant challenges in joint attention skills and in social communication. A child-centered, improvisational, music therapy intervention model was implemented to promote engagement in three young children with autism in a kindergarten classroom. A multiple baseline design compared the children's performance through three phases of intervention: focus on faces, response to joint attention, and initiation of joint attention. A complimentary qualitative analysis of teacher and parent experiences allowed for an in-depth understanding of the role of social environment in supporting emerging social communication skills among three children. As all children showed improvement in joint attention and actions of social engagement, this study bears evidence on the potential of music therapy as a promising intervention for promoting social skills of young children with autism spectrum disorder. © The Author(s) 2013.

Development of a framework towards successful implementation of e-governance initiatives in health sector in India.

PubMed

Ray, Subhasis; Mukherjee, Amitava

2007-01-01

The purpose of this paper is to explore the route map for employing efficient e-governance so that at least existing resource and infrastructure are better utilized and deficiencies are tracked for future planning. National health is one of the most important factors in a country's economic growth. India seems to be a victim of the vicious cycle around poor economy and poor health conditions. A detailed study was carried out to find out India's healthcare infrastructure and its standing in e-governance initiatives. After consolidating the fact that effective e-governance can enhance the quality of healthcare service even within limited resources, authors explored success and failure factors of many e-governance initiatives in India and abroad. Finally, an e-governance framework is suggested based on the above factors together with the authors' own experience of implementing e-governance projects in India and abroad. The suggested framework is based on a phased implementation approach. The first phase "Information Dissemination" is more geared towards breaking the "digital divide" across three dimensions: G2Business; G2Citizen; and G2Agent. The most advanced stage is aimed towards joining up healthcare information across the above three dimensions and drawing meaningful analytics out of it. The recommendations also include management of Policies, Scope, Process Reform, Infrastructure, Technology, Finance, Partnership and People for efficient implementation of such e-governance initiatives. The paper provides measures for continuous evaluation of systems as one passes through various stages of implementation. However, the framework can be tested on real or simulated environment to prove its worthiness. This paper can be a potential frame of reference for nation-wide e-healthcare projects not only in India but also in other developing countries. The paper also describes challenges that are most likely to be faced during implementation. Since the paper is practical in

Improving the Standards-Based Management-Recognition initiative to provide high-quality, equitable maternal health services in Malawi: an implementation research protocol.

PubMed

Mumtaz, Zubia; Salway, Sarah; Nyagero, Josephat; Osur, Joachim; Chirwa, Ellen; Kachale, Fannie; Saunders, Duncan

2016-01-01

The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative-the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research.

Diminishing friction of joint surfaces as initiating factor for destabilising permafrost rocks?

NASA Astrophysics Data System (ADS)

Funk, Daniel; Krautblatter, Michael

2010-05-01

Degrading alpine permafrost due to changing climate conditions causes instabilities in steep rock slopes. Due to a lack in process understanding, the hazard is still difficult to asses in terms of its timing, location, magnitude and frequency. Current research is focused on ice within joints which is considered to be the key-factor. Monitoring of permafrost-induced rock failure comprises monitoring of temperature and moisture in rock-joints. The effect of low temperatures on the strength of intact rock and its mechanical relevance for shear strength has not been considered yet. But this effect is signifcant since compressive and tensile strength is reduced by up to 50% and more when rock thaws (Mellor, 1973). We hypotheisze, that the thawing of permafrost in rocks reduces the shear strength of joints by facilitating the shearing/damaging of asperities due to the drop of the compressive/tensile strength of rock. We think, that decreasing surface friction, a neglected factor in stability analysis, is crucial for the onset of destabilisation of permafrost rocks. A potential rock slide within the permafrost zone in the Wetterstein Mountains (Zugspitze, Germany) is the basis for the data we use for the empirical joint model of Barton (1973) to estimate the peak shear strength of the shear plane. Parameters are the JRC (joint roughness coefficient), the JCS (joint compressive strength) and the residual friction angle (φr). The surface roughness is measured in the field with a profile gauge to create 2D-profiles of joint surfaces. Samples of rock were taken to the laboratory to measure compressive strength using a high-impact Schmidt-Hammer under air-dry, saturated and frozen conditions on weathered and unweathered surfaces. Plugs where cut out of the rock and sand blasted for shear tests under frozen and unfrozen conditions. Peak shear strength of frozen and unfrozen rocks will be calculated using Barton's model. First results show a mean decrease of compressive

Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT.

PubMed

Dryden-Peterson, Scott; Lockman, Shahin; Zash, Rebecca; Lei, Quonhong; Chen, Jennifer Y; Souda, Sajini; Petlo, Chipo; Dintwa, Eldah; Lebelonyane, Refeletswe; Mmalane, Mompati; Shapiro, Roger L

2015-03-01

: Botswana was one of the first African countries to transition from WHO Option A to Option B for prevention of mother-to-child HIV transmission (MTCT). We evaluated the impact of this transition on projected MTCT risk through review of 10,681 obstetric records of HIV-infected women delivering at 6 maternity wards. Compared with Option A, women receiving antenatal care under Option B were more likely to receive combination antiretroviral therapy (ART), adjusted odds ratio (aOR): 2.59 (95% confidence interval: 2.25 to 2.98), but they were also more likely to receive no antenatal antiretrovirals, aOR: 2.10 (95% confidence interval: 1.74 to 2.53). Consequently, initial implementation of Option B was associated with increased projected MTCT at 6 months of age, 3.79% under Option A and 4.69% under Option B (P < 0.001). Successful implementation of Option B or B+ may require that ART can be initiated within antenatal clinics, and novel strategies to remove barriers to rapid ART initiation.

Patellofemoral joint stress during running with alterations in foot strike pattern.

PubMed

Vannatta, Charles Nathan; Kernozek, Thomas W

2015-05-01

This study aimed to quantify differences in patellofemoral joint stress that may occur when healthy runners alter their foot strike pattern from their habitual rearfoot strike to a forefoot strike to gain insight on the potential etiology and treatment methods of patellofemoral pain. Sixteen healthy female runners completed 20 running trials in a controlled laboratory setting under rearfoot strike and forefoot strike conditions. Kinetic and kinematic data were used to drive a static optimization technique to estimate individual muscle forces to input into a model of the patellofemoral joint to estimate joint stress during running. Peak patellofemoral joint stress and the stress-time integral over stance phase decreased by 27% and 12%, respectively, in the forefoot strike condition (P < 0.001). Peak vertical ground reaction force increased slightly in the forefoot strike condition (P < 0.001). Peak quadriceps force and average hamstring force decreased, whereas gastrocnemius and soleus muscle forces increased when running with a forefoot strike (P < 0.05). Knee flexion angle at initial contact increased (P < 0.001), total knee excursion decreased (P < 0.001), and no change occurred in peak knee flexion angle (P = 0.238). Step length did not change between conditions (P = 0.375), but the leading leg landed with the foot positioned with a horizontal distance closer to the hip at initial contact in the forefoot strike condition (P < 0.001). Altering one's strike pattern to a forefoot strike results in consistent reductions in patellofemoral joint stress independent of changes in step length. Thus, implementation of forefoot strike training programs may be warranted in the treatment of runners with patellofemoral pain. However, it is suggested that the transition to a forefoot strike pattern should be completed in a graduated manner.

The Family Transition Program: Implementation and Three-Year Impacts of Florida's Initial Time-Limited Welfare Program.

ERIC Educational Resources Information Center

Bloom, Dan; Farrell, Mary; Kemple, James J.; Verma, Nandita

This report focuses on implementation, impacts, and time limit in Florida's Family Transition Program (FTP), a welfare reform initiative. Chapter 1 describes FTP and evaluation, target population, and data. Chapter 2 describes implementation of FTP in Escambia County: staffing and organizational structure of FTP and traditional Aid to Families…

Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.

PubMed

Semenic, Sonia; Childerhose, Janet E; Lauzière, Julie; Groleau, Danielle

2012-08-01

Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

Non-destructive and non-invasive observation of friction and wear of human joints and of fracture initiation by acoustic emission.

PubMed

Schwalbe, H J; Bamfaste, G; Franke, R P

1999-01-01

Quality control in orthopaedic diagnostics according to DIN EN ISO 9000ff requires methods of non-destructive process control, which do not harm the patient by radiation or by invasive examinations. To obtain an improvement in health economy, quality-controlled and non-destructive measurements have to be introduced into the diagnostics and therapy of human joints and bones. A non-invasive evaluation of the state of wear of human joints and of the cracking tendency of bones is, as of today's point of knowledge, not established. The analysis of acoustic emission signals allows the prediction of bone rupture far below the fracture load. The evaluation of dry and wet bone samples revealed that it is possible to conclude from crack initiation to the bone strength and thus to predict the probability of bone rupture.

Rehabilitation of jointed Portland cement concrete pavements : SPS-6--initial evaluation and analysis

DOT National Transportation Integrated Search

2005-10-01

The Specific Pavement Studies 6 (SPS-6) experiment, "Rehabilitation of Jointed Portland Cement Concrete Pavements," was designed as a controlled field experiment that focuses on the study of specific rehabilitation design features of jointed plain co...

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…

Meeting the challenge: implementing the Baby Friendly Hospital Initiative in a culturally diverse country.

PubMed

Edwards, Grace; Abdulali, Jane; Kumar, Rajakumari Ravi

2011-06-01

This paper describes the successful implementation of the WHO/Unicef Baby Friendly Hospital initiative (BFHI) in a large, culturally diverse hospital in the United Arab Emirates (UAE). Breastfeeding rates in the UAE are high (>90 per cent), although mixed feeding is considered the norm. Traditional religious practices for birth are common which may inhibit exclusive breastfeeding. An action research methodology was chosen as the most appropriate method in which to implement BFHI and a five stage cyclic approach was used. Staff knowledge around breastfeeding and BFHI varied enormously because of the diversity of ethnicity amongst staff. It was initially difficult to engage staff, particularly staff in the delivery suite and theatres, as breastfeeding was not seen as a high priority. There was a great resistance to closing the nurseries as both women and staff felt it was a benefit for the women to have some rest away from their babies, and the concepts of bonding and early feeding cues were unknown. By the time of the assessment for BFHI there was a theory-practice transformation. The implementation of BFHI and the successful achievement of the award can be attributed to ownership.

Getting Ready for School: The Early Childhood Cluster Initiative of Palm Beach County, Florida. Program Implementation and Early Outcomes: Year 3 Report

ERIC Educational Resources Information Center

Spielberger, Julie; Baker, Stephen; Winje, Carolyn; Mayers, Leifa

2009-01-01

Chapin Hall has been conducting an implementation and evaluability study of the ECCI (Early Childhood Cluster Initiative) project since the midway point of its first year. As described in the authors' first report (Spielberger & Goyette, 2006), the initiative made considerable progress in its initial year, particularly in implementing the…

West Antarctic Ice Sheet Initiative. Volume 1: Science and Implementation Plan

NASA Technical Reports Server (NTRS)

Bindschadler, Robert A. (Editor)

1990-01-01

The Science and Implementation Plan of the West Antarctic Ice Sheet Initiative (WAIS) is described. The goal of this initiative is the prediction of the future behavior of this ice sheet and an assessment of its potential to collapse, rapidly raising global sea level. The multidisciplinary nature of WAIS reflects the complexity of the polar ice sheet environment. The project builds upon past and current polar studies in many fields and meshes with future programs of both the U.S. and other countries. Important tasks in each discipline are described and a coordinated schedule by which the majority of these tasks can be accomplished in 5 years is presented. The companion report (Volume 2) contains seven discipline review papers on the state of knowledge of Antarctica and opinions on how that knowledge must be increased to attain the WAIS goal.

A 'joint venture' model of recontacting in clinical genomics: challenges for responsible implementation.

PubMed

Dheensa, Sandi; Carrieri, Daniele; Kelly, Susan; Clarke, Angus; Doheny, Shane; Turnpenny, Peter; Lucassen, Anneke

2017-07-01

Advances in genomics often lead healthcare professionals (HCPs) to learn new information, e.g., about reinterpreted variants that could have clinical significance for patients seen previously. A question arises of whether HCPs should recontact these former patients. We present some findings interrogating the views of patients (or parents of patients) with a rare or undiagnosed condition about how such recontacting might be organised ethically and practically. Forty-one interviews were analysed thematically. Participants suggested a 'joint venture' model in which efforts to recontact are shared with HCPs. Some proposed an ICT-approach involving an electronic health record that automatically alerts them to potentially relevant updates. The need for rigorous privacy controls and transparency about who could access their data was emphasised. Importantly, these findings highlight that the lack of clarity about recontacting is a symptom of a wider problem: the lack of necessary infrastructure to pool genomic data responsibly, to aggregate it with other health data, and to enable patients/parents to receive updates. We hope that our findings will instigate a debate about the way responsibilities for recontacting under any joint venture model could be allocated, as well as the limitations and normative implications of using ICT as a solution to this intractable problem. As a first step to delineating responsibilities in the clinical setting, we suggest HCPs should routinely discuss recontacting with patients/parents, including the new information that should trigger a HCP to initiate recontact, as part of the consent process for genetic testing. Copyright © 2017 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Reentry Works: The Implementation and Effectiveness of a Serious and Violent Offender Reentry Initiative

ERIC Educational Resources Information Center

Bouffard, Jeffrey A.; Bergeron, Lindsey E.

2006-01-01

Spurred by large increases in prison populations and other recent sentencing and correctional trends, the federal government has supported the development and implementation of Serious and Violent Offender Reentry Initiatives (SVORI) nationwide. While existing research demonstrates the effectiveness of the separate components of these programs…

The association between parental interaction style and children’s joint engagement in families with toddlers with autism

PubMed Central

Patterson, Stephanie Y; Elder, Lauren; Gulsrud, Amanda; Kasari, Connie

2014-01-01

Purpose This study examines the relationship between parental interaction style (responsive vs directive) and child-initiated joint engagement within caregiver–child interactions with toddlers diagnosed with autism spectrum disorders. Method Videotaped interactions of 85 toddler–caregiver dyads were coded for child engagement and both parental responsiveness and directiveness. Results Altogether, children spent less than one-third of the interaction jointly engaged. After controlling for child characteristics, parental style was associated with the initiator (child or parent) of joint engagement. Specifically, responsiveness predicted total time in child-initiated joint engagement, while directiveness predicted total time in parent-initiated joint engagement. Children’s social behaviours were associated with child-initiated joint engagement. Discussion Social initiations are a key target for children with autism spectrum disorders. Results demonstrate that child initiations and global social behaviour ratings are associated with parental responsivity. Responsivity may be a critical factor to facilitate children’s initiations. PMID:24104518

FE analysis of SMA-based bio-inspired bone-joint system

NASA Astrophysics Data System (ADS)

Yang, S.; Seelecke, S.

2009-10-01

This paper presents the finite element (FE) analysis of a bio-inspired bone-joint system. Motivated by the BATMAV project, which aims at the development of a micro-air-vehicle platform that implements bat-like flapping flight capabilities, we study the actuation of a typical elbow joint, using shape memory alloy (SMA) in a dual manner. Micro-scale martensitic SMA wires are used as 'metal muscles' to actuate a system of humerus, elbow joint and radius, in concert with austenitic wires, which operate as flexible joints due to their superelastic character. For the FE analysis, the humerus and radius are modeled as standard elastic beams, while the elbow joint and muscle wires use the Achenbach-Muller-Seelecke SMA model as beams and cable elements, respectively. The particular focus of the paper is on the implementation of the above SMA model in COMSOL.

Control algorithm implementation for a redundant degree of freedom manipulator

NASA Technical Reports Server (NTRS)

Cohan, Steve

1991-01-01

This project's purpose is to develop and implement control algorithms for a kinematically redundant robotic manipulator. The manipulator is being developed concurrently by Odetics Inc., under internal research and development funding. This SBIR contract supports algorithm conception, development, and simulation, as well as software implementation and integration with the manipulator hardware. The Odetics Dexterous Manipulator is a lightweight, high strength, modular manipulator being developed for space and commercial applications. It has seven fully active degrees of freedom, is electrically powered, and is fully operational in 1 G. The manipulator consists of five self-contained modules. These modules join via simple quick-disconnect couplings and self-mating connectors which allow rapid assembly/disassembly for reconfiguration, transport, or servicing. Each joint incorporates a unique drive train design which provides zero backlash operation, is insensitive to wear, and is single fault tolerant to motor or servo amplifier failure. The sensing system is also designed to be single fault tolerant. Although the initial prototype is not space qualified, the design is well-suited to meeting space qualification requirements. The control algorithm design approach is to develop a hierarchical system with well defined access and interfaces at each level. The high level endpoint/configuration control algorithm transforms manipulator endpoint position/orientation commands to joint angle commands, providing task space motion. At the same time, the kinematic redundancy is resolved by controlling the configuration (pose) of the manipulator, using several different optimizing criteria. The center level of the hierarchy servos the joints to their commanded trajectories using both linear feedback and model-based nonlinear control techniques. The lowest control level uses sensed joint torque to close torque servo loops, with the goal of improving the manipulator dynamic behavior

The Boston Middle School-Corner Store Initiative: Development, Implementation, and Initial Evaluation of a Program Designed to Improve Adolescents' Beverage-Purchasing Behaviors

ERIC Educational Resources Information Center

Hoffman, Jessica A.; Morris, Vivien; Cook, John

2009-01-01

The Boston Middle School Corner Store Initiative (CSI) brought together schools, businesses, and community partners to develop, implement, and evaluate a multicomponent pilot program designed to promote healthier beverage purchasing at corner stores among 3,500 middle school students living in Boston, Massachusetts. Healthy drinks were defined for…

Implementing Health Policy: Lessons from the Scottish Well Men's Policy Initiative.

PubMed

Douglas, Flora; van Teijlingen, Edwin; Smith, Cairns; Moffat, Mandy

2015-01-01

Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS) policy initiative as a 'real world' case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the 'rational planning' principles health professionals are commonly encouraged to use for implementation purposes. A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) 'policy problem', (b) interventions intended to address the problem, and (c) anticipated policy outcomes. This analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome . This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... of Electronic Protected Health Information § 164.318 Compliance dates for the initial implementation of the security standards. (a) Health plan. (1) A health plan that is not a small health plan must... the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... of Electronic Protected Health Information § 164.318 Compliance dates for the initial implementation of the security standards. (a) Health plan. (1) A health plan that is not a small health plan must... the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Compliance dates for the initial implementation of the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Security Standards for the Protection...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Compliance dates for the initial implementation of the security standards. 164.318 Section 164.318 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Security Standards for the Protection...

Experiential learning implementation based on joint responsibility in women's cooperative development (Case study on Farmer Women Cooperative, Sumedang, West Java)

NASA Astrophysics Data System (ADS)

Suseno, Gijanto Purbo; Nataliningsih

2017-09-01

Cooperative extension is one form of non-formal education. The follow up of cooperative extension is a coaching that aims to cooperative boards and members apply the knowledge and skills acquired during extension. Learning from the experience (experience learning) of others combined with the concept of joint responsibility is expected to develop the participation of cooperative members as indicated by the repayment of loans on time. The research was conducted at Sumedang Farmer Women Cooperative of West Java with the stages of cooperative extension and coaching for 6 months so it can be evaluated its impact. The results showed that from 30 extension participants who stated willingness to be a member of joint responsibility group as many as 15 people (50%), which then divided into 3 groups of mutual responsibility with member of each group is 5 people. The result of impact evaluation showed the development of group dynamics of the joint liability shown by 9 people (60%) developing business, 3 people (20%) business stagnant and 3 (20%) less profitable business. Implementation of experiental learning based on the concept of mutual responsibility encourages the improvement of entrepreneurship and cooperative skills and the ability of members to pay loan installments on cooperatives in a timely manner.

Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients.

PubMed

Hopkins, Laura; Brown-Broderick, Jennifer; Hearn, James; Malcolm, Janine; Chan, James; Hicks-Boucher, Wendy; De Sousa, Filomena; Walker, Mark C; Gagné, Sylvain

2017-08-01

To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. As part of a CUSP (Comprehensive Unit-based Safety Program) initiative, between January 5 and December 18, 2015, we implemented comprehensive, multidisciplinary glycemic control initiative to reduce SSI rates in patients undergoing major pelvic surgery for a gynecologic malignancy ('Group II'). Key components of this quality of care initiative included pre-operative HbA1c measurement with special triage for patients meeting criteria for diabetes or pre-diabetes, standardization of available intraoperative insulin choices, rigorous pre-op/intra-op/post-op glucose monitoring with control targets set to maintain BG ≤10mmol/L (180mg/dL) and communication/notification with primary care providers. Effectiveness was evaluated against a similar control group of patients ('Group I') undergoing surgery in 2014 prior to implementation of this initiative. We studied a total of 462 patients. Subjects in the screened (Group II) and comparison (Group I) groups were of similar age (avg. 61.0, 60.0years; p=0.422) and BMI (avg. 31.1, 32.3kg/m 2 ; p=0.257). Descriptive statistics served to compare surgical site infection (SSI) rates and other characteristics across groups. Women undergoing surgery prior to implementation of this algorithm (n=165) had an infection rate of 14.6%. Group II (n=297) showed an over 2-fold reduction in SSI compared to Group I [5.7%; p=0.001, adjRR: 0.45, 95% CI: (0.25, 0.81)]. Additionally, approximately 19% of Group II patients were newly diagnosed with either prediabetes (HbA1C 6.0-6.4) or diabetes (HbA1C≥6.5) and were referred to family or internal medicine for appropriate management. Implementation of a comprehensive multidisciplinary glycemic control initiative can lead to a significant reduction in surgical site infections in addition to early identification of an important health

THE PROSTAGLANDIN E2 RECEPTOR, EP2, IS UPREGULATED IN THE DRG AFTER PAINFUL CERVICAL FACET JOINT INJURY IN THE RAT

PubMed Central

Kras, Jeffrey V.; Dong, Ling; Winkelstein, Beth A.

2012-01-01

Study Design This study implemented immunohistochemistry to assay prostaglandin E2 (PGE2) receptor EP2 expression in the dorsal root ganglion (DRG) of rats after painful cervical facet joint injury. Objective The objective of this study was to identify if inflammatory cascades are induced in association with cervical facet joint distraction-induced pain by investigating the time course of EP2 expression in the DRG. Summary of Background Data The cervical facet joint is a common source of neck pain and non-physiological stretch of the facet capsular ligament can initiate pain from the facet joint via mechanical injury. PGE2 levels are elevated in painful inflamed and arthritic joints, and PGE2 sensitizes joint afferents to mechanical stimulation. Although in vitro studies suggest the EP2 receptor subtype contributes to painful joint disease the EP2 response has not been investigated for any association with painful mechanical joint injury. Methods Separate groups of male Holtzman rats underwent either a painful cervical facet joint distraction injury or sham procedure. Bilateral forepaw mechanical allodynia was assessed, and immunohistochemical techniques were used to quantify EP2 expression in the DRG at days 1 and 7. Results Facet joint distraction induced mechanical allodynia that was significant (p<0.024) at all time points. Painful joint injury also significantly elevated total EP2 expression in the DRG at day 1 (p=0.009), which was maintained also at day 7 (p<0.001). Neuronal expression of EP2 in the DRG was only increased over sham levels at day 1 (p=0.013). Conclusions Painful cervical facet joint distraction induces an immediate and sustained increase of EP2 expression in the DRG, implicating peripheral inflammation in the initiation and maintenance of facet joint pain. The transient increase in neuronal EP2 suggests, as in other painful joint conditions, that after joint injury non-neuronal cells may migrate to the DRG, some of which likely express EP2

Evaluation of Massachusetts Expanded Learning Time (ELT) Initiative: Implementation and Outcomes after Four Years

ERIC Educational Resources Information Center

Boulay, Beth; Gamse, Beth; Checkoway, Amy; Maree, Kenyon; Fox, Lindsay

2011-01-01

The Massachusetts Department of Elementary and Secondary Education (ESE) has supported a multi-year study of the Expanded Learning Time (ELT) initiative to learn about the process and impact of ELT. Abt Associates Inc. is conducting this research. The study has two components: 1) a planning and implementation component that explores the…

Initiation and growth of multiple-site damage in the riveted lap joint of a curved stiffened fuselage panel: An experimental and analytical study

NASA Astrophysics Data System (ADS)

Ahmed, Abubaker Ali

As part of the structural integrity research of the National Aging Aircraft Research Program, a comprehensive study on multiple-site damage (MSD) initiation and growth in a pristine lap-joint fuselage panel has been conducted. The curved stiffened fuselage panel was tested at the Full-Scale Aircraft Structural Test Evaluation and Research (FASTER) facility located at the Federal Aviation Administration William J. Hughes Technical Center. A strain survey test was conducted to verify proper load application. The panel was then subjected to a fatigue test with constant-amplitude cyclic loading. The applied loading spectrum included underload marker cycles so that crack growth history could be reconstructed from post-test fractographic examinations. Crack formation and growth were monitored via nondestructive and high-magnification visual inspections. Strain gage measurements recorded during the strain survey tests indicated that the inner surface of the skin along the upper rivet row of the lap joint experienced high tensile stresses due to local bending. During the fatigue loading, cracks were detected by eddy-current inspections at multiple rivet holes along the upper rivet row. Through-thickness cracks were detected visually after about 80% of the fatigue life. Once MSD cracks from two adjacent rivet holes linked up, there was a quick deterioration in the structural integrity of the lap joint. The linkup resulted in a 2.87" (72.9-mm) lead fatigue crack that rapidly propagated across 12 rivet holes and crossed over into the next skin bay, at which stage the fatigue test was terminated. A post-fatigue residual strength test was then conducted by loading the panel quasi-statically up to final failure. The panel failed catastrophically when the crack extended instantaneously across three additional bays. Post-test fractographic examinations of the fracture surfaces in the lap joint of the fuselage panel were conducted to characterize subsurface crack initiation and

Axial traction magnetic resonance imaging (MRI) of the glenohumeral joint in healthy volunteers: initial experience.

PubMed

Garwood, Elisabeth R; Souza, Richard B; Zhang, Amy; Zhang, Alan L; Ma, C Benjamin; Link, Thomas M; Motamedi, Daria

Evaluate technical feasibility and potential applications of glenohumeral (GH) joint axial traction magnetic resonance imaging (MRI) in healthy volunteers. Eleven shoulders were imaged in neutral and with 4kg axial traction at 3T. Quantitative measurements were assessed. Axial traction was well tolerated. There was statistically significant widening of the superior GH joint space (p=0.002) and acromial angle (p=0.017) with traction. Inter-rater agreement was high. GH joint axial traction MRI is technically feasible and well tolerated in volunteers. Traction of the capsule, widening of the superior GH joint space and acromial angle were observed. Copyright © 2017 Elsevier Inc. All rights reserved.

The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints

PubMed Central

Sperry, Megan M.; Ita, Meagan E.; Kartha, Sonia; Zhang, Sijia; Yu, Ya-Hsin; Winkelstein, Beth

2017-01-01

Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain. PMID:28056123

Virtual Passive Controller for Robot Systems Using Joint Torque Sensors

NASA Technical Reports Server (NTRS)

Aldridge, Hal A.; Juang, Jer-Nan

1997-01-01

This paper presents a control method based on virtual passive dynamic control that will stabilize a robot manipulator using joint torque sensors and a simple joint model. The method does not require joint position or velocity feedback for stabilization. The proposed control method is stable in the sense of Lyaponov. The control method was implemented on several joints of a laboratory robot. The controller showed good stability robustness to system parameter error and to the exclusion of nonlinear dynamic effects on the joints. The controller enhanced position tracking performance and, in the absence of position control, dissipated joint energy.

Neural joint control for Space Shuttle Remote Manipulator System

NASA Technical Reports Server (NTRS)

Atkins, Mark A.; Cox, Chadwick J.; Lothers, Michael D.; Pap, Robert M.; Thomas, Charles R.

1992-01-01

Neural networks are being used to control a robot arm in a telerobotic operation. The concept uses neural networks for both joint and inverse kinematics in a robotic control application. An upper level neural network is trained to learn inverse kinematic mappings. The output, a trajectory, is then fed to the Decentralized Adaptive Joint Controllers. This neural network implementation has shown that the controlled arm recovers from unexpected payload changes while following the reference trajectory. The neural network-based decentralized joint controller is faster, more robust and efficient than conventional approaches. Implementations of this architecture are discussed that would relax assumptions about dynamics, obstacles, and heavy loads. This system is being developed to use with the Space Shuttle Remote Manipulator System.

A universal six-joint robot controller

NASA Technical Reports Server (NTRS)

Bihn, D. G.; Hsia, T. C.

1987-01-01

A general purpose six-axis robotic manipulator controller was designed and implemented to serve as a research tool for the investigation of the practical and theoretical aspects of various control strategies in robotics. A 80286-based Intel System 310 running the Xenix operating servo software as well as the higher level software (e.g., kinematics and path planning) were employed. A Multibus compatible interface board was designed and constructed to handle I/O signals from the robot manipulator's joint motors. From the design point of view, the universal controller is capable of driving robot manipulators equipped with D.C. joint motors and position optical encoders. To test its functionality, the controller is connected to the joint motor D.C. power amplifier of a PUMA 560 arm bypassing completely the manufacturer-supplied Unimation controller. A controller algorithm consisting of local PD control laws was written and installed into the Xenix operating system. Additional software drivers were implemented to allow application programs access to the interface board. All software was written in the C language.

Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results.

PubMed

Doggen, Kris; Van Acker, Kristien; Beele, Hilde; Dumont, Isabelle; Félix, Patricia; Lauwers, Patrick; Lavens, Astrid; Matricali, Giovanni A; Randon, Caren; Weber, Eric; Van Casteren, Viviane; Nobels, Frank

2014-07-01

This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics. Copyright © 2014 John Wiley & Sons, Ltd.

Alphabétisation à travers l'Initiative LIFE et le suivi de CONFINTEA VI au Maghreb

NASA Astrophysics Data System (ADS)

Kissami, Mohamed Abdellatif

2011-08-01

Literacy education through the LIFE Initiative and follow-up of CONFINTEA VI in the Maghreb - Illiteracy is seriously compromising the economic and social development of the Maghreb countries. In Morocco and Mauritania, for instance, national strategies and literacy programmes have been implemented. These efforts ought to be assessed so that lessons can be learned from them and the contribution of the national and international initiatives implemented in recent years can be evaluated. The Sixth International Conference on Adult Education provided an opportunity to launch a Maghreb-wide literacy cooperation process. Drawing on the experience of two high-priority countries (Morocco and Mauritania), the countries of the Maghreb created a mechanism for ongoing exchange within the framework of the Forum on Literacy for the Maghreb Region. The second meeting of this Forum, which was held in May 2010 in Nouakchott, was devoted to monitoring the implementation of the Belém Framework for Action and resulted in the creation of a joint cooperation programme in this domain.

Cytokine mRNA expression in synovial fluid of affected and contralateral stifle joints and the left shoulder joint in dogs with unilateral disease of the stifle joint.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Duchateau, Luc; Cox, Eric

2007-09-01

To examine mRNA expression of cytokines in synovial fluid (SF) cells from dogs with cranial cruciate ligament (CrCL) rupture and medial patellar luxation (MPL) and determine mRNA expression for 3 joints (affected stifle, unaffected contralateral stifle, and left shoulder joints) in dogs with unilateral CrCL rupture. 29 stifle joints with CrCL rupture (29 dogs), 8 stifle joints with MPL (7 dogs), and 24 normal stifle joints (16 clinically normal dogs). Immediately before reconstructive surgery, SF was aspirated from the cruciate-deficient stifle joint or stifle joint with MPL. Fourteen of 29 dogs had unilateral CrCL rupture; SF was also aspirated from the unaffected contralateral stifle joint and left shoulder joint. Those 14 dogs were examined 6 and 12 months after reconstructive surgery. Total RNA was extracted from SF cells and reverse transcription-PCR assay was performed to obtain cDNA. Canine-specific cytokine mRNA expression was determined by use of a real-time PCR assay. Interleukin (IL)-8 and -10 and interferon-gamma expression differed significantly between dogs with arthropathies and dogs with normal stifle joints. For the 14 dogs with unilateral CrCL rupture, a significant difference was found for IL-8 expression. Before reconstructive surgery, IL-8 expression differed significantly between the affected stifle joint and left shoulder joint or contralateral stifle joint. Six months after surgery, IL-8 expression was significantly increased in the unaffected contralateral stifle joint, compared with the shoulder joint. No conclusions can be made regarding the role of the examined cytokines in initiation of CrCL disease.

Predictive Simulations of Neuromuscular Coordination and Joint-Contact Loading in Human Gait.

PubMed

Lin, Yi-Chung; Walter, Jonathan P; Pandy, Marcus G

2018-04-18

We implemented direct collocation on a full-body neuromusculoskeletal model to calculate muscle forces, ground reaction forces and knee contact loading simultaneously for one cycle of human gait. A data-tracking collocation problem was solved for walking at the normal speed to establish the practicality of incorporating a 3D model of articular contact and a model of foot-ground interaction explicitly in a dynamic optimization simulation. The data-tracking solution then was used as an initial guess to solve predictive collocation problems, where novel patterns of movement were generated for walking at slow and fast speeds, independent of experimental data. The data-tracking solutions accurately reproduced joint motion, ground forces and knee contact loads measured for two total knee arthroplasty patients walking at their preferred speeds. RMS errors in joint kinematics were < 2.0° for rotations and < 0.3 cm for translations while errors in the model-computed ground-reaction and knee-contact forces were < 0.07 BW and < 0.4 BW, respectively. The predictive solutions were also consistent with joint kinematics, ground forces, knee contact loads and muscle activation patterns measured for slow and fast walking. The results demonstrate the feasibility of performing computationally-efficient, predictive, dynamic optimization simulations of movement using full-body, muscle-actuated models with realistic representations of joint function.

25 CFR 217.7 - Implementation of decision.

Code of Federal Regulations, 2010 CFR

2010-04-01

... expendient to implement the decisions of the joint managers, insofar as such issuance is authorized by law, and he shall execute and/or approve such documents for and on behalf of the joint managers, or either... to execute an instrument on behalf of one or both of the joint managers and to approve the same...

Behavior of stress generated in semiconductor chips with high-temperature joints: Influence of mechanical properties of joint materials

NASA Astrophysics Data System (ADS)

Ito, H.; Kuwahara, M.; Ohta, R.; Usui, M.

2018-04-01

High-temperature joint materials are indispensable to realizing next-generation power modules with high-output performance. However, crack initiation resulting from stress concentration in semiconductor chips joined with high-temperature joint materials remains a critical problem in high-temperature operation. Therefore, clarifying the quantitative influence of joint materials on the stress generated in chips is essential. This study investigates the stress behavior of chips joined by Ni-Sn solid-liquid interdiffusion (SLID), which results in a high-temperature joint material likely to generate cracks after joining or when under thermal cycling. The results are compared with those fabricated using three types of solders, Pb-10%Sn, Sn-0.7%Cu, and Sn-10%Sb (mass %), which are conventional joint materials with different melting points and mechanical properties. Using Ni-Sn SLID results in the generation of high compressive stress (500 MPa) without stress relaxation after the joining process in contrast to the case of solders in which the compressive stresses are low (<300 MPa) and decrease to still lower levels (<250 MPa). In addition, no stress relaxation occurs during thermal cycling when using Ni-Sn SLID, whereas stress relaxation is clearly observed during heating to 200 °C using solders. Different stress behaviors between Ni-Sn SLID and other joint materials are illustrated by their mechanical strength and resistance against plastic and creep deformation. These results suggest that stress relaxation in a chip is key in suppressing crack initiation in highly reliable modules during high-temperature operation.

Results From the Audit of DOD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation

DTIC Science & Technology

2009-11-03

Results From the Audit of DoD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation Memorandum No. D-2010-RAM...number. 1. REPORT DATE 03 NOV 2009 2. REPORT TYPE 3. DATES COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Results From the Audit of...SUBJECT: Results From the Audit of DOD’ s American Recovery and Reinvestment Act of2009 Initial Data Quality Review Implementation (Report No. D

Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.

PubMed

Best, Janie T; Frith, Karen; Anderson, Faye; Rapp, Carla Gene; Rioux, Lisa; Ciccarello, Christina

2011-11-01

To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. Practice change. The oncology unit of an urban hospital in the south-eastern United States. Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set. Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18. Initial antibiotic times, order-set use, and length of stay. An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department. Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.

Joint Attention and Toddler Characteristics: Race, Sex and Socioeconomic Status.

ERIC Educational Resources Information Center

Saxon, Terrill F.; Reilly, John T.

1999-01-01

Investigated the relationship between joint attention and toddler's race, sex, and SES. Found that joint attention related to a "persisting" mother, whether or not the toddler accepted the initial maternal bid. Females engaged in joint attention bouts and nonpersistent maternal responses after the bid was accepted more often than males. Race and…

Implementing a University-Wide Change Initiative

ERIC Educational Resources Information Center

Styron, Ronald A., Jr.; Michaelsen, Larry K.; Styron, Jennifer L.

2015-01-01

This paper provides an account of the pilot and first year of a university improvement initiative, developed in response to a reaffirmation mandate from the Southern Association of Colleges and Schools Commission on Colleges. The initiative focused on increasing student retention and enhancing learning through the campus-wide use of team-based…

JOMAR: Joint Operations with Mobile Autonomous Robots

DTIC Science & Technology

2015-12-21

AFRL-AFOSR-JP-TR-2015-0009 JOMAR: Joint Operations with Mobile Autonomous Robots Edwin Olson UNIVERSITY OF MICHIGAN Final Report 12/21/2015...SUBTITLE JOMAR: Joint Operations with Mobile Autonomous Robots 5a. CONTRACT NUMBER FA23861114024 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...14. ABSTRACT Under this grant, we formulated and implemented a variety of novel algorithms that address core problems in multi- robot systems. These

75 FR 81454 - Privacy Act of 1974; Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

... JOINT BOARD FOR ENROLLMENT OF ACTUARIES 20 CFR Part 903 Privacy Act of 1974; Implementation AGENCY... requirements of the Privacy Act of 1974, as amended, the Joint Board for the Enrollment of Actuaries (Joint... Privacy Act, from certain of the Privacy Act's provisions, to revise language that incorrectly implies...

