How the gender of a victim character in a virtual scenario created to learn CPR protocol affects student nurses' performance.

PubMed

Boada, Imma; Rodriguez-Benitez, Antonio; Thió-Henestrosa, Santiago; Olivet, Josep; Soler, Josep

2018-08-01

Virtual simulations recreate scenarios where student nurses can practice procedures in a safe and supervised manner and with no risk to the patient. Virtual scenarios include digital characters that reproduce human actions. Generally, these characters are modeled as males and restricted roles are assigned to females. Our objective is to evaluate how the character gender of a victim in a scenario created to practice the cardiopulmonary resuscitation protocol (CPR) affects performance of student nurses. Three virtual scenarios with cardiac arrest victims modeled as males or females were assigned to 41 students of the Nursing Faculty to practice the CPR protocol. We evaluated student performance with respect to the time to remove clothes, the time to perform the CPR maneuver, and the hands position for CPR. Chi-square, Fisher exact, and Mann-Whitney U were used to test primary outcome measures in the experimental design of victim character sex (male vs. female) and student sex (men vs. women). The analysis performed did not find statistically differences in time to remove clothes or in time to start CPR. With respect to hands placement we also did not find significant difference in any of the cases. Nurse student actions are not influenced by the character gender of the victim. Excellent results with respect to hands placement to start CPR are obtained. Virtual scenarios can be a suitable strategy to reduce gender differences in gender sensitive situations such as CPR performance. Copyright © 2018 Elsevier B.V. All rights reserved.

Benefits and Limitations of Real Options Analysis for the Practice of River Flood Risk Management

NASA Astrophysics Data System (ADS)

Kind, Jarl M.; Baayen, Jorn H.; Botzen, W. J. Wouter

2018-04-01

Decisions on long-lived flood risk management (FRM) investments are complex because the future is uncertain. Flexibility and robustness can be used to deal with future uncertainty. Real options analysis (ROA) provides a welfare-economics framework to design and evaluate robust and flexible FRM strategies under risk or uncertainty. Although its potential benefits are large, ROA is hardly used in todays' FRM practice. In this paper, we investigate benefits and limitations of a ROA, by applying it to a realistic FRM case study for an entire river branch. We illustrate how ROA identifies optimal short-term investments and values future options. We develop robust dike investment strategies and value the flexibility offered by additional room for the river measures. We benchmark the results of ROA against those of a standard cost-benefit analysis and show ROA's potential policy implications. The ROA for a realistic case requires a high level of geographical detail, a large ensemble of scenarios, and the inclusion of stakeholders' preferences. We found several limitations of applying the ROA. It is complex. In particular, relevant sources of uncertainty need to be recognized, quantified, integrated, and discretized in scenarios, requiring subjective choices and expert judgment. Decision trees have to be generated and stakeholders' preferences have to be translated into decision rules. On basis of this study, we give general recommendations to use high discharge scenarios for the design of measures with high fixed costs and few alternatives. Lower scenarios may be used when alternatives offer future flexibility.

Life cycle analysis of pistachio production in Greece.

PubMed

Bartzas, Georgios; Komnitsas, Kostas

2017-10-01

In the present paper, a life cycle assessment (LCA) study regarding pistachio (Pistacia vera L.) cultivation in Aegina island, Greece, was performed to evaluate the energy use footprint and the associated environmental impacts. In this context, a detailed life cycle inventory was created based on site-survey data and used for a holistic cradle-to-farm gate LCA analysis using the GaBi 6.5 software. The main impact categories assessed were acidification potential (AP), eutrophication potential (EP), global warming potential (GWP), ozone depletion potential (ODP), photochemical ozone creation potential (POCP) and cumulative energy demand (CED). In order to reveal the main environmental concerns pertinent to pistachio production and in turn propose measures for the reduction of environmental and energetic impacts, three scenarios were compared, namely the Baseline scenario (BS) that involves current cultivation practices, the Green Energy (GE) scenario that involves the use of biological fertilizers i.e. compost, and the Waste Utilization (WU) scenario that involves the production of biochar from pistachio and other agricultural wastes and its subsequent soil application to promote carbon sequestration and improve soil quality. Based on the results of this study, the use of compost for fertilization (GE scenario), which results in approximately 9% savings in terms of energy consumption and the five environmental impact categories studied compared to BS scenario, is considered a promising alternative cultivation strategy. Slightly higher savings (10% on average) in terms of the five calculated environmental impact categories, compared to the BS scenario, were indicated when the WU scenario was considered. Regarding energy consumption, the WU scenario results in minor increase, 3%, compared to the BS scenario. Results of uncertainty analysis performed using the Monte Carlo technique and contribution analysis showed that GE and WU scenarios offer reliable and significant eco-profile improvements for pistachio production in the study area compared to the current situation. Copyright © 2017 Elsevier B.V. All rights reserved.

Agricultural Recharge Practices for Managing Nitrate in Regional Groundwater: Time-Resolution Assessment of Numerical Modeling Approach

NASA Astrophysics Data System (ADS)

Bastani, M.; Harter, T.

2017-12-01

Intentional recharge practices in irrigated landscapes are promising options to control and remediate groundwater quality degradation with respect to nitrate. To better understand the effect of these practices, a fully 3D transient heterogeneous transport model simulation is developed using MODFLOW and MT3D. The model is developed for a long-term study of nitrate improvements in an alluvial groundwater basin in Eastern San Joaquin Valley, CA. Different scenarios of agricultural recharge strategies including crop type change and winter flood flows are investigated. Transient simulations with high spatio-temporal resolutions are performed. We then consider upscaling strategies that would allow us to simplify the modeling process such that it can be applied at a very large basin-scale (1000s of square kilometers) for scenario analysis. We specifically consider upscaling of time-variant boundary conditions (both internal and external) that have significant influence on calculation cost of the model. We compare monthly transient stresses to upscaled annual and further upscaled average steady-state stresses on nitrate transport in groundwater under recharge scenarios.

Intravenous fluid prescription practices among pediatric residents in Korea.

PubMed

Lee, Jiwon M; Jung, Younghwa; Lee, Se Eun; Lee, Jun Ho; Kim, Kee Hyuck; Koo, Ja Wook; Park, Young Seo; Cheong, Hae Il; Ha, Il-Soo; Choi, Yong; Kang, Hee Gyung

2013-07-01

Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children. The present paper investigated the pattern of current practice in intravenous fluid prescription among Korean pediatric residents, to underscore the need for updated education. A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question proposed a unique scenario in which the respondents had to prescribe either a hypotonic or an isotonic fluid for the patient. Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.

Scenarios for Chemistry Teacher Training and Practice in Romania in 2030: Views of Chemistry Students

ERIC Educational Resources Information Center

Timofte, Roxana S.; Cozma, Danut G.

2017-01-01

Four scenarios regarding Chemistry teacher training and practice in Romania in 2030 were developed by using the 2x2 matrix design for scenario writing. The two driving forces taken in account for the design of scenarios were migration and consumerism. In two of the proposed scenarios teachers are trained to teach socioscientific courses at class.…

Future methane emissions from the heavy-duty natural gas transportation sector for stasis, high, medium, and low scenarios in 2035.

PubMed

Clark, Nigel N; Johnson, Derek R; McKain, David L; Wayne, W Scott; Li, Hailin; Rudek, Joseph; Mongold, Ronald A; Sandoval, Cesar; Covington, April N; Hailer, John T

2017-12-01

Today's heavy-duty natural gas-fueled fleet is estimated to represent less than 2% of the total fleet. However, over the next couple of decades, predictions are that the percentage could grow to represent as much as 50%. Although fueling switching to natural gas could provide a climate benefit relative to diesel fuel, the potential for emissions of methane (a potent greenhouse gas) from natural gas-fueled vehicles has been identified as a concern. Since today's heavy-duty natural gas-fueled fleet penetration is low, today's total fleet-wide emissions will be also be low regardless of per vehicle emissions. However, predicted growth could result in a significant quantity of methane emissions. To evaluate this potential and identify effective options for minimizing emissions, future growth scenarios of heavy-duty natural gas-fueled vehicles, and compressed natural gas and liquefied natural gas fueling stations that serve them, have been developed for 2035, when the populations could be significant. The scenarios rely on the most recent measurement campaign of the latest manufactured technology, equipment, and vehicles reported in a companion paper as well as projections of technology and practice advances. These "pump-to-wheels"(PTW) projections do not include methane emissions outside of the bounds of the vehicles and fuel stations themselves and should not be confused with a complete wells-to-wheels analysis. Stasis, high, medium, and low scenario PTW emissions projections for 2035 were 1.32%, 0.67%, 0.33%, and 0.15% of the fuel used. The scenarios highlight that a large emissions reductions could be realized with closed crankcase operation, improved best practices, and implementation of vent mitigation technologies. Recognition of the potential pathways for emissions reductions could further enhance the heavy-duty transportation sectors ability to reduce carbon emissions. Newly collected pump-to-wheels methane emissions data for current natural gas technologies were combined with future market growth scenarios, estimated technology advancements, and best practices to examine the climate benefit of future fuel switching. The analysis indicates the necessary targets of efficiency, methane emissions, market penetration, and best practices necessary to enable a pathway for natural gas to reduce the carbon intensity of the heavy-duty transportation sector.

Ethical challenges in everyday practice for healthcare lawyers.

PubMed

Taylor, L D; Pomerance, P L

2001-01-01

A lawyer representing healthcare clients confronts numerous ethical issues in day-to-day practice. The authors, practicing healthcare attorneys, first give a quick overview of the history of today's rules of legal ethics, and then turn to hypothetical (but realistic) scenarios to examine counsel's duties under various circumstances. The Article concludes with an examination of the overriding duties of confidentiality and privilege, which guide the analysis of ethical concerns in all areas.

Ambiguity and judgments of obese individuals: no news could be bad news.

PubMed

Ross, Kathryn M; Shivy, Victoria A; Mazzeo, Suzanne E

2009-08-01

Stigmatization towards obese individuals has not decreased despite the increasing prevalence of obesity. Nonetheless, stigmatization remains difficult to study, given concerns about social desirability. To address this issue, this study used paired comparisons and cluster analysis to examine how undergraduates (n=189) categorized scenarios describing the health-related behaviors of obese individuals. The cluster analysis found that the scenarios were categorized into two distinct clusters. The first cluster included all scenarios with health behaviors indicating high responsibility for body weight. These individuals were perceived as unattractive, lazy, less likeable, less disciplined, and more deserving of their condition compared to individuals in the second cluster, which included all scenarios with health behaviors indicating low responsibility for body weight. Four scenarios depicted obese individuals with ambiguous information regarding health behaviors; three out of these four individuals were categorized in the high-responsibility cluster. These findings suggested that participants viewed these individuals as negatively as those who were responsible for their condition. These results have practical implications for reducing obesity bias, as the etiology of obesity is typically not known in real-life situations.

Evaluating the impact of irrigation on surface water - groundwater interaction and stream temperature in an agricultural watershed.

PubMed

Essaid, Hedeff I; Caldwell, Rodney R

2017-12-01

Changes in groundwater discharge to streams caused by irrigation practices can influence stream temperature. Observations along two currently flood-irrigated reaches in the 640-square-kilometer upper Smith River watershed, an important agricultural and recreational fishing area in west-central Montana, showed a downstream temperature decrease resulting from groundwater discharge to the stream. A watershed-scale coupled surface water and groundwater flow model was used to examine changes in streamflow, groundwater discharge to the stream and stream temperature resulting from irrigation practices. The upper Smith River watershed was used to develop the model framework including watershed climate, topography, hydrography, vegetation, soil properties and current irrigation practices. Model results were used to compare watershed streamflow, groundwater recharge, and groundwater discharge to the stream for three scenarios: natural, pre-irrigation conditions (PreIrr); current irrigation practices involving mainly stream diversion for flood and sprinkler irrigation (IrrCurrent); and a hypothetical scenario with only groundwater supplying sprinkler irrigation (IrrGW). Irrigation increased groundwater recharge relative to natural PreIrr conditions because not all applied water was removed by crop evapotranspiration. Groundwater storage and groundwater discharge to the stream increased relative to natural PreIrr conditions when the source of irrigation water was mainly stream diversion as in the IrrCurrent scenario. The hypothetical IrrGW scenario, in which groundwater withdrawals were the sole source of irrigation water, resulted in widespread lowering of the water table and associated decreases in groundwater storage and groundwater discharge to the stream. A mixing analysis using model predicted groundwater discharge along the reaches suggests that stream diversion and flood irrigation, represented in the IrrCurrent scenario, has led to cooling of stream temperatures relative to natural PreIrr conditions improving fish thermal habitat. However, the decrease in groundwater discharge in the IrrGW scenario resulting from large-scale groundwater withdrawal for irrigation led to warmer than natural stream temperatures and possible degradation of fish habitat. Published by Elsevier B.V.

Evaluating the impact of irrigation on surface water – groundwater interaction and stream temperature in an agricultural watershed

USGS Publications Warehouse

Essaid, Hedeff I.; Caldwell, Rodney R.

2017-01-01

Changes in groundwater discharge to streams caused by irrigation practices can influence stream temperature. Observations along two currently flood-irrigated reaches in the 640-square-kilometer upper Smith River watershed, an important agricultural and recreational fishing area in west-central Montana, showed a downstream temperature decrease resulting from groundwater discharge to the stream. A watershed-scale coupled surface water and groundwater flow model was used to examine changes in streamflow, groundwater discharge to the stream and stream temperature resulting from irrigation practices. The upper Smith River watershed was used to develop the model framework including watershed climate, topography, hydrography, vegetation, soil properties and current irrigation practices. Model results were used to compare watershed streamflow, groundwater recharge, and groundwater discharge to the stream for three scenarios: natural, pre-irrigation conditions (PreIrr); current irrigation practices involving mainly stream diversion for flood and sprinkler irrigation (IrrCurrent); and a hypothetical scenario with only groundwater supplying sprinkler irrigation (IrrGW). Irrigation increased groundwater recharge relative to natural PreIrr conditions because not all applied water was removed by crop evapotranspiration. Groundwater storage and groundwater discharge to the stream increased relative to natural PreIrr conditions when the source of irrigation water was mainly stream diversion as in the IrrCurrent scenario. The hypothetical IrrGW scenario, in which groundwater withdrawals were the sole source of irrigation water, resulted in widespread lowering of the water table and associated decreases in groundwater storage and groundwater discharge to the stream. A mixing analysis using model predicted groundwater discharge along the reaches suggests that stream diversion and flood irrigation, represented in the IrrCurrent scenario, has led to cooling of stream temperatures relative to natural PreIrr conditions improving fish thermal habitat. However, the decrease in groundwater discharge in the IrrGW scenario resulting from large-scale groundwater withdrawal for irrigation led to warmer than natural stream temperatures and possible degradation of fish habitat.

COMBATXXI, JDAFS, and LBC Integration Requirements for EASE

DTIC Science & Technology

2015-10-06

process as linear and as new data is made available, any previous analysis is obsolete and has to start the process over again. Figure 2 proposes a...final line of the manifest file names the scenario file associated with the run. Under the usual practice, the analyst now starts the COMBATXXI...describes which events are to be logged. Finally the scenario is started with the click of a button. The simulation generates logs of a couple of sorts

Long-term prospects for the environmental profile of advanced sugar cane ethanol.

PubMed

da Silva, Cinthia R U; Franco, Henrique Coutinho Junqueira; Junqueira, Tassia Lopes; van Oers, Lauran; van der Voet, Ester; Seabra, Joaquim E A

2014-10-21

This work assessed the environmental impacts of the production and use of 1 MJ of hydrous ethanol (E100) in Brazil in prospective scenarios (2020-2030), considering the deployment of technologies currently under development and better agricultural practices. The life cycle assessment technique was employed using the CML method for the life cycle impact assessment and the Monte Carlo method for the uncertainty analysis. Abiotic depletion, global warming, human toxicity, ecotoxicity, photochemical oxidation, acidification, and eutrophication were the environmental impacts categories analyzed. Results indicate that the proposed improvements (especially no-til farming-scenarios s2 and s4) would lead to environmental benefits in prospective scenarios compared to the current ethanol production (scenario s0). Combined first and second generation ethanol production (scenarios s3 and s4) would require less agricultural land but would not perform better than the projected first generation ethanol, although the uncertainties are relatively high. The best use of 1 ha of sugar cane was also assessed, considering the displacement of the conventional products by ethanol and electricity. No-til practices combined with the production of first generation ethanol and electricity (scenario s2) would lead to the largest mitigation effects for global warming and abiotic depletion. For the remaining categories, emissions would not be mitigated with the utilization of the sugar cane products. However, this conclusion is sensitive to the displaced electricity sources.

Medication dispensing errors in Palestinian community pharmacy practice: a formal consensus using the Delphi technique.

PubMed

Shawahna, Ramzi; Haddad, Aseel; Khawaja, Baraa; Raie, Rand; Zaneen, Sireen; Edais, Tasneem

2016-10-01

Background Medication dispensing errors (MDEs) are frequent in community pharmacy practice. A definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice were not previously approached using formal consensus techniques. Objective This study was conducted to achieve consensus on a definition of MDEs and a wide range of scenarios that should or should not be considered as MDEs in Palestinian community pharmacy practice by a panel of community pharmacists. Setting Community pharmacy practice in Palestine. Method This was a descriptive study using the Delphi technique. A panel of fifty community pharmacists was recruited from different geographical locations of the West Bank of Palestine. A three round Delphi technique was followed to achieve consensus on a proposed definition of MDEs and 83 different scenarios representing potential MDEs using a nine-point scale. Main outcome measure Agreement or disagreement of a panel of community pharmacists on a proposed definition of MDEs and a series of scenarios representing potential MDEs. Results In the first Delphi round, views of key contact community pharmacists on MDEs were explored and situations representing potential MDEs were collected. In the second Delphi round, consensus was achieved to accept the proposed definition and to include 49 (59 %) of the 83 proposed scenarios as MDEs. In the third Delphi round, consensus was achieved to include further 13 (15.7 %) scenarios as MDEs, exclude 9 (10.8 %) scenarios and the rest of 12 (14.5 %) scenarios were considered equivocal based on the opinions of the panelists. Conclusion Consensus on a definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice was achieved using a formal consensus technique. The use of consensual definitions and scenarios representing MDE situations in community pharmacy practice might minimize methodological variations and their significant effects on the number and rate of MDEs reported in different studies.

Education research: communication skills for neurology residents: structured teaching and reflective practice.

PubMed

Watling, Christopher J; Brown, Judith B

2007-11-27

Despite the importance of communication skills for neurologists, specific training in this area at the residency level is often lacking. This study aimed to enhance learning of these skills and to encourage reflective practice around communication skills. A group of 12 neurology residents participated in a series of six case-based communication skills workshops. Each workshop focused on a particular clinical scenario, including breaking bad news, discussing do-not-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent for neurologic tests and procedures, and discussing life-and-death decisions with families of critically ill patients. Residents also kept reflective portfolios in which real examples of these interactions were recorded. The program was well accepted, and residents rated the workshops as effective and relevant to their practice. Analysis of residents' portfolios revealed three themes relevant to patient-physician communication: 1) communication is more successful when adequate time is allowed, 2) the ability to empathize with patients and their families is essential to successful interactions, and 3) the development of specific approaches to challenging scenarios can facilitate effective interactions. The portfolios also demonstrated that residents would engage in reflective practice. Targeting of communication skills training around specific clinical scenarios using neurologic cases was well accepted and was deemed relevant to practice. The use of portfolios may promote lifelong learning in this area.

I spy with my little eye: Analysis of airline pilots' gaze patterns in a manual instrument flight scenario.

PubMed

Haslbeck, Andreas; Zhang, Bo

2017-09-01

The aim of this study was to analyze pilots' visual scanning in a manual approach and landing scenario. Manual flying skills suffer from increasing use of automation. In addition, predominantly long-haul pilots with only a few opportunities to practice these skills experience this decline. Airline pilots representing different levels of practice (short-haul vs. long-haul) had to perform a manual raw data precision approach while their visual scanning was recorded by an eye-tracking device. The analysis of gaze patterns, which are based on predominant saccades, revealed one main group of saccades among long-haul pilots. In contrast, short-haul pilots showed more balanced scanning using two different groups of saccades. Short-haul pilots generally demonstrated better manual flight performance and within this group, one type of scan pattern was found to facilitate the manual landing task more. Long-haul pilots tend to utilize visual scanning behaviors that are inappropriate for the manual ILS landing task. This lack of skills needs to be addressed by providing specific training and more practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

A scenario-planning approach to human resources for health: the case of community pharmacists in Portugal.

PubMed

Gregório, João; Cavaco, Afonso; Velez Lapão, Luís

2014-10-13

Health workforce planning is especially important in a setting of political, social, and economic uncertainty. Portuguese community pharmacists are experiencing such conditions as well as increasing patient empowerment, shortage of primary care physicians, and primary health care reforms. This study aims to design three future scenarios for Portuguese community pharmacists, recognizing the changing environment as an opportunity to develop the role that community pharmacists may play in the Portuguese health system. The community pharmacist scenario design followed a three-stage approach. The first stage comprised thinking of relevant questions to be addressed and definition of the scenarios horizon. The second stage comprised two face-to-face, scenario-building workshops, for which 10 experts from practice and academic settings were invited. Academic and professional experience was the main selection criteria. The first workshop was meant for context analysis and design of draft scenarios, while the second was aimed at scenario analysis and validation. The final scenarios were built merging workshops' information with data collected from scientific literature followed by team consensus. The final stage involved scenario development carried by the authors alone, developing the narratives behind each scenario. Analysis allowed the identification of critical factors expected to have particular influence in 2020 for Portuguese community pharmacists, leading to two critical uncertainties: the "Legislative environment" and "Ability to innovate and develop services". Three final scenarios were built, namely "Pharmacy-Mall", "e-Pharmacist", and "Reorganize or Die". These scenarios provide possible trends for market needs, pharmacist workforce numbers, and expected qualifications to be developed by future professionals. In all scenarios it is clear that the future advance of Portuguese community pharmacists will depend on pharmaceutical services provision beyond medicine dispensing. This innovative professional role will require the acquisition or development of competencies in the fields of management, leadership, marketing, information technologies, teamwork abilities, and behavioural and communication skills. To accomplish a sustainable evolution, legislative changes and adequate financial incentives will be beneficial. The scenario development proves to be valuable as a strategic planning tool, not only for understanding future community pharmacist needs in a complex and uncertain environment, but also for other health care professionals.

Practical quantification of necrosis in histological whole-slide images.

PubMed

Homeyer, André; Schenk, Andrea; Arlt, Janine; Dahmen, Uta; Dirsch, Olaf; Hahn, Horst K

2013-06-01

Since the histological quantification of necrosis is a common task in medical research and practice, we evaluate different image analysis methods for quantifying necrosis in whole-slide images. In a practical usage scenario, we assess the impact of different classification algorithms and feature sets on both accuracy and computation time. We show how a well-chosen combination of multiresolution features and an efficient postprocessing step enables the accurate quantification necrosis in gigapixel images in less than a minute. The results are general enough to be applied to other areas of histological image analysis as well. Copyright © 2013 Elsevier Ltd. All rights reserved.

Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

PubMed

Popat, H; Thomas, K; Farnell, D J J

2016-07-08

Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

Inadvertent Intruder Analysis For The Portsmouth On-Site Waste Disposal Facility (OSWDF)

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

Smith, Frank G.; Phifer, Mark A.

2014-01-22

The inadvertent intruder analysis considers the radiological impacts to hypothetical persons who are assumed to inadvertently intrude on the Portsmouth OSWDF site after institutional control ceases 100 years after site closure. For the purposes of this analysis, we assume that the waste disposal in the OSWDF occurs at time zero, the site is under institutional control for the next 100 years, and inadvertent intrusion can occur over the following 1,000 year time period. Disposal of low-level radioactive waste in the OSWDF must meet a requirement to assess impacts on such individuals, and demonstrate that the effective dose equivalent to anmore » intruder would not likely exceed 100 mrem per year for scenarios involving continuous exposure (i.e. chronic) or 500 mrem for scenarios involving a single acute exposure. The focus in development of exposure scenarios for inadvertent intruders was on selecting reasonable events that may occur, giving consideration to regional customs and construction practices. An important assumption in all scenarios is that an intruder has no prior knowledge of the existence of a waste disposal facility at the site. Results of the analysis show that a hypothetical inadvertent intruder at the OSWDF who, in the worst case scenario, resides on the site and consumes vegetables from a garden established on the site using contaminated soil (chronic agriculture scenario) would receive a maximum chronic dose of approximately 7.0 mrem/yr during the 1000 year period of assessment. This dose falls well below the DOE chronic dose limit of 100 mrem/yr. Results of the analysis also showed that a hypothetical inadvertent intruder at the OSWDF who, in the worst case scenario, excavates a basement in the soil that reaches the waste (acute basement construction scenario) would receive a maximum acute dose of approximately 0.25 mrem/yr during the 1000 year period of assessment. This dose falls well below the DOE acute dose limit of 500 mrem/yr. Disposal inventory constraints based on the intruder analysis are well above conservative estimates of the OSWDF inventory and, based on intruder disposal limits; about 7% of the disposal capacity is reached with the estimated OSWDF inventory.« less

Instruments to Explore Blended Learning: Modifying a Method to Analyse Online Communication for the Analysis of Face-to-Face Communication

ERIC Educational Resources Information Center

de Leng, Bas A.; Dolmans, Diana H. J. M.; Donkers, H. H. L. M.; Muijtjens, Arno M. M.; van der Vleuten, Cees P. M.

2010-01-01

In the complex practice of today's blended learning, educators need to be able to evaluate both online and face-to-face communication in order to get the full picture of what is going on in blended learning scenarios. The aim of this study was to investigate the reliability and feasibility of a practical instrument for analysing face-to-face…

Cost-effectiveness of vaccination against cervical cancer: a multi-regional analysis assessing the impact of vaccine characteristics and alternative vaccination scenarios.

PubMed

Suárez, Eugenio; Smith, Jennifer S; Bosch, F Xavier; Nieminen, Pekka; Chen, Chien-Jen; Torvinen, Saku; Demarteau, Nadia; Standaert, Baudouin

2008-09-15

Mathematical models provide valuable insights into the public health and economic impact of cervical cancer vaccination programmes. An in-depth economic analysis should explore the effects of different vaccine-related factors and vaccination scenarios (independent of screening practices) on health benefits and costs. In this analysis, a Markov cohort model was used to explore the impact of vaccine characteristics (e.g. cross-type protection and waning of immunity) and different vaccination scenarios (e.g. age at vaccination and multiple cohort strategies) on the cost-effectiveness results of cervical cancer vaccination programmes. The analysis was applied across different regions in the world (Chile, Finland, Ireland, Poland and Taiwan) to describe the influence of location-specific conditions. The results indicate that in all the different settings cervical cancer vaccination becomes more cost-effective with broader and sustained vaccine protection, with vaccination at younger ages, and with the inclusion of several cohorts. When other factors were varied, the cost-effectiveness of vaccination was most negatively impacted by increasing the discount rate applied to costs and health effects.

Passive decoy-state quantum key distribution with practical light sources

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

Curty, Marcos; Ma, Xiongfeng; Qi, Bing

2010-02-15

Decoy states have been proven to be a very useful method for significantly enhancing the performance of quantum key distribution systems with practical light sources. Although active modulation of the intensity of the laser pulses is an effective way of preparing decoy states in principle, in practice passive preparation might be desirable in some scenarios. Typical passive schemes involve parametric down-conversion. More recently, it has been shown that phase-randomized weak coherent pulses (WCP) can also be used for the same purpose [M. Curty et al., Opt. Lett. 34, 3238 (2009).] This proposal requires only linear optics together with a simplemore » threshold photon detector, which shows the practical feasibility of the method. Most importantly, the resulting secret key rate is comparable to the one delivered by an active decoy-state setup with an infinite number of decoy settings. In this article we extend these results, now showing specifically the analysis for other practical scenarios with different light sources and photodetectors. In particular, we consider sources emitting thermal states, phase-randomized WCP, and strong coherent light in combination with several types of photodetectors, like, for instance, threshold photon detectors, photon number resolving detectors, and classical photodetectors. Our analysis includes as well the effect that detection inefficiencies and noise in the form of dark counts shown by current threshold detectors might have on the final secret key rate. Moreover, we provide estimations on the effects that statistical fluctuations due to a finite data size can have in practical implementations.« less

[Current status and future of telemonitoring : Scenarios for telemedical care in 2025].

PubMed

Zippel-Schultz, Bettina; Schultz, Carsten; Helms, Thomas M

2017-09-01

Telemonitoring is an already realized implementation of digital transformation in the healthcare system. It has the potential to support and secure a sustainable and comprehensive provision of healthcare for a rising number of chronically ill patients, e. g. patients with chronic heart failure. Remote regions in particular can profit from the benefits of telemonitoring; however, so far telemonitoring services have not become truly established in the German healthcare market. Together with experts from politics, science and practice, a scenario analysis "Health Care System 2025 - A Place for Telemonitoring?" was carried out with the aim to examine the future development of the healthcare market and to draw conclusions for providers of telemonitoring services or devices. The scenario analysis contained two workshops and an expert survey and was supported by a scenario software. The current drivers and barriers of the diffusion of telemonitoring were identified and the most relevant factors that influence the future development of the healthcare market were discussed. Based on those influencing factors, three different scenarios were determined: (1) administrating rather than shaping, (2) safely into the future and (3) interconnected and digital world. In the subsequent consequence analysis activities were defined, which describe the necessary infrastructure, software instruments, organizational structures and provision of services and discuss possible activities, which prepare telemonitoring solutions for the future.

Clusters of community exposure to coastal flooding hazards based on storm and sea level rise scenarios—implications for adaptation networks in the San Francisco Bay region

USGS Publications Warehouse

Hummel, Michelle; Wood, Nathan J.; Schweikert, Amy; Stacey, Mark T.; Jones, Jeanne; Barnard, Patrick L.; Erikson, Li H.

2018-01-01

Sea level is projected to rise over the coming decades, further increasing the extent of flooding hazards in coastal communities. Efforts to address potential impacts from climate-driven coastal hazards have called for collaboration among communities to strengthen the application of best practices. However, communities currently lack practical tools for identifying potential partner communities based on similar hazard exposure characteristics. This study uses statistical cluster analysis to identify similarities in community exposure to flooding hazards for a suite of sea level rise and storm scenarios. We demonstrate this approach using 63 jurisdictions in the San Francisco Bay region of California (USA) and compare 21 distinct exposure variables related to residents, employees, and structures for six hazard scenario combinations of sea level rise and storms. Results indicate that cluster analysis can provide an effective mechanism for identifying community groupings. Cluster compositions changed based on the selected societal variables and sea level rise scenarios, suggesting that a community could participate in multiple networks to target specific issues or policy interventions. The proposed clustering approach can serve as a data-driven foundation to help communities identify other communities with similar adaptation challenges and to enhance regional efforts that aim to facilitate adaptation planning and investment prioritization.

Validation of pharmaceutical potency determinations by quantitative nuclear magnetic resonance spectrometry.

PubMed

Webster, Gregory K; Marsden, Ian; Pommerening, Cynthia A; Tyrakowski, Christina M

2010-05-01

With the changing development paradigms in the pharmaceutical industry, laboratories are challenged to release materials for clinical studies with rapid turnaround times. To minimize cost demands, many businesses are looking to develop ways of using early Good Manufacturing Practice (GMP) materials of active pharmaceutical ingredients (API) for Good Laboratory Practice (GLP) toxicology studies. To make this happen, the analytical laboratory releases the material by one of three scenarios: (1) holding the GLP release until full GMP testing is ready, (2) issuing a separate lot number for a portion of the GMP material and releasing the material for GLP use, or (3) releasing the lot of material for GLP using alternate (equivalent) method(s) not specified for GMP release testing. Many companies are finding the third scenario to be advantageous in terms of cost and efficiency through the use of quantitative nuclear magnetic resonance (q-NMR). The use of q-NMR has proved to be a single-point replacement for routine early development testing that previously combined elements of identity testing, chromatographic assay, moisture analysis, residual solvent analysis, and elemental analysis. This study highlights that q-NMR can be validated to meet current regulatory analytical method guidelines for routine pharmaceutical analysis.

Energy and Exergy Analysis of Vapour Absorption Refrigeration Cycle—A Review

NASA Astrophysics Data System (ADS)

Kanabar, Bhaveshkumar Kantilal; Ramani, Bharatkumar Maganbhai

2016-07-01

In recent years, an energy crisis and the energy consumption have become global problems which restrict the sustainable growth. In these scenarios the scientific energy recovery and the utilization of various kinds of waste heat become very important. The waste heat can be utilized in many ways and one of the best practices is to use it for vapour absorption refrigeration system. To ensure efficient working of absorption cycle and utilization of optimum heat, exergy is the best tool for analysis. This paper provides the comprehensive picture of research and development of absorption refrigeration technology, practical and theoretical analysis with different arrangements of the cycle.

Rereading Columbus: Critical Multicultural Analysis of Multiple Historical Storylines

ERIC Educational Resources Information Center

Bothelho, Maria Jose; Young, Sara Lewis-Bernstein; Nappi, Tara

2014-01-01

One prevalent practice of multicultural education is enlisting multiple perspectives for teaching. Oftentimes, these perspectives enter classrooms via digital texts, simulations/scenarios, primary documents, and debates. Children's and young adult literature play a critical role in these comparisons. However, these multiple perspectives are…

Performance Systems Analysis: Learning by Doing

ERIC Educational Resources Information Center

Knowles, Marc P.; Suh, Sookyung

2005-01-01

The authors discuss potential shortfalls of assistantships and internships in preparing students for practical career application of professional degrees and describe the benefits to overall development of courses eliciting performance in authentic scenarios. This article explores what is necessary, not only to teach, but also to learn, human…

Simulation-Based Assessment of ECMO Clinical Specialists.

PubMed

Fehr, James J; Shepard, Mark; McBride, Mary E; Mehegan, Mary; Reddy, Kavya; Murray, David J; Boulet, John R

2016-06-01

The aims of the study were (1) to create multiple scenarios that simulate a range of urgent and emergent extracorporeal membrane oxygenation (ECMO) events and (2) to determine whether these scenarios can provide reliable and valid measures of a specialist's advanced skill in managing ECMO emergencies. Multiscenario simulation-based performance assessment was performed. The study was conducted in the Saigh Pediatric Simulation Center at St. Louis Children's Hospital. ECMO clinical specialists participated in the study. Twenty-five ECMO specialists completed 8 scenarios presenting acute events in simulated ECMO patients. Participants were evaluated by 2 separate reviewers for completion of key actions and for global performance. The scores were highest for the hemodilution scenario, whereas the air entrainment scenario had the lowest scores. Psychometric analysis demonstrated that ECMO specialists with more than 1 year of experience outperformed the specialists with less than 1 year of experience. Participants endorsed these sessions as important and representative of events that might be encountered in practice. The scenarios could serve as a component of an ECMO education curriculum and be used to assess clinical specialists' readiness to manage ECMO emergencies.

An introduction to kernel-based learning algorithms.

PubMed

Müller, K R; Mika, S; Rätsch, G; Tsuda, K; Schölkopf, B

2001-01-01

This paper provides an introduction to support vector machines, kernel Fisher discriminant analysis, and kernel principal component analysis, as examples for successful kernel-based learning methods. We first give a short background about Vapnik-Chervonenkis theory and kernel feature spaces and then proceed to kernel based learning in supervised and unsupervised scenarios including practical and algorithmic considerations. We illustrate the usefulness of kernel algorithms by discussing applications such as optical character recognition and DNA analysis.

Finite-key analysis for the 1-decoy state QKD protocol

NASA Astrophysics Data System (ADS)

Rusca, Davide; Boaron, Alberto; Grünenfelder, Fadri; Martin, Anthony; Zbinden, Hugo

2018-04-01

It has been shown that in the asymptotic case of infinite-key length, the 2-decoy state Quantum Key Distribution (QKD) protocol outperforms the 1-decoy state protocol. Here, we present a finite-key analysis of the 1-decoy method. Interestingly, we find that for practical block sizes of up to 108 bits, the 1-decoy protocol achieves for almost all experimental settings higher secret key rates than the 2-decoy protocol. Since using only one decoy is also easier to implement, we conclude that it is the best choice for QKD, in most common practical scenarios.

Workplace Learning in Malaysia: The Learner's Perspective

ERIC Educational Resources Information Center

Muhamad, Mazanah; Idris, Khairuddin

2005-01-01

This paper offers a scenario of workplace learning as practiced in Malaysia. Based on survey research, the article describes learner profiles, learning provision and pattern. The analysis shows that Malaysians participate in formal workplace learning as part of their employment activities. Workplace learning in Malaysia is contextual, promoted by…

An activity theory perspective of how scenario-based simulations support learning: a descriptive analysis.

PubMed

Battista, Alexis

2017-01-01

The dominant frameworks for describing how simulations support learning emphasize increasing access to structured practice and the provision of feedback which are commonly associated with skills-based simulations. By contrast, studies examining student participants' experiences during scenario-based simulations suggest that learning may also occur through participation. However, studies directly examining student participation during scenario-based simulations are limited. This study examined the types of activities student participants engaged in during scenario-based simulations and then analyzed their patterns of activity to consider how participation may support learning. Drawing from Engeström's first-, second-, and third-generation activity systems analysis, an in-depth descriptive analysis was conducted. The study drew from multiple qualitative methods, namely narrative, video, and activity systems analysis, to examine student participants' activities and interaction patterns across four video-recorded simulations depicting common motivations for using scenario-based simulations (e.g., communication, critical patient management). The activity systems analysis revealed that student participants' activities encompassed three clinically relevant categories, including (a) use of physical clinical tools and artifacts, (b) social interactions, and (c) performance of structured interventions. Role assignment influenced participants' activities and the complexity of their engagement. Importantly, participants made sense of the clinical situation presented in the scenario by reflexively linking these three activities together. Specifically, student participants performed structured interventions, relying upon the use of physical tools, clinical artifacts, and social interactions together with interactions between students, standardized patients, and other simulated participants to achieve their goals. When multiple student participants were present, such as in a team-based scenario, they distributed the workload to achieve their goals. The findings suggest that student participants learned as they engaged in these scenario-based simulations when they worked to make sense of the patient's clinical presentation. The findings may provide insight into how student participants' meaning-making efforts are mediated by the cultural artifacts (e.g., physical clinical tools) they access, the social interactions they engage in, the structured interventions they perform, and the roles they are assigned. The findings also highlight the complex and emergent properties of scenario-based simulations as well as how activities are nested. Implications for learning, instructional design, and assessment are discussed.

Evaluating the effectiveness of management practices on hydrology and water quality at watershed scale with a rainfall-runoff model.

PubMed

Liu, Yaoze; Bralts, Vincent F; Engel, Bernard A

2015-04-01

The adverse influence of urban development on hydrology and water quality can be reduced by applying best management practices (BMPs) and low impact development (LID) practices. This study applied green roof, rain barrel/cistern, bioretention system, porous pavement, permeable patio, grass strip, grassed swale, wetland channel, retention pond, detention basin, and wetland basin, on Crooked Creek watershed. The model was calibrated and validated for annual runoff volume. A framework for simulating BMPs and LID practices at watershed scales was created, and the impacts of BMPs and LID practices on water quantity and water quality were evaluated with the Long-Term Hydrologic Impact Assessment-Low Impact Development 2.1 (L-THIA-LID 2.1) model for 16 scenarios. The various levels and combinations of BMPs/LID practices reduced runoff volume by 0 to 26.47%, Total Nitrogen (TN) by 0.30 to 34.20%, Total Phosphorus (TP) by 0.27 to 47.41%, Total Suspended Solids (TSS) by 0.33 to 53.59%, Lead (Pb) by 0.30 to 60.98%, Biochemical Oxygen Demand (BOD) by 0 to 26.70%, and Chemical Oxygen Demand (COD) by 0 to 27.52%. The implementation of grass strips in 25% of the watershed where this practice could be applied was the most cost-efficient scenario, with cost per unit reduction of $1m3/yr for runoff, while cost for reductions of two pollutants of concern was $445 kg/yr for Total Nitrogen (TN) and $4871 kg/yr for Total Phosphorous (TP). The scenario with very high levels of BMP and LID practice adoption (scenario 15) reduced runoff volume and pollutant loads from 26.47% to 60.98%, and provided the greatest reduction in runoff volume and pollutant loads among all scenarios. However, this scenario was not as cost-efficient as most other scenarios. The L-THIA-LID 2.1 model is a valid tool that can be applied to various locations to help identify cost effective BMP/LID practice plans at watershed scales. Copyright © 2014 Elsevier B.V. All rights reserved.

Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services--A Cost Benefit Analysis.

PubMed

De Gruyter, Elaine; Ford, Greg; Stavreski, Bill

2016-02-01

Cardiac rehabilitation can reduce mortality, improve cardiac risk factor profile and reduce readmissions; yet uptake remains low at 30%. This research aims to investigate the social and economic impact of increasing the uptake of cardiac rehabilitation in Victoria, Australia using cost benefit analysis (CBA). Cost benefit analysis has been undertaken over a 10-year period to analyse three scenarios: (1) Base Case: 30% uptake; (2) Scenario 1: 50% uptake; and (3) Scenario 2: 65% uptake. Impacts considered include cardiac rehabilitation program costs, direct inpatient costs, other healthcare costs, burden of disease, productivity losses, informal care costs and net deadweight loss. There is a net financial saving of $46.7-$86.7 million under the scenarios. Compared to the Base Case, an additional net benefit of $138.9-$227.2 million is expected. This results in a Benefit Cost Ratio of 5.6 and 6.8 for Scenarios 1 and 2 respectively. Disability Adjusted Life Years were 21,117-37,565 years lower than the Base Case. Greater uptake of cardiac rehabilitation can reduce the burden of disease, directly translating to benefits for society and the economy. This research supports the need for greater promotion, routine referral to be made standard practice and implementation of reforms to boost uptake. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Constrained physical therapist practice: an ethical case analysis of recommending discharge placement from the acute care setting.

PubMed

Nalette, Ernest

2010-06-01

Constrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility-which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice. The case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States. An applied ethics approach was used for case analysis. The decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission. Constrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.

Barriers to accessing urethroplasty

PubMed Central

Consolo, Michael J.; Syed, Kirin K.; Robison, Christopher; McFadden, Jacob; Shalowitz, David I.; Brown, Gordon A.; Sussman, David O.; Figler, Bradley D.

2016-01-01

Urethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n 5 13, 15%) and concern about complications (n 5 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training. PMID:28127260

Barriers to accessing urethroplasty.

PubMed

Consolo, Michael J; Syed, Kirin K; Robison, Christopher; McFadden, Jacob; Shalowitz, David I; Brown, Gordon A; Sussman, David O; Figler, Bradley D

2016-01-01

Urethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n 5 13, 15%) and concern about complications (n 5 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training.

Geochemical Processes During Managed Aquifer Recharge With Desalinated Seawater

NASA Astrophysics Data System (ADS)

Ganot, Y.; Holtzman, R.; Weisbrod, N.; Russak, A.; Katz, Y.; Kurtzman, D.

2018-02-01

We study geochemical processes along the variably-saturated zone during managed aquifer recharge (MAR) with reverse-osmosis desalinated seawater (DSW). The DSW, post-treated at the desalination plant by calcite dissolution (remineralization) to meet the Israeli water quality standards, is recharged into the Israeli Coastal Aquifer through an infiltration pond. Water quality monitoring during two MAR events using suction cups and wells inside the pond indicates that cation exchange is the dominant subsurface reaction, driven by the high Ca2+ concentration in the post-treated DSW. Stable isotope analysis shows that the shallow groundwater composition is similar to the recharged DSW, except for enrichment of Mg2+, Na+, Ca2+, and HCO3-. A calibrated variably-saturated reactive transport model is used to predict the geochemical evolution during 50 years of MAR for two water quality scenarios: (i) post-treated DSW (current practice) and (ii) soft DSW (lacking the remineralization post-treatment process). The latter scenario was aimed to test soil-aquifer-treatment (SAT) as an alternative post-treatment technique. Both scenarios provide an enrichment of ˜2.5 mg L-1 in Mg2+ due to cation exchange, compared to practically zero Mg2+ currently found in the Israeli DSW. Simulations of the alternative SAT scenario provide Ca2+ and HCO3- remineralization due to calcite dissolution at levels that meet the Israeli standard for DSW. The simulated calcite content reduction in the sediments below the infiltration pond after 50 years of MAR was low (<1%). Our findings suggest that remineralization using SAT for DSW is a potentially sustainable practice at MAR sites overlying calcareous sandy aquifers.

Crosswalk navigation for people with visual impairments on a wearable device

NASA Astrophysics Data System (ADS)

Cheng, Ruiqi; Wang, Kaiwei; Yang, Kailun; Long, Ningbo; Hu, Weijian; Chen, Hao; Bai, Jian; Liu, Dong

2017-09-01

Detecting and reminding of crosswalks at urban intersections is one of the most important demands for people with visual impairments. A real-time crosswalk detection algorithm, adaptive extraction and consistency analysis (AECA), is proposed. Compared with existing algorithms, which detect crosswalks in ideal scenarios, the AECA algorithm performs better in challenging scenarios, such as crosswalks at far distances, low-contrast crosswalks, pedestrian occlusion, various illuminances, and the limited resources of portable PCs. Bright stripes of crosswalks are extracted by adaptive thresholding, and are gathered to form crosswalks by consistency analysis. On the testing dataset, the proposed algorithm achieves a precision of 84.6% and a recall of 60.1%, which are higher than the bipolarity-based algorithm. The position and orientation of crosswalks are conveyed to users by voice prompts so as to align themselves with crosswalks and walk along crosswalks. The field tests carried out in various practical scenarios prove the effectiveness and reliability of the proposed navigation approach.

Thermal Model Development for Ares I-X

NASA Technical Reports Server (NTRS)

Amundsen, Ruth M.; DelCorso, Joe

2008-01-01

Thermal analysis for the Ares I-X vehicle has involved extensive thermal model integration, since thermal models of vehicle elements came from several different NASA and industry organizations. Many valuable lessons were learned in terms of model integration and validation. Modeling practices such as submodel, analysis group and symbol naming were standardized to facilitate the later model integration. Upfront coordination of coordinate systems, timelines, units, symbols and case scenarios was very helpful in minimizing integration rework. A process for model integration was developed that included pre-integration runs and basic checks of both models, and a step-by-step process to efficiently integrate one model into another. Extensive use of model logic was used to create scenarios and timelines for avionics and air flow activation. Efficient methods of model restart between case scenarios were developed. Standardization of software version and even compiler version between organizations was found to be essential. An automated method for applying aeroheating to the full integrated vehicle model, including submodels developed by other organizations, was developed.

An ecosystem service approach to support integrated pond management: a case study using Bayesian belief networks--highlighting opportunities and risks.

PubMed

Landuyt, Dries; Lemmens, Pieter; D'hondt, Rob; Broekx, Steven; Liekens, Inge; De Bie, Tom; Declerck, Steven A J; De Meester, Luc; Goethals, Peter L M

2014-12-01

Freshwater ponds deliver a broad range of ecosystem services (ESS). Taking into account this broad range of services to attain cost-effective ESS delivery is an important challenge facing integrated pond management. To assess the strengths and weaknesses of an ESS approach to support decisions in integrated pond management, we applied it on a small case study in Flanders, Belgium. A Bayesian belief network model was developed to assess ESS delivery under three alternative pond management scenarios: intensive fish farming (IFF), extensive fish farming (EFF) and nature conservation management (NCM). A probabilistic cost-benefit analysis was performed that includes both costs associated with pond management practices and benefits associated with ESS delivery. Whether or not a particular ESS is included in the analysis affects the identification of the most preferable management scenario by the model. Assessing the delivery of a more complete set of ecosystem services tends to shift the results away from intensive management to more biodiversity-oriented management scenarios. The proposed methodology illustrates the potential of Bayesian belief networks. BBNs facilitate knowledge integration and their modular nature encourages future model expansion to more encompassing sets of services. Yet, we also illustrate the key weaknesses of such exercises, being that the choice whether or not to include a particular ecosystem service may determine the suggested optimal management practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of high fidelity operating room simulation to assess and teach communication, teamwork and laparoscopic skills: initial experience.

PubMed

Gettman, Matthew T; Pereira, Claudio W; Lipsky, Katja; Wilson, Torrence; Arnold, Jacqueline J; Leibovich, Bradley C; Karnes, R Jeffrey; Dong, Yue

2009-03-01

Structured opportunities for learning communication, teamwork and laparoscopic principles are limited for urology residents. We evaluated and taught teamwork, communication and laparoscopic skills to urology residents in a simulated operating room. Scenarios related to laparoscopy (insufflator failure, carbon dioxide embolism) were developed using mannequins, urology residents and nurses. These scenarios were developed based on Accreditation Council for Graduate Medical Education core competencies and performed in a simulation center. Between the pretest scenario (insufflation failure) and the posttest scenario (carbon dioxide embolism) instruction was given on teamwork, communication and laparoscopic skills. A total of 19 urology residents participated in the training that involved participation in at least 2 scenarios. Performance was evaluated using validated teamwork instruments, questionnaires and videotape analysis. Significant improvement was noted on validated teamwork instruments between scenarios based on resident (pretest 24, posttest 27, p = 0.01) and expert (pretest 16, posttest 25, p = 0.008) evaluation. Increased teamwork and team performance were also noted between scenarios on videotape analysis with significant improvement for adherence to best practice (p = 0.01) and maintenance of positive rapport among team members (p = 0.02). Significant improvement in the setup of the laparoscopic procedure was observed (p = 0.01). Favorable face and content validity was noted for both scenarios. Teamwork, intraoperative communication and laparoscopic skills of urology residents improved during the high fidelity simulation course. Face and content validity of the individual sessions was favorable. In this study high fidelity simulation was effective for assessing and teaching Accreditation Council for Graduate Medical Education core competencies related to intraoperative communication, teamwork and laparoscopic skills.

Narrative of a Teaching Practice. An Autoethnography about Being a Geriatrics Professor

ERIC Educational Resources Information Center

Bulgarelli, Alexandre F.; Toassi, Ramona F. C.

2018-01-01

This study was developed to show a professor's perspective to comprehend his difficulties and challenges, within a different scenario and culture of teaching geriatric dentistry in a nursing home. It was a self-analysis theoretically supported by the Social Constructionism and the Interpretative Autoethnography perspective. Data were constructed…

Examining the effects of an eco-driving message on driver distraction.

PubMed

Rouzikhah, Hossein; King, Mark; Rakotonirainy, Andry

2013-01-01

This paper examines the effects of an eco-driving message on driver distraction. Two in-vehicle distracter tasks were compared with an eco-driving task and a baseline task in an advanced driving simulator. N=22 subjects were asked to perform an eco-driving, CD changing, and a navigation task while engaged in critical manoeuvres during which they were expected to respond to a peripheral detection task (PDT) with total duration of 3.5h. The study involved two sessions over two consecutive days. The results show that drivers' mental workloads are significantly higher during navigation and CD changing tasks in comparison to the two other scenarios. However, eco-driving mental workload is still marginally significant (p∼.05) across different manoeuvres. Similarly, event detection tasks show that drivers miss significantly more events in the navigation and CD changing scenarios in comparison to both the baseline and eco-driving scenario. Analysis of the practice effect shows that drivers' baseline scenario and navigation scenario exhibit significantly less demand on the second day. Drivers also can detect significantly more events on the second day for all scenarios. The authors conclude that even reading a simple message while driving could potentially lead to missing an important event, especially when executing critical manoeuvres. However, there is some evidence of a practice effect which suggests that future research should focus on performance with habitual rather than novel tasks. It is recommended that sending text as an eco-driving message analogous to the study circumstances should not be delivered to drivers on-line when vehicle is in motion. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cultural and hierarchical influences: ethical issues faced by Taiwanese nursing students.

PubMed

Yeh, Mei-Yu; Wu, Shu-Mei; Che, Hui-Lian

2010-05-01

OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.

The Top 10 Ethical Challenges in Dental Practice in Indian Scenario: Dentist Perspective

PubMed Central

Kemparaj, Vanishree M.; Panchmal, Ganesh Shenoy; Kadalur, Umashankar Gangadaraiah

2018-01-01

Aim: This exploratory qualitative research is an attempt to assess the health care ethical challenges in dental practice in an Indian scenario. Methodology: Qualitative indepth interview was conducted on 20 dental professionals to assess the ethical challenges prevailing in dental practice in Indian scenario. After obtaining the responses the verbatims were categorized into categories and finally 36 themes emerged. Later from two group of 6 panellists each after conducting focus group discussion the themes of ethical issues occurring in dental practice were ranked based on order of significance impact on the practice, patient and society using Delphi method. Result: The top ten ethical challenges listed by the panellists are inadequate sterilization and waste management in dental clinics, poor knowledge and attitude towards ethics among our dental practitioners, in competence among dental professional, increase in cost of oral health service, poor informed consent process, requirement of consensus about the treatment procedures among dentists, Conflict in Advertising, clustering of dental clinics in urban areas, disagreement with treatment modalities among dentist and patient, poor medical record maintenance among our dental practitioners. Conclusion: The study attempts to bring the prevailing ethical challenges in oral health care practice in Indian scenario. PMID:29599593

Learning crisis resource management: Practicing versus an observational role in simulation training - a randomized controlled trial.

PubMed

Lai, Anita; Haligua, Alexis; Dylan Bould, M; Everett, Tobias; Gale, Mark; Pigford, Ashlee-Ann; Boet, Sylvain

2016-08-01

Simulation training has been shown to be an effective way to teach crisis resource management (CRM) skills. Deliberate practice theory states that learners need to actively practice so that learning is effective. However, many residency programs have limited opportunities for learners to be "active" participants in simulation exercises. This study compares the effectiveness of learning CRM skills when being an active participant versus being an observer participant in simulation followed by a debriefing. Participants were randomized to two groups: active or observer. Active participants managed a simulated crisis scenario (pre-test) while paired observer participants viewed the scenario via video transmission. Then, a trained instructor debriefed participants on CRM principles. On the same day, each participant individually managed another simulated crisis scenario (post-test) and completed a post-test questionnaire. Two independent, blinded raters evaluated all videos using the Ottawa Global Rating Scale (GRS). Thirty-nine residents were included in the analysis. Normally distributed data were analyzed using paired and unpaired t-tests. Inter-rater reliability was 0.64. Active participants significantly improved from pre-test to post-test (P=0.015). There was no significant difference between the post-test performance of active participants compared to observer participants (P=0.12). We found that learning CRM principles was not superior when learners were active participants compared to being observers followed by debriefing. These findings challenge the deliberate practice theory claiming that learning requires active practice. Assigning residents as observers in simulation training and involving them in debriefing is still beneficial. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Agricultural conservation planning framework: 1. Developing multipractice watershed planning scenarios and assessing nutrient reduction potential.

PubMed

Tomer, M D; Porter, S A; Boomer, K M B; James, D E; Kostel, J A; Helmers, M J; Isenhart, T M; McLellan, E

2015-05-01

Spatial data on soils, land use, and topography, combined with knowledge of conservation effectiveness, can be used to identify alternatives to reduce nutrient discharge from small (hydrologic unit code [HUC]12) watersheds. Databases comprising soil attributes, agricultural land use, and light detection and ranging-derived elevation models were developed for two glaciated midwestern HUC12 watersheds: Iowa's Beaver Creek watershed has an older dissected landscape, and Lime Creek in Illinois is young and less dissected. Subsurface drainage is common in both watersheds. We identified locations for conservation practices, including in-field practices (grassed waterways), edge-of-field practices (nutrient-removal wetlands, saturated buffers), and drainage-water management, by applying terrain analyses, geographic criteria, and cross-classifications to field- and watershed-scale geographic data. Cover crops were randomly distributed to fields without geographic prioritization. A set of alternative planning scenarios was developed to represent a variety of extents of implementation among these practices. The scenarios were assessed for nutrient reduction potential using a spreadsheet approach to calculate the average nutrient-removal efficiency required among the practices included in each scenario to achieve a 40% NO-N reduction. Results were evaluated in the context of the Iowa Nutrient Reduction Strategy, which reviewed nutrient-removal efficiencies of practices and established the 40% NO-N reduction as Iowa's target for Gulf of Mexico hypoxia mitigation by agriculture. In both test watersheds, planning scenarios that could potentially achieve the targeted NO-N reduction but remove <5% of cropland from production were identified. Cover crops and nutrient removal wetlands were common to these scenarios. This approach provides an interim technology to assist local watershed planning and could provide planning scenarios to evaluate using watershed simulation models. A set of ArcGIS tools is being released to enable transfer of this mapping technology. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

The potential for land use change to reduce flood risk in mid-sized catchments in the Myjava region of Slovakia

NASA Astrophysics Data System (ADS)

Rončák, Peter; Lisovszki, Evelin; Szolgay, Ján; Hlavčová, Kamila; Kohnová, Silvia; Csoma, Rózsa; Poórová, Jana

2017-06-01

The effects of land use management practices on surface runoff are evident on a local scale, but evidence of their impact on the scale of a watershed is limited. This study focuses on an analysis of the impact of land use changes on the flood regime in the Myjava River basin, which is located in Western Slovakia. The Myjava River basin has an area of 641.32 km2 and is typified by the formation of fast runoff processes, intensive soil erosion, and muddy floods. The main factors responsible for these problems with flooding and soil erosion are the basin's location, geology, pedology, agricultural land use, and cropping practices. The GIS-based, spatially distributed WetSpa rainfall-runoff model was used to simulate mean daily discharges in the outlet of the basin as well as the individual components of the water balance. The model was calibrated based on the period between 1997 and 2012 with outstanding results (an NS coefficient of 0.702). Various components of runoff (e.g., surface, interflow and groundwater) and several elements of the hydrological balance (evapotranspiration and soil moisture) were simulated under various land use scenarios. Six land use scenarios (`crop', `grass', `forest', `slope', `elevation' and `optimal') were developed. The first three scenarios exhibited the ability of the WetSpa model to simulate runoff under changed land use conditions and enabled a better adjustment of the land use parameters of the model. Three other "more realistic" land use scenarios, which were based on the distribution of land use classes (arable land, grass and forest) regarding permissible slopes in the catchment, confirmed the possibility of reducing surface runoff and maximum discharges with applicable changes in land use and land management. These scenarios represent practical, realistic and realizable land use management solutions and they could be economically implemented to mitigate soil erosion processes and enhance the flood protection measures in the Myjava River basin.

Age differences in the effect of framing on risky choice: A meta-analysis

PubMed Central

Best, Ryan; Charness, Neil

2015-01-01

The framing of decision scenarios in terms of potential gains versus losses has been shown to influence choice preferences between sure and risky options. Normative cognitive changes associated with aging have been known to affect decision-making, which has led to a number of studies investigating the influence of aging on the effect of framing. Mata, Josef, Samanez-Larkin, and Hertwig (2011) systematically reviewed the available literature using a meta-analytic approach, but did not include tests of homogeneity nor subsequent moderator variable analyses. The current review serves to extend the previous analysis to include such tests as well as update the pool of studies available for analysis. Results for both positively and negatively framed conditions were reviewed using two meta-analyses encompassing data collected from 3,232 subjects across 18 studies. Deviating from the previous results, the current analysis finds a tendency for younger adults to choose the risky option more often than older adults for positively framed items. Moderator variable analyses find this effect to likely be driven by the specific decision scenario, showing a significant effect with younger adults choosing the risky option more often in small-amount financial and large-amount mortality-based scenarios. For negatively framed items, the current review found no overall age difference in risky decision making, confirming the results from the prior meta-analysis. Moderator variable analyses conducted to address heterogeneity found younger adults to be more likely than older adults to choose the risky option for negatively framed high-amount mortality-based decision scenarios. Practical implications for older adults are discussed. PMID:26098168

Age differences in the effect of framing on risky choice: A meta-analysis.

PubMed

Best, Ryan; Charness, Neil

2015-09-01

The framing of decision scenarios in terms of potential gains versus losses has been shown to influence choice preferences between sure and risky options. Normative cognitive changes associated with aging have been known to affect decision making, which has led to a number of studies investigating the influence of aging on the effect of framing. Mata, Josef, Samanez-Larkin, and Hertwig (2011) systematically reviewed the available literature using a meta-analytic approach, but did not include tests of homogeneity or subsequent moderator variable analyses. The current review serves to extend the previous analysis to include such tests as well as update the pool of studies available for analysis. Results for both positively and negatively framed conditions were reviewed using 2 meta-analyses encompassing data collected from 3,232 subjects across 18 studies. Deviating from the previous results, the current analysis found a tendency for younger adults to choose the risky option more often than older adults for positively framed items. Moderator variable analyses found this effect likely to be driven by the specific decision scenario, showing a significant effect, with younger adults choosing the risky option more often in small-amount financial and large-amount mortality-based scenarios. For negatively framed items, the current review found no overall age difference in risky decision making, confirming the results from the prior meta-analysis. Moderator variable analyses conducted to address heterogeneity found younger adults to be more likely than older adults to choose the risky option for negatively framed high-amount mortality-based decision scenarios. Practical implications for older adults are discussed. (c) 2015 APA, all rights reserved).

Objective comparison of particle tracking methods.

PubMed

Chenouard, Nicolas; Smal, Ihor; de Chaumont, Fabrice; Maška, Martin; Sbalzarini, Ivo F; Gong, Yuanhao; Cardinale, Janick; Carthel, Craig; Coraluppi, Stefano; Winter, Mark; Cohen, Andrew R; Godinez, William J; Rohr, Karl; Kalaidzidis, Yannis; Liang, Liang; Duncan, James; Shen, Hongying; Xu, Yingke; Magnusson, Klas E G; Jaldén, Joakim; Blau, Helen M; Paul-Gilloteaux, Perrine; Roudot, Philippe; Kervrann, Charles; Waharte, François; Tinevez, Jean-Yves; Shorte, Spencer L; Willemse, Joost; Celler, Katherine; van Wezel, Gilles P; Dan, Han-Wei; Tsai, Yuh-Show; Ortiz de Solórzano, Carlos; Olivo-Marin, Jean-Christophe; Meijering, Erik

2014-03-01

Particle tracking is of key importance for quantitative analysis of intracellular dynamic processes from time-lapse microscopy image data. Because manually detecting and following large numbers of individual particles is not feasible, automated computational methods have been developed for these tasks by many groups. Aiming to perform an objective comparison of methods, we gathered the community and organized an open competition in which participating teams applied their own methods independently to a commonly defined data set including diverse scenarios. Performance was assessed using commonly defined measures. Although no single method performed best across all scenarios, the results revealed clear differences between the various approaches, leading to notable practical conclusions for users and developers.

Application of risk-based multiple criteria decision analysis for selection of the best agricultural scenario for effective watershed management.

PubMed

Javidi Sabbaghian, Reza; Zarghami, Mahdi; Nejadhashemi, A Pouyan; Sharifi, Mohammad Bagher; Herman, Matthew R; Daneshvar, Fariborz

2016-03-01

Effective watershed management requires the evaluation of agricultural best management practice (BMP) scenarios which carefully consider the relevant environmental, economic, and social criteria involved. In the Multiple Criteria Decision-Making (MCDM) process, scenarios are first evaluated and then ranked to determine the most desirable outcome for the particular watershed. The main challenge of this process is the accurate identification of the best solution for the watershed in question, despite the various risk attitudes presented by the associated decision-makers (DMs). This paper introduces a novel approach for implementation of the MCDM process based on a comparative neutral risk/risk-based decision analysis, which results in the selection of the most desirable scenario for use in the entire watershed. At the sub-basin level, each scenario includes multiple BMPs with scores that have been calculated using the criteria derived from two cases of neutral risk and risk-based decision-making. The simple additive weighting (SAW) operator is applied for use in neutral risk decision-making, while the ordered weighted averaging (OWA) and induced OWA (IOWA) operators are effective for risk-based decision-making. At the watershed level, the BMP scores of the sub-basins are aggregated to calculate each scenarios' combined goodness measurements; the most desirable scenario for the entire watershed is then selected based on the combined goodness measurements. Our final results illustrate the type of operator and risk attitudes needed to satisfy the relevant criteria within the number of sub-basins, and how they ultimately affect the final ranking of the given scenarios. The methodology proposed here has been successfully applied to the Honeyoey Creek-Pine Creek watershed in Michigan, USA to evaluate various BMP scenarios and determine the best solution for both the stakeholders and the overall stream health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Student Loans Schemes in Mauritius: Experience, Analysis and Scenarios

ERIC Educational Resources Information Center

Mohadeb, Praveen

2006-01-01

This study makes a comprehensive review of the situation of student loans schemes in Mauritius, and makes recommendations, based on best practices, for setting up a national scheme that attempts to avoid weaknesses identified in some of the loans schemes of other countries. It suggests that such a scheme would be cost-effective and beneficial both…

Sedation provider practice variation: a survey analysis of pediatric emergency subspecialists and fellows.

PubMed

Shavit, Itai; Leder, Marc; Cohen, Daniel M

2010-10-01

Pediatric emergency physicians use various techniques and medications when performing procedural sedation and analgesia. The goals of our study were to assess US pediatric emergency medicine subspecialists and fellows (PEMSSFs) for individual practice variation and to evaluate (1) the use of supplemental oxygen and capnography monitoring and (2) adverse sedation events (ADSEs). A Web-based tool was used to survey and analyze data collected from a selected group of PEMSSFs, regarding their responses to 5 common sedation case scenarios, use of supplemental oxygen and capnography monitoring, and ADSEs. Logistic regression analysis was used to examine the association between medication strategy and various levels of professional experience. Two hundred one surveys were received. One hundred ninety-five of these were eligible for the study: 140 from specialists and 55 from fellows. Respondents used multiple combinations of pharmaceutical agents to the scenarios presented. For some scenarios, statistical association was found between medication selection strategy and longer professional experience. Sixty percent of respondents do not routinely provide oxygen supplementation. Despite current guidelines supporting the routine use of capnography monitoring, 45% of respondents never use it. Adverse sedation event was reported in 17 cases; all patients were discharged with no further complications. A statistical association was found between years of practitioner experience and the likelihood of reporting an ADSE (P < 0.018). This group of PEMSSFs reported a wide spectrum of medication sedation strategies, dichotomous approaches to the use of oxygen supplementation and capnography monitoring, and a low rate of ADSEs.

Spatially Explicit Landscape-Level Ecological Risks Induced by Land Use and Land Cover Change in a National Ecologically Representative Region in China.

PubMed

Gong, Jian; Yang, Jianxin; Tang, Wenwu

2015-11-09

Land use and land cover change is driven by multiple influential factors from environmental and social dimensions in a land system. Land use practices of human decision-makers modify the landscape of the land system, possibly leading to landscape fragmentation, biodiversity loss, or environmental pollution-severe environmental or ecological impacts. While landscape-level ecological risk assessment supports the evaluation of these impacts, investigations on how these ecological risks induced by land use practices change over space and time in response to alternative policy intervention remain inadequate. In this article, we conducted spatially explicit landscape ecological risk analysis in Ezhou City, China. Our study area is a national ecologically representative region experiencing drastic land use and land cover change, and is regulated by multiple policies represented by farmland protection, ecological conservation, and urban development. We employed landscape metrics to consider the influence of potential landscape-level disturbance for the evaluation of landscape ecological risks. Using spatiotemporal simulation, we designed scenarios to examine spatiotemporal patterns in landscape ecological risks in response to policy intervention. Our study demonstrated that spatially explicit landscape ecological risk analysis combined with simulation-driven scenario analysis is of particular importance for guiding the sustainable development of ecologically vulnerable land systems.

Spatially Explicit Landscape-Level Ecological Risks Induced by Land Use and Land Cover Change in a National Ecologically Representative Region in China

PubMed Central

Gong, Jian; Yang, Jianxin; Tang, Wenwu

2015-01-01

Land use and land cover change is driven by multiple influential factors from environmental and social dimensions in a land system. Land use practices of human decision-makers modify the landscape of the land system, possibly leading to landscape fragmentation, biodiversity loss, or environmental pollution—severe environmental or ecological impacts. While landscape-level ecological risk assessment supports the evaluation of these impacts, investigations on how these ecological risks induced by land use practices change over space and time in response to alternative policy intervention remain inadequate. In this article, we conducted spatially explicit landscape ecological risk analysis in Ezhou City, China. Our study area is a national ecologically representative region experiencing drastic land use and land cover change, and is regulated by multiple policies represented by farmland protection, ecological conservation, and urban development. We employed landscape metrics to consider the influence of potential landscape-level disturbance for the evaluation of landscape ecological risks. Using spatiotemporal simulation, we designed scenarios to examine spatiotemporal patterns in landscape ecological risks in response to policy intervention. Our study demonstrated that spatially explicit landscape ecological risk analysis combined with simulation-driven scenario analysis is of particular importance for guiding the sustainable development of ecologically vulnerable land systems. PMID:26569270

Scenario analysis of freight vehicle accident risks in Taiwan.

PubMed

Tsai, Ming-Chih; Su, Chien-Chih

2004-07-01

This study develops a quantitative risk model by utilizing Generalized Linear Interactive Model (GLIM) to analyze the major freight vehicle accidents in Taiwan. Eight scenarios are established by interacting three categorical variables of driver ages, vehicle types and road types, each of which contains two levels. The database that consists of 2043 major accidents occurring between 1994 and 1998 in Taiwan is utilized to fit and calibrate the model parameters. The empirical results indicate that accident rates of freight vehicles in Taiwan were high in the scenarios involving trucks and non-freeway systems, while; accident consequences were severe in the scenarios involving mature drivers or non-freeway systems. Empirical evidences also show that there is no significant relationship between accident rates and accident consequences. This is to stress that safety studies that describe risk merely as accident rates rather than the combination of accident rates and consequences by definition might lead to biased risk perceptions. Finally, the study recommends using number of vehicle as an alternative of traffic exposure in commercial vehicle risk analysis. The merits of this would be that it is simple and thus reliable; meanwhile, the resulted risk that is termed as fatalities per vehicle could provide clear and direct policy implications for insurance practices and safety regulations.

On the limits of probabilistic forecasting in nonlinear time series analysis II: Differential entropy.

PubMed

Amigó, José M; Hirata, Yoshito; Aihara, Kazuyuki

2017-08-01

In a previous paper, the authors studied the limits of probabilistic prediction in nonlinear time series analysis in a perfect model scenario, i.e., in the ideal case that the uncertainty of an otherwise deterministic model is due to only the finite precision of the observations. The model consisted of the symbolic dynamics of a measure-preserving transformation with respect to a finite partition of the state space, and the quality of the predictions was measured by the so-called ignorance score, which is a conditional entropy. In practice, though, partitions are dispensed with by considering numerical and experimental data to be continuous, which prompts us to trade off in this paper the Shannon entropy for the differential entropy. Despite technical differences, we show that the core of the previous results also hold in this extended scenario for sufficiently high precision. The corresponding imperfect model scenario will be revisited too because it is relevant for the applications. The theoretical part and its application to probabilistic forecasting are illustrated with numerical simulations and a new prediction algorithm.

EDITORIAL: Where next with global environmental scenarios? Where next with global environmental scenarios?

NASA Astrophysics Data System (ADS)

O'Neill, Brian; Pulver, Simone; Van Deveer, Stacy; Garb, Yaakov

2008-12-01

Scenarios have become a standard tool in the portfolio of techniques that scientists and policy-makers use to envision and plan for the future. Defined as plausible, challenging and relevant stories about how the future might unfold that integrate quantitative models with qualitative assessments of social and political trends, scenarios are a central component in assessment processes for a range of global issues, including climate change, biodiversity, agriculture, and energy. Yet, despite their prevalence, systematic analysis of scenarios is in its beginning stages. Fundamental questions remain about both the epistemology and scientific credibility of scenarios and their roles in policymaking and social change. Answers to these questions have the potential to determine the future of scenario analyses. Is scenario analysis moving in the direction of earth system governance informed by global scenarios generated through increasingly complex and comprehensive models integrating socio-economic and earth systems? Or will global environmental scenario analyses lose favour compared to more focused, policy-driven, regionally specific modelling? These questions come at an important time for the climate change issue, given that the scenario community, catalyzed by the Intergovernmental Panel on Climate Change (IPCC), is currently preparing to embark on a new round of scenario development processes aimed at coordinating research and assessment, and informing policy, over the next five to ten years. These and related questions about where next to go with global environmental scenarios animated a workshop held at Brown University (Note1) that brought together leading practitioners and scholars of global environmental change scenarios from research, policy-making, advocacy, and business settings. The workshop aimed to provide an overview of current practices/best practices in scenario production and scenario use across a range of global environmental change arenas. Participants worked to bring the experience generated from over four decades of scenario development in other issue domains, including energy and security, to bear on environmental scenarios, and to bring into dialogue scenario practitioners, both producers and users, with social science scholars. The set of contributions to this focus issue of Environmental Research Letters arose out of this workshop and collectively examines key challenges facing the scenario community, synthesizes lessons, and offers recommendations for new research and practice in this field. One theme that emerged in many of the discussions at the workshop revolved around the distinction between two broad perspectives on the goals of scenario exercises: scenarios as products and scenarios as processes. Most global environmental change scenario exercises are product-oriented; the content of the scenarios developed is the main goal of many participants and those who commission or organize the scenario development process. Typically, what is of most interest are the environmental outcomes produced, how they relate to the various factors driving them, and what the results tell us about the prospects for future environmental change, for impacts, and for mitigation. A product-oriented perspective assumes that once produced, scenario products have lives of their own, divorced from the processes that generated them and able to serve multiple, often unspecified purposes. Thus, it is often assumed that the scenario products can be 'taken up' by a variety of users in a variety of fora. A contrasting scenario approach is process-oriented and self-consciously privileges the process of scenario development as the primary goal, for example as a means to motivate organizational learning, find commonalities across different perspectives, achieve consensus on goals, or come to a shared understanding of challenges. Focusing on scenarios as processes highlights the social contexts in which scenarios are created and used. Process-oriented scenario exercises also generate scenario products, but such products are recognized as meaningful mostly (or only) in the social context in which they were developed. It should be noted that those seeking to understand the functions, implications and utility of scenarios can approach analysis of scenarios and their impacts from either perspective—focusing attention on product outcomes and influence or assessing procedural and contextual dynamics and implications. Papers in this issue examine various aspects of scenario products, scenario processes and their interactions, with specific reference to global environmental change scenarios. Hulme and Dessai (2008) use the product-process distinction as a starting point for developing a framework to evaluate the success of scenario exercises. They identify 'prediction success', 'decision success' and 'learning success' as three evaluation metrics for scenarios, with the first two most relevant to scenario products and the last emphasizing procedural aspects of scenarios. They suggest that viewing scenarios primarily as products implies examining how closely actual outcomes have matched envisioned outcomes, while viewing them primarily as processes suggests evaluating the extent to which scenarios engaged participants and enabled their learning. O'Neill and Nakicenovic (2008) focus on Hulme and Dessai's evaluation metric, learning. Based on a review of six scenario/assessment exercises, they ask if and how scenario products have incorporated comparative assessments of results in order to enable cumulative learning across scenario efforts. The authors conclude that, although participating modelling teams have benefited greatly from the process of scenario activities and applied that learning to other scenario exercises in which they engage, learning from comparative assessments of scenario products has been rather limited; the latter due to the limited time and resources invested in comparative analysis. Pitcher (2009) speaks to a similar audience, namely the emissions scenario communities that are organizing to undertake a new round of scenario development in the lead-up to the IPCC Fifth Assessment Report. His focus is primarily on a set of concerns that need to be addressed if the new set of socio-economic and emissions scenario products are to adequately support climate model runs, mitigation analyses, and impacts, adaptation and vulnerability research. Pitcher flags issues associated with assessment and measurement of economic growth, challenges associated with downscaling long-term, global scenarios to finer geographic and time scales, and possible ways to grapple with probability and uncertainty in scenario analyses. Garb et al (2008) shift focus to the process aspects of scenarios, focusing on how scenarios simultaneously shape and embed their social contexts. They outline and give examples from a research agenda, drawing on concepts and methods from sociology, political science, and science and technology studies, aimed at redressing the growing imbalance between the increasing technical sophistication of the quantitative components of scenarios on the one hand, and the continued simplicity of our understandings of the social origins, linkages, and implications of the narratives to which they are coupled on the other. Focusing on the treatment of equity concerns in the IPCC Special Report on Emissions Scenarios, Baer (2009) offers a concrete example of how particular social assumptions and definitions of equity are built into scenarios which then create particular worldviews about rights and responsibilities. Baer argues that incorporating distributions of income within—and not only between—countries in quantitative scenario exercises makes visible questions regarding the assignment of rights and the distribution of costs and benefits; such equity considerations, he argues, are central to engendering the cooperation necessary to address the climate crisis. For Parson (2008), the product-process distinction serves to highlight the unique characteristics and challenges of scenarios for global environmental change, including their use in large-scale official assessments, basis in biophysical modelling, weak connections to decision-makers, and roles as sites of public controversy. Parson argues that these characteristics of global environmental change scenarios prohibit process-oriented approaches, which rely on pre-identifying intended users and engaging them in the scenario development process. Instead, he proposes ways in which scenario products can be enhanced to support use by multiple, non-participant user communities. Wilkinson and Eidinow (2008) reach a different conclusion. They too identify the particular challenges of grappling with global environmental change. They examine approaches to past scenario efforts and categorize them into two groups that map loosely onto the product-process distinction: 'problem-focused' and 'actor-centric' approaches. They propose that progress in global environmental issues can best be made through a new, third type of approach ('reflexive interventionist or multi-agent based') that would combine elements of problem- and actor-focused approaches, creating scenario processes that can simultaneously support longer-term thinking as well as more immediate actions. Collectively, the papers in this issue range widely across issues associated with contemporary scenario processes and products. We can discern in them the outlines of an important set of suggestions for improving scenario development in the future, including, among others, the following: Focus scenario exercises on more specific questions so that results from multiple models can be more illuminating (O'Neill and Nakicenovic; Garb et al 2008). Enhance scenario transparency so as to enable extensions by users, rather than further expanding representation in global scenarios themselves (Parson 2008). Incorporate relatively simple measures (such as sub-national disaggregation of income distributions and climate change impacts) in order to boost the equity sensitivity of scenarios (Baer 2009). Recognize topics where social science inputs are becoming important for improving modelling and model relevance, such as providing a logic for how societies manage to transition from historical paths to the various future development paths foreseen in the scenarios, or developing measures of well-being which are independent of income levels, and include in global environmental scenario teams more representatives of social science professionals (Pitcher 2009; Garb et al 2008). Invest greater resources in assessing scenario results, and in understanding and overcoming the barriers to carrying out such assessment (Hulme and Dessai 2008; O'Neill and Nakicenovic, 2008). Disaggregate the variety of global change decision makers targeted as audiences for scenarios (Parson 2008; Garb et al 2008). Develop an additional 'reflective interventionist' scenarios approach that involves different epistemologies for active learning in the public interest (Wilkinson and Eidinow 2008). Draw on the extensive toolkit of social science research methods to analyze the social work of scenarios (Garb et al 2008). Create new institutions and scenario activities that can adapt and extend global scenarios to specific, often local or regional decision contexts (Parson 2008). Create fora in which scenario practitioners, modellers, decision-makers, and social scientists of various kinds can discuss the process of scenario construction and use (Garb et al 2008). We do not mean to imply a consensus among the participants in the Brown University workshop or of contributors to this collection of papers. At the same time, we believe that these and other insights and suggestions from these contributions do have a certain coherence, and collectively point to a deepening and reinvigoration of the environmental scenario-modelling enterprise—an enterprise now facing environmental change processes that are emerging as some of the most pressing challenges of our time. Acknowledgements We would like to thank the Global Environment Program at the Watson Institute for International Studies at Brown University and the US Environmental Protection Agency for financially supporting publication of this focus issue. Focus on Global Environmental Scenarios Contents Predicting, deciding, learning: can one evaluate the 'success' of national climate scenarios? Mike Hulme and Suraje Dessai Learning from global emissions scenarios Brian C O'Neill and Nebojsa Nakicenovic Scenarios in society, society in scenarios: toward a social scientific analysis of storyline-driven environmental modeling Yaakov Garb, Simone Pulver and Stacy D VanDeveer Useful global-change scenarios: current issues and challenges E A Parson Evolving practices in environmental scenarios: a new scenario typology Angela Wilkinson and Esther Eidinow Notes Note1 The workshop was held in March 2007, jointly sponsored by the Watson Institute for International Studies at Brown University, the International Institute for Applied Systems Analysis (IIASA) in Austria, and the US National Intelligence Council. See http://www.watsoninstitute.org/ge/scenarios/ for more information.

Comparative Life Cycle Assessment of possible methods for the treatment of contaminated soil at an environmentally degraded site.

PubMed

Mauko Pranjić, Alenka; Oprčkal, Primož; Mladenovič, Ana; Zapušek, Peter; Urleb, Marjan; Turk, Janez

2018-07-15

This study reports on the assessment of the environmental sustainability of different management practices for an environmentally degraded site in Slovenia: the Old Zinc-Works in the town of Celje. Life Cycle Assessments (LCAs) were applied in order to evaluate possible trade-offs by comparing a proposed in situ remediation scenario with two other reclamation scenarios (scenario 2: incineration, metal extraction, underground disposal and reclamation of the site by refilling it with replacement material, and scenario 3: underground disposal and reclamation of the site by refilling it with replacement material) and with a no-action scenario. The results of the comparisons performed show that in the case of the in situ remediation scenario, the consumption of resources is smaller by a factor of 51 compared to that in the second scenario and by a factor of 7 compared to that in the third scenario. The impacts on human health and ecosystem quality are approximately 30 and 3.5 times less in the first scenario than in the second and third scenarios, respectively. Compared to the impact of the no-action scenario, the impact on human health of the in situ soil remediation scenario is approximately 6 times less, whereas its impact on the ecosystem is approximately 4 times less. The results confirmed that the in situ soil remediation scenario is the most sustainable practice from an environmental point of view. Its main advantage lies in the achieved conservation of natural resources. Despite the recovery of valuable metals (Zn, Pb, Cu, and Ni) from the bottom ash, the second scenario is significantly more environmentally burdensome compared to both the first and third scenarios. This outcome is due to the significantly high impacts related to the consumption of fuels needed to support the incineration of low-calorific contaminated soil and to electricity consumption. The present study demonstrates that the results of LCA studies, in addition to technological, economic and social indicators, yield important information about the sustainability of different management practices and therefore should be an important part of decision-making when approaching the reclamation of environmentally degraded sites. Copyright © 2018 Elsevier Ltd. All rights reserved.

Translating research into practice: is evidence-based medicine being practiced in military-relevant orthopedic trauma?

PubMed

Niles, Sarah E; Balazs, George C; Cawley, Christina; Bosse, Michael; Mackenzie, Ellen; Li, Yaunzhang; Andersen, Romney C

2015-04-01

Orthopedic trauma remains one of the most survivable battlefield injuries seen in modern conflicts. Translating research into practice is a critical bridge that permits surgeons to further optimize medical outcomes. Orthopedic surgeons serving in the military may treat little to no trauma in their stateside practice. In conflict zones, however, the majority of their patients will have traumatic injuries. Determining risk factors for nonevidence-based practice can help identify provider knowledge gaps, which can then be targeted before deployment. Surveys were developed which sought to identify factors contributing to continued medical education and practice, as well as scenario-based questions on military-relevant orthopedic trauma. Analysis of 188 survey respondents revealed that providers with military service and less than 10 years of practice are optimally bridging research into military-relevant orthopedic trauma practice. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Estimating the effect of coppice practice on carbon dynamics of oak forests in Turkey

NASA Astrophysics Data System (ADS)

Lee, J.; Han, S. H.; Makineci, E.; Tolunay, D.; Son, Y.

2016-12-01

Coppice is a forest management practice, maximizing wood production by short-interval harvest. Coppice practice of oak forests in Turkey was abandoned in 2006, however, quantitative assessment to carbon (C) dynamics after the abandonment is still lacking. Accordingly, we simulated the annual changes in C stocks of oak forests in Turkey (7 regions) under the two management scenarios, using a forest C model (FBDC model): 200-year-interval harvest (A scenario) and abandonment of 20-year-interval coppice (B scenario). Growth of biomass was estimated by diameter at breast height (DBH) and allometric functions from previous studies. Survival of root and regeneration from sprout were formulated by a combination of empirical data and assumptions. Dead organic matter C dynamics were estimated by turnover (mortality) rates of biomass and decay rates of dead organic matter. The model estimates were verified by comparing the estimates and measured C stocks. Under the A scenario, the total (biomass, litter, dead wood, and mineral soil) C stock (Mg C ha-1) varied with stand age, ranging from 153.65 to 284.64. The total C stock (Mg C ha-1) started increasing rapidly after abandonment of coppice practice from 134.23 at 1 year to 280.71 at 200 year. The total C stock under the B scenario converged to the level of total C stock under the A scenario. After the abandonment of coppice practice, the C stocks of biomass, litter, and dead wood almost recovered in 30 years, however, the mineral soil C stock required longer time for recovery. This study was supported by Korea Ministry of Environment (2014001310008) and Korea Forest Service (S111314L100110).

Implementation of an education development project in pathology to improve student competency-lessons learnt.

PubMed

Negi, Gita; Harsh, Meena; Chauhan, Vijendra D; Kalra, Vinita; Agarwal, Pradeep; Kusum, Anuradha

2015-08-01

Basic medical sciences and clinical teachings are not coordinated in the present medical education system. They are not taught keeping in mind the outcomes required at the time of actual handling of patients in the community. An educational development project was implemented in the Department of Pathology with the aim that it will result in the student learning to link the pathophysiology of the disease to clinical scenarios and become fully competent for lifelong medical practice. The pathology teaching of the second professional batch was modified by starting with defining the desired outcomes/competencies in the student's knowledge, skills, and attitude which were then addressed by lectures, demonstrations, practical classes and small group activities where case scenarios and laboratory reports were included. The outcome was assessed by Objectively Structured Clinical/Practical Examination and multiple choice questions. Force field analysis, faculty and student interviews, and questionnaires were used to assess the factors affecting its implementation and impact. Totally 80 students of the 2(nd) Professional MBBS were exposed to a competency-based education development project. It was found that the system was appreciated by faculty and students, especially the integration with clinical scenarios. There were many factors which influenced the execution of this program, including motivation level of students and faculty, time, logistics and meticulous planning. There was a significant improvement in student's performance and satisfaction. Many factors including prior planning were a major determinant for the success of this education development project.

Are Visual Informatics Actually Useful in Practice: A Study in a Film Studies Context

NASA Astrophysics Data System (ADS)

Mohamad Ali, Nazlena; Smeaton, Alan F.

This paper describes our work in examining the question of whether providing a visual informatics application in an educational scenario, in particular, providing video content analysis, does actually yield real benefit in practice. We provide a new software tool in the domain of movie content analysis technologies for use by students of film studies students at Dublin City University, and we try to address the research question of measuring the 'benefit' from the use of these technologies to students. We examine their real practices in studying for the module using our advanced application as compared to using conventional DVD browsing of movie content. In carrying out this experiment, we found that students have better essay outcomes, higher satisfactions levels and the mean time spent on movie analyzing is longer with the new technologies.

Using Image Modelling to Teach Newton's Laws with the Ollie Trick

ERIC Educational Resources Information Center

Dias, Marco Adriano; Carvalho, Paulo Simeão; Vianna, Deise Miranda

2016-01-01

Image modelling is a video-based teaching tool that is a combination of strobe images and video analysis. This tool can enable a qualitative and a quantitative approach to the teaching of physics, in a much more engaging and appealling way than the traditional expositive practice. In a specific scenario shown in this paper, the Ollie trick, we…

Avoiding the Complex History, Simple Answer Syndrome: A Lesson Plan for Providing Depth and Analysis in the High School History Classroom

ERIC Educational Resources Information Center

Lindquist, David H.

2012-01-01

Examining history from the perspective of investigators who wrestle with involved scenarios for which no simple answers exist, or from which no obvious conclusions can be drawn, allows students to understand the historiographic process and the complex nature of historical events, while gaining valuable practice in applying analytical and critical…

Developing standardised treatment for adults with myositis and different phenotypes: an international survey of current prescribing preferences.

PubMed

Tansley, Sarah; Shaddick, Gavin; Christopher-Stine, Lisa; Sharp, Charlotte; Dourmishev, Lyubomir; Maurer, Britta; Chinoy, Hector; McHugh, Neil

2016-01-01

The evidence base for treatment of the idiopathic inflammatory myopathies is extremely limited. The rarity and heterogeneity of these diseases has hampered the development of good quality clinical trials and while a range of immunomodulatory treatments are commonly used in clinical practice, as yet there are no clear guidelines directing their use. We aimed to establish current prescribing regimens used to treat adults with myositis internationally. An electronic survey based on different clinical scenarios was distributed internationally to clinicians involved in the treatment of patients with myositis. Participants were asked to select their first-line treatment preferences in each situation. A multinomial regression analysis was used to assess the influence of clinical scenario, respondent expertise and country of origin on first-line treatment choice. 107 survey responses were received. 57% of respondents considered themselves an expert in myositis and the majority of respondents were rheumatologists although responses from other specialities were also received. Pharmacological treatment with steroids and additional immunotherapy was the preference in most scenarios. First-line immunosuppressant choice was significantly influenced by the clinical scenario, the expertise of the treating physician and country of practice. Azathioprine, methotrexate and mycophenolate mofetil were the most commonly chosen agents. In the absence of available evidence, clinical experience and expert consensus often forms the basis of treatment guidelines. These results suggest that an international consensus approach would be possible in myositis and would overcome an urgent, yet unmet need for patients suffering with this difficult disease.

Assessing the probability of infection by Salmonella due to sewage sludge use in agriculture under several exposure scenarios for crops and soil ingestion.

PubMed

Krzyzanowski, Flávio; de Souza Lauretto, Marcelo; Nardocci, Adelaide Cássia; Sato, Maria Inês Zanoli; Razzolini, Maria Tereza Pepe

2016-10-15

A deeper understanding about the risks involved in sewage sludge practice in agriculture is required. The aims of the present study were to determine the annual risk of infection of consuming lettuce, carrots and tomatoes cultivated in soil amended with sewage sludge. The risk to agricultural workers of accidental ingestion of sludge or amended soil was also investigated. A Quantitative Microbial Risk Assessment was conducted based on Salmonella concentrations from five WWTPs were used to estimate the probability of annual infection associated with crops and soil ingestion. The risk of infection was estimated for nine exposure scenarios considering concentration of the pathogen, sewage sludge dilution in soil, variation of Salmonella concentration in soil, soil attachment to crops, seasonal average temperatures, hours of post-harvesting exposure, Salmonella regrowth in lettuce and tomatoes, Salmonella inhibition factor in carrots, crop ingestion and frequency of exposure, sludge/soil ingestion by agricultural workers and frequency of exposure. Annual risks values varied across the scenarios evaluated. Highest values of annual risk were found for scenarios in which the variation in the concentration of Salmonella spp. in both soil and crops (scenario 1) and without variation in the concentration of Salmonella spp. in soil and variation in crops (scenario 3) ranging from 10(-3) to 10(-2) for all groups considered. For agricultural workers, the highest annual risks of infection were found when workers applied sewage sludge to agricultural soils (2.26×10(-2)). Sensitivity analysis suggests that the main drivers for the estimated risks are Salmonella concentration and ingestion rate. These risk values resulted from conservative scenarios since some assumptions were derived from local or general studies. Although these scenarios can be considered conservative, the sensitivity analysis yielded the drivers of the risks, which can be useful for managing risks from the fresh products chain with stakeholders' involvement. Copyright © 2016. Published by Elsevier B.V.

A Multi-criteria Decision Analysis System for Prioritizing Sites and Types of Low Impact Development Practices

NASA Astrophysics Data System (ADS)

Song, Jae Yeol; Chung, Eun-Sung

2017-04-01

This study developed a multi-criteria decision analysis framework to prioritize sites and types of low impact development (LID) practices. This framework was systemized as a web-based system coupled with the Storm Water Management Model (SWMM) from the Environmental Protection Agency (EPA). Using the technique for order of preference by similarity to ideal solution (TOPSIS), which is a type of multi-criteria decision-making (MCDM) method, multiple types and sites of designated LID practices are prioritized. This system is named the Water Management Prioritization Module (WMPM) and is an improved version of the Water Management Analysis Module (WMAM) that automatically generates and simulates multiple scenarios of LID design and planning parameters for a single LID type. WMPM can simultaneously determine the priority of multiple LID types and sites. In this study, an infiltration trench and permeable pavement were considered for multiple sub-catchments in South Korea to demonstrate the WMPM procedures. The TOPSIS method was manually incorporated to select the vulnerable target sub-catchments and to prioritize the LID planning scenarios for multiple types and sites considering socio-economic, hydrologic and physical-geometric factors. In this application, the Delphi method and entropy theory were used to determine the subjective and objective weights, respectively. Comparing the ranks derived by this system, two sub-catchments, S16 and S4, out of 18 were considered to be the most suitable places for installing an infiltration trench and porous pavement to reduce the peak and total flow, respectively, considering both socio-economic factors and hydrological effectiveness. WMPM can help policy-makers to objectively develop urban water plans for sustainable development. Keywords: Low Impact Development, Multi-Criteria Decision Analysis, SWMM, TOPSIS, Water Management Prioritization Module (WMPM)

Effect of farming practices for greenhouse gas mitigation and subsequent alternative land use on environmental impacts of beef cattle production systems.