The Early Childhood Cluster Initiative of Palm Beach County, Florida. Early Implementation Study and Evaluability Assessment. Executive Summary

ERIC Educational Resources Information Center

Spielberger, Julie; Goyette, Paul

2006-01-01

This report summarizes findings from the first year of an implementation study of the Early Childhood Cluster Initiative (ECCI). ECCI is a prekindergarten program in ten elementary schools and a community child care center in Palm Beach County, based on the design of the High/Scope Perry Preschool model. The initiative is characterized by low…

Heat-shock proteins in stromal joint tissues: innocent bystanders or disease-initiating proteins?

PubMed

Lambrecht, Stijn; Juchtmans, Nele; Elewaut, Dirk

2014-02-01

Heat-shock proteins (HSPs) are molecular chaperones that are highly conserved between species. In recent decades it has become clear that these proteins play an important role in the pathogenesis of inflammatory and degenerative joint diseases by (dys)regulating the immune system and by direct effects on the stromal tissues of the joint. In this review we discuss current insights into the expression pattern of HSPs in connective tissues, the direct biological role of HSPs in stromal tissues and the potential clinical applications.

Sacroiliac joint pain in the pediatric population.

PubMed

Stoev, Ivan; Powers, Alexander K; Puglisi, Joan A; Munro, Rebecca; Leonard, Jeffrey R

2012-06-01

The sacroiliac (SI) joint can be a pain generator in 13%-27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms. A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits. Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations. Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not

EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING.

PubMed

Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S; Miller, Jessica; Gheidi, Naghmeh

2017-10-01

Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. A repeated-measures research design. Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. 3b.

Developing and Implementing a Food Insecurity Screening Initiative for Adult Patients Living With Type 2 Diabetes.

PubMed

Thomas, Brittany; Fitzpatrick, Sandra; Sidani, Souraya; Gucciardi, Enza

2018-06-01

Routine food insecurity screening is recommended in diabetes care to inform more tailored interventions that better support diabetes self-management among food-insecure patients. This pilot study explored the acceptability and feasibility of a food insecurity screening initiative within a diabetes care setting in Toronto. A systematic literature review informed the development of a food insecurity screening initiative to help health-care providers tailor diabetes management plans and better support food-insecure patients with type 2 diabetes. Interviews with 10 patients and a focus group with 15 care providers elicited feedback on the relevance and acceptance of the food insecurity screening questions and a care algorithm. Subsequently, 5 care providers at 4 sites implemented the screening initiative over 2 weeks, screening 33 patients. After implementation, 7 patients and 5 care providers were interviewed to assess the acceptability and feasibility of the screening initiative. Our findings demonstrate that patients are willing to share their experiences of food insecurity, despite the sensitivity of this topic. Screening elicited information about how patients cope with food insecurity and how this affects their ability to self-manage diabetes. Care providers found this information helpful in directing their care and support for patients. Using a standardized, respectful method of assessing food insecurity can better equip health-care providers to support food-insecure patients with diabetes self-management. Further evaluation of this initiative is needed to determine how food insecurity screening can affect patients' self-management and related health outcomes. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Implementation Approach for Plug-in Electric Vehicles at Joint Base Lewis McChord. Task 4

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

Schey, Stephen; Francfort, Jim

2014-12-01

This study focused on Joint Base Lewis McChord (JBLM), which is located in Washington State. Task 1 consisted of a survey of the non-tactical fleet of vehicles at JBLM to begin the review of vehicle mission assignments and the types of vehicles in service. In Task 2, daily operational characteristics of select vehicles were identified and vehicle movements were recorded in data loggers in order to characterize the vehicles’ missions. In Task 3, the results of the data analysis and observations were provided. Individual observations of the selected vehicles provided the basis for recommendations related to PEV adoption (i.e., whethermore » a battery electric vehicle or plug-in hybrid electric vehicle [collectively referred to as PEVs] can fulfill the mission requirements0, as well as the basis for recommendations related to placement of PEV charging infrastructure. This report focuses on an implementation plan for the near-term adoption of PEVs into the JBLM fleet.« less

Joint carrier phase and frequency-offset estimation with parallel implementation for dual-polarization coherent receiver.

PubMed

Lu, Jianing; Li, Xiang; Fu, Songnian; Luo, Ming; Xiang, Meng; Zhou, Huibin; Tang, Ming; Liu, Deming

2017-03-06

We present dual-polarization complex-weighted, decision-aided, maximum-likelihood algorithm with superscalar parallelization (SSP-DP-CW-DA-ML) for joint carrier phase and frequency-offset estimation (FOE) in coherent optical receivers. By pre-compensation of the phase offset between signals in dual polarizations, the performance can be substantially improved. Meanwhile, with the help of modified SSP-based parallel implementation, the acquisition time of FO and the required number of training symbols are reduced by transferring the complex weights of the filters between adjacent buffers, where differential coding/decoding is not required. Simulation results show that the laser linewidth tolerance of our proposed algorithm is comparable to traditional blind phase search (BPS), while a complete FOE range of ± symbol rate/2 can be achieved. Finally, performance of our proposed algorithm is experimentally verified under the scenario of back-to-back (B2B) transmission using 10 Gbaud DP-16/32-QAM formats.

Joint mobilization acutely improves landing kinematics in chronic ankle instability.

PubMed

Delahunt, Eamonn; Cusack, Kim; Wilson, Laura; Doherty, Cailbhe

2013-03-01

The objective of this study is to examine the acute effect of ankle joint mobilizations akin to those performed in everyday clinical practice on sagittal plane ankle joint kinematics during a single-leg drop landing in participants with chronic ankle instability (CAI). Fifteen participants with self-reported CAI (defined as <24 on the Cumberland Ankle Instability Tool) performed three single-leg drop landings under two different conditions: 1) premobilization and, 2) immediately, postmobilization. The mobilizations performed included Mulligan talocrural joint dorsiflexion mobilization with movement, Mulligan inferior tibiofibular joint mobilization, and Maitland anteroposterior talocrural joint mobilization. Three CODA cx1 units (Charnwood Dynamics Ltd., Leicestershire, UK) were used to provide information on ankle joint sagittal plane angular displacement. The dependent variable under investigation was the angle of ankle joint plantarflexion at the point of initial contact during the drop landing. There was a statistically significant acute decrease in the angle of ankle joint plantarflexion from premobilization (34.89° ± 4.18°) to postmobilization (31.90° ± 5.89°), t(14) = 2.62, P < 0.05 (two-tailed). The mean decrease in the angle of ankle joint plantarflexion as a result of the ankle joint mobilization was 2.98° with a 95% confidence interval ranging from 0.54 to 5.43. The eta squared statistic (0.32) indicated a large effect size. These results indicate that mobilization acted to acutely reduce the angle of ankle joint plantarflexion at initial contact during a single-leg drop landing. Mobilization applied to participants with CAI has a mechanical effect on the ankle joint, thus facilitating a more favorable positioning of the ankle joint when landing from a jump.

Multi-atlas segmentation with joint label fusion and corrective learning—an open source implementation

PubMed Central

Wang, Hongzhi; Yushkevich, Paul A.

2013-01-01

Label fusion based multi-atlas segmentation has proven to be one of the most competitive techniques for medical image segmentation. This technique transfers segmentations from expert-labeled images, called atlases, to a novel image using deformable image registration. Errors produced by label transfer are further reduced by label fusion that combines the results produced by all atlases into a consensus solution. Among the proposed label fusion strategies, weighted voting with spatially varying weight distributions derived from atlas-target intensity similarity is a simple and highly effective label fusion technique. However, one limitation of most weighted voting methods is that the weights are computed independently for each atlas, without taking into account the fact that different atlases may produce similar label errors. To address this problem, we recently developed the joint label fusion technique and the corrective learning technique, which won the first place of the 2012 MICCAI Multi-Atlas Labeling Challenge and was one of the top performers in 2013 MICCAI Segmentation: Algorithms, Theory and Applications (SATA) challenge. To make our techniques more accessible to the scientific research community, we describe an Insight-Toolkit based open source implementation of our label fusion methods. Our implementation extends our methods to work with multi-modality imaging data and is more suitable for segmentation problems with multiple labels. We demonstrate the usage of our tools through applying them to the 2012 MICCAI Multi-Atlas Labeling Challenge brain image dataset and the 2013 SATA challenge canine leg image dataset. We report the best results on these two datasets so far. PMID:24319427

[Divorce and joint physical custody].

PubMed

Golse, B

2014-04-01

This work first recalls the definition of joint physical custody, as well as the current legal procedure for obtaining it, its practical implementation, the financial implications for parents, and finally some statistics. Some psychological and psychopathological reflections on the impact of divorce on children are then presented before considering the question of joint physically custody with regard to attachment theory and depending on the age of the child (a great caution seems to be required before three years). The article concludes with a brief discussion of parental alienation syndrome. Copyright © 2014. Published by Elsevier SAS.

Implementation and evaluation of the HEROES initiative: a tri-state coordinated school health program to reduce childhood obesity.

PubMed

King, Mindy H; Lederer, Alyssa M; Sovinski, Danielle; Knoblock, Heidi M; Meade, Rhonda K; Seo, Dong-Chul; Kim, Nayoung

2014-05-01

This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention's recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.

Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

PubMed

Doran, James P; Zabinski, Stephen J

2015-03-01

In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.

Composite SAR imaging using sequential joint sparsity

NASA Astrophysics Data System (ADS)

Sanders, Toby; Gelb, Anne; Platte, Rodrigo B.

2017-06-01

This paper investigates accurate and efficient ℓ1 regularization methods for generating synthetic aperture radar (SAR) images. Although ℓ1 regularization algorithms are already employed in SAR imaging, practical and efficient implementation in terms of real time imaging remain a challenge. Here we demonstrate that fast numerical operators can be used to robustly implement ℓ1 regularization methods that are as or more efficient than traditional approaches such as back projection, while providing superior image quality. In particular, we develop a sequential joint sparsity model for composite SAR imaging which naturally combines the joint sparsity methodology with composite SAR. Our technique, which can be implemented using standard, fractional, or higher order total variation regularization, is able to reduce the effects of speckle and other noisy artifacts with little additional computational cost. Finally we show that generalizing total variation regularization to non-integer and higher orders provides improved flexibility and robustness for SAR imaging.

Evaluation Report: Year 2 Implementation of the Small High Schools Initiative Manual Complex, Denver, Colorado

ERIC Educational Resources Information Center

Goldfeder, Elizabeth; Ross, Steven M.

2003-01-01

This report presents the findings of a study conducted by the Center for Research in Educational Policy (CREP) on the second year of implementation of the Small Schools Initiative at the Manual High School Complex. The major goal of this research was to evaluate perceived progress and outcomes at all three high schools. The design and methodology…

The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff.

PubMed

Vamos, Cheryl A; Cantor, Allison; Thompson, Erika L; Detman, Linda A; Bronson, Emily A; Phelps, Annette; Louis, Judette M; Gregg, Anthony R; Curran, John S; Sappenfield, William M

2016-10-01

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and

Implementation of STUD Pulses at the Trident Laser and Initial Results

NASA Astrophysics Data System (ADS)

Johnson, R. P.; Shimada, T.; Montgomery, D. S.; Afeyan, B.; Hüller, S.

2012-10-01

Controlling and mitigating laser-plasma instabilities such as stimulated Brillouin scattering, stimulated Raman scattering, and crossed-beam energy transfer is important to achieve high-gain inertial fusion using laser drivers. Recent theory and simulations show that these instabilities can be largely controlled using laser pulses consisting of spike trains of uneven duration and delay (STUD) by modulating the laser on a picosecond time scale [1,2]. We have designed and implemented a STUD pulse generator at the LANL Trident Laser Facility using Fourier synthesis to produce a 0.5-ns envelope of psec-duration STUD pulses using a spatial light modulator. Initial results from laser propagation tests and measurements as well as initial laser-plasma characterization experiments will be presented.[4pt] [1] B. Afeyan and S. H"uller, ``Optimal Control of Laser Plasma Instabilities using STUD pulses,'' IFSA 2011, P.Mo.1, to appear in Euro. Phys. J. Web of Conf. (2012).[2] S. H"uller and B. Afeyan, ``Simulations of drastically reduced SBS with STUD pulses,'' IFSA 2011, O.Tu8-1, to appear in Euro. Phys. J. Web of Conf. (2012).

Joint attention and language evolution

NASA Astrophysics Data System (ADS)

Kwisthout, Johan; Vogt, Paul; Haselager, Pim; Dijkstra, Ton

2008-06-01

This study investigates how more advanced joint attentional mechanisms, rather than only shared attention between two agents and an object, can be implemented and how they influence the results of language games played by these agents. We present computer simulations with language games showing that adding constructs that mimic the three stages of joint attention identified in children's early development (checking attention, following attention, and directing attention) substantially increase the performance of agents in these language games. In particular, the rates of improved performance for the individual attentional mechanisms have the same ordering as that of the emergence of these mechanisms in infants' development. These results suggest that language evolution and joint attentional mechanisms have developed in a co-evolutionary way, and that the evolutionary emergence of the individual attentional mechanisms is ordered just like their developmental emergence.

NATO initial common operational picture capability project

NASA Astrophysics Data System (ADS)

Fanti, Laura; Beach, David

2002-08-01

The Common Operational Picture (COP) capability can be defined as the ability to display on a single screen integrated views of the Recognized Maritime, Air and Ground Pictures, enriched by other tactical data, such as theater plans, assets, intelligence and logistics information. The purpose of the COP capability is to provide military forces a comprehensive view of the battle space, thereby enhancing situational awareness and the decision-making process across the military command and control spectrum. The availability of a COP capability throughout the command structure is a high priority operational requirement in NATO. A COP capability for NATO is being procured and implemented in an incremental way within the NATO Automated Information System (Bi-SC AIS) Functional Services programme under the coordination of the NATO Consultation, Command and Control Agency (NC3A) Integrated Programme Team 5 (IPT5). The NATO Initial COP (iCOP) capability project, first step of this evolutionary procurement, will provide an initial COP capability to NATO in a highly pragmatic and low-risk fashion, by using existing operational communications infrastructure and NATO systems, i.e. the NATO-Wide Integrated Command and Control Software for Air Operations (ICC), the Maritime Command and Control Information System (MCCIS), and the Joint Operations and Intelligence Information System (JOIIS), which will provide respectively the Recognized Air, Maritime and Ground Pictures. This paper gives an overview of the NATO Initial COP capability project, including its evolutionary implementation approach, and describes the technical solution selected to satisfy the urgent operational requirement in a timely and cost effective manner.

A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

PubMed

Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

2018-03-09

Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project

Facilitators and barriers to implementation of the AIDES initiative, a social innovation for participative assessment of children in need and for coordination of services.

PubMed

Dufour, Sarah; Lessard, Danielle; Chamberland, Claire

2014-12-01

As part of an implementation evaluation, this study aims to identify the conditions of practice that facilitated or hindered implementation of the AIDES initiative, a social innovation to support collaboration between partners involved with vulnerable children. Evaluators conducted qualitative telephone interviews with 36 respondents (19 practitioners and 17 managers) who participated in the AIDES initiative trial. Respondents were chosen to include all participating organisations (child protection services, prevention social services). Participants' comments were submitted to descriptive content analysis. Conditions facilitating or hindering implementation of the initiative included the following dimensions: (1) implementation quality; (2) organisational elements (organisational functioning, cooperation between organisations); (3) socio-political issues; and (4) personal and professional characteristics. The study highlights critical elements to consider in implementing and maintaining significant changes in practice in organisations providing assistance to vulnerable children and their families. Social innovations that do not consider such elements are likely to compromise their implementation and sustainability. We must prevent promising social changes from being considered unrealistic or inappropriate due to contextual barriers. Copyright © 2014 Elsevier Ltd. All rights reserved.

[President's Information Technology Advisory Committee (PITAC) Review of the Information Technology for the Twenty-First Century Initiative and Its Implementation Plan.

ERIC Educational Resources Information Center

National Coordination Office for Information Technology Research and Development, Arlington, VA.

As a part of its ongoing mission, the President's Information Technology Advisory Committee (PITAC) has completed an initial review of the Information Technology for the 21st Century (IT[squared]) initiative and its implementation plan put forward by the participating federal agencies. This letter conveys the initial conclusions of that review.…

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation.

PubMed

Lang, Jason M; Campbell, Kimberly; Shanley, Paul; Crusto, Cindy A; Connell, Christian M

2016-05-01

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed. © The Author(s) 2016.

Implementation of a new blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell wastage.

PubMed

Fadeyi, Emmanuel A; Emery, Wanda; Simmons, Julie H; Jones, Mary Rose; Pomper, Gregory J

2017-10-01

The objective was to report a successful implementation of a blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell (RBC) wastage. The blood bank database was used to quantify and categorize total RBC units issued in blood coolers from January 2010 to December 2015 with and without the new inserts throughout the hospital. Radiofrequency identification tags were used with special software to monitor blood cooler tracking. An educational policy on how to handle the coolers was initiated. Data were gathered from the software that provided a real-time location monitoring of the blood coolers with inserts throughout the institution. The implementation of the blood cooler with inserts and tracking device reduced mean yearly RBC wastage by fourfold from 0.64% to 0.17% between 2010 and 2015. The conserved RBCs corresponded to a total cost savings of $167,844 during the 3-year postimplementation period. The implementation of new blood cooler inserts, tracking system, and educational initiatives substantially reduced the mean annual total RBC wastage. The cost to implement this initiative may be small if there is an existing institutional infrastructure to monitor and track hospital equipment into which the blood bank intervention can be adapted when compared to the cost of blood wastage. © 2017 AABB.

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

ERIC Educational Resources Information Center

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

2016-01-01

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…

School staff, parent and student perceptions of a Breakfast in the Classroom model during initial implementation.

PubMed

Folta, Sara C; Carmichael Djang, Holly; Halmo, Megan; Metayer, Nesly; Blondin, Stacy A; Smith, Kathleen S; Economos, Christina D

2016-06-01

To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program. Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program. Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students. Purposively selected stakeholders in elementary schools that had implemented BIC for 3-6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10). Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC's potential impacts. The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.

National strategy for suicide prevention in Japan: impact of a national fund on progress of developing systems for suicide prevention and implementing initiatives among local authorities.

PubMed

Nakanishi, Miharu; Yamauchi, Takashi; Takeshima, Tadashi

2015-01-01

In Japan, the Cabinet Office released the 'General Principles of Suicide Prevention Policy' in 2007 and suggested nine initiatives. In 2009, a national fund was launched to help prefectures (the administrative divisions of Japan) and local authorities implement five categories of suicide-prevention programs. This paper examines the impact of the national fund on the establishment of the systems for suicide prevention and the implementation of these initiatives among local authorities. The present study included 1385 local authorities (79.5%) from all 47 prefectures that responded to the cross-sectional questionnaire survey. Improved suicide-prevention systems and the implementation of nine initiatives in April 2013 were observed among 265 local authorities (19.1%) that implemented 'Training of community service providers' and 'Public awareness campaigns'; 178 local authorities (12.9%) that implemented 'Face-to-face counseling', 'Training of community service providers' and 'Public awareness campaigns'; and 324 local authorities (23.4%) that implemented 'Trauma-informed policies and practices'. There was no significant difference in suicide-prevention systems and the implementation of nine initiatives between 203 local authorities (14.7%) that implemented only 'Public awareness campaigns' and 231 local authorities (16.7%) that did not implement any suicide-prevention programs. The results of our study suggest that the national fund promoted the establishment of community systems for suicide prevention and helped implement initiatives among local authorities. The national suicide-prevention strategy in Japan should explore a standard package of programs to guide community suicide-prevention efforts with a sustained workforce among local authorities. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

77 FR 30900 - Approval and Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Department in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County; Fees for Permits and...

EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING

PubMed Central

Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S.; Miller, Jessica; Gheidi, Naghmeh

2017-01-01

Background Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Purpose Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. Study Design A repeated-measures research design Methods Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. Results When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. Conclusions Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is

Ocean Observatories Initiative (OOI): Status of Design, Capabilities, and Implementation

NASA Astrophysics Data System (ADS)

Brasseur, L. H.; Banahan, S.; Cowles, T.

2009-05-01

The National Science Foundation's (NSF) Ocean Observatories Initiative (OOI) will implement the construction and operation of an interactive, integrated ocean observing network. This research- driven, multi-scale network will provide the broad ocean science community with access to advanced technology to enable studies of fundamental ocean processes. The OOI will afford observations at coastal, regional, and global scales on timeframes of milliseconds to decades in support of investigations into climate variability, ocean ecosystems, biogeochemical processes, coastal ocean dynamics, circulation and mixing dynamics, fluid-rock interactions, and the sub-seafloor biosphere. The elements of the OOI include arrays of fixed and re-locatable moorings, autonomous underwater vehicles, and cabled seafloor nodes. All assets combined, the OOI network will provide data from over 45 distinct types of sensors, comprising over 800 total sensors distributed in the Pacific and Atlantic oceans. These core sensors for the OOI were determined through a formal process of science requirements development. This core sensor array will be integrated through a system-wide cyberinfrastructure allowing for remote control of instruments, adaptive sampling, and near-real time access to data. Implementation of the network will stimulate new avenues of research and the development of new infrastructure, instrumentation, and sensor technologies. The OOI is funded by the NSF and managed by the Consortium for Ocean Leadership which focuses on the science, technology, education, and outreach for an emerging network of ocean observing systems.

SOHO Mission Interruption Joint NASA/ESA Investigation Board

NASA Technical Reports Server (NTRS)

1998-01-01

Contact with the SOlar Heliospheric Observatory (SOHO) spacecraft was lost in the early morning hours of June 25, 1998, Eastern Daylight Time (EDT), during a planned period of calibrations, maneuvers, and spacecraft reconfigurations. Prior to this the SOHO operations team had concluded two years of extremely successful science operations. A joint European Space Agency (ESA)/National Aeronautics and Space Administration (NASA) engineering team has been planning and executing recovery efforts since loss of contact with some success to date. ESA and NASA management established the SOHO Mission Interruption Joint Investigation Board to determine the actual or probable cause(s) of the SOHO spacecraft mishap. The Board has concluded that there were no anomalies on-board the SOHO spacecraft but that a number of ground errors led to the major loss of attitude experienced by the spacecraft. The Board finds that the loss of the SOHO spacecraft was a direct result of operational errors, a failure to adequately monitor spacecraft status, and an erroneous decision which disabled part of the on-board autonomous failure detection. Further, following the occurrence of the emergency situation, the Board finds that insufficient time was taken by the operations team to fully assess the spacecraft status prior to initiating recovery operations. The Board discovered that a number of factors contributed to the circumstances that allowed the direct causes to occur. The Board strongly recommends that the two Agencies proceed immediately with a comprehensive review of SOHO operations addressing issues in the ground procedures, procedure implementation, management structure and process, and ground systems. This review process should be completed and process improvements initiated prior to the resumption of SOHO normal operations.

Optimal Synthesis of the Joint Unitary Evolutions

NASA Astrophysics Data System (ADS)

Wei, Hai-Rui; Alsaedi, Ahmed; Hobiny, Aatef; Deng, Fu-Guo; Hu, Hui; Zhang, Dun

2018-07-01

Joint unitary operations play a central role in quantum communication and computation. We give a quantum circuit for implementing a type of unconstructed useful joint unitary evolutions in terms of controlled-NOT (CNOT) gates and single-qubit rotations. Our synthesis is optimal and possible in experiment. Two CNOT gates and seven R x , R y or R z rotations are required for our synthesis, and the arbitrary parameter contained in the evolutions can be controlled by local Hamiltonian or external fields.

Optimal Synthesis of the Joint Unitary Evolutions

NASA Astrophysics Data System (ADS)

Wei, Hai-Rui; Alsaedi, Ahmed; Hobiny, Aatef; Deng, Fu-Guo; Hu, Hui; Zhang, Dun

2018-03-01

Joint unitary operations play a central role in quantum communication and computation. We give a quantum circuit for implementing a type of unconstructed useful joint unitary evolutions in terms of controlled-NOT (CNOT) gates and single-qubit rotations. Our synthesis is optimal and possible in experiment. Two CNOT gates and seven R x , R y or R z rotations are required for our synthesis, and the arbitrary parameter contained in the evolutions can be controlled by local Hamiltonian or external fields.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Joint-ventures as strategic choice--a literature review.

PubMed

Lyons, M P

1991-08-01

The concept of 'strategic options' has become firmly established in recent years--this regards choices such as 'organic growth', acquisition, merger, and so on. This paper explores one such route forward, the option of joint-ventures. The examination is undertaken within a framework that considers market structures and the pressures for change. Initial sections introduce a form of analysis based upon the work of Michael Porter. This is used to suggest how and why joint-ventures and other alliances are attractive. Later discussion considers some of the practical considerations when setting-up a joint-venture.

Cross-Shear Implementation in Sliding-Distance-Coupled Finite Element Analysis of Wear in Metal-on-Polyethylene Total Joint Arthroplasty: Intervertebral Total Disc Replacement as an Illustrative Application

PubMed Central

Goreham-Voss, Curtis M.; Hyde, Philip J.; Hall, Richard M.; Fisher, John; Brown, Thomas D.

2010-01-01

Computational simulations of wear of orthopaedic total joint replacement implants have proven to valuably complement laboratory physical simulators, for pre-clinical estimation of abrasive/adhesive wear propensity. This class of numerical formulations has primarily involved implementation of the Archard/Lancaster relationship, with local wear computed as the product of (finite element) contact stress, sliding speed, and a bearing-couple-dependent wear factor. The present study introduces an augmentation, whereby the influence of interface cross-shearing motion transverse to the prevailing molecular orientation of the polyethylene articular surface is taken into account in assigning the instantaneous local wear factor. The formulation augment is implemented within a widely-utilized commercial finite element software environment (ABAQUS). Using a contemporary metal-on-polyethylene total disc replacement (ProDisc-L) as an illustrative implant, physically validated computational results are presented to document the role of cross-shearing effects in alternative laboratory consensus testing protocols. Going forward, this formulation permits systematically accounting for cross-shear effects in parametric computational wear studies of metal-on-polyethylene joint replacements, heretofore a substantial limitation of such analyses. PMID:20399432

Benchmarking progress in the implementation of the Fourth Joint Societies' Task Force Guidelines on the Prevention of Cardiovascular Disease in Clinical Practice.

PubMed

Morgan, Karen; Burke, Helen; McGee, Hannah

2013-02-01

The Fourth Joint Societies' Task Force (4th JTF) Guidelines on Cardiovascular Disease Prevention in Clinical Practice are agreed, evidence-based standards of care across European countries and professions. In advance of the publication of the 5th JTF Guidelines in 2012, this work assesses the extent to which the 4th JTF guidelines have been implemented. Qualitative study of guideline implementation in 13 European countries, focusing on the themes of guideline implementation structures, processes, and outcomes. Key personnel in 13 selected countries completed interviews or comparable questionnaires: they were national coordinators for CVD prevention (n = 14) and representatives of the national cardiac society (n = 9), heart foundations (n = 11), health ministry (n = 8), and service providers (n = 3). Interview and service-related data from each country were compiled to provide a detailed overview. Ten of the 13 countries used European Society of Cardiology (ESC) guidelines on prevention at a national level, where three broad approaches to implementation were identified. In all 10 countries, multidisciplinary alliances oversaw implementation, but ongoing promotion of the guidelines was not evident, with just two of the 10 countries conducting evaluation of implementation. Barriers to implementation included weak health authority support, the unwieldy nature of the guidelines, guideline fatigue, and the lesser role of prevention in national healthcare systems. Substantial progress had been made in implementing the guidelines, but countries struggled with the task. Some rebalancing of the ESC focus may be warranted so that part of the effort dedicated to improving guidelines might be redirected at translating them into practice.

Numerical built-in method for the nonlinear JRC/JCS model in rock joint.

PubMed

Liu, Qunyi; Xing, Wanli; Li, Ying

2014-01-01

The joint surface is widely distributed in the rock, thus leading to the nonlinear characteristics of rock mass strength and limiting the effectiveness of the linear model in reflecting characteristics. The JRC/JCS model is the nonlinear failure criterion and generally believed to describe the characteristics of joints better than other models. In order to develop the numerical program for JRC/JCS model, this paper established the relationship between the parameters of the JRC/JCS and Mohr-Coulomb models. Thereafter, the numerical implement method and implementation process of the JRC/JCS model were discussed and the reliability of the numerical method was verified by the shear tests of jointed rock mass. Finally, the effect of the JRC/JCS model parameters on the shear strength of the joint was analyzed.

A self-aligning knee joint for walking assistance devices.

PubMed

Byungjune Choi; Younbaek Lee; Jeonghun Kim; Minhyung Lee; Jongwon Lee; Se-Gon Roh; Hyundo Choi; Yong-Jae Kim; Jung-Yun Choi

2016-08-01

This paper presents a novel self-aligning knee mechanism for walking assistance devices for the elderly to provide physical gait assistance. Self-aligning knee joints can assist in flexion/extension motions of the knee joint and compensate the knee's transitional movements in the sagittal plane. In order to compensate the center of rotation, which moves with the flexion/extension motion of the human knee joint, a self-aligning knee joint is proposed that adds redundant degrees of freedom (i.e., 2-DoF) to the 1-DoF revolute joint. The key idea of the proposed mechanism is to decouple joint rotations and translations for use in lower-extremity wearable devices. This paper describes the mechanical design of this self-aligning knee mechanism and its implementation on a wearable robot and in preliminary experiments. The performance of the proposed mechanism is verified by simulations and experiments.

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

PubMed

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.

PubMed

Kipps, Alaina K; Poole, Sarah F; Slaney, Cheryl; Feehan, Shannon; Longhurst, Christopher A; Sharek, Paul J; Goel, Veena V

2017-08-01

To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) ( P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit. Copyright © 2017 by the American Academy of Pediatrics.

Perspectives on the institutional needs of joint implementation projects for China, Egypt, India, Mexico, and Thailand

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

Mabel, M.; Watt, E.; Sathaye, J.

One avenue for reducing the net emissions of greenhouse gases (GHG) under the Framework Convention on Climate Change (FCCC) is the joint implementation (JI) of policies and projects to the Convention. Although debate on the practical aspects of JI projects is relatively young, it already includes issues concerning the ability of governments to accept JI projects as well as the project participants` capacity to monitor, evaluate, and verify the financial and GHG benefits. The focus of this paper is an in-depth, country-by-country analysis of current and conceivable institutions in potential host countries. To understand these concerns better, in August 1994more » the authors asked colleagues in five developing countries to evaluate their countries` institutional capacity for JI projects. Their perspectives are presented here as individual country case studies. The five countries--Mexico, Egypt, Thailand, India, and China--were chosen because each has significant potential for JI projects.« less

Planning and implementing forest operations to achieve sustainable forests: Proceedings of papers presented at the joint meeting of the Council on Forest Engineering and International Union of Forest Research Organizations.

Treesearch

Charles R. Blinn; Michael A. Thompson

1996-01-01

Contains a variety of papers presented at the joint meeting of the Council on Forest Engineering and International Union of Forest Research Organizations Subject Group S3.04 and that support the meeting theme "Planning and Implementing Forest Operations to Achieve Sustainable Forests."

The NASA Scientific and Technical Information (STI) Program's Implementation of Open Archives Initiation (OAI) for Data Interoperability and Data Exchange

NASA Technical Reports Server (NTRS)

Rocker, JoAnne; Roncaglia, George J.; Heimerl, Lynn N.; Nelson, Michael L.

2002-01-01

Interoperability and data-exchange are critical for the survival of government information management programs. E-government initiatives are transforming the way the government interacts with the public. More information is to be made available through web-enabled technologies. Programs such as the NASA's Scientific and Technical Information (STI) Program Office are tasked to find more effective ways to disseminate information to the public. The NASA STI Program is an agency-wide program charged with gathering, organizing, storing, and disseminating NASA-produced information for research and public use. The program is investigating the use of a new protocol called the Open Archives Initiative (OAI) as a means to improve data interoperability and data collection. OAI promotes the use of the OAI harvesting protocol as a simple way for data sharing among repositories. In two separate initiatives, the STI Program is implementing OAI In collaboration with the Air Force, Department of Energy, and Old Dominion University, the NASA STI Program has funded research on implementing the OAI to exchange data between the three organizations. The second initiative is the deployment of OAI for the NASA technical report server (TRS) environment. The NASA TRS environment is comprised of distributed technical report servers with a centralized search interface. This paper focuses on the implementation of OAI to promote interoperability among diverse data repositories.

Do lower-extremity joint dynamics change when stair negotiation is initiated with a self-selected comfortable gait speed?

PubMed

Vallabhajosula, Srikant; Yentes, Jennifer M; Momcilovic, Mira; Blanke, Daniel J; Stergiou, Nicholas

2012-02-01

Previous research on the biomechanics of stair negotiation has ignored the effect of the approaching speed. We examined if initiating stair ascent with a comfortable self-selected speed can affect the lower-extremity joint moments and powers as compared to initiating stair ascent directly in front of the stairs. Healthy young adults ascended a custom-built staircase instrumented with force platforms. Kinematics and kinetics data were collected simultaneously for two conditions: starting from farther away and starting in front of the stairs and analyzed at the first and second ipsilateral steps. Results showed that for the first step, participants produced greater peak knee extensor moment, peak hip extensor and flexor moments and peak hip positive power while starting from farther away. Also, for both the conditions combined, participants generated lesser peak ankle plantiflexor, greater peak knee flexor moment, lesser peak ankle negative power and greater peak hip negative power while encountering the first step. These results identify the importance of the starting position in experiments dealing with biomechanics of stair negotiation. Further, these findings have important implications for studying stair ascent characteristics of other populations such as older adults. Copyright © 2011 Elsevier B.V. All rights reserved.

Implementing Evidence-Based Teen Pregnancy-Prevention Interventions in a Community-Wide Initiative: Building Capacity and Reaching Youth.

PubMed

House, L Duane; Tevendale, Heather D; Martinez-Garcia, Genevieve

2017-03-01

To describe efforts to implement evidence-based interventions (EBIs) within multicomponent, community-wide initiatives to reduce teen pregnancy. During 2011-2014, we collected information about the capacity (i.e., knowledge, confidence, training, and experience) of state and community-based organizations to support implementation of the following: EBIs, number and characteristics of youth served by EBIs, type of EBIs implemented, EBI settings, hours of training, and technical assistance provided. State and community-based organizations reported these data annually; however, training and technical assistance was reported monthly. We used aggregated data from these annual and monthly reports to describe the implementation of EBIs in the community-wide initiative project. From baseline in 2011-2014, state and community-based organizations increased their capacities to support program partners in delivering EBIs. They provided 5,015 hours of technical assistance and training on topics, including ensuring adequate capacity, process and outcome evaluation, program planning, and continuous quality improvement. Program partners increased the number of youth reached by an EBI in targeted communities by 349%, from 4,304 in the first year of implementation in 2012 to 19,344 in 2014. Most youth in 2014 received sexuality education programs (59%), whereas smaller percentages received abstinence-based, youth development, and clinic-based programs. Most youth were reached through schools (72%) and community-based organizations (16%), and smaller numbers were reached in other settings (e.g., faith-based organizations, health centers). Building and monitoring the capacity of program partners to deliver EBIs through technical assistance and training is important. In addition, partnering with schools leads to reaching more youth. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Should I stay or should I go? Initiation of joint travel in mother-infant dyads of two chimpanzee communities in the wild.

PubMed

Fröhlich, Marlen; Wittig, Roman M; Pika, Simone

2016-05-01

It is well established that great apes communicate via intentionally produced, elaborate and flexible gestural means. Yet relatively little is known about the most fundamental steps into this communicative endeavour-communicative exchanges of mother-infant dyads and gestural acquisition; perhaps because the majority of studies concerned captive groups and single communities in the wild only. Here, we report the first systematic, quantitative comparison of communicative interactions of mother-infant dyads in two communities of wild chimpanzees by focusing on a single communicative function: initiation of carries for joint travel. Over 156 days of observation, we recorded 442 actions, 599 cases of intentional gesture production, 51 multi-modal combinations and 80 vocalisations in the Kanyawara community, Kibale National Park, Uganda, and the Taï South community, Taï National Park, Côte d'Ivoire. Our results showed that (1) mothers and infants differed concerning the signal frequency and modality employed to initiate joint travel, (2) concordance rates of mothers' gestural production were relatively low within but also between communities, (3) infant communicative development is characterised by a shift from mainly vocal to gestural means, and (4) chimpanzee mothers adjusted their signals to the communicative level of their infants. Since neither genetic channelling nor ontogenetic ritualization explains our results satisfactorily, we propose a revised theory of gestural acquisition, social negotiation, in which gestures are the output of social shaping, shared understanding and mutual construction in real time by both interactants.

7 CFR 3405.7 - Joint project proposals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... agricultural sciences. The goals of such joint initiatives should include maximizing the use of limited...), increasing cost-effectiveness through achieving economies of scale, strengthening the scope and quality of a...

7 CFR 3405.7 - Joint project proposals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... agricultural sciences. The goals of such joint initiatives should include maximizing the use of limited...), increasing cost-effectiveness through achieving economies of scale, strengthening the scope and quality of a...