PubMed

Nguyen, T T H; Doreau, M; Eugène, M; Corson, M S; Garcia-Launay, F; Chesneau, G; van der Werf, H M G

2013-05-01

This study evaluated effects of farming practice scenarios aiming to reduce greenhouse gas (GHG) emissions and subsequent alternative land use on environmental impacts of a beef cattle production system using the life cycle assessment approach. The baseline scenario includes a standard cow-calf herd with finishing heifers based on grazing, and a standard bull-fattening herd using a diet mainly based on maize silage, corresponding to current farm characteristics and management by beef farmers in France. Alternative scenarios were developed with changes in farming practices. Some scenarios modified grassland management (S1: decreasing mineral N fertiliser on permanent grassland; S2: decreasing grass losses during grazing) or herd management (S3: underfeeding of heifers in winter; S4: fattening female calves instead of being reared at a moderate growth rate; S5: increasing longevity of cows from 7 to 9 years; S6: advancing first calving age from 3 to 2 years). Other scenarios replaced protein sources (S7: partially replacing a protein supplement by lucerne hay for the cow-calf herd; S8: replacing soya bean meal with rapeseed meal for the fattening herd) or increased n-3 fatty acid content using extruded linseed (S9). The combination of compatible scenarios S1, S2, S5, S6 and S8 was also studied (S10). The impacts, such as climate change (CC, not including CO2 emissions/sequestration of land use and land-use change, LULUC), CC/LULUC (including CO2 emissions of LULUC), cumulative energy demand, eutrophication (EP), acidification and land occupation (LO) were expressed per kg of carcass mass and per ha of land occupied. Compared with the baseline, the most promising practice to reduce impacts per kg carcass mass was S10 (all reduced by 13% to 28%), followed by S6 (by 8% to 10%). For other scenarios, impact reduction did not exceed 5%, except for EP (up to 11%) and LO (up to 10%). Effects of changes in farming practices (the scenarios) on environmental impacts varied according to impact category and functional unit. For some scenarios (S2, S4, S6 and S10), permanent grassland area and LO per kg of carcass decreased by 12% to 23% and 9% to 19%, respectively. If the 'excess' permanent grassland was converted to fast-growing conifer forest to sequester carbon in tree and soil biomass, CC/LULUC per kg of carcass could be reduced by 20%, 25%, 27% and 48% for scenarios S2, S4, S6 and S10, respectively. These results illustrate the potential of farming practices and forest as an alternative land use to contribute to short- and mid-term GHG mitigation of beef cattle production systems.

Development and evaluation of a critical care e-learning scenario.

PubMed

Tait, Michael; Tait, Desiree; Thornton, Frances; Edwards, Mark

2008-11-01

This paper describes the development and evaluation of a critical care e-learning scenario for student nurses. At present, there are insufficient opportunities in the United Kingdom (UK) for student nurses to experience clinical placements where their skills in care of the critically-ill can be developed. There is therefore a need for new learning materials that help learners recognise the signs of clinical deterioration and rehearse the management of critically-ill patients. One way of meeting this need is by using electronic care scenarios. Several electronic care scenarios have been developed at Swansea University as part of the eWARD project. This article describes the design and evaluation of a critical care scenario that follows the care of a road casualty (John Macadam) after admission to an intensive care unit. The scenario was designed by an advisory team comprising a clinical lecturer and e-learning specialists. After using the scenario, 144 nursing students completed a Web-based questionnaire that collected demographic and attitudinal data for analysis using SPSS. Nursing students had a strongly positive attitude to the scenario with median scores in excess of 20 compared to maxima of 25 for scales measuring ease-of-use, interactivity, realism and confidence. None of the demographic data collected had a significant effect on these attitudes. The positive attitude of student nurses to this scenario strongly supports its use to help learners to (1) acquire knowledge and awareness when real life placements in these settings are not available and (2) extend their knowledge after coming across similar situations in practice.

Objective comparison of particle tracking methods

PubMed Central

Chenouard, Nicolas; Smal, Ihor; de Chaumont, Fabrice; Maška, Martin; Sbalzarini, Ivo F.; Gong, Yuanhao; Cardinale, Janick; Carthel, Craig; Coraluppi, Stefano; Winter, Mark; Cohen, Andrew R.; Godinez, William J.; Rohr, Karl; Kalaidzidis, Yannis; Liang, Liang; Duncan, James; Shen, Hongying; Xu, Yingke; Magnusson, Klas E. G.; Jaldén, Joakim; Blau, Helen M.; Paul-Gilloteaux, Perrine; Roudot, Philippe; Kervrann, Charles; Waharte, François; Tinevez, Jean-Yves; Shorte, Spencer L.; Willemse, Joost; Celler, Katherine; van Wezel, Gilles P.; Dan, Han-Wei; Tsai, Yuh-Show; de Solórzano, Carlos Ortiz; Olivo-Marin, Jean-Christophe; Meijering, Erik

2014-01-01

Particle tracking is of key importance for quantitative analysis of intracellular dynamic processes from time-lapse microscopy image data. Since manually detecting and following large numbers of individual particles is not feasible, automated computational methods have been developed for these tasks by many groups. Aiming to perform an objective comparison of methods, we gathered the community and organized, for the first time, an open competition, in which participating teams applied their own methods independently to a commonly defined data set including diverse scenarios. Performance was assessed using commonly defined measures. Although no single method performed best across all scenarios, the results revealed clear differences between the various approaches, leading to important practical conclusions for users and developers. PMID:24441936

Integrating Simulation Scenarios and Clinical Practices Guided by Concepts of Translational Medicine

ERIC Educational Resources Information Center

Yang, Jing; Huang, Si-min; Li, Ze-jian; Feng, Lie; Lu, Chun-ting

2018-01-01

Purpose: To develop a novel method for closely and effectively integrating simulation scenarios and clinical practices to improve clinical skills training in the concepts of translational medicine. Methods: Forty-two and 38 third-year medical students in the classes of 2010 and 2009 at Jinan University were selected as an observation group and a…

Use of the Generating Options for Active Risk Control (GO-ARC) Technique can lead to more robust risk control options.

PubMed

Card, Alan J; Simsekler, Mecit Can Emre; Clark, Michael; Ward, James R; Clarkson, P John

2014-01-01

Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions. Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique. Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group. Proportion of NARCOs decreased from 0.18 at baseline to 0.12. Intervention group: Proportion increased from 0.10 at baseline to 0.29 using the GO-ARC Technique. Results were statistically significant. There was no decrease in the number of administrative controls generated by the intervention group. The Generating Options for Active Risk Control (GO-ARC) Technique appears to lead to more robust risk control options.

What would you say? Genetic counseling graduate students' and counselors' hypothetical responses to patient requested self-disclosure.

PubMed

Redlinger-Grosse, Krista; Veach, Patricia McCarthy; MacFarlane, Ian M

2013-08-01

Genetic counselor self-disclosure is a complex behavior that lacks extensive characterization. In particular, data are limited about genetic counselors' responses when patients ask them to self-disclose. Accordingly, this study investigated genetic counseling students' (n = 114) and practicing genetic counselors' (n = 123) responses to two hypothetical scenarios in which a female prenatal patient requests self-disclosure. Scenarios were identical except for a final patient question: "Have you ever had an amniocentesis?" or "What would you do if you were me?" Imagining themselves as the counselor, participants wrote a response for each scenario and then explained their response. Differences in disclosure frequency for students vs. counselors and disclosure question were assessed, and themes in participant responses and explanations were extracted via content and thematic analysis methods. Chi-square analyses indicated no significant differences in frequency of student versus counselor disclosure. Self-disclosure was significantly higher for, "Have you ever had an amniocentesis?" (78.5 %) than for, "What would you do if you were me?" (53.2 %) (p < .001). Types of self-disclosures included personal, professional, and mixed disclosures. Prevalent explanations for disclosure and non-disclosure responses included: remain patient focused and support/empower the patient. Additional findings, practice and training implications, and research recommendations are presented.

Sustainability analysis of bioenergy based land use change under climate change and variability

NASA Astrophysics Data System (ADS)

Raj, C.; Chaubey, I.; Brouder, S. M.; Bowling, L. C.; Cherkauer, K. A.; Frankenberger, J.; Goforth, R. R.; Gramig, B. M.; Volenec, J. J.

2014-12-01

Sustainability analyses of futuristic plausible land use and climate change scenarios are critical in making watershed-scale decisions for simultaneous improvement of food, energy and water management. Bioenergy production targets for the US are anticipated to impact farming practices through the introduction of fast growing and high yielding perennial grasses/trees, and use of crop residues as bioenergy feedstocks. These land use/land management changes raise concern over potential environmental impacts of bioenergy crop production scenarios, both in terms of water availability and water quality; impacts that may be exacerbated by climate variability and change. The objective of the study was to assess environmental, economic and biodiversity sustainability of plausible bioenergy scenarios for two watersheds in Midwest US under changing climate scenarios. The study considers fourteen sustainability indicators under nine climate change scenarios from World Climate Research Programme's (WCRP's) Coupled Model Intercomparison Project phase 3 (CMIP3). The distributed hydrological model SWAT (Soil and Water Assessment Tool) was used to simulate perennial bioenergy crops such as Miscanthus and switchgrass, and corn stover removal at various removal rates and their impacts on hydrology and water quality. Species Distribution Models (SDMs) developed to evaluate stream fish response to hydrology and water quality changes associated with land use change were used to quantify biodiversity sustainability of various bioenergy scenarios. The watershed-scale sustainability analysis was done in the St. Joseph River watershed located in Indiana, Michigan, and Ohio; and the Wildcat Creek watershed, located in Indiana. The results indicate streamflow reduction at watershed outlet with increased evapotranspiration demands for high-yielding perennial grasses. Bioenergy crops in general improved in-stream water quality compared to conventional cropping systems (maize-soybean). Water quality benefits due to land use change were generally greater than the effects of climate change variability.

40 CFR 68.28 - Alternative release scenario analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Alternative release scenario analysis... scenario analysis. (a) The number of scenarios. The owner or operator shall identify and analyze at least... release scenario under § 68.25; and (ii) That will reach an endpoint offsite, unless no such scenario...

Capacity Model and Constraints Analysis for Integrated Remote Wireless Sensor and Satellite Network in Emergency Scenarios

PubMed Central

Zhang, Wei; Zhang, Gengxin; Dong, Feihong; Xie, Zhidong; Bian, Dongming

2015-01-01

This article investigates the capacity problem of an integrated remote wireless sensor and satellite network (IWSSN) in emergency scenarios. We formulate a general model to evaluate the remote sensor and satellite network capacity. Compared to most existing works for ground networks, the proposed model is time varying and space oriented. To capture the characteristics of a practical network, we sift through major capacity-impacting constraints and analyze the influence of these constraints. Specifically, we combine the geometric satellite orbit model and satellite tool kit (STK) engineering software to quantify the trends of the capacity constraints. Our objective in analyzing these trends is to provide insights and design guidelines for optimizing the integrated remote wireless sensor and satellite network schedules. Simulation results validate the theoretical analysis of capacity trends and show the optimization opportunities of the IWSSN. PMID:26593919

What Could Be Future Scenarios?—Lessons from the History of Public Health Surveillance for the Future

PubMed Central

Choi, Bernard C.K.

2015-01-01

This article provides insights into the future based on a review of the past and present of public health surveillance—the ongoing systematic collection, analysis, interpretation, and dissemination of health data for the planning, implementation, and evaluation of public health action. Public health surveillance dates back to the first recorded epidemic in 3180 BC in Egypt. A number of lessons and items of interest are summarised from a review of historical perspectives in the past 5,000 years and the current practice of surveillance. Some future scenarios are presented: exploring new frontiers; enhancing computer technology; improving epidemic investigations; improving data collection, analysis, dissemination and use; building on lessons from the past; building capacity; and enhancing global surveillance. It is concluded that learning from the past, reflecting on the present, and planning for the future can further enhance public health surveillance. PMID:29546093

Capacity Model and Constraints Analysis for Integrated Remote Wireless Sensor and Satellite Network in Emergency Scenarios.

PubMed

Zhang, Wei; Zhang, Gengxin; Dong, Feihong; Xie, Zhidong; Bian, Dongming

2015-11-17

This article investigates the capacity problem of an integrated remote wireless sensor and satellite network (IWSSN) in emergency scenarios. We formulate a general model to evaluate the remote sensor and satellite network capacity. Compared to most existing works for ground networks, the proposed model is time varying and space oriented. To capture the characteristics of a practical network, we sift through major capacity-impacting constraints and analyze the influence of these constraints. Specifically, we combine the geometric satellite orbit model and satellite tool kit (STK) engineering software to quantify the trends of the capacity constraints. Our objective in analyzing these trends is to provide insights and design guidelines for optimizing the integrated remote wireless sensor and satellite network schedules. Simulation results validate the theoretical analysis of capacity trends and show the optimization opportunities of the IWSSN.

Rural domestic waste management in Zhejiang Province, China: Characteristics, current practices, and an improved strategy.

PubMed

Guan, Yidong; Zhang, Yuan; Zhao, Dongye; Huang, Xiaofeng; Li, Haini

2015-06-01

Lack of access to adequate sanitation facilities has serious health implications for rural dwellers and can degrade the ecosystems. This study offers a systemantic and quantitative overview of historical data on rural domestic waste (RDW) production and past and current management practices in a prototype region in China, where rural areas are undergoing rapid urbanization and are confronted with great environmental challenges associated with poor RDW management practices. The results indicate that RDW is characterized with a large fraction of kitchen waste (42.9%) and high water content (53.4%). The RDW generation (RDWG) per capita between 2012 and 2020 is estimated to increase from 0.68 to 1.01 kg/d-cap. The Hill 1 model is able to adequately simulate/project the population growth in a rural area from 1993 to 2020. The annual RDWG in the region is estimated to double from 6,033,000 tons/year in 2008 to 12,030,000 tons/year by 2020. By comparing three RDW management scenarios based on the life-cycle inventory approach and cost-benefit analysis, it is strongly recommended that the present Scenario 2 (sanitary landfill treatment) be upgraded to Scenario 3 (source separation followed by composting and landfill of RDW) to significantly reduce the ecological footprint and to improve the cost-effectiveness and long-term sustainability. Rural domestic waste (RDW) is affecting 720 million people in China and more than 3221 million people worldwide. Consequently, handling and disposal of RDW have serious health implications to rural dwellers and the ecosystems. This study offers a systemantic and quantitative overview and analysis of historical data on RDW production and management practices in a prototype region in China, which is confronted with great environmental challenges associated with RDW. Then we predict future production of RDW and propose a sustainable RDW management strategy, which holds the promise of greatly mitigating the mounting environmental pressure associated with RDW and provides science-based guidance for decision makers and practitioners for assuring rapid yet "green" economic development.

Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research.

PubMed

Wanyonyi, Kristina L; Radford, David R; Harper, Paul R; Gallagher, Jennifer E

2015-09-15

In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England. The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix". Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.

Mathematics Teachers' Conceptions and Constraints for Changing Teaching Practices in Brazilian Higher Education: An Analysis through Activity Theory

ERIC Educational Resources Information Center

Campos, Dilhermando Ferreira; Pinto, Márcia Maria Fusaro

2016-01-01

In recent years, changes in the Brazilian economic and social scenario have generated a growing demand for higher education in the country. In response to this new context, the federal government launched in 2007 a programme aiming at expansion of the enrolment to public higher education. In such environment of changes, several proposals have…

Practical security analysis of continuous-variable quantum key distribution with jitter in clock synchronization

NASA Astrophysics Data System (ADS)

Xie, Cailang; Guo, Ying; Liao, Qin; Zhao, Wei; Huang, Duan; Zhang, Ling; Zeng, Guihua

2018-03-01

How to narrow the gap of security between theory and practice has been a notoriously urgent problem in quantum cryptography. Here, we analyze and provide experimental evidence of the clock jitter effect on the practical continuous-variable quantum key distribution (CV-QKD) system. The clock jitter is a random noise which exists permanently in the clock synchronization in the practical CV-QKD system, it may compromise the system security because of its impact on data sampling and parameters estimation. In particular, the practical security of CV-QKD with different clock jitter against collective attack is analyzed theoretically based on different repetition frequencies, the numerical simulations indicate that the clock jitter has more impact on a high-speed scenario. Furthermore, a simplified experiment is designed to investigate the influence of the clock jitter.

Minimizing Erosion and Agro-Pollutants Transport from Furrow Irrigated Fields to the Nearby Water Body Using Spatially-Explicit Agent Based Model and Decision Optimization Platform

NASA Astrophysics Data System (ADS)

Ghoveisi, H.; Al Dughaishi, U.; Kiker, G.

2017-12-01

Maintaining water quality in agricultural watersheds is a worldwide challenge, especially where furrow irrigation is being practiced. The Yakima River Basin watershed in south central Washington State, (USA) is an example of these impacted areas with elevated load of sediments and other agricultural products due to runoff from furrow-irrigated fields. Within the Yakima basin, the Granger Drain watershed (area of 75 km2) is particularly challenged in this regard with more than 400 flood-irrigated individual parcels (area of 21 km2) growing a variety of crops from maize to grapes. Alternatives for improving water quality from furrow-irrigated parcels include vegetated filter strip (VFS) implementation, furrow water application efficiency, polyacrylamide (PAM) application and irrigation scheduling. These alternatives were simulated separately and in combinations to explore potential Best Management Practices (BMPs) for runoff-related-pollution reduction in a spatially explicit, agent based modeling system (QnD:GrangerDrain). Two regulatory scenarios were tested to BMP adoption within individual parcels. A blanket-style regulatory scenario simulated a total of 60 BMP combinations implemented in all 409 furrow-irrigated parcels. A second regulatory scenario simulated the BMPs in 119 furrow-irrigated parcels designated as "hotspots" based on a standard 12 Mg ha-1 seasonal sediment load. The simulated cumulative runoff and sediment loading from all BMP alternatives were ranked using Multiple Criteria Decision Analysis (MCDA), specifically the Stochastic Multi-Attribute Acceptability Analysis (SMAA) method. Several BMP combinations proved successful in reducing loads below a 25 NTU (91 mg L-1) regulatory sediment concentration. The QnD:GrangerDrain simulations and subsequent MCDA ranking revealed that the BMP combinations of 5 m-VFS and high furrow water efficiency were highly ranked alternatives for both the blanket and hotspot scenarios.

[Music therapy on Parkinson disease].

PubMed

Côrte, Beltrina; Lodovici Neto, Pedro

2009-01-01

This study is a result of a qualitative research, in the Gerontology and Music therapy scenario. It was analyzed the importance of alternative practices like playing an instrument (piano, violin, etc.), singing, or practicing a guided musical exercise as a therapy activity for elder people with Parkinson Disease. The analysis, systematization and interpretation of the data pointed: music therapy is an excellent way to improve the life of the patient that becomes more sociable, decreasing physical and psychological symptoms ('symptomatology') and the subject change for a singular and own position in the relation with your disease and the people around.

Using scenario-based training to promote information literacy among on-call consultant pediatricians

PubMed Central

Pettersson, Jonas; Bjorkander, Emil; Bark, Sirpa; Holmgren, Daniel; Wekell, Per

2017-01-01

Background Traditionally, teaching hospital staff to search for medical information relies heavily on educator-defined search methods. In contrast, the authors describe our experiences using real-time scenarios to teach on-call consultant pediatricians information literacy skills as part of a two-year continuing professional development program. Case Presentation Two information-searching workshops were held at Sahlgrenska University Hospital in Gothenburg, Sweden. During the workshops, pediatricians were presented with medical scenarios that were closely related to their clinical practice. Participants were initially encouraged to solve the problems using their own preferred search methods, followed by group discussions led by clinical educators and a medical librarian in which search problems were identified and overcome. The workshops were evaluated using questionnaires to assess participant satisfaction and the extent to which participants intended to implement changes in their clinical practice and reported actual change. Conclusions A scenario-based approach to teaching clinicians how to search for medical information is an attractive alternative to traditional lectures. The relevance of such an approach was supported by a high level of participant engagement during the workshops and high scores for participant satisfaction, intended changes to clinical practice, and reported benefits in actual clinical practice. PMID:28670215

Using scenario-based training to promote information literacy among on-call consultant pediatricians.

PubMed

Pettersson, Jonas; Bjorkander, Emil; Bark, Sirpa; Holmgren, Daniel; Wekell, Per

2017-07-01

Traditionally, teaching hospital staff to search for medical information relies heavily on educator-defined search methods. In contrast, the authors describe our experiences using real-time scenarios to teach on-call consultant pediatricians information literacy skills as part of a two-year continuing professional development program. Two information-searching workshops were held at Sahlgrenska University Hospital in Gothenburg, Sweden. During the workshops, pediatricians were presented with medical scenarios that were closely related to their clinical practice. Participants were initially encouraged to solve the problems using their own preferred search methods, followed by group discussions led by clinical educators and a medical librarian in which search problems were identified and overcome. The workshops were evaluated using questionnaires to assess participant satisfaction and the extent to which participants intended to implement changes in their clinical practice and reported actual change. A scenario-based approach to teaching clinicians how to search for medical information is an attractive alternative to traditional lectures. The relevance of such an approach was supported by a high level of participant engagement during the workshops and high scores for participant satisfaction, intended changes to clinical practice, and reported benefits in actual clinical practice.

Future methods in pharmacy practice research.

PubMed

Almarsdottir, A B; Babar, Z U D

2016-06-01

This article describes the current and future practice of pharmacy scenario underpinning and guiding this research and then suggests future directions and strategies for such research. First, it sets the scene by discussing the key drivers which could influence the change in pharmacy practice research. These are demographics, technology and professional standards. Second, deriving from this, it seeks to predict and forecast the future shifts in use of methodologies. Third, new research areas and availability of data impacting on future methods are discussed. These include the impact of aging information technology users on healthcare, understanding and responding to cultural and social disparities, implementing multidisciplinary initiatives to improve health care, medicines optimization and predictive risk analysis, and pharmacy as business and health care institution. Finally, implications of the trends for pharmacy practice research methods are discussed.

Estimating the consequences of fire exclusion for food crop production, soil fertility, and fallow recovery in shifting cultivation landscapes in the humid tropics.

PubMed

Norgrove, Lindsey; Hauser, Stefan

2015-03-01

In the Congo Basin, smallholder farmers practice slash-and-burn shifting cultivation. Yet, deliberate burning might no longer be sustainable under reduced fallow scenarios. We synthesized data from the Forest Margins Benchmark Area (FMBA), comprising 1.54 million hectares (ha), in southern Cameroon and assessed the impact of fire exclusion on yield, labor inputs, soil fertility, ecosystem carbon stocks, and fallow recovery indicators in two common field types (plantain and maize) under both current and reduced fallow scenarios. While we could not distinguish between impacts of standard farmer burning practice and fire exclusion treatments for the current fallow scenario, we concluded that fire exclusion would lead to higher yields, higher ecosystem carbon stocks as well as potentially faster fallow recovery under the reduced fallow scenario. While its implementation would increase labor requirements, we estimated increased revenues of 421 and 388 US$ ha(-1) for plantain and maize, respectively. Applied to the FMBA, and assuming a 6-year reduced fallow scenario, fire exclusion in plantain fields would potentially retain 240,464 Mg more ecosystem carbon, comprising topsoil carbon plus tree biomass carbon, than standard farmer practice. Results demonstrate a potential "win-win scenario" where yield benefits, albeit modest, and conservation benefits can be obtained simultaneously. This could be considered as a transitional phase towards higher input use and thus higher yielding systems.

Estimating the Consequences of Fire Exclusion for Food Crop Production, Soil Fertility, and Fallow Recovery in Shifting Cultivation Landscapes in the Humid Tropics

NASA Astrophysics Data System (ADS)

Norgrove, Lindsey; Hauser, Stefan

2015-03-01

In the Congo Basin, smallholder farmers practice slash-and-burn shifting cultivation. Yet, deliberate burning might no longer be sustainable under reduced fallow scenarios. We synthesized data from the Forest Margins Benchmark Area (FMBA), comprising 1.54 million hectares (ha), in southern Cameroon and assessed the impact of fire exclusion on yield, labor inputs, soil fertility, ecosystem carbon stocks, and fallow recovery indicators in two common field types (plantain and maize) under both current and reduced fallow scenarios. While we could not distinguish between impacts of standard farmer burning practice and fire exclusion treatments for the current fallow scenario, we concluded that fire exclusion would lead to higher yields, higher ecosystem carbon stocks as well as potentially faster fallow recovery under the reduced fallow scenario. While its implementation would increase labor requirements, we estimated increased revenues of 421 and 388 US ha-1 for plantain and maize, respectively. Applied to the FMBA, and assuming a 6-year reduced fallow scenario, fire exclusion in plantain fields would potentially retain 240,464 Mg more ecosystem carbon, comprising topsoil carbon plus tree biomass carbon, than standard farmer practice. Results demonstrate a potential "win-win scenario" where yield benefits, albeit modest, and conservation benefits can be obtained simultaneously. This could be considered as a transitional phase towards higher input use and thus higher yielding systems.

Test ordering by GP trainees: Effects of an educational intervention on attitudes and intended practice.

PubMed

Morgan, Simon; Morgan, Andy; Kerr, Rohan; Tapley, Amanda; Magin, Parker

2016-09-01

To assess the effectiveness of an educational intervention on test-ordering attitudes and intended practice of GP trainees, and any associations between changes in test ordering and trainee characteristics. Preworkshop and postworkshop survey of attitudes to test ordering, intended test-ordering practices for 3 clinical scenarios (fatigue, screening, and shoulder pain), and tolerance for uncertainty. Three Australian regional general practice training providers. General practice trainees (N = 167). A 2-hour workshop session and an online module. Proportion of trainees who agreed with attitudinal statements before and after the workshop; proportion of trainees who would order tests, mean number of tests ordered, and number of appropriate and inappropriate tests ordered for each scenario before and after the workshop. Of 167 trainees, 132 (79.0%) completed both the preworkshop and postworkshop questionnaires. A total of 122 trainees attended the workshop. At baseline, 88.6% thought that tests can harm patients, 84.8% believed overtesting was a problem, 72.0% felt pressured by patients, 52.3% believed that tests would reassure patients, and 50.8% thought that they were less likely to be sued if they ordered tests. There were desirable changes in all attitudes after the workshop. Before the workshop, the mean number of tests that trainees would have ordered was 4.4, 4.8, and 1.5 for the fatigue, screening, and shoulder pain scenarios, respectively. After the workshop there were decreases in the mean number of both appropriate tests (decrease of 0.94) and inappropriate tests (decrease of 0.24) in the fatigue scenario; there was no change in the mean number of appropriate tests and a decrease in inappropriate tests (decrease of 0.76) in the screening scenario; and there was an increase in the proportion of trainees who would appropriately not order tests in the shoulder pain scenario. There were no significant associations between changes in test ordering and trainee demographic characteristics or tolerance for uncertainty subscale scores. General practice trainees have conflicting attitudes to test ordering and demonstrate nonrational test ordering in 3 common scenarios. A workshop on rational test ordering led to desirable changes in attitudes and more rational intended test ordering. Our findings inform the development of appropriate educational interventions that address nonrational testing in family medicine. Copyright© the College of Family Physicians of Canada.

Antimicrobial prescribing practice in UK equine veterinary practice.

PubMed

Hughes, L A; Pinchbeck, G; Callaby, R; Dawson, S; Clegg, P; Williams, N

2013-03-01

Antimicrobial use is known to select for the emergence of resistant strains of bacteria; therefore prudent use in both human and veterinary medicine is essential to preserve their efficacy. To characterise antimicrobial prescribing patterns in UK equine practice and evaluate factors associated with prescribing. A postal questionnaire including 4 clinical scenarios was sent to 740 veterinary surgeons that treat horses. Data were collected on the clinician, their practice and sources of information regarding antimicrobials and their use. Multivariable logistic regression analysis was used to ascertain factors associated with 5 outcomes; prescribing off-licence drugs; prescribing at incorrect doses; prescribing 3rd or 4th generation cephalosporins; prescribing fluoroquinolones and prescribing potentiated sulphonamides. Questionnaires were completed by 38% of veterinary surgeons who were sent questionnaires. Less than 1% of practices had antimicrobial use guidelines. Trimethoprim-sulphonamides were most commonly prescribed in each clinical scenario. Eleven percent of prescriptions were for antimicrobial drugs not licensed for use in horses in the UK. Five percent of prescriptions for licensed antimicrobials were under the recommended dose rate and 56% over the recommended dose rate. Fluoroquinolones and 3rd and 4th generation cephalosporins accounted for 1 and 3% of prescriptions, respectively. Veterinary surgeons working at referral practices were more likely to prescribe 3rd and 4th generation cephalosporins and fluoroquinolones and off-licence antimicrobials whereas those working in first-opinion practices were more likely to prescribe potentiated sulphonamides. Sources of information regarding antimicrobials also had an effect on prescribing. Prescription of antimicrobials at inappropriate doses was common even when provided with the weight of the animal. It is uncommon for UK equine veterinary practices to have guidelines for antimicrobial use. The introduction of such guidelines could lead to more prudent use of antimicrobials. © 2012 EVJ Ltd.

Land management strategies for improving water quality in biomass production under changing climate

NASA Astrophysics Data System (ADS)

Ha, Miae; Wu, May

2017-03-01

The Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. The watershed is covered primarily with annual crops (corn and soybeans). With cropland conversion to switchgrass, stover harvest, and implementation of best management practices (BMPs) (such as establishing riparian buffers and applying cover crops), significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under a historical climate scenario, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compared with current land use when a portion of the cropland is converted to switchgrass and a cover crop is in place. Climate change could cause increases of 9.7% in SS, 4.1% in N, and 7.2% in P compared to current land use. Under future climate scenarios, nutrients including SS, N, and P were reduced through land management and practices and BMPs by up to 54.0% (SS), 30.4% (N), and 7.1% (P). Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management by using long-term monitoring data from field to watershed is necessary to verify the findings and move toward watershed-specific regional programs for climate adaptation.

How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.

PubMed

Eikemo, Terje A; Hoffmann, Rasmus; Kulik, Margarete C; Kulhánová, Ivana; Toch-Marquardt, Marlen; Menvielle, Gwenn; Looman, Caspar; Jasilionis, Domantas; Martikainen, Pekka; Lundberg, Olle; Mackenbach, Johan P

2014-01-01

Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

How Can Inequalities in Mortality Be Reduced? A Quantitative Analysis of 6 Risk Factors in 21 European Populations

PubMed Central

Eikemo, Terje A.; Hoffmann, Rasmus; Kulik, Margarete C.; Kulhánová, Ivana; Toch-Marquardt, Marlen; Menvielle, Gwenn; Looman, Caspar; Jasilionis, Domantas; Martikainen, Pekka; Lundberg, Olle; Mackenbach, Johan P.

2014-01-01

Background Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible. PMID:25369287

Cost-effectiveness and resource implications of aggressive action on TB in China, India and South Africa: a combined analysis of nine models

PubMed Central

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein MGJ; Kimerling, Michael E; White, Richard G; Vassall, Anna

2017-01-01

BACKGROUND The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. FINDINGS Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. INTERPRETATION Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country. PMID:27720689

Reflections in the clinical practice.

PubMed

Borrell-Carrió, F; Hernández-Clemente, J C

2014-03-01

The purpose of this article is to analyze some models of expert decision and their impact on the clinical practice. We have analyzed decision-making considering the cognitive aspects (explanatory models, perceptual skills, analysis of the variability of a phenomenon, creating habits and inertia of reasoning and declarative models based on criteria). We have added the importance of emotions in decision making within highly complex situations, such as those occurring within the clinical practice. The quality of the reflective act depends, among other factors, on the ability of metacognition (thinking about what we think). Finally, we propose an educational strategy based on having a task supervisor and rectification scenarios to improve the quality of medical decision making. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Water use implications of biofuel scenarios

NASA Astrophysics Data System (ADS)

Teter, J.; Mishra, G. S.; Yeh, S.

2012-12-01

Existing studies rely upon attributional lifecycle analysis (LCA) approaches to estimate water intensity of biofuels in liters of irrigated/evapotranspiration water consumed for biofuel production. Such approaches can be misleading. From a policy perspective, a better approach is to compare differential water impacts among scenarios on a landscape scale. We address the shortcomings of existing studies by using consequential LCA, and incorporate direct and indirect land use (changes) of biofuel scenarios, marginal vs. average biofuel water use estimates, future climate, and geographic heterogeneity. We use the outputs of a partial equilibrium economic model, climate and soil data, and a process-based crop-soil-climate-water model to estimate differences in green water (GW - directly from precipitation to soil) and blue water (BW - supplied by irrigation) use among three scenarios: (1) business-as-usual (BAU), (2) Renewable Fuels Standard (RFS) mandates, and (3) a national Low Carbon Fuel Standard (LCFS) plus the RFS scenario. We use spatial statistical methods to interpolate key climatic variables using daily climate observations for the contiguous USA. Finally, we use FAO's crop model AquaCrop to estimate the domestic GW and BW impacts of biofuel policies from 2007-2035. We assess the differences among scenarios along the following metrics: (1) crop area expansion at the county level, including prime and marginal lands, (2) crop-specific and overall annual/seasonal water balances including (a) water inflows (irrigation & precipitation), (b) crop-atmosphere interactions: (evaporation & transpiration) and (d) soil-water flows (runoff & soil infiltration), in mm 3 /acre over the relevant time period. The functional unit of analysis is the BW and GW requirements of biofuels (mm3 per Btu biofuel) at the county level. Differential water use impacts among scenarios are a primarily a function of (1) land use conversion, in particular that of formerly uncropped land classes (2) irrigation practices, (3) feedstock water use efficiency, and (4) the longer growing season and a predominance of rainfed cultivation of dedicated biofuel feedstocks. National-level total water use is lowest in the BAU scenario and highest in the RFS2 + LCFS scenario. Figure: Million acres converted to growing miscanthus (top) & switchgrass (bottom) under the RFS + LCFS scenario in 2035. Land use classes are crop pasture (blue), idle cropland (red-purple) & prime cropland (brown).

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

PubMed Central

Booth, Neill; Jula, Antti; Aronen, Pasi; Kaila, Minna; Klaukka, Timo; Kukkonen-Harjula, Katriina; Reunanen, Antti; Rissanen, Pekka; Sintonen, Harri; Mäkelä, Marjukka

2007-01-01

Background Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario). Methods A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole. Results The impact of the use of the ACCG scenario in subgroups (aged 40–80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective. Conclusion The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall. PMID:17958883

2016 Billion-Ton Report: Advancing Domestic Resources for a Thriving Bioeconomy, Volume 2: Environmental Sustainability Effects of Select Scenarios from Volume 1

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

Efroymson, Rebecca Ann; Langholtz, Matthew H.

With the goal of understanding environmental effects of a growing bioeconomy, the U.S. Department of Energy (DOE), national laboratories, and U.S. Forest Service research laboratories, together with academic and industry collaborators, undertook a study to estimate environmental effects of potential biomass production scenarios in the United States, with an emphasis on agricultural and forest biomass. Potential effects investigated include changes in soil organic carbon (SOC), greenhouse gas (GHG) emissions, water quality and quantity, air emissions, and biodiversity. Effects of altered land-management regimes were analyzed based on select county-level biomass-production scenarios for 2017 and 2040 taken from the 2016 Billion-Ton Report:more » Advancing Domestic Resources for a Thriving Bioeconomy (BT16), volume 1, which assumes that the land bases for agricultural and forestry would not change over time. The scenarios reflect constraints on biomass supply (e.g., excluded areas; implementation of management practices; and consideration of food, feed, forage, and fiber demands and exports) that intend to address sustainability concerns. Nonetheless, both beneficial and adverse environmental effects might be expected. To characterize these potential effects, this research sought to estimate where and under what modeled scenarios or conditions positive and negative environmental effects could occur nationwide. The report also includes a discussion of land-use change (LUC) (i.e., land management change) assumptions associated with the scenario transitions (but not including analysis of indirect LUC [ILUC]), analyses of climate sensitivity of feedstock productivity under a set of potential scenarios, and a qualitative environmental effects analysis of algae production under carbon dioxide (CO2) co-location scenarios. Because BT16 biomass supplies are simulated independent of a defined end use, most analyses do not include benefits from displacing fossil fuels or other products, with the exception of including a few illustrative cases on potential reductions in GHG emissions and fossil energy consumption associated with using biomass supplies for fuel, power, heat, and chemicals.« less

New Evaluation Vector through the Stanford Mobile Inquiry-Based Learning Environment (SMILE) for Participatory Action Research

PubMed Central

An, Ji-Young

2016-01-01

Objectives This article reviews an evaluation vector model driven from a participatory action research leveraging a collective inquiry system named SMILE (Stanford Mobile Inquiry-based Learning Environment). Methods SMILE has been implemented in a diverse set of collective inquiry generation and analysis scenarios including community health care-specific professional development sessions and community-based participatory action research projects. In each scenario, participants are given opportunities to construct inquiries around physical and emotional health-related phenomena in their own community. Results Participants formulated inquiries as well as potential clinical treatments and hypothetical scenarios to address health concerns or clarify misunderstandings or misdiagnoses often found in their community practices. From medical universities to rural village health promotion organizations, all participatory inquiries and potential solutions can be collected and analyzed. The inquiry and solution sets represent an evaluation vector which helps educators better understand community health issues at a much deeper level. Conclusions SMILE helps collect problems that are most important and central to their community health concerns. The evaluation vector, consisting participatory and collective inquiries and potential solutions, helps the researchers assess the participants' level of understanding on issues around health concerns and practices while helping the community adequately formulate follow-up action plans. The method used in SMILE requires much further enhancement with machine learning and advanced data visualization. PMID:27525157

Combining Water Quality and Cost-Benefit Analysis to Examine the Implications of Agricultural Best Management Practices

NASA Astrophysics Data System (ADS)

Rao, N. S.; Easton, Z. M.; Lee, D. R.; Steenhuis, T. S.

2007-12-01

Nutrient runoff from agricultural fields threatens water quality and can impair habitats in many watersheds. Agencies consider these potential risks as they determine acceptable levels of nutrient loading. For example, in the New York City (NYC) watershed, the Environmental Protection Agency's Total Maximum Daily Load (TMDL) for phosphorus (P) has been set at 15μg P L-1 to protect against eutrophication and bacterial outbreaks. In the NYC watersheds agricultural Best Management Practices (BMPs) are the primary means to control nonpoint source P loading. BMPs include riparian buffers, filter strips, manure storage facilities, crop rotation, stripcropping, tree planting and nutrient management plans (NMPs). Water quality research on BMPs to date has included studies on site-specificity of different BMPs, short and long term BMP efficacy, and placement of BMPs with respect to critical source areas. A necessary complement to studies addressing water quality aspects of different BMPs are studies examining the cost-benefit aspects of BMPs. In general, there are installment, maintenance and opportunity costs associated with each BMP, and there are benefits, including cost share agreements between farmers and farm agencies, and increased efficiency of farm production and maintenance. Combining water quality studies and related cost-benefit analyses would help planners and watershed managers determine how best improve water quality. Our research examines the costs-benefit structure associated with BMP scenarios on a one-farm headwater watershed in the Catskill Mountains of NY. The different scenarios include "with and without" BMPs, combinations of BMPs, and different BMP placements across agricultural fields. The costs associated with each BMP scenarios are determined using information from farm agencies and watershed planning agencies. With these data we perform a cost-benefit analysis for the different BMP scenarios and couple the water quality modeling using the Variable Source Loading Function (VSLF) model (Schneiderman et al., 2007) with the cost-benefit analysis to look at the specific water quality and economic consequences of different watershed management scenarios. The results of our study will be useful for planners and watershed managers in determining how best to reduce nonpoint source pollution in a cost-effective manner. References Schneiderman, E.M., T.S. Steenhuis, D.J. Thongs, Z.M. Easton, M.S. Zion, G.F. Mendoza, M.T. Walter, and A.C. Neal. 2007. Incorporating variable source area hydrology into curve number based watershed loading functions. Hydrol. Proc. (In Press).

A visual approach to efficient analysis and quantification of ductile iron and reinforced sprayed concrete.

PubMed

Fritz, Laura; Hadwiger, Markus; Geier, Georg; Pittino, Gerhard; Gröller, M Eduard

2009-01-01

This paper describes advanced volume visualization and quantification for applications in non-destructive testing (NDT), which results in novel and highly effective interactive workflows for NDT practitioners. We employ a visual approach to explore and quantify the features of interest, based on transfer functions in the parameter spaces of specific application scenarios. Examples are the orientations of fibres or the roundness of particles. The applicability and effectiveness of our approach is illustrated using two specific scenarios of high practical relevance. First, we discuss the analysis of Steel Fibre Reinforced Sprayed Concrete (SFRSpC). We investigate the orientations of the enclosed steel fibres and their distribution, depending on the concrete's application direction. This is a crucial step in assessing the material's behavior under mechanical stress, which is still in its infancy and therefore a hot topic in the building industry. The second application scenario is the designation of the microstructure of ductile cast irons with respect to the contained graphite. This corresponds to the requirements of the ISO standard 945-1, which deals with 2D metallographic samples. We illustrate how the necessary analysis steps can be carried out much more efficiently using our system for 3D volumes. Overall, we show that a visual approach with custom transfer functions in specific application domains offers significant benefits and has the potential of greatly improving and optimizing the workflows of domain scientists and engineers.

Revealing Risks in Adaptation Planning: expanding Uncertainty Treatment and dealing with Large Projection Ensembles during Planning Scenario development

NASA Astrophysics Data System (ADS)

Brekke, L. D.; Clark, M. P.; Gutmann, E. D.; Wood, A.; Mizukami, N.; Mendoza, P. A.; Rasmussen, R.; Ikeda, K.; Pruitt, T.; Arnold, J. R.; Rajagopalan, B.

2015-12-01

Adaptation planning assessments often rely on single methods for climate projection downscaling and hydrologic analysis, do not reveal uncertainties from associated method choices, and thus likely produce overly confident decision-support information. Recent work by the authors has highlighted this issue by identifying strengths and weaknesses of widely applied methods for downscaling climate projections and assessing hydrologic impacts. This work has shown that many of the methodological choices made can alter the magnitude, and even the sign of the climate change signal. Such results motivate consideration of both sources of method uncertainty within an impacts assessment. Consequently, the authors have pursued development of improved downscaling techniques spanning a range of method classes (quasi-dynamical and circulation-based statistical methods) and developed approaches to better account for hydrologic analysis uncertainty (multi-model; regional parameter estimation under forcing uncertainty). This presentation summarizes progress in the development of these methods, as well as implications of pursuing these developments. First, having access to these methods creates an opportunity to better reveal impacts uncertainty through multi-method ensembles, expanding on present-practice ensembles which are often based only on emissions scenarios and GCM choices. Second, such expansion of uncertainty treatment combined with an ever-expanding wealth of global climate projection information creates a challenge of how to use such a large ensemble for local adaptation planning. To address this challenge, the authors are evaluating methods for ensemble selection (considering the principles of fidelity, diversity and sensitivity) that is compatible with present-practice approaches for abstracting change scenarios from any "ensemble of opportunity". Early examples from this development will also be presented.

[Scientific production in online journals on the practice of psychological harassment: an integrative review].

PubMed

Cahú, Graziela Pontes Ribeiro; Rosenstock, Karelline Izaltemberg Vasconcelos; da Costa, Solange Fátima Geraldo; Leite, Alice Iana Tavares; Costa, Isabelle Cristinne Pinto; Gomes e Claudino, Hellen

2011-09-01

The discussion about the practice of psychological harassment has gained notoriety due to the intensification and the severity of the phenomenon in various scenarios, such as educational institutions, public agencies and private companies. This study aims to characterize the scientific production about the scenarios of psychological harassment in online journals in the areas of Health Sciences, Social Sciences and Humanities from 2002 to 2010. This is an integrative literature review. Its sample consists of 24 publications. The survey revealed that most of the publications were made from 2005 to 2010. Highlighted areas of knowledge were Health Sciences and Humanities. We identified three scenarios of psychological harrassment: education institutions, public agencies and private companies. We conclude that psychological harrassment affects workers employed in various work scenarios, and that the discussion about this phenomenon stands in the interdisciplinary field.

Alice’s Delirium: A Theatre-based Simulation Scenario for Nursing

PubMed Central

Posner, Glenn D

2018-01-01

As an educational methodology, simulation has been used by nursing education at the academic level for numerous years and has started to gain traction in the onboarding education and professional development of practicing nurses. Simulation allows the learner to apply knowledge and skills in a safe environment where mistakes and learning can happen without an impact on patient safety. The development of a simulation scenario to demonstrate the benefits of simulation education methodologies to a large group of nurse educators was requested by nursing education leadership at The Ottawa Hospital (TOH). Since the demonstration of this scenario in the fall of 2016, there has been significant uptake and adaptation of this particular scenario within the nursing education departments of TOH. Originally written to be used with a simulated patient (SP), “Alice” has since been adapted to be used with a hi-fidelity manikin within an inpatient surgery department continuing professional development (CPD) program for practicing nurses, orientation for nurses to a level 2 trauma unit and at the corporate level of nursing orientation using an SP. Therefore, this scenario is applicable to nurses practicing in an area of inpatient surgery at varying levels, from novice to expert. It could easily be adapted for use with medicine nursing education programs. The case presented in this technical report is of the simulation scenario used for the inpatient surgery CPD program. Varying adaptations of the case are included in the appendices. PMID:29872592

A simulation framework for mapping risks in clinical processes: the case of in-patient transfers.

PubMed

Dunn, Adam G; Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

2011-05-01

To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols.

Clinical algorithms to aid osteoarthritis guideline dissemination.

PubMed

Meneses, S R F; Goode, A P; Nelson, A E; Lin, J; Jordan, J M; Allen, K D; Bennell, K L; Lohmander, L S; Fernandes, L; Hochberg, M C; Underwood, M; Conaghan, P G; Liu, S; McAlindon, T E; Golightly, Y M; Hunter, D J

2016-09-01

Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios

PubMed Central

Majzoub, Ahmad; Esteves, Sandro C.; Ko, Edmund; Ramasamy, Ranjith; Zini, Armand

2016-01-01

Sperm DNA fragmentation (SDF) has been generally acknowledged as a valuable tool for male fertility evaluation. While its detrimental implications on sperm function were extensively investigated, little is known about the actual indications for performing SDF analysis. This review delivers practice based recommendations on commonly encountered scenarios in the clinic. An illustrative description of the different SDF measurement techniques is presented. SDF testing is recommended in patients with clinical varicocele and borderline to normal semen parameters as it can better select varicocelectomy candidates. High SDF is also linked with recurrent spontaneous abortion (RSA) and can influence outcomes of different assisted reproductive techniques. Several studies have shown some benefit in using testicular sperm rather than ejaculated sperm in men with high SDF, oligozoospermia or recurrent in vitro fertilization (IVF) failure. Infertile men with evidence of exposure to pollutants can benefit from sperm DNA testing as it can help reinforce the importance of lifestyle modification (e.g., cessation of cigarette smoking, antioxidant therapy), predict fertility and monitor the patient’s response to intervention. PMID:28078226

Global Sensitivity Analysis for Identifying Important Parameters of Nitrogen Nitrification and Denitrification under Model and Scenario Uncertainties

NASA Astrophysics Data System (ADS)

Ye, M.; Chen, Z.; Shi, L.; Zhu, Y.; Yang, J.