7 CFR 3405.7 - Joint project proposals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... agricultural sciences. The goals of such joint initiatives should include maximizing the use of limited...), increasing cost-effectiveness through achieving economies of scale, strengthening the scope and quality of a...

Joint FACET: the Canada-Netherlands initiative to study multisensor data fusion systems

NASA Astrophysics Data System (ADS)

Bosse, Eloi; Theil, Arne; Roy, Jean; Huizing, Albert G.; van Aartsen, Simon

1998-09-01

This paper presents the progress of a collaborative effort between Canada and The Netherlands in analyzing multi-sensor data fusion systems, e.g. for potential application to their respective frigates. In view of the overlapping interest in studying and comparing applicability and performance and advanced state-of-the-art Multi-Sensor Data FUsion (MSDF) techniques, the two research establishments involved have decided to join their efforts in the development of MSDF testbeds. This resulted in the so-called Joint-FACET, a highly modular and flexible series of applications that is capable of processing both real and synthetic input data. Joint-FACET allows the user to create and edit test scenarios with multiple ships, sensor and targets, generate realistic sensor outputs, and to process these outputs with a variety of MSDF algorithms. These MSDF algorithms can also be tested using typical experimental data collected during live military exercises.

Joint approach for reducing eccentricity and spurious gravitational radiation in binary black hole initial data construction

NASA Astrophysics Data System (ADS)

Zhang, Fan; Szilágyi, Béla

2013-10-01

At the beginning of binary black hole simulations, there is a pulse of spurious radiation (or junk radiation) resulting from the initial data not matching astrophysical quasi-equilibrium inspiral exactly. One traditionally waits for the junk radiation to exit the computational domain before taking physical readings, at the expense of throwing away a segment of the evolution, and with the hope that junk radiation exits cleanly. We argue that this hope does not necessarily pan out, as junk radiation could excite long-lived constraint violation. Another complication with the initial data is that they contain orbital eccentricity that needs to be removed, usually by evolving the early part of the inspiral multiple times with gradually improved input parameters. We show that this procedure is also adversely impacted by junk radiation. In this paper, we do not attempt to eliminate junk radiation directly, but instead tackle the much simpler problem of ameliorating its long-lasting effects. We report on the success of a method that achieves this goal by combining the removal of junk radiation and eccentricity into a single procedure. Namely, we periodically stop a low resolution simulation; take the numerically evolved metric data and overlay it with eccentricity adjustments; run it through an initial data solver (i.e. the solver receives as free data the numerical output of the previous iteration); restart the simulation; repeat until eccentricity becomes sufficiently low; and then launch the high resolution “production run” simulation. This approach has the following benefits: (1) We do not have to contend with the influence of junk radiation on eccentricity measurements for later iterations of the eccentricity reduction procedure. (2) We reenforce constraints every time the initial data solver is invoked, removing the constraint violation excited by junk radiation previously. (3) The wasted simulation segment associated with the junk radiation’s evolution is

[Implementation of a regional system for the emergency care of acute ischemic stroke: Initial results].

PubMed

Soares-Oliveira, Miguel; Araújo, Fernando

2014-06-01

Implementing integrated systems for emergency care of patients with acute ischemic stroke helps reduce morbidity and mortality. We describe the process of organizing and implementing a regional system to cover around 3.7 million people and its main initial results. We performed a descriptive analysis of the implementation process and a retrospective analysis of the following parameters: number of patients prenotified by the pre-hospital system; number of times thrombolysis was performed; door-to-needle time; and functional assessment three months after stroke. The implementation process started in November 2005 and ended in December 2009, and included 11 health centers. There were 3574 prenotifications from the prehospital system. Thrombolysis was performed in 1142 patients. The percentage of patients receiving thrombolysis rose during the study period, with a maximum of 16%. Median door-to-needle time was 62 min in 2009. Functional recovery three months after stroke was total or near total in 50% of patients. The regional system implemented for emergency care of patients with acute ischemic stroke has led to health gains, with progressive improvements in patients' access to thrombolysis, and to greater equity in the health care system, thus helping to reduce mortality from cerebrovascular disease in Portugal. Our results, which are comparable with those of international studies, support the strategy adopted for implementation of this system. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

PubMed

2015-11-24

This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

Root Cause Investigation of Lead-Free Solder Joint Interfacial Failures After Multiple Reflows

NASA Astrophysics Data System (ADS)

Li, Yan; Hatch, Olen; Liu, Pilin; Goyal, Deepak

2017-03-01

Solder joint interconnects in three-dimensional (3D) packages with package stacking configurations typically must undergo multiple reflow cycles during the assembly process. In this work, interfacial open joint failures between the bulk solder and the intermetallic compound (IMC) layer were found in Sn-Ag-Cu (SAC) solder joints connecting a small package to a large package after multiple reflow reliability tests. Systematic progressive 3D x-ray computed tomography experiments were performed on both incoming and assembled parts to reveal the initiation and evolution of the open failures in the same solder joints before and after the reliability tests. Characterization studies, including focused ion beam cross-sections, scanning electron microscopy, and energy-dispersive x-ray spectroscopy, were conducted to determine the correlation between IMC phase transformation and failure initiation in the solder joints. A comprehensive failure mechanism, along with solution paths for the solder joint interfacial failures after multiple reflow cycles, is discussed in detail.

Development and implementation of mass media campaigns to delay sexual initiation among African American and White youth.

PubMed

Noar, Seth M; Zimmerman, Rick S; Palmgreen, Philip; Cupp, Pamela K; Floyd, Brenikki R; Mehrotra, Purnima

2014-01-01

Reducing new HIV/STD infections among at-risk adolescents requires developing and evaluating evidence-based health communication approaches. Research overwhelmingly supports the conclusion that early sexual initiation is associated with STDs and other negative outcomes in later years (e.g., unintended pregnancy). The authors' research group secured funding from the National Institute of Mental Health to develop, implement, and rigorously evaluate televised mass media campaigns to delay initiation of sexual intercourse among African American and White adolescents in two cities in the Southeastern United States. The focus of the present study is on the development and implementation of the campaigns, including (a) rationale and theoretical underpinnings; (b) collection, screening, and assessment of existing public service announcements; (c) development of new public service announcements; (d) study design and campaign airing plan; and (e) message exposure achieved in the campaigns. Health communication campaigns hold much promise in reaching at-risk adolescent populations with targeted, timely, and relevant risk-reduction messages.

Implementation of the Port Hope Area Initiative Biophysical and Socioeconomic Environmental Assessment Follow-up Programs - 13209

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

Baba, Nina; Friedmann, Karyn; Groulx, Charles

2013-07-01

The Port Hope Initiative (PHAI) involves the cleanup of historic low-level radioactive waste in various locations throughout the communities of Port Hope and Clarington, Ontario, as well as the construction of two engineered aboveground mounds for safe long-term management. The PHAI is comprised of two major projects - the Port Hope Project and the Port Granby Project. An Environmental Assessment (EA) was undertaken for each project and as a result EA Follow-up Programs were developed and are being implemented addressing both biophysical and socioeconomic aspects. This paper provides insight on elements of the EA Follow-up Program development, and its implementation.more » (authors)« less

Recrystallization Behavior in Mixed Solder Joints of BGA Components during Thermal Shock

NASA Astrophysics Data System (ADS)

Tan, Shihai; Han, Jing; Guo, Fu

2018-03-01

Sn-37Pb and Sn-3.0Ag-0.5Cu solder pastes printed onto a board were attached to ball grid array (BGA) samples using Sn-3.0Ag-0.5Cu solder balls. Before thermal shock, the initial grain orientations on the cross-section were obtained by scanning electron microscopy equipped with an electron backscattered diffraction system. Three mixed solder joints (two from the corner and another from the middle of the BGA component) and three lead-free solder joints (at the same positions) were selected to investigate the recrystallization behavior under thermal shock (TS) cycling conditions. All of the mixed and lead-free solder joints were initially single crystal. The results showed that recrystallization occurred in both the mixed and lead-free solder joints after 200 TS. For the mixed solder joints, more recrystallization was observed and the location of samples had a significant influence on their recrystallization behavior, while location was not as important for the lead-free samples after 200 TS in this study. Both the mixed and lead-free solder joints at the corner of BGA components showed the poorest reliability. According to misorientation distribution maps and subgrain rotation behaviors, the reliability of mixed solder joints was much poorer than that of lead-free solder joints.

Loading Analysis of Composite Wind Turbine Blade for Fatigue Life Prediction of Adhesively Bonded Root Joint

NASA Astrophysics Data System (ADS)

Salimi-Majd, Davood; Azimzadeh, Vahid; Mohammadi, Bijan

2015-06-01

Nowadays wind energy is widely used as a non-polluting cost-effective renewable energy resource. During the lifetime of a composite wind turbine which is about 20 years, the rotor blades are subjected to different cyclic loads such as aerodynamics, centrifugal and gravitational forces. These loading conditions, cause to fatigue failure of the blade at the adhesively bonded root joint, where the highest bending moments will occur and consequently, is the most critical zone of the blade. So it is important to estimate the fatigue life of the root joint. The cohesive zone model is one of the best methods for prediction of initiation and propagation of debonding at the root joint. The advantage of this method is the possibility of modeling the debonding without any requirement to the remeshing. However in order to use this approach, it is necessary to analyze the cyclic loading condition at the root joint. For this purpose after implementing a cohesive interface element in the Ansys finite element software, one blade of a horizontal axis wind turbine with 46 m rotor diameter was modelled in full scale. Then after applying loads on the blade under different condition of the blade in a full rotation, the critical condition of the blade is obtained based on the delamination index and also the load ratio on the root joint in fatigue cycles is calculated. These data are the inputs for fatigue damage growth analysis of the root joint by using CZM approach that will be investigated in future work.

Mother-infant joint attention and sharing: relations to disorganized attachment and maternal disrupted communication.

PubMed

Annie Yoon, Seungyeon; Kelso, Gwendolyn A; Lock, Anna; Lyons-Ruth, Karlen

2014-01-01

The normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother-infant shared attention. The authors examined both maternal initiations of joint attention and infants' responses to those initiations during the reunion episodes of the Strange Situation Procedure at 12 and 18 months of infant age. The mothers' initiations of joint attention and three forms of infant response, including shunning, simple joint attention, and sharing attention, were examined in relation to infant disorganized attachment and maternal disrupted communication. Mothers who were disrupted in communication with their infants at 18 months initiated fewer bids for joint attention at 12 months, and, at 18 months, mothers of infants classified disorganized initiated fewer bids. However, the infant' responses were unrelated to either the infant' or the mother' disturbed attachment. At both ages, disorganized infants and infants of disrupted mothers were as likely to respond to maternal bids as were their lower risk counterparts. Our results suggest that a disposition to share experiences with others is robust in infancy, even among infants with adverse attachment experiences, but this infant disposition may depend on adult initiation of bids to be realized.

Joint ETV/NOWATECH test plan for the Sorbisense GSW40 passive sampler

EPA Science Inventory

The joint test plan is the implementation of a test design developed for verification of the performance of an environmental technology following the NOWATECH ETV method. The verification is a joint verification with the US EPA ETV scheme and the Advanced Monitoring Systems Cent...

Experimental Studies on the Mechanical Behaviour of Rock Joints with Various Openings

NASA Astrophysics Data System (ADS)

Li, Y.; Oh, J.; Mitra, R.; Hebblewhite, B.

2016-03-01

The mechanical behaviour of rough joints is markedly affected by the degree of joint opening. A systematic experimental study was conducted to investigate the effect of the initial opening on both normal and shear deformations of rock joints. Two types of joints with triangular asperities were produced in the laboratory and subjected to compression tests and direct shear tests with different initial opening values. The results showed that opened rock joints allow much greater normal closure and result in much lower normal stiffness. A semi-logarithmic law incorporating the degree of interlocking is proposed to describe the normal deformation of opened rock joints. The proposed equation agrees well with the experimental results. Additionally, the results of direct shear tests demonstrated that shear strength and dilation are reduced because of reduced involvement of and increased damage to asperities in the process of shearing. The results indicate that constitutive models of rock joints that consider the true asperity contact area can be used to predict shear resistance along opened rock joints. Because rock masses are loosened and rock joints become open after excavation, the model suggested in this study can be incorporated into numerical procedures such as finite-element or discrete-element methods. Use of the model could then increase the accuracy and reliability of stability predictions for rock masses under excavation.

Moral Competence for the Joint Warfighter: The Missing Element in Defense Transformation

DTIC Science & Technology

2006-06-01

warriors. Further, it argues that through a combination of benign neglect and intentional acquiescence, the Services have undermined their own ethical ...initiate a Joint Ethical Transformation Campaign to improve moral competence and ethical cultures within all of the Services...21 Demand for Moral Skill Joint Values in Joint Warfare Challenging Ethical Environment Special Trust Avoiding the Worst Possible Outcome

Experimental studies of glued Aluminum-glass joints

NASA Astrophysics Data System (ADS)

Ligaj, B.; Wirwicki, M.; Karolewska, K.; Jasińska, A.

2018-04-01

Glued steel-glass or aluminum-glass joints are to be found, among other things, in vehicles (cars, buses, trains, trams) as windscreen assembly pieces for the supporting structure. For the purposes of the experiments, samples were made in which the top beam was made of the AW-2017A aluminum alloy and the bottom beam was made of thermally reinforced soda-lime glass whereas the glued joints were made of one-component polyurethane glue Körapur 175. The tests were performed under four-point bending conditions at monotonic incremental bending moment values on the Instron 5965 durability machine. The experimental study of the durability of glued joints under four-point bending conditions with the monotonic incremental bending moment allows to determine the values of stresses, whose value is related to initiation of damage of the tested joint.

U.S. Perspectives on the Joint Convention

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

Strosnider, J.; Federline, M.; Camper, L.

The Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (Joint Convention) is an international convention, under the auspices of the International Atomic Energy Agency (IAEA). It is a companion to a suite of international conventions on nuclear safety and physical security, which serve to promote a global culture for the safe use of radioactive materials. Although the U.S. was the first nation to sign the Joint Convention on September 29, 1997, the ratification process was a challenging experience for the U.S., in the face of legislative priorities dominated by concerns formore » national security and threats from terrorism after September 11, 2001. Notwithstanding these prevailing circumstances, the U.S. ratified the Joint Convention in 2003, just prior to the First Review Meeting of the Contracting Parties, and participated fully therein. For the United States, participation as a Contracting Party provides many benefits. These range from working with other Parties to harmonize international approaches to achieve strong and effective nuclear safety programs on a global scale, to stimulating initiatives to improve safety systems within our own domestic programs, to learning about technical innovations by other Parties that can be useful to U.S. licensees, utilities, and industry in managing safety and its associated costs in our waste management activities. The Joint Convention process also provides opportunities to identify future areas of bilateral and multilateral technical and regulatory cooperation with other Parties, as well as an opportunity for U.S. vendors and suppliers to broaden their market to include foreign clients for safety improvement equipment and services. The Joint Convention is consistent with U.S. foreign policy considerations to support, as a priority, the strengthening of the worldwide safety culture in the use of nuclear energy. Because of its many benefits, we believe it is important

Implementation of a pharmacist-managed heart failure medication titration clinic.

PubMed

Martinez, Amanda S; Saef, Jerold; Paszczuk, Anna; Bhatt-Chugani, Hetal

2013-06-15

The development, implementation, and initial results of a pharmacist-managed heart failure (HF) medication titration clinic are described. In a quality-improvement initiative at a Veterans Affairs health care system, clinical pharmacists were incorporated into the hospital system's interprofessional outpatient HF clinic. In addition, a separate pharmacist-managed HF medication titration clinic was established, in which pharmacists were granted an advanced scope of practice and prescribing privileges, enabling them to initiate and adjust medication dosages under specific protocols jointly established by cardiology and pharmacy staff. Pharmacists involved in the titration clinic tracked patients' daily body weight, vital signs, and volume status using telephone-monitoring technology and via patient interviews. A retrospective chart review comparing achievement of target doses of angiotensin-converting enzyme inhibitor (ACEI), angiotensin-receptor blocker (ARB), and β-blocker therapies in a group of patients (n = 28) whose dosage titrations were carried out by nurses or physicians prior to implementation of the pharmacist-managed HF medication titration clinic and a group of patients (n = 27) enrolled in the medication titration clinic during its first six months of operation indicated that target ACEI and ARB doses were achieved in a significantly higher percentage of pharmacist-managed titration clinic enrollees (52.9% versus 31%, p = 0.007). Patients enrolled in the pharmacist-managed HF medication titration clinic also had a significantly higher rate of attainment of optimal β-blocker doses (49% versus 24.7%, p = 0.012). Implementation of a pharmacist-managed HF medication titration clinic increased the percentage of patients achieving optimal ACEI, ARB, and β-blocker dosages.

Compensating for intersegmental dynamics across the shoulder, elbow, and wrist joints during feedforward and feedback control.

PubMed

Maeda, Rodrigo S; Cluff, Tyler; Gribble, Paul L; Pruszynski, J Andrew

2017-10-01

Moving the arm is complicated by mechanical interactions that arise between limb segments. Such intersegmental dynamics cause torques applied at one joint to produce movement at multiple joints, and in turn, the only way to create single joint movement is by applying torques at multiple joints. We investigated whether the nervous system accounts for intersegmental limb dynamics across the shoulder, elbow, and wrist joints during self-initiated planar reaching and when countering external mechanical perturbations. Our first experiment tested whether the timing and amplitude of shoulder muscle activity account for interaction torques produced during single-joint elbow movements from different elbow initial orientations and over a range of movement speeds. We found that shoulder muscle activity reliably preceded movement onset and elbow agonist activity, and was scaled to compensate for the magnitude of interaction torques arising because of forearm rotation. Our second experiment tested whether elbow muscles compensate for interaction torques introduced by single-joint wrist movements. We found that elbow muscle activity preceded movement onset and wrist agonist muscle activity, and thus the nervous system predicted interaction torques arising because of hand rotation. Our third and fourth experiments tested whether shoulder muscles compensate for interaction torques introduced by different hand orientations during self-initiated elbow movements and to counter mechanical perturbations that caused pure elbow motion. We found that the nervous system predicted the amplitude and direction of interaction torques, appropriately scaling the amplitude of shoulder muscle activity during self-initiated elbow movements and rapid feedback control. Taken together, our results demonstrate that the nervous system robustly accounts for intersegmental dynamics and that the process is similar across the proximal to distal musculature of the arm as well as between feedforward (i

Infants’ Early Visual Attention and Social Engagement as Developmental Precursors to Joint Attention

PubMed Central

Salley, Brenda; Sheinkopf, Stephen J.; Neal-Beevers, A. Rebecca; Tenenbaum, Elena J.; Miller-Loncar, Cynthia L.; Tronick, Ed; Lagasse, Linda L.; Shankaran, Seetha; Bada, Henrietta; Bauer, Charles; Whitaker, Toni; Hammond, Jane; Lester, Barry M.

2016-01-01

This study examined infants’ early visual attention (at 1 month of age) and social engagement (4 months) as predictors of their later joint attention (12 and 18 months). The sample (n=325), drawn from the Maternal Lifestyle Study, a longitudinal multicenter project conducted at four centers of the NICHD Neonatal Research Network, included high-risk (cocaine exposed) and matched non-cocaine exposed infants. Hierarchical regressions revealed that infants’ attention orienting at 1 month significantly predicted more frequent initiating joint attention at 12 (but not 18) months of age. Social engagement at 4 months predicted initiating joint attention at 18 months. Results provide the first empirical evidence for the role of visual attention and social engagement behaviors as developmental precursors for later joint attention outcome. PMID:27786527

Development, implementation and evaluation of a peer review of teaching (PRoT) initiative in nursing education.

PubMed

Mager, Diana R; Kazer, Meredith W; Conelius, Jaclyn; Shea, Joyce; Lippman, Doris T; Torosyan, Roben; Nantz, Kathryn

2014-06-03

For many years, an area of research in higher education has been emerging around the development and implementation of fair and effective peer evaluation programs. Recently, a new body of knowledge has developed regarding the development and implementation of fair and effective peer evaluation programs resulting in formative and summative evaluations. The purpose of this article is to describe the development, implementation, and evaluation of a peer review of teaching (PRoT) program for nursing faculty, initiated at one small comprehensive university in the northeastern United States. Pairs of nursing faculty evaluated each other's teaching, syllabi, and course materials after collaborating in a pre-evaluation conference to discuss goals of the classroom visit. Qualitative data gathered in post project focus groups revealed that faculty found their modified PRoT process to be a mutually beneficial experience that was more useful, flexible and collegial, and less stressful than their previous evaluation process.

Framework for Evaluating Educational Systemic Initiatives.

ERIC Educational Resources Information Center

Ikegulu, T. Nelson

This paper describes the implementation of the Holistic Systemic Evaluation (HSE), a component of an Education Systemic Initiative's strategic management. The HSE provides general guidance for the implementation and continual improvement of an Education Systemic Initiative Reform (ESIR). The implementation of the education system initiative plan:…

Rotational joint assembly for the prosthetic leg

NASA Technical Reports Server (NTRS)

Owens, L. J.; Jones, W. C. (Inventor)

1977-01-01

A rotational joint assembly for a prosthetic leg has been devised, which enables an artificial foot to rotate slightly when a person is walking, running or turning. The prosthetic leg includes upper and lower tubular members with the rotational joint assembly interposed between them. The assembly includes a restrainer mechanism which consists of a pivotably mounted paddle element. This device applies limiting force to control the rotation of the foot and also restores torque to return the foot back to its initial position.

Colonoscopy Quality: Metrics and Implementation

PubMed Central

Calderwood, Audrey H.; Jacobson, Brian C.

2013-01-01

Synopsis Colonoscopy is an excellent area for quality improvement 1 because it is high volume, has significant associated risk and expense, and there is evidence that variability in its performance affects outcomes. The best endpoint for validation of quality metrics in colonoscopy is colorectal cancer incidence and mortality, but because of feasibility issues, a more readily accessible metric is the adenoma detection rate (ADR). Fourteen quality metrics were proposed by the joint American Society of Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on “Quality Indicators for Colonoscopy” in 2006, which are described in further detail below. Use of electronic health records and quality-oriented registries will facilitate quality measurement and reporting. Unlike traditional clinical research, implementation of quality improvement initiatives involves rapid assessments and changes on an iterative basis, and can be done at the individual, group, or facility level. PMID:23931862

Joint Venture Health Plans May Give ACOs a Run for Their Money.

PubMed

Reinke, Thomas

2016-12-01

Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.

[Viscosity determination of synovial fluids from the canine hip and elbow joint as well as the human knee joint].

PubMed

Helms, Gabriele; Rittmann, Pia; Wefstaedt, Patrick; Windhagen, Henning; Pressel, Thomas; Behrens, Bernd-Arno; Nolte, Ingo

2008-01-01

The development of pathological changes in both human and canine hip joints is mainly caused by a lack of synovial fluid lubrication. This results in an increased joint abrasion. Even after implantation of joint prosthesis, inadequate lubrication can lead to abrasion in the tribological pair. This can finally result in aseptic loosening of the prosthesis. In spite of the enormous number of studies that have been performed on human, only little knowledge about the tribological properties of the joints in dogs is available in the literature. For this reason the viscosities of synovial fluid, derived from physiological and pathologically changed canine elbow joints were measured. The viscosities were determined by the use of a cone-plate viscometer at different temperatures and shear rates. The obtained values were compared with the viscosity values of pathologically changed synovial fluids from human knee joints as well as with pathological samples from the canine hip joint. The results show that the viscosity values vary within a series of measurements and are inversely proportional to the temperature of the sample and the shear rate. The differences between the average viscosities of canine and human synovial fluids taken from pathologically changed joints are below 4% (22.5 s(-1) at theta1 = 25 degrees C). The findings of this study are being implemented in a FE-Model for the computation of actual forces in the hip joint during different movements. This would represent a contribution to an improved prosthetic treatment of canine and human hips.

Implementing a C++ Version of the Joint Seismic-Geodetic Algorithm for Finite-Fault Detection and Slip Inversion for Earthquake Early Warning

NASA Astrophysics Data System (ADS)

Smith, D. E.; Felizardo, C.; Minson, S. E.; Boese, M.; Langbein, J. O.; Guillemot, C.; Murray, J. R.

2015-12-01

The earthquake early warning (EEW) systems in California and elsewhere can greatly benefit from algorithms that generate estimates of finite-fault parameters. These estimates could significantly improve real-time shaking calculations and yield important information for immediate disaster response. Minson et al. (2015) determined that combining FinDer's seismic-based algorithm (Böse et al., 2012) with BEFORES' geodetic-based algorithm (Minson et al., 2014) yields a more robust and informative joint solution than using either algorithm alone. FinDer examines the distribution of peak ground accelerations from seismic stations and determines the best finite-fault extent and strike from template matching. BEFORES employs a Bayesian framework to search for the best slip inversion over all possible fault geometries in terms of strike and dip. Using FinDer and BEFORES together generates estimates of finite-fault extent, strike, dip, preferred slip, and magnitude. To yield the quickest, most flexible, and open-source version of the joint algorithm, we translated BEFORES and FinDer from Matlab into C++. We are now developing a C++ Application Protocol Interface for these two algorithms to be connected to the seismic and geodetic data flowing from the EEW system. The interface that is being developed will also enable communication between the two algorithms to generate the joint solution of finite-fault parameters. Once this interface is developed and implemented, the next step will be to run test seismic and geodetic data through the system via the Earthworm module, Tank Player. This will allow us to examine algorithm performance on simulated data and past real events.

Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction.

PubMed

Lohrer, Heinz; Arentz, Sabine

2004-05-01

A case history of a 13-year-old female national top-level gymnast, suffering from calcaneocuboid joint instability, is presented. The procedure was done as an anatomic repair by capsular reefing, which was augmented using a local periosteal flap. Initially, the athlete twisted her ankle. Clinical investigation revealed no sign of a lateral ankle ligament injury, but following this initial examination, recurrent giving-way of the foot occurred. She additionally felt significant but diffuse pain on the lateral side of the foot during loading in training and competition. For 2 months she was unable to run and conservative treatment failed. Diagnosis of a calcaneocuboid instability was established 4 months after the initial lesion by clinical and x-ray stress examination of the calcaneocuboid joint. Open surgery was successfully performed. Early functional posttreatment was done and the patient returned to full high-level gymnastics ability 16 weeks after surgery. Two years later, a similar injury occurred to the opposite calcaneocuboid joint and the same operative procedure again led to full sports ability.

The Utah Educational Technology Initiative Year Two Evaluation: Program Implementation, Computer Acquisition and Placement, and Computer Use.

ERIC Educational Resources Information Center

Mergendoller, John R.; And Others

This evaluation report describes program implementation, computer acquisition and placement, and computer use during the second year (1991-92) of the Utah Educational Technology Initiative (ETI). In addition, it discusses the various ways computers are used in Utah schools and reports the opinions and experiences of ETI coordinators in the 12…

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

PubMed

Keurhorst, M; Anderson, P; Heinen, M; Bendtsen, Preben; Baena, Begoña; Brzózka, Krzysztof; Colom, Joan; Deluca, Paolo; Drummond, Colin; Kaner, Eileen; Kłoda, Karolina; Mierzecki, Artur; Newbury-Birch, Dorothy; Okulicz-Kozaryn, Katarzyna; Palacio-Vieira, Jorge; Parkinson, Kathryn; Reynolds, Jillian; Ronda, Gaby; Segura, Lidia; Słodownik, Luiza; Spak, Fredrik; van Steenkiste, Ben; Wallace, Paul; Wolstenholme, Amy; Wojnar, Marcin; Gual, Antoni; Laurant, M; Wensing, M

2016-07-16

Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ClinicalTrials.gov: NCT01501552.

Fractal Analysis of Rock Joint Profiles

NASA Astrophysics Data System (ADS)

Audy, Ondřej; Ficker, Tomáš

2017-10-01

Surface reliefs of rock joints are analyzed in geotechnics when shear strength of rocky slopes is estimated. The rock joint profiles actually are self-affine fractal curves and computations of their fractal dimensions require special methods. Many papers devoted to the fractal properties of these profiles were published in the past but only a few of those papers employed a convenient computational method that would have guaranteed a sound value of that dimension. As a consequence, anomalously low dimensions were presented. This contribution deals with two computational modifications that lead to sound fractal dimensions of the self-affine rock joint profiles. These are the modified box-counting method and the modified yard-stick method sometimes called the compass method. Both these methods are frequently applied to self-similar fractal curves but the self-affine profile curves due to their self-affine nature require modified computational procedures implemented in computer programs.

Impact of mechanical heterogeneity on joint density in a welded ignimbrite

NASA Astrophysics Data System (ADS)

Soden, A. M.; Lunn, R. J.; Shipton, Z. K.

2016-08-01

Joints are conduits for groundwater, hydrocarbons and hydrothermal fluids. Robust fluid flow models rely on accurate characterisation of joint networks, in particular joint density. It is generally assumed that the predominant factor controlling joint density in layered stratigraphy is the thickness of the mechanical layer where the joints occur. Mechanical heterogeneity within the layer is considered a lesser influence on joint formation. We analysed the frequency and distribution of joints within a single 12-m thick ignimbrite layer to identify the controls on joint geometry and distribution. The observed joint distribution is not related to the thickness of the ignimbrite layer. Rather, joint initiation, propagation and termination are controlled by the shape, spatial distribution and mechanical properties of fiamme, which are present within the ignimbrite. The observations and analysis presented here demonstrate that models of joint distribution, particularly in thicker layers, that do not fully account for mechanical heterogeneity are likely to underestimate joint density, the spatial variability of joint distribution and the complex joint geometries that result. Consequently, we recommend that characterisation of a layer's compositional and material properties improves predictions of subsurface joint density in rock layers that are mechanically heterogeneous.

Infant Joint Attention, Temperament, and Social Competence in Preschool Children

ERIC Educational Resources Information Center

Vaughan Van Hecke, Amy; Mundy, Peter C.; Acra, C. Francoise.; Block, Jessica J.; Delgado, Christine E. F.; Parlade, Meaghan V.; Meyer, Jessica A.; Neal, A. Rebecca; Pomares, Yuly B.

2007-01-01

Infant joint attention has been observed to be related to social-emotional outcomes in at-risk children. To address whether this relation is also evident in typically developing children, 52 children were tested at 12, 15, 24, and 30 months to examine associations between infant joint attention and social outcomes. Twelve-month initiating and…

Are the Kinematics of the Knee Joint Altered during the Loading Response Phase of Gait in Individuals with Concurrent Knee Osteoarthritis and Complaints of Joint Instability? A Dynamic Stereo X-ray Study

PubMed Central

Farrokhi, Shawn; Tashman, Scott; Gil, Alexandra B.; Klatt, Brian A.; Fitzgerald, G. Kelley

2011-01-01

Background Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional declines in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear. Methods Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait. Findings Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P < 0.01), while the total abduction/adduction range of motion was increased (P < 0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P < 0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait. Interpretations The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics. PMID:22071429

Technology Self-Efficacy Beliefs of Ninth-Grade Students after One Year of One-to-One Initiative Implementation

ERIC Educational Resources Information Center

McGee, Adrianne Nicole

2015-01-01

This dissertation was designed to gather data regarding the self-efficacy beliefs of ninth graders after experiencing the one-to-one technology initiative for 1 school year. The goal was to obtain information based on the experiences of the students in order to enlighten leaders of other schools and districts when implementing their own technology…

Creating Workforce Development Systems That Work: An Evaluation of the Initial One-Stop Implementation Experience. Final Report.

ERIC Educational Resources Information Center

Kogan, Deborah; Dickinson, Katherine P.; Fedrau, Ruth; Midling, Michael J.; Wolff, Kristin E.

This report analyzes progress states and local sites have made in implementing the One-Stop Career Center systems. An executive summary is followed by Section A, Introduction, which provides an overview of the One-Stop initiative and describes evaluation objectives and methods. The main portion of the report is organized into three major sections.…

All joint moments significantly contribute to trunk angular acceleration

PubMed Central

Nott, Cameron R.; Zajac, Felix E.; Neptune, Richard R.; Kautz, Steven A.

2010-01-01

Computationally advanced biomechanical analyses of gait demonstrate the often counter intuitive roles of joint moments on various aspects of gait such as propulsion, swing initiation, and balance. Each joint moment can produce linear and angular acceleration of all body segments (including those on which the moment does not directly act) due to the dynamic coupling inherent in the interconnected musculoskeletal system. This study presents the quantitative relationships between individual joint moments and trunk control with respect to balance during gait to show that the ankle, knee, and hip joint moments all affect the angular acceleration of the trunk. We show that trunk angular acceleration is affected by all the joints in the leg with varying degrees of dependence during the gait cycle. Furthermore, it is shown that inter-planar coupling exists and a two dimensional analysis of trunk balance neglects important out-of-plane joint moments that affect trunk angular acceleration. PMID:20646711

Strategies to Build Readiness in Community Mobilization Efforts for Implementation in a Multi-Year Teen Pregnancy Prevention Initiative.

PubMed

Bhuiya, Nazmim; House, L Duane; Desmarais, Jeffrey; Fletcher, Erica; Conlin, Maeve; Perez-McAdoo, Sarah; Waggett, Jessica; Tendulkar, Shalini A

2017-03-01

This paper describes an assessment of community readiness to implement a community-wide teen pregnancy prevention initiative, Youth First, and presents strategies used to enhance this readiness as informed by the assessment. Twenty-five community stakeholder interviews were conducted to assess four domains of readiness: (1) attitudes, perception, and knowledge of teen pregnancy; (2) perceived level of readiness; (3) resources, existing and current efforts; and (4) leadership. Interview transcripts were coded and analyzed to identify key themes. Stakeholders acknowledged teen pregnancy as an issue but lacked contextual information. They also perceived the community as ready to address the issue and recognized some organizations already championing efforts. However, many key players were not involved, and ongoing data collection to assess teen pregnancy and prevention efforts was limited. Though many stakeholders were ready to engage in teen pregnancy prevention efforts, they required additional information and training to appropriately address the issue. In response to the assessment findings, several strategies were applied to address readiness and build Youth First partners' capacity to implement the community-wide initiative. Thus, to successfully implement community-wide prevention efforts, it is valuable to assess the level of community readiness to address health issues. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Implementation of Title I and Title II-A Program Initiatives: Results from 2013-14. NCEE 2017-4014

ERIC Educational Resources Information Center

Troppe, Patricia; Milanowski, Anthony T.; Heid, Camilla; Gill, Brian; Ross, Christine

2017-01-01

This report describes the implementation of policies and initiatives supported by Title I and Title II-A of the federal Elementary and Secondary Education Act (ESEA) during the 2013-14 school year. Title I is one of the U.S. Department of Education's largest programs, accounting for $15 billion in the 2016 federal budget. Historically, Title I has…

Structural factors of jointed plain concrete pavements : SPS-2--initial evaluation and analysis

DOT National Transportation Integrated Search

2005-04-01

The SPS-2 experiment, "Strategic Study of Structural Factors for Jointed Plain Concrete Pavements (JPCP)," is one of the key components of the Long Term Pavement Performance (LTPP) program. The main objective of this experiment is to determine the re...

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these

How joint torques affect hamstring injury risk in sprinting swing-stance transition.

PubMed

Sun, Yuliang; Wei, Shutao; Zhong, Yunjian; Fu, Weijie; Li, Li; Liu, Yu

2015-02-01

The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases.

Evaluation of joint sealant materials : final report.

DOT National Transportation Integrated Search

1977-05-01

In May, 1968, the Department's Research and Development Section initiated a project to evaluate joint sealants being marketed for use on roads and bridges. In the study, representatives of 31 companies installed 40 products primarily on one road and ...

A nondestructive, reproducible method of measuring joint reaction force at the distal radioulnar joint.

PubMed

Canham, Colin D; Schreck, Michael J; Maqsoodi, Noorullah; Doolittle, Madison; Olles, Mark; Elfar, John C

2015-06-01

To develop a nondestructive method of measuring distal radioulnar joint (DRUJ) joint reaction force (JRF) that preserves all periarticular soft tissues and more accurately reflects in vivo conditions. Eight fresh-frozen human cadaveric limbs were obtained. A threaded Steinmann pin was placed in the middle of the lateral side of the distal radius transverse to the DRUJ. A second pin was placed into the middle of the medial side of the distal ulna colinear to the distal radial pin. Specimens were mounted onto a tensile testing machine using a custom fixture. A uniaxial distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Force-displacement curves were generated and a best-fit polynomial was solved to determine JRF. All force-displacement curves demonstrated an initial high slope where relatively large forces were required to distract the joint. This ended with an inflection point followed by a linear area with a low slope, where small increases in force generated larger amounts of distraction. Each sample was measured 3 times and there was high reproducibility between repeated measurements. The average baseline DRUJ JRF was 7.5 N (n = 8). This study describes a reproducible method of measuring DRUJ reaction forces that preserves all periarticular stabilizing structures. This technique of JRF measurement may also be suited for applications in the small joints of the wrist and hand. Changes in JRF can alter native joint mechanics and lead to pathology. Reliable methods of measuring these forces are important for determining how pathology and surgical interventions affect joint biomechanics. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Are the kinematics of the knee joint altered during the loading response phase of gait in individuals with concurrent knee osteoarthritis and complaints of joint instability? A dynamic stereo X-ray study.

PubMed

Farrokhi, Shawn; Tashman, Scott; Gil, Alexandra B; Klatt, Brian A; Fitzgerald, G Kelley

2012-05-01

Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional decline in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear. Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait. Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P<0.01), while the total abduction/adduction range of motion was increased (P<0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P<0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait. The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics. Copyright © 2011 Elsevier Ltd. All rights reserved.