2017-12-01

Nitrogen reactive transport modeling is subject to uncertainty in model parameters, structures, and scenarios. While global sensitivity analysis is a vital tool for identifying the parameters important to nitrogen reactive transport, conventional global sensitivity analysis only considers parametric uncertainty. This may result in inaccurate selection of important parameters, because parameter importance may vary under different models and modeling scenarios. By using a recently developed variance-based global sensitivity analysis method, this paper identifies important parameters with simultaneous consideration of parametric uncertainty, model uncertainty, and scenario uncertainty. In a numerical example of nitrogen reactive transport modeling, a combination of three scenarios of soil temperature and two scenarios of soil moisture leads to a total of six scenarios. Four alternative models are used to evaluate reduction functions used for calculating actual rates of nitrification and denitrification. The model uncertainty is tangled with scenario uncertainty, as the reduction functions depend on soil temperature and moisture content. The results of sensitivity analysis show that parameter importance varies substantially between different models and modeling scenarios, which may lead to inaccurate selection of important parameters if model and scenario uncertainties are not considered. This problem is avoided by using the new method of sensitivity analysis in the context of model averaging and scenario averaging. The new method of sensitivity analysis can be applied to other problems of contaminant transport modeling when model uncertainty and/or scenario uncertainty are present.

Determining which land management practices reduce catchment scale flood risk and where to implement them for optimum effect

NASA Astrophysics Data System (ADS)

Pattison, Ian; Lane, Stuart; Hardy, Richard; Reaney, Sim

2010-05-01

The theoretical basis for why changes in land management might increase flood risk are well known, but proving them through numerical modelling still remains a challenge. In large catchments, like the River Eden in Cumbria, NW England, one of the reasons for this is that it is unfeasible to test multiple scenarios in all their possible locations. We have developed two linked approaches to refine the number of scenarios and locations using 1) spatial downscaling and 2) participatory decision making, which potentially should increase the likelihood of finding a link between land use and downstream flooding. Firstly, land management practices can have both flood reducing and flood increasing effects, depending on their location. As a result some areas of the catchment are more important in determining downstream flood risk than others, depending on the land use and hydrological connectivity. We apply a downscaling approach to identify which sub-catchments are most important in explaining downstream flooding. This is important because it is in these areas that management options are most likely to have a positive and detectable effect. Secondly, once the dominant sub-catchment has been identified, the land management scenarios that are both feasible and likely to impact flood risk need to be determined. This was done through active stakeholder engagement. The stakeholder group undertook a brainstorming exercise, which suggested about 30 different rural land management scenarios, which were mapped on to a literature-based conceptual framework of hydrological processes. Then these options were evaluated based on five criteria: relevance to catchment, scientific effectiveness, testability, robustness/uncertainty and feasibility of implementation. The suitability of each scenario was discussed and prioritised by the stakeholder group based on scientific needs and expectations and local suitability and feasibility. The next stage of the participatory approach was a mapping workshop, whereby a map of the catchment was laid out and locations where each scenario could feasibly be implemented were drawn on. This was combined with an analysis of historical maps to identify past land covers and a catchment walkover survey to put modelling work in the real world context. The land management scenarios were tested using hydrological and hydraulic models. Landscape scale changes, such as the effects of compaction and afforestation were tested using a catchment scale hydrological mode, CRUM2D. Channel scale changes, such as re-meandering and floodplain storage were tested using the 1D hydraulic model, iSIS, by altering channel cross sections and creating spills between the channel and floodplain. It is expected that the channel modification and floodplain storage scenarios will have the greatest impact on flooding both at the local and catchment scales. The landscape scale changes are more diffuse and therefore their impact is expected to be less significant. Although, early analysis indicates that the spatial location of changes strongly influences their effect on flooding.

Assessing the application of knowledge in clinical problem-solving: The structured professional reasoning exercise.

PubMed

Escudier, M P; Woolford, M J; Tricio, J A

2018-05-01

Clinical reasoning is a fundamental and core clinical competence of healthcare professionals. The study aimed to investigate the utility of the Structured Professional Reasoning Exercise (SPRE), a new competence assessment method designed to measure dental students' clinical reasoning in simulated scenarios, covering the clinical areas of Oral Disease, Primary Dental Care and Restorative Dentistry, Child Dental Health and Dental Practice and Clinical Governance. A total of 313 year-5 students sat for the assessment. Students spent 45 minutes assimilating the scenarios, before rotating through four pairs of 39 trained examiners who each independently assessed a single scenario over a ten-minute period, using a structured marking sheet. After the assessment, all students and examiners were invited to complete an anonymous perception questionnaire of the exercise. These questionnaires and the examination scores were statistically analysed. Oral Disease showed the lowest scores; Dental Practice and Governance the highest. The overall Intraclass Correlation Coefficient (ICC) was 0.770, whilst examiner training helped to increase the ICC from 0.716 in 2013 to 0.835 in 2014. Exploratory factor analysis revealed one major factor with an eigenvalue of 2.75 (68.8% of total variance). The Generalizability coefficient was consistent at 0.806. A total of 295 students and 32 examiners completed the perception questionnaire. Students' lowest examination perceptions were an "Unpleasant" and "Unenjoyable" experience, whilst the highest were "Interesting", "Valuable" and "Important". The majority of students and examiners reported the assessment as acceptable, fair and valid. The SPRE offers a reliable, valid and acceptable assessment method, provided it comprises at least four scenarios with two independently marking and trained assessors. 3. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Future Climate Impacts on Crop Water Demand and Groundwater Longevity in Agricultural Regions

NASA Astrophysics Data System (ADS)

Russo, T. A.; Sahoo, S.; Elliott, J. W.; Foster, I.

2016-12-01

Improving groundwater management practices under future drought conditions in agricultural regions requires three steps: 1) estimating the impacts of climate and drought on crop water demand, 2) projecting groundwater availability given climate and demand forcing, and 3) using this information to develop climate-smart policy and water use practices. We present an innovative combination of models to address the first two steps, and inform the third. Crop water demand was simulated using biophysical crop models forced by multiple climate models and climate scenarios, with one case simulating climate adaptation (e.g. modify planting or harvest time) and another without adaptation. These scenarios were intended to represent a range of drought projections and farm management responses. Nexty, we used projected climate conditions and simulated water demand across the United States as inputs to a novel machine learning-based groundwater model. The model was applied to major agricultural regions relying on the High Plains and Mississippi Alluvial aquifer systems in the US. The groundwater model integrates input data preprocessed using single spectrum analysis, mutual information, and a genetic algorithm, with an artificial neural network model. Model calibration and test results indicate low errors over the 33 year model run, and strong correlations to groundwater levels in hundreds of wells across each aquifer. Model results include a range of projected groundwater level changes from the present to 2050, and in some regions, identification and timeframe of aquifer depletion. These results quantify aquifer longevity under climate and crop scenarios, and provide decision makers with the data needed to compare scenarios of crop water demand, crop yield, and groundwater response, as they aim to balance water sustainability with food security.

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

PubMed

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

2016-11-01

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

A Methodological Review of US Budget-Impact Models for New Drugs.

PubMed

Mauskopf, Josephine; Earnshaw, Stephanie

2016-11-01

A budget-impact analysis is required by many jurisdictions when adding a new drug to the formulary. However, previous reviews have indicated that adherence to methodological guidelines is variable. In this methodological review, we assess the extent to which US budget-impact analyses for new drugs use recommended practices. We describe recommended practice for seven key elements in the design of a budget-impact analysis. Targeted literature searches for US studies reporting estimates of the budget impact of a new drug were performed and we prepared a summary of how each study addressed the seven key elements. The primary finding from this review is that recommended practice is not followed in many budget-impact analyses. For example, we found that growth in the treated population size and/or changes in disease-related costs expected during the model time horizon for more effective treatments was not included in several analyses for chronic conditions. In addition, all drug-related costs were not captured in the majority of the models. Finally, for most studies, one-way sensitivity and scenario analyses were very limited, and the ranges used in one-way sensitivity analyses were frequently arbitrary percentages rather than being data driven. The conclusions from our review are that changes in population size, disease severity mix, and/or disease-related costs should be properly accounted for to avoid over- or underestimating the budget impact. Since each budget holder might have different perspectives and different values for many of the input parameters, it is also critical for published budget-impact analyses to include extensive sensitivity and scenario analyses based on realistic input values.

Test ordering by GP trainees

PubMed Central

Morgan, Simon; Morgan, Andy; Kerr, Rohan; Tapley, Amanda; Magin, Parker

2016-01-01

Abstract Objective To assess the effectiveness of an educational intervention on test-ordering attitudes and intended practice of GP trainees, and any associations between changes in test ordering and trainee characteristics. Design Preworkshop and postworkshop survey of attitudes to test ordering, intended test-ordering practices for 3 clinical scenarios (fatigue, screening, and shoulder pain), and tolerance for uncertainty. Setting Three Australian regional general practice training providers. Participants General practice trainees (N = 167). Intervention A 2-hour workshop session and an online module. Main outcome measures Proportion of trainees who agreed with attitudinal statements before and after the workshop; proportion of trainees who would order tests, mean number of tests ordered, and number of appropriate and inappropriate tests ordered for each scenario before and after the workshop. Results Of 167 trainees, 132 (79.0%) completed both the preworkshop and postworkshop questionnaires. A total of 122 trainees attended the workshop. At baseline, 88.6% thought that tests can harm patients, 84.8% believed overtesting was a problem, 72.0% felt pressured by patients, 52.3% believed that tests would reassure patients, and 50.8% thought that they were less likely to be sued if they ordered tests. There were desirable changes in all attitudes after the workshop. Before the workshop, the mean number of tests that trainees would have ordered was 4.4, 4.8, and 1.5 for the fatigue, screening, and shoulder pain scenarios, respectively. After the workshop there were decreases in the mean number of both appropriate tests (decrease of 0.94) and inappropriate tests (decrease of 0.24) in the fatigue scenario; there was no change in the mean number of appropriate tests and a decrease in inappropriate tests (decrease of 0.76) in the screening scenario; and there was an increase in the proportion of trainees who would appropriately not order tests in the shoulder pain scenario. There were no significant associations between changes in test ordering and trainee demographic characteristics or tolerance for uncertainty subscale scores. Conclusion General practice trainees have conflicting attitudes to test ordering and demonstrate nonrational test ordering in 3 common scenarios. A workshop on rational test ordering led to desirable changes in attitudes and more rational intended test ordering. Our findings inform the development of appropriate educational interventions that address nonrational testing in family medicine. PMID:27629671

What Could Be Future Scenarios?-Lessons from the History of Public Health Surveillance for the Future: --A keynote address presented at the 8th World Alliance for Risk Factor Surveillance (WARFS) Global Conference on October 30, 2013, Beijing, China.

PubMed

Choi, Bernard C K

2015-01-01

This article provides insights into the future based on a review of the past and present of public health surveillance-the ongoing systematic collection, analysis, interpretation, and dissemination of health data for the planning, implementation, and evaluation of public health action. Public health surveillance dates back to the first recorded epidemic in 3180 BC in Egypt. A number of lessons and items of interest are summarised from a review of historical perspectives in the past 5,000 years and the current practice of surveillance. Some future scenarios are presented: exploring new frontiers; enhancing computer technology; improving epidemic investigations; improving data collection, analysis, dissemination and use; building on lessons from the past; building capacity; and enhancing global surveillance. It is concluded that learning from the past, reflecting on the present, and planning for the future can further enhance public health surveillance.

From "farm to fork" strawberry system: current realities and potential innovative scenarios from life cycle assessment of non-renewable energy use and green house gas emissions.

PubMed

Girgenti, Vincenzo; Peano, Cristiana; Baudino, Claudio; Tecco, Nadia

2014-03-01

In this study, we analysed the environmental profile of the strawberry industry in Northern Italy. The analysis was conducted using two scenarios as reference systems: strawberry crops grown in unheated plastic tunnels using currently existing cultivation techniques, post-harvest management practices and consumption patterns (scenario 1) and the same strawberry cultivation chain in which some of the materials used were replaced with bio-based materials (scenario 2). In numerous studies, biodegradable polymers have been shown to be environmentally friendly, thus potentially reducing environmental impacts. These materials can be recycled into carbon dioxide and water through composting. Many materials, such as Mater-BI® and PLA®, are also derived from renewable resources. The methodology chosen for the environmental analysis was a life cycle assessment (LCA) based on a consequential approach developed to assess a product's overall environmental impact from the production system to its usage and disposal. In the field stage, a traditional mulching film (non-biodegradable) could be replaced with a biodegradable product. This change would result in waste production of 0 kg/ha for the bio-based product compared to 260 kg/ha of waste for polyethylene (PE). In the post-harvest stage, the issue addressed was the use and disposal of packaging materials. The innovative scenario evaluated herein pertains to the use of new packaging materials that increase the shelf life of strawberries, thereby decreasing product losses while increasing waste management efficiency at the level of a distribution platform and/or sales outlet. In the event of product deterioration or non-sale of the product, the packaging and its contents could be collected together as organic waste without any additional processes because the packaging is compostable according to EN13432. Scenario 2 would achieve reductions of 20% in the global warming potential and non-renewable energy impact categories. Copyright © 2013 Elsevier B.V. All rights reserved.

Fiche pratique: En chantant; Recrire un scenario; Pour en decoudre avec le subjonctif; Cri d'alerte (Practical Ideas: Singing; Rewriting a Scenario; to Unravel the Subjunctive; Cry of Alarm).

ERIC Educational Resources Information Center

Delbende, Jean-Christophe; And Others

1996-01-01

Four ideas for French language classroom activities are described: an exercise in listening to popular songs; a film scenario rewriting exercise; a technique for teaching the subjunctive mood; and a paired or small-group activity to enhance understanding of advertising. (MSE)

Modelling consequences of change in biodiversity and ...

EPA Pesticide Factsheets

This chapter offers an assessment of the rapidly changing landscape of methods assessing and forecasting the benefits that people receive from nature and how these benefits are shaped by institutions and various anthropogenic assets. There has been an explosion of activity in understanding and modeling the benefits that people receive from nature, and this explosion has provided a diversity of approaches that are both complementary and contradictory. However, there remain major gaps in what current models can do. They are not well suited to estimate most types of benefits at national, regional, or global scales. they are focused on decision analysis, but have not focused on implementation, learning, or dialogue. This hap in particular means that current models are not well suited to bridging among multiple knowledge systems, however, there are initial efforts made towards this goal. Furthermore, while participatory social-ecological scenarios are able to bridge multiple knowledge systems in their assessment and analysis of multiple ecosystem series, the social-ecological scenarios community is fragmented and not well connected. Consequently, IPBES has an excellent knowledge base to build upon, but a real investment in building a more integrated modeling and scenarios community of practice is needed to produce a more complete and useful toolbox of approaches to meet the needs of IPBES assessment and other assessment of nature benefits. This Chapter describes

Simulation of Streamflow and Selected Water-Quality Constituents through a Model of the Onondaga Lake Basin, Onondaga County, New York - A Guide to Model Application

USGS Publications Warehouse

Coon, William F.

2008-01-01

A computer model of hydrologic and water-quality processes of the Onondaga Lake basin in Onondaga County, N.Y., was developed during 2003-07 to assist water-resources managers in making basin-wide management decisions that could affect peak flows and the water quality of tributaries to Onondaga Lake. The model was developed with the Hydrological Simulation Program-Fortran (HSPF) and was designed to allow simulation of proposed or hypothetical land-use changes, best-management practices (BMPs), and instream stormwater-detention basins such that their effects on flows and loads of suspended sediment, orthophosphate, total phosphorus, ammonia, organic nitrogen, and nitrate could be analyzed. Extreme weather conditions, such as intense storms and prolonged droughts, can be simulated through manipulation of the precipitation record. Model results obtained from different scenarios can then be compared and analyzed through an interactive computer program known as Generation and Analysis of Model Simulation Scenarios for Watersheds (GenScn). Background information on HSPF and GenScn is presented to familiarize the user with these two programs. Step-by-step examples are provided on (1) the creation of land-use, BMP, and stormflow-detention scenarios for simulation by the HSPF model, and (2) the analysis of simulation results through GenScn.

Teaching undergraduate nursing students about environmental health: addressing public health issues through simulation.

PubMed

Stanley, Mary Jo; Rojas, Deb

2014-01-01

Schools of nursing are challenged to find clinical placements in public health settings. Use of simulation can address situations unique to public health, with attention to specific concerns, such as environmental health. Environmental health is an integral part of public health nursing and is a standard of professional practice. Current simulations focus on acute care situations, offering limited scenarios with a public health perspective and excluding environmental health. This study's simulation scenario was created to enhance nursing students' understanding of public health concepts within an environmental health context. Outcomes from the simulation include the need for integration of environmental issues in public health teaching. Students stated that this scenario provided a broader understanding of the environmental influences that can affect the client's and family's health. This scenario fills a void in simulation content, while providing an interactive teaching and learning strategy to help students to apply knowledge to practice. Copyright 2014, SLACK Incorporated.

Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment.

PubMed

Bussard, Michelle E

2016-09-01

Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated. This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study. Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice. This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.]. Copyright 2016, SLACK Incorporated.

Tree cover in Central Africa: determinants and sensitivity under contrasted scenarios of global change.

PubMed

Aleman, Julie C; Blarquez, Olivier; Gourlet-Fleury, Sylvie; Bremond, Laurent; Favier, Charly

2017-01-30

Tree cover is a key variable for ecosystem functioning, and is widely used to study tropical ecosystems. But its determinants and their relative importance are still a matter of debate, especially because most regional and global analyses have not considered the influence of agricultural practices. More information is urgently needed regarding how human practices influence vegetation structure. Here we focused in Central Africa, a region still subjected to traditional agricultural practices with a clear vegetation gradient. Using remote sensing data and global databases, we calibrated a Random Forest model to correlatively link tree cover with climatic, edaphic, fire and agricultural practices data. We showed that annual rainfall and accumulated water deficit were the main drivers of the distribution of tree cover and vegetation classes (defined by the modes of tree cover density), but agricultural practices, especially pastoralism, were also important in determining tree cover. We simulated future tree cover with our model using different scenarios of climate and land-use (agriculture and population) changes. Our simulations suggest that tree cover may respond differently regarding the type of scenarios, but land-use change was an important driver of vegetation change even able to counterbalance the effect of climate change in Central Africa.

Tree cover in Central Africa: determinants and sensitivity under contrasted scenarios of global change

NASA Astrophysics Data System (ADS)

Aleman, Julie C.; Blarquez, Olivier; Gourlet-Fleury, Sylvie; Bremond, Laurent; Favier, Charly

2017-01-01

Tree cover is a key variable for ecosystem functioning, and is widely used to study tropical ecosystems. But its determinants and their relative importance are still a matter of debate, especially because most regional and global analyses have not considered the influence of agricultural practices. More information is urgently needed regarding how human practices influence vegetation structure. Here we focused in Central Africa, a region still subjected to traditional agricultural practices with a clear vegetation gradient. Using remote sensing data and global databases, we calibrated a Random Forest model to correlatively link tree cover with climatic, edaphic, fire and agricultural practices data. We showed that annual rainfall and accumulated water deficit were the main drivers of the distribution of tree cover and vegetation classes (defined by the modes of tree cover density), but agricultural practices, especially pastoralism, were also important in determining tree cover. We simulated future tree cover with our model using different scenarios of climate and land-use (agriculture and population) changes. Our simulations suggest that tree cover may respond differently regarding the type of scenarios, but land-use change was an important driver of vegetation change even able to counterbalance the effect of climate change in Central Africa.

The effectiveness of virtual simulation in improving student nurses' knowledge and performance during patient deterioration: A pre and post test design.

PubMed

Borg Sapiano, Alexis; Sammut, Roberta; Trapani, Josef

2018-03-01

Preparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration. To investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration. A pre- and post-test design was used. Nursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST 2 ACTWeb™, using their own computer devices. A total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study. The simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database. Findings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, p<0.001). Highest mean performance scores were obtained in the last scenario (M=19.7, median: 20.0, s.d. 3.41) indicating a learning effect. Knowledge was not a predictor of students' performance in the scenarios. This study supports virtual simulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of undergraduate nurse education, to prepare students to manage complex situations as practicing nurses. Copyright © 2018 Elsevier Ltd. All rights reserved.

Analysis on LID for highly urbanized areas' waterlogging control: demonstrated on the example of Caohejing in Shanghai.

PubMed

Liao, Z L; He, Y; Huang, F; Wang, S; Li, H Z

2013-01-01

Although a commonly applied measure across the United States and Europe for alleviating the negative impacts of urbanization on the hydrological cycle, low impact development (LID) has not been widely used in highly urbanized areas, especially in rapidly urbanizing cities in developing countries like China. In this paper, given five LID practices including Bio-Retention, Infiltration Trench, Porous Pavement, Rain Barrels, and Green Swale, an analysis on LID for highly urbanized areas' waterlogging control is demonstrated using the example of Caohejing in Shanghai, China. Design storm events and storm water management models are employed to simulate the total waterlogging volume reduction, peak flow rate reduction and runoff coefficient reduction of different scenarios. Cost-effectiveness is calculated for the five practices. The aftermath shows that LID practices can have significant effects on storm water management in a highly urbanized area, and the comparative results reveal that Rain Barrels and Infiltration Trench are the two most suitable cost-effective measures for the study area.

Globalisation, economics and professionalism.

PubMed

Tan, Chay-Hoon; Macneill, Paul

2015-01-01

This paper presents an analysis of the effect of globalisation and attendant economic factors on the global practice of medicine, medical education, medical ethics and medical professionalism. The authors discuss the implications of these trends, citing case scenarios in the healthcare insurance, medical tourism, pharmaceutical industries, and the educational systems as well as in clinical practice, to illustrate the impact of globalisation and economics on professionalism. Globalisation, on the one hand, offers benefits for the global practice of medicine and for medical education. On the other, globalisation can have negative effects, particularly when the main driver is to maximise profitability across national boundaries rather than concern for human well-being. Appraising the effect of globalisation on professionalism involves assessing its effects at the intrapersonal, interpersonal, and institutional levels, and its effect on society at large.

Travellers' diarrhoea-a survey of practice.

PubMed

McGrath, Christian M; Leder, Karin

2017-03-01

Travellers' diarrhoea (TD) is a common problem, affecting millions of tourists each year and creating a large economic burden. Risk factors for TD are known and guidelines exist to assist practitioners in advising travellers on how to prevent and treat TD. However, data are lacking regarding actual prescribing practices or approaches used in TD management. This study aims to establish a baseline which identifies uniformities and diversities in practice. An online survey created using the SurveyMonkey tool was developed to test respondent approaches to TD pre-travel management. An invitation to participate in the survey was distributed early 2016 through selected Australian and New Zealand speciality travel medicine centres and through the electronic mailing list of the International Society of Travel Medicine (ISTM). Descriptive statistics and analyses using Chi Square analysis and two-sided Fishers exact tests for significance were used. Three hundred and sixty-four completed or partially completed surveys were collected from respondents in 23 countries. Approach to TD, antibiotic choice and management of four different clinical scenarios were assessed, with analyses focused on identifying significant differences in approach according to region of practice, professional background and level of experience. The responses to the clinical scenarios suggest most uniformity in recommended treatment strategies in clearly mild or severe disease, and greater variability in moderate disease. There is practice diversity in the discussion of preventative techniques and prescribing of self-treatment medications for TD, especially for moderate TD disease. Evidence-based guidelines that address the competing issues of patient health and morbidity vs the risk of colonization with resistant organisms may lead to more consistent antibiotic prescribing practices. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Clinical factors affecting physicians' management decisions in cases of female partner abuse.

PubMed

Ferris, L E; Norton, P; Dunn, E V; Gort, E H

1999-06-01

This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative.

PubMed

Ferket, Bart S; Feldman, Zachary; Zhou, Jing; Oei, Edwin H; Bierma-Zeinstra, Sita M A; Mazumdar, Madhu

2017-03-28

Objectives  To evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms. Design  Marginal structural modeling and cost effectiveness analysis based on lifetime predictions for total knee replacement and death from population based cohort data. Setting  Data from two studies-Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)-within the US health system. Participants  4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous knee replacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up. Intervention  Scenarios ranging from current practice, defined as total knee replacement practice as performed in the OAI (with procedural rates estimated by a prediction model), to practice limited to patients with severe symptoms to no surgery. Main outcome measures  Generic (SF-12) and osteoarthritis specific quality of life measured over 96 months, model based QALYs, costs, and incremental cost effectiveness ratios over a lifetime horizon. Results  In the OAI, total knee replacement showed improvements in quality of life with small absolute changes when averaged across levels of confounding variables: 1.70 (95% uncertainty interval 0.26 to 3.57) for SF-12 physical component summary (PCS); -10.69 (-13.39 to -8.01) for Western Ontario and McMaster Universities arthritis index (WOMAC); and 9.16 (6.35 to 12.49) for knee injury and osteoarthritis outcome score (KOOS) quality of life subscale. These improvements became larger with decreasing functional status at baseline. Provision of total knee replacement to patients with SF-12 PCS scores <35 was the optimal scenario given a cost effectiveness threshold of $200 000/QALY, with cost savings of $6974 ($5789 to $8269) and a minimal loss of 0.008 (-0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY. Conclusion  Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Review of Dangerous Radioisotopes: What is Available in Practice, What Should We be Concerned About?

DTIC Science & Technology

2015-06-01

of the credibility of a radioactive material as a radiological weapon to be applied to specific scenarios. • This does not replace the IAEA "AID...34 ratios, but more precisely applies this concept to assessments of interest. 7Jt#,�$ 2 IDA I Radiological Weapons • This analysis identified the...radiological weapons under seven different routes of exposure (or types of radiological weapons ), including external irradiation from a point source

Assessing Performance Outcomes of New Graduates Utilizing Simulation in a Military Transition Program

DTIC Science & Technology

2013-01-01

pretest and posttests ( p G .05). An additional analysis was conducted to determine if there were differences in outcomes based on whether par- ticipants...would be predicted based on FIGURE 1 Pretest and posttest mean performance scores for all 26 objectives of the anaphylaxis scenario. FIGURE 2 Pretest ...clinical practice. Another limitation of the study is the use of a pretest / posttest designwithout a control group for comparison of results. Finally

Towards interactive narrative medicine.

PubMed

Cavazza, Marc; Charles, Fred

2013-01-01

Interactive Storytelling technologies have attracted significant interest in the field of simulation and serious gaming for their potential to provide a principled approach to improve user engagement in training scenarios. In this paper, we explore the use of Interactive Storytelling to support Narrative Medicine as a reflective practice. We describe a workflow for the generation of virtual narratives from high-level descriptions of patients' experiences as perceived by physicians, which can help to objectivize such perceptions and support various forms of analysis.

Simulation-Based Communication Skills Training for Experienced Clinicians to Improve Family Conversations About Organ and Tissue Donation.

PubMed

Potter, Julie Elizabeth; Gatward, Jonathan J; Kelly, Michelle A; McKay, Leigh; McCann, Ellie; Elliott, Rosalind M; Perry, Lin

2017-12-01

The approach, communication skills, and confidence of clinicians responsible for raising deceased organ donation may influence families' donation decisions. The aim of this study was to increase the preparedness and confidence of intensive care clinicians allocated to work in a "designated requester" role. We conducted a posttest evaluation of an innovative simulation-based training program. Simulation-based training enabled clinicians to rehearse the "balanced approach" to family donation conversations (FDCs) in the designated requester role. Professional actors played family members in simulated clinical settings using authentic scenarios, with video-assisted reflective debriefing. Participants completed an evaluation after the workshop. Simple descriptive statistical analysis and content analysis were performed. Between January 2013 and July 2015, 25 workshops were undertaken with 86 participants; 82 (95.3%) returned evaluations. Respondents were registered practicing clinicians; over half (44/82; 53.7%) were intensivists. Most attended a single workshop. Evaluations were overwhelmingly positive with the majority rating workshops as outstanding (64/80; 80%). Scenario fidelity, competence of the actors, opportunity to practice and receive feedback on performance, and feedback from actors, both in and out of character, were particularly valued. Most (76/78; 97.4%) reported feeling more confident about their designated requester role. Simulation-based communication training for the designated requester role in FDCs increased the knowledge and confidence of clinicians to raise the topic of donation.

Effects of future climate and land use scenarios on riverine source water quality.

PubMed

Delpla, Ianis; Rodriguez, Manuel J

2014-09-15

Surface water quality is particularly sensitive to land use practices and climatic events that affect its catchment. The relative influence of a set of watershed characteristics (climate, land use, morphology and pedology) and climatic variables on two key water quality parameters (turbidity and fecal coliforms (FC)) was examined in 24 eastern Canadian catchments at various spatial scales (1 km, 5 km, 10 km and the entire catchment). A regression analysis revealed that the entire catchment was a better predictor of water quality. Based on this information, linear mixed effect models for predicting turbidity and FC levels were developed. A set of land use and climate scenarios was considered and applied within the water quality models. Four land use scenarios (no change, same rate of variation, optimistic and pessimistic) and three climate change scenarios (B1, A1B and A2) were tested and variations for the near future (2025) were assessed and compared to the reference period (2000). Climate change impacts on water quality remained low annually for this time horizon (turbidity: +1.5%, FC: +1.6%, A2 scenario). On the other hand, the influence of land use changes appeared to predominate. Significant benefits for both parameters could be expected following the optimistic scenario (turbidity: -16.4%, FC: -6.3%; p < 0.05). However, pessimistic land use scenario led to significant increases on an annual basis (turbidity: +11.6%, FC: +15.2%; p < 0.05). Additional simulations conducted for the late 21st century (2090) revealed that climate change impacts could become equivalent to those modeled for land use for this horizon. Copyright © 2014 Elsevier B.V. All rights reserved.

Web Based Tool for Mission Operations Scenarios

NASA Technical Reports Server (NTRS)

Boyles, Carole A.; Bindschadler, Duane L.

2008-01-01

A conventional practice for spaceflight projects is to document scenarios in a monolithic Operations Concept document. Such documents can be hundreds of pages long and may require laborious updates. Software development practice utilizes scenarios in the form of smaller, individual use cases, which are often structured and managed using UML. We have developed a process and a web-based scenario tool that utilizes a similar philosophy of smaller, more compact scenarios (but avoids the formality of UML). The need for a scenario process and tool became apparent during the authors' work on a large astrophysics mission. It was noted that every phase of the Mission (e.g., formulation, design, verification and validation, and operations) looked back to scenarios to assess completeness of requirements and design. It was also noted that terminology needed to be clarified and structured to assure communication across all levels of the project. Attempts to manage, communicate, and evolve scenarios at all levels of a project using conventional tools (e.g., Excel) and methods (Scenario Working Group meetings) were not effective given limitations on budget and staffing. The objective of this paper is to document the scenario process and tool created to offer projects a low-cost capability to create, communicate, manage, and evolve scenarios throughout project development. The process and tool have the further benefit of allowing the association of requirements with particular scenarios, establishing and viewing relationships between higher- and lower-level scenarios, and the ability to place all scenarios in a shared context. The resulting structured set of scenarios is widely visible (using a web browser), easily updated, and can be searched according to various criteria including the level (e.g., Project, System, and Team) and Mission Phase. Scenarios are maintained in a web-accessible environment that provides a structured set of scenario fields and allows for maximum visibility across the project. One key aspect is that the tool was built for a scenario process that accounts for stakeholder input, review, comment, and concurrence. By creating well-designed opportunities for stakeholder input and concurrence and by making the scenario content easily accessible to all project personnel, we maximize the opportunities for stakeholders to both understand and agree on the concepts for how their mission is to be carried out.

A multivariate copula-based framework for dealing with hazard scenarios and failure probabilities

NASA Astrophysics Data System (ADS)

Salvadori, G.; Durante, F.; De Michele, C.; Bernardi, M.; Petrella, L.

2016-05-01

This paper is of methodological nature, and deals with the foundations of Risk Assessment. Several international guidelines have recently recommended to select appropriate/relevant Hazard Scenarios in order to tame the consequences of (extreme) natural phenomena. In particular, the scenarios should be multivariate, i.e., they should take into account the fact that several variables, generally not independent, may be of interest. In this work, it is shown how a Hazard Scenario can be identified in terms of (i) a specific geometry and (ii) a suitable probability level. Several scenarios, as well as a Structural approach, are presented, and due comparisons are carried out. In addition, it is shown how the Hazard Scenario approach illustrated here is well suited to cope with the notion of Failure Probability, a tool traditionally used for design and risk assessment in engineering practice. All the results outlined throughout the work are based on the Copula Theory, which turns out to be a fundamental theoretical apparatus for doing multivariate risk assessment: formulas for the calculation of the probability of Hazard Scenarios in the general multidimensional case (d≥2) are derived, and worthy analytical relationships among the probabilities of occurrence of Hazard Scenarios are presented. In addition, the Extreme Value and Archimedean special cases are dealt with, relationships between dependence ordering and scenario levels are studied, and a counter-example concerning Tail Dependence is shown. Suitable indications for the practical application of the techniques outlined in the work are given, and two case studies illustrate the procedures discussed in the paper.

Using "The Burns Suite" as a Novel High Fidelity Simulation Tool for Interprofessional and Teamwork Training.

PubMed

Sadideen, Hazim; Wilson, David; Moiemen, Naiem; Kneebone, Roger

2016-01-01

Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed based on "advanced trauma and life support" and "emergency management of severe burns" principles, refined utilizing expert opinion through cognitive task analysis. The focus of this analysis was on nontechnical and interpersonal skills of clinicians and nurses within the scenario, mirroring what happens in real life. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's alpha was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twenty-two participants completed TBS resuscitation scenario. Mean face and content validity ratings were high (4.4 and 4.7 respectively; range 4-5). The internal consistency of questions was high. Qualitative data analysis revealed two new themes. Participants reported that the experience felt particularly authentic because the simulation had high psychological and social fidelity, and there was a demand for such a facility to be made available to improve nontechnical skills and interprofessional relations. TBS provides a realistic, novel tool for SBTT, addressing both nontechnical and interprofessional team skills. Recreating clinical challenge is crucial to optimize SBTT. With a better understanding of the theories underpinning simulation and interprofessional education, future simulation scenarios can be designed to provide unique educational experiences whereby team members will learn with and from other specialties and professions in a safe, controlled environment.

Exploring NASA Human Spaceflight and Pioneering Scenarios

NASA Technical Reports Server (NTRS)

Zapata, Edgar; Wilhite, Alan

2015-01-01

The life cycle cost analysis of space exploration scenarios is explored via a merger of (1) scenario planning, separating context and (2) modeling and analysis of specific content. Numerous scenarios are presented, leading to cross-cutting recommendations addressing life cycle costs, productivity, and approaches applicable to any scenarios. Approaches address technical and non-technical factors.

Scenario Analysis for the Safety Assessment of Nuclear Waste Repositories: A Critical Review.

PubMed

Tosoni, Edoardo; Salo, Ahti; Zio, Enrico

2018-04-01

A major challenge in scenario analysis for the safety assessment of nuclear waste repositories pertains to the comprehensiveness of the set of scenarios selected for assessing the safety of the repository. Motivated by this challenge, we discuss the aspects of scenario analysis relevant to comprehensiveness. Specifically, we note that (1) it is necessary to make it clear why scenarios usually focus on a restricted set of features, events, and processes; (2) there is not yet consensus on the interpretation of comprehensiveness for guiding the generation of scenarios; and (3) there is a need for sound approaches to the treatment of epistemic uncertainties. © 2017 Society for Risk Analysis.

New Orleans Regional Planning Commission scenario planning workshop : sponsored by the Federal Highway Administration

DOT National Transportation Integrated Search

2016-05-01

This report summarizes noteworthy practices and key recommendations shared during a scenario planning workshop, hosted by the New Orleans Regional Planning Commission, on August 12-13, 2015, in New Orleans, Louisiana. The Federal Highway Administrati...

Gulf Regional Planning Commission scenario planning workshop : sponsored by the Federal Highway Administration

DOT National Transportation Integrated Search

2016-03-01

This report summarizes noteworthy practices shared during a scenario planning workshop, hosted by the Gulf Regional Planning Commission, on March 15-16, 2016, in Biloxi, Mississippi. The Federal Highway Administration (FHWA) sponsored this event as p...

Mid-America Regional Council Scenario Planning Workshop: Sponsored by the Federal Highway Administration

DOT National Transportation Integrated Search

2017-05-01

This report summarizes noteworthy practices and key recommendations shared during a scenario planning workshop, hosted by the Mid-America Regional Council, on January 31-February 1, 2017, in Kansas City, Missouri. The Federal Highway Administration (...

A COMPUTATIONAL FRAMEWORK FOR EVALUATION OF NPS MANAGEMENT SCENARIOS: ROLE OF PARAMETER UNCERTAINTY

EPA Science Inventory

Utility of complex distributed-parameter watershed models for evaluation of the effectiveness of non-point source sediment and nutrient abatement scenarios such as Best Management Practices (BMPs) often follows the traditional {calibrate ---> validate ---> predict} procedure. Des...

Development and Application of an Integrated Approach toward NASA Airspace Systems Research

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Fong, Robert K.; Abramson, Paul D.; Koenke, Ed

2008-01-01

The National Aeronautics and Space Administration's (NASA) Airspace Systems Program is contributing air traffic management research in support of the 2025 Next Generation Air Transportation System (NextGen). Contributions support research and development needs provided by the interagency Joint Planning and Development Office (JPDO). These needs generally call for integrated technical solutions that improve system-level performance and work effectively across multiple domains and planning time horizons. In response, the Airspace Systems Program is pursuing an integrated research approach and has adapted systems engineering best practices for application in a research environment. Systems engineering methods aim to enable researchers to methodically compare different technical approaches, consider system-level performance, and develop compatible solutions. Systems engineering activities are performed iteratively as the research matures. Products of this approach include a demand and needs analysis, system-level descriptions focusing on NASA research contributions, system assessment and design studies, and common systemlevel metrics, scenarios, and assumptions. Results from the first systems engineering iteration include a preliminary demand and needs analysis; a functional modeling tool; and initial system-level metrics, scenario characteristics, and assumptions. Demand and needs analysis results suggest that several advanced concepts can mitigate demand/capacity imbalances for NextGen, but fall short of enabling three-times current-day capacity at the nation s busiest airports and airspace. Current activities are focusing on standardizing metrics, scenarios, and assumptions, conducting system-level performance assessments of integrated research solutions, and exploring key system design interfaces.

Modeling Impacts of Alternative Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Rice–Wheat Annual Rotation in China

PubMed Central

Wang, Jinyang; Zhang, Xiaolin; Liu, Yinglie; Pan, Xiaojian; Liu, Pingli; Chen, Zhaozhi; Huang, Taiqing; Xiong, Zhengqin

2012-01-01

Background Evaluating the net exchange of greenhouse gas (GHG) emissions in conjunction with soil carbon sequestration may give a comprehensive insight on the role of agricultural production in global warming. Materials and Methods Measured data of methane (CH4) and nitrous oxide (N2O) were utilized to test the applicability of the Denitrification and Decomposition (DNDC) model to a winter wheat – single rice rotation system in southern China. Six alternative scenarios were simulated against the baseline scenario to evaluate their long-term (45-year) impacts on net global warming potential (GWP) and greenhouse gas intensity (GHGI). Principal Results The simulated cumulative CH4 emissions fell within the statistical deviation ranges of the field data, with the exception of N2O emissions during rice-growing season and both gases from the control treatment. Sensitivity tests showed that both CH4 and N2O emissions were significantly affected by changes in both environmental factors and management practices. Compared with the baseline scenario, the long-term simulation had the following results: (1) high straw return and manure amendment scenarios greatly increased CH4 emissions, while other scenarios had similar CH4 emissions, (2) high inorganic N fertilizer increased N2O emissions while manure amendment and reduced inorganic N fertilizer scenarios decreased N2O emissions, (3) the mean annual soil organic carbon sequestration rates (SOCSR) under manure amendment, high straw return, and no-tillage scenarios averaged 0.20 t C ha−1 yr−1, being greater than other scenarios, and (4) the reduced inorganic N fertilizer scenario produced the least N loss from the system, while all the scenarios produced comparable grain yields. Conclusions In terms of net GWP and GHGI for the comprehensive assessment of climate change and crop production, reduced inorganic N fertilizer scenario followed by no-tillage scenario would be advocated for this specified cropping system. PMID:23029173

Incorporating Budget Impact Analysis in the Implementation of Complex Interventions: A Case of an Integrated Intervention for Multimorbid Patients within the CareWell Study.

PubMed

Soto-Gordoa, Myriam; Arrospide, Arantzazu; Merino Hernández, Marisa; Mora Amengual, Joana; Fullaondo Zabala, Ane; Larrañaga, Igor; de Manuel, Esteban; Mar, Javier

2017-01-01

To develop a framework for the management of complex health care interventions within the Deming continuous improvement cycle and to test the framework in the case of an integrated intervention for multimorbid patients in the Basque Country within the CareWell project. Statistical analysis alone, although necessary, may not always represent the practical significance of the intervention. Thus, to ascertain the true economic impact of the intervention, the statistical results can be integrated into the budget impact analysis. The intervention of the case study consisted of a comprehensive approach that integrated new provider roles and new technological infrastructure for multimorbid patients, with the aim of reducing patient decompensations by 10% over 5 years. The study period was 2012 to 2020. Given the aging of the general population, the conventional scenario predicts an increase of 21% in the health care budget for care of multimorbid patients during the study period. With a successful intervention, this figure should drop to 18%. The statistical analysis, however, showed no significant differences in costs either in primary care or in hospital care between 2012 and 2014. The real costs in 2014 were by far closer to those in the conventional scenario than to the reductions expected in the objective scenario. The present implementation should be reappraised, because the present expenditure did not move closer to the objective budget. This work demonstrates the capacity of budget impact analysis to enhance the implementation of complex interventions. Its integration in the context of the continuous improvement cycle is transferable to other contexts in which implementation depth and time are important. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis.

PubMed

Liu, Nan; D'Aunno, Thomas

2012-04-01

To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. © Health Research and Educational Trust.

Finding the right compromise between productivity and environmental efficiency on high input tropical dairy farms: a case study.

PubMed

Berre, David; Blancard, Stéphane; Boussemart, Jean-Philippe; Leleu, Hervé; Tillard, Emmanuel

2014-12-15

This study focused on the trade-off between milk production and its environmental impact on greenhouse gas (GHG) emissions and nitrogen surplus in a high input tropical system. We first identified the objectives of the three main stakeholders in the dairy sector (farmers, a milk cooperative and environmentalists). The main aim of the farmers and cooperative's scenarios was to increase milk production without additional environmental deterioration but with the possibility of increasing the inputs for the cooperative. The environmentalist's objective was to reduce environmental deterioration. Second, we designed a sustainable intensification scenario combining maximization of milk production and minimization of environmental impacts. Third, the objectives for reducing the eco-inefficiency of dairy systems in Reunion Island were incorporated in a framework for activity analysis, which was used to model a technological approach with desirable and undesirable outputs. Of the four scenarios, the sustainable intensification scenario produced the best results, with a potential decrease of 238 g CO2-e per liter of milk (i.e. a reduction of 13.93% compared to the current level) and a potential 7.72 L increase in milk produced for each kg of nitrogen surplus (i.e. an increase of 16.45% compared to the current level). These results were based on the best practices observed in Reunion Island and optimized manure management, crop-livestock interactions, and production processes. Our results also showed that frontier efficiency analysis can shed new light on the challenge of developing sustainable intensification in high input tropical dairy systems. Copyright © 2014 Elsevier Ltd. All rights reserved.

Economic consequences of earthquakes: bridging research and practice with HayWired

NASA Astrophysics Data System (ADS)

Wein, A. M.; Kroll, C.

2016-12-01

The U.S. Geological Survey partners with organizations and experts to develop multiple hazard scenarios. The HayWired earthquake scenario refers to a rupture of the Hayward fault in the Bay Area of California and addresses the potential chaos related to interconnectedness at many levels: the fault afterslip and aftershocks, interdependencies of lifelines, wired/wireless technology, communities at risk, and ripple effects throughout today's digital economy. The scenario is intended for diverse audiences. HayWired analyses translate earthquake hazards (surface rupture, ground shaking, liquefaction, landslides) into physical engineering and environmental health impacts, and into societal consequences. Damages to life and property and lifeline service disruptions are direct causes of business interruption. Economic models are used to estimate the economic impacts and resilience in the regional economy. The objective of the economic analysis is to inform policy discourse about economic resilience at all three levels of the economy: macro, meso, and micro. Stakeholders include businesses, economic development, and community leaders. Previous scenario analyses indicate the size of an event: large earthquakes and large winter storms are both "big ones" for California. They motivate actions to reduce the losses from fire following earthquake and water supply outages. They show the effect that resilience can have on reducing economic losses. Evaluators find that stakeholders learned the most about the economic consequences.

An Expert Elicitation of the Proliferation Resistance of Using Small Modular Reactors (SMR) for the Expansion of Civilian Nuclear Systems.

PubMed

Siegel, Jonas; Gilmore, Elisabeth A; Gallagher, Nancy; Fetter, Steve

2018-02-01

To facilitate the use of nuclear energy globally, small modular reactors (SMRs) may represent a viable alternative or complement to large reactor designs. One potential benefit is that SMRs could allow for more proliferation resistant designs, manufacturing arrangements, and fuel-cycle practices at widespread deployment. However, there is limited work evaluating the proliferation resistance of SMRs, and existing proliferation assessment approaches are not well suited for these novel arrangements. Here, we conduct an expert elicitation of the relative proliferation resistance of scenarios for future nuclear energy deployment driven by Generation III+ light-water reactors, fast reactors, or SMRs. Specifically, we construct the scenarios to investigate relevant technical and institutional features that are postulated to enhance the proliferation resistance of SMRs. The experts do not consistently judge the scenario with SMRs to have greater overall proliferation resistance than scenarios that rely on conventional nuclear energy generation options. Further, the experts disagreed on whether incorporating a long-lifetime sealed core into an SMR design would strengthen or weaken proliferation resistance. However, regardless of the type of reactor, the experts judged that proliferation resistance would be enhanced by improving international safeguards and operating several multinational fuel-cycle facilities rather than supporting many more national facilities. © 2017 Society for Risk Analysis.

Identification using face regions: application and assessment in forensic scenarios.