Joint venture schemes in Limpopo Province and their outcomes on smallholder farmers livelihoods

NASA Astrophysics Data System (ADS)

Mapedza, Everisto; van Koppen, Barbara; Sithole, Pinimidzai; Bourblanc, Magalie

2016-04-01

Joint Venture schemes based on the floppy irrigation technology are being promoted in the post-Apartheid South Africa's Limpopo Province. Access to land and water resources in South Africa are largely viewed as a mechanism for re-dressing the Apartheid injustices. This research was part of a broader applied research to help inform irrigation practise in the Limpopo Province. The research used literature review, key informant interviews and a questionnaire survey. The overall research question sought to understand how the Joint Venture Schemes had benefited the smallholder farmers. This paper argues that the joint venture partnership created a new injustice. Firstly, the Joint Venture Scheme design is fundamentally a bad idea which disempower farmers not only to water access but also land as well. The choice of the 'efficient' floppy irrigation technology was made by the state and entailed that land had to be managed as a single unit. In order to make more effective use of this highly sophisticated new technology, the smallholder farmers also needed to go into a joint venture partnership with a white commercial farmer. By virtue of signing the Joint Venture agreement the farmers were also forfeiting their land and water rights to be used for crop production. The smallholder farmers lost access to their water and land resources and were largely relegated to sharing profits - when they exist - with hardly any skills development despite what was initially envisaged in the Joint Venture partnership. Secondly, the implementation of the JVS has been skewed from the start which explains the bad results. This paper further shows how the negative outcomes affected women in particular. As the smallholder farmers argue the technological options chosen by the state have excluded both male and female farmers from accessing and utilising their land and water resources in order to improve their livelihoods; it has entrenched the role of the state and the private interests at the

Initial implementation and evaluation of a Hepatitis C treatment clinical decision support system (CDSS)

PubMed Central

Fathauer, L; Meek, J.

2012-01-01

Background Clinician compliance with clinical guidelines in the treatment of patients with Hepatitis C (HCV) has been reported to be as low as 18.5%. Treatment is complex and patient compliance is often inconsistent thus, active clinician surveillance and support is essential to successful outcomes. A clinical decision support system (CDSS) embedded within an electronic health record can provide reminders, summarize key data, and facilitate coordination of care. To date, the literature is bereft of information describing the implementation and evaluation of a CDSS to support HCV treatment. Objective The purpose of this case report is to describe the design, implementation, and initial evaluation of an HCV-specific CDSS while piloting data collection metrics and methods to be used in a larger study across multiple practices. Methods The case report describes the design and implementation processes with preliminary reporting on impact of the CDSS on quality indicator completion by comparing the pre-CDSS group to the post-CDSS group. Results The CDSS was successfully designed and implemented using an iterative, collaborative process. Pilot testing of the clinical outcomes of the CDSS revealed high rates of quality indicator completion in both the pre- and post-CDSS; although the post-CDSS group received a higher frequency of reminders (4.25 per patient) than the pre-CDSS group (.25 per patient). Conclusions This case report documents the processes used to successfully design and implement an HCV CDSS. While the small sample size precludes generalizability of findings, results did positively demonstrate the feasibility of comparing quality indicator completion rates pre-CDSS and post-CDSS. It is recommended that future studies include a larger sample size across multiple providers with expanded outcomes measures related to patient outcomes, staff satisfaction with the CDSS, and time studies to evaluate efficiency and cost effectiveness of the CDSS. PMID:23646082

Analysis and optimization of the active rigidity joint

NASA Astrophysics Data System (ADS)

Manzo, Justin; Garcia, Ephrahim

2009-12-01

The active rigidity joint is a composite mechanism using shape memory alloy and shape memory polymer to create a passively rigid joint with thermally activated deflection. A new model for the active rigidity joint relaxes constraints of earlier methods and allows for more accurate deflection predictions compared to finite element results. Using an iterative process to determine the strain distribution and deflection, the method demonstrates accurate results for both surface bonded and embedded actuators with and without external loading. Deflection capabilities are explored through simulated annealing heuristic optimization using a variety of cost functions to explore actuator performance. A family of responses presents actuator characteristics in terms of load bearing and deflection capabilities given material and thermal constraints. Optimization greatly expands the available workspace of the active rigidity joint from the initial configuration, demonstrating specific work capabilities comparable to those of muscle tissue.

European Initiatives in Postgraduate Education in Gerontology

ERIC Educational Resources Information Center

van Rijsselt, Rene J. T.; Parkatti, Terttu; Troisi, Joseph

2007-01-01

This paper describes three innovative European initiatives in postgraduate education in gerontology. The first is the European Masters Program in Gerontology (EuMaG), developed as an interdisciplinary joint program, supported and delivered by 22 European universities. Second, the Nordplus initiative to increase mobility of students and staff in…

Joint Attention Enhances Visual Working Memory

ERIC Educational Resources Information Center

Gregory, Samantha E. A.; Jackson, Margaret C.

2017-01-01

Joint attention--the mutual focus of 2 individuals on an item--speeds detection and discrimination of target information. However, what happens to that information beyond the initial perceptual episode? To fully comprehend and engage with our immediate environment also requires working memory (WM), which integrates information from second to…

7 CFR 3405.7 - Joint project proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE HIGHER EDUCATION CHALLENGE GRANTS PROGRAM Program... strengthening higher education in the food and agricultural sciences. The goals of such joint initiatives should...

Decentralized control of large flexible structures by joint decoupling

NASA Technical Reports Server (NTRS)

Su, Tzu-Jeng; Juang, Jer-Nan

1994-01-01

This paper presents a novel method to design decentralized controllers for large complex flexible structures by using the idea of joint decoupling. Decoupling of joint degrees of freedom from the interior degrees of freedom is achieved by setting the joint actuator commands to cancel the internal forces exerting on the joint degrees of freedom. By doing so, the interactions between substructures are eliminated. The global structure control design problem is then decomposed into several substructure control design problems. Control commands for interior actuators are set to be localized state feedback using decentralized observers for state estimation. The proposed decentralized controllers can operate successfully at the individual substructure level as well as at the global structure level. Not only control design but also control implementation is decentralized. A two-component mass-spring-damper system is used as an example to demonstrate the proposed method.

Effects of footwear on lead limb knee and ankle joint kinematics in a fast bowler with a history of posterior ankle joint impingement-a case report.

PubMed

Bishop, Chris; Bartold, Simon; Thewlis, Dominic

2013-11-01

This case study reports the kinematic effect of 2 different cricket shoes on a fast bowler who reports a history of posterior ankle joint impingement. The participant bowled 6 trials in 2 pairs of cricket shoes. The 3-dimensional kinematics of the joints of the front leg was quantified during stance phase of the delivery stride. Wearing the high-cut shoe resulted in the ankle being 7.7-degree angle more plantarflexed at initial contact compared with the low-cut shoe. Again, when wearing the high-cut shoe compared with the low-cut shoe, the ankle joint was 15.5-degree angle more adducted and the knee was 4.1-degree angle less externally rotated at initial contact. This case study identifies the bowler's preferred shoe (high-cut shoe) as a potential contributing factor to the symptoms he was experiencing.

Bridging the Technology Valley of Death in Joint Medical Development

DTIC Science & Technology

2015-11-01

Force lieutenant colonel, is the Air Force Medical Support Agency Advanced Development Liaison Field Engineer in Falls Church, Virginia. Prusaczyk is...Awareness, communication and coordination may be mini - mal among Service S&T and AD programs. Joint Transition Planning Process A Joint Transition...Human Proof of Phase III NDA/BLA ling Approval, Launch Concept*** Launch Review Program Initiation Materiel Technology Engineering & Production

A Longitudinal Analysis of Joint Attention and Language Development in Young Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Tek, Saime

2010-01-01

Joint attention (JA), which occurs when two individuals focus on the same object or event, plays a critical role in social and language development. Two major kinds of joint attention have been observed: response to joint attention (RJA), in which children follow the attentional focus of their social partners, and initiation of joint attention…

Development and modeling of a more efficient frangible separation joint

NASA Astrophysics Data System (ADS)

Renfro, Steven L.; Harris, Gary N.; Olson, Steven L.

1993-06-01

A low-cost, robust, and contamination-free separation system for spacecraft or launch vehicle stage and fairing separation was developed, which includes a frangible joint to sever an aluminum extrusion and to control contamination. The installed joint uses a sealing manifold to provide redundant initiation transfer between Flexible Confined Detonating Cord assemblies and HNS-IA loaded cups on the ends of the HNS-IIA Mild Detonating Fuse. A shock matching model of the system was developed, and the margin of joint severance, contamination control of the system, and correlation of the model are demonstrated.

Brazilian obesity prevention and control initiatives.

PubMed

Jaime, P C; da Silva, A C F; Gentil, P C; Claro, R M; Monteiro, C A

2013-11-01

Obesity prevalence in the Brazilian adult population is 12.5% among men and 16.9% among women. Obesity control has been a subject of concern in Brazilian health policies since the publication of the National Food and Nutrition Policy in 1999. The initiatives include a comprehensive national intersectorial plan for obesity prevention and control focused on confronting its social and environmental causes, development of a food and nutrition education framework aimed at intersectorial public policies in the food and nutritional security field, promotion and provision of healthy food in school environments (linked to family farming), structuring nutrition actions in primary healthcare in the national healthcare system, promoting community physical activity, food regulation and control, and encouragement of public participation and food control. We conclude that several initiatives have been developed in Brazil to deal with the challenge of implementing an intergovernmental, intersectorial response to reverse the rising overweight and obesity rates. The success of this response will depend on a governance model that promotes joint and integrated action by different sectors and active participation of society to consolidate the actions, places and laws that protect health and promote healthy lifestyles. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Demonstration of movement in the sacroiliac joint using ultrasound

NASA Astrophysics Data System (ADS)

Krupinski, Elizabeth A.; Brooks, William J.; Lund, Pamela J.

1995-05-01

The goal of this study was to demonstrate quantitatively, using ultrasound (US) recording techniques, the extent of motion of the sacroiliac joint achieved using manual medicine techniques. Initial judgements of perceived (i.e., felt) SI mobility during manual examination were made on 22 subjects. Baseline no movement ultrasound images (static) were obtained of the left and right SI joints at two levels-- posterior-superior-iliac-spine and inferior (PSIS, INF)--and two projections (AP and LAT). Manual medicine spring testing of the SI joint was then performed while ultrasound recordings (on video) were made. The differences between baseline separation of the SI joint and displacement distance during spring testing were measured by six radiologists who typically read US images. Significant movement of at least one SI joint was demonstrated in 91% of the subjects using ultrasound recordings. The extent of movement appeared to corroborate the experience of manual medicine practitioners.

Bird Habitat Conservation at Various Scales in the Atlantic Coast Joint Venture

Treesearch

Andrew Milliken; Craig Watson; Chuck Hayes

2005-01-01

The Atlantic Coast Joint Venture is a partnership focused on the conservation of habitats for migratory birds within the Atlantic Flyway/Atlantic Coast Region from Maine south to Puerto Rico. In order to be effective in planning and implementing conservation in this large and diverse area, the joint venture must work at multiple spatial scales, from the largest ?...

Synergistic Approach Integrating Joint Capabilities for USSOCOM Contingency Contracting: Construction Management Module

DTIC Science & Technology

2010-12-01

59 a. The Joint Uniform Lessons Learned System (JULLS) .........59 b. Acquisition Community Connection (ACC) ..........................59 c...Report ACC Acquisition Community Connection ADDIE Analyze, Design, Develop, Implement, Evaluate AFFARS Air Force Federal Acquisition Regulation...Operations J4 Logistics J5 Plans J6 Communications J8 Programming and Comptroller J&A Justification and Approval JARB Joint Acquisition

Effects of Joint Attention Mediated Learning for Toddlers with Autism Spectrum Disorders: An Initial Randomized Controlled Study

ERIC Educational Resources Information Center

Schertz, Hannah H.; Odom, Samuel L.; Baggett, Kathleen M.; Sideris, John H.

2013-01-01

The purpose of this study was to determine effects of the Joint Attention Mediated Learning (JAML) intervention on acquisition of joint attention and other early social communication competencies for toddlers with autism spectrum disorders (ASD). Twenty-three parents and their toddlers were randomly assigned to JAML or a control condition.…

Intelligent Vehicle Initiative: Business Plan

DOT National Transportation Integrated Search

1997-11-01

The U.S. Department of Transportation (USDOT) is embarking on a new program called the Intelligent Vehicle Initiative (IVI). The USDOT intends to jointly define the program plan and conduct the IVI in cooperation with the motor vehicle, trucking, and...

Implementing a patient-initiated review system for people with rheumatoid arthritis: a prospective, comparative service evaluation.

PubMed

Goodwin, Victoria A; Paudyal, Priyamvada; Perry, Mark G; Day, Nikki; Hawton, Annie; Gericke, Christian; Ukoumunne, Obioha C; Byng, Richard

2016-06-01

The management of rheumatoid arthritis (RA) usually entails regular hospital reviews with a specialist often when the patient is well rather than during a period of exacerbation. An alternative approach where patients initiate appointments when they need them can improve patient satisfaction and resource use whilst being safe. This service evaluation reports a system-wide implementation of a patient-initiated review appointment system called Direct Access (DA) for people with RA. The aim was to establish the impact on patient satisfaction of the new system versus usual care as well as evaluate the implementation processes. As all patients could not start on the new system at once, in order to manage the implementation, patients were randomly allocated to DA or to usual care. Instead of regular follow-up appointments, DA comprised an education session and access to a nurse-led telephone advice line where appointments could be accessed within two weeks. Usual care comprised routine follow-ups with the specialist. Data were collected on patient satisfaction, service use and outcomes of any contact to the advice line. Three hundred and eleven patients with RA were assessed as being suitable for DA. In terms of patient satisfaction, between-group differences were found in favour of DA for accessibility and convenience, ease of contacting the nurse and overall satisfaction with the service. Self-reported visits to the general practitioner were also significantly lower. DA resulted in a greater number of telephone contacts (incidence rate ratio = 1.69; 95% confidence interval 1.07 to 2.68). Hospital costs of the two different service models were similar. Mean waiting time for an appointment was 10.8 days This service evaluation found that DA could be implemented and it demonstrated patient benefit in a real-world setting. Further research establishing the broader cost-consequences across the whole patient pathway would add to our findings. © 2016 John Wiley & Sons

Establishment of joint attention in dyads involving hearing mothers of deaf and hearing children, and its relation to adaptive social behavior.

PubMed

Nowakowski, Matilda E; Tasker, Susan L; Schmidt, Louis A

2009-01-01

Mounting evidence points to joint attention as a mediating variable in children's adaptive behavior development. Joint attention in interactions between hearing mothers and congenitally deaf (n = 27) and hearing (n = 29) children, ages 18-36 months, was examined. All deaf children had severe to profound hearing loss. Mother-child interactions were coded for maternally initiated and child-initiated success rates in establishing joint attention; mothers completed ratings of their children's adaptive behavior. Hearing mother-deaf child dyads had significantly lower maternally initiated success rates. No significant between-group differences on child-initiated success rates were shown. Maternal ratings of adaptive behavior were significantly lower for deaf children, and related positively and significantly to both child-initiated and maternally initiated success rates. The findings suggest that mother-child interactions that are low in successful establishment of joint attention might mediate the development of socioemotional problems evident in deaf children with hearing families.

Test and Analysis Correlation for a Y-Joint Specimen for a Composite Cryotank

NASA Technical Reports Server (NTRS)

Mason, Brian H.; Sleight, David W.; Grenoble, Ray

2015-01-01

The Composite Cryotank Technology Demonstration (CCTD) project under NASA's Game Changing Development Program (GCDP) developed space technologies using advanced composite materials. Under CCTD, NASA funded the Boeing Company to design and test a number of element-level joint specimens as a precursor to a 2.4-m diameter composite cryotank. Preliminary analyses indicated that the y-joint in the cryotank had low margins of safety; hence the y-joint was considered to be a critical design region. The y-joint design includes a softening strip wedge to reduce localized shear stresses at the skirt/dome interface. In this paper, NASA-developed analytical models will be correlated with the experimental results of a series of positive-peel y-joint specimens from Boeing tests. Initial analytical models over-predicted the experimental strain gage readings in the far-field region by approximately 10%. The over-prediction was attributed to uncertainty in the elastic properties of the laminate and a mismatch between the thermal expansion of the strain gages and the laminate. The elastic properties of the analytical model were adjusted to account for the strain gage differences. The experimental strain gages also indicated a large non-linear effect in the softening strip region that was not predicted by the analytical model. This non-linear effect was attributed to delamination initiating in the softening strip region at below 20% of the failure load for the specimen. Because the specimen was contained in a thermally insulated box during cryogenic testing to failure, delamination initiation and progression was not visualized during the test. Several possible failure initiation locations were investigated, and a most likely failure scenario was determined that correlated well with the experimental data. The most likely failure scenario corresponded to damage initiating in the softening strip and delamination extending to the grips at final failure.

Effect of the Grain Size of the Initial Structure of 1565chM Alloy on the Structure and Properties of the Joints Fabricated by Friction Stir Welding

NASA Astrophysics Data System (ADS)

Ovchinnikov, V. V.; Drits, A. M.; Gureeva, M. A.; Malov, D. V.

2017-12-01

The effect of the initial grain size in the structure of the aluminum 1565chM alloy on the mechanical properties of the welded joints formed by friction stir welding and on the grain size in the weld core is studied. It is shown that the design of tool and, especially, the parameters of a screw groove exert a great effect on the grain size in the weld core.

Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty.

PubMed

Sporer, Scott M; Rogers, Thea; Abella, Linda

2016-09-01

Deep infection after elective total joint arthroplasty remains a devastating complication. Preoperative nasal swab screening for Staphylococcus aureus colonization and subsequent treatment of colonized patients is one proposed method to identify at-risk patients and decrease surgical site infections (SSIs). The purpose of this study was to determine whether a preoperative staphylococcus screening and treatment program would decrease the incidence of SSI in elective joint arthroplasty patients. Since January 2009, a total of 9690 patients having an elective joint arthroplasty were screened before surgery for Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) with nares swabs. All patients with positive nare colonization for MSSA and MRSA were treated with mupirocin and chlorhexidine gluconate showers for 5 days before surgery. MRSA patients received vancomycin preoperatively and were placed in contact isolation. All elective arthroplasty patients used chlorhexidine gluconate antiseptic cloths the evening prior and the day of surgery. Perioperative infection rates were compared from 1 year before implementation to 5 years after implementation of this screening protocol. SSI rates have decreased from 1.11% (prescreening) to 0.34% (nasal screening; P < .05) after initiation of the process. Staphylococcus was identified in 66.7% of the SSI infections before nasal screening and in 33.3% of the SSI after routine screening (P > .05). The addition of MRSA and/or MSSA nares screening along with a perioperative decolonization protocol has resulted in a decreased SSI rate by 69%. Copyright © 2016 Elsevier Inc. All rights reserved.

Joint Force Quarterly. Issue 48, 1st Quarter 2008

DTIC Science & Technology

2008-01-01

Closure and joint basing initiatives. n Engage in the development of a broad- based, flexible, effective , and affordable joint military health care system...in a London hospital in November 2006 due to ingested alpha particles from Polonium 210 . Just the trace trail of Polonium 210 across the city and...can we adequately defend the Nation. Therefore, we will: n Determine the true health of our ground forces in terms of people, training, equipment

Thermal Barriers Developed for Solid Rocket Motor Nozzle Joints

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Dunlap, Patrick H., Jr.

2000-01-01

Space shuttle solid rocket motor case assembly joints are sealed with conventional O-ring seals that are shielded from 5500 F combustion gases by thick layers of insulation and by special joint-fill compounds that fill assembly splitlines in the insulation. On a number of occasions, NASA has observed hot gas penetration through defects in the joint-fill compound of several of the rocket nozzle assembly joints. In the current nozzle-to-case joint, NASA has observed penetration of hot combustion gases through the joint-fill compound to the inboard wiper O-ring in one out of seven motors. Although this condition does not threaten motor safety, evidence of hot gas penetration to the wiper O-ring results in extensive reviews before resuming flight. The solid rocket motor manufacturer (Thiokol) approached the NASA Glenn Research Center at Lewis Field about the possibility of applying Glenn's braided fiber preform seal as a thermal barrier to protect the O-ring seals. Glenn and Thiokol are working to improve the nozzle-to-case joint design by implementing a more reliable J-leg design and by using a braided carbon fiber thermal barrier that would resist any hot gases that the J-leg does not block.

Modeling Anisotropic Elastic Wave Propagation in Jointed Rock Masses

NASA Astrophysics Data System (ADS)

Hurley, R.; Vorobiev, O.; Ezzedine, S. M.; Antoun, T.

2016-12-01

We present a numerical approach for determining the anisotropic stiffness of materials with nonlinearly-compliant joints capable of sliding. The proposed method extends existing ones for upscaling the behavior of a medium with open cracks and inclusions to cases relevant to natural fractured and jointed rocks, where nonlinearly-compliant joints can undergo plastic slip. The method deviates from existing techniques by incorporating the friction and closure states of the joints, and recovers an anisotropic elastic form in the small-strain limit when joints are not sliding. We present the mathematical formulation of our method and use Representative Volume Element (RVE) simulations to evaluate its accuracy for joint sets with varying complexity. We then apply the formulation to determine anisotropic elastic constants of jointed granite found at the Nevada Nuclear Security Site (NNSS) where the Source Physics Experiments (SPE), a campaign of underground chemical explosions, are performed. Finally, we discuss the implementation of our numerical approach in a massively parallel Lagrangian code Geodyn-L and its use for studying wave propagation from underground explosions. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

Multidisciplinary approach for in-deep assessment of joint prosthesis failure.

PubMed

Tessarolo, F; Caola, I; Piccoli, F; Dorigotti, P; Demattè, E; Molinari, M; Malavolta, M; Barbareschi, M; Caciagli, P; Nollo, G

2009-01-01

In spite of advancement in biomaterials and biomechanics, in development of new osteo-integrative materials and coatings, and in macro- micro- component design, a non negligible fraction of the implanted prosthesis fails before the expected lifetime. A prospective observational clinical study has been conducted to define and apply a set of experimental techniques to in-deep assess the failure of joint prosthesis. Microbiological, histological and micro-structural techniques were implemented to specifically address phenomena occurring at the tissue-implant interface. Results obtained from 27 cases of prosthetic joint failure are discussed in terms of sensitivity and specificity. A procedural flow-chart is finally proposed for the assessment of joint prosthesis failure.

Evaluation of an implementation initiative for embedding Dialectical Behavior Therapy in community settings.

PubMed

Herschell, Amy D; Lindhiem, Oliver J; Kogan, Jane N; Celedonia, Karen L; Stein, Bradley D

2014-04-01

We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a 2-year period from front-line mental health therapists (N=64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes toward consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training was associated with positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes toward individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Joint Bayesian Component Separation and CMB Power Spectrum Estimation

NASA Technical Reports Server (NTRS)

Eriksen, H. K.; Jewell, J. B.; Dickinson, C.; Banday, A. J.; Gorski, K. M.; Lawrence, C. R.

2008-01-01

We describe and implement an exact, flexible, and computationally efficient algorithm for joint component separation and CMB power spectrum estimation, building on a Gibbs sampling framework. Two essential new features are (1) conditional sampling of foreground spectral parameters and (2) joint sampling of all amplitude-type degrees of freedom (e.g., CMB, foreground pixel amplitudes, and global template amplitudes) given spectral parameters. Given a parametric model of the foreground signals, we estimate efficiently and accurately the exact joint foreground- CMB posterior distribution and, therefore, all marginal distributions such as the CMB power spectrum or foreground spectral index posteriors. The main limitation of the current implementation is the requirement of identical beam responses at all frequencies, which restricts the analysis to the lowest resolution of a given experiment. We outline a future generalization to multiresolution observations. To verify the method, we analyze simple models and compare the results to analytical predictions. We then analyze a realistic simulation with properties similar to the 3 yr WMAP data, downgraded to a common resolution of 3 deg FWHM. The results from the actual 3 yr WMAP temperature analysis are presented in a companion Letter.

How Joint Torques Affect Hamstring Injury Risk in Sprinting Swing–Stance Transition

PubMed Central

SUN, YULIANG; WEI, SHUTAO; ZHONG, YUNJIAN; FU, WEIJIE; LI, LI; LIU, YU

2015-01-01

ABSTRACT Purpose The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Methods Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. Results During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. Conclusions During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases. PMID:24911288

Joint remote control of an arbitrary single-qubit state by using a multiparticle entangled state as the quantum channel

NASA Astrophysics Data System (ADS)

Lv, Shu-Xin; Zhao, Zheng-Wei; Zhou, Ping

2018-01-01

We present a scheme for joint remote implementation of an arbitrary single-qubit operation following some ideas in one-way quantum computation. All the senders share the information of implemented quantum operation and perform corresponding single-qubit measurements according to their information of implemented operation. An arbitrary single-qubit operation can be implemented upon the remote receiver's quantum system if the receiver cooperates with all the senders. Moreover, we study the protocol of multiparty joint remote implementation of an arbitrary single-qubit operation with many senders by using a multiparticle entangled state as the quantum channel.

Multidisciplinary perspectives: Application of the Consolidated Framework for Implementation Research to evaluate a health coaching initiative.

PubMed

Brook, Judy; McGraw, Caroline

2018-05-01

Long-term conditions are a leading cause of mortality and morbidity. Their management is founded on a combination of approaches involving government policy, better integration between health and care systems, and individual responsibility for self-care. Health coaching has emerged as an approach to encouraging individual responsibility and enhancing the self-management of long-term conditions. This paper focuses on the evaluation of a workforce initiative in a diverse and socially deprived community. The initiative sought both to improve integration between health and care services for people with long-term conditions, and equip practitioners with health coaching skills. The aim of the study was to contribute an empirical understanding of what practitioners perceive to be the contextual factors that impact on the adoption of health coaching in community settings. These factors were conceptualised using the Consolidated Framework for Implementation Research (CFIR). A stratified purposive sample of 22 health and care practitioners took part in semi-structured telephone interviews. Data were analysed using the CFIR as an analytical framework. The perceptions of trainees mapped onto the major domains of the CFIR: characteristics of the intervention, outer setting, inner setting, characteristics of individuals involved and process of implementation. Individual patient expectations, comorbidities and social context were central to the extent to which practitioners and patients engaged with health coaching. Structural constraints within provider services and the wider NHS were also reported as discouraging initiatives that focused on long-term rewards rather than short-term wins. The authors recommend further research is undertaken both to understand the role of health coaching in disadvantaged communities and ensure the service user voice is heard. © 2018 John Wiley & Sons Ltd.

Three-dimensional reconstruction of rat knee joint using episcopic fluorescence image capture.

PubMed

Takaishi, R; Aoyama, T; Zhang, X; Higuchi, S; Yamada, S; Takakuwa, T

2014-10-01

Development of the knee joint was morphologically investigated, and the process of cavitation was analyzed by using episcopic fluorescence image capture (EFIC) to create spatial and temporal three-dimensional (3D) reconstructions. Knee joints of Wister rat embryos between embryonic day (E)14 and E20 were investigated. Samples were sectioned and visualized using an EFIC. Then, two-dimensional image stacks were reconstructed using OsiriX software, and 3D reconstructions were generated using Amira software. Cavitations of the knee joint were constructed from five divided portions. Cavity formation initiated at multiple sites at E17; among them, the femoropatellar cavity (FPC) was the first. Cavitations of the medial side preceded those of the lateral side. Each cavity connected at E20 when cavitations around the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were completed. Cavity formation initiated from six portions. In each portion, development proceeded asymmetrically. These results concerning anatomical development of the knee joint using EFIC contribute to a better understanding of the structural feature of the knee joint. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The Early Childhood Cluster Initiative of Palm Beach County, Florida. Early Implementation Study And Evaluability Assessment. Final Report. Chapin Hall Working Paper

ERIC Educational Resources Information Center

Spielberger, Julie; Goyette, Paul

2006-01-01

This publication reports findings from the first year of an implementation study of the Early Childhood Cluster Initiative (ECCI). ECCI is a prekindergarten program in ten elementary schools and a community child care center in Palm Beach County, based on the design of the High/Scope Perry Preschool model. The initiative is characterized by low…

Dataglove measurement of joint angles in sign language handshapes

PubMed Central

Eccarius, Petra; Bour, Rebecca; Scheidt, Robert A.

2012-01-01

In sign language research, we understand little about articulatory factors involved in shaping phonemic boundaries or the amount (and articulatory nature) of acceptable phonetic variation between handshapes. To date, there exists no comprehensive analysis of handshape based on the quantitative measurement of joint angles during sign production. The purpose of our work is to develop a methodology for collecting and visualizing quantitative handshape data in an attempt to better understand how handshapes are produced at a phonetic level. In this pursuit, we seek to quantify the flexion and abduction angles of the finger joints using a commercial data glove (CyberGlove; Immersion Inc.). We present calibration procedures used to convert raw glove signals into joint angles. We then implement those procedures and evaluate their ability to accurately predict joint angle. Finally, we provide examples of how our recording techniques might inform current research questions. PMID:23997644

Implementation of lung cancer CT screening in the Nordic countries.

PubMed

Pedersen, Jesper Holst; Sørensen, Jens Benn; Saghir, Zaigham; Fløtten, Øystein; Brustugun, Odd Terje; Ashraf, Haseem; Strand, Trond-Eirik; Friesland, Signe; Koyi, Hirsh; Ek, Lars; Nyrén, Sven; Bergman, Per; Jekunen, Antti; Nieminen, Eeva-Maija; Gudbjartsson, Tomas

2017-10-01

We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.

Development of Thermal Barriers For Solid Rocket Motor Nozzle Joints

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Dunlap, Patrick H., Jr.

2000-01-01

Joints in the Space Shuttle solid rocket motors are sealed by O-rings to contain combustion gases inside the rocket that reach pressures of up to 900 psi and temperatures of up to 5500 F. To provide protection for the O-rings, the motors are insulated with either phenolic or rubber insulation. Gaps in the joints leading up to the O-rings are filled with polysulfide joint-fill compounds as an additional level of protection. The current RSRM nozzle-to-case joint design incorporating primary, secondary, and wiper O-rings experiences gas paths through the joint-fill compound to the innermost wiper O-ring in about one out of every seven motors. Although this does not pose a safety hazard to the motor, it is an undesirable condition that NASA and rocket manufacturer Thiokol want to eliminate. Each nozzle-to-case joint gas path results in extensive reviews and evaluation before flights can be resumed. Thiokol and NASA Marshall are currently working to improve the nozzle-to-case joint design by implementing a more reliable J-leg design that has been used successfully in the field and igniter joint. They are also planning to incorporate the NASA Glenn braided carbon fiber thermal barrier into the joint. The thermal barrier would act as an additional level of protection for the O-rings and allow the elimination of the joint-fill compound from the joint.

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

Fayette County Better Buildings Initiative

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

Capella, Arthur

The Fayette County Better Buildings Initiative represented a comprehensive and collaborative approach to promoting and implementing energy efficiency improvements. The initiative was designed to focus on implementing energy efficiency improvements in residential units, while simultaneously supporting general marketing of the benefits of implementing energy efficiency measures. The ultimate goal of Fayette County’s Better Buildings Initiative was to implement a total of 1,067 residential energy efficiency retrofits with a minimum 15% estimated energy efficiency savings per unit. Program partners included: United States Department of Energy, Allegheny Power, and Private Industry Council of Westmoreland-Fayette, Fayette County Redevelopment Authority, and various local partners.more » The program was open to any Fayette County residents who own their home and meet the prequalifying conditions. The level of assistance offered depended upon household income and commitment to undergo a BPI – Certified Audit and implement energy efficiency measures, which aimed to result in at least a 15% reduction in energy usage. The initiative was designed to focus on implementing energy efficiency improvements in residential units, while simultaneously supporting general marketing of the benefits of implementing energy efficiency measures. Additionally, the program had components that involved recruitment and training for employment of persons in the energy sector (green jobs), as well as marketing and implementation of a commercial or community facilities component. The residential component of Fayette County’s Better Buildings Initiative involved a comprehensive approach, providing assistance to low- moderate- and market-rate homeowners. The initiative will also coordinate activities with local utility providers to further incentivize energy efficiency improvements among qualifying homeowners. The commercial component of Fayette County’s Better Building Initiative involved

Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives.

PubMed

Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L

2014-01-01

Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Health information technology: initial set of standards, implementation specifications, and certification criteria for electronic health record technology. Interim final rule.

PubMed

2010-01-13

The Department of Health and Human Services (HHS) is issuing this interim final rule with a request for comments to adopt an initial set of standards, implementation specifications, and certification criteria, as required by section 3004(b)(1) of the Public Health Service Act. This interim final rule represents the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology and to support its meaningful use. The certification criteria adopted in this initial set establish the capabilities and related standards that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support the achievement of the proposed meaningful use Stage 1 (beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.

Joint stars phased array radar antenna

NASA Astrophysics Data System (ADS)

Shnitkin, Harold

1994-10-01

The Joint STARS phased array radar system is capable of performing long range airborne surveillance and was used during the Persian Gulf war on two E8-A aircraft to fly many around-the-clock missions to monitor the Kuwait and Iraq battlefield from a safe distance behind the front lines. This paper is a follow-on to previous publications on the subject of the Joint STARS antenna and deals mainly with mission performance and technical aspects not previously covered. Radar data of troop movements and armament installations will be presented, a brief review of the antenna design is given, followed by technical discussions concerning the three-port interferometry, gain and sidelobe design approach, cost control, range test implementation and future improvements.

Joint Common Architecture Demonstration (JCA Demo) Final Report

DTIC Science & Technology

2016-07-28

approach for implementing open systems [16], formerly known as the Modular Open Systems Approach (MOSA). OSA is a business and technical strategy to... TECHNICAL REPORT RDMR-AD-16-01 JOINT COMMON ARCHITECTURE DEMONSTRATION (JCA DEMO) FINAL REPORT Scott A. Wigginton... Modular Avionics .......................................................................... 5 E. Model-Based Engineering

An algorithm for continuum modeling of rocks with multiple embedded nonlinearly-compliant joints [Continuum modeling of elasto-plastic media with multiple embedded nonlinearly-compliant joints

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

Hurley, R. C.; Vorobiev, O. Y.; Ezzedine, S. M.

Here, we present a numerical method for modeling the mechanical effects of nonlinearly-compliant joints in elasto-plastic media. The method uses a series of strain-rate and stress update algorithms to determine joint closure, slip, and solid stress within computational cells containing multiple “embedded” joints. This work facilitates efficient modeling of nonlinear wave propagation in large spatial domains containing a large number of joints that affect bulk mechanical properties. We implement the method within the massively parallel Lagrangian code GEODYN-L and provide verification and examples. We highlight the ability of our algorithms to capture joint interactions and multiple weakness planes within individualmore » computational cells, as well as its computational efficiency. We also discuss the motivation for developing the proposed technique: to simulate large-scale wave propagation during the Source Physics Experiments (SPE), a series of underground explosions conducted at the Nevada National Security Site (NNSS).« less

An algorithm for continuum modeling of rocks with multiple embedded nonlinearly-compliant joints [Continuum modeling of elasto-plastic media with multiple embedded nonlinearly-compliant joints

DOE PAGES

Hurley, R. C.; Vorobiev, O. Y.; Ezzedine, S. M.

2017-04-06

Here, we present a numerical method for modeling the mechanical effects of nonlinearly-compliant joints in elasto-plastic media. The method uses a series of strain-rate and stress update algorithms to determine joint closure, slip, and solid stress within computational cells containing multiple “embedded” joints. This work facilitates efficient modeling of nonlinear wave propagation in large spatial domains containing a large number of joints that affect bulk mechanical properties. We implement the method within the massively parallel Lagrangian code GEODYN-L and provide verification and examples. We highlight the ability of our algorithms to capture joint interactions and multiple weakness planes within individualmore » computational cells, as well as its computational efficiency. We also discuss the motivation for developing the proposed technique: to simulate large-scale wave propagation during the Source Physics Experiments (SPE), a series of underground explosions conducted at the Nevada National Security Site (NNSS).« less

OC35 - Child Friendly Healthcare Initiative, implementation project in a paediatric department in Greece.

PubMed

Boutopoulou, Barbara; Clarke, Andrew; Christothanopoulou, Ioanna; Douros, Konstantinos; Tsirouda, Maria; Papaevangelou, Vasiliki

2016-05-09

Theme: Accreditation and quality improvement. Child Friendly Healthcare Initiative (CFHI) aims to improve quality of experience and health care given to children and families by improving realisation of children's rights and reducing unnecessary fear, anxiety and suffering during and because of health care. To present results of preliminary CFH assessment. Implementation was initiated in a paediatric department of a University Hospital in Athens, Greece, consisting of a 37-bed ward, Outpatient Clinic and Emergency Department. For the preliminary assessment of the CFHI tool No1, which is for parents-caregiverschildren and health workers, this was translated into Greek. 112 parents-caregivers and six children were interviewed by an independent interviewer. In total, 24 health workers - 5 paediatricians, 11 residents and 8 nurses - responded to the CFHI tool No 1. Issues highlighted were mostly about CFH Standard 3 and Standard 7. Suggestions for improvement in all Standards were suggested. Preliminary assessment revealed the quality of care needs improvement. The next step is the training health workers, planning and making improvements.

Early Implementation of the Class Size Reduction Initiative.

ERIC Educational Resources Information Center

Illig, David C.

A survey of school districts was conducted to determine the initial progress and problems associated with the 1997 Class Size Reduction (CSR) Initiative. Data reveal that most school districts had enough space for smaller classes for at least two grade levels; small school districts were much less likely to report space constraints. The CSR did…

Hydrologic Geospatial Fabric as Community Cyberinfrastructure: International standardization best practices and the U.S. Open Water Data Initiative implementation.

NASA Astrophysics Data System (ADS)

Blodgett, D. L.

2016-12-01

Recent prolonged droughts, catastrophic flooding, and the need to protect and restore aquatic ecosystems, has increased the emphasis on information sharing in the water resources science and engineering domains. Internationally the joint World Meteorological Organization (WMO) and Open Geospatial Consortium (OGC) Hydrology Domain Working Group (HDWG) has been working toward a comprehensive system of standards and best practices for the Hydrology Domain. In the U.S. the multi-agency led and open to all U.S. Advisory Committee on Water Information (ACWI) was tasked to implement an Open Water Data Initiative (OWDI), "that will integrate currently fragmented water information into a connected, national water data framework"[1]. The status of both will be presented with focus on a community hydrologic geospatial fabric. Hydrology observations data standardization was the emphasis of the first 5 years of the HDWG. This work included WaterML 2.0 parts 1 - timeseries and part 2 - ratings and gagings. In 2016, the first of two new hydrographic feature models, GroundwaterML2, was completed and the second, for surface water features, was in active development. The WMO Commission for Hydrology is considering adoption of all these standards and their adoption is central to the U.S. OWDI. OWDI participants have produced a special collection in the Journal of American Water Resources Association and several initiative working groups have concluded their activities. One early deliverable from the OWDI was a new easier to use structure for the NHDPlus dataset. Building on this, a project to create a national Network Linked Data Index (NLDI) is being undertaken as an open-source community endeavor. The NLDI centralizes river network data, network navigation tools, crawlers that index data to the network, and utilities to register or remove data from the network. Research that informed the design of the NLDI will be presented along with recent development and findings of the project

Concurrent validation of Xsens MVN measurement of lower limb joint angular kinematics.

PubMed

Zhang, Jun-Tian; Novak, Alison C; Brouwer, Brenda; Li, Qingguo

2013-08-01

This study aims to validate a commercially available inertial sensor based motion capture system, Xsens MVN BIOMECH using its native protocols, against a camera-based motion capture system for the measurement of joint angular kinematics. Performance was evaluated by comparing waveform similarity using range of motion, mean error and a new formulation of the coefficient of multiple correlation (CMC). Three dimensional joint angles of the lower limbs were determined for ten healthy subjects while they performed three daily activities: level walking, stair ascent, and stair descent. Under all three walking conditions, the Xsens system most accurately determined the flexion/extension joint angle (CMC > 0.96) for all joints. The joint angle measurements associated with the other two joint axes had lower correlation including complex CMC values. The poor correlation in the other two joint axes is most likely due to differences in the anatomical frame definition of limb segments used by the Xsens and Optotrak systems. Implementation of a protocol to align these two systems is necessary when comparing joint angle waveforms measured by the Xsens and other motion capture systems.

Dopaminergic Variants in Siblings at High Risk for Autism: Associations With Initiating Joint Attention

PubMed Central

Gangi, Devon N.; Messinger, Daniel S.; Martin, Eden R.; Cuccaro, Michael L.

2016-01-01

Younger siblings of children with autism spectrum disorder (ASD; high-risk siblings) exhibit lower levels of initiating joint attention (IJA; sharing an object or experience with a social partner through gaze and/or gesture) than low-risk siblings of children without ASD. However, high-risk siblings also exhibit substantial variability in this domain. The neurotransmitter dopamine is linked to brain areas associated with reward, motivation, and attention, and common dopaminergic variants have been associated with attention difficulties. We examined whether these common dopaminergic variants, DRD4 and DRD2, explain variability in IJA in high-risk (n = 55) and low-risk (n = 38) siblings. IJA was assessed in the first year during a semi-structured interaction with an examiner. DRD4 and DRD2 genotypes were coded according to associated dopaminergic functioning to create a gene score, with higher scores indicating more genotypes associated with less efficient dopaminergic functioning. Higher dopamine gene scores (indicative of less efficient dopaminergic functioning) were associated with lower levels of IJA in the first year for high-risk siblings, while the opposite pattern emerged in low-risk siblings. Findings suggest differential susceptibility—IJA was differentially associated with dopaminergic functioning depending on familial ASD risk. Understanding genes linked to ASD-relevant behaviors in high-risk siblings will aid in early identification of children at greatest risk for difficulties in these behavioral domains, facilitating targeted prevention and intervention. PMID:26990357

Aerosol Modeling for the Global Model Initiative

NASA Technical Reports Server (NTRS)

Weisenstein, Debra K.; Ko, Malcolm K. W.

2001-01-01

The goal of this project is to develop an aerosol module to be used within the framework of the Global Modeling Initiative (GMI). The model development work will be preformed jointly by the University of Michigan and AER, using existing aerosol models at the two institutions as starting points. The GMI aerosol model will be tested, evaluated against observations, and then applied to assessment of the effects of aircraft sulfur emissions as needed by the NASA Subsonic Assessment in 2001. The work includes the following tasks: 1. Implementation of the sulfur cycle within GMI, including sources, sinks, and aqueous conversion of sulfur. Aerosol modules will be added as they are developed and the GMI schedule permits. 2. Addition of aerosol types other than sulfate particles, including dust, soot, organic carbon, and black carbon. 3. Development of new and more efficient parameterizations for treating sulfate aerosol nucleation, condensation, and coagulation among different particle sizes and types.

Strengthening of defected beam-column joints using CFRP.

PubMed

Mahmoud, Mohamed H; Afefy, Hamdy M; Kassem, Nesreen M; Fawzy, Tarek M

2014-01-01

This paper presents an experimental study for the structural performance of reinforced concrete (RC) exterior beam-column joints rehabilitated using carbon-fiber-reinforced polymer (CFRP). The present experimental program consists of testing 10 half-scale specimens divided into three groups covering three possible defects in addition to an adequately detailed control specimen. The considered defects include the absence of the transverse reinforcement within the joint core, insufficient bond length for the beam main reinforcement and inadequate spliced implanted column on the joint. Three different strengthening schemes were used to rehabilitate the defected beam-column joints including externally bonded CFRP strips and sheets in addition to near surface mounted (NSM) CFRP strips. The failure criteria including ultimate capacity, mode of failure, initial stiffness, ductility and the developed ultimate strain in the reinforcing steel and CFRP were considered and compared for each group for the control and the CFRP-strengthened specimens. The test results showed that the proposed CFRP strengthening configurations represented the best choice for strengthening the first two defects from the viewpoint of the studied failure criteria. On the other hand, the results of the third group showed that strengthening the joint using NSM strip technique enabled the specimen to outperform the structural performance of the control specimen while strengthening the joints using externally bonded CFRP strips and sheets failed to restore the strengthened joints capacity.

A randomized wait-list controlled analysis of the implementation integrity of team-initiated problem solving processes.

PubMed

Newton, J Stephen; Horner, Robert H; Algozzine, Bob; Todd, Anne W; Algozzine, Kate

2012-08-01

Members of Positive Behavior Interventions and Supports (PBIS) teams from 34 elementary schools participated in a Team-Initiated Problem Solving (TIPS) Workshop and follow-up technical assistance. Within the context of a randomized wait-list controlled trial, team members who were the first recipients of the TIPS intervention demonstrated greater implementation integrity in using the problem-solving processes during their team meetings than did members of PBIS Teams in the Wait-List Control group. The success of TIPS at improving implementation integrity of the problem-solving processes is encouraging and suggests the value of conducting additional research focused on determining whether there is a functional relation between use of these problem-solving processes and actual resolution of targeted student academic and social problems. Copyright © 2012 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

PubMed

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Flat H Frangible Joint Evolution

NASA Technical Reports Server (NTRS)

Diegelman, Thomas E.; Hinkel, Todd J.; Benjamin, Andrew; Rochon, Brian V.; Brown, Christopher W.

2016-01-01

Space vehicle staging and separation events require pyrotechnic devices. They are single-use mechanisms that cannot be tested, nor can failure-tolerant performance be demonstrated in actual flight articles prior to flight use. This necessitates the implementation of a robust design and test approach coupled with a fully redundant, failure-tolerant explosive mechanism to ensure that the system functions even in the event of a single failure. Historically, NASA has followed the single failure-tolerant (SFT) design philosophy for all human-rated spacecraft, including the Space Shuttle Program. Following the end of this program, aerospace companies proposed building the next generation human-rated vehicles with off-the-shelf, non-redundant, zero-failure-tolerant (ZFT) separation systems. Currently, spacecraft and launch vehicle providers for both the Orion and Commercial Crew Programs (CCPs) plan to deviate from the heritage safety approach and NASA's SFT human rating requirements. Both programs' partners have base-lined ZFT frangible joints for vehicle staging and fairing separation. These joints are commercially available from pyrotechnic vendors. Non-human-rated missions have flown them numerous times. The joints are relatively easy to integrate structurally within the spacecraft. In addition, the separation event is debris free, and the resultant pyro shock is lower than that of other design solutions. It is, however, a serious deficiency to lack failure tolerance. When used for critical applications on human-rated vehicles, a single failure could potentially lead to loss of crew (LOC) or loss of mission (LOM)). The Engineering and Safety & Mission Assurance directorates within the NASA Johnson Space Center took action to address this safety issue by initiating a project to develop a fully redundant, SFT frangible joint design, known as the Flat H. Critical to the ability to retrofit on launch vehicles being developed, the SFT mechanisms must fit within the same

Preparing for Operational Use of High Priority Products from the Joint Polar Satellite System (JPSS) in Numerical Weather Prediction

NASA Astrophysics Data System (ADS)

Nandi, S.; Layns, A. L.; Goldberg, M.; Gambacorta, A.; Ling, Y.; Collard, A.; Grumbine, R. W.; Sapper, J.; Ignatov, A.; Yoe, J. G.

2017-12-01

This work describes end to end operational implementation of high priority products from National Oceanic and Atmospheric Administration's (NOAA) operational polar-orbiting satellite constellation, to include Suomi National Polar-orbiting Partnership (S-NPP) and the Joint Polar Satellite System series initial satellite (JPSS-1), into numerical weather prediction and earth systems models. Development and evaluation needed for the initial implementations of VIIRS Environmental Data Records (EDR) for Sea Surface Temperature ingestion in the Real-Time Global Sea Surface Temperature Analysis (RTG) and Polar Winds assimilated in the National Weather Service (NWS) Global Forecast System (GFS) is presented. These implementations ensure continuity of data in these models in the event of loss of legacy sensor data. Also discussed is accelerated operational implementation of Advanced Technology Microwave Sounder (ATMS) Temperature Data Records (TDR) and Cross-track Infrared Sounder (CrIS) Sensor Data Records, identified as Key Performance Parameters by the National Weather Service. Operational use of SNPP after 28 October, 2011 launch took more than one year due to the learning curve and development needed for full exploitation of new remote sensing capabilities. Today, ATMS and CrIS data positively impact weather forecast accuracy. For NOAA's JPSS initial satellite (JPSS-1), scheduled for launch in late 2017, we identify scope and timelines for pre-launch and post-launch activities needed to efficiently transition these capabilities into operations. As part of these alignment efforts, operational readiness for KPPs will be possible as soon as 90 days after launch. The schedule acceleration is possible because of the experience with S-NPP. NOAA operational polar-orbiting satellite constellation provides continuity and enhancement of earth systems observations out to 2036. Program best practices and lessons learned will inform future implementation for follow-on JPSS-3 and -4

The numerical high cycle fatigue damage model of fillet weld joint under weld-induced residual stresses

NASA Astrophysics Data System (ADS)

Nguyen Van Do, Vuong

2018-04-01

In this study, a development of nonlinear continuum damage mechanics (CDM) model for multiaxial high cycle fatigue is proposed in which the cyclic plasticity constitutive model has been incorporated in the finite element (FE) framework. T-joint FE simulation of fillet welding is implemented to characterize sequentially coupled three-dimensional (3-D) of thermo-mechanical FE formulation and simulate the welding residual stresses. The high cycle fatigue damage model is then taken account into the fillet weld joints under the various cyclic fatigue load types to calculate the fatigue life considering the residual stresses. The fatigue crack initiation and the propagation in the present model estimated for the total fatigue is compared with the experimental results. The FE results illustrated that the proposed high cycle fatigue damage model in this study could become a powerful tool to effectively predict the fatigue life of the welds. Parametric studies in this work are also demonstrated that the welding residual stresses cannot be ignored in the computation of the fatigue life of welded structures.

Field joint environmental protection system vibration/pressurization qualification

NASA Technical Reports Server (NTRS)

Cook, M.

1989-01-01

The procedures used and results obtained from vibration testing the redesigned solid rocket motor (RSRM) field joint environmental protection system (FJEPS), hereafter referred to as the joint protection system (JPS) are documented. The major purposes were to certify that the flight-designed JPS will withstand the dynamic environmental conditions of the redesigned solid rocket booster, and to certify that the cartridge check valve (vent valve) will relieve pressure build-up under the JPS during the initial 120 sec of flight. Also, an evaluation of the extruded cork insulation bonding was performed after the vibration testing.

Teacher Evaluation Initial Policy Implementation: Superintendent and Principal Perceptions

ERIC Educational Resources Information Center

Derrington, Mary Lynne

2014-01-01

This multi-site qualitative study examined the perspectives of K-12 superintendents and principals in four districts of a Southeastern state during the implementation of a new teacher evaluation system required by the Race to the Top federal grant. Specifically, these educators' viewpoints regarding this two-year implementation's impact are…

Progressive Damage Modeling of Durable Bonded Joint Technology

NASA Technical Reports Server (NTRS)

Leone, Frank A.; Davila, Carlos G.; Lin, Shih-Yung; Smeltzer, Stan; Girolamo, Donato; Ghose, Sayata; Guzman, Juan C.; McCarville, Duglas A.

2013-01-01

The development of durable bonded joint technology for assembling composite structures for launch vehicles is being pursued for the U.S. Space Launch System. The present work is related to the development and application of progressive damage modeling techniques to bonded joint technology applicable to a wide range of sandwich structures for a Heavy Lift Launch Vehicle. The joint designs studied in this work include a conventional composite splice joint and a NASA-patented Durable Redundant Joint. Both designs involve a honeycomb sandwich with carbon/epoxy facesheets joined with adhesively bonded doublers. Progressive damage modeling allows for the prediction of the initiation and evolution of damage. For structures that include multiple materials, the number of potential failure mechanisms that must be considered increases the complexity of the analyses. Potential failure mechanisms include fiber fracture, matrix cracking, delamination, core crushing, adhesive failure, and their interactions. The joints were modeled using Abaqus parametric finite element models, in which damage was modeled with user-written subroutines. Each ply was meshed discretely, and layers of cohesive elements were used to account for delaminations and to model the adhesive layers. Good correlation with experimental results was achieved both in terms of load-displacement history and predicted failure mechanisms.

Understanding the Determinants of Australian Hospital Nurses' Hand Hygiene Decisions Following the Implementation of a National Hand Hygiene Initiative

ERIC Educational Resources Information Center

White, Katherine M.; Starfelt, Louise C.; Jimmieson, Nerina L.; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G.; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David

2015-01-01

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The "5 critical moments" of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this…

Multispectral diffuse optical tomography of finger joints

NASA Astrophysics Data System (ADS)

Lighter, Daniel; Filer, Andrew; Dehghani, Hamid

2017-07-01

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation. The current treatment paradigm for earlier, more aggressive therapy places importance on development of functional imaging modalities, capable of quantifying joint changes at the earliest stages. Diffuse optical tomography (DOT) has shown great promise in this regard, due to its cheap, non-invasive, non-ionizing and high contrast nature. Underlying pathological activity in afflicted joints leads to altered optical properties of the synovial region, with absorption and scattering increasing. Previous studies have used these optical changes as features for classifying diseased joints from healthy. Non-tomographic, single wavelength, continuous wave (CW) measurements of trans-illuminated joints have previously reported achieving this with specificity and sensitivity in the range 80 - 90% [1]. A single wavelength, frequency domain DOT system, combined with machine learning techniques, has been shown to achieve sensitivity and specificity in the range of 93.8 - 100% [2]. A CW system is presented here which collects data at 5 wavelengths, enabling reconstruction of pathophysiological parameters such as oxygenation and total hemoglobin, with the aim of identifying localized hypoxia and angiogenesis associated with inflammation in RA joints. These initial studies focus on establishing levels of variation in recovered parameters from images of healthy controls.

Time-lapse joint inversion of geophysical data with automatic joint constraints and dynamic attributes

NASA Astrophysics Data System (ADS)

Rittgers, J. B.; Revil, A.; Mooney, M. A.; Karaoulis, M.; Wodajo, L.; Hickey, C. J.

2016-12-01

Joint inversion and time-lapse inversion techniques of geophysical data are often implemented in an attempt to improve imaging of complex subsurface structures and dynamic processes by minimizing negative effects of random and uncorrelated spatial and temporal noise in the data. We focus on the structural cross-gradient (SCG) approach (enforcing recovered models to exhibit similar spatial structures) in combination with time-lapse inversion constraints applied to surface-based electrical resistivity and seismic traveltime refraction data. The combination of both techniques is justified by the underlying petrophysical models. We investigate the benefits and trade-offs of SCG and time-lapse constraints. Using a synthetic case study, we show that a combined joint time-lapse inversion approach provides an overall improvement in final recovered models. Additionally, we introduce a new approach to reweighting SCG constraints based on an iteratively updated normalized ratio of model sensitivity distributions at each time-step. We refer to the new technique as the Automatic Joint Constraints (AJC) approach. The relevance of the new joint time-lapse inversion process is demonstrated on the synthetic example. Then, these approaches are applied to real time-lapse monitoring field data collected during a quarter-scale earthen embankment induced-piping failure test. The use of time-lapse joint inversion is justified by the fact that a change of porosity drives concomitant changes in seismic velocities (through its effect on the bulk and shear moduli) and resistivities (through its influence upon the formation factor). Combined with the definition of attributes (i.e. specific characteristics) of the evolving target associated with piping, our approach allows localizing the position of the preferential flow path associated with internal erosion. This is not the case using other approaches.

Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.

PubMed

Castellanos-Joya, Martín; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Cruz-Hervert, Pablo; Ferreira-Guerrero, Elizabeth; Ortiz-Solís, Gabriela; Jiménez, Mirtha Irene; Salazar, Leslie Lorena; Montero-Campos, Rogelio; Mongua-Rodríguez, Norma; Baez-Saldaña, Renata; Bobadilla-del-Valle, Miriam; González-Roldán, Jesús Felipe; Ponce-de-León, Alfredo; Sifuentes-Osornio, José; García-García, Lourdes

2014-01-01

Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. Prospective observational cohort. 15 primary care units in 5 states in Mexico. Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β)  = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups. Joint management of TB and DM is feasible and appears to improve clinical outcomes.

Results of the Implementation of a Pilot Model for the Bidirectional Screening and Joint Management of Patients with Pulmonary Tuberculosis and Diabetes Mellitus in Mexico

PubMed Central

Castellanos-Joya, Martín; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Cruz-Hervert, Pablo; Ferreira-Guerrero, Elizabeth; Ortiz-Solís, Gabriela; Jiménez, Mirtha Irene; Salazar, Leslie Lorena; Montero-Campos, Rogelio; Mongua-Rodríguez, Norma; Baez-Saldaña, Renata; Bobadilla-del-Valle, Miriam; González-Roldán, Jesús Felipe; Ponce-de-León, Alfredo; Sifuentes-Osornio, José; García-García, Lourdes

2014-01-01

Background Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. Objective To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. Design. Prospective observational cohort. Setting. 15 primary care units in 5 states in Mexico. Participants: Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. Intervention: The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. Main outcome measures. Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. Results Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β)  = −0.660, (95% confidence interval (CI), −0.96 to −0.35); and β = −1.889 (95% CI, −2.77 to −1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28–6.13) and same period (aOR 2.37, 95% CI 1.13–4.96) comparison groups. Conclusions Joint management of TB and DM is feasible and appears to

Comparative Study of 3-Dimensional Woven Joint Architectures for Composite Spacecraft Structures

NASA Technical Reports Server (NTRS)

Jones, Justin S.; Polis, Daniel L.; Segal, Kenneth N.

2011-01-01

The National Aeronautics and Space Administration (NASA) Exploration Systems Mission Directorate initiated an Advanced Composite Technology (ACT) Project through the Exploration Technology Development Program in order to support the polymer composite needs for future heavy lift launch architectures. As an example, the large composite structural applications on Ares V inspired the evaluation of advanced joining technologies, specifically 3D woven composite joints, which could be applied to traditionally manufactured barrel segments. Implementation of these 3D woven joint technologies may offer enhancements in damage tolerance without sacrificing weight. However, baseline mechanical performance data is needed to properly analyze the joint stresses and subsequently design/down-select a preform architecture. Six different configurations were designed and prepared for this study; each consisting of a different combination of warp/fill fiber volume ratio and preform interlocking method (z-fiber, fully interlocked, or hybrid). Tensile testing was performed for this study with the enhancement of a dual camera Digital Image Correlation (DIC) system which provides the capability to measure full-field strains and three dimensional displacements of objects under load. As expected, the ratio of warp/fill fiber has a direct influence on strength and modulus, with higher values measured in the direction of higher fiber volume bias. When comparing the z-fiber weave to a fully interlocked weave with comparable fiber bias, the z-fiber weave demonstrated the best performance in two different comparisons. We report the measured tensile strengths and moduli for test coupons from the 6 different weave configurations under study.

Comparative Study of 3-Dimensional Woven Joint Architectures for Composite Spacecraft Structures

NASA Technical Reports Server (NTRS)

Jones, Justin S.; Polis, Daniel L.; Rowles, Russell R.; Segal, Kenneth N.

2011-01-01

The National Aeronautics and Space Administration (NASA) Exploration Systems Mission Directorate initiated an Advanced Composite Technology (ACT) Project through the Exploration Technology Development Program in order to support the polymer composite needs for future heavy lift launch architectures. As an example, the large composite structural applications on Ares V inspired the evaluation of advanced joining technologies, specifically 3D woven composite joints, which could be applied to segmented barrel structures needed for autoclave cured barrel segments due to autoclave size constraints. Implementation of these 3D woven joint technologies may offer enhancements in damage tolerance without sacrificing weight. However, baseline mechanical performance data is needed to properly analyze the joint stresses and subsequently design/down-select a preform architecture. Six different configurations were designed and prepared for this study; each consisting of a different combination of warp/fill fiber volume ratio and preform interlocking method (Z-fiber, fully interlocked, or hybrid). Tensile testing was performed for this study with the enhancement of a dual camera Digital Image Correlation (DIC) system which provides the capability to measure full-field strains and three dimensional displacements of objects under load. As expected, the ratio of warp/fill fiber has a direct influence on strength and modulus, with higher values measured in the direction of higher fiber volume bias. When comparing the Z-fiber weave to a fully interlocked weave with comparable fiber bias, the Z-fiber weave demonstrated the best performance in two different comparisons. We report the measured tensile strengths and moduli for test coupons from the 6 different weave configurations under study.

The implementation of California's tobacco tax initiative: the critical role of outsider strategies in protecting Proposition 99.

PubMed

Balbach, E D; Traynor, M P; Glantz, S A

2000-08-01

Enacted in 1988, Proposition 99 increased California's cigarette tax by 25 cents per pack and allocated a minimum of 20 percent of the revenues to fund antitobacco education. Tobacco control advocates had used an initiative to secure the tax increase because the legislature had not increased the tobacco tax since 1967, even though public opinion polls showed that the tax was politically popular. Advocates, however, then had to return to the legislature to negotiate implementing legislation. Between 1989 and 1996, the legislature underfunded the Proposition 99 Health Education programs by over $273 million. This underfunding occurred because the public health groups failed to exercise power, ideas, and the leadership needed for legislative success. Even successful litigation against the governor failed to restore the programs. In July 1996, however, the underexpenditures stopped because the issue of the diversions received significant media and public attention. The tobacco control groups used a variety of outsider strategies, including paid advertising, free media, and a grassroots campaign, and the leadership of these groups, in addition to the lobbyists, got involved in the campaign to secure implementing legislation. Without ongoing public pressure, it is likely that policy changes created by tobacco tax initiatives will dissipate into something acceptable to powerful insider interests, such as the tobacco and medical service provider industries.

Effect on hospital-wide sedation practices after implementation of the 2001 JCAHO procedural sedation and analgesia guidelines.

PubMed

Pitetti, Raymond; Davis, Peter J; Redlinger, Robert; White, Jean; Wiener, Eugene; Calhoun, Karen H

2006-02-01

To describe the effect of implementing the Joint Commission on Accreditation of Healthcare Organization's guidelines for procedural sedation and analgesia (PSA) on the frequency of adverse events occurring during sedation. Prospective, descriptive study. Urban, tertiary care children's hospital. Patients requiring PSA. A PSA committee and a standardized protocol for PSA were developed during a 6-month period. Institutional oversight was initiated to monitor practitioner compliance with the program. Data were abstracted from the sedation record. The change in incidence of adverse events during PSA during the study. The strength of the association was determined by computing the Pearson product moment correlation. A total of 14 386 patients received PSA between July 1, 2001, and June 30, 2004. During the study, 7.6% of patients had an adverse event, with the most common being hypoxemia (39.7% of all adverse events). A trend toward a decrease in the incidence of adverse events was found during the study (Pearson product moment correlation, -0.68; P<.001). Implementation of the 2001 Joint Commission on Accreditation of Healthcare Organizations guidelines for the provision of PSA appeared to lead to a decrease in the incidence of adverse events during the study. Implementation of uniform standards of monitoring and care for the provision of PSA may lead to safer conditions for pediatric patients undergoing PSA.

Design, implementation, and initial results from a water-quality monitoring network for Atlanta, Georgia, USA

USGS Publications Warehouse

Horowitz, A.J.; Elrick, K.A.; Smith, J.J.

2005-01-01

In cooperation with the City of Atlanta, Georgia, the US Geological Survey has designed and implemented a water-quantity and quality monitoring network that measures a variety of biological and chemical constituents in water and suspended sediment. The network consists of 20 long-term monitoring sites and is intended to assess water-quality trends in response to planned infrastructural improvements. Initial results from the network indicate that nonpoint-source contributions may be more significant than point-source contributions for selected sediment associated trace elements and nutrients. There also are indications of short-term discontinuous point-source contributions of these same constituents during baseflow.

Why Does Joint Attention Look Atypical in Autism?

PubMed Central

Gernsbacher, Morton Ann; Stevenson, Jennifer L.; Khandakar, Suraiya; Goldsmith, H. Hill

2014-01-01

This essay answers the question of why autistic children are less likely to initiate joint attention (e.g., use their index finger to point to indicate interest in something) and why they are less likely to respond to bids for their joint attention (e.g., turn their heads to look at something to which another person points). It reviews empirical evidence that autistic toddlers, children, adolescents, and adults can attend covertly, even to social stimuli, such as the direction in which another person’s eyes are gazing. It also reviews empirical evidence that autistics of various ages understand the intentionality of other persons’ actions. The essay suggests that autistics’ atypical resistance to distraction, atypical skill at parallel perception, and atypical execution of volitional actions underlie their atypical manifestations of joint attention. PMID:25520747

Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial.

PubMed

Georgeu, Daniella; Colvin, Christopher J; Lewin, Simon; Fairall, Lara; Bachmann, Max O; Uebel, Kerry; Zwarenstein, Merrick; Draper, Beverly; Bateman, Eric D

2012-07-16

Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands significant training and support, and

Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial

PubMed Central

2012-01-01

Background Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme. Methods This study was a qualitative process evaluation using in-depth interviews and focus group discussions with patients, health workers, health managers, and other key informants as well as observation in clinics. Research questions focused on perceptions of STRETCH, changes in health provider roles, attitudes and patient relationships, and impact of the implementation context on trial outcomes. Data were analysed collaboratively by the research team using thematic analysis. Results NIMART appears to be highly acceptable among nurses, patients, and physicians. Managers and nurses expressed confidence in their ability to deliver ART successfully. This confidence developed slowly and unevenly, through a phased and well-supported approach that guided nurses through training, re-prescription, and initiation. The research also shows that NIMART changes the working and referral relationships between health staff, demands

Performance of concrete joint sealants in hot climates

DOT National Transportation Integrated Search

1987-11-01

A research project was initiated in 1979 on project IR-17-1(126) to compare and evaluate several joint sealants. In 1982 another test section on project F 028-1-506 was established to evaluate several other sealants. This report documents the placeme...

Septic arthritis of the sacroiliac joint

PubMed Central

Sebastian, Agata; Błach, Katarzyna; Silicki, Jurand; Wiland, Piotr

2018-01-01

Septic arthritis is an inflammation of a joint caused directly by various microorganisms. It is often characterized by many unspecific symptoms. Bacteria is the most often etiological factor. We present a case report of a 76-years old woman with a unilateral septic arthritis of the sacroiliac joint. Bacterial sacroiliitis should be taken into account in patients with sacroiliitis and fever onset. Proper diagnosis can be very often difficult and delayed but fast implementation of antibiotic therapy is extremely important in the treatment process. Diagnostic imaging is crucial to the diagnosis and monitoring of septic arthritis. Magnetic resonance imaging is the most relevant tool for the detection of sacroiliitis, allowing the institution of therapeutic strategies to impede the progression of the disease. PMID:29686444

Finite Element Analysis of Composite Joint Configurations with Gaps and Overlaps

NASA Technical Reports Server (NTRS)

Krueger, Ronald

2014-01-01

The goal of the current study is to identify scenarios for which thermal and moisture effects become significant in the loading of a composite structure. In the current work, a simple configuration was defined, and material properties were selected. A Fortran routine was created to automate the mesh generation process. The routine was used to create the models for the initial mesh refinement study. A combination of element length and width suitable for further studies was identified. Also, the effect of the overlap length and gap length on computed shear and through-thickness stresses along the bondline of the joints was studied for the mechanical load case. Further, the influence of neighboring gaps and overlaps on these joint stresses was studied and was found to be negligible. The results suggest that for an initial study it is sufficient to focus on one configuration with fixed overlap and gap lengths to study the effects of mechanical, thermal and moisture loading and combinations thereof on computed joint stresses

Prevention of the Post traumatic Fibrotic Response in Joints

DTIC Science & Technology

2016-12-01

researchers focusing on research associated with post -traumatic joint stiffness. This team has grown from a group of three initial Principal Investigators...The formation of the Translational Research Partnership ensured reaching the stated objective. Two Specific Aims were defined to test the...body weight of rabbits during the initial 8 weeks of the experimental study. During this time the rabbits were treated with tested and control

Effect of the sagittal ankle angle at initial contact on energy dissipation in the lower extremity joints during a single-leg landing.

PubMed

Lee, Jinkyu; Song, Yongnam; Shin, Choongsoo S

2018-05-01

During landing, the ankle angle at initial contact (IC) exhibits relatively wide individual variation compared to the knee and hip angles. However, little is known about the effect of different IC ankle angles on energy dissipation. The purpose of this study was to investigate the relationship between individual ankle angles at IC and energy dissipation in the lower extremity joints. Twenty-seven adults performed single-leg landings from a 0.3-m height. Kinetics and kinematics of the lower extremity joints were measured. The relationship between ankle angles at IC and negative work, range of motion, the time to peak ground reaction force, and peak loading rate were analyzed. The ankle angle at IC was positively correlated with ankle negative work (r = 0.80, R 2  = 0.64, p < 0.001) and the contribution of the ankle to total (ankle, knee and hip joint) negative work (r = 0.84, R 2  = 0.70, p < 0.001), but the ankle angle was negatively correlated with hip negative work (r = -0.46, R 2  = 0.21, p = 0.01) and the contribution of the hip to total negative work (r = -0.61, R 2  = 0.37, p < 0.001). The knee negative work and the contribution of the knee to total negative work were not correlated with the ankle angle at IC. The ankle angle at IC was positively correlated with total negative work (r = 0.50, R 2  = 0.25, p < 0.01) and negatively correlated with the peak loading rate (r = -0.76, R 2  = 0.57, p < 0.001). These results indicated that landing mechanics changed as the ankle angle at IC increased, such that the ankle energy dissipation increased and redistributed the energy dissipation in the ankle and hip joints. Further, these results suggest that increased ankle energy dissipation with a higher IC plantar flexion angle may be a potential landing technique for reducing the risk of injury to the anterior cruciate ligament and hip musculature. Copyright © 2018 Elsevier B.V. All rights reserved.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

PubMed Central

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. PMID:25018637

Knee joint transplantation combined with surgical angiogenesis in rabbits – a new experimental model

PubMed Central

Kremer, Thomas; Giusti, Guilherme; Friedrich, Patricia F.; Willems, Wouter; Bishop, Allen T.; Giessler, Goetz A.

2012-01-01

Summary Purpose We have previously described a means to maintain bone allotransplant viability, without long-term immune modulation, replacing allogenic bone vasculature with autogenous vessels. A rabbit model for whole knee joint transplantation was developed and tested using the same methodology, initially as an autotransplant. Materials/Methods Eight New Zealand White rabbit knee joints were elevated on a popliteal vessel pedicle to evaluate limb viability in a non-survival study. Ten additional joints were elevated and replaced orthotopically in a fashion identical to allotransplantation, obviating only microsurgical repairs and immunosuppression. A superficial inferior epigastric facial (SIEF) flap and a saphenous arteriovenous (AV) bundle were introduced into the femur and tibia respectively, generating a neoangiogenic bone circulation. In allogenic transplantation, this step maintains viability after cessation of immunosuppression. Sixteen weeks later, x-rays, microangiography, histology, histomorphometry and biomechanical analysis were performed. Results Limb viability was preserved in the initial 8 animals. Both soft tissue and bone healing occurred in 10 orthotopic transplants. Surgical angiogenesis from the SIEF flap and AV bundle was always present. Bone and joint viability was maintained, with demonstrable new bone formation. Bone strength was less than the opposite side. Arthrosis and joint contractures were frequent. Conclusion We have developed a rabbit knee joint model and evaluation methods suitable for subsequent studies of whole joint allotransplantation. PMID:22113889

The Manchester Fly Facility: Implementing an objective-driven long-term science communication initiative.

PubMed

Patel, Sanjai; Prokop, Andreas

2017-10-01

Science communication is increasingly important for scientists, although research, teaching and administration activities tend to eat up our time already, and budgets for science communication are usually low. It appears impossible to combine all these tasks and, in addition, to develop engagement activities to a quality and impact that would make the efforts worth their while. Here we argue that these challenges are easier addressed when centering science communication initiatives on a long-term vision with a view to eventually forming outreach networks where the load can be shared whilst being driven to higher momentum. As one example, we explain the science communication initiative of the Manchester Fly Facility. It aims to promote public awareness of research using the model organism Drosophila, which is a timely, economic and most efficient experimental strategy to drive discovery processes in the biomedical sciences and must have a firm place in the portfolios of funding organisations. Although this initiative by the Manchester Fly Facility is sustained on a low budget, its long-term vision has allowed gradual development into a multifaceted initiative: (1) targeting university students via resources and strategies for the advanced training in fly genetics; (2) targeting the general public via science fairs, educational YouTube videos, school visits, teacher seminars and the droso4schools project; (3) disseminating and marketing strategies and resources to the public as well as fellow scientists via dedicated websites, blogs, journal articles, conference presentations and workshops - with a view to gradually forming networks of drosophilists that will have a greater potential to drive the science communication objective to momentum and impact. Here we explain the rationales and implementation strategies for our various science communication activities - which are similarly applicable to other model animals and other areas of academic science - and share our

Computer simulation of solder joint failure

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

Burchett, S.N.; Frear, D.R.; Rashid, M.M.

The thermomechanical fatigue failure of solder joints is increasingly becoming an important reliability issue for electronic packages. The purpose of this Laboratory Directed Research and Development (LDRD) project was to develop computational tools for simulating the behavior of solder joints under strain and temperature cycling, taking into account the microstructural heterogeneities that exist in as-solidified near eutectic Sn-Pb joints, as well as subsequent microstructural evolution. The authors present two computational constitutive models, a two-phase model and a single-phase model, that were developed to predict the behavior of near eutectic Sn-Pb solder joints under fatigue conditions. Unique metallurgical tests provide themore » fundamental input for the constitutive relations. The two-phase model mathematically predicts the heterogeneous coarsening behavior of near eutectic Sn-Pb solder. The finite element simulations with this model agree qualitatively with experimental thermomechanical fatigue tests. The simulations show that the presence of an initial heterogeneity in the solder microstructure could significantly degrade the fatigue lifetime. The single-phase model was developed to predict solder joint behavior using materials data for constitutive relation constants that could be determined through straightforward metallurgical experiments. Special thermomechanical fatigue tests were developed to give fundamental materials input to the models, and an in situ SEM thermomechanical fatigue test system was developed to characterize microstructural evolution and the mechanical behavior of solder joints during the test. A shear/torsion test sample was developed to impose strain in two different orientations. Materials constants were derived from these tests. The simulation results from the two-phase model showed good fit to the experimental test results.« less

A way to motivate Danish GPs to implement a new national service.

PubMed

Kristensen, Alice; Wengler, Bente

2012-01-01

The Common Medicine card (CMC) is a new national service in Denmark which aim is to ensure better patient care and minimize medication errors. All health professionals as well as authorities have to use this system. CMC requires changing the organization of work for both physicians and clinical staff in General Practice (GP). Commissioning of CMC in GP requires a significant effort beyond the technical installation of the solution. Finding the right way to implement a new service in a busy GP has been the main focus of the national project organization MedCom. MedCom has in collaboration with the five regions in Denmark, established a joint plan and has created an implementation model contraining various initiatives including "after hours" meetings for each service provider of EMR (Electronic Medicine Records) in order to disseminate and support the new CMC service. This paper shows the status of the "after hours" meetings effect in dissemination of CMC from August to November 2011.