PubMed

Tome, Pedro; Fierrez, Julian; Vera-Rodriguez, Ruben; Ramos, Daniel

2013-12-10

This paper reports an exhaustive analysis of the discriminative power of the different regions of the human face on various forensic scenarios. In practice, when forensic examiners compare two face images, they focus their attention not only on the overall similarity of the two faces. They carry out an exhaustive morphological comparison region by region (e.g., nose, mouth, eyebrows, etc.). In this scenario it is very important to know based on scientific methods to what extent each facial region can help in identifying a person. This knowledge obtained using quantitative and statical methods on given populations can then be used by the examiner to support or tune his observations. In order to generate such scientific knowledge useful for the expert, several methodologies are compared, such as manual and automatic facial landmarks extraction, different facial regions extractors, and various distances between the subject and the acquisition camera. Also, three scenarios of interest for forensics are considered comparing mugshot and Closed-Circuit TeleVision (CCTV) face images using MORPH and SCface databases. One of the findings is that depending of the acquisition distances, the discriminative power of the facial regions change, having in some cases better performance than the full face. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Water-Energy Nexus Challenges & Opportunities in the Arabian Peninsula under Climate Change

NASA Astrophysics Data System (ADS)

Flores-Lopez, F.; Yates, D. N.; Galaitsi, S.; Binnington, T.; Dougherty, W.; Vinnaccia, M.; Glavan, J. C.

2016-12-01

Demand for water in the GCC countries relies mainly on fossil groundwater resources and desalination. Satisfying water demand requires a great deal of energy as it treats and moves water along the supply chain from sources, through treatment processes, and ultimately to the consumer. Hence, there is an inherent connection between water and energy and with climate change, the links between water and energy are expected to become even stronger. As part of AGEDI's Local, National, and Regional Climate Change Programme, a study of the water-energy nexus of the countries in the Arabian Peninsula was implemented. For water, WEAP models both water demand - and its main drivers - and water supply, simulating policies, priorities and preferences. For energy, LEAP models both energy supply and demand, and is able to capture the impacts of low carbon development strategies. A coupled WEAP-LEAP model was then used to evaluate the future performance of the energy-water system under climate change and policy scenarios. The coupled models required detailed data, which were obtained through literature reviews and consultations with key stakeholders in the region. As part of this process, the outputs of both models were validated for historic periods using existing data The models examined 5 policy scenarios of different futures of resource management to the year 2060. A future under current management practices with current climate and a climate projection based on the RCP8.5; a High Efficiency scenario where each country gradually implements policies to reduce the consumption of water and electricity; a Natural Resource Protection scenario with resource efficiency and phasing out of groundwater extraction and drastic reduction of fossil fuel usage in favor of solar; and an Integrated Policy scenario that integrates the prior two policy scenarios Water demands can mostly be met in any scenario through supply combinations of groundwater, desalination and wastewater reuse, with some regional fossil groundwater basins draw to extinction by 2060. While the analysis includes both demand and supply oriented scenarios, the results of the analysis strongly suggest that the region will need to simultaneously purse demand and supply side policies to achieve more sustainable uses of water and energy into the second half of the 21st century.

New York Metropolitan Transportation Council scenario planning workshop : sponsored by the Federal Highway Administration

DOT National Transportation Integrated Search

2016-01-01

This report summarizes noteworthy practices and key recommendations shared during a scenario planning workshop, hosted by the New York Metropolitan Transportation Council, on July 14-15, 2015, in New York, New York. The Federal Highway Administration...

Greater Buffalo-Niagara Regional Transportation Council Scenario Planning Workshop : Sponsored by the Federal Highway Administration

DOT National Transportation Integrated Search

2016-04-01

This report summarizes noteworthy practices and key recommendations shared during a scenario planning workshop, hosted by the Greater Buffalo-Niagara Regional Transportation Council, on April 19-20, 2016, in Buffalo, New York. The Federal Highway Adm...

Hypothermia in a Rural Setting: An Emergency Medicine Simulation Scenario

PubMed Central

Jong, Robert; Heroux, Aron; Dubrowski, Adam

2017-01-01

Patients presenting with hypothermia in a rural emergency department can be quite challenging to manage without significant mortality and morbidity. Standard medical school curricula do not fully prepare trainees for the unique aspects of practice in northern rural and remote communities. Training opportunities on site may provide a solution to this lack of experience. However, these communities often have limited simulation-based resources and expertise for conducting and developing simulation scenarios. In this technical report, we outline a hypothermia simulation that utilizes only basic resources and is, thus, practical for rural and remote facilities. The aim of this report is to better equip trainees, clinicians, and emergency department staff who may encounter such a scenario in their practice. While the simulation is specifically designed for medical students, resident doctors, and emergency department staff, it could also be applicable in other low-resource settings, such as military bases, search and rescue stations, and arctic travel and tourism infirmaries. PMID:29511605

Tree cover in Central Africa: determinants and sensitivity under contrasted scenarios of global change

PubMed Central

Aleman, Julie C.; Blarquez, Olivier; Gourlet-Fleury, Sylvie; Bremond, Laurent; Favier, Charly

2017-01-01

Tree cover is a key variable for ecosystem functioning, and is widely used to study tropical ecosystems. But its determinants and their relative importance are still a matter of debate, especially because most regional and global analyses have not considered the influence of agricultural practices. More information is urgently needed regarding how human practices influence vegetation structure. Here we focused in Central Africa, a region still subjected to traditional agricultural practices with a clear vegetation gradient. Using remote sensing data and global databases, we calibrated a Random Forest model to correlatively link tree cover with climatic, edaphic, fire and agricultural practices data. We showed that annual rainfall and accumulated water deficit were the main drivers of the distribution of tree cover and vegetation classes (defined by the modes of tree cover density), but agricultural practices, especially pastoralism, were also important in determining tree cover. We simulated future tree cover with our model using different scenarios of climate and land-use (agriculture and population) changes. Our simulations suggest that tree cover may respond differently regarding the type of scenarios, but land-use change was an important driver of vegetation change even able to counterbalance the effect of climate change in Central Africa. PMID:28134259

Women, family medicine, and career choice: An opportunity cost analysis.

PubMed

Essary, Alison C; Coplan, Bettie H; Cawley, James F; Schneller, Eugene S; Ohsfeldt, Robert L

2016-09-01

This study compared the cost of physician versus physician assistant (PA) education for women practicing in family medicine. Using 2013 salary survey data from both the Medical Group Management Association and the American Academy of PAs as well as other publicly available data sources, the authors compared the current net present value (NPV) of physician and PA training for women practicing in family medicine. Considering a base case scenario involving a 24-year-old woman, the NPV to become a family medicine physician was $2,015,000 compared with an NPV of $1,751,000 to become a family medicine PA. Alternative projections produced an NPV for PA training that slightly exceeded the NPV for family medicine physician training. For a woman practicing in family medicine, becoming a physician or a PA offers similar financial rewards.

Security Analysis of Selected AMI Failure Scenarios Using Agent Based Game Theoretic Simulation

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

Abercrombie, Robert K; Schlicher, Bob G; Sheldon, Frederick T

Information security analysis can be performed using game theory implemented in dynamic Agent Based Game Theoretic (ABGT) simulations. Such simulations can be verified with the results from game theory analysis and further used to explore larger scale, real world scenarios involving multiple attackers, defenders, and information assets. We concentrated our analysis on the Advanced Metering Infrastructure (AMI) functional domain which the National Electric Sector Cyber security Organization Resource (NESCOR) working group has currently documented 29 failure scenarios. The strategy for the game was developed by analyzing five electric sector representative failure scenarios contained in the AMI functional domain. From thesemore » five selected scenarios, we characterize them into three specific threat categories affecting confidentiality, integrity and availability (CIA). The analysis using our ABGT simulation demonstrates how to model the AMI functional domain using a set of rationalized game theoretic rules decomposed from the failure scenarios in terms of how those scenarios might impact the AMI network with respect to CIA.« less

From scenarios to domain models: processes and representations

NASA Astrophysics Data System (ADS)

Haddock, Gail; Harbison, Karan

1994-03-01

The domain specific software architectures (DSSA) community has defined a philosophy for the development of complex systems. This philosophy improves productivity and efficiency by increasing the user's role in the definition of requirements, increasing the systems engineer's role in the reuse of components, and decreasing the software engineer's role to the development of new components and component modifications only. The scenario-based engineering process (SEP), the first instantiation of the DSSA philosophy, has been adopted by the next generation controller project. It is also the chosen methodology of the trauma care information management system project, and the surrogate semi-autonomous vehicle project. SEP uses scenarios from the user to create domain models and define the system's requirements. Domain knowledge is obtained from a variety of sources including experts, documents, and videos. This knowledge is analyzed using three techniques: scenario analysis, task analysis, and object-oriented analysis. Scenario analysis results in formal representations of selected scenarios. Task analysis of the scenario representations results in descriptions of tasks necessary for object-oriented analysis and also subtasks necessary for functional system analysis. Object-oriented analysis of task descriptions produces domain models and system requirements. This paper examines the representations that support the DSSA philosophy, including reference requirements, reference architectures, and domain models. The processes used to create and use the representations are explained through use of the scenario-based engineering process. Selected examples are taken from the next generation controller project.

Preservice Science Teachers' Informal Reasoning about Socioscientific Issues: The influence of issue context

NASA Astrophysics Data System (ADS)

Sami Topcu, Mustafa; Sadler, Troy D.; Yilmaz-Tuzun, Ozgul

2010-12-01

The purpose of the current study is to explicitly test the extent to which issue contexts affect the informal reasoning processes engaged in by individuals. In order to address the research question framing this study, we engaged 39 Turkish preservice science teachers (PSTs) in interviews designed to elicit argumentation related to multiple socioscientific scenarios. Three scenarios related to gene therapy, another three related to human cloning, and the final scenario related to global warming. The data were analyzed using an interpretive qualitative research approach. Our work builds on a framework initially proposed by Toulmin in 1958. This study has provided new evidence related to informal reasoning in the context of socioscientific issues (SSI). At the sample level, there was strong consistency in informal reasoning quality among varying socioscientific scenarios. However, finer-grained analyses indicated a greater level of variability in the informal reasoning practices of individual PSTs. These results support previous conclusions that suggest context dependence for informal reasoning related to SSI. This study provides an initial picture of the reasoning practices of preservice teachers as opposed to science learners. The results indicate that teachers, at least those in this Turkish setting, would benefit from learning experiences that support their own informal reasoning practices as well as their ability to foster development of these practices among their students. We encourage the field to continue the investigation of SSI as contexts for education particularly as it relates to the education of teachers.

Non-invasive prenatal testing for single gene disorders: exploring the ethics.

PubMed

Deans, Zuzana; Hill, Melissa; Chitty, Lyn S; Lewis, Celine

2013-07-01

Non-invasive prenatal testing for single gene disorders is now clearly on the horizon. This new technology offers obvious clinical benefits such as safe testing early in pregnancy. Before widespread implementation, it is important to consider the possible ethical implications. Four hypothetical scenarios are presented that highlight how ethical ideals of respect for autonomy, privacy and fairness may come into play when offering non-invasive prenatal testing for single gene disorders. The first scenario illustrates the moral case for using these tests for 'information only', identifying a potential conflict between larger numbers of women seeking the benefits of the test and the wider social impact of funding tests that do not offer immediate clinical benefit. The second scenario shows how the simplicity and safety of non-invasive prenatal testing could lead to more autonomous decision-making and, conversely, how this could also lead to increased pressure on women to take up testing. In the third scenario we show how, unless strong safeguards are put in place, offering non-invasive prenatal testing could be subject to routinisation with informed consent undermined and that woman who are newly diagnosed as carriers may be particularly vulnerable. The final scenario introduces the possibility of a conflict of the moral rights of a woman and her partner through testing for single gene disorders. This analysis informs our understanding of the potential impacts of non-invasive prenatal testing for single gene disorders on clinical practice and has implications for future policy and guidelines for prenatal care.

Optimizing Environmental Flow Operation Rules based on Explicit IHA Constraints

NASA Astrophysics Data System (ADS)

Dongnan, L.; Wan, W.; Zhao, J.

2017-12-01

Multi-objective operation of reservoirs are increasingly asked to consider the environmental flow to support ecosystem health. Indicators of Hydrologic Alteration (IHA) is widely used to describe environmental flow regimes, but few studies have explicitly formulated it into optimization models and thus is difficult to direct reservoir release. In an attempt to incorporate the benefit of environmental flow into economic achievement, a two-objective reservoir optimization model is developed and all 33 hydrologic parameters of IHA are explicitly formulated into constraints. The benefit of economic is defined by Hydropower Production (HP) while the benefit of environmental flow is transformed into Eco-Index (EI) that combined 5 of the 33 IHA parameters chosen by principal component analysis method. Five scenarios (A to E) with different constraints are tested and solved by nonlinear programming. The case study of Jing Hong reservoir, located in the upstream of Mekong basin, China, shows: 1. A Pareto frontier is formed by maximizing on only HP objective in scenario A and on only EI objective in scenario B. 2. Scenario D using IHA parameters as constraints obtains the optimal benefits of both economic and ecological. 3. A sensitive weight coefficient is found in scenario E, but the trade-offs between HP and EI objectives are not within the Pareto frontier. 4. When the fraction of reservoir utilizable capacity reaches 0.8, both HP and EI capture acceptable values. At last, to make this modelmore conveniently applied to everyday practice, a simplified operation rule curve is extracted.

Virtual Physical Therapy Clinician: Development, Validation and Testing

ERIC Educational Resources Information Center

Huhn, Karen

2011-01-01

Introduction: Clinical reasoning skills develop through repeated practice in realistic patient scenarios. Time constraints, declining availability of clinical education sites and patient safety are some of the factors that limit physical therapy educators' ability to expose students to realistic patient scenarios. Computerized simulations may be…

State of practice and emerging application of analytical techniques of nuclear forensic analysis: highlights from the 4th Collaborative Materials Exercise of the Nuclear Forensics International Technical Working Group (ITWG)

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

Schwantes, Jon M.; Marsden, Oliva; Pellegrini, Kristi L.

Founded in 1996 upon the initiative of the “Group of 8” governments (G8), the Nuclear Forensics International Technical Working Group (ITWG) is an ad hoc organization of official nuclear forensics practitioners (scientists, law enforcement, and regulators) that can be called upon to provide technical assistance to the global community in the event of a seizure of nuclear or radiological materials. The ITWG is supported by and is affiliated with roughly 40 countries and international partner organizations including the International Atomic Energy Agency (IAEA), EURATOM, INTERPOL, EUROPOL, and the United Nations Interregional Crime and Justice Research Institute (UNICRI). Besides providing amore » network of nuclear forensics laboratories that are able to assist law enforcement during a nuclear smuggling event, the ITWG is also committed to the advancement of the science of nuclear forensic analysis, largely through participation in periodic table top and Collaborative Materials Exercises (CMXs). Exercise scenarios use “real world” samples with realistic forensics investigation time constraints and reporting requirements. These exercises are designed to promote best practices in the field and test, evaluate, and improve new technical capabilities, methods and techniques in order to advance the science of nuclear forensics. The ITWG recently completed its fourth CMX in the 20 year history of the organization. This was also the largest materials exercise to date, with participating laboratories from 16 countries or organizations. Three samples of low enriched uranium were shipped to these laboratories as part of an illicit trafficking scenario, for which each laboratory was asked to conduct nuclear forensic analyses in support of a fictitious criminal investigation. An objective review of the State Of Practice and Art of international nuclear forensic analysis based upon the outcome of this most recent exercise is provided.« less

Impact of Spatial Scales on the Intercomparison of Climate Scenarios

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

Luo, Wei; Steptoe, Michael; Chang, Zheng

2017-01-01

Scenario analysis has been widely applied in climate science to understand the impact of climate change on the future human environment, but intercomparison and similarity analysis of different climate scenarios based on multiple simulation runs remain challenging. Although spatial heterogeneity plays a key role in modeling climate and human systems, little research has been performed to understand the impact of spatial variations and scales on similarity analysis of climate scenarios. To address this issue, the authors developed a geovisual analytics framework that lets users perform similarity analysis of climate scenarios from the Global Change Assessment Model (GCAM) using a hierarchicalmore » clustering approach.« less

Fuzzy logic based sensor performance evaluation of vehicle mounted metal detector systems

NASA Astrophysics Data System (ADS)

Abeynayake, Canicious; Tran, Minh D.

2015-05-01

Vehicle Mounted Metal Detector (VMMD) systems are widely used for detection of threat objects in humanitarian demining and military route clearance scenarios. Due to the diverse nature of such operational conditions, operational use of VMMD without a proper understanding of its capability boundaries may lead to heavy causalities. Multi-criteria fitness evaluations are crucial for determining capability boundaries of any sensor-based demining equipment. Evaluation of sensor based military equipment is a multi-disciplinary topic combining the efforts of researchers, operators, managers and commanders having different professional backgrounds and knowledge profiles. Information acquired through field tests usually involves uncertainty, vagueness and imprecision due to variations in test and evaluation conditions during a single test or series of tests. This report presents a fuzzy logic based methodology for experimental data analysis and performance evaluation of VMMD. This data evaluation methodology has been developed to evaluate sensor performance by consolidating expert knowledge with experimental data. A case study is presented by implementing the proposed data analysis framework in a VMMD evaluation scenario. The results of this analysis confirm accuracy, practicability and reliability of the fuzzy logic based sensor performance evaluation framework.

Active euthanasia and assisted suicide: a perspective from an American abortion and Dutch euthanasia scenario.

PubMed

Musgrave, C F

1998-10-01

To discuss the critical issues involved in the legalization of active euthanasia and physician-assisted suicide. Nursing, medical, legal, and ethics literature; newspaper articles; book chapters. The major terms employed in the discussion of active euthanasia and physician-assisted suicide are defined. The implications of the recent Supreme Court decision on these practices are outlined. The Dutch euthanasia and the American abortion scenarios are used as models for the interpretation of the effects of future legislation on such practices. Oncology nurses need to be cognizant of the crucial issues involved in the practices of active euthanasia and physician-assisted suicide and determine their philosophical stance regarding the practices. If active euthanasia and physician-assisted suicide practices are legalized, oncology nurses will have to make decisions about their desired degree of involvement in acts that will end their patients' lives.

Seismic Hazard Analysis — Quo vadis?

NASA Astrophysics Data System (ADS)

Klügel, Jens-Uwe

2008-05-01

The paper is dedicated to the review of methods of seismic hazard analysis currently in use, analyzing the strengths and weaknesses of different approaches. The review is performed from the perspective of a user of the results of seismic hazard analysis for different applications such as the design of critical and general (non-critical) civil infrastructures, technical and financial risk analysis. A set of criteria is developed for and applied to an objective assessment of the capabilities of different analysis methods. It is demonstrated that traditional probabilistic seismic hazard analysis (PSHA) methods have significant deficiencies, thus limiting their practical applications. These deficiencies have their roots in the use of inadequate probabilistic models and insufficient understanding of modern concepts of risk analysis, as have been revealed in some recent large scale studies. These deficiencies result in the lack of ability of a correct treatment of dependencies between physical parameters and finally, in an incorrect treatment of uncertainties. As a consequence, results of PSHA studies have been found to be unrealistic in comparison with empirical information from the real world. The attempt to compensate these problems by a systematic use of expert elicitation has, so far, not resulted in any improvement of the situation. It is also shown that scenario-earthquakes developed by disaggregation from the results of a traditional PSHA may not be conservative with respect to energy conservation and should not be used for the design of critical infrastructures without validation. Because the assessment of technical as well as of financial risks associated with potential damages of earthquakes need a risk analysis, current method is based on a probabilistic approach with its unsolved deficiencies. Traditional deterministic or scenario-based seismic hazard analysis methods provide a reliable and in general robust design basis for applications such as the design of critical infrastructures, especially with systematic sensitivity analyses based on validated phenomenological models. Deterministic seismic hazard analysis incorporates uncertainties in the safety factors. These factors are derived from experience as well as from expert judgment. Deterministic methods associated with high safety factors may lead to too conservative results, especially if applied for generally short-lived civil structures. Scenarios used in deterministic seismic hazard analysis have a clear physical basis. They are related to seismic sources discovered by geological, geomorphologic, geodetic and seismological investigations or derived from historical references. Scenario-based methods can be expanded for risk analysis applications with an extended data analysis providing the frequency of seismic events. Such an extension provides a better informed risk model that is suitable for risk-informed decision making.

Training of neonatal cardiopulmonary resuscitation instructors.

PubMed

Wada, Masaki; Tamura, Masanori

2015-08-01

The Consensus on Science and Treatment Recommendations 2010 supported simulation-based training for education in resuscitation. This approach has been introduced into neonatal cardiopulmonary resuscitation (NCPR) courses in Japan, but no method for teaching instructors has been established. We developed a course for training instructors of NCPR, with inclusion of an instruction practice program. The goal of the study was to evaluate the performance of instructors who completed the course. Based on problems in the conventional instructor training course (old course 1), we developed and implemented a new course. Persons who had completed an NCPR course took the new course after developing two resuscitation scenarios. The new course included lectures and instruction practice, in which participants provided instruction using these scenarios. Instruction by participants was evaluated, and knowledge, opinions and satisfaction were examined by questionnaire after the course. Activity of the participants as instructors for 6 months after certification was also evaluated. The performance of trained instructors was compared between the old and new courses. Of 143 participants in the new course, > 90% had confidence to teach NCPR, while only 50-60% of the 89 participants in the old course indicated that they could instruct on resuscitation procedures and practice (P < 0.001). All participants in the new course recognized the value of scenario practice and all were glad they had taken the course. For 6 months after certification, significantly more participants who had done the new course worked as instructors compared with those who had done the old course (60% vs 34%, P < 0.001). This is the first trial of a resuscitation training course using scenarios that participants developed themselves. A new course including instruction practice for training NCPR instructors was effective for improving instructor performance. © 2015 Japan Pediatric Society.

Automated Scenario Generation: Toward Tailored and Optimized Military Training in Virtual Environments

DTIC Science & Technology

2012-01-01

us.army.mil ABSTRACT Scenario-based training exemplifies the learning-by-doing approach to human performance improvement. In this paper , we enumerate...through a narrative, mission, quest, or scenario. In this paper we argue for a combinatorial optimization search approach to selecting and ordering...the role of an expert for the purposes of practicing skills and knowledge in realistic situations in a learning-by-doing approach to performance

Cost-benefit analysis of riparian protection in an eastern Canadian watershed.

PubMed

Trenholm, Ryan; Lantz, Van; Martínez-Espiñeira, Roberto; Little, Shawn

2013-02-15

Forested riparian buffers have proved to be an effective management practice that helps maintain ecological goods and services in watersheds. In this study, we assessed the non-market benefits and opportunity costs associated with implementing these buffers in an eastern Canadian watershed using contingent valuation and wood supply modeling methods, respectively. A number of buffer scenarios were considered, including 30 and 60 m buffers on woodlots and on all land (including woodlots, agricultural, and residential lands) in the watershed. Household annual WTP estimates ranged from -$6.80 to $42.85, and total present value benefits ranged from -$11.7 to $121.7 million (CDN 2007), depending on the buffer scenario, affected population, time horizon, and econometric modeling assumptions considered. Opportunity cost estimates range from $1.3 to $10.4 million in present value terms, depending on silvicultural and agriculture land rental rate assumptions. Overall, we found that the net present value of riparian buffers was positive for the majority of scenarios and assumptions. Some exceptions were found under more conservative benefit, and higher unit cost, assumptions. These results provide decision makers with data on stated benefits and opportunity costs of riparian buffers, as well as insight into the importance of modeling assumptions when using this framework of analysis. Copyright © 2012 Elsevier Ltd. All rights reserved.

Desktop microsimulation: a tool to improve efficiency in the medical office practice.

PubMed

Montgomery, James B; Linville, Beth A; Slonim, Anthony D

2013-01-01

Because the economic crisis in the United States continues to have an impact on healthcare organizations, industry leaders must optimize their decision making. Discrete-event computer simulation is a quality tool with a demonstrated track record of improving the precision of analysis for process redesign. However, the use of simulation to consolidate practices and design efficiencies into an unfinished medical office building was a unique task. A discrete-event computer simulation package was used to model the operations and forecast future results for four orthopedic surgery practices. The scenarios were created to allow an evaluation of the impact of process change on the output variables of exam room utilization, patient queue size, and staff utilization. The model helped with decisions regarding space allocation and efficient exam room use by demonstrating the impact of process changes in patient queues at check-in/out, x-ray, and cast room locations when compared to the status quo model. The analysis impacted decisions on facility layout, patient flow, and staff functions in this newly consolidated practice. Simulation was found to be a useful tool for process redesign and decision making even prior to building occupancy. © 2011 National Association for Healthcare Quality.

Nurses' scope of practice and the implication for quality nursing care.

PubMed

Lubbe, J C Irene; Roets, Lizeth

2014-01-01

This article provides an overview of the implications for patients' health status and care needs when assessments are performed by nurses not licensed or competent to perform this task. The Waterlow scale (Judy Waterlow, The Nook, Stroke Road, Henlade, TAUNTON, TA3 5LX) scenario is used as a practice example to illustrate this case. The international nursing regulatory bodies, in South Africa called the South African Nursing Council, set the scope of practice wherein nurses are allowed to practice. Different categories of nurses are allowed to practice according to specified competencies, in alignment with their scope of practice. A retrospective quantitative study was utilized. A checklist was used to perform an audit on a random sample of 157 out of an accessible population of 849 patient files. Data were gathered in May 2012, and the analysis was done using frequencies and percentages for categorical data. Reliability and validity were ensured, and all ethical principles were adhered to. Eighty percent of risk assessments were performed by nurses not licensed or enrolled to perform this task unsupervised. Areas such as tissue malnutrition, neurological deficits, and medication were inaccurately scored, resulting in 50% of the Waterlow risk-assessment scales, as an example, being incorrectly interpreted. This has implications for quality nursing care and might put the patient and the institution at risk. Lower-category nurses and student nurses should be allowed to perform only tasks within their scope of practice for which they are licensed or enrolled. Nurses with limited formal theoretical training are not adequately prepared to perform tasks unsupervised, even in the current global nursing shortage scenario. To optimize and ensure safe and quality patient care, risk assessments should be done by a registered professional nurse, who will then coordinate the nursing care of the patient with the assistance of the lower category of nurses. © 2013 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.

Applying Qualitative Hazard Analysis to Support Quantitative Safety Analysis for Proposed Reduced Wake Separation Conops

NASA Technical Reports Server (NTRS)

Shortle, John F.; Allocco, Michael

2005-01-01

This paper describes a scenario-driven hazard analysis process to identify, eliminate, and control safety-related risks. Within this process, we develop selective criteria to determine the applicability of applying engineering modeling to hypothesized hazard scenarios. This provides a basis for evaluating and prioritizing the scenarios as candidates for further quantitative analysis. We have applied this methodology to proposed concepts of operations for reduced wake separation for closely spaced parallel runways. For arrivals, the process identified 43 core hazard scenarios. Of these, we classified 12 as appropriate for further quantitative modeling, 24 that should be mitigated through controls, recommendations, and / or procedures (that is, scenarios not appropriate for quantitative modeling), and 7 that have the lowest priority for further analysis.

Incorporating Agricultural Management Practices into the Assessment of Soil Carbon Change and Life-Cycle Greenhouse Gas Emissions of Corn Stover Ethanol Production

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

Qin, Zhangcai; Canter, Christina E.; Dunn, Jennifer B.

Land management practices such as cover crop adoption or manure application that can increase soil organic carbon (SOC) may provide a way to counter SOC loss upon removal of stover from corn fields for use as a biofuel feedstock. This report documents the data, methodology, and assumptions behind the incorporation of land management practices into corn-soybean systems that dominate U.S. grain production using varying levels of stover removal in the GREETTM (Greenhouse gases, Regulated Emissions, and Energy use in Transportation) model and its CCLUB (Carbon Calculator for Land Use change from Biofuels production) module. Tillage (i.e., conventional, reduced and nomore » tillage), corn stover removal (i.e., at 0, 30% and 60% removal rate), and organic matter input techniques (i.e., cover crop and manure application) are included in the analysis as major land management practices. Soil carbon changes associated with land management changes were modeled with a surrogate CENTURY model. The resulting SOC changes were incorporated into CCLUB while GREET was expanded to include energy and material consumption associated with cover crop adoption and manure application. Life-cycle greenhouse gas (GHG) emissions of stover ethanol were estimated using a marginal approach (all burdens and benefits assigned to corn stover ethanol) and an energy allocation approach (burdens and benefits divided between grain and stover ethanol). In the latter case, we considered corn grain and corn stover ethanol to be produced at an integrated facility. Life-cycle GHG emissions of corn stover ethanol are dependent upon the analysis approach selected (marginal versus allocation) and the land management techniques applied. The expansion of CCLUB and GREET to accommodate land management techniques can produce a wide range of results because users can select from multiple scenario options such as choosing tillage levels, stover removal rates, and whether crop yields increase annually or remain constant. In a scenario with conventional tillage and a 30% stover removal rate, life-cycle GHG emissions for a combined gallon of corn grain and stover ethanol without cover crop adoption or manure application are 49 g CO2eq MJ-1, in comparison with 91 g CO2eq MJ-1 for petroleum gasoline. Adopting a cover crop or applying manure reduces the former ethanol life-cycle GHG emissions by 8% and 10%, respectively. We considered two different life cycle analysis approaches to develop estimates of life-cycle GHG emissions for corn stover ethanol, marginal analysis and energy allocation. In the same scenario, this fuel has GHG emissions of 12 – 20 g CO2eq MJ-1 (for manure and cover crop application, respectively) and 45 – 48 g CO2eq MJ-1 with the marginal approach and the energy allocation approach, respectively.« less

Determination of the potential implementation impact of 2016 ministry of environmental protection generic assessment criteria for potentially contaminated sites in China.

PubMed

Cheng, Yuanyuan; Tang, Yu-Ting; Nathanail, C Paul

2017-04-12

The Ministry of Environmental Protection of China issued a 3rd draft edition of risk-based Generic Assessment Criteria (the MEP-GAC) in March 2016. Since these will be the first authoritative GAC in China, their implementation is likely to have a significant impact on China's growing contaminated land management sector. This study aims to determine the potential implementation impact of the MEP-GAC through an in-depth analysis of the management context, land use scenarios, health criteria values adopted and exposure pathways considered. The MEP-GAC have been proposed for two broad categories of land use scenarios for contaminated land risk assessment, and these two categories of land use scenarios need to be further delved, and a MEP-GAC for Chinese cultivated land scenario ought to be developed, to ensure human health protection of Chinese farmers. The MEP-GAC have adopted 10 -6 as the acceptable lifetime cancer risk, given the widespread extent and severe level of land contamination in China, consideration should be given to the decision on excess lifetime cancer risk of 10 -5 . During risk assessment process in practice, it is better to review the 20% TDI against local circumstances to determine their suitability before adopting it. The MEP-GAC are based on a SOM value of 1%, for regions with particularly high SOM, it might be necessary to develop regional GAC, due to SOM's significant impact on the GAC developed. An authoritative risk assessment model developed based on HJ25.3-2014 would help facilitate the DQRA process in practice. The MEP-GAC could better reflect the likely exposures of China's citizens due to vapour inhalation by using characteristics of Chinese exposure scenarios, including China-generic building stock, as inputs into the Johnson and Ettinger model as opposed to adoption of the US EPA parameters. The MEP-GAC once implemented will set the trajectory for the development of the investigation, assessment and remediation of land contamination for years.

Improving educational environment in medical colleges through transactional analysis practice of teachers.

PubMed

Rajan, Marina; Chacko, Thomas

2012-01-01

 A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to improve faculty awareness resulting in changed teaching practices and better teacher student relationships using Transactional Analysis (TA). Practicing TA tools help development of 'awareness' about intrapersonal and interpersonal processes. To improve self-awareness among medical educators.To bring about self-directed change in practices among medical educators.To assess usefulness of TA tools for the same.  An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported improvement in awareness and changes in practices were assessed immediately after, at three months, and one year after training.  The mean improvement in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in practices within a year include, collecting feedback, new teaching styles and better relationship with students.  These findings demonstrate sustainable and measurable improvement in self-awareness by practice of TA tools. Improvement in self-'awareness' of faculty resulted in self-directed changes in teaching practices. Medical faculty has judged the TA tools effective for improving self-awareness leading to self-directed changes.

Improving educational environment in medical colleges through transactional analysis practice of teachers

PubMed Central

Rajan, Marina

2012-01-01

Context: A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to improve faculty awareness resulting in changed teaching practices and better teacher student relationships using Transactional Analysis (TA). Practicing TA tools help development of ‘awareness’ about intrapersonal and interpersonal processes. Objectives: To improve self-awareness among medical educators.To bring about self-directed change in practices among medical educators.To assess usefulness of TA tools for the same. Methods: An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported improvement in awareness and changes in practices were assessed immediately after, at three months, and one year after training. Findings: The mean improvement in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in practices within a year include, collecting feedback, new teaching styles and better relationship with students. Discussion and Conclusions: These findings demonstrate sustainable and measurable improvement in self-awareness by practice of TA tools. Improvement in self-'awareness' of faculty resulted in self-directed changes in teaching practices. Medical faculty has judged the TA tools effective for improving self-awareness leading to self-directed changes. PMID:24358808

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

Aden, Nathaniel T.; Zheng, Nina; Fridley, David G.

Urbanization has re-shaped China's economy, society, and energy system. Between 1990 and 2007 China added 290 million new urban residents, bringing the total urbanization rate to 45%. This population adjustment spurred energy demand for construction of new buildings and infrastructure, as well as additional residential use as rural biomass was replaced with urban commercial energy services. Primary energy demand grew at an average annual rate of 10% between 2000 and 2007. Urbanization's effect on energy demand was compounded by the boom in domestic infrastructure investment, and in the export trade following World Trade Organization (WTO) accession in 2001. Industry energymore » consumption was most directly affected by this acceleration. Whereas industry comprised 32% of 2007 U.S. energy use, it accounted for 75% of China's 2007 energy consumption. Five sub-sectors accounted for 78% of China's industry energy use in 2007: iron and steel, energy extraction and processing, chemicals, cement, and non-ferrous metals. Ferrous metals alone accounted for 25% of industry and 18% of total primary energy use. The rapid growth of heavy industry has led China to become by far the world's largest producer of steel, cement, aluminum, and other energy-intensive commodities. However, the energy efficiency of heavy industrial production continues to lag world best practice levels. This study uses scenario analysis to quantify the impact of urbanization and trade on industrial and residential energy consumption from 2000 to 2025. The BAU scenario assumed 67% urbanization, frozen export amounts of heavy industrial products, and achievement of world best practices by 2025. The China Lightens Up (CLU) scenario assumed 55% urbanization, zero net exports of heavy industrial products, and more aggressive efficiency improvements by 2025. The five dominant industry sub-sectors were modeled in both scenarios using a LEAP energy end-use accounting model. The results of this study show that a CLU-style development path would avoid 430 million tonnes coal-equivalent energy use by 2025. More than 60% of these energy savings would come from reduced activity and production levels. In carbon terms, this would amount to more than a billion-tonne reduction of energy-related carbon emissions compared with the BAU scenario in 2025, though the absolute level of emissions rises in both scenarios. Aside from the energy and carbon savings related to CLU scenario development, this study showed impending saturation effects in commercial construction, urban appliance ownership, and fertilizer application. The implication of these findings is that urbanization will have a direct impact on future energy use and emissions - policies to guide urban growth can play a central role in China's efforts to mitigate emissions growth.« less

Analysis of the efficacy and cost-effectiveness of best management practices for controlling sediment yield: A case study of the Joumine watershed, Tunisia.

PubMed

Mtibaa, Slim; Hotta, Norifumi; Irie, Mitsuteru

2018-03-01

Soil erosion can be reduced through the strategic selection and placement of best management practices (BMPs) in critical source areas (CSAs). In the present study, the Soil Water Assessment Tool (SWAT) model was used to identify CSAs and investigate the effectiveness of different BMPs in reducing sediment yield in the Joumine watershed, an agricultural river catchment located in northern Tunisia. A cost-benefit analysis (CBA) was used to evaluate the cost-effectiveness of different BMP scenarios. The objective of the present study was to determine the most cost-effective management scenario for controlling sediment yield. The model performance for the simulation of streamflow and sediment yield at the outlet of the Joumine watershed was good and satisfactory, respectively. The model indicated that most of the sediment was originated from the cultivated upland area. About 34% of the catchment area consisted of CSAs that were affected by high to very high soil erosion risk (sediment yield >10t/ha/year). Contour ridges were found to be the most effective individual BMP in terms of sediment yield reduction. At the watershed level, implementing contour ridges in the CSAs reduced sediment yield by 59%. Combinations of BMP scenarios were more cost-effective than the contour ridges alone. Combining buffer strips (5-m width) with other BMPs depending on land slope (> 20% slope: conversion to olive orchards; 10-20% slope: contour ridges; 5-10% slope: grass strip cropping) was the most effective approach in terms of sediment yield reduction and economic benefits. This approach reduced sediment yield by 61.84% with a benefit/cost ratio of 1.61. Compared with the cost of dredging, BMPs were more cost-effective for reducing sediment loads to the Joumine reservoir, located downstream of the catchment. Our findings may contribute to ensure the sustainability of future conservation programs in Tunisian regions. Copyright © 2017 Elsevier B.V. All rights reserved.

DIY Solar Market Analysis Webinar Series: Community Solar Scenario Tool |

Science.gov Websites

State, Local, and Tribal Governments | NREL Webinar Series: Community Solar Scenario Tool DIY Solar Market Analysis Webinar Series: Community Solar Scenario Tool Wednesday, August 13, 2014 As part ) presented a live webinar titled, "Community Solar Scenario Tool: Planning for a fruitful solar garden

Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.

PubMed

Wan, Xiang; Wang, Wenqian; Liu, Jiming; Tong, Tiejun

2014-12-19

In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.'s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations.

Water Quantity and Water Quality Impacts of Intensive Woody Biomass Feedstock Production in the Southeastern US.

NASA Astrophysics Data System (ADS)

Bitew, M. M.; Jackson, C. R.; Vache, K. B.; Griffiths, N.; Starr, G.; McDonnell, J.; Rau, B.; Younger, S. E.; Fouts, K.

2016-12-01

Intensively managed loblolly pine is a candidate species for biofuel feedstock production in the southeastern Coastal Plain of the United States. However, the water quantity and quality effects of high intensity, short-rotation silviculture are largely unknown. Here we evaluate the potential hydrologic and water quality impacts of biofuel-induced land use changes based on model scenarios developed using existing forest BMPs and industry wide experiences. We quantified the effect of bio-energy production scenarios on each of water the balance components by applying an integrated physically based distributed watershed modeling system, and multi-objective assessment functions that accurately describes the flow regimes, water quality, and isotopic observations from three experimental headwater watersheds of Fourmile Creek at Savannah River Site, SC. The model incorporates optimized travel times of groundwater flowpaths and flow control processes in the riparian region allowing water quality analysis of groundwater dominated watershed systems. We compared five different short rotation pine management scenarios ranging from 35 year (low intensity) to 10 year (high intensity) rotations and a mixture of forestry and agriculture/pasture production practices. Simulation results, based on long-term climate records, revealed that complete conversion to short-rotation woody crops would have a negligible effect on water budget components; <2% decrease in streamflow, <1.5% increase in actual evapotranspiration, an average 0.5 m fall in the groundwater table, and no change in subsurface flow due to biofuel production. Simulation results of mixed 50% agriculture and pasture and 50% short-rotation woody crops showed the largest deviation in water budget components compared to the reference condition. Analysis of extreme stream flows showed that the largest effect was observed in the low intensity mixed land use scenario. The smallest effect was in the low intensity biomass production scenario with a 0.5% increase in a 100 year return event.

Increasing Transparency Through a Multiverse Analysis.

PubMed

Steegen, Sara; Tuerlinckx, Francis; Gelman, Andrew; Vanpaemel, Wolf

2016-09-01

Empirical research inevitably includes constructing a data set by processing raw data into a form ready for statistical analysis. Data processing often involves choices among several reasonable options for excluding, transforming, and coding data. We suggest that instead of performing only one analysis, researchers could perform a multiverse analysis, which involves performing all analyses across the whole set of alternatively processed data sets corresponding to a large set of reasonable scenarios. Using an example focusing on the effect of fertility on religiosity and political attitudes, we show that analyzing a single data set can be misleading and propose a multiverse analysis as an alternative practice. A multiverse analysis offers an idea of how much the conclusions change because of arbitrary choices in data construction and gives pointers as to which choices are most consequential in the fragility of the result. © The Author(s) 2016.

Growth of Salmonella and Listeria monocytogenes on fresh-cut cantaloupe under different temperature abuse scenarios

USDA-ARS?s Scientific Manuscript database

Effective cold chain management is a critical component of food safety practice. In this study, we examined the impact of commonly encountered temperature abuse scenarios on the proliferation of Salmonela enterica and Listeria monocytogenes on fresh-cut cantaloupe. During one week of storage, Salmon...

Learning Chinese Formulaic Expressions in a Scenario-Based Interactive Environment

ERIC Educational Resources Information Center

Taguchi, Naoko; Li, Qiong; Tang, Xiaofei

2017-01-01

This study examined the effectiveness and usability of a scenario-based interactive practice in teaching Chinese formulaic expressions. Thirty students enrolled in Chinese classes in a U.S. university interacted with characters in videos featuring scenes recorded in Shanghai. Students were prompted to use formulaic expressions during their…

The Apollo Structured Vocabulary: an OWL2 ontology of phenomena in infectious disease epidemiology and population biology for use in epidemic simulation.

PubMed

Hogan, William R; Wagner, Michael M; Brochhausen, Mathias; Levander, John; Brown, Shawn T; Millett, Nicholas; DePasse, Jay; Hanna, Josh

2016-08-18

We developed the Apollo Structured Vocabulary (Apollo-SV)-an OWL2 ontology of phenomena in infectious disease epidemiology and population biology-as part of a project whose goal is to increase the use of epidemic simulators in public health practice. Apollo-SV defines a terminology for use in simulator configuration. Apollo-SV is the product of an ontological analysis of the domain of infectious disease epidemiology, with particular attention to the inputs and outputs of nine simulators. Apollo-SV contains 802 classes for representing the inputs and outputs of simulators, of which approximately half are new and half are imported from existing ontologies. The most important Apollo-SV class for users of simulators is infectious disease scenario, which is a representation of an ecosystem at simulator time zero that has at least one infection process (a class) affecting at least one population (also a class). Other important classes represent ecosystem elements (e.g., households), ecosystem processes (e.g., infection acquisition and infectious disease), censuses of ecosystem elements (e.g., censuses of populations), and infectious disease control measures. In the larger project, which created an end-user application that can send the same infectious disease scenario to multiple simulators, Apollo-SV serves as the controlled terminology and strongly influences the design of the message syntax used to represent an infectious disease scenario. As we added simulators for different pathogens (e.g., malaria and dengue), the core classes of Apollo-SV have remained stable, suggesting that our conceptualization of the information required by simulators is sound. Despite adhering to the OBO Foundry principle of orthogonality, we could not reuse Infectious Disease Ontology classes as the basis for infectious disease scenarios. We thus defined new classes in Apollo-SV for host, pathogen, infection, infectious disease, colonization, and infection acquisition. Unlike IDO, our ontological analysis extended to existing mathematical models of key biological phenomena studied by infectious disease epidemiology and population biology. Our ontological analysis as expressed in Apollo-SV was instrumental in developing a simulator-independent representation of infectious disease scenarios that can be run on multiple epidemic simulators. Our experience suggests the importance of extending ontological analysis of a domain to include existing mathematical models of the phenomena studied by the domain. Apollo-SV is freely available at: http://purl.obolibrary.org/obo/apollo_sv.owl .

The scenario-based generalization of radiation therapy margins.

PubMed

Fredriksson, Albin; Bokrantz, Rasmus

2016-03-07

We give a scenario-based treatment plan optimization formulation that is equivalent to planning with geometric margins if the scenario doses are calculated using the static dose cloud approximation. If the scenario doses are instead calculated more accurately, then our formulation provides a novel robust planning method that overcomes many of the difficulties associated with previous scenario-based robust planning methods. In particular, our method protects only against uncertainties that can occur in practice, it gives a sharp dose fall-off outside high dose regions, and it avoids underdosage of the target in 'easy' scenarios. The method shares the benefits of the previous scenario-based robust planning methods over geometric margins for applications where the static dose cloud approximation is inaccurate, such as irradiation with few fields and irradiation with ion beams. These properties are demonstrated on a suite of phantom cases planned for treatment with scanned proton beams subject to systematic setup uncertainty.

A White Paper on Global Wheat Health Based on Scenario Development and Analysis.

PubMed

Savary, S; Djurle, A; Yuen, J; Ficke, A; Rossi, V; Esker, P D; Fernandes, J M C; Del Ponte, E M; Kumar, J; Madden, L V; Paul, P; McRoberts, N; Singh, P K; Huber, L; Pope de Vallavielle, C; Saint-Jean, S; Willocquet, L

2017-10-01

Scenario analysis constitutes a useful approach to synthesize knowledge and derive hypotheses in the case of complex systems that are documented with mainly qualitative or very diverse information. In this article, a framework for scenario analysis is designed and then, applied to global wheat health within a timeframe from today to 2050. Scenario analysis entails the choice of settings, the definition of scenarios of change, and the analysis of outcomes of these scenarios in the chosen settings. Three idealized agrosystems, representing a large fraction of the global diversity of wheat-based agrosystems, are considered, which represent the settings of the analysis. Several components of global changes are considered in their consequences on global wheat health: climate change and climate variability, nitrogen fertilizer use, tillage, crop rotation, pesticide use, and the deployment of host plant resistances. Each idealized agrosystem is associated with a scenario of change that considers first, a production situation and its dynamics, and second, the impacts of the evolving production situation on the evolution of crop health. Crop health is represented by six functional groups of wheat pathogens: the pathogens associated with Fusarium head blight; biotrophic fungi, Septoria-like fungi, necrotrophic fungi, soilborne pathogens, and insect-transmitted viruses. The analysis of scenario outcomes is conducted along a risk-analytical pattern, which involves risk probabilities represented by categorized probability levels of disease epidemics, and risk magnitudes represented by categorized levels of crop losses resulting from these levels of epidemics within each production situation. The results from this scenario analysis suggest an overall increase of risk probabilities and magnitudes in the three idealized agrosystems. Changes in risk probability or magnitude however vary with the agrosystem and the functional groups of pathogens. We discuss the effects of global changes on the six functional groups, in terms of their epidemiology and of the crop losses they cause. Scenario analysis enables qualitative analysis of complex systems, such as plant pathosystems that are evolving in response to global changes, including climate change and technology shifts. It also provides a useful framework for quantitative simulation modeling analysis for plant disease epidemiology.

A new scenario-based approach to damage detection using operational modal parameter estimates

NASA Astrophysics Data System (ADS)

Hansen, J. B.; Brincker, R.; López-Aenlle, M.; Overgaard, C. F.; Kloborg, K.

2017-09-01

In this paper a vibration-based damage localization and quantification method, based on natural frequencies and mode shapes, is presented. The proposed technique is inspired by a damage assessment methodology based solely on the sensitivity of mass-normalized experimental determined mode shapes. The present method differs by being based on modal data extracted by means of Operational Modal Analysis (OMA) combined with a reasonable Finite Element (FE) representation of the test structure and implemented in a scenario-based framework. Besides a review of the basic methodology this paper addresses fundamental theoretical as well as practical considerations which are crucial to the applicability of a given vibration-based damage assessment configuration. Lastly, the technique is demonstrated on an experimental test case using automated OMA. Both the numerical study as well as the experimental test case presented in this paper are restricted to perturbations concerning mass change.