Osteophyte formation after ACL rupture in mice is associated with joint restabilization and loss of range of motion

PubMed Central

Hsia, Allison W.; Anderson, Matthew J.; Heffner, Mollie A.; Lagmay, Earl P.; Zavodovskaya, Regina; Christiansen, Blaine A.

2016-01-01

Osteophytes are a typical radiographic finding during osteoarthritis (OA). Osteophytes are thought to form in response to joint instability, however the time course of osteophyte formation and joint stabilization following joint injury is not well understood. In this study, we investigated the time course of osteophyte formation and joint function following non-invasive knee injury in mice. We hypothesized that initial joint instability following knee injury would initiate osteophyte formation, which would in turn restabilize the joint and reduce range of motion (ROM). Mice were subjected to non-invasive anterior cruciate ligament (ACL) rupture. Anterior-posterior (AP) joint laxity, ROM, and chondro/osteophyte formation were measured immediately after injury, and 2, 4, 6, and 8 weeks post-injury. Chondrophyte areas at each time point were measured with histology, while mineralized osteophyte volume was determined using micro-computed tomography. Immediately after ACL rupture, AP joint laxity was increased 2-fold, while ROM was increased 11.7%. Chondrophytes appeared by 2 weeks post-injury, corresponding with a decrease in AP joint laxity and ROM. By 8 weeks post-injury, considerable osteophyte formation was observed around the joint, AP joint laxity returned to control levels, and joint ROM decreased to 61% of control values. These data support a role for chondro/osteophytes in joint restabilization after injury, and provide crucial insight into the time course and pathology of joint degeneration during OA development in the mouse. PMID:27031945

Implementing the WHO/UNICEF Baby Friendly Initiative in the community: a 'hearts and minds' approach.

PubMed

Thomson, Gill; Bilson, Andy; Dykes, Fiona

2012-04-01

to describe a 'hearts and minds' approach to community Baby Friendly Initiative implementation developed from the views of multidisciplinary professionals. a qualitative descriptive study utilising focus groups and interviews, with thematic networks analysis conducted. forty-seven professionals were consulted from two primary health-care facilities located in the North-West of England. thematic networks analysis generated a global theme of a 'hearts and minds approach' to BFI implementation, which embodies emotional and rational engagement. The three underpinning organising themes (and their associated basic themes): 'credible leadership', 'engagement of key partners' and 'changing attitudes and practice' reflect the context, processes and outcomes of a 'hearts and minds' approach. a 'hearts and minds' approach transcends the prescriptive aspects of a macro-level intervention with its emphasis upon audits, training, statistics and 'hard' evidence through valuing other professionals and engaging staff at all levels. It offers insights into how organisational change may move beyond traditional top-down mechanisms for driving change to incorporate ways that value others and promote cooperation and reflection. Copyright © 2011 Elsevier Ltd. All rights reserved.

Barriers and facilitators to implementing the Baby-Friendly hospital initiative in neonatal intensive care units.

PubMed

Benoit, Britney; Semenic, Sonia

2014-01-01

To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU). Qualitative, descriptive design. Two university-affiliated level-III NICUs in Canada. A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners. In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis. Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration. Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Crack Damage Parameters and Dilatancy of Artificially Jointed Granite Samples Under Triaxial Compression

NASA Astrophysics Data System (ADS)

Walton, G.; Alejano, L. R.; Arzua, J.; Markley, T.

2018-06-01

A database of post-peak triaxial test results was created for artificially jointed planes introduced in cylindrical compression samples of a Blanco Mera granite. Aside from examining the artificial jointing effect on major rock and rock mass parameters such as stiffness, peak strength and residual strength, other strength parameters related to brittle cracking and post-yield dilatancy were analyzed. Crack initiation and crack damage values for both the intact and artificially jointed samples were determined, and these damage envelopes were found to be notably impacted by the presence of jointing. The data suggest that with increased density of jointing, the samples transition from a combined matrix damage and joint slip yielding mechanism to yield dominated by joint slip. Additionally, post-yield dilation data were analyzed in the context of a mobilized dilation angle model, and the peak dilation angle was found to decrease significantly when there were joints in the samples. These dilatancy results are consistent with hypotheses in the literature on rock mass dilatancy.

Dopaminergic variants in siblings at high risk for autism: Associations with initiating joint attention.

PubMed

Gangi, Devon N; Messinger, Daniel S; Martin, Eden R; Cuccaro, Michael L

2016-11-01

Younger siblings of children with autism spectrum disorder (ASD; high-risk siblings) exhibit lower levels of initiating joint attention (IJA; sharing an object or experience with a social partner through gaze and/or gesture) than low-risk siblings of children without ASD. However, high-risk siblings also exhibit substantial variability in this domain. The neurotransmitter dopamine is linked to brain areas associated with reward, motivation, and attention, and common dopaminergic variants have been associated with attention difficulties. We examined whether these common dopaminergic variants, DRD4 and DRD2, explain variability in IJA in high-risk (n = 55) and low-risk (n = 38) siblings. IJA was assessed in the first year during a semi-structured interaction with an examiner. DRD4 and DRD2 genotypes were coded according to associated dopaminergic functioning to create a gene score, with higher scores indicating more genotypes associated with less efficient dopaminergic functioning. Higher dopamine gene scores (indicative of less efficient dopaminergic functioning) were associated with lower levels of IJA in the first year for high-risk siblings, while the opposite pattern emerged in low-risk siblings. Findings suggest differential susceptibility-IJA was differentially associated with dopaminergic functioning depending on familial ASD risk. Understanding genes linked to ASD-relevant behaviors in high-risk siblings will aid in early identification of children at greatest risk for difficulties in these behavioral domains, facilitating targeted prevention and intervention. Autism Res 2016, 9: 1142-1150. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Extracting joint weak values with local, single-particle measurements.

PubMed

Resch, K J; Steinberg, A M

2004-04-02

Weak measurement is a new technique which allows one to describe the evolution of postselected quantum systems. It appears to be useful for resolving a variety of thorny quantum paradoxes, particularly when used to study properties of pairs of particles. Unfortunately, such nonlocal or joint observables often prove difficult to measure directly in practice (for instance, in optics-a common testing ground for this technique-strong photon-photon interactions would be needed to implement an appropriate von Neumann interaction). Here we derive a general, experimentally feasible, method for extracting these joint weak values from correlations between single-particle observables.

Implementation of Title I and Title II-A Program Initiatives: Results from 2013-14. Executive Summary. NCEE 2017-4015

ERIC Educational Resources Information Center

Troppe, Patricia; Milanowski, Anthony T.; Heid, Camilla; Gill, Brian; Ross, Christine

2017-01-01

This report describes the implementation of policies and initiatives supported by Title I and Title II-A of the federal Elementary and Secondary Education Act (ESEA) during the 2013-14 school year. Title I is one of the U.S. Department of Education's largest programs, accounting for $15 billion in the 2016 federal budget. Historically, Title I has…

The Promise and Challenge of Practice-Research Collaborations: Guiding Principles and Strategies for Initiating, Designing, and Implementing Program Evaluation Research

ERIC Educational Resources Information Center

Secret, Mary; Abell, Melissa L.; Berlin, Trey

2011-01-01

The authors present a set of guiding principles and strategies to facilitate the collaborative efforts of social work researchers and practitioners as they initiate, design, and implement outcome evaluations of human service interventions and programs. Beginning with an exploration of the interpersonal barriers to practice-research collaborations,…

Debonding of Stitched Composite Joints: Testing and Analysis

NASA Technical Reports Server (NTRS)

Glaessgen, E. H.; Raju, I. S.; Poe, C. C., Jr.

1999-01-01

The effect of stitches on the failure of a single lap joint configuration was determined in a combined experimental and analytical study. The experimental study was conducted to determine debond growth under static monotonic loading. The stitches were shown to delay the initiation ofthe debond and provide load transfer beyond the load necessary to completely debond the stitched lap joint. The strain energy release rates at the debond front were calculated using a finite element-based technique. Models of the unstitched configuration showed significant values of modes I and II across the width of the joint and showed that mode III is zero at the centerline but increases near the free edge. Models of the stitched configuration showed that the stitches effectively reduced mode I to zero, but had less of an effect on modes II and III.

2007 Precision Strike PEO Summer Forum - Joint Perspectives on Precision Engagement

DTIC Science & Technology

2007-07-11

Status,” Colonel Richard Justice, USAF—Commander of the Miniature Munitions Systems Group (MMSG), Eglin Air Force Base “Unmanned Systems (UAS) Roadmap...Role in the Roadmap Implementation Methods & Processes Working Group Issues delineated in Implementation Plan form basis for JTEM methodology...Test and Evaluation JMETC – Joint Mission Environment Test Capability WG – Working Group DOT&E AT&L DOT&E Unclassified 5 Background: JTEM Problem

Can infants' orientation to social stimuli predict later joint attention skills?

PubMed

Schietecatte, Inge; Roeyers, Herbert; Warreyn, Petra

2012-06-01

From the moment infants are born, they seem to prefer orienting to social stimuli, over objects and non-social stimuli. This preference lasts throughout adulthood and is believed to play a crucial role in social-communicative development. By following up a group of infants at the age of 6, 8, and 12 months, this study explored the role of social orienting in the early development of joint attention skills. The expected association between social orienting and joint attention was partially confirmed. Social orienting in real-life photographs of everyday situations was not related to later joint attention skills, however fixation to the eyes in a neutral face was related to response to joint attention skills, and fixation to the eyes in a dynamic video clip of a talking person was predictive of initiating joint attention skills. Several alternative interpretations of the results are discussed. ©2011 The British Psychological Society.

In-game Management of Common Joint Dislocations

PubMed Central

Skelley, Nathan W.; McCormick, Jeremy J.; Smith, Matthew V.

2014-01-01

Context: Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints. Evidence Acquisition: A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries. Conclusion: When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game. PMID:24790695

Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle".

PubMed

Kansagra, Ankit; Andrzejewski, Chester; Krushell, Robert; Lehman, Andrew; Greenbaum, Jordan; Visintainer, Paul; McGirr, Joan; Mahoney, Kathleen; Cloutier, Darlene; Ehresman, Alice; Stefan, Mihaela S

Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.

Implementation of a closed-loop reporting system for critical values and clinical communication in compliance with goals of the joint commission.

PubMed

Parl, Fritz F; O'Leary, Mandy F; Kaiser, Allen B; Paulett, John M; Statnikova, Kristina; Shultz, Edward K

2010-03-01

Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission's 2008 National Patient Safety Goals. A multidisciplinary team of laboratorians, clinicians, and information technology experts developed an electronic ALERTS system that reports critical values via the laboratory and hospital information systems to alphanumeric pagers of clinicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. A method for automated acknowledgment of message receipt was incorporated into the system design. The ALERTS system has been applied to inpatients and eliminated approximately 9000 phone calls a year made by medical technologists. Although a small number of phone calls were still made as a result of pages not acknowledged by clinicians within 10 min, they were made by telephone operators, who either contacted the same physician who was initially paged by the automated system or identified and contacted alternate physicians or the patient's nurse. Overall, documentation of physician acknowledgment of receipt in the electronic medical record increased to 95% of critical values over 9 months, while the median time decreased to <3 min. We improved laboratory efficiency and physician communication by developing an electronic system for reporting of critical values that is in compliance with The Joint Commission's goals.

Levels of Participation of the School Stakeholders to the Different School-Initiated Activities and the Implementation of School-Based Management

ERIC Educational Resources Information Center

Cabardo, Jimmy Rey Opong

2016-01-01

This study aimed to evaluate the levels of participation of the school stakeholders to the different school-initiated activities and the implementation of school-based management (SBM) in selected schools in the Division of Davao del Sur for the school year 2014-2015 using a descriptive-correlational survey research design. A…

Lessons Learned: Implementation of the Milwaukee Urban Systemic Initiative in Years One and Two. Report for the Milwaukee Public Schools.

ERIC Educational Resources Information Center

Doyle, Lynn H.; Huinker, DeAnn

The Urban Systemic Initiatives (USI) program is an effort sponsored by the National Science Foundation (NSF) that targets large urban school systems with the goal of sustainable implementation of high-quality, standards-based teaching for the purpose of attaining system-wide increases in students' learning of challenging mathematics and science.…

Interprofessional approach for teaching functional knee joint anatomy.

PubMed

Meyer, Jakob J; Obmann, Markus M; Gießler, Marianne; Schuldis, Dominik; Brückner, Ann-Kathrin; Strohm, Peter C; Sandeck, Florian; Spittau, Björn

2017-03-01

Profound knowledge in functional and clinical anatomy is a prerequisite for efficient diagnosis in medical practice. However, anatomy teaching does not always consider functional and clinical aspects. Here we introduce a new interprofessional approach to effectively teach the anatomy of the knee joint. The presented teaching approach involves anatomists, orthopaedists and physical therapists to teach anatomy of the knee joint in small groups under functional and clinical aspects. The knee joint courses were implemented during early stages of the medical curriculum and medical students were grouped with students of physical therapy to sensitize students to the importance of interprofessional work. Evaluation results clearly demonstrate that medical students and physical therapy students appreciated this teaching approach. First evaluations of following curricular anatomy exams suggest a benefit of course participants in knee-related multiple choice questions. Together, the interprofessional approach presented here proves to be a suitable approach to teach functional and clinical anatomy of the knee joint and further trains interprofessional work between prospective physicians and physical therapists as a basis for successful healthcare management. Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

The influences of sex and posture on joint energetics during drop landings.

PubMed

Norcross, M F; Shultz, S J; Weinhold, P S; Lewek, M D; Padua, D A; Blackburn, J T

2015-04-01

Previous observations suggest that females utilize a more erect initial landing posture than males with sex differences in landing posture possibly related to sex-specific energy absorption (EA) strategies. However, sex-specific EA strategies have only been observed when accompanied by sex differences in initial landing posture. This study (a) investigated the potential existence of sex-specific EA strategies; and (b) determined the influences of sex and initial landing posture on the biomechanical determinants of EA. The landing biomechanics of 80 subjects were recorded during drop landings in Preferred, Flexed, and Erect conditions. No sex differences in joint EA were identified after controlling for initial landing posture. Males and females exhibited greater ankle EA during Erect vs Flexed landings with this increase driven by 12% greater ankle velocity, but no change in ankle extensor moment. No differences in hip and knee EA were observed between conditions. However, to achieve similar knee EA, subjects used 7% greater mean knee extensor moment but 9% less knee angular velocity during Flexed landings. The results suggest that sex-specific EA strategies do not exist, and that the magnitude of knee joint EA can be maintained by modulating the relative contributions of joint moment and angular velocity to EA. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

PubMed Central

Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

2011-01-01

Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184

Joint surface modeling with thin-plate splines.

PubMed

Boyd, S K; Ronsky, J L; Lichti, D D; Salkauskas, K; Chapman, M A; Salkauskas, D

1999-10-01

Mathematical joint surface models based on experimentally determined data points can be used to investigate joint characteristics such as curvature, congruency, cartilage thickness, joint contact areas, as well as to provide geometric information well suited for finite element analysis. Commonly, surface modeling methods are based on B-splines, which involve tensor products. These methods have had success; however, they are limited due to the complex organizational aspect of working with surface patches, and modeling unordered, scattered experimental data points. An alternative method for mathematical joint surface modeling is presented based on the thin-plate spline (TPS). It has the advantage that it does not involve surface patches, and can model scattered data points without experimental data preparation. An analytical surface was developed and modeled with the TPS to quantify its interpolating and smoothing characteristics. Some limitations of the TPS include discontinuity of curvature at exactly the experimental surface data points, and numerical problems dealing with data sets in excess of 2000 points. However, suggestions for overcoming these limitations are presented. Testing the TPS with real experimental data, the patellofemoral joint of a cat was measured with multistation digital photogrammetry and modeled using the TPS to determine cartilage thicknesses and surface curvature. The cartilage thickness distribution ranged between 100 to 550 microns on the patella, and 100 to 300 microns on the femur. It was found that the TPS was an effective tool for modeling joint surfaces because no preparation of the experimental data points was necessary, and the resulting unique function representing the entire surface does not involve surface patches. A detailed algorithm is presented for implementation of the TPS.

Ankle Joint Angle and Lower Leg Musculotendinous Unit Responses to Cryotherapy.

PubMed

Akehi, Kazuma; Long, Blaine C; Warren, Aric J; Goad, Carla L

2016-09-01

Akehi, K, Long, BC, Warren, AJ, and Goad, CL. Ankle joint angle and lower leg musculotendinous unit responses to cryotherapy. J Strength Cond Res 30(9): 2482-2492, 2016-The use of cold application has been debated for its influence on joint range of motion (ROM) and stiffness. The purpose of this study was to determine whether a 30-minute ice bag application to the plantarflexor muscles or ankle influences passive ankle dorsiflexion ROM and lower leg musculotendinous stiffness (MTS). Thirty-five recreationally active college-aged individuals with no history of lower leg injury 6 months before data collection volunteered. On each testing day, we measured maximum passive ankle dorsiflexion ROM (°) and plantarflexor torque (N·m) on an isokinetic dynamometer to calculate the passive plantarflexor MTS (N·m per degree) at 4 joint angles before, during, and after a treatment. Surface electromyography amplitudes (μV), and skin surface and ambient air temperature (°C) were also measured. Subjects received an ice bag to the posterior lower leg, ankle joint, or nothing for 30 minutes in different days. Ice bag application to the lower leg and ankle did not influence passive ROM (F(12,396) = 0.67, p = 0.78). Passive torque increased after ice bag application to the lower leg (F(12,396) = 2.21, p = 0.011). Passive MTS at the initial joint angle increased after ice bag application to the lower leg (F(12,396) = 2.14, p = 0.014) but not at the other joint angles (p > 0.05). Surface electromyography amplitudes for gastrocnemius and soleus muscles increased after ice application to the lower leg (F(2,66) = 5.61, p = 0.006; F(12,396) = 3.60, p < 0.001). Ice bag application to the lower leg and ankle joint does not alter passive dorsiflexion ROM but increases passive ankle plantarflexor torque in addition to passive ankle plantarflexor MTS at the initial joint angle.

Joint Experimentation on Scalable Parallel Processors (JESPP)

DTIC Science & Technology

2006-04-01

made use of local embedded relational databases, implemented using sqlite on each node of an SPP to execute queries and return results via an ad hoc ...rl.af.mil 12a. DISTRIBUTION / AVAILABILITY STATEENT APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. 12b. DISTRIBUTION CODE 13. ABSTRACT...Experimentation Directorate (J9) required expansion of its joint semi-automated forces (JSAF) code capabilities; including number of entities, behavior complexity

Percutaneous foot joint needle placement using a C-arm flat-panel detector CT.

PubMed

Wiewiorski, Martin; Takes, Martin Thanh Long; Valderrabano, Victor; Jacob, Augustinus Ludwig

2012-03-01

Image guidance is valuable for diagnostic injections in foot orthopaedics. Flat-detector computed tomography (FD-CT) was implemented using a C-arm, and the system was tested for needle guidance in foot joint injections. FD-CT-guided joint infiltration was performed in 6 patients referred from the orthopaedic department for diagnostic foot injections. All interventions were performed utilising a flat-panel fluoroscopy system utilising specialised image guidance and planning software. Successful infiltration was defined by localisation of contrast media depot in the targeted joint. The pre- and post-interventional numeric analogue scale (NAS) pain score was assessed. All injections were technically successful. Contrast media deposit was documented in all targeted joints. Significant relief of symptoms was noted by all 6 participants. FD-CT-guided joint infiltration is a feasible method for diagnostic infiltration of midfoot and hindfoot joints. The FD-CT approach may become an alternative to commonly used 2D-fluoroscopically guidance.

Overview of the Implementation of the Climate Data Initiative

NASA Astrophysics Data System (ADS)

Tilmes, C.; Goodman, H. M.; Privette, A. P.

2014-12-01

One of the efforts described in the President's Climate Action Plan is the Climate Data Initiative, a broad effort to leverage the federal government's extensive, freely-available climate-relevant data resources data to spur innovation and private-sector entrepreneurship in order to advance awareness of and preparedness for the impacts of climate change. The Climate Data Initiative, launched in March 2014, leverages commitments from government and the private sector to unleash data and make it accessible in ways that can be used by communities and companies to prepare for climate change. It builds on the White House's other Open Data Initiatives—in areas such as health, education, and safety. The Climate Data Initiative unleashes federal data relevant to addressing climate-related risks and vulnerabilities through the Climate.Data.gov web site. This talk will describe the Climate Data Initiative and its support and interactions with the Climate Resilience Toolkit.

Medical students as health coaches: Implementation of a student-initiated Lifestyle Medicine curriculum.

PubMed

Polak, Rani; Finkelstein, Adi; Axelrod, Tom; Dacey, Marie; Cohen, Matan; Muscato, Dennis; Shariv, Avi; Constantini, Naama W; Brezis, Mayer

2017-11-10

By 2020, the World Health Organization predicts that two-thirds of all diseases worldwide will be the result of lifestyle choices. Physicians often do not counsel patients about healthy behaviors, and lack of training has been identified as one of the barriers. Between 2010 and 2014, Hebrew University developed and implemented a 58-h Lifestyle Medicine curriculum spanning five of the 6 years of medical school. Content includes nutrition, exercise, smoking cessation, and behavior change, as well as health coaching practice with friends/relatives (preclinical years) and patients (clinical years). This report describes this development and diffusion process, and it also presents findings related to the level of acceptance of this student-initiated Lifestyle Medicine (LM) curriculum. Students completed an online semi-structured questionnaire after the first coaching session (coaching questionnaire) and the last coaching session (follow-up questionnaire). Nine hundred and twenty-three students completed the coaching questionnaire (296 practices were with patients, 627 with friends /relatives); and 784 students completed the follow-up questionnaire (208 practices were with patients, 576 with friends /relatives). They reported overall that health coaching domains included smoking cessation (263 students), nutrition (79), and exercise (117); 464 students reported on combined topics. Students consistently described a high acceptance of the curriculum and their active role in coaching. Further, most students reported that they were eager to address their own health behaviors. We described the development and acceptance of a student-initiated comprehensive LM curriculum. Students perceived LM as an important component of physicians' professional role and were ready to explore it both as coaches and in their personal lives. Thus, medical school deans might consider developing similar initiatives in order to position medical schools as key players within a preventive strategy

Relevance of adjacent joint imaging in the evaluation of ankle fractures.

PubMed

Antoci, Valentin; Patel, Shaun P; Weaver, Michael J; Kwon, John Y

2016-10-01

Routinely obtaining adjacent joint radiographs when evaluating patients with ankle fractures may be of limited clinical utility and an unnecessary burden, particularly in the absence of clinical suspicion for concomitant injuries. One thousand, three hundred and seventy patients who sustained ankle fractures over a 5-year period presenting to two level 1 trauma centers were identified. Medical records were retrospectively reviewed for demographics, physical examination findings, and radiographic information. Analyses included descriptive statistics along with sensitivity and predictive value calculations for the presence of adjacent joint fracture. Adjacent joint imaging (n=1045 radiographs) of either the knee or foot was obtained in 873 patients (63.7%). Of those, 75/761 patients (9.9%) demonstrated additional fractures proximal to the ankle joint, most commonly of the proximal fibula. Twenty-two of 284 (7.7%) demonstrated additional fractures distal to the ankle joint, most commonly of the metatarsals. Tenderness to palpation demonstrated sensitivities of 0.92 and 0.77 and positive predictive values of 0.94 and 0.89 for the presence of proximal and distal fractures, respectively. Additionally, 19/22 (86.4%) of patients sustaining foot fractures had their injury detectable on initial ankle X-rays. Overall, only 5.5% (75/1370) of patients sustained fractures proximal to the ankle and only 0.2% (3/1370) of patients had additional foot fractures not evident on initial ankle X-rays. The addition of adjacent joint imaging for the evaluation of patients sustaining ankle fractures is low yield. As such, patient history, physical examination, and clinical suspicion should direct the need for additional X-rays. Level IV. Copyright © 2016 Elsevier Ltd. All rights reserved.

Corrosion Performance of Friction Stir Linear Lap Welded AM60B Joints

NASA Astrophysics Data System (ADS)

Kish, J. R.; Birbilis, N.; McNally, E. M.; Glover, C. F.; Zhang, X.; McDermid, J. R.; Williams, G.

2017-11-01

A corrosion investigation of friction stir linear lap welded AM60B joints used to fabricate an Mg alloy-intensive automotive front end sub-assembly was performed. The stir zone exhibited a slightly refined grain size and significant break-up and re-distribution of the divorced Mg17Al12 (β-phase) relative to the base material. Exposures in NaCl (aq) environments revealed that the stir zone was more susceptible to localized corrosion than the base material. Scanning vibrating electrode technique measurements revealed differential galvanic activity across the joint. Anodic activity was confined to the stir zone surface and involved initiation and lateral propagation of localized filaments. Cathodic activity was initially confined to the base material surface, but was rapidly modified to include the cathodically-activated corrosion products in the filament wake. Site-specific surface analyses revealed that the corrosion observed across the welded joint was likely linked to variations in Al distribution across the surface film/metal interface.

CHANGES IN PATELLOFEMORAL JOINT STRESS DURING RUNNING WITH THE APPLICATION OF A PREFABRICATED FOOT ORTHOTIC.

PubMed

Almonroeder, Thomas G; Benson, Lauren C; O'Connor, Kristian M

2015-12-01

Foot orthotics are commonly utilized in the treatment of patellofemoral pain (PFP) and have shown clinical benefit; however, their mechanism of action remains unclear. Patellofemoral joint stress (PFJS) is thought to be one of the main etiological factors associated with PFP. The primary purpose of this study was to investigate the effects of a prefabricated foot orthotic with 5 ° of medial rearfoot wedging on the magnitude and the timing of the peak PFJS in a group of healthy female recreational athletes. The hypothesis was that there would be significant reduction in the peak patellofemoral joint stress and a delay in the timing of this peak in the orthotic condition. Cross-sectional. Kinematic and kinetic data were collected during running trials in a group of healthy, female recreational athletes. The knee angle and moment data in the sagittal plane were incorporated into a previously developed model to estimate patellofemoral joint stress. The dependent variables of interest were the peak patellofemoral joint stress as well as the percentage of stance at which this peak occurred, as both the magnitude and the timing of the joint loading are thought to be important in overuse running injuries. The peak patellofemoral joint stress significantly increased in the orthotic condition by 5.8% (p=.02, ES=0.24), which does not support the initial hypothesis. However, the orthotic did significantly delay the timing of the peak during the stance phase by 3.8% (p=.002, ES=0.47). The finding that the peak patellofemoral joint stress increased in the orthotic condition did not support the initial hypothesis. However, the finding that the timing of this peak was delayed to later in the stance phase in the orthotic condition did support the initial hypothesis and may be related to the clinical improvements previously reported in subjects with PFP. Level 4.

Initial planetary base construction techniques and machine implementation

NASA Technical Reports Server (NTRS)

Crockford, William W.

1987-01-01

Conceptual designs of (1) initial planetary base structures, and (2) an unmanned machine to perform the construction of these structures using materials local to the planet are presented. Rock melting is suggested as a possible technique to be used by the machine in fabricating roads, platforms, and interlocking bricks. Identification of problem areas in machine design and materials processing is accomplished. The feasibility of the designs is contingent upon favorable results of an analysis of the engineering behavior of the product materials. The analysis requires knowledge of several parameters for solution of the constitutive equations of the theory of elasticity. An initial collection of these parameters is presented which helps to define research needed to perform a realistic feasibility study. A qualitative approach to estimating power and mass lift requirements for the proposed machine is used which employs specifications of currently available equipment. An initial, unmanned mission scenario is discussed with emphasis on identifying uncompleted tasks and suggesting design considerations for vehicles and primitive structures which use the products of the machine processing.

Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques.

PubMed

Harwich, Andrew S

2017-12-01

The objective of this study was to describe the initial stage of a generalized theory of high-velocity, low-amplitude thrust (HVLAT) techniques for joint manipulation. This study examined the movements described by authors from the fields of osteopathy, chiropractic, and physical therapy to produce joint cavitation in both the metacarpophalangeal (MCP) joint and the cervical spine apophysial joint. This study qualitatively compared the kinetics, the similarities, and the differences between MCP cavitation and cervical facet joint cavitation. A qualitative vector analysis of forces and movements was undertaken by constructing computer-generated, simplified graphical models of the MCP joint and a typical cervical apophysial joint and imposing the motions dictated by the clinical technique. Comparing the path to cavitation of 2 modes of HVLAT for the MCP joint, namely, distraction and hyperflexion, it was found that the hyperflexion method requires an axis of rotation, the hinge axis, which is also required for cervical HVLAT. These results show that there is an analogue of cervical HVLAT in one of the MCP joint HVLATs. The study demonstrated that in a theoretical model, the path to joint cavitation is the same for asymmetric separation of the joint surfaces in the cervical spine and the MCP joints.

Joint attention, language, social relating, and stereotypical behaviours in children with autistic disorder.

PubMed

Delinicolas, Erin K; Young, Robyn L

2007-09-01

This study aimed to investigate the relationships between abilities to initiate and respond to joint attention and symptoms of autism that have, and have not, been theoretically linked to joint attention. Participants were 51 boys and five girls with autistic disorder, aged between 2 years and 6 years 5 months. Measures of joint attention behaviours, language, social relating, and stereotypical behaviour were administered during a single assessment. As predicted, the correlations between joint attention and the two behaviours theoretically linked to joint attention (i.e. social relating and language) were significantly stronger than those between joint attention and the behaviour not theoretically linked (i.e. stereotypical behaviour). While causation cannot be inferred from this study, these results support the suggestion that difficulties with joint attention behaviours commonly found among children with autism are linked to language and social relating, beyond what might be expected simply due to their co-occurrence as symptoms.

A play and joint attention intervention for teachers of young children with autism: a randomized controlled pilot study.

PubMed

Wong, Connie S

2013-05-01

The aim of this study was to pilot test a classroom-based intervention focused on facilitating play and joint attention for young children with autism in self-contained special education classrooms. Thirty-three children with autism between the ages of 3 and 6 years participated in the study with their classroom teachers (n = 14). The 14 preschool special education teachers were randomly assigned to one of three groups: (1) symbolic play then joint attention intervention, (2) joint attention then symbolic intervention, and (3) wait-list control period then further randomized to either group 1 or group 2. In the intervention, teachers participated in eight weekly individualized 1-h sessions with a researcher that emphasized embedding strategies targeting symbolic play and joint attention into their everyday classroom routines and activities. The main child outcome variables of interest were collected through direct classroom observations. Findings indicate that teachers can implement an intervention to significantly improve joint engagement of young children with autism in their classrooms. Furthermore, multilevel analyses showed significant increases in joint attention and symbolic play skills. Thus, these pilot data emphasize the need for further research and implementation of classroom-based interventions targeting play and joint attention skills for young children with autism.

Patterns of Ninety-Day Readmissions Following Total Joint Replacement in a Bundled Payment Initiative.

PubMed

Behery, Omar A; Kester, Benjamin S; Williams, Jarrett; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2017-04-01

Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis. A retrospective cohort of 80 readmissions out of 1412 total joint replacement patients reimbursed through a bundled payment plan was analyzed. Patients were grouped by readmission diagnosis (surgical or medical) and the main variables analyzed were time to readmission, location of readmission, and baseline Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores capturing pre-existing state of health. Nonparametric tests and multivariable regressions were used to test associations. Surgical readmissions occurred earlier than medical readmissions (mean 18 vs 33 days, P = .011), and were more likely to occur at the hospital where the surgery was performed (P = .035). Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores did not predict medical vs surgical readmissions (P = .466 and .879) after adjusting for confounding variables. Readmissions appear to follow different patterns depending on whether they are surgical or medical. Surgical readmissions occur earlier than medical readmissions, and more often at the hospital where the surgery was performed. The results of this study suggest that these 2 types of readmissions have different patterns with different implications toward perioperative care and follow-up after total joint replacement. Copyright © 2016 Elsevier Inc

Design fabrication and test of graphite/polyimide composite joints and attachments for advanced aerospace vehicles

NASA Technical Reports Server (NTRS)

1979-01-01

Graphite/polyimide (Gr/PI) bolted and bonded joints were investigated. Possible failure modes and the design loads for the four generic joint types are discussed. Preliminary sizing of a type 1 joint, bonded and bolted configuration is described, including assumptions regarding material properties and sizing methodology. A general purpose finite element computer code is described that was formulated to analyze single and double lap joints, with and without tapered adherends, and with user-controlled variable element size arrangements. An initial order of Celion 6000/PMR-15 prepreg was received and characterized.

Trans-dimensional joint inversion of seabed scattering and reflection data.

PubMed

Steininger, Gavin; Dettmer, Jan; Dosso, Stan E; Holland, Charles W

2013-03-01

This paper examines joint inversion of acoustic scattering and reflection data to resolve seabed interface roughness parameters (spectral strength, exponent, and cutoff) and geoacoustic profiles. Trans-dimensional (trans-D) Bayesian sampling is applied with both the number of sediment layers and the order (zeroth or first) of auto-regressive parameters in the error model treated as unknowns. A prior distribution that allows fluid sediment layers over an elastic basement in a trans-D inversion is derived and implemented. Three cases are considered: Scattering-only inversion, joint scattering and reflection inversion, and joint inversion with the trans-D auto-regressive error model. Including reflection data improves the resolution of scattering and geoacoustic parameters. The trans-D auto-regressive model further improves scattering resolution and correctly differentiates between strongly and weakly correlated residual errors.

Degenerative joint disease: multiple joint involvement in young and mature dogs.

PubMed

Olsewski, J M; Lust, G; Rendano, V T; Summers, B A

1983-07-01

Radiologic, pathologic, and ancillary methods were used to determine the occurrence of degenerative joint disease involving multiple joints of immature and adult dogs. Animals were selected for the development of hip joint dysplasia and chronic degenerative joint disease. Of disease-prone dogs, 82% (45 of 55 dogs) had radiologic changes, indicative of hip dysplasia, by 1 year of age. At necropsy, more abnormal joints were identified than by radiographic examination. Among 92 dogs between 3 to 11 months of age that had joint abnormalities, 71% had hip joint involvement; 38%, shoulder joint involvement; 22%, stifle joint involvement; and 40% had multiple joint involvement. Polyarthritis was asymptomatic and unexpected. Radiographic examination of older dogs also revealed evidence of degenerative joint disease in many joints. Multiple joint involvement was substantiated at necropsy of young and mature dogs. A similar pattern of polyarticular osteoarthritis was revealed in a survey (computer search) of necropsy reports from medical case records of 100 adult and elderly dogs. Usually, the joint disease was an incidental observation, unrelated to the clinical disease or to the cause of death. The frequent occurrence of degenerative changes in several joints of dogs aged 6 months to 17 years indicated that osteoarthritis may be progressive in these joints and raises the possibility that systemic factors are involved in the disease process.

Implementing an mHealth system for substance use disorders in primary care: a mixed methods study of clinicians' initial expectations and first year experiences.

PubMed

Mares, Marie-Louise; Gustafson, David H; Glass, Joseph E; Quanbeck, Andrew; McDowell, Helene; McTavish, Fiona; Atwood, Amy K; Marsch, Lisa A; Thomas, Chantelle; Shah, Dhavan; Brown, Randall; Isham, Andrew; Nealon, Mary Jane; Ward, Victoria

2016-09-29

Millions of Americans need but don't receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs' implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients' health tracking and relapses. We examined (a) clinicians' initial perspectives about implementing Seva, and (b) the first year of implementation at Site 1. Prior to staggered implementation at three FQHCs (Midwest city in WI vs. rural town in MT vs. metropolitan NY), interviews, meetings, and focus groups were conducted with 53 clinicians to identify core themes of initial expectations about implementation. One year into implementation at Site 1, clinicians there were re-interviewed. Their reports were supplemented by quantitative data on clinician and patient use of Seva. Clinicians anticipated that Seva could help patients and make behavioral health appointments more efficient, but they were skeptical that physicians would engage with Seva (given high caseloads), and they were uncertain whether patients would use Seva. They were concerned about legal obligations for monitoring patients' interactions online, including possible "cries for help" or inappropriate interactions. One year later at Site 1, behavioral health care providers, rather than physicians, had incorporated Seva into patient care, primarily by discussing it during appointments. Given workflow/load concerns, only a few key clinicians monitored health tracking/relapses and prompted outreach when needed; two researchers monitored the discussion board and alerted the clinic as needed

Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women's hospitals.

PubMed

Fisher, Jane; Chatham, Elizabeth; Haseler, Sally; McGaw, Beth; Thompson, Jane

2012-12-01

Australia is a leader in recognising that perinatal mental health problems are prevalent and constitute a significant burden of disease among women. In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) to address this. To investigate implementation of Australia's NPDI. Data were collected by a structured online survey assessing: screening for depression and depression risk in women receiving antenatal and postnatal care; staff training about perinatal depression; barriers and enablers to implementing the NPDI recommendations. All Australian members of Women's Healthcare Australasia (WHA) were invited to complete the survey in March 2011. Of 30 Australian WHA members, 14 (46.6%) completed the survey. The sample included a representative distribution of small, medium and large hospitals. All respondents had introduced some NPDI recommendations. Most (80%) reported using the Edinburgh Postnatal Depression Scale (EPDS) to screen for antenatal depression and for risk of developing depression but at varied gestational ages, and with differing cut-off scores for follow-up or referral. Only one assessed depression status postpartum. Responsibility for screening and feedback was predominantly assigned to midwives, most of whom were offered <4 h training. Implementation barriers included insufficient personnel; per-client time requirements; insufficient clarity about screening protocols; difficulties modifying the medical record; few referral options and a lack of training resources. Implementation of the NPDI is uneven among Australian maternity hospitals. Little is known about perinatal mental health screening practices in the private sector and hospitals with <1000 births annually. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Working together: a joint initiative between academics and clinicians to prepare undergraduate nursing students to work in mental health settings.