Advanced Insider Threat Mitigation Workshop Instructional Materials

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

Gibbs, Philip; Larsen, Robert; O'Brien, Mike

Insiders represent a formidable threat to nuclear facilities. This set of workshop materials covers methodologies to analyze and approaches to mitigate the threat of an insider attempting abrupt and protracted theft of nuclear materials. This particular set of materials is an update of a January 2008 version to add increased emphasis on Material Control and Accounting and its role with respect to protracted insider nuclear material theft scenarios. This report is a compilation of workshop materials consisting of lectures on technical and administrative measures used in Physical Protection (PP) and Material Control and Accounting (MC&A) and methods for analyzing theirmore » effectiveness against a postulated insider threat. The postulated threat includes both abrupt and protracted theft scenarios. Presentation is envisioned to be through classroom instruction and discussion. Several practical and group exercises are included for demonstration and application of the analysis approach contained in the lecture/discussion sessions as applied to a hypothetical nuclear facility.« less

The Productivity and Cost-Efficiency of Models for Involving Nurse Practitioners in Primary Care: A Perspective from Queueing Analysis

PubMed Central

Liu, Nan; D'Aunno, Thomas

2012-01-01

Objective To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. Data Sources and Study Design The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Principal Findings Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. Conclusions The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. PMID:22092009

[Scenario analysis on sustainable development of Sino-Singapore Tianjin Eco-city based on emergy and system dynamics].

PubMed

Li, Chun-fa; Cao, Ying-ying; Yang, Jian-cho; Yang, Qi-qi

2015-08-01

Dynamic evaluation of sustainable development is one of the key fundamental parts of the success of Sino-Singapore Tianjin Eco-city, which is the first eco-city in China constructed by international cooperation. Based on the analysis of nature and economy, function and structure, planning control indices and so on, we constructed a sustainable development evaluation index system and a system dynamics model of Sino-Singapore Tianjin Eco-city to explore dynamic trends of its population, material and currency by comprehensive utilization of emergy analysis and system dynamics method. Five scenarios were set up and simulated, including inertial scenario, scientific and technological scenario, economic scenario, environmental scenario and harmonious development scenario. Then, the sustainability of the 5 scenarios was evaluated and compared. The results showed that in the economy and environment sustainable development scenario, there was a steady growth trend of GDP, accumulation of both emergy and currency, and relatively lower values in emergy waste ratio, emergy ratio of waste, and emergy loading ratio. Although both sustainable evaluation indices, such as ESI and UEI, were relatively low, the economy and environment sustainable development scenario was still the best development scenario which was more active than others.

Las experiencias clinicas de los estudiantes de enfermeria: Estudio de caso hacia la integracion de la mentoria

NASA Astrophysics Data System (ADS)

Rivera Rodriguez, Ivelisse

Clinical experiences are an essential part of the training of future nursing professionals. The period of clinical experience aims to develop in the student the necessary skills to practice as a nursing professional, when the academic program ends. This case study aimed to understand the opinion and explore the perception of faculty, clinical instructors, and nursing students on the meaning, contributions and challenges presented during clinical experiences. Among the themes explored in the focus groups were the meaning and importance to learning about the profession of clinical experiences, teaching strategies used during the practice scenarios, didactic relationships developed among students, clinical instructors, and teachers. The goal was to learn from all participants about what they do, their expectations, and the challenges presented during the clinical experiences. A qualitative, descriptive and contextual research design was followed, which required conducting six focus groups to collect the information from the perspective of all the participants. Faculty, clinical instructors, and nursing students participated each in two focus groups. Collected data were transcribed, coded and analyzed in order to organize it under themes related to the research framework. The qualitative analysis of the focus groups revealed that nursing faculty and clinical instructors perceived clinical experiences as a very important element in the training of nursing students, but that coordination between the academy and practice scenarios is disconnected and needs improvement. They also expressed that they use various learning strategies during the clinical experiences, however, they recognize it needs more structure and suggested mentoring as a strategy to consider. They affirmed that mentoring could contribute positively to enhance the teaching-learning process. Clinical instructors understand they perform mentoring roles, but they would like to have a more defined role and structured process. Nursing students, also, recognized the importance of clinical experiences in their professional training. They expressed the need to improve the communication between the academy and the practice scenarios in order to reduce the levels of anxiety they experience when entering the clinical experiences. Nursing students also expressed the need to consider the use of different teaching strategies, such as mentoring, to improve clinical experiences.

Air Pollutant Emissions Projections for the Cement and Steel Industry in China and the Impact of Emissions Control Technologies

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

Hasanbeigi, Ali; Khanna, Nina; Price, Lynn

China’s cement and steel industry accounts for approximately half of the world’s total cement and steel production. These two industries are two of the most energy-intensive and highest carbon dioxide (CO 2)-emitting industries and two of the key industrial contributors to air pollution in China. For example, the cement industry is the largest source of particulate matter (PM) emissions in China, accounting for 40 percent of its industrial PM emissions and 27 percent of its total national PM emissions. The Chinese steel industry contributed to approximately 20 percent of sulfur dioxide (SO 2) emissions and 27 percent of PM emissionsmore » for all key manufacturing industries in China in 2013. In this study, we analyzed and projected the total PM and SO2 emissions from the Chinese cement and steel industry from 2010–2050 under three different scenarios: a Base Case scenario, an Advanced scenario, and an Advanced EOP (end-of-pipe) scenario. We used bottom-up emissions control technologies data and assumptions to project the emissions. In addition, we conducted an economic analysis to estimate the cost for PM emissions reductions in the Chinese cement industry using EOP control technologies, energy efficiency measures, and product change measures. The results of the emissions projection showed that there is not a substantial difference in PM emissions between the Base Case and Advanced scenarios, for both the cement and steel industries. This is mainly because PM emissions in the cement industry caused mainly by production process and not the fuel use. Since our forecast for the cement production in the Base Case and Advanced scenarios are not too different from each other, this results in only a slight difference in PM emissions forecast for these two scenarios. Also, we assumed a similar share and penetration rate of control technologies from 2010 up to 2050 for these two scenarios for the cement and steel industry. However, the Advanced EOP scenario showed significantly lower PM emissions for the cement industry, reaching to 1.7 million tons of PM in 2050, which is less than half of that in the other two scenarios. The Advanced EOP scenario also has the lowest SO2 emissions for the cement industry in China, reaching to 212,000 tons of SO2 in 2050, which is equal to 40 percent of the SO2 emissions in the Advanced scenario and 30 percent of the emissions in the Base Case scenario. The SO2 emission is mainly caused by fuel (coal) burning in cement kiln or steel processes. For the steel industry, the SO2 emissions of the Advanced EOP scenario are significantly lower than the other scenarios, with emissions declining to 323,000 tons in 2050, which is equal to 21 percent and 17 percent of the emissions of Advanced and Base Case scenarios in 2050, respectively. Results of the economic analysis show that for the Chinese cement industry, end-of-pipe PM control technologies have the lowest abatement cost per ton of PM reduced, followed by product change measures and energy efficiency measures, respectively. In summary, in order to meet Chinese national and regional air quality standards, best practice end-of-pipe emissions control technologies must be installed in both cement and steel industry and it must be supplemented by implementation of energy efficiency technologies and reduction of cement and steel production through structural change in industry.« less

Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance.

PubMed

Louridas, M; Bonrath, E M; Sinclair, D A; Dedy, N J; Grantcharov, T P

2015-01-01

Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario. Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool. An improvement in OSATS (P = 0.003) and BOSATS (P = 0.003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0.011), but not in the conventional group (P = 0.083). No differences in objective or subjective stress levels or non-technical skills were evident. Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Predicting dentists' decisions: a choice-based conjoint analysis of Medicaid participation.

PubMed

Kateeb, Elham T; McKernan, Susan C; Gaeth, Gary J; Kuthy, Raymond A; Adrianse, Nancy B; Damiano, Peter C

2016-06-01

Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program's administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade-offs dentists make when deciding to accept Medicaid patients. An online choice-based conjoint survey was sent to 272 general dentists in Iowa. Hypothetical scenarios presented factors at systematically varied levels. The primary determination was whether dentists would accept a new Medicaid patient in each scenario. Using an ecological model of behavior, determining factors were selected from the categories of policy, administration, community, and patient population to estimate dentists' relative preferences. 62 percent of general dentists responded to the survey. The probability of accepting a new Medicaid patient was highest (81 percent) when reimbursement rates were 85 percent of the dentist's fees, patients never missed appointments, claims were approved on first submission, and no other practices in the area accepted Medicaid. Although dentists preferred higher reimbursement rates, 56 percent would still accept a new Medicaid patient when reimbursement decreased to 55 percent if they were told that the patient would never miss appointments and claims would be approved on initial submission. This study revealed trade-offs that dentists make when deciding to participate in Medicaid. Findings indicate that states can potentially improve Medicaid participation without changing reimbursement rates by making improvements in claims processing and care coordination to reduce missed appointments. © 2015 American Association of Public Health Dentistry.

Using Watershed Models and Human Behavioral Analyses to identify Management Options to Reduce Lake Erie's Harmful Algal Blooms

NASA Astrophysics Data System (ADS)

Martin, J.; Wilson, R. S.; Aloysius, N.; Kalcic, M. M.; Roe, B.; Howard, G.; Irwin, E.; Zhang, W.; Liu, H.

2017-12-01

In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, a key question is what management options should be pursued to reach the 40% reduction. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. This information was then used to guide another round of watershed modeling analysis to evaluate scenarios that represented more realistic scenarios based on potential levels of management adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, and that some of these greater adoption levels are possible based on likely adoption rates. Increasing the perceived efficacy of the practices is one method that will support greater voluntary rates of adoption.

Resistance delaying strategies on UK sheep farms: A cost benefit analysis.

PubMed

Learmount, Jane; Glover, Mike J; Taylor, Mike A

2018-04-30

UK guidelines for the sustainable control of parasites in sheep (SCOPS) were formulated with the primary aim of delaying development of anthelmintic resistance (AR) on UK sheep farms. Promoting their use requires the engagement and commitment of stakeholders. An important driver for behavioural change in sheep farmers is evidence of economic benefits. A recent evaluation of SCOPS guidance in practice demonstrated a significant reduction in anthelmintic use, suggesting economic benefits through a direct reduction in product and labour costs. However, in order to maintain production, a range of alternative control strategies are advised, resulting in additional costs to farmers and so a full cost benefit analysis of best practice management was undertaken. We allocated financial values to the management recommendations described in the SCOPS technical manual. Benefits were calculated using data for production variables and anthelmintic use measured during studies to evaluate the effect of SCOPS recommendations on 16 UK sheep farms and from other published work. As SCOPS control is not prescriptive and a range of different diagnostics are available, best and worst case scenarios were presented, comparing the cheapest methods (e.g. egg counts without larval culture) and management situations (e.g closed flocks not requiring quarantine treatments) with the most laborious and expensive. Simulations were run for farms with a small, medium or large flock (300; 1000; 1900 ewes) as well as comparing scenarios with and without potential production benefits from using effective wormers. Analysis demonstrated a moderate cost for all farms under both scenarios when production benefits were not included. A cost benefit was demonstrated for medium and large farms when production benefits were included and the benefit could be perceived as significant in the case of the large farms for the best case scenario (>£5000 per annum). Despite a significant potential reduction in anthelmintic use by farmers employing SCOPS guidance, the very low price of the older anthelmintic classes meant that the benefit did not always outweigh the additional management/diagnostic costs unless an increase in production was also achieved. This is an important finding. Focussing research on key innovations that will improve the cost effectiveness of diagnostic assays in a diagnostic driven control strategy, as well as designing treatment options that can improve production outcomes, and presenting them in a clear and transparent way, must be high priority goals. Coupling targeted research with improvements in the delivery of messages to the end user is important in the light of increasing global concerns over drug resistance. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Climate sensitivity of DSSAT under different agriculture practice scenarios in China

NASA Astrophysics Data System (ADS)

Xia, L.; Robock, A.

2014-12-01

Crop yields are sensitive to both agricultural practice and climate changes. Under different agricultural practice scenarios, crop yield may have different climate sensitivities. Since it is important to understand how future climate changes affect agriculture productivity and what the potential adaptation strategies would be to compensate for possible negative impacts on crop production, we performed experiments to study climate sensitivity under different agricultural practice scenarios for rice, maize and wheat in the top four production provinces in China using the Decision Support System for Agrotechnology Transfer (DSSAT) crop model. The agricultural practice scenarios include four categories: different amounts of nitrogen fertilizer or no nitrogen stress; irrigation turned on or off, or no water stress; all possible seeds in the DSSAT cultivar data base; and different planting dates. For the climate sensitivity test, the control climate is from 1998 to 2007, and we individually modify four climate variables: daily maximum and minimum temperature by +2 °C and -2 °C, daily precipitation by +20% and -20%, and daily solar radiation by + 20% and -20%. With more nitrogen fertilizer applied, crops are more sensitive to temperature changes as well as precipitation changes because of their release from nitrogen limitation. With irrigation turned on, crop yield sensitivity to temperature decreases in most of the regions depending on the amount of the local precipitation, since more water is available and soil temperature varies less with higher soil moisture. Those results indicate that there could be possible agriculture adaptation strategies under certain future climate scenarios. For example, increasing nitrogen fertilizer usage by a certain amount might compensate for the negative impact on crop yield from climate changes. However, since crops are more sensitive to climate changes when there is more nitrogen fertilizer applied, if the climate changes are unfavorable to crop yields, increasing nitrogen fertilizer usage at certain levels might enhance the negative climate change impact. Enhanced nitrogen fertilizer use might have additional negative impacts on climate because of nitrogen emissions to the atmosphere, but those effects were not studied here.

Business Ethics: Perceptions in a Vocational Development Setting.

ERIC Educational Resources Information Center

Ponthieu, Louis D.; And Others

1993-01-01

Secondary business students (n=341) responded to 19 scenarios of illegal/questionable business practices. Some students do not know what constitutes legal/ethical business practice, would knowingly or unknowingly engage in illegal/unethical practices, and perceive small business owners as less inclined to behave legally/ethically. (SK)

Introduction to Educational Leadership and Organizational Behavior: Theory into Practice. Second Edition

ERIC Educational Resources Information Center

Chance, Patti L.

2009-01-01

Like the bestselling first edition, this introductory textbook succinctly presents concepts and theories of educational leadership and organizational behavior and immediately applies them to problems of practice. It includes practical case studies, real-world scenarios and analyses, reflection questions, and straightforward explanations of…

Impacts of traffic and rainfall characteristics on heavy metals build-up and wash-off from urban roads.

PubMed

Mahbub, Parvez; Ayoko, Godwin A; Goonetilleke, Ashantha; Egodawatta, Prasanna; Kokot, Serge

2010-12-01

An investigation into the effects of changes in urban traffic characteristics due to rapid urbanisation and the predicted changes in rainfall characteristics due to climate change on the build-up and wash-off of heavy metals was carried out in Gold Coast, Australia. The study sites encompassed three different urban land uses. Nine heavy metals commonly associated with traffic emissions were selected. The results were interpreted using multivariate data analysis and decision making tools, such as principal component analysis (PCA), fuzzy clustering (FC), PROMETHEE, and GAIA. Initial analyses established high, low, and moderate traffic scenarios as well as low, low to moderate, moderate, high, and extreme rainfall scenarios for build-up and wash-off investigations. GAIA analyses established that moderate to high traffic scenarios could affect the build-up, while moderate to high rainfall scenarios could affect the wash-off of heavy metals under changed conditions. However, in wash-off, metal concentrations in 1-75 μm fraction were found to be independent of the changes to rainfall characteristics. In build-up, high traffic activities in commercial and industrial areas influenced the accumulation of heavy metal concentrations in particulate size range from 75 - >300 μm, whereas metal concentrations in finer size range of <1-75 μm were not affected. As practical implications, solids <1 μm and organic matter from 1 - >300 μm can be targeted for removal of Ni, Cu, Pb, Cd, Cr, and Zn from build-up, while organic matter from <1 - >300 μm can be targeted for removal of Cd, Cr, Pb, and Ni from wash-off. Cu and Zn need to be removed as free ions from most fractions in wash-off.

EOS imaging versus current radiography: A health technology assessment study

PubMed Central

Mahboub-Ahari, Alireza; Hajebrahimi, Sakineh; Yusefi, Mahmoud; Velayati, Ashraf

2016-01-01

Background: EOS is a 2D/3D muscle skeletal diagnostic imaging system. The device has been developed to produce a high quality 2D, full body radiographs in standing, sitting and squatting positions. Three dimensional images can be reconstructed via sterEOS software. This Health Technology Assessment study aimed to investigate efficacy, effectiveness and cost-effectiveness of new emerged EOS imaging system in comparison with conventional x-ray radiographic techniques. Methods: All cost and outcome data were assessed from Iran's Ministry of Health Perspective. Data for clinical effectiveness was extracted using a rigorous systematic review. As clinical outcomes the rate of x-ray emission and related quality of life were compared with Computed Radiography (CR) and Digital Radiography (DR). Standard costing method was conducted to find related direct medical costs. In order to examine robustness of the calculated Incremental Cost Effectiveness Ratios (ICERs) we used two-way sensitivity analysis. GDP Per capita of Islamic Republic of Iran (2012) adopted as cost-effectiveness threshold. Results: Review of related literature highlighted the lack of rigorous evidence for clinical outcomes. Ultra low dose EOS imaging device is known as a safe intervention because of FDA, CE and CSA certificates. The rate of emitted X-ray was 2 to 18 fold lower for EOS compared to the conventional techniques (p<0.001). The Incremental Cost Effectiveness Ratio for EOS relative to CR calculated $50706 in baseline analysis (the first scenario) and $50714, $9446 respectively for the second and third scenarios. Considering the value of neither $42146 as upper limit, nor the first neither the second scenario could pass the cost-effectiveness threshold for Iran. Conclusion: EOS imaging technique might not be considered as a cost-effective intervention in routine practice of health system, especially within in-patient wards. Scenario analysis shows that, only in an optimum condition such as lower assembling costs and higher utilization rates, the device can be recruited for research and therapeutic purposes in pediatric orthopedic centers. PMID:27390701

Land management strategies for improving water quality in biomass production under changing climate

DOE PAGES

Ha, Miae; Wu, May

2017-03-07

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

Land management strategies for improving water quality in biomass production under changing climate

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

Ha, Miae; Wu, May

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

Critical Pedagogy and APA: A Resonant (and Timely) Interdisciplinary Blend.

PubMed

Connolly, Maureen; Harvey, William J

2018-04-12

Critical pedagogy owes much of its emergence, development, and ongoing relevance to the work of Paulo Freire whose legacy remains relevant for a next generation of scholars who seek to explore issues of inclusion, oppression, social justice, and authentic expression. An interdisciplinary dialogue between critical pedagogy and adapted physical activity is timely, appropriate, and should focus on complex profiles of neurodiversity, mental illness, and mental health, with emphasis on pedagogic practices of practitioners in service delivery and teacher educators who prepare them for professional practice. A case-based scenario approach is used to present practitioner and teacher educator practices. Concrete examples are provided for analyzing and understanding deeper issues and challenges related to neurodiversity in a variety of embodied dimensions in educational and activity contexts. We work with Szostak's approach to interdisciplinary research and model an analysis strategy that integrates and applies the methodological features of interdisciplinarity, adapted physical activity, and critical pedagogy.

SAFETY: an integrated clinical reasoning and reflection framework for undergraduate nursing students.

PubMed

Hicks Russell, Bedelia; Geist, Melissa J; House Maffett, Jenny

2013-01-01

Nurse educators can no longer focus on imparting to students knowledge that is merely factual and content specific. Activities that provide students with opportunities to apply concepts in real-world scenarios can be powerful tools. Nurse educators should take advantage of student-patient interactions to model clinical reasoning and allow students to practice complex decision making throughout the entire curriculum. In response to this change in nursing education, faculty in a pediatric course designed a reflective clinical reasoning activity based on the SAFETY template, which is derived from the National Council of State Boards of Nursing RN practice analysis. Students were able to prioritize key components of nursing care, as well as integrate practice issues such as delegation, Health Insurance Portability and Accountability Act violations, and questioning the accuracy of orders. SAFETY is proposed as a framework for integration of content knowledge, clinical reasoning, and reflection on authentic professional nursing concerns. Copyright 2012, SLACK Incorporated.

TH-A-12A-01: Medical Physicist's Role in Digital Information Security: Threats, Vulnerabilities and Best Practices

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

McDonald, K; Curran, B

I. Information Security Background (Speaker = Kevin McDonald) Evolution of Medical Devices Living and Working in a Hostile Environment Attack Motivations Attack Vectors Simple Safety Strategies Medical Device Security in the News Medical Devices and Vendors Summary II. Keeping Radiation Oncology IT Systems Secure (Speaker = Bruce Curran) Hardware Security Double-lock Requirements “Foreign” computer systems Portable Device Encryption Patient Data Storage System Requirements Network Configuration Isolating Critical Devices Isolating Clinical Networks Remote Access Considerations Software Applications / Configuration Passwords / Screen Savers Restricted Services / access Software Configuration Restriction Use of DNS to restrict accesse. Patches / Upgrades Awareness Intrusionmore » Prevention Intrusion Detection Threat Risk Analysis Conclusion Learning Objectives: Understanding how Hospital IT Requirements affect Radiation Oncology IT Systems. Illustrating sample practices for hardware, network, and software security. Discussing implementation of good IT security practices in radiation oncology. Understand overall risk and threats scenario in a networked environment.« less

Prescriptive Authority and Nursing: a comparative analysis of Brazil and Canada

PubMed Central

Bellaguarda, Maria Lígia dos Reis; Nelson, Sioban; Padilha, Maria Itayra; Caravaca-Morera, Jaime Alonso

2015-01-01

Objective: to analyse the differences between medication prescriptions by nurses in Brazil and Ontario, Canada. Methods: a comparative study between two different scenarios; this comparison was not performed between the two countries because Canada does not standardize this practice, which is legally established and is considered as an advanced professional knowledge area in Brazil. Results: prescription is a professional position to be occupied by nurses. However, there is tension surrounding this practice because it is perceived as a threat to privileges or traditions of other health professionals. Prescibing medication by nurses in Brazil and Ontario follows current legislation and training proccess in each context. Conclusions: there are some challenges to be overcome in ensuring the visibility and consolidation of the practice by nurses in these realities: guarantee of professional competence, credibility, acceptability, and the respectability of clientele in your professional scope by other health professionals. PMID:26625997

The Clinical Health Economics System Simulation (CHESS): a teaching tool for systems- and practice-based learning.

PubMed

Voss, John D; Nadkarni, Mohan M; Schectman, Joel M

2005-02-01

Academic medical centers face barriers to training physicians in systems- and practice-based learning competencies needed to function in the changing health care environment. To address these problems, at the University of Virginia School of Medicine the authors developed the Clinical Health Economics System Simulation (CHESS), a computerized team-based quasi-competitive simulator to teach the principles and practical application of health economics. CHESS simulates treatment costs to patients and society as well as physician reimbursement. It is scenario based with residents grouped into three teams, each team playing CHESS using differing (fee-for-service or capitated) reimbursement models. Teams view scenarios and select from two or three treatment options that are medically justifiable yet have different potential cost implications. CHESS displays physician reimbursement and patient and societal costs for each scenario as well as costs and income summarized across all scenarios extrapolated to a physician's entire patient panel. The learners are asked to explain these findings and may change treatment options and other variables such as panel size and case mix to conduct sensitivity analyses in real time. Evaluations completed in 2003 by 68 (94%) CHESS resident and faculty participants at 19 U.S. residency programs preferred CHESS to a traditional lecture-and-discussion format to learn about medical decision making, physician reimbursement, patient costs, and societal costs. Ninety-eight percent reported increased knowledge of health economics after viewing the simulation. CHESS demonstrates the potential of computer simulation to teach health economics and other key elements of practice- and systems-based competencies.

[The influence of pedagogic and discipline training on the teaching quality of university professors].

PubMed

Troncoso G, Diego; Pérez V, Cristhian; Vaccarezza G, Giulietta; Aguilar A, César; Muñoz N, Nadia

2017-05-01

University teachers prioritize acquiring knowledge about their disciplines over pedagogic training. However, the latter is becoming increasingly important in the present teaching scenario. To relate pedagogic practices with pedagogic training of teachers from health care careers of public and private universities. Pedagogic practice and training activities participation questionnaires were answered by 296 teachers of undergraduate students from Chilean public and private universities. There was a direct correlation between discipline training and all pedagogic practice factors. However, pedagogic training correlated with all the factors with the exception of teacher centered learning. Teachers with a master degree had higher scores in factors related to teaching planning and process assessment. Having a doctor degree had no impact on these factors. A multiple regression analysis showed that both discipline and pedagogic training and having a master degree were associated with pedagogic practices of teachers. Both pedagogic and discipline training influence the quality of teaching provided by undergraduate teachers.

Developing awareness of sustainability in nursing and midwifery using a scenario-based approach: Evidence from a pre and post educational intervention study.

PubMed

Richardson, Janet; Grose, Jane; Bradbury, Martyn; Kelsey, Janet

2017-07-01

The delivery of healthcare has an impact on the environment and contributes to climate change. As a consequence, the way in which nurses and midwives use and dispose of natural resources in clinical practice, and the subsequent impact on the environment, should be integral component of nursing and midwifery education. Opportunities need to be found to embed such issues into nursing curricula; thus bringing sustainability issues 'closer to home' and making them more relevant for clinical practice. The study was designed to measure the impact of a sustainability-focussed, scenario-based learning educational intervention on the attitudes and knowledge of student nurses and midwives. Pre test/Post test intervention study using scenario-based learning as the educational intervention. The Sustainability Attitudes in Nursing Survey (SANS_2) was used as the outcome measure. Clinical skills session in a UK University School of Nursing and Midwifery. 676 second year undergraduate nursing and midwifery students. The 7-point scale SANS survey was completed before and after the teaching session; standard non-parametric analysis compared pre and post intervention scores. Changes were observed in attitude towards climate change and sustainability and to the inclusion of these topics within the nursing curricula (p=0.000). Participants demonstrated greater knowledge of natural resource use and the cost of waste disposal following the session (p=0.000). Participants also reported that sessions were realistic, and levels of agreement with statements supporting the value of the session and the interactive nature of delivery were higher following the session. Using a scenario-based learning approach with nursing and midwifery students can change attitudes and knowledge towards sustainability and climate change. Embedding this approach in the context of clinical skills provides a novel and engaging approach that is both educationally sound and clinically relevant. Copyright © 2017. Published by Elsevier Ltd.

Cooperative Monitoring Center Occasional Paper/8: Cooperative Border Security for Jordan: Assessment and Options

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

Qojas, M.

1999-03-01

This document is an analysis of options for unilateral and cooperative action to improve the security of Jordan's borders. Sections describe the current political, economic, and social interactions along Jordan's borders. Next, the document discusses border security strategy for cooperation among neighboring countries and the adoption of confidence-building measures. A practical cooperative monitoring system would consist of hardware for early warning, command and control, communications, and transportation. Technical solutions can expand opportunities for the detection and identification of intruders. Sensors (such as seismic, break-wire, pressure-sensing, etc.) can warn border security forces of intrusion and contribute to the identification of themore » intrusion and help formulate the response. This document describes conceptual options for cooperation, offering three scenarios that relate to three hypothetical levels (low, medium, and high) of cooperation. Potential cooperative efforts under a low cooperation scenario could include information exchanges on military equipment and schedules to prevent misunderstandings and the establishment of protocols for handling emergency situations or unusual circumstances. Measures under a medium cooperation scenario could include establishing joint monitoring groups for better communications, with hot lines and scheduled meetings. The high cooperation scenario describes coordinated responses, joint border patrols, and sharing border intrusion information. Finally, the document lists recommendations for organizational, technical, and operational initiatives that could be applicable to the current situation.« less

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

PubMed

Azzam, Pierre N; Gopalan, Priya; Brown, Jennifer R; Aquino, Patrick R

2016-04-01

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

A Comparison of Probabilistic and Deterministic Campaign Analysis for Human Space Exploration

NASA Technical Reports Server (NTRS)

Merrill, R. Gabe; Andraschko, Mark; Stromgren, Chel; Cirillo, Bill; Earle, Kevin; Goodliff, Kandyce

2008-01-01

Human space exploration is by its very nature an uncertain endeavor. Vehicle reliability, technology development risk, budgetary uncertainty, and launch uncertainty all contribute to stochasticity in an exploration scenario. However, traditional strategic analysis has been done in a deterministic manner, analyzing and optimizing the performance of a series of planned missions. History has shown that exploration scenarios rarely follow such a planned schedule. This paper describes a methodology to integrate deterministic and probabilistic analysis of scenarios in support of human space exploration. Probabilistic strategic analysis is used to simulate "possible" scenario outcomes, based upon the likelihood of occurrence of certain events and a set of pre-determined contingency rules. The results of the probabilistic analysis are compared to the nominal results from the deterministic analysis to evaluate the robustness of the scenario to adverse events and to test and optimize contingency planning.

Use of the AGNPS model to assess impacts of development and best management practices in an urban watershed

NASA Astrophysics Data System (ADS)

Cross, J. A.

2006-12-01

A Geographical Information System (GIS) is an invaluable tool in the estimation of land use changes and spatial variability in urban areas. (Non-Point Source (NPS) models provide hypothetical opportunities to assess impacts which storm water management strategies and land use changes have on watersheds by predicting loadings on a watershed scale. This study establishes a methodology for analyzing land use changes and management associated with them by utilizing a GIS analysis of impervious surfaces and AGricultural Non- Point Source (AGNPS) modeling. The GIS analysis of Total Impervious Area (TIA) was used to quantify increases in development and provided land use data for use in AGNPS modeling in a small artificially- delineated urban watershed. AGNPS modeling was executed in several different scenarios to predict changes in NPS loadings associated with increases in TIA and its subsequent management in a small artificially- delineated urban watershed. Data editing, creation and extracting was completed using ArcView (3.2) GeoMedia (6) GIS systems. The GIS analysis quantified the increase in urbanization via TIA within the Bluebonnet Swamp Watershed (BSW) in East Baton Rouge Parish (EBRP), Louisiana. The BSW had significant increases in urbanization in the 8 year time span of 1996 2004 causing and increase in quantity and decrease in quality of subsequent runoff. Datasets made available from the GIS analysis included TIA and the change in percentage from 1996 to 2004. This information is fundamental for the AGNPS model because it was used to calculate TIA percentages within each AGNPS cell. A 30 year daily climate file was used to execute AGNPS in different land use and storm water management scenarios within the 1100 acre BSW. Runoff qualities and quantities were then compared for different periods of 1996 and 2004. Predictions of sediment, erosion and runoff were compared according by scenario year. Management practices were also simulated by changing the Runoff Curve Number (RCN) within AGNPS and their results were also compared. This study provides an aid to planners and managers in estimating increases in urbanization by artificially- delineated watershed. It also in illustrates how to use AGNPS to predict NPS pollution and the influence that change in TIA, land use and storm water management strategies have on sediment loadings, erosion and runoff in a watershed.

A Scenario-Based Process for Requirements Development: Application to Mission Operations Systems

NASA Technical Reports Server (NTRS)

Bindschadler, Duane L.; Boyles, Carole A.

2008-01-01

The notion of using operational scenarios as part of requirements development during mission formulation (Phases A & B) is widely accepted as good system engineering practice. In the context of developing a Mission Operations System (MOS), there are numerous practical challenges to translating that notion into the cost-effective development of a useful set of requirements. These challenges can include such issues as a lack of Project-level focus on operations issues, insufficient or improper flowdown of requirements, flowdown of immature or poor-quality requirements from Project level, and MOS resource constraints (personnel expertise and/or dollars). System engineering theory must be translated into a practice that provides enough structure and standards to serve as guidance, but that retains sufficient flexibility to be tailored to the needs and constraints of a particular MOS or Project. We describe a detailed, scenario-based process for requirements development. Identifying a set of attributes for high quality requirements, we show how the portions of the process address many of those attributes. We also find that the basic process steps are robust, and can be effective even in challenging Project environments.

Method meets application: on the use of earthquake scenarios in community-based disaster preparedness and response

NASA Astrophysics Data System (ADS)

Sargeant, S.; Sorensen, M. B.

2011-12-01

More than 50% of the world's population now live in urban areas. In less developed countries, future urban population increase will be due to natural population growth and rural-to-urban migration. As urban growth continues, the vulnerability of those living in these areas is also increasing. This presents a wide variety of challenges for humanitarian organisations that often have more experience of disaster response in rural settings rather than planning for large urban disasters. The 2010 Haiti earthquake highlighted the vulnerability of these organisations and the communities that they seek to support. To meet this challenge, a key consideration is how scientific information can support the humanitarian sector and their working practices. Here we review the current state of earthquake scenario modelling practice, with special focus on scenarios to be used in disaster response and response planning, and present an evaluation of how the field looks set to evolve. We also review current good practice and lessons learned from previous earthquakes with respect to planning for and responding to earthquakes in urban settings in the humanitarian sector, identifying key sectoral priorities. We then investigate the interface between these two areas to investigate the use of earthquake scenarios in disaster response planning and identify potential challenges both with respect to development of scientific models and their application on the ground.

An Evidential Reasoning-Based CREAM to Human Reliability Analysis in Maritime Accident Process.

PubMed

Wu, Bing; Yan, Xinping; Wang, Yang; Soares, C Guedes

2017-10-01

This article proposes a modified cognitive reliability and error analysis method (CREAM) for estimating the human error probability in the maritime accident process on the basis of an evidential reasoning approach. This modified CREAM is developed to precisely quantify the linguistic variables of the common performance conditions and to overcome the problem of ignoring the uncertainty caused by incomplete information in the existing CREAM models. Moreover, this article views maritime accident development from the sequential perspective, where a scenario- and barrier-based framework is proposed to describe the maritime accident process. This evidential reasoning-based CREAM approach together with the proposed accident development framework are applied to human reliability analysis of a ship capsizing accident. It will facilitate subjective human reliability analysis in different engineering systems where uncertainty exists in practice. © 2017 Society for Risk Analysis.

Correcting bias due to missing stage data in the non-parametric estimation of stage-specific net survival for colorectal cancer using multiple imputation.

PubMed

Falcaro, Milena; Carpenter, James R

2017-06-01

Population-based net survival by tumour stage at diagnosis is a key measure in cancer surveillance. Unfortunately, data on tumour stage are often missing for a non-negligible proportion of patients and the mechanism giving rise to the missingness is usually anything but completely at random. In this setting, restricting analysis to the subset of complete records gives typically biased results. Multiple imputation is a promising practical approach to the issues raised by the missing data, but its use in conjunction with the Pohar-Perme method for estimating net survival has not been formally evaluated. We performed a resampling study using colorectal cancer population-based registry data to evaluate the ability of multiple imputation, used along with the Pohar-Perme method, to deliver unbiased estimates of stage-specific net survival and recover missing stage information. We created 1000 independent data sets, each containing 5000 patients. Stage data were then made missing at random under two scenarios (30% and 50% missingness). Complete records analysis showed substantial bias and poor confidence interval coverage. Across both scenarios our multiple imputation strategy virtually eliminated the bias and greatly improved confidence interval coverage. In the presence of missing stage data complete records analysis often gives severely biased results. We showed that combining multiple imputation with the Pohar-Perme estimator provides a valid practical approach for the estimation of stage-specific colorectal cancer net survival. As usual, when the percentage of missing data is high the results should be interpreted cautiously and sensitivity analyses are recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

FORMAL SCENARIO DEVELOPMENT FOR ENVIRONMENTAL IMPACT ASSESSMENT STUDIES

EPA Science Inventory

Scenario analysis is a process of evaluating possible future events through the consideration of alternative plausible (though not equally likely) outcomes (scenarios). The analysis is designed to enable improved decision-making and assessment through a more rigorous evaluation o...

Applying Servant Leadership in Today's Schools

ERIC Educational Resources Information Center

Culver, Mary K.

2009-01-01

This book illustrates how the ideal of servant leadership can be applied in your school today. With real-life scenarios, discussions, and self assessments, this book gives practical suggestions to help you develop into a caring and effective servant leader. There are 52 scenarios in this book, focusing on situations as varied as: (1) Dealing with…

The Scenario of Gifted Education in Brazil

ERIC Educational Resources Information Center

Wechsler, Solange Muglia; Fleith, Denise de Souza

2017-01-01

The purpose of this paper is to provide an overview of gifted education in Brazil. A scenario of the education of the gifted is presented, including the official concept of giftedness as well as programs and services available to emphasize important contributions to the area. Although there are considerable advances regarding policies, practices,…

Reenacted Case Scenarios for Undergraduate Healthcare Students to Illustrate Person-Centered Care in Dementia

ERIC Educational Resources Information Center

Bradley, Sandra L.; De Bellis, Anita; Guerin, Pauline; Walters, Bonnie; Wotherspoon, Alison; Cecchin, Maggie; Paterson, Jan

2010-01-01

Healthcare practitioners have suggested that interpreting person-centered care for people who have dementia to undergraduate students requires guidance in practical application. This article describes the production of a written and digital interdisciplinary educational resource for tertiary students. It uses real-life case scenarios provided by…

The Influence of Perceived Poverty and Academic Achievement on School Counselor Conceptualization

ERIC Educational Resources Information Center

Hutchison, Brian

2011-01-01

This analog study presented 173 practicing school counselors with one of four case scenarios depicting a student new to their school. Each scenario manipulated one of two levels of the independent variables, which were perceived poverty and academic achievement. Main effects indicate that participants rated students as more attractive counseling…

A GIS-based protocol for the simulation and evaluation of realistic 3-D thinning scenarios in recreational forest management.

PubMed

Lin, Chinsu; Thomson, Gavin; Hung, Shih-Hsiang; Lin, Yu-Dung

2012-12-30

This study introduces a GIS-based protocol for the simulation and evaluation of thinning treatments in recreational forest management. The protocol was implemented in a research study based on an area of recreational forest in Alishan National Scenic Area, Taiwan. Ground survey data were mapped to a GIS database, to create a precise, yet flexible, GIS-based digital forest. The digital forest model was used to generate 18 different thinning scenario images and one image of the existing unthinned forest. A questionnaire was completed by 456 participants while simultaneously viewing the scenario images. The questionnaire was used to determine the scenic beauty preferences of the respondents. Statistical analysis of the data revealed that the respondents preferred low density, upper-storey thinning treatments and a dispersed retention pattern of the remaining trees. High density upper-storey treatments evoked a strongly negative reaction in the observers. The experiment demonstrated that the proposed protocol is suitable for selecting an appropriate thinning strategy for recreational forest and that the protocol has practical value in recreational forest management. Copyright © 2012 Elsevier Ltd. All rights reserved.

Climate Change Mitigation Challenge for Wood Utilization-The Case of Finland.

PubMed

Soimakallio, Sampo; Saikku, Laura; Valsta, Lauri; Pingoud, Kim

2016-05-17

The urgent need to mitigate climate change invokes both opportunities and challenges for forest biomass utilization. Fossil fuels can be substituted by using wood products in place of alternative materials and energy, but wood harvesting reduces forest carbon sink and processing of wood products requires material and energy inputs. We assessed the extended life cycle carbon emissions considering substitution impacts for various wood utilization scenarios over 100 years from 2010 onward for Finland. The scenarios were based on various but constant wood utilization structures reflecting current and anticipated mix of wood utilization activities. We applied stochastic simulation to deal with the uncertainty in a number of input variables required. According to our analysis, the wood utilization decrease net carbon emissions with a probability lower than 40% for each of the studied scenarios. Furthermore, large emission reductions were exceptionally unlikely. The uncertainty of the results were influenced clearly the most by the reduction in the forest carbon sink. There is a significant trade-off between avoiding emissions through fossil fuel substitution and reduction in forest carbon sink due to wood harvesting. This creates a major challenge for forest management practices and wood utilization activities in responding to ambitious climate change mitigation targets.

Security Analysis of Smart Grid Cyber Physical Infrastructures Using Modeling and Game Theoretic Simulation

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

Abercrombie, Robert K; Sheldon, Frederick T.

Cyber physical computing infrastructures typically consist of a number of sites are interconnected. Its operation critically depends both on cyber components and physical components. Both types of components are subject to attacks of different kinds and frequencies, which must be accounted for the initial provisioning and subsequent operation of the infrastructure via information security analysis. Information security analysis can be performed using game theory implemented in dynamic Agent Based Game Theoretic (ABGT) simulations. Such simulations can be verified with the results from game theory analysis and further used to explore larger scale, real world scenarios involving multiple attackers, defenders, andmore » information assets. We concentrated our analysis on the electric sector failure scenarios and impact analyses by the NESCOR Working Group Study, From the Section 5 electric sector representative failure scenarios; we extracted the four generic failure scenarios and grouped them into three specific threat categories (confidentiality, integrity, and availability) to the system. These specific failure scenarios serve as a demonstration of our simulation. The analysis using our ABGT simulation demonstrates how to model the electric sector functional domain using a set of rationalized game theoretic rules decomposed from the failure scenarios in terms of how those scenarios might impact the cyber physical infrastructure network with respect to CIA.« less

Differences in case-mix can influence the comparison of standardised mortality ratios even with optimal risk adjustment: an analysis of data from paediatric intensive care.

PubMed

Manktelow, Bradley N; Evans, T Alun; Draper, Elizabeth S

2014-09-01

The publication of clinical outcomes for consultant surgeons in 10 specialties within the NHS has, along with national clinical audits, highlighted the importance of measuring and reporting outcomes with the aim of monitoring quality of care. Such information is vital to be able to identify good and poor practice and to inform patient choice. The need to adequately adjust outcomes for differences in case-mix has long been recognised as being necessary to provide 'like-for-like' comparisons between providers. However, directly comparing values of the standardised mortality ratio (SMR) between different healthcare providers can be misleading even when the risk-adjustment perfectly quantifies the risk of a poor outcome in the reference population. An example is shown from paediatric intensive care. Using observed case-mix differences for 33 paediatric intensive care units (PICUs) in the UK and Ireland for 2009-2011, SMRs were calculated under four different scenarios where, in each scenario, all of the PICUs were performing identically for each patient type. Each scenario represented a clinically plausible difference in outcome from the reference population. Despite the fact that the outcome for any patient was the same no matter which PICU they were to be admitted to, differences between the units were seen when compared using the SMR: scenario 1, 1.07-1.21; scenario 2, 1.00-1.14; scenario 3, 1.04-1.13; scenario 4, 1.00-1.09. Even if two healthcare providers are performing equally for each type of patient, if their patient populations differ in case-mix their SMRs will not necessarily take the same value. Clinical teams and commissioners must always keep in mind this weakness of the SMR when making decisions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Management of Carpal Tunnel Syndrome.

PubMed

Mooar, Pekka A; Doherty, William J; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

2018-03-15

The American Academy of Orthopaedic Surgeons (AAOS) has developed Appropriate Use Criteria (AUC) for Management of Carpal Tunnel Syndrome. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. To provide the evidence foundation for this AUC, the AAOS Evidence-Based Medicine Unit provided the writing panel and voting panel with the 2016 AAOS Clinical Practice Guideline titled Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. The Management of Carpal Tunnel Syndrome AUC clinical patient scenarios were derived from indications typical of patients with suspected carpal tunnel syndrome in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of treatments. The 135 patient scenarios and 6 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Hydrothermal Liquefaction Treatment Hazard Analysis Report

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

Lowry, Peter P.; Wagner, Katie A.

Hazard analyses were performed to evaluate the modular hydrothermal liquefaction treatment system. The hazard assessment process was performed in 2 stages. An initial assessment utilizing Hazard Identification and Preliminary Hazards Analysis (PHA) techniques identified areas with significant or unique hazards (process safety-related hazards) that fall outside of the normal operating envelope of PNNL and warranted additional analysis. The subsequent assessment was based on a qualitative What-If analysis. The analysis was augmented, as necessary, by additional quantitative analysis for scenarios involving a release of hazardous material or energy with the potential for affecting the public. The following selected hazardous scenarios receivedmore » increased attention: •Scenarios involving a release of hazardous material or energy, controls were identified in the What-If analysis table that prevent the occurrence or mitigate the effects of the release. •Scenarios with significant consequences that could impact personnel outside the immediate operations area, quantitative analyses were performed to determine the potential magnitude of the scenario. The set of “critical controls” were identified for these scenarios (see Section 4) which prevent the occurrence or mitigate the effects of the release of events with significant consequences.« less

Social transformation in transdisciplinary natural hazard management

NASA Astrophysics Data System (ADS)

Attems, Marie-Sophie; Fuchs, Sven; Thaler, Thomas

2017-04-01

Due to annual increases of natural hazard losses, there is a discussion among authorities and communities in Europe on innovative solutions to increase resilience, and consequently, business-as-usual in risk management practices is often questioned. Therefore, the current situation of risk management requests a societal transformation to response adequately and effectively to the new global dynamics. An emerging concept is the implementation of multiple-use mitigation systems against hazards such as floods, avalanches and land-slides. However, one key aspect refers to the involvement of knowledge outside academic research. Therefore, transdisciplinary knowledge can be used to discuss vital factors which are needed to upscale the implementation of multiple-use mitigation measures. The method used in this contribution is an explorative scenario analysis applied in Austria and processes the knowledge gained in transdisciplinary workshops. The scenario analysis combines qualitative data and the quantitative relations in order to generate a set of plausible future outcomes. The goal is to establish a small amount of consistent scenarios, which are efficient and thereby representative as well as significantly different from each other. The results of the discussions among relevant stakeholders within the workshops and a subsequent quantitative analysis, showed that vital variables influencing the multiple use of mitigation measures are the (1) current legislation, (2) risk acceptance among authorities and the public, (3) land-use pressure, (4) the demand for innovative solutions, (5) the available technical standards and possibilities and (6) finally the policy entrepreneurship. Four different scenarios were the final result of the analysis. Concluding the results, in order to make multiple-use alleviations systems possible contemporary settings concerning risk management strategies will have to change in the future. Legislation and thereby current barriers have to be altered in order to create a possibility for innovative solutions. If the state of the art in technical perspectives allows constructions with limited additional risk, multiple-use structures are an option in risk management. The present and future land-use pressure also intensifies the economic interest in finding and accepting such measures.

Bridging Scales: Developing a Framework to Build a City-Scale Environmental Scenario for Japanese Municipalities

NASA Astrophysics Data System (ADS)

Hashimoto, S.; Fujita, T.; Nakayama, T.; Xu, K.

2007-12-01

There is an ongoing project on establishing environmental scenarios in Japan to evaluate middle to long-term environmental policy and technology options toward low carbon society. In this project, the time horizon of the scenarios is set for 2050 on the ground that a large part of social infrastructure in Japan is likely to be renovated by that time, and cities are supposed to play important roles in building low carbon society in Japan. This belief is held because cities or local governments could implement various policies and programs, such as land use planning and promotion of new technologies with low GHG emissions, which produce an effect in an ununiform manner, taking local socio-economic conditions into account, while higher governments, either national or prefectural, could impose environmental tax on electricity and gas to alleviate ongoing GHG emissions, which uniformly covers their jurisdictions. In order for local governments to devise and implement concrete administrative actions equipped with rational policies and technologies, referring the environmental scenarios developed for the entire nation, we need to localize the national scenarios, both in terms of spatial and temporal extent, so that they could better reflect local socio-economic and institutional conditions. In localizing the national scenarios, the participation of stakeholders is significant because they play major roles in shaping future society. Stakeholder participation in the localization process would bring both creative and realistic inputs on how future unfolds on a city scale. In this research, 1) we reviewed recent efforts on international and domestic scenario development to set a practical time horizon for a city-scale environmental scenario, which would lead to concrete environmental policies and programs, 2) designed a participatory scenario development/localization process, drawing on the framework of the 'Story-and-Simulation' or SAS approach, which Alcamo(2001) proposed, and 3) started implementing it to the city of Kawasaki, Kanagawa, Japan, in cooperation with municipal officials and stakeholders. The participatory process is to develop city-scale environmental scenarios toward low carbon society, referring international and domestic environmental scenarios. Though the scenario development is still in process, it has already brought practical knowledge about and experience on how to bridge scenarios developed for different temporal and spatial scales.

Cost-effectiveness of possible future smoking cessation strategies in Hungary: results from the EQUIPTMOD.

PubMed

Németh, Bertalan; Józwiak-Hagymásy, Judit; Kovács, Gábor; Kovács, Attila; Demjén, Tibor; Huber, Manuel B; Cheung, Kei-Long; Coyle, Kathryn; Lester-George, Adam; Pokhrel, Subhash; Vokó, Zoltán

2018-01-25

To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. The EQUIPTMOD, a Markov-based economic model, was used to assess the cost-effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group-based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life-time costs and quality-adjusted life years (QALYs) were calculated from a health-care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost-effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health-care cost-savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost-savings increased to €14.1598 per smoker. Doubling the reach of existing group-based behavioural support therapies and proactive telephone support resulted in health-care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. According to the EQUIPTMOD modelling tool, it would be cost-effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group-based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term. © 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

A new comprehension and communication tool: a valuable resource for internationally educated occupational therapists.

PubMed

Nguyen, Tram; Baptiste, Sue; Jung, Bonny; Wilkins, Seanne

2014-06-01

The need was identified for a way to assess internationally educated occupational therapists’ skills in understanding and communicating professional terminology used in occupational therapy practice. The project aim was to develop and validate such a resource. A scenario-based assessment was developed using a three-phase process for tool development. The development process involved completion of a literature scan of professional terminology used in occupational therapy practice; selection of terms and concepts commonly used in occupational therapy practice; and, creation of practice-based scenarios illustrating key concepts complete with rating rubrics. An advisory group provided oversight, and a sample of internationally educated occupational therapists completed pilot and validity testing. The initial findings showed the assessment to be easy to complete and sensitive to testing understanding of the defined terms. The final outcome is an assessment tool that has broad application for occupational therapists wishing to enter professional practice in a new country. © 2013 Occupational Therapy Australia.

Revenue-based cost assignment: a potent but hidden threat to the survival of the multispecialty medical practice.

PubMed

Cooper, Robin; Kramer, Theresa R

2010-03-01

To demonstrate detrimental effects of revenue-based cost assignment (RBCA) in clinical practice and to compare that system with activity-based costing (ABC). Four cost-allocation methods including RBCA were applied to a comprehensive ophthalmology practice using typical accounting methods. Data were obtained by a survey of practitioners or practices and/or extracted from decision support and practice management systems. Inaccuracies and distortions in reported costs were enumerated. Accounting scenario analysis was used to predict resultant provider and managerial decisions. A sampling survey was used to analyze other specialties. ABC was applied to the practice. RBCA causes procedures with higher profitability to appear less profitable and those with lower profitability to appear more profitable. The distortion in reported costs, in medical settings, is often sufficient to incentivize providers with higher profitability to exit a practice and those with lower profitability to remain in it. The departure of providers causes the residual practice profits to decline. These detrimental effects occur in many subspecialties, which suggests a national effect on health care. ABC allocation can reduce cost distortions and eliminate detrimental effects. RBCA leads to fragmentation of health care and a reduction in the profitability of multispecialty practices. Its use may slow the updating of reimbursement and help eliminate low-profitability specialties.

2016 Billion-Ton Report: Advancing Domestic Resources for a Thriving Bioeconomy, Volume 2: Environmental Sustainability Effects of Select Scenarios from Volume 1

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

Efroymson, Rebecca Ann; Langholtz, Matthew H.; Johnson, Kristen

With the goal of understanding environmental effects of a growing bioeconomy, the U.S. Department of Energy (DOE), national laboratories, and U.S. Forest Service research laboratories, together with academic and industry collaborators, undertook a study to estimate environmental effects of potential biomass production scenarios in the United States, with an emphasis on agricultural and forest biomass. Potential effects investigated include changes in soil organic carbon (SOC), greenhouse gas (GHG) emissions, water quality and quantity, air emissions, and biodiversity. Effects of altered land-management regimes were analyzed based on select county-level biomass-production scenarios for 2017 and 2040 taken from the 2016 Billion-Ton Report:more » Advancing Domestic Resources for a Thriving Bioeconomy (BT16), volume 1, which assumes that the land bases for agricultural and forestry would not change over time. The scenarios reflect constraints on biomass supply (e.g., excluded areas; implementation of management practices; and consideration of food, feed, forage, and fiber demands and exports) that intend to address sustainability concerns. Nonetheless, both beneficial and adverse environmental effects might be expected. To characterize these potential effects, this research sought to estimate where and under what modeled scenarios or conditions positive and negative environmental effects could occur nationwide. The report also includes a discussion of land-use change (LUC) (i.e., land management change) assumptions associated with the scenario transitions (but not including analysis of indirect LUC [ILUC]), analyses of climate sensitivity of feedstock productivity under a set of potential scenarios, and a qualitative environmental effects analysis of algae production under carbon dioxide (CO 2) co-location scenarios. Because BT16 biomass supplies are simulated independent of a defined end use, most analyses do not include benefits from displacing fossil fuels or other products, with the exception of including a few illustrative cases on potential reductions in GHG emissions and fossil energy consumption associated with using biomass supplies for fuel, power, heat, and chemicals. Most analyses in volume 2 show potential for a substantial increase in biomass production with minimal or negligible environmental effects under the biomass supply constraints assumed in BT16. Although corn ethanol has been shown to achieve GHG emissions improvements over fossil fuels, cellulosic biomass shows further improvements in certain environmental indicators covered in this report. The harvest of agricultural and forestry residues generally shows the smallest contributions to changes in certain environmental indicators investigated. The scenarios show national-level net SOC gains. When expanding the system boundary in illustrative cases that consider biomass end use, reductions in GHG emissions are estimated for scenarios in which biomass—rather than oil, coal, and natural gas—is used to produce fuel, power, heat, and chemicals. Analyses of water quality reveal that there could be tradeoffs between biomass productivity and some water quality indicators, but better outcomes for both biomass productivity and water quality can be achieved with selected conservation practices. Biodiversity analyses show possible habitat benefits to some species, with other species showing potential adverse effects that may require additional safeguards. Increasing productivity of algae can reduce GHG emissions and water consumption associated with producing algal biomass, though the effects of water consumption are likely of greater concern in some regions than in others. Moreover, the effects of climate change on potential biomass production show gains and losses in yield among feedstocks across the continental United States. Key research gaps and priorities include actions that can enhance benefits and reduce potential for negative effects of increased biomass production. The results from this report will help DOE, the bioenergy industry, and other institutions continue important discussions on environmental effects and will help chart a path toward a more environmentally sustainable bioeconomy.« less

Teaching childbirth with high-fidelity simulation. Is it better observing the scenario during the briefing session?

PubMed

Cuerva, Marcos J; Piñel, Carlos S; Martin, Lourdes; Espinosa, Jose A; Corral, Octavio J; Mendoza, Nicolás

2018-02-12

The design of optimal courses for obstetric undergraduate teaching is a relevant question. This study evaluates two different designs of simulator-based learning activity on childbirth with regard to respect to the patient, obstetric manoeuvres, interpretation of cardiotocography tracings (CTG) and infection prevention. This randomised experimental study which differs in the content of their briefing sessions consisted of two groups of undergraduate students, who performed two simulator-based learning activities on childbirth. The first briefing session included the observations of a properly performed scenario according to Spanish clinical practice guidelines on care in normal childbirth by the teachers whereas the second group did not include the observations of a properly performed scenario, and the students observed it only after the simulation process. The group that observed a properly performed scenario after the simulation obtained worse grades during the simulation, but better grades during the debriefing and evaluation. Simulator use in childbirth may be more fruitful when the medical students observe correct performance at the completion of the scenario compared to that at the start of the scenario. Impact statement What is already known on this subject? There is a scarcity of literature about the design of optimal high-fidelity simulation training in childbirth. It is known that preparing simulator-based learning activities is a complex process. Simulator-based learning includes the following steps: briefing, simulation, debriefing and evaluation. The most important part of high-fidelity simulations is the debriefing. A good briefing and simulation are of high relevance in order to have a fruitful debriefing session. What do the results of this study add? Our study describes a full simulator-based learning activity on childbirth that can be reproduced in similar facilities. The findings of this study add that high-fidelity simulation training in childbirth is favoured by a short briefing session and an abrupt start to the scenario, rather than a long briefing session that includes direct instruction in the scenario. What are the implications of these findings for clinical practice and/or further research? The findings of this study reveal what to include in the briefing of simulator-based learning activities on childbirth. These findings have implications in medical teaching and in medical practice.

SERA Scenarios of Early Market Fuel Cell Electric Vehicle Introductions: Modeling Framework, Regional Markets, and Station Clustering

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

Bush, B.; Melaina, M.; Penev, M.

This report describes the development and analysis of detailed temporal and spatial scenarios for early market hydrogen fueling infrastructure clustering and fuel cell electric vehicle rollout using the Scenario Evaluation, Regionalization and Analysis (SERA) model. The report provides an overview of the SERA scenario development framework and discusses the approach used to develop the nationwidescenario.

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters.

PubMed

Del Cura-González, Isabel; López-Rodríguez, Juan A; Sanz-Cuesta, Teresa; Rodríguez-Barrientos, Ricardo; Martín-Fernández, Jesús; Ariza-Cardiel, Gloria; Polentinos-Castro, Elena; Román-Crespo, Begoña; Escortell-Mayor, Esperanza; Rico-Blázquez, Milagros; Hernández-Santiago, Virginia; Azcoaga-Lorenzo, Amaya; Ojeda-Ruiz, Elena; González-González, Ana I; Ávila-Tomas, José F; Barrio-Cortés, Jaime; Molero-García, José M; Ferrer-Peña, Raul; Tello-Bernabé, María Eugenia; Trujillo-Martín, Mar

2016-05-17

Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model. The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. ClinicalTrials.gov: NCT02210442 .

Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario

PubMed Central

Horwood, Chrystal; Skinner, Tate; Brown, Robert; Renouf, Tia; Dubrowski, Adam

2017-01-01

Simulation has been shown to improve both learner knowledge and patient outcomes. Many emergency medicine training programs incorporate simulation into their curricula to provide learners with experiences that are rare to encounter in practice, yet performance with a high degree of competence is critical. One rare encounter, which is depicted in the report, is the management of a trauma patient who was hypothermic after falling from an expedition vessel into the cold Southern Ocean. The unique scenario presented in this technical report incorporates CanMEDS learning objectives including the communicator, health advocate, and collaborator roles. Using medical simulation facilities, marine performance simulation facilities, and a video, this scenario provides teaching that is uncommon in traditional emergency medicine training. As such, it is valuable for trainees who intend to practice rural, remote, or expedition medicine, or provide coverage for ships and marine installations. PMID:28706765

DENTAL CARE PROFESSIONALS AND CHILD PROTECTION: CASE SCENARIOS AND DISCUSSIONS.

PubMed

Park, Christine

2015-11-01

Any concerns about paediatric patients in general dental practice can be stressful for all involved. Barriers to the reporting of concerns by dental teams are known to exist. Anything that can help ease those situations can only be beneficial. In this article we look at three scenarios that could arise which I am often asked about during teaching and training sessions on safeguarding and child protection for dental teams. They can be discussed at team meetings and training, so that if they are ever to happen for real, everyone will know exactly what to do. This article cannot be completely prescriptive as there will be local variations, but it gives general guidance on issues raised by the scenarios. If you already have a child protection policy in your practice, make sure you know what it says; and if you don't this article will point the way to further resources for developing one.

AN ALTERNATIVE FUTURES ANALYSIS OF FARMINGTON BAY WETLANDS IN THE GREAT SALT LAKE

EPA Science Inventory

An Alternative Futures Analysis (AFA) was conducted to evaluate tradeoffs between landscape design scenarios and ecological services for Farmington Bay, Great Salt Lake (GSL), wetlands. Model scenarios included plan trend and conservation "futures" scenarios projected to 2030. ...

What strategy is needed for attaining the EU air quality regulations under future climate change scenarios? A sensitivity analysis over Europe

NASA Astrophysics Data System (ADS)

Jiménez-Guerrero, P.; Baró, R.; Gómez-Navarro, J. J.; Lorente-Plazas, R.; García-Valero, J. A.; Hernández, Z.; Montávez, J. P.

2012-04-01

A wide number of studies show that several areas over Europe exceed some of the air quality thresholds established in the legislation. These exceedances will become more frequent under future climate change scenarios, since the policies aimed at improving air quality in the EU directives have not accounted for the variations in the climate. Climate change alone will influence the future concentrations of atmospheric pollutants through modifications of gas-phase chemistry, transport, removal, and natural emissions. In this sense, chemistry transport models (CTMs) play a key role in assessing and understanding the emissions abatement plans through the use of sensitivity analysis strategies. These sensitivity analyses characterize the change in model output due to variations in model input parameters. Since the management strategies of air pollutant emission is one of the predominant factors for controlling urban air quality, this work assesses the impact of various emission reduction scenarios in air pollution levels over Europe under two climate change scenarios. The methodology includes the use of a climate version of the meteorological model MM5 coupled with the CHIMERE chemistry transport model. Experiments span the periods 1971-2000, as a reference, and 2071-2100, as two future enhanced greenhouse gas and aerosol scenarios (SRES A2 and B2). The atmospheric simulations have an horizontal resolution of 25 km and 23 vertical layers up to 100 hPa, and are driven by the global climate model ECHO-G . In order to represent the sensitivity of the chemistry and transport of aerosols, tropospheric ozone and other photochemical species, several hypothetical scenarios of emission control have been implemented to quantify the influence of diverse emission sources in the area, such as on-road traffic, port and industrial emissions, among others. The modeling strategy lies on a sensitivity analysis to determine the emission reduction and strategy needed in the target area in order to attain the standards and thresholds set in the European Directive 2008/50/EC. Results depict that the system is able to characterize the exceedances occurring in Europe, mainly related to the maximum 8h moving average exceeding the target value of 120 μg/m3, mainly over southern Europe. Also, compliance of the PM10 daily limit values (50 μg/m3) is not achieved over wide areas in Europe. The sensitivity analysis indicates that large reductions of precursors emissions are needed in all the scenarios examined for attaining the thresholds set in the European Directive. In most cases this abatement strategy is hard to take into practice (e.g. unrealistic percentage of emission reductions in on-road traffic, industry or harbor activity); however, ozone and particulate matter air pollution improve considerably in most of the scenarios included. Results also unveil the propagation of uncertainties from the meteorological projections into future air quality and claim for future studies aimed at deepening the knowledge about the parameterized processes, the definition of emissions and, last, reducing uncertainties.

Using root cause analysis to promote critical thinking in final year Bachelor of Midwifery students.

PubMed

Carter, Amanda G; Sidebotham, Mary; Creedy, Debra K; Fenwick, Jennifer; Gamble, Jenny

2014-06-01

Midwives require well developed critical thinking to practice autonomously. However, multiple factors impinge on students' deep learning in the clinical context. Analysis of actual case scenarios using root cause analysis may foster students' critical thinking and application of 'best practice' principles in complex clinical situations. To examine the effectiveness of an innovative teaching strategy involving root cause analysis to develop students' perceptions of their critical thinking abilities. A descriptive, mixed methods design was used. Final 3rd year undergraduate midwifery students (n=22) worked in teams to complete and present an assessment item based on root cause analysis. The cases were adapted from coroners' reports. After graduation, 17 (77%) students evaluated the course using a standard university assessment tool. In addition 12 (54%) students provided specific feedback on the teaching strategy using a 16-item survey tool based on the domain concepts of Educational Acceptability, Educational Impact, and Preparation for Practice. Survey responses were on a 5-point Likert scale and analysed using descriptive statistics. Open-ended responses were analysed using content analysis. The majority of students perceived the course and this teaching strategy positively. The domain mean scores were high for Educational Acceptability (mean=4.3, SD=.49) and Educational Impact (mean=4.19, SD=.75) but slightly lower for Preparation for Practice (mean=3.7, SD=.77). Overall student responses to each item were positive with no item mean less than 3.42. Students found the root cause analysis challenging and time consuming but reported development of critical thinking skills about the complexity of practice, clinical governance and risk management principles. Analysing complex real life clinical cases to determine a root cause enhanced midwifery students' perceptions of their critical thinking. Teaching and assessment strategies to promote critical thinking need to be made explicit to students in order to foster ongoing development. © 2013.

Greenhouse gas footprint and the carbon flow associated with different solid waste management strategy for urban metabolism in Bangladesh.

PubMed

Islam, K M Nazmul

2017-02-15

Greenhouse gas (GHG) emissions from municipal solid waste (MSW) and associated climate change consequences are gripping attention globally, while MSW management as a vital subsystem of urban metabolism significantly influences the urban carbon cycles. This study evaluates the GHG emissions and carbon flow of existing and proposed MSW management in Bangladesh through scenario analysis, including landfill with landfill gas (LFG) recovery, waste to energy (WtE), and material recovery facility (MRF). The analysis indicates that, scenario H 2 and H 5 emitted net GHGs -152.20kg CO 2 eq. and -140.32kg CO 2 eq., respectively, in comparison with 420.88kg CO 2 eq. of scenario H 1 for managing per ton of wastes during the reference year 2015. The annual horizontal carbon flux of the waste input was 319Gg and 158Gg during 2015 in Dhaka and Chittagong, respectively. An integrated strategy of managing the wastes in the urban areas of Bangladesh involving WtE incineration plant and LFG recovery to generate electricity as well as MRF could reverse back 209.46Gg carbon and 422.29Gg carbon to the Chittagong and Dhaka urban system, respectively. This study provides valuable insights for the MSW policy framework and revamp of existing MSW management practices with regards to reduction of GHGs emissions from the waste sector in Bangladesh. Copyright © 2016 Elsevier B.V. All rights reserved.

Prophylactic antibiotic use in pediatric patients undergoing urinary tract catheterization: a survey of members of the Society for Pediatric Urology.

PubMed

Glaser, Alexander P; Rosoklija, Ilina; Johnson, Emilie K; Yerkes, Elizabeth B

2017-09-06

Current organizational guidelines regarding use of antibiotics during urinary tract catheterization are based on limited evidence and are not directly applicable to the pediatric urology population. We seek to improve understanding of this population by first evaluating current practices. This study aims to investigate practice patterns and attitudes of pediatric urologists regarding the use of antibiotics in the setting of urinary tract catheterization. An online survey was sent to members of the Society for Pediatric Urology. Questionnaire sections included demographics, general questions about antibiotic use with catheterization, and specific clinical scenarios. Descriptive statistics were used, and chi-square analysis was performed to examine associations between demographics and specific responses. Of 448 pediatric urologists surveyed, 154 (34%) responded to the survey. A majority of surveyed urologists (78%) prescribe daily prophylactic antibiotics with a hypospadias stent in place, but extensive variation in use of antibiotics was reported with other catheters and tubes. Extensive variation in practice patterns was also reported for three case scenarios regarding antibiotic prophylaxis with catheterization. Urologists > 50 years of age and fellowship-trained urologists were more likely to prescribe antibiotics for hypospadias stents (p = 0.02, p = 0.03), but no other significant associations between demographic characteristics and antibiotic use were found. There is substantial variation in practice patterns among surveyed pediatric urologists regarding prophylactic antibiotic use with urinary catheterization. This variation, combined with a lack of objective data and increasing pressure to decrease infectious complications and combat antibiotic resistance, highlights the need for development of management guidelines for this unique population.

Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey

PubMed Central

Baidya, Sumana; Acharya, Ranjeeta S.; Coppieters, Michel W.

2016-01-01

Context: As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent. PMID:27076708

Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation in Taiwan.

PubMed

Chang, Chia-Hsien; Yang, Yea-Huei Kao; Chen, Jyh-Hong; Lin, Li-Jen

2014-05-01

Economic evaluation of dabigatran, a new anti-antithrombotic agent, is done mostly in Western countries. It remains to be seen whether dabigatran will be cost effective in a practice environment where warfarin is significantly underused and the costs of both warfarin and international normalized ration INR monitoring are cheap. We performed a cost-effectiveness analysis with a Markov model to evaluate the value of dabigatran to prevent stroke and systemic embolism in patients with atrial fibrillation (AF) in Taiwan. Dabigatran was given through sequential dosing, where patients<80 years old received 150 mg of dabigatran twice a day and the dosage was reduced to 110 mgs for patients ≥ 80 years old. Dabigatran was compared with warfarin under two scenarios: the "real-world adjusted-dose warfarin" assuming all AF patients eligible for warfarin were given the medication and maintained at the INR observed in routine clinical practice in Taiwan, and the "real-world prescribing behaviour" similar to the treatment with antithrombotics in real-world practice in Taiwan, where eligible patients could receive warfarin, aspirin, or no treatment. The percentage of AF patients who received warfarin, aspirin or no treatment in Taiwan was 16%, 62% and 22%, respectively. The event rates of ischemic stroke per 100 patient-years were 4.5, 8.0, and 6.0 for sequential dabigatran, real-world prescribing behaviour and real-world warfarin use, respectively. The incremental cost-effectiveness ratio was $280 US per quality-adjusted-year (QALY) in the real-world prescribing scenario and $10,551 US/QALY in real-word warfarin use. Dabigatran was highly cost-effective in a clinical practice setting where warfarin has been significantly underused. Copyright © 2014 Elsevier Ltd. All rights reserved.

A One-Versus-All Class Binarization Strategy for Bearing Diagnostics of Concurrent Defects

PubMed Central

Ng, Selina S. Y.; Tse, Peter W.; Tsui, Kwok L.

2014-01-01

In bearing diagnostics using a data-driven modeling approach, a concern is the need for data from all possible scenarios to build a practical model for all operating conditions. This paper is a study on bearing diagnostics with the concurrent occurrence of multiple defect types. The authors are not aware of any work in the literature that studies this practical problem. A strategy based on one-versus-all (OVA) class binarization is proposed to improve fault diagnostics accuracy while reducing the number of scenarios for data collection, by predicting concurrent defects from training data of normal and single defects. The proposed OVA diagnostic approach is evaluated with empirical analysis using support vector machine (SVM) and C4.5 decision tree, two popular classification algorithms frequently applied to system health diagnostics and prognostics. Statistical features are extracted from the time domain and the frequency domain. Prediction performance of the proposed strategy is compared with that of a simple multi-class classification, as well as that of random guess and worst-case classification. We have verified the potential of the proposed OVA diagnostic strategy in performance improvements for single-defect diagnosis and predictions of BPFO plus BPFI concurrent defects using two laboratory-collected vibration data sets. PMID:24419162

Multiple Interactive Pollutants in Water Quality Trading

NASA Astrophysics Data System (ADS)

Sarang, Amin; Lence, Barbara J.; Shamsai, Abolfazl

2008-10-01

Efficient environmental management calls for the consideration of multiple pollutants, for which two main types of transferable discharge permit (TDP) program have been described: separate permits that manage each pollutant individually in separate markets, with each permit based on the quantity of the pollutant or its environmental effects, and weighted-sum permits that aggregate several pollutants as a single commodity to be traded in a single market. In this paper, we perform a mathematical analysis of TDP programs for multiple pollutants that jointly affect the environment (i.e., interactive pollutants) and demonstrate the practicality of this approach for cost-efficient maintenance of river water quality. For interactive pollutants, the relative weighting factors are functions of the water quality impacts, marginal damage function, and marginal treatment costs at optimality. We derive the optimal set of weighting factors required by this approach for important scenarios for multiple interactive pollutants and propose using an analytical elasticity of substitution function to estimate damage functions for these scenarios. We evaluate the applicability of this approach using a hypothetical example that considers two interactive pollutants. We compare the weighted-sum permit approach for interactive pollutants with individual permit systems and TDP programs for multiple additive pollutants. We conclude by discussing practical considerations and implementation issues that result from the application of weighted-sum permit programs.

Formulating treatment recommendation as a logical consequence of the diagnosis in post-surgical oncological visits.

PubMed

Fatigante, Marilena; Alby, Francesca; Zucchermaglio, Cristina; Baruzzo, Mattia

2016-06-01

the article analyzes how a doctor delivers diagnoses and recommends treatment in a set of post-surgical oncological visits. The pattern of activities are explored in two different cases: when all diagnostic information is available, and when information is still missing. The data consist of 12 video-recorded visits of breast cancer patients to a senior oncologist. Conversation analysis is employed to analyze sequences in which the delivery of diagnosis and treatment recommendation unfold. The oncologist formulates the treatment recommendation as a logical consequence deriving from the available diagnostic information. In cases when definitive diagnostic information on the cancer type is missing, the oncologist opts to anticipate hypothetical diagnostic scenarios, and to draw the therapeutic alternatives as logical outcomes envisionable from each of the different scenarios. The communicative practice appears functional to encourage the patients' acceptance of a single treatment option rather than present the patients to and involve them in deliberating over multiple available treatment alternatives. Rather than a normative adoption of existing protocols of communication in cancer care, a better understanding of communication practices in use can help practitioners to reflect upon and make intentional choices about different arrangements for the patient's participation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A one-versus-all class binarization strategy for bearing diagnostics of concurrent defects.

PubMed

Ng, Selina S Y; Tse, Peter W; Tsui, Kwok L

2014-01-13

In bearing diagnostics using a data-driven modeling approach, a concern is the need for data from all possible scenarios to build a practical model for all operating conditions. This paper is a study on bearing diagnostics with the concurrent occurrence of multiple defect types. The authors are not aware of any work in the literature that studies this practical problem. A strategy based on one-versus-all (OVA) class binarization is proposed to improve fault diagnostics accuracy while reducing the number of scenarios for data collection, by predicting concurrent defects from training data of normal and single defects. The proposed OVA diagnostic approach is evaluated with empirical analysis using support vector machine (SVM) and C4.5 decision tree, two popular classification algorithms frequently applied to system health diagnostics and prognostics. Statistical features are extracted from the time domain and the frequency domain. Prediction performance of the proposed strategy is compared with that of a simple multi-class classification, as well as that of random guess and worst-case classification. We have verified the potential of the proposed OVA diagnostic strategy in performance improvements for single-defect diagnosis and predictions of BPFO plus BPFI concurrent defects using two laboratory-collected vibration data sets.

Developing a Scenario for widespread use: Best practices, lessons learned

USGS Publications Warehouse

Perry, S.; Jones, L.; Cox, D.

2011-01-01

The ShakeOut Scenario is probably the most widely known and used earthquake scenario created to date. Much of the credit for its widespread dissemination and application lies with scenario development criteria that focused on the needs and involvement of end users and with a suite of products that tailored communication of the results to varied end users, who ranged from emergency managers to the general public, from corporations to grassroots organizations. Products were most effective when they were highly visual, when they emphasized the findings of social scientists, and when they communicated the experience of living through the earthquake. This paper summarizes the development criteria and the products that made the ShakeOut Scenario so widely known and used, and it provides some suggestions for future improvements. ?? 2011, Earthquake Engineering Research Institute.

Tailoring Green Infrastructure Implementation Scenarios based on Stormwater Management Objectives

EPA Science Inventory

Green infrastructure (GI) refers to stormwater management practices that mimic nature by soaking up, storing, and controlling onsite. GI practices can contribute reckonable benefits towards meeting stormwater management objectives, such as runoff peak shaving, volume reduction, f...

Spatial Translation and Scaling Up of LID Practices in Deer Creek Watershed in East Missouri

NASA Astrophysics Data System (ADS)

Di Vittorio, Damien

This study investigated two important aspects of hydrologic effects of low impact development (LID) practices at the watershed scale by (1) examining the potential benefits of scaling up of LID design, and (2) evaluating downstream effects of LID design and its spatial translation within a watershed. The Personal Computer Storm Water Management Model (PCSWMM) was used to model runoff reduction with the implementation of LID practices in Deer Creek watershed (DCW), Missouri. The model was calibrated from 2003 to 2007 (R2 = 0.58 and NSE = 0.57), and validated from 2008 to 2012 (R2 = 0.64 and NSE = 0.65) for daily direct runoff. Runoff simulated for the study period, 2003 to 2012 (NSE = 0.61; R2 = 0.63), was used as the baseline for comparison to LID scenarios. Using 1958 areal imagery to assign land cover, a predevelopment scenario was constructed and simulated to assess LID scenarios' ability to restore predevelopment hydrologic conditions. The baseline and all LID scenarios were simulated using 2006 National Land Cover Dataset. The watershed was divided in 117 subcatchments, which were clustered in six groups of approximately equal areas and two scaling concepts consisting of incremental scaling and spatial scaling were modelled. Incremental scaling was investigated using three LID practices (rain barrel, porous pavement, and rain garden). Each LID practice was simulated at four implementation levels (25%, 50%, 75%, and 100%) in all subcatchments for the study period (2003 to 2012). Results showed an increased runoff reduction, ranging from 3% to 31%, with increased implementation level. Spatial scaling was investigated by increasing the spatial extent of LID practices using the subcatchment groups and all three LID practices (combined) implemented at 50% level. Results indicated that as the spatial extent of LID practices increased the runoff reduction at the outlet also increased, ranging from 3% to 19%. Spatial variability of LID implementation was examined by normalizing LID treated area to impervious area for each subcatchment group. The normalized LID implementation levels for each group revealed a reduction in runoff at the outlet of the watershed, ranging from 0.6% to 3.7%. This study showed that over a long-term period LID practices could restore pre-development hydrologic conditions. The optimal location for LID practice implementation within the study area was found to be near the outlet; however, these results cannot be generalized for all watersheds.

A loop-counting method for covariate-corrected low-rank biclustering of gene-expression and genome-wide association study data.

PubMed

Rangan, Aaditya V; McGrouther, Caroline C; Kelsoe, John; Schork, Nicholas; Stahl, Eli; Zhu, Qian; Krishnan, Arjun; Yao, Vicky; Troyanskaya, Olga; Bilaloglu, Seda; Raghavan, Preeti; Bergen, Sarah; Jureus, Anders; Landen, Mikael

2018-05-14

A common goal in data-analysis is to sift through a large data-matrix and detect any significant submatrices (i.e., biclusters) that have a low numerical rank. We present a simple algorithm for tackling this biclustering problem. Our algorithm accumulates information about 2-by-2 submatrices (i.e., 'loops') within the data-matrix, and focuses on rows and columns of the data-matrix that participate in an abundance of low-rank loops. We demonstrate, through analysis and numerical-experiments, that this loop-counting method performs well in a variety of scenarios, outperforming simple spectral methods in many situations of interest. Another important feature of our method is that it can easily be modified to account for aspects of experimental design which commonly arise in practice. For example, our algorithm can be modified to correct for controls, categorical- and continuous-covariates, as well as sparsity within the data. We demonstrate these practical features with two examples; the first drawn from gene-expression analysis and the second drawn from a much larger genome-wide-association-study (GWAS).

Studying Professional Knowledge Use in Practice Using Multimedia Scenarios Delivered Online

ERIC Educational Resources Information Center

Herbst, Patricio; Chazan, Daniel

2015-01-01

We describe how multimedia scenarios delivered online can be used in instruments for the study of professional knowledge. Based on our work in the study of the knowledge and rationality involved in mathematics teaching, we describe how the study of professional knowledge writ large can benefit from the capacity to represent know-how using…

From Guide on the Side to Impresario with a Scenario

ERIC Educational Resources Information Center

Weston, Anthony

2015-01-01

This article proposes a conception of the teacher as an "Impresario with a Scenario," a multi-centric and co-constructivist model in contrast to the familiarly student-centered and constructivist ideal of the Guide on the Side. I argue that the Impresario conception is truer to the practices of many teachers inspired by the "Guide…

Blending Face-to-Face Higher Education with Web-Based Lectures: Comparing Different Didactical Application Scenarios

ERIC Educational Resources Information Center

Montrieux, Hannelore; Vangestel, Sandra; Raes, Annelies; Matthys, Paul; Schellens, Tammy

2015-01-01

Blended learning as an instructional approach is getting more attention in the educational landscape and has been researched thoroughly. Yet, this study reports the results of an innovation project aiming to gain insight into three different scenarios of applying web-based lectures: as preparation for face-to-face practical exercises, as a…

Conversations: Risk, Passion and Frank Speaking in Education

ERIC Educational Resources Information Center

Fulford, Amanda

2012-01-01

This article considers conversations in and about education. To focus the discussion, it uses the scenario of a conversation between a trainee teacher and her mentor reflecting together on a lesson that the trainee has just taught. I begin by outlining the notion of reflective practice as popularised by Donald Schon, and show how, in the scenario,…

[Scenario analysis--a method for long-term planning].

PubMed

Stavem, K

2000-01-10

Scenarios are known from the film industry, as detailed descriptions of films. This has given name to scenario analysis, a method for long term planning using descriptions of composite future pictures. This article is an introduction to the scenario method. Scenarios describe plausible, not necessarily probable, developments. They focus on problems and questions that decision makers must be aware of and prepare to deal with, and the consequences of alternative decisions. Scenarios are used in corporate and governmental planning, and they can be useful and complementary to traditional planning and extrapolation of past experience. The method is particularly useful in a rapidly changing world with shifting external conditions.

Quantifying the impacts of agricultural management and climate change on soil organic carbon changes in the uplands of Eastern China

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

Zhang, Liming; Wang, Guangxiang; Zheng, Qiaofeng

In order to implement optimal farming practices for increasing soil organic carbon (SOC) in agro-ecosystems, there is a need for understanding how management practices and climate change alter SOC levels. This study quantified the influence of agricultural management practices and climatic factors on SOC changes in Eastern China’s upland-crop fields in northern Jiangsu Province for the period of 2010–2039, by using the DeNitrification-DeComposition (DNDC, version 9.5) model. We utilized the currently most detailed soil database, which is at a scale of 1:50,000, containing 17,024 soil polygons derived from 983 upland soil profiles. Across all the examined scenarios of agricultural managementmore » practices, our results show that the carbon sequestration potential in the upper layer soil (0–50 cm) of the study area varied from 6.93 to 155.11 Tg C during 2010–2039, with an average rate of 59 to 1317 kg C ha-1 year-1. As a promising alternative, the combined scenario of crop residue return rate of 50% and farmyard manure incorporation rate of 50% is recommended for agricultural management practice in this region. Meanwhile, climate conditions play a significant role in the annual SOC changes as well. Air temperature increase of 2–4 °C leads to 3.41–7.51 Tg C decrease in SOC under conventional management for the entire study region. Decreasing or increasing precipitation by 20% would increase 0.57 Tg C or decrease 1.09 Tg C under the conventional management scenario, respectively. Additionally, among all the soil groups, the fluvo-aquic soils have the highest C sequestration rate in most scenarios. Our findings could be used to inform optimal agricultural management toward climate mitigation.« less

Global megatrends and their implications for environmental assessment practice

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

Retief, Francois, E-mail: francois.retief@nwu.ac.za; Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University

This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication andmore » participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.« less

State of practice and emerging application of analytical techniques of nuclear forensic analysis: highlights from the 4th Collaborative Materials Exercise of the Nuclear Forensics International Technical Working Group (ITWG)

DOE PAGES

Schwantes, Jon M.; Marsden, Oliva; Pellegrini, Kristi L.

2016-09-16

The Nuclear Forensics International Technical Working Group (ITWG) recently completed its fourth Collaborative Materials Exercise (CMX-4) in the 21 year history of the Group. This was also the largest materials exercise to date, with participating laboratories from 16 countries or international organizations. Moreover, exercise samples (including three separate samples of low enriched uranium oxide) were shipped as part of an illicit trafficking scenario, for which each laboratory was asked to conduct nuclear forensic analyses in support of a fictitious criminal investigation. In all, over 30 analytical techniques were applied to characterize exercise materials, for which ten of those techniques weremore » applied to ITWG exercises for the first time. We performed an objective review of the state of practice and emerging application of analytical techniques of nuclear forensic analysis based upon the outcome of this most recent exercise is provided.« less

State of practice and emerging application of analytical techniques of nuclear forensic analysis: highlights from the 4th Collaborative Materials Exercise of the Nuclear Forensics International Technical Working Group (ITWG)

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

Schwantes, Jon M.; Marsden, Oliva; Pellegrini, Kristi L.

The Nuclear Forensics International Technical Working Group (ITWG) recently completed its fourth Collaborative Materials Exercise (CMX-4) in the 21 year history of the Group. This was also the largest materials exercise to date, with participating laboratories from 16 countries or international organizations. Moreover, exercise samples (including three separate samples of low enriched uranium oxide) were shipped as part of an illicit trafficking scenario, for which each laboratory was asked to conduct nuclear forensic analyses in support of a fictitious criminal investigation. In all, over 30 analytical techniques were applied to characterize exercise materials, for which ten of those techniques weremore » applied to ITWG exercises for the first time. We performed an objective review of the state of practice and emerging application of analytical techniques of nuclear forensic analysis based upon the outcome of this most recent exercise is provided.« less

Developing Scenarios: Linking Environmental Scanning and Strategic Planning.

ERIC Educational Resources Information Center

Whiteley, Meredith A.; And Others

1990-01-01

The multiple scenario analysis technique for organizational planning used by multinational corporations is adaptable for colleges and universities. Arizona State University launched a futures-based planning project using the Delphi technique and cross-impact analysis to produce three alternative scenarios (stable, turbulent, and chaotic) to expand…

A strategic planning approach for operational-environmental tradeoff assessments in terminal areas

NASA Astrophysics Data System (ADS)

Jimenez, Hernando

This thesis proposes the use of well established statistical analysis techniques, leveraging on recent developments in interactive data visualization capabilities, to quantitatively characterize the interactions, sensitivities, and tradeoffs prevalent in the complex behavior of airport operational and environmental performance. Within the strategic airport planning process, this approach is used in the assessment of airport performance under current/reference conditions, as well as in the evaluation of terminal area solutions under projected demand conditions. More specifically, customized designs of experiments are utilized to guide the intelligent selection and definition of modeling and simulation runs that will yield greater understanding, insight, and information about the inherent systemic complexity of a terminal area, with minimal computational expense. For the research documented in this thesis, a modeling and simulation environment was created featuring three primary components. First, a generator of schedules of operations, based primarily on previous work on aviation demand characterization, whereby growth factors and scheduling adjustment algorithms are applied on appropriate baseline schedules so as to generate notional operational sets representative of consistent future demand conditions. The second component pertains to the modeling and simulation of aircraft operations, defined by a schedule of operations, on the airport surface and within its terminal airspace. This component is a discrete event simulator for multiple queuing models that captures the operational architecture of the entire terminal area along with all the necessary operational logic pertaining to simulated Air Traffic Control (ATC) functions, rules, and standard practices. The third and final component is comprised of legacy aircraft performance, emissions and dispersion, and noise exposure modeling tools, that use the simulation history of aircraft movements to generate estimates of fuel burn, emissions, and noise. The implementation of the proposed approach for the assessment of terminal area solutions incorporates the use of discrete response surface equations, and eliminates the use of quadratic terms that have no practical significance in this context. Rather, attention is entire placed on the main effects of different terminal area solutions, namely additional airport infrastructure, operational improvements, and advanced aircraft concepts, modeled as discrete independent variables for the regression model. Results reveal that an additional runway and a new international terminal, as well as reduced aircraft separation, have a major effect on all operational metrics of interest. In particular, the additional runway has a dominant effect for departure delay metrics and gate hold periods, with moderate interactions with respect to separation reduction. On the other hand, operational metrics for arrivals are co-dependent on additional infrastructure and separation reduction, featuring marginal improvements whenever these two solutions are implemented in isolation, but featuring a dramatic compounding effect when implemented in combination. The magnitude of these main effects for departures and of the interaction between these solutions for arrivals is confirmed through appropriate statistical significance testing. Finally, the inclusion o advanced aircraft concepts is shown to be most beneficial for airborne arrival operations and to a lesser extent for arrival ground movements. More specifically, advanced aircraft concepts were found to be primarily responsible for reductions in volatile organic compounds, unburned hydrocarbons, and particulate matter in this flight regime, but featured relevant interactions with separation reduction and additional airport infrastructure. To address the selection of scenarios for strategic airport planning, a technique for risk-based scenario construction, evaluation, and selection is proposed, incorporating n-dimensional dependence tree probability approximations into a morphological analysis approach. This approach to scenario construction and downselection is a distinct and novel contribution to the scenario planning field as it provides a mathematically and explicitly testable definition for an H parameter, contrasting with the qualitative alternatives in the current state of the art, which can be used in morphological analysis for scenario construction and downselection. By demonstrating that dependence tree probability product approximations are an adequate aggregation function, probability can be used for scenario construction and downselection without any mathematical or methodological restriction on the resolution of the probability scale or the number of morphological alternatives that have previously plagued probabilization and scenario downselection approaches. In addition, this approach requires expert input elicitation that is comparable or less than the current state of the art practices. (Abstract shortened by UMI.)

Modelling multiple sources of dissemination bias in meta-analysis.

PubMed

Bowden, Jack; Jackson, Dan; Thompson, Simon G

2010-03-30

Asymmetry in the funnel plot for a meta-analysis suggests the presence of dissemination bias. This may be caused by publication bias through the decisions of journal editors, by selective reporting of research results by authors or by a combination of both. Typically, study results that are statistically significant or have larger estimated effect sizes are more likely to appear in the published literature, hence giving a biased picture of the evidence-base. Previous statistical approaches for addressing dissemination bias have assumed only a single selection mechanism. Here we consider a more realistic scenario in which multiple dissemination processes, involving both the publishing authors and journals, are operating. In practical applications, the methods can be used to provide sensitivity analyses for the potential effects of multiple dissemination biases operating in meta-analysis.

Reduced length of stay in hospital for burn patients following a change in practice guidelines: financial implications.

PubMed

Jansen, Leigh A; Hynes, Sally L; Macadam, Sheina A; Papp, Anthony

2012-01-01

The objective of this study was to analyze the financial implications of the implementation of new institutional practice guidelines including greater outpatient care and earlier operative intervention in a provincial burn center. A retrospective review was performed including all patients admitted to the Burn Unit with burns up to 20% TBSA between August 2005 and July 2009, including 2 years before and after the new guidelines were introduced. Daily costs for the burn unit were used to calculate this portion of cost. Length of stay (LOS) was based on actual data and representative clinical scenarios. Two hundred sixty-four patients were included. Mean LOS decreased from 10.3 to 3.9 (P < .01) and 21.0 to 13.3 (P > .05) for nonoperative burns 0 to 10% and 10 to 20% TBSA, respectively. Mean LOS for operative burns decreased from 16.6 to 12.9 and 32.3 to 29.8 days for 0 to 10% and 10 to 20% TBSA, respectively (P > .05). Burn patient management requires significant financial resources, and LOS has a large impact on cost. Given per diem rates of Can$1,663, scenario analysis shows potential cost savings of Can$19,956 per patient for operative and nonoperative burns <20% TBSA. With an average of 66 such patients treated each year, potential annual cost savings are Can$1.3 million. If outcomes are not compromised, earlier operative management and greater outpatient care can translate into significant cost savings. A prospective analysis capturing all costs and patient quality of life is required for further assessment.

Life-cycle cost-benefit analysis of extensive vegetated roof systems.

PubMed

Carter, Timothy; Keeler, Andrew

2008-05-01

The built environment has been a significant cause of environmental degradation in the previously undeveloped landscape. As public and private interest in restoring the environmental integrity of urban areas continues to increase, new construction practices are being developed that explicitly value beneficial environmental characteristics. The use of vegetation on a rooftop--commonly called a green roof--as an alternative to traditional roofing materials is an increasingly utilized example of such practices. The vegetation and growing media perform a number of functions that improve environmental performance, including: absorption of rainfall, reduction of roof temperatures, improvement in ambient air quality, and provision of urban habitat. A better accounting of the green roof's total costs and benefits to society and to the private sector will aid in the design of policy instruments and educational materials that affect individual decisions about green roof construction. This study uses data collected from an experimental green roof plot to develop a benefit cost analysis (BCA) for the life cycle of extensive (thin layer) green roof systems in an urban watershed. The results from this analysis are compared with a traditional roofing scenario. The net present value (NPV) of this type of green roof currently ranges from 10% to 14% more expensive than its conventional counterpart. A reduction of 20% in green roof construction cost would make the social NPV of the practice less than traditional roof NPV. Considering the positive social benefits and relatively novel nature of the practice, incentives encouraging the use of this practice in highly urbanized watersheds are strongly recommended.

The use of scenario analysis in local public health departments: alternative futures for strategic planning.

PubMed Central

Venable, J M; Ma, Q L; Ginter, P M; Duncan, W J

1993-01-01

Scenario analysis is a strategic planning technique used to describe and evaluate an organization's external environment. A methodology for conducting scenario analysis using the Jefferson County Department of Health and the national, State, and county issues confronting it is outlined. Key health care and organizational issues were identified using published sources, focus groups, questionnaires, and personal interviews. The most important of these issues were selected by asking health department managers to evaluate the issues according to their probability of occurrence and likely impact on the health department. The high-probability, high-impact issues formed the basis for developing scenario logics that constitute the story line holding the scenario together. The results were a set of plausible scenarios that aided in strategic planning, encouraged strategic thinking among managers, eliminated or reduced surprise about environmental changes, and improved managerial discussion and communication. PMID:8265754

Research on response spectrum of dam based on scenario earthquake

NASA Astrophysics Data System (ADS)

Zhang, Xiaoliang; Zhang, Yushan

2017-10-01

Taking a large hydropower station as an example, the response spectrum based on scenario earthquake is determined. Firstly, the potential source of greatest contribution to the site is determined on the basis of the results of probabilistic seismic hazard analysis (PSHA). Secondly, the magnitude and epicentral distance of the scenario earthquake are calculated according to the main faults and historical earthquake of the potential seismic source zone. Finally, the response spectrum of scenario earthquake is calculated using the Next Generation Attenuation (NGA) relations. The response spectrum based on scenario earthquake method is less than the probability-consistent response spectrum obtained by PSHA method. The empirical analysis shows that the response spectrum of scenario earthquake considers the probability level and the structural factors, and combines the advantages of the deterministic and probabilistic seismic hazard analysis methods. It is easy for people to accept and provide basis for seismic engineering of hydraulic engineering.