PubMed

Curtis, Janette

2007-08-01

There is ongoing concern among mental health professionals regarding the recruitment of newly graduated nurses to this specialist nursing area. Many reasons for the problem have been identified, including the perceived inadequate preparation by the tertiary sector, students' prejudices and anxieties about mental illness, a perceived lack of support while undertaking clinical placement, and the quality of the clinical placement itself. This paper describes a collaborative response to these issues undertaken in the Illawarra region of New South Wales, Australia. The implementation of preclinical undergraduate workshops using problem-based learning and role plays were undertaken. Mental health nursing scenarios were developed in association with experienced clinicians to introduce core concepts in a supportive learning environment. Quantitative and qualitative evaluation data were collected immediately following the workshop and again after the students returned to the university following a mental health clinical placement. A further survey of one cohort was undertaken 12 months after initial state registration and the beginning of a career in mental health nursing. Results showed that both students' and clinicians' attitudes to the workshops were consistently positive and indicated that the workshops were beneficial in preparing students for their clinical placement. Importantly, since the implementation of the workshops and other collaborative initiatives, an increasing number of newly graduated nurses from the region are choosing to work in mental health.

Evaluation of anticollagen type I antibody titers in synovial fluid of both stifle joints and the left shoulder joint of dogs with unilateral cranial cruciate disease.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Cox, Eric

2007-03-01

To evaluate anticollagen type I antibodies in synovial fluid of the affected stifle joint, the contralateral stifle joint, and the left shoulder joint of dogs with unilateral cranial cruciate ligament (CrCL) rupture during an extended period of 12 to 18 months. 13 client-owned dogs with CrCL rupture and 2 sham-operated dogs. All dogs were examined and arthrocentesis of all 3 joints was performed every 6 months after surgery. Synovial fluid samples were tested for anticollagen type I antibodies by use of an ELISA. Dogs with partial CrCL rupture had higher antibody titers than dogs with complete rupture. Six of 13 dogs ruptured the contralateral CrCL during the study, whereby higher antibody titers were found for the stifle joints than for the shoulder joint. Seronegative dogs or dogs with extremely low antibody titers and 2 dogs with high antibody titers did not sustain a CrCL rupture in the contralateral stifle joint. In most dogs that had a CrCL rupture of the contralateral stifle joint, a distinct antibody titer gradient toward the stifle joints was detected, suggesting that there was a local inflammatory process in these joints. However, only a small number of sham-operated dogs were used to calculate the cutoff values used to determine the anticollagen type I antibody titers in these patients. Synovial fluid antibodies against collagen type I alone do not initiate CrCL rupture because not all dogs with high antibody titers sustained a CrCL rupture in the contralateral stifle joint.

Extending systematic reviews to include evidence on implementation: methodological work on a review of community-based initiatives to prevent injuries.

PubMed

Roen, Katrina; Arai, Lisa; Roberts, Helen; Popay, Jennie

2006-08-01

Unintentional injury is a leading cause of mortality and disability among young and old. While evidence about the effectiveness of interventions in reducing injuries is accumulating, reviews of this evidence frequently fail to include details of implementation processes. Our research, of which the work reported here formed a part, had two main objectives: (1) to identify evidence about the implementation of interventions aimed at reducing unintentional injuries amongst children and young people; and (2) to explore methods for systematically reviewing evidence on implementation. Existing systematic reviews of the effectiveness of interventions aiming to reduce unintentional injuries in children and young people formed the starting point for the work reported here. In summary, many of the published papers we identified contained little information on implementation processes and, even when these were discussed, the extent to which authors' claims were based on research evidence was unclear. On the basis of the studies we reviewed implementation data were insufficiently strong to provide a sound evidence base for practitioners and policymakers. Notwithstanding this, we identified valuable data about the context in which such initiatives are implemented and the type of factors that might impinge on implementation. This work has implications in three areas: (1) researchers with an interest in evidence-based public health could be encouraged to consider implementation issues in the design of intervention studies; (2) funding bodies could be encouraged to prioritise intervention studies using mixed methods that will enable researchers to consider effectiveness and implementation; (3) journal editors could work towards increasing the quality of reporting on implementation issues through the development of guidelines.

Speeding Up the Bilateral Filter: A Joint Acceleration Way.

PubMed

Dai, Longquan; Yuan, Mengke; Zhang, Xiaopeng

2016-06-01

Computational complexity of the brute-force implementation of the bilateral filter (BF) depends on its filter kernel size. To achieve the constant-time BF whose complexity is irrelevant to the kernel size, many techniques have been proposed, such as 2D box filtering, dimension promotion, and shiftability property. Although each of the above techniques suffers from accuracy and efficiency problems, previous algorithm designers were used to take only one of them to assemble fast implementations due to the hardness of combining them together. Hence, no joint exploitation of these techniques has been proposed to construct a new cutting edge implementation that solves these problems. Jointly employing five techniques: kernel truncation, best N-term approximation as well as previous 2D box filtering, dimension promotion, and shiftability property, we propose a unified framework to transform BF with arbitrary spatial and range kernels into a set of 3D box filters that can be computed in linear time. To the best of our knowledge, our algorithm is the first method that can integrate all these acceleration techniques and, therefore, can draw upon one another's strong point to overcome deficiencies. The strength of our method has been corroborated by several carefully designed experiments. In particular, the filtering accuracy is significantly improved without sacrificing the efficiency at running time.

Joint Military Education: Actions Needed to Implement DOD Recommendations for Enhancing Leadership Development

DTIC Science & Technology

2013-10-01

Joint Chiefs of Staff. The university conducts JPME seminars, symposia, and professional development and conferencing for DOD and Congressional...all enlisted personnel. Basic Enlisted JPME addresses educational guidelines that should be completed by pay grade E -6,20 while Career Enlisted JPME...addresses educational guidelines for senior enlisted personnel in grades E -6 or E -7 and above. Beyond these

Delivery, Student Engagement and the Implementation of Good Practice in Entrepreneurship Education: Learning from the UK's New Entrepreneur Scholarship Initiative

ERIC Educational Resources Information Center

Lam, Wing

2010-01-01

This paper presents and discusses the results of a research-informed teaching project carried out to identify key factors in the content and delivery of a successful UK government initiative, the New Entrepreneur Scholarship (NES), from 2001 to 2008. The aim of the project was to evaluate the feasibility of implementing appropriate changes to…

OEI and OPA Issue a Joint Memorandum of Understanding (2002 Memo)

EPA Pesticide Factsheets

This MOU delineates certain interdependent functions, oversight responsibilities, and joint initiatives of the Office of Public Affairs (OPA) and the Office of Environmental Information (OEI) for the Agency's public Web site.

Spacesuit mobility joints

NASA Technical Reports Server (NTRS)

Vykukal, H. C. (Inventor)

1978-01-01

Joints for use in interconnecting adjacent segments of an hermetically sealed spacesuit which have low torques, low leakage and a high degree of reliability are described. Each of the joints is a special purpose joint characterized by substantially constant volume and low torque characteristics. Linkages which restrain the joint from longitudinal distension and a flexible, substantially impermeable diaphragm of tubular configuration spanning the distance between pivotally supported annuli are featured. The diaphragms of selected joints include rolling convolutions for balancing the joints, while various joints include wedge-shaped sections which enhance the range of motion for the joints.

Incudomalleal joint formation: the roles of apoptosis, migration and downregulation

PubMed Central

Amin, Susan; Matalova, Eva; Simpson, Carol; Yoshida, Hiroki; Tucker, Abigail S

2007-01-01

Background The middle ear of mammals is composed of three endochondrial ossicles, the stapes, incus and malleus. Joints link the malleus to the incus and the incus to the stapes. In the mouse the first arch derived malleus and incus are formed from a single Sox9 and Type II collagen expressing condensation that later subdivides to give rise to two separate ossicles. In contrast the stapes forms from a separate condensation derived from the second branchial arch. Fusion of the malleus and incus is observed in a number of human syndromes and results in conductive hearing loss. Understanding how this joint forms during normal development is thus an important step in furthering our understanding of such defects. Results We show that the developing incudomalleal joint is characterised by a lack of proliferation and discrete areas of apoptosis. Apoptosis has been suggested to aid in the removal of pre-cartilaginous cells from the joint region, allowing for the physical separation of the cartilaginous elements, however, we show that joint initiation is unaffected by blocking apoptosis. There is also no evidence of cell migration out of the presumptive joint region, as observed by labelling of joint and ossicle cells in culture. Using Type II collagen lacZ reporter mice, however, it is evident that cells in the presumptive joint region remain in place and downregulate cartilage markers. Conclusion The malleus and incus first appear as a single united condensation expressing early cartilage markers. The incudomalleal joint region forms by cells in the presumptive joint region switching off cartilage markers and turning on joint markers. Failure in this process may result in fusion of this joint, as observed in human syndromes such as Branchio-Oto-Renal Syndrome or Treacher Collins Syndrome. PMID:18053235

The Ponseti method in Latin America: initial impact and barriers to its diffusion and implementation.

PubMed

Boardman, Allison; Jayawardena, Asitha; Oprescu, Florin; Cook, Thomas; Morcuende, Jose A

2011-01-01

The Ponseti method for correcting clubfoot is a safe, effective, and minimally invasive treatment that has recently been implemented in Latin America. This study evaluates the initial impact and unique barriers to the diffusion of the Ponseti method throughout this region. Structured interviews were conducted with 30 physicians practicing the Ponseti method in three socioeconomically diverse countries: Chile, Peru and Guatemala. Since learning the Ponseti method, these physicians have treated approximately 1,740 clubfoot patients, with an estimated 1,705 (98%) patients treated using the Ponseti method, and 35 (2%) patients treated using surgical techniques. The barriers were classified into the following themes: physician education, health care system of the country, culture and beliefs of patients, physical distance and transport, financial barriers for patients, and parental compliance with the method. The results yielded several common barriers throughout Latin America including lack of physician education, physical distance to the treatment centers, and financial barriers for patients. Information from this study can be used to inform, and to implement and evaluate specific strategies to improve the diffusion of the Ponseti method for treating clubfoot throughout Latin America.

Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability.

PubMed

Yu, Binsheng; Zheng, Zhaomin; Zhuang, Xinming; Chen, Hui; Xie, Denghui; Luk, K D K; Lu, W W

2009-06-01

In vitro laboratory study. To measure the effects of transverse partial sacrectomies on the compressive and torsional stiffness of the sacroiliac joints. Surgical treatment for sacral tumor of different location and nature includes partial or complete sacrectomy. Though the biomechanical investigations about the local destructive force of residual sacrum after partial sacrectomy have been reported, biomechanical properties of the residual sacroiliac joints after different transverse partial sacrectomies remain unknown. Seven fresh human cadaveric L5-pelves with normal bone mineral density were used in this study. Each specimen was tested in intact condition first, followed by a series of segmental transverse partial sacrectomies: under S2 partial sacrectomy (U-S2); U-(1/2)S2; U-S1; U-(1/2)S1; and right side sacroiliac joint resection (one-side). A material testing machine was used to apply 800 N compression and 7 Nm torsion loads through the L5/S1 joint. The resected dimensional area of sacroiliac joints and structural stiffness of the residual sacroiliac joints were analyzed. Average percentages of the resected area of sacroiliac joints were 8.4% in U-S2, 15.1% in U-(1/2)S2, 24.8% in U-S1, and 72.3% in U-(1/2)S1, respectively. In compression U-S2 approximately one-side preserved 98.7%, 97.1%, 94.4%, 82.9%, and 55.2% of the initial stiffness of the sacroiliac joint, respectively. No significant differences were detected among intact, U-S2, U-(1/2)S2, and U-S1 (P > 0.05). However, compressive stiffness of U-(1/2)S1 and one-side was markedly less than that of intact, U-S2, and U-(1/2)S2 (P < 0.05). In Torsion U-S2 approximately one-side preserved 90.7%, 88.5%, 81.9%, 71.9%, and 44.5% of the initial sacroiliac joint stiffness, respectively. No significant differences were demonstrated among intact, U-S2, and U-(1/2)S2 (P > 0.05); However, U-S1, U-(1/2)S1 and one-side exhibited significantly less torsional stiffness than intact and U-S2 (P < 0.05). In surgical

Experimental joint quantum measurements with minimum uncertainty.

PubMed

Ringbauer, Martin; Biggerstaff, Devon N; Broome, Matthew A; Fedrizzi, Alessandro; Branciard, Cyril; White, Andrew G

2014-01-17

Quantum physics constrains the accuracy of joint measurements of incompatible observables. Here we test tight measurement-uncertainty relations using single photons. We implement two independent, idealized uncertainty-estimation methods, the three-state method and the weak-measurement method, and adapt them to realistic experimental conditions. Exceptional quantum state fidelities of up to 0.999 98(6) allow us to verge upon the fundamental limits of measurement uncertainty.

Finite element model updating of riveted joints of simplified model aircraft structure

NASA Astrophysics Data System (ADS)

Yunus, M. A.; Rani, M. N. Abdul; Sani, M. S. M.; Shah, M. A. S. Aziz

2018-04-01

Thin metal sheets are widely used to fabricate a various type of aerospace structures because of its flexibility and easily to form into any type shapes of structure. The riveted joint has turn out to be one of the popular joint types in jointing the aerospace structures because they can be easily be disassembled, maintained and inspected. In this paper, thin metal sheet components are assembled together via riveted joints to form a simplified model of aerospace structure. However, to model the jointed structure that are attached together via the mechanical joints such as riveted joint are very difficult due to local effects. Understandably that the dynamic characteristic of the joined structure can be significantly affected by these joints due to local effects at the mating areas of the riveted joints such as surface contact, clamping force and slips. A few types of element connectors that available in MSC NATRAN/PATRAN have investigated in order to presented as the rivet joints. Thus, the results obtained in term of natural frequencies and mode shapes are then contrasted with experimental counterpart in order to investigate the acceptance level of accuracy between element connectors that are used in modelling the rivet joints of the riveted joints structure. The reconciliation method via finiteelement model updating is used to minimise the discrepancy of the initial finite element model of the riveted joined structure as close as experimental data and their results are discussed.

Improving transition of care for veterans after total joint replacement.

PubMed

Green, Uthona R; Dearmon, Valorie; Taggart, Helen

2015-01-01

Patients transitioning from hospital to home are at risk for readmission to the hospital. Readmissions are costly and occur too often. Standardized discharge education processes have shown to decrease readmissions. The purpose of this quality improvement project was to utilize evidence-based practice changes to decrease 30-day all-cause readmissions after total joint replacement. Review of literature revealed that improved discharge education can decrease unnecessary readmissions after discharge. A quality improvement project was developed including standardized total joint replacement discharge education, teach-back education methodology, and improved postdischarge telephone follow-up. The quality improvement project was initiated and outcomes were evaluated. Improving coordination of the discharge process, enhanced education for patients/caregivers, and postdischarge follow-up decreased total joint replacement readmissions.

Influence of the implant-abutment connection design and diameter on the screw joint stability.

PubMed

Shin, Hyon-Mo; Huh, Jung-Bo; Yun, Mi-Jeong; Jeon, Young-Chan; Chang, Brian Myung; Jeong, Chang-Mo

2014-04-01

This study was conducted to evaluate the influence of the implant-abutment connection design and diameter on the screw joint stability. Regular and wide-diameter implant systems with three different joint connection designs: an external butt joint, a one-stage internal cone, and a two-stage internal cone were divided into seven groups (n=5, in each group). The initial removal torque values of the abutment screw were measured with a digital torque gauge. The postload removal torque values were measured after 100,000 cycles of a 150 N and a 10 Hz cyclic load had been applied. Subsequently, the rates of the initial and postload removal torque losses were calculated to evaluate the effect of the joint connection design and diameter on the screw joint stability. Each group was compared using Kruskal-Wallis test and Mann-Whitney U test as post-hoc test (α=0.05). THE POSTLOAD REMOVAL TORQUE VALUE WAS HIGH IN THE FOLLOWING ORDER WITH REGARD TO MAGNITUDE: two-stage internal cone, one-stage internal cone, and external butt joint systems. In the regular-diameter group, the external butt joint and one-stage internal cone systems showed lower postload removal torque loss rates than the two-stage internal cone system. In the wide-diameter group, the external butt joint system showed a lower loss rate than the one-stage internal cone and two-stage internal cone systems. In the two-stage internal cone system, the wide-diameter group showed a significantly lower loss rate than the regular-diameter group (P<.05). The results of this study showed that the external butt joint was more advantageous than the internal cone in terms of the postload removal torque loss. For the difference in the implant diameter, a wide diameter was more advantageous in terms of the torque loss rate.

Influence of the implant-abutment connection design and diameter on the screw joint stability

PubMed Central

Shin, Hyon-Mo; Huh, Jung-Bo; Yun, Mi-Jeong; Jeon, Young-Chan; Chang, Brian Myung

2014-01-01

PURPOSE This study was conducted to evaluate the influence of the implant-abutment connection design and diameter on the screw joint stability. MATERIALS AND METHODS Regular and wide-diameter implant systems with three different joint connection designs: an external butt joint, a one-stage internal cone, and a two-stage internal cone were divided into seven groups (n=5, in each group). The initial removal torque values of the abutment screw were measured with a digital torque gauge. The postload removal torque values were measured after 100,000 cycles of a 150 N and a 10 Hz cyclic load had been applied. Subsequently, the rates of the initial and postload removal torque losses were calculated to evaluate the effect of the joint connection design and diameter on the screw joint stability. Each group was compared using Kruskal-Wallis test and Mann-Whitney U test as post-hoc test (α=0.05). RESULTS The postload removal torque value was high in the following order with regard to magnitude: two-stage internal cone, one-stage internal cone, and external butt joint systems. In the regular-diameter group, the external butt joint and one-stage internal cone systems showed lower postload removal torque loss rates than the two-stage internal cone system. In the wide-diameter group, the external butt joint system showed a lower loss rate than the one-stage internal cone and two-stage internal cone systems. In the two-stage internal cone system, the wide-diameter group showed a significantly lower loss rate than the regular-diameter group (P<.05). CONCLUSION The results of this study showed that the external butt joint was more advantageous than the internal cone in terms of the postload removal torque loss. For the difference in the implant diameter, a wide diameter was more advantageous in terms of the torque loss rate. PMID:24843398

10 CFR 1021.216 - Procurement, financial assistance, and joint ventures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... a decision on proposals and will include: (1) A brief discussion of the purpose of the procurement... 10 Energy 4 2010-01-01 2010-01-01 false Procurement, financial assistance, and joint ventures... POLICY ACT IMPLEMENTING PROCEDURES DOE Decisionmaking § 1021.216 Procurement, financial assistance, and...

Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

PubMed

Jankowski, Irene M; Nadzam, Deborah Morris

2011-06-01

Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

Accessible Transportation Technologies Research Initiative (ATTRI) : User Needs Assessment: Stakeholder Engagement Report.

DOT National Transportation Integrated Search

2016-05-01

The Accessible Transportation Technologies Research Initiative (ATTRI) is a joint U.S. Department of Transportation (U.S. DOT) initiative that is co-led by the Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA). ATTRI ...

Infrastructure Joint Venture Projects in Malaysia: A Preliminary Study

NASA Astrophysics Data System (ADS)

Romeli, Norsyakilah; Muhamad Halil, Faridah; Ismail, Faridah; Sufian Hasim, Muhammad

2018-03-01

As many developed country practise, the function of the infrastructure is to connect the each region of Malaysia holistically and infrastructure is an investment network projects such as transportation water and sewerage, power, communication and irrigations system. Hence, a billions allocations of government income reserved for the sake of the infrastructure development. Towards a successful infrastructure development, a joint venture approach has been promotes by 2016 in one of the government thrust in Construction Industry Transformation Plan which encourage the internationalisation among contractors. However, there is depletion in information on the actual practise of the infrastructure joint venture projects in Malaysia. Therefore, this study attempt to explore the real application of the joint venture in Malaysian infrastructure projects. Using the questionnaire survey, a set of survey question distributed to the targeted respondents. The survey contained three section which the sections are respondent details, organizations background and project capital in infrastructure joint venture project. The results recorded and analyse using SPSS software. The contractors stated that they have implemented the joint venture practice with mostly the client with the usual construction period of the infrastructure project are more than 5 years. Other than that, the study indicates that there are problems in the joint venture project in the perspective of the project capital and the railway infrastructure should be given a highlights in future study due to its high significant in term of cost and technical issues.

Camera pose estimation to improve accuracy and reliability of joint angles assessed with attitude and heading reference systems.

PubMed

Lebel, Karina; Hamel, Mathieu; Duval, Christian; Nguyen, Hung; Boissy, Patrick

2018-01-01

Joint kinematics can be assessed using orientation estimates from Attitude and Heading Reference Systems (AHRS). However, magnetically-perturbed environments affect the accuracy of the estimated orientations. This study investigates, both in controlled and human mobility conditions, a trial calibration technic based on a 2D photograph with a pose estimation algorithm to correct initial difference in AHRS Inertial reference frames and improve joint angle accuracy. In controlled conditions, two AHRS were solidly affixed onto a wooden stick and a series of static and dynamic trials were performed in varying environments. Mean accuracy of relative orientation between the two AHRS was improved from 24.4° to 2.9° using the proposed correction method. In human conditions, AHRS were placed on the shank and the foot of a participant who performed repeated trials of straight walking and walking while turning, varying the level of magnetic perturbation in the starting environment and the walking speed. Mean joint orientation accuracy went from 6.7° to 2.8° using the correction algorithm. The impact of starting environment was also greatly reduced, up to a point where one could consider it as non-significant from a clinical point of view (maximum mean difference went from 8° to 0.6°). The results obtained demonstrate that the proposed method improves significantly the mean accuracy of AHRS joint orientation estimations in magnetically-perturbed environments and can be implemented in post processing of AHRS data collected during biomechanical evaluation of motion. Copyright © 2017 Elsevier B.V. All rights reserved.

Research into automatic recognition of joints in human symmetrical movements

NASA Astrophysics Data System (ADS)

Fan, Yifang; Li, Zhiyu

2008-03-01

High speed photography is a major means of collecting data from human body movement. It enables the automatic identification of joints, which brings great significance to the research, treatment and recovery of injuries, the analysis to the diagnosis of sport techniques and the ergonomics. According to the features that when the adjacent joints of human body are in planetary motion, their distance remains the same, and according to the human body joint movement laws (such as the territory of the articular anatomy and the kinematic features), a new approach is introduced to process the image thresholding of joints filmed by the high speed camera, to automatically identify the joints and to automatically trace the joint points (by labeling markers at the joints). Based upon the closure of marking points, automatic identification can be achieved through thresholding treatment. Due to the screening frequency and the laws of human segment movement, when the marking points have been initialized, their automatic tracking can be achieved with the progressive sequential images.Then the testing results, the data from three-dimensional force platform and the characteristics that human body segment will only rotate around the closer ending segment when the segment has no boding force and only valid to the conservative force all tell that after being analyzed kinematically, the approach is approved to be valid.

Information Management Utilizing Valued Information at the Right Time (VIRT) as Applied to a Joint Terminal Attack Controller (JTAC) Mission

DTIC Science & Technology

2008-03-01

technology in an effective way without taking a decade for implementation. 15. NUMBER OF PAGES 77 14. SUBJECT TERMS VIRT, Model Based... effective way without taking a decade for implementation. vi THIS PAGE INTENTIONALLY LEFT BLANK vii TABLE OF CONTENTS I. INTRODUCTION...To build the most effective force for 2020, we must be fully joint.”2 What does being fully joint mean and how does the DoD take advantage of

Development and Implementation of Joint Programs in Laser Ranging and Other Space Geodetic Techniques

NASA Technical Reports Server (NTRS)

Pearlman, Michael R.; Carter, David (Technical Monitor)

2004-01-01

This progress report discusses the status and progress made in joint international programs including: 1) WEGENER; 2) Arabian Peninsula program; 3) Asia-Pacific Space Geodynamics (APSG) program; 4) the Fourteenth International Workshop on Laser Ranging; 5) the International Laser Ranging Service; and 6) current support for the NASA network.

Codifying Implementation Guidelines for a Collaborative Improvement Initiative

ERIC Educational Resources Information Center

Coughlan, Paul; Coghlan, David

2008-01-01

The application of action learning in inter-organizational settings is largely undeveloped. This article presents a description of and reflection on an action learning approach to enabling collaborative improvement in the extended manufacturing enterprise. The article focuses in particular on implementing the action learning approach. However, the…

Thermal conductance measurements of bolted copper joints for SuperCDMS

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

Schmitt, R.; Tatkowski, Greg; Ruschman, M.

2015-09-01

Joint thermal conductance testing has been undertaken for bolted copper to copper connections from 60 mK to 26 K. This testing was performed to validate an initial design basis for the SuperCDMS experiment, where a dilution refrigerator will be coupled to a cryostat via multiple bolted connections. Copper used during testing was either gold plated or passivated with citric acid to prevent surface oxidation. Results obtained are well fit by a power law regression of joint thermal conductance to temperature and match well with data collected during a literature review.

Optical joint transform correlation on the DMD. [deformable mirror device

NASA Technical Reports Server (NTRS)

Knopp, Jerome; Juday, Richard D.

1989-01-01

Initial experimental investigation of the deformable mirror device (DMD) in a joint optical transform correlation is reported. The inverted cloverleaf version of the DMD, in which form the DMD is phase-mostly but of limited phase range, is used. Binarized joint Fourier transforms were calculated for similar and dissimilar objects and written onto the DMD. Inverse Fourier transform was done in a diffraction order for which the DMD shows phase-mostly modulation. Matched test objects produced sharp correlation, distinct objects did not. Further studies are warranted and they are outlined.

Thermal conductance measurements of bolted copper joints for SuperCDMS

DOE PAGES

Schmitt, R. L.; Tatkowski, G.; Ruschman, M.; ...

2015-04-28

Joint thermal conductance testing has been undertaken for bolted copper to copper connections from 60 mK to 26 K. This testing was performed to validate an initial design basis for the SuperCDMS experiment, where a dilution refrigerator will be coupled to a cryostat via multiple bolted connections. Copper used during testing was either gold plated or passivated with citric acid to prevent surface oxidation. Finally, the results we obtained are well fit by a power law regression of joint thermal conductance to temperature and match well with data collected during a literature review.

Optimised robot-based system for the exploration of elastic joint properties.

PubMed

Frey, M; Burgkart, R; Regenfelder, F; Riener, R

2004-09-01

Numerous publications provide measured biomechanical data relating to synovial joints. However, in general, they do not reflect the non-linear elastic joint properties in detail or do not consider all degrees of freedom (DOF), or the quantity of data is sparse. To perform more comprehensive, extended measurements of elastic joint properties, an optimised robot-based approach was developed. The basis was an industrial, high-precision robot that was capable of applying loads to the joint and measuring the joint displacement in 6 DOF. The system was equipped with novel, custom-made control hardware. In contrast to the commonly used sampling rates that are below 100 Hz, a rate of 4 kHz was realised for each DOF. This made it possible to implement advanced, highly dynamic, quasi-continuous closed-loop controllers. Thus oscillations of the robot were avoided, and measurements were speeded up. The stiffness of the entire system was greater than 44 kNm(-1) and 22 Nm deg(-1), and the maximum difference between two successive measurements was less than 0.5 deg. A sophisticated CT-based referencing routine facilitated the matching of kinematic data with the individual anatomy of the tested joint. The detailed detection of the elastic varus-valgus properties of a human knee joint is described, and the need for high spatial resolution is demonstrated.

Towards Scalable Strain Gauge-Based Joint Torque Sensors

PubMed Central

D’Imperio, Mariapaola; Cannella, Ferdinando; Caldwell, Darwin G.; Cuschieri, Alfred

2017-01-01

During recent decades, strain gauge-based joint torque sensors have been commonly used to provide high-fidelity torque measurements in robotics. Although measurement of joint torque/force is often required in engineering research and development, the gluing and wiring of strain gauges used as torque sensors pose difficulties during integration within the restricted space available in small joints. The problem is compounded by the need for a scalable geometric design to measure joint torque. In this communication, we describe a novel design of a strain gauge-based mono-axial torque sensor referred to as square-cut torque sensor (SCTS), the significant features of which are high degree of linearity, symmetry, and high scalability in terms of both size and measuring range. Most importantly, SCTS provides easy access for gluing and wiring of the strain gauges on sensor surface despite the limited available space. We demonstrated that the SCTS was better in terms of symmetry (clockwise and counterclockwise rotation) and more linear. These capabilities have been shown through finite element modeling (ANSYS) confirmed by observed data obtained by load testing experiments. The high performance of SCTS was confirmed by studies involving changes in size, material and/or wings width and thickness. Finally, we demonstrated that the SCTS can be successfully implementation inside the hip joints of miniaturized hydraulically actuated quadruped robot-MiniHyQ. This communication is based on work presented at the 18th International Conference on Climbing and Walking Robots (CLAWAR). PMID:28820446

Towards Scalable Strain Gauge-Based Joint Torque Sensors.

PubMed

Khan, Hamza; D'Imperio, Mariapaola; Cannella, Ferdinando; Caldwell, Darwin G; Cuschieri, Alfred; Semini, Claudio

2017-08-18

During recent decades, strain gauge-based joint torque sensors have been commonly used to provide high-fidelity torque measurements in robotics. Although measurement of joint torque/force is often required in engineering research and development, the gluing and wiring of strain gauges used as torque sensors pose difficulties during integration within the restricted space available in small joints. The problem is compounded by the need for a scalable geometric design to measure joint torque. In this communication, we describe a novel design of a strain gauge-based mono-axial torque sensor referred to as square-cut torque sensor (SCTS) , the significant features of which are high degree of linearity, symmetry, and high scalability in terms of both size and measuring range. Most importantly, SCTS provides easy access for gluing and wiring of the strain gauges on sensor surface despite the limited available space. We demonstrated that the SCTS was better in terms of symmetry (clockwise and counterclockwise rotation) and more linear. These capabilities have been shown through finite element modeling (ANSYS) confirmed by observed data obtained by load testing experiments. The high performance of SCTS was confirmed by studies involving changes in size, material and/or wings width and thickness. Finally, we demonstrated that the SCTS can be successfully implementation inside the hip joints of miniaturized hydraulically actuated quadruped robot- MiniHyQ . This communication is based on work presented at the 18th International Conference on Climbing and Walking Robots (CLAWAR).

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

PubMed

Tenforde, Adam S; Shull, Pete B; Fredericson, Michael

2012-05-01

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

From micro to macro: assessing implementation of integrated care in Australia.

PubMed

Angus, Lisa; Valentijn, Pim P

2018-03-01

Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical-professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia.

78 FR 5210 - Open Government Initiative: Implementation of the iCERT Labor Certification Registry for the H-1B...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-24

...: Implementation of the iCERT Labor Certification Registry for the H-1B, H-1B1, E-3, H-2A, H-2B and Permanent Labor... new initiative to make available to the general public appropriately redacted copies of H-1B, H-1B1, E-3, H-2A, H-2B and permanent labor certification documents through its iCERT Visa Portal System. This...

Geometry and Material Constraint Effects on Creep Crack Growth Behavior in Welded Joints

NASA Astrophysics Data System (ADS)

Li, Y.; Wang, G. Z.; Xuan, F. Z.; Tu, S. T.

2017-02-01

In this work, the geometry and material constraint effects on creep crack growth (CCG) and behavior in welded joints were investigated. The CCG paths and rates of two kinds of specimen geometry (C(T) and M(T)) with initial cracks located at soft HAZ (heat-affected zone with lower creep strength) and different material mismatches were simulated. The effect of constraint on creep crack initiation (CCI) time was discussed. The results show that there exists interaction between geometry and material constraints in terms of their effects on CCG rate and CCI time of welded joints. Under the condition of low geometry constraint, the effect of material constraint on CCG rate and CCI time becomes more obvious. Higher material constraint can promote CCG due to the formation of higher stress triaxiality around crack tip. Higher geometry constraint can increase CCG rate and reduce CCI time of welded joints. Both geometry and material constraints should be considered in creep life assessment and design for high-temperature welded components.

Anatomy of a Joint: Comparing Self-Reported and Actual Dose of Cannabis and Tobacco in a Joint, and How These Are Influenced by Controlled Acute Administration.

PubMed

Hindocha, Chandni; Freeman, Tom P; Curran, H Valerie

2017-01-01

Introduction: Major gaps exist in the measurement of cannabis exposure. The accuracy of self-reported cannabis and tobacco dose per joint is poorly characterized and has never been investigated following acute cannabis/tobacco exposure. Using an innovative "Roll a Joint" paradigm, this study aims to (1) compare estimated and actual dose of cannabis and tobacco per joint at baseline and (2) examine the acute effects of cannabis and/or tobacco on estimated and actual dose. Materials and Methods: We investigated this by using a randomized, double-blind, placebo-controlled crossover 2 (active cannabis, placebo cannabis)×2 (active tobacco, placebo tobacco) design in a laboratory setting. Participants were 24 recreational cousers of cannabis and tobacco. At baseline, they were asked to measure out the amount of cannabis and tobacco they would put in an average joint for themselves (dose per joint). Then, on each of four drug administration sessions, participants were again asked to do this for a joint they would want to smoke "right now." Self-reported and actual amount was recorded (g). Results: At baseline, the estimated amount of cannabis per joint (0.28±0.23 g) was double the actual amount (0.14±0.12 g) ( p =0.003, d =0.723). No difference emerged between estimated (0.43±0.25 g) and actual (0.35±0.15 g) ( p =0.125) amount of tobacco per joint. Compared to placebo, active cannabis reduced the actual dose of both cannabis ( p =0.035) and tobacco ( p <0.001) they put in a joint. Participants accurately estimated this reduction for tobacco ( p =0.014), but not for cannabis ( p =0.680). Conclusions: Self-reported dose per joint is accurate for tobacco but dramatically overestimates cannabis exposure and therefore should be viewed with caution. Cannabis administration reduced the amount of cannabis and tobacco added to joints, suggesting a reduction in dose during a smoking session. The "Roll A Joint" paradigm should be implemented for better accuracy in

Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.

PubMed

Karabicak, Gul Oznur; Bek, Nilgun; Tiftikci, Ugur

2015-10-01

The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. There was a significant reduction in goniometric measurement of hallux valgus angle (P = .001). There was a significant reduction in pain intensity (P = .001) and AOFAS and Foot Function Index scores at the end of the treatment (P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control (P = .009). For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Anterior fracture dislocation of the sacroiliac joint: A case report and literature review.

PubMed

Xiao, Jianlin; Wang, Yang; Zhang, Minglei; Jiang, Rui; Zhu, Tongtong; Liu, Guangyao; Zuo, Jianlin

2017-08-09

Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks' gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.

Joint-specific risk of impaired function in fibrodysplasia ossificans progressiva (FOP).

PubMed

Pignolo, Robert J; Durbin-Johnson, Blythe P; Rocke, David M; Kaplan, Frederick S

2018-04-01

Fibrodysplasia ossificans progressiva (FOP) causes progressive disability due to heterotopic ossification from episodic flare-ups. Using data from 500 FOP patients (representing 63% of all known patients world-wide), age- and joint-specific risks of new joint involvement were estimated using parametric and nonparametric statistical methods. Compared to data from a 1994 survey of 44 individuals with FOP, our current estimates of age- and joint-specific risks of new joint involvement are more accurate (narrower confidence limits), based on a wider range of ages, and have less bias due to its greater comprehensiveness (captures over three-fifths of the known FOP patients worldwide). For the neck, chest, abdomen, and upper back, the estimated hazard decreases over time. For the jaw, lower back, shoulder, elbow, wrist, fingers, hip, knee, ankle, and foot, the estimated hazard increases initially then either plateaus or decreases. At any given time and for any anatomic site, the data indicate which joints are at risk. This study of approximately 63% of the world's known population of FOP patients provides a refined estimate of risk for new involvement at any joint at any age, as well as the proportion of patients with uninvolved joints at any age. Importantly, these joint-specific survival curves can be used to facilitate clinical trial design and to determine if potential treatments can modify the predicted trajectory of progressive joint dysfunction. Copyright © 2017 Elsevier Inc. All rights reserved.

KmL3D: a non-parametric algorithm for clustering joint trajectories.

PubMed

Genolini, C; Pingault, J B; Driss, T; Côté, S; Tremblay, R E; Vitaro, F; Arnaud, C; Falissard, B

2013-01-01

In cohort studies, variables are measured repeatedly and can be considered as trajectories. A classic way to work with trajectories is to cluster them in order to detect the existence of homogeneous patterns of evolution. Since cohort studies usually measure a large number of variables, it might be interesting to study the joint evolution of several variables (also called joint-variable trajectories). To date, the only way to cluster joint-trajectories is to cluster each trajectory independently, then to cross the partitions obtained. This approach is unsatisfactory because it does not take into account a possible co-evolution of variable-trajectories. KmL3D is an R package that implements a version of k-means dedicated to clustering joint-trajectories. It provides facilities for the management of missing values, offers several quality criteria and its graphic interface helps the user to select the best partition. KmL3D can work with any number of joint-variable trajectories. In the restricted case of two joint trajectories, it proposes 3D tools to visualize the partitioning and then export 3D dynamic rotating-graphs to PDF format. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Periprosthetic joint infection: are patients with multiple prosthetic joints at risk?

PubMed

Jafari, S Mehdi; Casper, David S; Restrepo, Camilo; Zmistowski, Benjamin; Parvizi, Javad; Sharkey, Peter F

2012-06-01

Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. The type of organism was the same as the first infection in 4 (36%) of 11 patients. The time to developing a second infection averaged 2.0 years (range, 0-6.9 years). Copyright © 2012 Elsevier Inc. All rights reserved.

Flight set 360T004 (STS-30) field joint protection system, volume 7

NASA Technical Reports Server (NTRS)

Hale, Elgie

1989-01-01

The Redesigned Solid Rocket Motors (RSRM) of the Space Transportation System have three field joints that are protected by the Joint Protection Systems (JPS). The igniter heater was mounted on the igniter flange. This report documents the performance of the JPS and igniter heaters on the pad and the post-flight condition of the JPS components. All observations that were written up as Squawks and/or Problem Reports are also discussed. The primary heaters performed satisfactorily and maintained the field joint temperatures within the required temperature range. A secondary heater failed Dielectric Withstanding Voltage (DWV) test during the joint closeout prior to launch. This heater was not used, however, since the primary heater functioned properly. Post-test inspection revealed that pin A of the heater power cable was shorted to the connector shell. Design changes have been implemented to resolve the heater power cable problem. All field joint assemblies met all of the performance requirements.

Physical Modeling of Shear Behavior of Infilled Rock Joints Under CNL and CNS Boundary Conditions

NASA Astrophysics Data System (ADS)

Shrivastava, Amit Kumar; Rao, K. Seshagiri

2018-01-01

Despite their frequent natural occurrence, filled discontinuities under constant normal stiffness (CNS) boundary conditions have been studied much less systematically, perhaps because of the difficulties arising from the increased number of variable parameters. Because of the lack of reliable and realistic theoretical or empirical relations and the difficulties in obtaining and testing representative samples, engineers rely on judgment and often consider the shear strength of the infilled material itself as shear strength of rock joints. This assumption leads to uneconomical and also sometimes the unsafe design of underground structures, slopes, rock-socketed piles and foundations. To study the effect of infill on the shear behavior of rock joints, tests were performed on the modeled infilled rock joint having different joint roughness under constant normal load (CNL) and CNS boundary conditions at various initial normal stress and varying thickness of the infilled material. The test results indicate that shear strength decreases with an increase in t/ a ratio for both CNL and CNS conditions, but the reduction in shear strength is more for CNL than for CNS condition for a given initial normal stress. The detailed account of the effect of thickness of infilled material on shear and deformation behavior of infilled rock joint is discussed in this paper, and a model is proposed to predict shear strength of infilled rock joint.

Failure of dissimilar material bonded joints

NASA Astrophysics Data System (ADS)

Konstantakopoulou, M.; Deligianni, A.; Kotsikos, G.

2016-03-01

Joining of materials in structural design has always been a challenge for engineers. Bolting and riveting has been used for many years, until the emergence of fusion welding which revolutionised construction in areas such as shipbuilding, automotive, infrastructure and consumer goods. Extensive research in the past 50 years has resulted in better understanding of the process and minimised the occurrence of failures associated with fusion welding such as, residual stress cracking, stress corrosion and corrosion fatigue cracking, localised reduction in mechanical properties due to microstructural changes (heat affected zone) etc. Bonding has been a technique that has been proposed as an alternative because it eliminates several of the problems associated with fusion welding. But, despite some applications it has not seen wide use. There is however a renewed interest in adhesively bonded joints, as designers look for ever more efficient structures which inevitably leads to the use and consequently joining of combinations of lightweight materials, often with fundamentally different mechanical and physical properties. This chapter provides a review of adhesively bonded joints and reports on improvements to bonded joint strength through the introduction of carbon nanotubes at the bond interface. Results from various workers in the field are reported as well as the findings of the authors in this area of research. It is obvious that there are several challenges that need to be addressed to further enhance the strength of bonded joints and worldwide research is currently underway to address those shortcomings and build confidence in the implementation of these new techniques.

Short-term functional health and well-being after marital separation: does initiator status make a difference?

PubMed

Hewitt, Belinda; Turrell, Gavin

2011-06-01

The authors investigated the health consequences of marital separation and whether the partners who initiated the separation had better health than those who did not. The data came from the Households, Income and Labour Dynamics in Australia (HILDA) panel study (2001-2007), comprising an analytic sample of 1,786 men and 2,068 women who were in their first marriages in 2001. For participants who separated, the authors distinguished between self-initiated, partner-initiated, and jointly initiated separations. Using linear random-intercept models, they examined scores on the 8 physical and mental health dimensions of Short Form 36, with scale scores ranging from 0 to 100. The results indicated that in general, men who separated had a decline in health, although this was more pronounced for mental dimensions than for physical dimensions. Among separated men, those whose partner initiated the separation had poorer mental health than those for whom the separation was self-initiated or jointly initiated (-4.61). Women's physical health improved with separation, but their mental health declined. For separated women, those whose partner initiated the separation had lower scores on the general health (-5.39), role-emotional (-11.08), and mental health (-7.18) scales than women who self-initiated separation. The health consequences of separation were less severe for self- or jointly initiated separations, suggesting that not all marital dissolutions are equally bad for health.

[Dislocation of the PIP-Joint - Treatment of a common (ball)sports injury].

PubMed

Müller-Seubert, Wibke; Bührer, Gregor; Horch, Raymund E

2017-09-01

Background  Fractures or fracture dislocations of the proximal interphalangeal joint often occur during sports or accidents. Dislocations of the PIP-joint are the most common ligamentary injuries of the hand. As this kind of injury is so frequent, hand surgeons and other physicians should be aware of the correct treatment. Objectives  This paper summarises the most common injury patterns and the correct treatment of PIP-joint dislocations. Materials and Methods  This paper reviews the current literature and describes the standardised treatment of PIP-joint dislocations. Results  What is most important is that reposition is anatomically correct, and this should be controlled by X-ray examination. Depending on the instability and possible combination with other injuries (e. g. injury to the palmar plate), early functional physiotherapy of the joint or a short immobilisation period is indicated. Conclusions  Early functional treatment of the injured PIP-joint, initially using buddy taping, is important to restore PIP-joint movement and function. Depending on the injury, joint immobilisation using a K-wire may be indicated. Detailed informed consent is necessary to explain to the patient the severity of the injury and possible complications, such as chronic functional disorders or development of arthrosis. © Georg Thieme Verlag KG Stuttgart · New York.

Initiative for Molecular Profiling and Advanced Cancer Therapy and challenges in the implementation of precision medicine.

PubMed

Tsimberidou, Apostolia-Maria

In the last decade, breakthroughs in technology have improved our understanding of genomic, transcriptional, proteomic, epigenetic aberrations and immune mechanisms in carcinogenesis. Genomics and model systems have enabled the validation of novel therapeutic strategies. Based on these developments, in 2007, we initiated the IMPACT (Initiative for Molecular Profiling and Advanced Cancer Therapy) study, the first personalized medicine program for patients with advanced cancer at The University of Texas MD Anderson Cancer Center. We demonstrated that in patients referred for Phase I clinical trials, the use of tumor molecular profiling and treatment with matched targeted therapy was associated with encouraging rates of response, progression-free survival and overall survival compared to non-matched therapy. We are currently conducting IMPACT2, a randomized study evaluating molecular profiling and targeted agents in patients with metastatic cancer. Optimization of innovative biomarker-driven clinical trials that include targeted therapy and/or immunotherapeutic approaches for carefully selected patients will accelerate the development of novel drugs and the implementation of precision medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

The Joint Experiment for Crop Assessment and Monitoring (JECAM) Initiative: Developing methods and best practices for global agricultural monitoring

NASA Astrophysics Data System (ADS)

Champagne, C.; Jarvis, I.; Defourny, P.; Davidson, A.

2014-12-01

Agricultural systems differ significantly throughout the world, making a 'one size fits all' approach to remote sensing and monitoring of agricultural landscapes problematic. The Joint Experiment for Crop Assessment and Monitoring (JECAM) was established in 2009 to bring together the global scientific community to work towards a set of best practices and recommendations for using earth observation data to map, monitor and report on agricultural productivity globally across an array of diverse agricultural systems. These methods form the research and development component of the Group on Earth Observation Global Agricultural Monitoring (GEOGLAM) initiative to harmonize global monitoring efforts and increase market transparency. The JECAM initiative brings together researchers from a large number of globally distributed, well monitored agricultural test sites that cover a range of crop types, cropping systems and climate regimes. Each test site works independently as well as together across multiple sites to test methods, sensors and field data collection techniques to derive key agricultural parameters, including crop type, crop condition, crop yield and soil moisture. The outcome of this project will be a set of best practices that cover the range of remote sensing monitoring and reporting needs, including satellite data acquisition, pre-processing techniques, information retrieval and ground data validation. These outcomes provide the research and development foundation for GEOGLAM and will help to inform the development of the GEOGLAM "system of systems" for global agricultural monitoring. The outcomes of the 2014 JECAM science meeting will be discussed as well as examples of methods being developed by JECAM scientists.

Lower extremity control during turns initiated with and without hip external rotation.

PubMed

Zaferiou, Antonia M; Flashner, Henryk; Wilcox, Rand R; McNitt-Gray, Jill L

2017-02-08

The pirouette turn is often initiated in neutral and externally rotated hip positions by dancers. This provides an opportunity to investigate how dancers satisfy the same mechanical objectives at the whole-body level when using different leg kinematics. The purpose of this study was to compare lower extremity control strategies during the turn initiation phase of pirouettes performed with and without hip external rotation. Skilled dancers (n=5) performed pirouette turns with and without hip external rotation. Joint kinetics during turn initiation were determined for both legs using ground reaction forces (GRFs) and segment kinematics. Hip muscle activations were monitored using electromyography. Using probability-based statistical methods, variables were compared across turn conditions as a group and within-dancer. Despite differences in GRFs and impulse generation between turn conditions, at least 90% of each GRF was aligned with the respective leg plane. A majority of the net joint moments at the ankle, knee, and hip acted about an axis perpendicular to the leg plane. However, differences in shank alignment relative to the leg plane affected the distribution of the knee net joint moment when represented with respect to the shank versus the thigh. During the initiation of both turns, most participants used ankle plantar flexor moments, knee extensor moments, flexor and abductor moments at the push leg׳s hip, and extensor and abductor moments at the turn leg׳s hip. Representation of joint kinetics using multiple reference systems assisted in understanding control priorities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model.

PubMed

Bertocci, Gina E; Brown, Nathan P; Mich, Patrice M

2017-01-01

OBJECTIVE To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)-deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer). SAMPLE A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever. PROCEDURES A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge]) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures. RESULTS The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario. CONCLUSIONS AND CLINICAL RELEVANCE Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.

Ductile Crack Initiation Criterion with Mismatched Weld Joints Under Dynamic Loading Conditions.

PubMed

An, Gyubaek; Jeong, Se-Min; Park, Jeongung

2018-03-01

Brittle failure of high toughness steel structures tends to occur after ductile crack initiation/propagation. Damages to steel structures were reported in the Hanshin Great Earthquake. Several brittle failures were observed in beam-to-column connection zones with geometrical discontinuity. It is widely known that triaxial stresses accelerate the ductile fracture of steels. The study examined the effects of geometrical heterogeneity and strength mismatches (both of which elevate plastic constraints due to heterogeneous plastic straining) and loading rate on critical conditions initiating ductile fracture. This involved applying the two-parameter criterion (involving equivalent plastic strain and stress triaxiality) to estimate ductile cracking for strength mismatched specimens under static and dynamic tensile loading conditions. Ductile crack initiation testing was conducted under static and dynamic loading conditions using circumferentially notched specimens (Charpy type) with/without strength mismatches. The results indicated that the condition for ductile crack initiation using the two parameter criterion was a transferable criterion to evaluate ductile crack initiation independent of the existence of strength mismatches and loading rates.

Joint NASA/EPA AVIRIS Analysis in the Chesapeake Bay Region: Plans and Initial Results

NASA Technical Reports Server (NTRS)

Johnson, Lee; Stokely, Peter; Lobitz, Brad; Shelton, Gary

1998-01-01

NASA's Ames Research Center is performing an AVIRIS demonstration project in conjunction with the U. S. Environmental Protection Agency (Region 3). NASA and EPA scientists have jointly defined a Study Area in eastern Virginia to include portions of the Chesapeake Bay, southern Delmarva Peninsula, and the mouths of the York and James Rivers. Several environmental issues have been identified for study. These include, by priority: 1) water constituent analysis in the Chesapeake Bay, 2) mapping of submerged aquatic vegetation in the Bay, 3) detection of vegetation stress related to Superfund sites at the Yorktown Naval Weapons Station, and 4) wetland species analysis in the York River vicinity. In support of this project, three lines of AVIRIS data were collected during the Wallops Island deployment on 17 August 1997. The remote sensing payload included AVIRIS, MODIS Airborne Simulator and an RC-10 color infrared film camera. The AVIRIS data were delivered to Ames from the JPL AVIRIS Data Facility, on 29 September 1997. Quicklook images indicate nominal data acquisition, and at the current time an atmospheric correction is being applied. Water constituent analysis of the Bay is our highest priority based on EPA interest and available collateral data, both from the surface and from other remote sensing instruments. Constituents of interest include suspended sediments, chlorophyll-a and accessory pigments, Analysis steps will include: verification of data quality, location of study sites in imagery, incorporation of relevant field data from EPA and other Chesapeake Bay cooperators, processing of imagery to show phenomenon of interest, verification of results with cooperators. By 1st quarter CY98 we plan to circulate initial results to NASA and EPA management for review. In the longer term we will finalize documentation, prepare results for publication, and complete any needed technology transfer to EPA remote sensing personnel.

Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record.

PubMed

Yadav, Siddhartha; Kazanji, Noora; K C, Narayan; Paudel, Sudarshan; Falatko, John; Shoichet, Sandor; Maddens, Michael; Barnes, Michael A

2017-01-01

There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes. Initial progress notes from patients with 5 specific diagnoses with invariable physical findings admitted to Beaumont Hospital, Royal Oak, between August 2011 and July 2013 were randomly selected for this study. A total of 500 progress notes were retrospectively reviewed. The paper chart arm consisted of progress notes completed prior to the transition to an EHR on July 1, 2012. The remaining charts were placed in the EHR arm. The primary endpoints were accuracy, inaccuracy, and omission of information. Secondary endpoints were time of initiation of progress note, word count, number of systems documented, and accuracy based on level of training. The rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts (24.4% vs 4.4%). However, expected physical examination findings were more likely to be omitted in the paper notes compared to EHRs (41.2% vs 17.6%). Resident physicians had a smaller number of inaccuracies (5.3% vs 17.3%) and omissions (16.8% vs 33.9%) compared to attending physicians. During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

PubMed

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

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

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

PubMed Central

Sanders, Thomas L.; Maradit Kremers, Hilal; Schleck, Cathy D.; Larson, Dirk R.; Berry, Daniel J.

2017-01-01

Background: Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. Methods: This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. Results: During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Conclusions: Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure

Human arm joints reconstruction algorithm in rehabilitation therapies assisted by end-effector robotic devices.

PubMed

Bertomeu-Motos, Arturo; Blanco, Andrea; Badesa, Francisco J; Barios, Juan A; Zollo, Loredana; Garcia-Aracil, Nicolas

2018-02-20

End-effector robots are commonly used in robot-assisted neuro-rehabilitation therapies for upper limbs where the patient's hand can be easily attached to a splint. Nevertheless, they are not able to estimate and control the kinematic configuration of the upper limb during the therapy. However, the Range of Motion (ROM) together with the clinical assessment scales offers a comprehensive assessment to the therapist. Our aim is to present a robust and stable kinematic reconstruction algorithm to accurately measure the upper limb joints using only an accelerometer placed onto the upper arm. The proposed algorithm is based on the inverse of the augmented Jaciobian as the algorithm (Papaleo, et al., Med Biol Eng Comput 53(9):815-28, 2015). However, the estimation of the elbow joint location is performed through the computation of the rotation measured by the accelerometer during the arm movement, making the algorithm more robust against shoulder movements. Furthermore, we present a method to compute the initial configuration of the upper limb necessary to start the integration method, a protocol to manually measure the upper arm and forearm lengths, and a shoulder position estimation. An optoelectronic system was used to test the accuracy of the proposed algorithm whilst healthy subjects were performing upper limb movements holding the end effector of the seven Degrees of Freedom (DoF) robot. In addition, the previous and the proposed algorithms were studied during a neuro-rehabilitation therapy assisted by the 'PUPArm' planar robot with three post-stroke patients. The proposed algorithm reports a Root Mean Square Error (RMSE) of 2.13cm in the elbow joint location and 1.89cm in the wrist joint location with high correlation. These errors lead to a RMSE about 3.5 degrees (mean of the seven joints) with high correlation in all the joints with respect to the real upper limb acquired through the optoelectronic system. Then, the estimation of the upper limb joints through

Static analysis of large-scale multibody system using joint coordinates and spatial algebra operator.

PubMed

Omar, Mohamed A

2014-01-01

Initial transient oscillations inhibited in the dynamic simulations responses of multibody systems can lead to inaccurate results, unrealistic load prediction, or simulation failure. These transients could result from incompatible initial conditions, initial constraints violation, and inadequate kinematic assembly. Performing static equilibrium analysis before the dynamic simulation can eliminate these transients and lead to stable simulation. Most exiting multibody formulations determine the static equilibrium position by minimizing the system potential energy. This paper presents a new general purpose approach for solving the static equilibrium in large-scale articulated multibody. The proposed approach introduces an energy drainage mechanism based on Baumgarte constraint stabilization approach to determine the static equilibrium position. The spatial algebra operator is used to express the kinematic and dynamic equations of the closed-loop multibody system. The proposed multibody system formulation utilizes the joint coordinates and modal elastic coordinates as the system generalized coordinates. The recursive nonlinear equations of motion are formulated using the Cartesian coordinates and the joint coordinates to form an augmented set of differential algebraic equations. Then system connectivity matrix is derived from the system topological relations and used to project the Cartesian quantities into the joint subspace leading to minimum set of differential equations.

Elbow joint fatigue and bench-press training.

PubMed

Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

Lower extremity joint moments of collegiate soccer players differ between genders during a forward jump.

PubMed

Hart, Joseph M; Garrison, J Craig; Palmieri-Smith, Riann; Kerrigan, D Casey; Ingersoll, Christopher D

2008-05-01

Lower extremity kinetics while performing a single-leg forward jump landing may help explain gender biased risk for noncontact anterior cruciate ligament injury. Gender comparison of lower extremity joint angles and moments. Static groups comparison. Motion analysis laboratory. 8 male and 8 female varsity, collegiate soccer athletes. 5 single-leg landings from a 100cm forward jump. Peak and initial contact external joint moments and joint angles of the ankle, knee, and hip. At initial heel contact, males exhibited a adduction moment whereas females exhibited a abduction moment at the hip. Females also had significantly less peak hip extension moment and significantly less peak hip internal rotation moment than males had. Females exhibited greater knee adduction and hip internal rotation angles than men did. When decelerating from a forward jump, gender differences exist in forces acting at the hip.

Impact extractive fracture of jointed steel plates of a bolted joint

NASA Astrophysics Data System (ADS)

Daimaruya, M.; Fujiki, H.; Ambarita, H.

2012-08-01

This study is concerned with the development of a fracture criterion for the impact fracture of jointed steel plates of a bolted joint used in a car body. For the accurate prediction of crash characteristics of car bodies by computer-aided engineering (CAE), it is also necessary to examine the behavior and fracture of jointed steel plates subjected to impact loads. Although the actual impact fracture of jointed steel plates of a bolted joint used in cars is complicated, for simplifying the problem it might be classified into the shear fracture and the extractive fracture of jointed steel plates. Attention is given to the extractive fracture of jointed steel plates in this study. The extractive behavior and fracture of three kinds of steel plates used for cars are examined in experiments and numerical simulations. The impact extraction test of steel plates jointed by a bolt is performed using the one-bar method, together with the static test. In order to understand the mechanism of extractive fracture process of jointed steel plates, numerical simulations by a FEM code LS-DYNA are also carried out. The obtained results suggest that a stress-based fracture criterion may be developed for the impact extractive fracture of jointed steel plates of a bolted joint used in a car body.

Mobile computing initiatives within pharmacy education.

PubMed

Cain, Jeff; Bird, Eleanora R; Jones, Mikael

2008-08-15

To identify mobile computing initiatives within pharmacy education, including how devices are obtained, supported, and utilized within the curriculum. An 18-item questionnaire was developed and delivered to academic affairs deans (or closest equivalent) of 98 colleges and schools of pharmacy. Fifty-four colleges and schools completed the questionnaire for a 55% completion rate. Thirteen of those schools have implemented mobile computing requirements for students. Twenty schools reported they were likely to formally consider implementing a mobile computing initiative within 5 years. Numerous models of mobile computing initiatives exist in terms of device obtainment, technical support, infrastructure, and utilization within the curriculum. Responders identified flexibility in teaching and learning as the most positive aspect of the initiatives and computer-aided distraction as the most negative, Numerous factors should be taken into consideration when deciding if and how a mobile computing requirement should be implemented.

Under Construction: Benchmark Assessments and Common Core Math Implementation in Grades K-8. Formative Evaluation Cycle Report for the Math in Common Initiative, Volume 1

ERIC Educational Resources Information Center

Flaherty, John, Jr.; Sobolew-Shubin, Alexandria; Heredia, Alberto; Chen-Gaddini, Min; Klarin, Becca; Finkelstein, Neal D.

2014-01-01

Math in Common® (MiC) is a five-year initiative that supports a formal network of 10 California school districts as they implement the Common Core State Standards in mathematics (CCSS-M) across grades K-8. As the MiC initiative moves into its second year, one of the central activities that each of the districts is undergoing to support CCSS…

Initial investigation of organisational factors associated with the implementation of active support.

PubMed

Fyffe, Chris; McCubbery, Jeffrey; Reid, Katharine J

2008-09-01

Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.

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.

Improvements and Extensions for Joint Polar Satellite System Algorithms

NASA Astrophysics Data System (ADS)

Grant, K. D.

2016-12-01

The National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) are jointly acquiring the next-generation civilian weather satellite system: the Joint Polar Satellite System (JPSS). JPSS replaced the afternoon orbit component and ground processing of the old POES system managed by NOAA. JPSS satellites carry sensors designed to collect meteorological, oceanographic, climatological, and solar-geophysical observations of the earth, atmosphere, and space. The ground processing system for JPSS is the Common Ground System (CGS), and provides command, control, and communications (C3), data processing and product delivery. CGS's data processing capability provides environmental data products (Sensor Data Records (SDRs) and Environmental Data Records (EDRs)) to the NOAA Satellite Operations Facility. The first satellite in the JPSS constellation, S-NPP, was launched in October 2011. The second satellite, JPSS-1, is scheduled for launch in January 2017. During a satellite's calibration and validation (Cal/Val) campaign, numerous algorithm updates occur. Changes identified during Cal/Val become available for implementation into the operational system for both S-NPP and JPSS-1. In addition, new capabilities, such as higher spectral and spatial resolution, will be exercised on JPSS-1. This paper will describe changes to current algorithms and products as a result of S-NPP Cal/Val and related initiatives for improved capabilities. Improvements include Cross Track Infrared Sounder high spectral processing, extended spectral and spatial ranges for Ozone Mapping and Profiler Suite ozone Total Column and Nadir Profiles, and updates to Vegetation Index, Snow Cover, Active Fires, Suspended Matter, and Ocean Color. Updates will include Sea Surface Temperature, Cloud Mask, Cloud Properties, and other improvements.

Ultrasonic measurement and monitoring of loads in bolts used in structural joints

NASA Astrophysics Data System (ADS)

Koshti, Ajay M.

2015-04-01

The paper is an overview of work by the author in measuring and monitoring loads in bolts using an ultrasonic extensometer. A number of cases of bolted joints are covered. These include, a clamped joint with clearance fit between the bolt and hole, a clamped joint with bolt in an interference fit with the hole, a flanged joint which allows the flange and bolt to bend; and a shear joint in a clevis and tang configuration. These applications were initially developed for measuring and monitoring preload in National Aeronautics and Space Administration (NASA) Space Shuttle Orbiter critical joints but are also applicable for monitoring loads in other critical bolted joints of structures such as transportation bridges and other aerospace structures. The papers cited here explain how to set-up a model to estimate the ultrasonic load factor and accuracy for the ultrasonic preload application in a clamped joint with clearance fit. The ultrasonic preload application for clamped joint with bolt in an interference fit can also be used to measure diametrical interference between the bolt shank and hole, as well as interference pressure on the bolt shank. Results of simulation and experimental data are given to demonstrate use of ultrasonic measurements in a shear joint. A bolt in a flanged joint experiences both tensile and bending loads. This application involves measurement of bending and tensile preload in a bolt. The ultrasonic beam bends due to bending load on the bolt. Results of a numerical technique to compute the trace of ultrasonic ray are presented.

Joint Instability and Osteoarthritis

PubMed Central

Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

2015-01-01

Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA. PMID:25741184

Joint instability and osteoarthritis.

PubMed

Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

2015-01-01

Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Testing "What If?" Scenarios: A Process Known as System Dynamics Allows Leaders to Try out an Initiative before Actually Implementing It

ERIC Educational Resources Information Center

Brauer, Ralph A.

2004-01-01

One challenge of system leadership always has been that even with the best data and research in place, with all the programmatic and political dimensions under control and with years of experience handling similar decisions, you never really know whether a policy initiative will work until you implement it. That is why anyone who has been a school…

Progress and challenges in implementing HIV care and treatment policies in Latin America following the treatment 2.0 initiative.

PubMed

Perez, Freddy; Gomez, Bertha; Ravasi, Giovanni; Ghidinelli, Massimo

2015-12-19

The Pan American Health Organization provides technical cooperation to countries in Latin America and the Caribbean for the scale-up of HIV care and treatment based on the Treatment 2.0 initiative. Fourteen Joint Review Missions (JRMs) were conducted between March 2012 and October 2014. Evaluating the degree of implementation of the recommendations of the JRMs and their impact on health policies, would help countries identify their gaps and areas for priority interventions. A descriptive analysis of the JRM recommendations was conducted for eight countries. An in-depth cross-sectional retrospective analysis of the degree of implementation of these recommendations in Ecuador, Venezuela, Bolivia, and El Salvador was performed through a standardized self-administered questionnaire applied to key informants. A comparative quantitative analysis on the optimization of antiretroviral regimens 'before/after' JRMs was conducted in three of the latter four countries, using data reported in 2013 and 2014. The priority areas with most recommendations were the optimization of antiretroviral treatment (ART) regimens (n = 57), the rational and efficient use of resources (n = 27) and the provision of point-of-care diagnostics and monitoring tools (n = 26), followed by community mobilization (n = 23), strategic information (n = 17) and the adaptation of delivery services (n = 15). The in-depth analysis in four countries showed that the two priority areas where most progress was observed were the rational and efficient use of resources (62%) and the optimization of ART regimens (60%). Adaptation of delivery services, community mobilization and strategic information were rated at 52% and the provision of point-of-care diagnostics and monitoring tools 38%. The quantitative analysis on optimization evidenced a 36% reduction in the number of first-line and second-line ART regimens, a 5.4% increase in the proportion of patients on WHO-recommended first-line regimens, a 19.4% increase in

An easily implemented static condensation method for structural sensitivity analysis

NASA Technical Reports Server (NTRS)

Gangadharan, S. N.; Haftka, R. T.; Nikolaidis, E.

1990-01-01

A black-box approach to static condensation for sensitivity analysis is presented with illustrative examples of a cube and a car structure. The sensitivity of the structural response with respect to joint stiffness parameter is calculated using the direct method, forward-difference, and central-difference schemes. The efficiency of the various methods for identifying joint stiffness parameters from measured static deflections of these structures is compared. The results indicate that the use of static condensation can reduce computation times significantly and the black-box approach is only slightly less efficient than the standard implementation of static condensation. The ease of implementation of the black-box approach recommends it for use with general-purpose finite element codes that do not have a built-in facility for static condensation.

Special Features of Induction Annealing of Friction Stir Welded Joints of Medium-Alloy Steels

NASA Astrophysics Data System (ADS)

Priymak, E. Yu.; Stepanchukova, A. V.; Bashirova, E. V.; Fot, A. P.; Firsova, N. V.

2018-01-01

Welded joints of medium-alloy steels XJY750 and 40KhN2MA are studied in the initial condition and after different variants of annealing. Special features of the phase transformations occurring in the welded steels are determined. Optimum modes of annealing are recommended for the studied welded joints of drill pipes, which provide a high level of mechanical properties including the case of impact loading.

Implementing a robotics curriculum at an academic general surgery training program: our initial experience.

PubMed

Winder, Joshua S; Juza, Ryan M; Sasaki, Jennifer; Rogers, Ann M; Pauli, Eric M; Haluck, Randy S; Estes, Stephanie J; Lyn-Sue, Jerome R

2016-09-01

The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console. 20 surgical residents were included. Residents were provided the curriculum and notified the department upon completion. Bedside assistance and operative console training were completed in the operating room through a mix of biliary, foregut, and colorectal cases. During the fiscal years of 2014 and 2015, there were 164 and 263 robot-assisted surgeries performed within the General Surgery Department, respectively. All 20 residents completed the online and bedside instruction portions of the curriculum. Of the 20 residents trained, 13/20 (65 %) sat at the Surgeon console during at least one case. Utilizing this curriculum, we have trained and incorporated residents into robot-assisted cases in an efficient manner. A successful curriculum must be based on didactic learning, reading, bedside training, simulation, and training in the operating room. Each program must examine their caseload and resident class to ensure proper exposure to this platform.

Utilisation of Blood Components in Trauma Surgery: A Single-Centre, Retrospective Analysis before and after the Implementation of an Educative PBM Initiative.

PubMed

Geissler, Raoul Georg; Kösters, Clemens; Franz, Dominik; Buddendick, Hubert; Borowski, Matthias; Juhra, Christian; Lange, Matthias; Bunzemeier, Holger; Roeder, Norbert; Sibrowski, Walter; Raschke, Michael J; Schlenke, Peter

2015-03-01

The aim of our single-centre retrospective study presented here is to further analyse the utilisation of allogeneic blood components within a 5-year observation period (2009-2013) in trauma surgery (15,457 patients) under the measures of an educational patient blood management (PBM) initiative. After the implementation of the PBM initiative in January 2012, the Institute of Transfusion Medicine und Transplantation Immunology educates surgeons and nurses at the Department of Trauma Surgery to avoid unnecessary blood transfusions. A standardised reporting system was used to document the utilisation of blood components carefully for the most frequent diagnoses and surgical interventions in trauma surgery. These measures served as basis for the implementation of an interdisciplinary systematic exchange of information to foster decision-making processes in favour of patient blood management. Since January 2012, the proportion of patients who received a transfusion as well as the number of transfused red blood cell (RBC) (7.3%/6.4%; p = 0.02), fresh frozen plasma (FFP) (1.7%/1.3%; p < 0.05) and platelet (PLT) (1.0%/0.5%; p < 0.001) units were reduced as a result of our PBM initiative. However, among the transfused patients, the number of administered RBC, FFP and PLT units did not decrease significantly. Overall, patients who did not receive transfusions were younger than transfused patients (p = 0.001). The subgroup with the highest probability of blood transfusion administered included patients with intensive care and long-term ventilation (before/after implementation of PBM: RBC 81.5%/75.9%; FFP 33.3%/20.4%; PLT 24.1%/13.0%). Only a total of 60 patients of 531 patients suffering multiple traumas were massively transfused (before/after implementation of PBM: RBC 55.6%/49.8%; FFP 28.4%/20.4%; PLT 17.6%/8.9%). According to our educational PBM initiative, at least the proportion of trauma patients who received allogeneic blood transfusions could be reduced significantly

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

PubMed

Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P < .001). Non-VA care was completely eliminated for patients undergoing total hip and knee replacement at the Richard L. Roudebush Veterans Affairs Medical Center, producing an estimated return on investment of $1 million annually when compared with baseline cost and volumes. In addition, the volume of total joint replacements at this center increased during the data collection period. The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in

Low Activation Joining of SiC/SiC Composites for Fusion Applications: Thermomechanical Modeling of Dual-Phase Microstructures and Dissimilar Material Joints

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

Nguyen, Ba Nghiep; Henager, Charles H.; Kurtz, Richard J.

2016-09-30

Finite element (FE) continuum damage mechanics (CDM) models have been developed to simulate and model dual-phase joints and cracked joints for improved analysis of SiC materials in nuclear environments. This report extends the analysis from the last reporting cycle by including preliminary thermomechanical analyses of cracked joints and implementation of dual-phase damage models.

Joint Precision Approach and Landing System Increment 1A (JPALS Inc 1A)

DTIC Science & Technology

2015-12-01

Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-238 Joint Precision Approach and Landing System Increment 1A (JPALS Inc 1A) As of FY 2017...President’s Budget Defense Acquisition Management Information Retrieval (DAMIR) March 10, 2016 11:30:56 UNCLASSIFIED JPALS Inc 1A December 2015 SAR...Fiscal Year FYDP - Future Years Defense Program ICE - Independent Cost Estimate IOC - Initial Operational Capability Inc - Increment JROC - Joint

Viscoplastic crack initiation and propagation in crosslinked UHMWPE from clinically relevant notches up to 0.5mm radius.

PubMed

Sirimamilla, P Abhiram; Rimnac, Clare M; Furmanski, Jevan

2018-01-01

Highly crosslinked UHMWPE is now the material of choice for hard-on-soft bearing couples in total joint replacements. However, the fracture resistance of the polymer remains a design concern for increased longevity of the components in vivo. Fracture research utilizing the traditional linear elastic fracture mechanics (LEFM) or elastic plastic fracture mechanics (EPFM) approach has not yielded a definite failure criterion for UHMWPE. Therefore, an advanced viscous fracture model has been applied to various notched compact tension specimen geometries to estimate the fracture resistance of the polymer. Two generic crosslinked UHMWPE formulations (remelted 65kGy and remelted 100kGy) were analyzed in this study using notched test specimens with three different notch radii under static loading conditions. The results suggest that the viscous fracture model can be applied to crosslinked UHMWPE and a single value of critical energy governs crack initiation and propagation in the material. To our knowledge, this is one of the first studies to implement a mechanistic approach to study crack initiation and propagation in UHMWPE for a range of clinically relevant stress-concentration geometries. It is believed that a combination of structural analysis of components and material parameter quantification is a path to effective failure prediction in UHMWPE total joint replacement components, though additional testing is needed to verify the rigor of this approach. Copyright © 2017 Elsevier Ltd. All rights reserved.

Radiation hydrodynamic effects in two beryllium plates with an idealized aluminum joint

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

Belkov, S.A.; Mkhitarian, L.S.; Vinokurov, O.A.

A beryllium capsule formed from two hemispherical shells with a thin bond is one possible ignition target for the National Ignition Facility [J. A. Paisner {ital et al.}, Laser Focus World {bold 30}, 75 (1994)] Nonuniformities in density, opacity, and interface position at the joint between these hemishells will initiate two-dimensional (2-D) perturbations of the shock wave and material behind the shock as the shock passes through the shell perpendicular to the joint width. Rarefaction of material flow behind the shock front can cause the interface between the shell and joint material to oscillate in position. The amplitude of thesemore » oscillations may be comparable to the joint width. The evolution of these perturbations is studied by numerically simulating shock passage through flat beryllium plates containing aluminum joints. Using the MIMOSA-ND code [D. Sofronov {ital et al.}, Vopr. At. Nauki Tekh., Ser: Mat. modelirovanie fizicheskih processov {bold 2}, 3 (1990)] two different cases are calculated{emdash}a wide (10 {mu}m) and a narrow (1 {mu}m) joint of aluminum between two 150 {mu}m long semiinfinite beryllium plates. Both cases showed good agreement with an analytic representation of the oscillation behavior. For the narrow joint, a special technique allows the calculation of mixing between the joint and surrounding material caused by the Kelvin{endash}Helmholtz instability. {copyright} {ital 1999 American Institute of Physics.}« less

Partially linear mixed-effects joint models for skewed and missing longitudinal competing risks outcomes.

PubMed

Lu, Tao; Lu, Minggen; Wang, Min; Zhang, Jun; Dong, Guang-Hui; Xu, Yong

2017-12-18

Longitudinal competing risks data frequently arise in clinical studies. Skewness and missingness are commonly observed for these data in practice. However, most joint models do not account for these data features. In this article, we propose partially linear mixed-effects joint models to analyze skew longitudinal competing risks data with missingness. In particular, to account for skewness, we replace the commonly assumed symmetric distributions by asymmetric distribution for model errors. To deal with missingness, we employ an informative missing data model. The joint models that couple the partially linear mixed-effects model for the longitudinal process, the cause-specific proportional hazard model for competing risks process and missing data process are developed. To estimate the parameters in the joint models, we propose a fully Bayesian approach based on the joint likelihood. To illustrate the proposed model and method, we implement them to an AIDS clinical study. Some interesting findings are reported. We also conduct simulation studies to validate the proposed method.

Implementer-Initiated Adaptation of Evidence-Based Interventions: Kids Remember the Blue Wig

ERIC Educational Resources Information Center

Gibbs, D. A.; Krieger, K. E.; Cutbush, S. L.; Clinton-Sherrod, A. M.; Miller, S.

2016-01-01

Adaptation of evidence-based interventions by implementers is widespread. Although frequently viewed as departures from fidelity, adaptations may be positive in impact and consistent with fidelity. Research typically catalogs adaptations but rarely includes the implementers' perspectives on adaptation. We report data on individuals implementing an…