Risk-Hedged Approach for Re-Routing Air Traffic Under Weather Uncertainty

NASA Technical Reports Server (NTRS)

Sadovsky, Alexander V.; Bilimoria, Karl D.

2016-01-01

This presentation corresponds to: our paper explores a new risk-hedged approach for re-routing air traffic around forecast convective weather. In this work, flying through a more likely weather instantiation is considered to pose a higher level of risk. Current operational practice strategically plans re-routes to avoid only the most likely (highest risk) weather instantiation, and then tactically makes any necessary adjustments as the weather evolves. The risk-hedged approach strategically plans re-routes by minimizing the risk-adjusted path length, incorporating multiple possible weather instantiations with associated likelihoods (risks). The resulting model is transparent and is readily analyzed for realism and treated with well-understood shortest-path algorithms. Risk-hedged re-routes are computed for some example weather instantiations. The main result is that in some scenarios, relative to an operational-practice proxy solution, the risk-hedged solution provides the benefits of lower risk as well as shorter path length. In other scenarios, the benefits of the risk-hedged solution are ambiguous, because the solution is characterized by a tradeoff between risk and path length. The risk-hedged solution can be executed in those scenarios where it provides a clear benefit over current operational practice.

Global Simulation of Bioenergy Crop Productivity: Analytical Framework and Case Study for Switchgrass

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

Kang, Shujiang; Kline, Keith L; Nair, S. Surendran

A global energy crop productivity model that provides geospatially explicit quantitative details on biomass potential and factors affecting sustainability would be useful, but does not exist now. This study describes a modeling platform capable of meeting many challenges associated with global-scale agro-ecosystem modeling. We designed an analytical framework for bioenergy crops consisting of six major components: (i) standardized natural resources datasets, (ii) global field-trial data and crop management practices, (iii) simulation units and management scenarios, (iv) model calibration and validation, (v) high-performance computing (HPC) simulation, and (vi) simulation output processing and analysis. The HPC-Environmental Policy Integrated Climate (HPC-EPIC) model simulatedmore » a perennial bioenergy crop, switchgrass (Panicum virgatum L.), estimating feedstock production potentials and effects across the globe. This modeling platform can assess soil C sequestration, net greenhouse gas (GHG) emissions, nonpoint source pollution (e.g., nutrient and pesticide loss), and energy exchange with the atmosphere. It can be expanded to include additional bioenergy crops (e.g., miscanthus, energy cane, and agave) and food crops under different management scenarios. The platform and switchgrass field-trial dataset are available to support global analysis of biomass feedstock production potential and corresponding metrics of sustainability.« less

Scenario Analysis of Soil and Water Conservation in Xiejia Watershed Based on Improved CSLE Model

NASA Astrophysics Data System (ADS)

Liu, Jieying; Yu, Ming; Wu, Yong; Huang, Yao; Nie, Yawen

2018-01-01

According to the existing research results and related data, use the scenario analysis method, to evaluate the effects of different soil and water conservation measures on soil erosion in a small watershed. Based on the analysis of soil erosion scenarios and model simulation budgets in the study area, it is found that all scenarios simulated soil erosion rates are lower than the present situation of soil erosion in 2013. Soil and water conservation measures are more effective in reducing soil erosion than soil and water conservation biological measures and soil and water conservation tillage measures.

Spatially Explicit Life Cycle Analysis of Cellulosic Ethanol Production Scenarios in Southwestern Michigan

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

Cronin, Keith R.; Runge, Troy M.; Zhang, Xuesong

By modeling the life cycle of fuel pathways for cellulosic ethanol (CE) it can help identify logistical barriers and anticipated impacts for the emerging commercial CE industry. Such models contain high amounts of variability, primarily due to the varying nature of agricultural production but also because of limitations in the availability of data at the local scale, resulting in the typical practice of using average values. In this study, 12 spatially explicit, cradle-to-refinery gate CE pathways were developed that vary by feedstock (corn stover, switchgrass, and Miscanthus), nitrogen application rate (higher, lower), pretreatment method (ammonia fiber expansion [AFEX], dilute acid),more » and co-product treatment method (mass allocation, sub-division), in which feedstock production was modeled at the watershed scale over a nine-county area in Southwestern Michigan. When comparing feedstocks, the model showed that corn stover yielded higher global warming potential (GWP), acidification potential (AP), and eutrophication potential (EP) than the perennial feedstocks of switchgrass and Miscanthus, on an average per area basis. Full life cycle results per MJ of produced ethanol demonstrated more mixed results, with corn stover-derived CE scenarios that use sub-division as a co-product treatment method yielding similarly favorable outcomes as switchgrass- and Miscanthus-derived CE scenarios. Variability was found to be greater between feedstocks than watersheds. Additionally, scenarios using dilute acid pretreatment had more favorable results than those using AFEX pretreatment.« less

Future riverine nitrogen export to US coastal regions ...

EPA Pesticide Factsheets

Excess nitrogen (N) in the environment degrades ecosystems and adversely affects human health. Here we examine predictions of contemporary (2000) and future (2030) coastal N loading in the continental US by the Nutrient Export from WaterSheds (NEWS) model. Future output is from storylines of the Millennium Ecosystem Assessment (MEA) and two additional scenarios that reflect “business as usual” and “ambitious” approaches to nutrient management. Modeled total nitrogen (TN) export by rivers to US coastal areas ranged between 2.5 Tg N y-1 in 2000 and 1.9 - 3.0 Tg N y-1 in 2030, depending on scenario. Differences among scenarios reflect the interactions of increased food and energy demands associated with population growth and efforts to reduce losses of N to the environment. Depending on year and scenario, agriculture supplies 25-43% of coastal TN, atmospheric N deposition 6-8%, human sewage 6-12%, and natural and particulate N sources account for the remainder. Our analysis suggests that achieving reductions in coastal N loading will require aggressive management actions. Coastal TN export could be reduced 22% between 2000 and 2030 to 1.9 Tg N y-1 if currently available best management practices and technologies are fully implemented to control N from agriculture, fossil fuel emissions, and wastewater effluent. If N management capabilities do not improve by 2030, coastal N loads could increase 20% to 3.0 Tg N y-1, due primarily to increases in N from agricu

Spatially Explicit Life Cycle Analysis of Cellulosic Ethanol Production Scenarios in Southwestern Michigan

DOE PAGES

Cronin, Keith R.; Runge, Troy M.; Zhang, Xuesong; ...

2016-07-13

By modeling the life cycle of fuel pathways for cellulosic ethanol (CE) it can help identify logistical barriers and anticipated impacts for the emerging commercial CE industry. Such models contain high amounts of variability, primarily due to the varying nature of agricultural production but also because of limitations in the availability of data at the local scale, resulting in the typical practice of using average values. In this study, 12 spatially explicit, cradle-to-refinery gate CE pathways were developed that vary by feedstock (corn stover, switchgrass, and Miscanthus), nitrogen application rate (higher, lower), pretreatment method (ammonia fiber expansion [AFEX], dilute acid),more » and co-product treatment method (mass allocation, sub-division), in which feedstock production was modeled at the watershed scale over a nine-county area in Southwestern Michigan. When comparing feedstocks, the model showed that corn stover yielded higher global warming potential (GWP), acidification potential (AP), and eutrophication potential (EP) than the perennial feedstocks of switchgrass and Miscanthus, on an average per area basis. Full life cycle results per MJ of produced ethanol demonstrated more mixed results, with corn stover-derived CE scenarios that use sub-division as a co-product treatment method yielding similarly favorable outcomes as switchgrass- and Miscanthus-derived CE scenarios. Variability was found to be greater between feedstocks than watersheds. Additionally, scenarios using dilute acid pretreatment had more favorable results than those using AFEX pretreatment.« less

TAR (Theatre as Representation) as a Provocative Teaching Tool in School Administration: A Dramatized Inclusive Classroom Scenario

ERIC Educational Resources Information Center

Meyer, Matthew J.; Young, David C.

2013-01-01

The following dramatized classroom scenario depicts a teacher struggling with the nature of an inclusive learning environment, with instructional leadership and supervision of instruction as the theoretical and practical backdrop. The purpose of this article is to demonstrate how the use of a TAR (theatre as representation) case study can be used…

Modeling potential outcomes of fire and fuel management scenarios on the structure of forested habitats in northeast Oregon, USA.

Treesearch

B.C. Wales; L.H. Suring; M.A. Hemstrom

2007-01-01

Thinning and prescribed fire are being used extensively across the interior Western United States to reduce the risk of large, severe wildfires. However, the full ecological consequences of implementing these management practices on the landscape have not been completely evaluated. We projected future vegetation trends resulting from four management scenarios and...

Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury.

PubMed

Sanders, James O; Heggeness, Michael H; Murray, Jayson N; Pezold, Ryan C; Sevarino, Kaitlyn S

2016-02-01

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany a pediatric supracondylar humerus fracture with vascular injury, as well as from current evidence-based clinical practice guidelines and supporting literature. The 6 patient scenarios and 18 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Quantifying climate change mitigation potential in Great Plains wetlands for three greenhouse gas emission scenarios

USGS Publications Warehouse

Byrd, Kristin B.; Ratliff, Jamie L.; Wein, Anne; Bliss, Norman B.; Sleeter, Benjamin M.; Sohl, Terry L.; Li, Zhengpeng

2015-01-01

We examined opportunities for avoided loss of wetland carbon stocks in the Great Plains of the United States in the context of future agricultural expansion through analysis of land-use land-cover (LULC) change scenarios, baseline carbon datasets and biogeochemical model outputs. A wetland map that classifies wetlands according to carbon pools was created to describe future patterns of carbon loss and potential carbon savings. Wetland avoided loss scenarios, superimposed upon LULC change scenarios, quantified carbon stocks preserved under criteria of carbon densities or land value plus cropland suitability. Up to 3420 km2 of wetlands may be lost in the region by 2050, mainly due to conversion of herbaceous wetlands in the Temperate Prairies where soil organic carbon (SOC) is highest. SOC loss would be approximately 0.20 ± 0.15 megagrams of carbon per hectare per year (MgC ha−1 yr−1), depending upon tillage practices on converted wetlands, and total ecosystem carbon loss in woody wetlands would be approximately 0.81 ± 0.41 MgC ha−1 yr−1, based on biogeochemical model results. Among wetlands vulnerable to conversion, wetlands in the Northern Glaciated Plains and Lake Agassiz Plains ecoregions exhibit very high mean SOC and on average, relatively low land values, potentially creating economically competitive opportunities for avoided carbon loss. This mitigation scenarios approach may be adapted by managers using their own preferred criteria to select sites that best meet their objectives. Results can help prioritize field-based assessments, where site-level investigations of carbon stocks, land value, and consideration of local priorities for climate change mitigation programs are needed.

Complexity associated with the optimisation of capability options in military operations

NASA Astrophysics Data System (ADS)

Pincombe, A.; Bender, A.; Allen, G.

2005-12-01

In the context of a military operation, even if the intended actions, the geographic location, and the capabilities of the opposition are known, there are still some critical uncertainties that could have a major impact on the effectiveness of a given set of capabilities. These uncertainties include unpredictable events and the response alternatives that are available to the command and control elements of the capability set. They greatly complicate any a priori mathematical description. In a forecasting approach, the most likely future might be chosen and a solution sought that is optimal for that case. With scenario analysis, futures are proposed on the basis of critical uncertainties and the option that is most robust is chosen. We use scenario analysis but our approach is different in that we focus on the complexity and use the coupling between scenarios and options to create information on ideal options. The approach makes use of both soft and hard operations research methods, with subject matter expertise being used to define plausible responses to scenarios. In each scenario, uncertainty affects only a subset of the system-inherent variables and the variables that describe system-environment interactions. It is this scenario-specific reduction of variables that makes the problem mathematically tractable. The process we define is significantly different to existing scenario analysis processes, so we have named it adversarial scenario analysis. It can be used in conjunction with other methods, including recent improvements to the scenario analysis process. To illustrate the approach, we undertake a tactical level scenario analysis for a logistics problem that is defined by a network, expected throughputs to end users, the transport capacity available, the infrastructure at the nodes and the capacities of roads, stocks etc. The throughput capacity, e.g. the effectiveness, of the system relies on all of these variables and on the couplings between them. The system is initially in equilibrium for a given level of demand. However, different, and simpler, solutions emerge as the balance of couplings and the importance of variables change. The scenarios describe such changes in conditions. For each scenario it was possible to define measures that describe the differences between options. As with agent-based distillations, the solution is essentially qualitative and exploratory, bringing awareness of possible future difficulties and of the capabilities that are necessary if we are to deal successfully with those difficulties.

Optimizing cultivation of agricultural products using socio-economic and environmental scenarios.

PubMed

RaheliNamin, Behnaz; Mortazavi, Samar; Salmanmahiny, Abdolrassoul

2016-11-01

The combination of degrading natural conditions and resources, climate change, growing population, urban development, and competition in a global market complicate optimization of land for agricultural products. The use of pesticides and fertilizers for crop production in the agricultural fields has become excessive in the recent years and Golestan Province of Iran is no exception in this regard. For this, effective management with an efficient and cost-effective practice should be undertaken, maintaining public service at a high level and preserving the environment. Improving the production efficiency of agriculture, efficient use of water resources, decreasing the use of pesticides and fertilizers, improving farmer revenue, and conservation of natural resources are the main objectives of the allocation, ranking, and optimization of agricultural products. The goal of this paper is to use an optimization procedure to lower the negative effects of agriculture while maintaining a high production rate, which is currently a gap in the study area. We collected information about fertilizer and pesticide consumption and other data in croplands of eastern Golestan Province through face-to-face interviews with farmers to optimize cultivation of the agricultural products. The toxicity of pesticides according to LD50 was also included in the optimization model. A decision-support software system called multiple criteria analysis tool was used to simultaneously minimize consumption of water, chemical fertilizers, and pesticides and maximize socio-economic returns. Three scenarios for optimization of agricultural products were generated that alternatively emphasized on environmental and socio-economic goals. Comparing socio-economic and environmental performance of the optimized agricultural products under the three scenarios illustrated the conflict between social, economic, and environmental objectives. Of the six crops studied (wheat, barley, rice, soybeans, oilseed rape, and maize), rice ranked second in the social and fifth in the economic scenarios. Soybeans had the lowest rank for economic and social scenarios and its cultivation in the study area, in terms of economic and social goals, was rejected by the model. However, cultivation of soybeans continues in the area as a responsibility to cater for the major need of the country. Because of subsidized prices of water, fertilizers, and pesticides, the use of these items are far from optimized in the current agricultural practices in the area.

Modelling the impacts of altered management practices, land use and climate changes on the water quality of the Millbrook catchment-reservoir system in South Australia.

PubMed

Nguyen, Hong Hanh; Recknagel, Friedrich; Meyer, Wayne; Frizenschaf, Jacqueline; Shrestha, Manoj Kumar

2017-11-01

Sustainable management of drinking water reservoirs requires taking into account the potential effects of their catchments' development. This study is an attempt to estimate the daily patterns of nutrients transport in the catchment - reservoir systems through the application of the ensemble of complementary models SWAT-SALMO. SWAT quantifies flow, nitrate and phosphate loadings originating in catchments before entering downstream reservoirs meanwhile SALMO determines phosphate, nitrate, and chlorophyll-a concentrations within the reservoirs. The study applies to the semi-arid Millbrook catchment-reservoir system that supplies drinking water to north-eastern suburbs of Adelaide, South Australia. The catchment hosts viti- and horticultural land uses. The warm-monomictic, mesotrophic reservoir is artificially aerated in summer. After validating the simulation results for both Millbrook catchment and reservoir, a comprehensive scenario analysis has been conducted to reveal cascading effects of altered management practices, land uses and climate conditions on water quality in the reservoir. Results suggest that the effect on reservoir condition in summer would be severe, most likely resulting in chlorophyll-a concentrations of greater than 40 μg/l if the artificial destratification was not applied from early summer. A 50% curbing of water diversion from an external pipeline to the catchment will slightly limit chlorophyll-a concentrations by 1.22% as an effect of reduced inflow phosphate loads. The simulation of prospective land use scenarios converting 50% of present pasture in the Millbrook catchment into residential and orchards areas indicates an increase of summer chlorophyll-a concentrations by 9.5-107.9%, respectively in the reservoir. Global warming scenarios based on the high emission simulated by SWAT-SALMO did result in earlier growth of chlorophyll-a but overall the effects on water quality in the Millbrook reservoir was not significant. However scenarios combining global warming and land use changes resulted in significant eutrophication effects in the reservoir, especially in the unmanaged condition with stratification in summer. This study has demonstrated that complementary model ensembles like SWAT-SALMO allow to comprehend more realistically cascading effects of distinct catchment processes on internal reservoir's processes, and facilitate integrated management scenarios. Copyright © 2017 Elsevier Ltd. All rights reserved.

Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS.

PubMed

Saposnik, Gustavo; Maurino, Jorge; Sempere, Angel P; Ruff, Christian C; Tobler, Philippe N

2017-01-01

Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS. We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding. Out of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P =0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01-1.14). Conversely, physician's age, gender, years of practice, setting of practice, or risk preferences were not associated with herding. Herding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may affect medical decisions and lead to poorer outcomes in the management of MS.

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management.

PubMed

Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L

2014-01-01

To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

PubMed Central

Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

Specialty distribution of physician assistants and nurse practitioners in North Carolina.

PubMed

Fraher, Erin P; Morgan, Perri; Johnson, Anna

2016-04-01

Physician workforce projections often include scenarios that forecast physician shortages under different assumptions about the deployment of physician assistants (PAs) and nurse practitioners (NPs). These scenarios generally assume that PAs and NPs are an interchangeable resource and that their specialty distributions do not change over time. This study investigated changes in PA and NP specialty distribution in North Carolina between 1997 and 2013. The data show that over the study period, PAs and NPs practiced in a wide range of specialties, but each profession had a specific pattern. The proportion of PAs-but not NPs-reporting practice in primary care dropped significantly. PAs were more likely than NPs to report practice in urgent care, emergency medicine, and surgical subspecialties. Physician workforce models need to account for the different and changing specialization trends of NPs and PAs.

Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.

PubMed

Ironmonger, Dean; Edeghere, Obaghe; Gossain, Savita; Hawkey, Peter M

2016-05-24

There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community. The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination. Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.

2016 Standard Scenarios Report: A U.S. Electricity Sector Outlook

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

Cole, Wesley; Mai, Trieu; Logan, Jeffrey

The Standard Scenarios and this associated report, which are now in their second year, present an examination of some of the key aspects of the change occurring, or anticipated to occur, in the power sector over the next several decades. The Standard Scenarios consist of 18 power sector scenarios which have been projected using the National Renewable Energy Laboratory's (NREL's) Regional Energy Deployment System (ReEDS) long-term capacity expansion model and the dGen rooftop PV diffusion model. The purpose of the Standard Scenarios and this associated report is to provide context, discussion, and data to inform stakeholder decision-making regarding the futuremore » direction of U.S. power sector. As an extension to this report, the Standard Scenario outputs are presented in a downloadable format online using the Standard Scenarios' Results Viewer at http://en.openei.org/apps/reeds/. This report reflects high-level conclusions and analysis, whereas the Standard Scenarios' Results Viewer includes the scenario results that can be used for more in-depth analysis.« less

Landscaping practices, land use patterns and stormwater quantity and quality in urban watersheds

NASA Astrophysics Data System (ADS)

Miles, B.; Band, L. E.

2011-12-01

Increasing quantity and decreasing quality of urban stormwater threatens biodiversity in local streams and reservoirs, jeopardizes water supplies, and ultimately contributes to estuarine eutrophication. To estimate the effects that present and alternative landscaping practices and land use patterns may have on urban stormwater quantity and quality, simulations of existing land use/land cover using the Regional Hydro-Ecologic Simulation System (RHESSys), a process-based surface hydrology and biogeochemistry model, were developed for watersheds in Baltimore, MD (as part of the Baltimore Ecosystem Study (BES) NSF Long-Term Ecological Research (LTER) site) and Durham, NC (as part of the NSF Urban Long-Term Research Area (ULTRA) program). The influence of land use patterns and landscaping practices on nutrient export in urban watersheds has been explored as part of the BES; this work has focused on improving our understanding of how residential landscaping practices (i.e. lawn fertilization rates) vary across land use and socioeconomic gradients. Elsewhere, others have explored the political ecology of residential landscaping practices - seeking to understand the economic, political, and cultural influences on the practice of high-input residential turf-grass management. Going forward, my research will synthesize and extend this prior work. Rather than pre-supposing predominant residential land use patterns and landscaping practices (i.e. lower-density periphery development incorporating high-input turf landscapes) alternate land use and landscaping scenarios (e.g. higher-density/transit-oriented development, rain gardens, vegetable gardens, native plant/xeriscaping) will be developed through interviews/focus groups with stakeholders (citizens, public officials, developers, non-profits). These scenarios will then be applied to the RHESSys models already developed for catchments in Baltimore and Durham. The modeled scenario results will be used to identify alternate land use patterns and landscaping practices that would: (1) help to reduce non-point sources of nutrient pollution in urban watersheds; and (2) be likely to gain public support. This research will inform sustainable development policy while furthering interdisciplinary research in the fields of planning and water resource management.

Counselling practices in community pharmacies in Riyadh, Saudi Arabia: a cross-sectional study.

PubMed

Alaqeel, Sinaa; Abanmy, Norah O

2015-12-15

Community pharmacists play a crucial role in optimising medication use and improving patient outcomes, whilst preventing medication misuse and reducing costs. Evidence suggests that pharmacists counselling improves clinical outcomes, quality of life, drug and disease knowledge and reduces health service utilisation. This study aims to investigate the counselling practices of community pharmacists in Riyadh, the capital of Saudi Arabia. The study consisted of two parts: simulated patients (SPs) visits to observe actual counselling practices, and a cross-sectional survey of community pharmacists to assess their reported counselling practices. In the SPs method, there were four scenarios involving four medications. Scenarios 1 and 2 concerned drug-drug interactions, scenario 3 concerned the proper time of administration, and scenario 4 concerned side effects. The simulated visits were conducted between April and May 2012. A four-sections questionnaire was distributed in the same period. We conducted 161 simulated visits. Out of the 161 visits a medicine was dispensed in 150 visits. When SPs requested medications, pharmacists asked questions during 15 visits (10.0%), provided information during 7 visits (4.6%), and both asked questions and provided information, i.e. provided counselling, during 4 visits (2.6%). When the SPs started to be inquisitive and demanded information, pharmacists asked SPs questions during 71 visits (47.3%), provided information during 150 visits (100%), and both asked questions and provided information, i.e. provided counselling, during 65 visits (43.3%). Information regarding dose was the most common type of information provided in 146 visits (97.3%). After the SPs started to be inquisitive and probed for information, only 10% were counselled on precautions. In the cross-sectional survey, four hundred pharmacists were approached and 350 agreed to participate in the questionnaire (87% response rate). Of the respondents, 223 (63.7%) reported that they usually or always tell the patient about the purpose of medicines or the diagnosis, 302 (86.2%) reported that they usually or always give patient information on how to use or apply the medicine; 299 (85.3%) said they were satisfied with their counselling practices. The present study highlights the current deficiencies in appropriate dispensing practices and medication counselling at community pharmacies in Saudi Arabia. Policy makers, stakeholders, and researchers should collaborate to design interventions to improve the current dispensing practices at community pharmacies across the country.

Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study.

PubMed

Egenberg, Signe; Masenga, Gileard; Bru, Lars Edvin; Eggebø, Torbjørn Moe; Mushi, Cecilia; Massay, Deodatus; Øian, Pål

2017-09-05

Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome. This quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants. To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression. The random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with the time period (pre- vs. post-training), cesarean section, patients tranferred from other hospitals, maternal age, and female genital mutilation and cutting. We found that multi-professional, scenario-based training was associated with a significant, 47% reduction in whole blood transfusion rates. These results suggested that training that included all levels of maternity staff, repeated sessions with realistic scenarios, and debriefing may have contributed to reduced blood transfusion rates in this high-risk maternity setting.

Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses.

PubMed

Franklin, Ashley E; Burns, Paulette; Lee, Christopher S

2014-10-01

In 2006, the National League for Nursing published three measures related to novice nurses' beliefs about self-confidence, scenario design, and educational practices associated with simulation. Despite the extensive use of these measures, little is known about their reliability and validity. The psychometric properties of the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire were studied among a sample of 2200 surveys completed by novice nurses from a liberal arts university in the southern United States. Psychometric tests included item analysis, confirmatory and exploratory factor analyses in randomly-split subsamples, concordant and discordant validity, and internal consistency. All three measures have sufficient reliability and validity to be used in education research. There is room for improvement in content validity with the Student Satisfaction and Self-Confidence in Learning and Simulation Design Scale. This work provides robust evidence to ensure that judgments made about self-confidence after simulation, simulation design and educational practices are valid and reliable. Copyright © 2014 Elsevier Ltd. All rights reserved.

Community Solar Scenario Tool | Integrated Energy Solutions | NREL

Science.gov Websites

Community Solar Scenario Tool Community Solar Scenario Tool The Community Solar Scenario Tool (CSST ) provides a "first cut" analysis of different community or shared solar program options. NREL sponsoring utility. Community Solar Scenario Tool -Beta Version Available as a Microsoft Excel file, which

ACR Appropriateness Criteria® Chronic Ankle Pain.

PubMed

Chang, Eric Y; Tadros, Anthony S; Amini, Behrang; Bell, Angela M; Bernard, Stephanie A; Fox, Michael G; Gorbachova, Tetyana; Ha, Alice S; Lee, Kenneth S; Metter, Darlene F; Mooar, Pekka A; Shah, Nehal A; Singer, Adam D; Smith, Stacy E; Taljanovic, Mihra S; Thiele, Ralf; Kransdorf, Mark J

2018-05-01

Chronic ankle pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic ankle pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

ACR Appropriateness Criteria® Chronic Hip Pain.

PubMed

Mintz, Douglas N; Roberts, Catherine C; Bencardino, Jenny T; Baccei, Steven J; Caird, Michelle S; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Gyftopoulos, Soterios; Kransdorf, Mark J; Metter, Darlene F; Morrison, William B; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Subhas, Naveen; Tambar, Siddharth; Towers, Jeffrey D; Yu, Joseph S; Weissman, Barbara N

2017-05-01

Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

An integrated approach for the management of demolition waste in Cyprus.

PubMed

Kourmpanis, Basilis; Papadopoulos, Achilleas; Moustakas, Konstantinos; Kourmoussis, Fotis; Stylianou, Marinos; Loizidou, Maria

2008-12-01

This study investigated the generation and management of demolition waste (DW) in Cyprus. A methodology has been developed and applied for the estimation of the quantities of the waste stream under examination, since quantitative primary data were not available. The existing situation relating to the practices applied for the management of DW was investigated and assessed. Furthermore, a multi-criteria analysis method (PROMETHEE II) was developed and applied in order to examine alternative systems that could be implemented for the management of the DW in the country. In particular, nine management systems (scenarios) were examined, evaluated and ranked according to their efficiency using seventeen individual criteria, divided into four groups (social-legislative, environmental, economic and technical). The ranking of the alternative waste management scenarios indicated that the optimum management system for possible implementation in the island included complete selective demolition procedures and transfer of mixed recyclable materials to the recycling centre and non-recyclable material to landfill.

Regional forestry practices and forest management certification

Treesearch

Steverson O. Moffat; Frederick W. Cubbage; Matthew H. Pelkki

2001-01-01

Under a "mandated" management scenario, landowners in states with comprehensive forest practices laws meet more sustainable forestry standards and certification programs' guidelines than do owners in states with other regulatory approaches. This confers certification advantages to landowners in the Pacific Northwest where comprehensive forest laws...

Mind Map Our Way into Effective Student Questioning: a Principle-Based Scenario

NASA Astrophysics Data System (ADS)

Stokhof, Harry; de Vries, Bregje; Bastiaens, Theo; Martens, Rob

2017-07-01

Student questioning is an important self-regulative strategy and has multiple benefits for teaching and learning science. Teachers, however, need support to align student questioning to curricular goals. This study tests a prototype of a principle-based scenario that supports teachers in guiding effective student questioning. In the scenario, mind mapping is used to provide both curricular structure as well as support for student questioning. The fidelity of structure and the process of implementation were verified by interviews, video data and a product collection. Results show that the scenario was relevant for teachers, practical in use and effective for guiding student questioning. Results also suggest that shared responsibility for classroom mind maps contributed to more intensive collective knowledge construction.

EM in high-dimensional spaces.

PubMed

Draper, Bruce A; Elliott, Daniel L; Hayes, Jeremy; Baek, Kyungim

2005-06-01

This paper considers fitting a mixture of Gaussians model to high-dimensional data in scenarios where there are fewer data samples than feature dimensions. Issues that arise when using principal component analysis (PCA) to represent Gaussian distributions inside Expectation-Maximization (EM) are addressed, and a practical algorithm results. Unlike other algorithms that have been proposed, this algorithm does not try to compress the data to fit low-dimensional models. Instead, it models Gaussian distributions in the (N - 1)-dimensional space spanned by the N data samples. We are able to show that this algorithm converges on data sets where low-dimensional techniques do not.

Towards Sustainable Integrated Watershed Ecosystem Management: A Case Study in Dingxi on the Loess Plateau, China

NASA Astrophysics Data System (ADS)

Chen, Liding; Yang, Lei; Wei, Wei; Wang, Ziting; Mo, Baoru; Cai, Guojun

2013-01-01

The Chinese government initiated a massive conservation program called "Grain-for-Green" in 1999 to reduce soil erosion and improve ecosystem function. Implementing practical sustainable development in the loess plateau still remains problematic, particularly in its eco-fragile areas. Here we discussed an approach for sustainable development at the watershed scale by integrating land use suitability, ecosystem services and public participation in the loess hilly area. We linked land use scenario analysis and economic modeling to compare the outcomes of three scenarios, CLU (Current Land Use), GOLU (Grain-production Oriented Land Use) and PSLU (Potential Sustainable Land Use). The results indicated that compared to PSLU, GOLU may provide a higher economic productivity in the short-term, but not in the long-term. CLU ranked lowest in terms of economic benefits and did not meet the daily needs of the local farmers. To reconcile the land use adjustments with farmers' basic needs, a labor-saving land use strategy is necessary. Since the PSLU scenario assumes that slope cropland should be converted to pastures or orchards, more time may be available for off-farm work and for more public participation in integrated ecosystem management. Financial support to the local farmers for environmental conservation should be modulated in function of their positive contribution to ecosystem management.

Quantifying Anthropogenic Stress on Groundwater Resources.

PubMed

Ashraf, Batool; AghaKouchak, Amir; Alizadeh, Amin; Mousavi Baygi, Mohammad; R Moftakhari, Hamed; Mirchi, Ali; Anjileli, Hassan; Madani, Kaveh

2017-10-10

This study explores a general framework for quantifying anthropogenic influences on groundwater budget based on normalized human outflow (h out ) and inflow (h in ). The framework is useful for sustainability assessment of groundwater systems and allows investigating the effects of different human water abstraction scenarios on the overall aquifer regime (e.g., depleted, natural flow-dominated, and human flow-dominated). We apply this approach to selected regions in the USA, Germany and Iran to evaluate the current aquifer regime. We subsequently present two scenarios of changes in human water withdrawals and return flow to the system (individually and combined). Results show that approximately one-third of the selected aquifers in the USA, and half of the selected aquifers in Iran are dominated by human activities, while the selected aquifers in Germany are natural flow-dominated. The scenario analysis results also show that reduced human withdrawals could help with regime change in some aquifers. For instance, in two of the selected USA aquifers, a decrease in anthropogenic influences by ~20% may change the condition of depleted regime to natural flow-dominated regime. We specifically highlight a trending threat to the sustainability of groundwater in northwest Iran and California, and the need for more careful assessment and monitoring practices as well as strict regulations to mitigate the negative impacts of groundwater overexploitation.

A risk explicit interval linear programming model for uncertainty-based environmental economic optimization in the Lake Fuxian watershed, China.

PubMed

Zhang, Xiaoling; Huang, Kai; Zou, Rui; Liu, Yong; Yu, Yajuan

2013-01-01

The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of "low risk and high return efficiency" in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management.

A Risk Explicit Interval Linear Programming Model for Uncertainty-Based Environmental Economic Optimization in the Lake Fuxian Watershed, China

PubMed Central

Zou, Rui; Liu, Yong; Yu, Yajuan

2013-01-01

The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of “low risk and high return efficiency” in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management. PMID:24191144

Longitudinal data subject to irregular observation: A review of methods with a focus on visit processes, assumptions, and study design.

PubMed

Pullenayegum, Eleanor M; Lim, Lily Sh

2016-12-01

When data are collected longitudinally, measurement times often vary among patients. This is of particular concern in clinic-based studies, for example retrospective chart reviews. Here, typically no two patients will share the same set of measurement times and moreover, it is likely that the timing of the measurements is associated with disease course; for example, patients may visit more often when unwell. While there are statistical methods that can help overcome the resulting bias, these make assumptions about the nature of the dependence between visit times and outcome processes, and the assumptions differ across methods. The purpose of this paper is to review the methods available with a particular focus on how the assumptions made line up with visit processes encountered in practice. Through this we show that no one method can handle all plausible visit scenarios and suggest that careful analysis of the visit process should inform the choice of analytic method for the outcomes. Moreover, there are some commonly encountered visit scenarios that are not handled well by any method, and we make recommendations with regard to study design that would minimize the chances of these problematic visit scenarios arising. © The Author(s) 2014.

Practical secure quantum communications

NASA Astrophysics Data System (ADS)

Diamanti, Eleni

2015-05-01

We review recent advances in the field of quantum cryptography, focusing in particular on practical implementations of two central protocols for quantum network applications, namely key distribution and coin flipping. The former allows two parties to share secret messages with information-theoretic security, even in the presence of a malicious eavesdropper in the communication channel, which is impossible with classical resources alone. The latter enables two distrustful parties to agree on a random bit, again with information-theoretic security, and with a cheating probability lower than the one that can be reached in a classical scenario. Our implementations rely on continuous-variable technology for quantum key distribution and on a plug and play discrete-variable system for coin flipping, and necessitate a rigorous security analysis adapted to the experimental schemes and their imperfections. In both cases, we demonstrate the protocols with provable security over record long distances in optical fibers and assess the performance of our systems as well as their limitations. The reported advances offer a powerful toolbox for practical applications of secure communications within future quantum networks.

Strategic Analysis Overview

NASA Technical Reports Server (NTRS)

Cirillo, William M.; Earle, Kevin D.; Goodliff, Kandyce E.; Reeves, J. D.; Stromgren, Chel; Andraschko, Mark R.; Merrill, R. Gabe

2008-01-01

NASA s Constellation Program employs a strategic analysis methodology in providing an integrated analysis capability of Lunar exploration scenarios and to support strategic decision-making regarding those scenarios. The strategic analysis methodology integrates the assessment of the major contributors to strategic objective satisfaction performance, affordability, and risk and captures the linkages and feedbacks between all three components. Strategic analysis supports strategic decision making by senior management through comparable analysis of alternative strategies, provision of a consistent set of high level value metrics, and the enabling of cost-benefit analysis. The tools developed to implement the strategic analysis methodology are not element design and sizing tools. Rather, these models evaluate strategic performance using predefined elements, imported into a library from expert-driven design/sizing tools or expert analysis. Specific components of the strategic analysis tool set include scenario definition, requirements generation, mission manifesting, scenario lifecycle costing, crew time analysis, objective satisfaction benefit, risk analysis, and probabilistic evaluation. Results from all components of strategic analysis are evaluated a set of pre-defined figures of merit (FOMs). These FOMs capture the high-level strategic characteristics of all scenarios and facilitate direct comparison of options. The strategic analysis methodology that is described in this paper has previously been applied to the Space Shuttle and International Space Station Programs and is now being used to support the development of the baseline Constellation Program lunar architecture. This paper will present an overview of the strategic analysis methodology and will present sample results from the application of the strategic analysis methodology to the Constellation Program lunar architecture.

The use of multi criteria analysis to compare the operating scenarios of the hybrid generation system of wind turbines, photovoltaic modules and a fuel cell

NASA Astrophysics Data System (ADS)

Ceran, Bartosz

2017-11-01

The paper presents the results of the use of multi-criteria analysis to compare hybrid power generation system collaboration scenarios (HSW) consisting of wind turbines, solar panels and energy storage electrolyzer - PEM type fuel cell with electricity system. The following scenarios were examined: the base S-I-hybrid system powers the off-grid mode receiver, S-II, S-III, S-IV scenarios-electricity system covers 25%, 50%, 75% of energy demand by the recipient. The effect of weights of the above-mentioned criteria on the final result of the multi-criteria analysis was examined.

Twelve Best Practices for Early Childhood Education: Integrating Reggio and Other Inspired Approaches. Early Childhood Education Series

ERIC Educational Resources Information Center

Lewin-Benham, Ann

2011-01-01

In her new book, popular author Ann Lewin-Benham draws on her intimate knowledge and experience with the Reggio Approach to present 12 "best practices" inspired not only by Reggio, but also by play-based and Montessori approaches to early childhood education. These practices are demonstrated, one per chapter, with scenarios from classrooms,…

Approximating the Practice of Mathematics Teaching: What Learning Can Web-Based, Multimedia Storyboarding Software Enable?

ERIC Educational Resources Information Center

Herbst, Patricio; Chieu, Vu-Minh; Rougée, Annick

2014-01-01

This paper builds on Grossman's notion of approximations of practice as scaled-down opportunities for preservice teachers to learn to teach by doing. The authors propose the use of media rich, collaborative web-authoring tools for preservice teachers to create, complete, or edit scenarios in which they practice particular activities of teaching,…

Radiology applications of financial accounting.

PubMed

Leibenhaut, Mark H

2005-03-01

A basic knowledge of financial accounting can help radiologists analyze business opportunities and examine the potential impacts of new technology or predict the adverse consequences of new competitors entering their service area. The income statement, balance sheet, and cash flow statement are the three basic financial statements that document the current financial position of the radiology practice and allow managers to monitor the ongoing financial operations of the enterprise. Pro forma, or hypothetical, financial statements can be generated to predict the financial impact of specific business decisions or investments on the profitability of the practice. Sensitivity analysis, or what-if scenarios, can be performed to determine the potential impact of changing key revenue, investment, operating cost or financial assumptions. By viewing radiology as both a profession and a business, radiologists can optimize their use of scarce economic resources and maximize the return on their financial investments.

Overview of the Hydrogen Financial Analysis Scenario Tool (H2FAST); NREL (National Renewable Energy Laboratory)

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

Melaina, Marc; Bush, Brian; Penev, Michael

This presentation provides an introduction to the Hydrogen Financial Analysis Scenario Tool (H2FAST) and includes an overview of each of the three versions of H2FAST: the Web tool, the Excel spreadsheet version, and the beta version of the H2FAST Business Case Scenario tool.

Annual Technology Baseline and Standard Scenarios | Energy Analysis | NREL

Science.gov Websites

electric sector analysis in the United States. NREL analysts consistently apply the products of this work Scenarios Annual Report and A U.S. Electric Sector Outlook - This annual report presents an outlook of the U.S. electricity sector based on a suite of standard scenarios with their associated assumptions

New Strategies for Delivering Library Resources to Users: Rethinking the Mechanisms in which Libraries Are Processing and Delivering Bibliographic Records

ERIC Educational Resources Information Center

El-Sherbini, Magda; Wilson, Amanda J

2007-01-01

The focus of this paper is to examine the current library practice of processing and delivering information and to introduce alternative scenarios that may keep librarians relevant in the technological era. In the scenarios presented here, the authors will attempt to challenge basic assumptions about the usefulness of and need for OPAC systems,…

Gathering Real World Evidence with Cluster Analysis for Clinical Decision Support.

PubMed

Xia, Eryu; Liu, Haifeng; Li, Jing; Mei, Jing; Li, Xuejun; Xu, Enliang; Li, Xiang; Hu, Gang; Xie, Guotong; Xu, Meilin

2017-01-01

Clinical decision support systems are information technology systems that assist clinical decision-making tasks, which have been shown to enhance clinical performance. Cluster analysis, which groups similar patients together, aims to separate patient cases into phenotypically heterogenous groups and defining therapeutically homogeneous patient subclasses. Useful as it is, the application of cluster analysis in clinical decision support systems is less reported. Here, we describe the usage of cluster analysis in clinical decision support systems, by first dividing patient cases into similar groups and then providing diagnosis or treatment suggestions based on the group profiles. This integration provides data for clinical decisions and compiles a wide range of clinical practices to inform the performance of individual clinicians. We also include an example usage of the system under the scenario of blood lipid management in type 2 diabetes. These efforts represent a step toward promoting patient-centered care and enabling precision medicine.

The DRG shift: a new twist for ICD-10 preparation.

PubMed

Long, Peri L

2012-06-01

Analysis of your specific business is a key component of ICD-10 implementation. An understanding of your organization's current reimbursement trends will go a long way to assessing and preparing for the impact of ICD-10 in your environment. If you cannot be prepared for each detailed scenario, remember that much of the analysis and resolution requires familiar coding, DRG analysis, and claims processing best practices. Now, they simply have the new twist of researching new codes and some new concepts. The news of a delay in the implementation compliance date, along with the release of grouper Version 29, should encourage your educational and business analysis efforts. This is a great opportunity to maintain open communication with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, and Centers for Disease Control. This is also a key time to report any unusual or discrepant findings in order to provide input to the final rule.

GetReal in network meta-analysis: a review of the methodology.

PubMed

Efthimiou, Orestis; Debray, Thomas P A; van Valkenhoef, Gert; Trelle, Sven; Panayidou, Klea; Moons, Karel G M; Reitsma, Johannes B; Shang, Aijing; Salanti, Georgia

2016-09-01

Pairwise meta-analysis is an established statistical tool for synthesizing evidence from multiple trials, but it is informative only about the relative efficacy of two specific interventions. The usefulness of pairwise meta-analysis is thus limited in real-life medical practice, where many competing interventions may be available for a certain condition and studies informing some of the pairwise comparisons may be lacking. This commonly encountered scenario has led to the development of network meta-analysis (NMA). In the last decade, several applications, methodological developments, and empirical studies in NMA have been published, and the area is thriving as its relevance to public health is increasingly recognized. This article presents a review of the relevant literature on NMA methodology aiming to pinpoint the developments that have appeared in the field. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

A Computer Simulation of Community Pharmacy Practice for Educational Use.

PubMed

Bindoff, Ivan; Ling, Tristan; Bereznicki, Luke; Westbury, Juanita; Chalmers, Leanne; Peterson, Gregory; Ollington, Robert

2014-11-15

To provide a computer-based learning method for pharmacy practice that is as effective as paper-based scenarios, but more engaging and less labor-intensive. We developed a flexible and customizable computer simulation of community pharmacy. Using it, the students would be able to work through scenarios which encapsulate the entirety of a patient presentation. We compared the traditional paper-based teaching method to our computer-based approach using equivalent scenarios. The paper-based group had 2 tutors while the computer group had none. Both groups were given a prescenario and postscenario clinical knowledge quiz and survey. Students in the computer-based group had generally greater improvements in their clinical knowledge score, and third-year students using the computer-based method also showed more improvements in history taking and counseling competencies. Third-year students also found the simulation fun and engaging. Our simulation of community pharmacy provided an educational experience as effective as the paper-based alternative, despite the lack of a human tutor.

[Variation in closeness to reality of standardized resuscitation scenarios : Effects on the success of cognitive learning of medical students].

PubMed

Schaumberg, A

2015-04-01

Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transfer goes beyond the mere exchange of soft skills and practical abilities and also includes practical knowledge and decision-making behavior; however, verification of knowledge or practical skills seldom unfolds during simulations. Simulation-based learning seems to affect many learning domains and can, therefore, be considered to be multifactorial in nature. At present, studies examining the effects of learning environments with varying levels of reality on the cognitive long-term retention of students are lacking. The present study focused on the question whether case scenarios with varying levels of reality produce differences in the cognitive long-term retention of students, in particular with regard to the learning dimensions knowledge, understanding and transfer. The study was conducted on 153 students in the first clinical semester at the Justus-Liebig University of Giessen. Students were randomly selected and subsequently assigned, also in a random fashion, to two practice groups, i.e. realistic and unrealistic. In both groups the students were presented with standardized case scenarios consisting of three case studies, which were accurately defined with a case report containing a detailed description of each scenario and all relevant values so as to ensure identical conditions for both groups. The unrealistic group sat in an unfurnished practice room as a learning environment. The realistic group sat in a furnished learning environment with various background pictures and ambient noise. Students received examination questions before, immediately following and 14 days after the practice. Examination questions were identical at each of the three time points, classified into three learning dimensions following Bloom's taxonomy and evaluated. Furthermore, examination questions were supplemented by a questionnaire concerning the individual perception of reality and own learning success, to be filled in by students immediately after the practice. Examination questions and questionnaires were anonymous but associated with each other. Even with less experienced participants, realistic simulation design led to a significant increase of knowledge immediately after the end of the simulation. This effect, however, did not impact the cognitive long-term retention of students. While the realistic group showed a higher initial knowledge after the simulation, this "knowledge delta" was forgotten within 14 days, putting them back on par with the unrealistic comparison group. It could be significantly demonstrated that 2 weeks after the practice, comprehension questions were answered better than those on pure knowledge. Therefore, it can be concluded that even vaguely realistic simulation scenarios affect the learning dimension of understanding. For simulation-based learning the outcome depends not only on knowledge, practical skills and motivational variables but also on the onset of negative emotions, perception of own ability and personality profile. Simulation training alone does not appear to guarantee learning success but it seems to be necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students.

SERA Scenarios of Early Market Fuel Cell Electric Vehicle Introductions: Modeling Framework, Regional Markets, and Station Clustering; NREL (National Renewable Energy Laboratory)

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

Melaina, M.

This presentation provides an overview of the Scenario Evaluation and Regionalization Analysis (SERA) model, describes the methodology for developing scenarios for hydrogen infrastructure development, outlines an example "Hydrogen Success" scenario, and discusses detailed scenario metrics for a particular case study region, the Northeast Corridor.

Eutrophication assessment and management methodology of multiple pollution sources of a landscape lake in North China.

PubMed

Chen, Yanxi; Niu, Zhiguang; Zhang, Hongwei

2013-06-01

Landscape lakes in the city suffer high eutrophication risk because of their special characters and functions in the water circulation system. Using a landscape lake HMLA located in Tianjin City, North China, with a mixture of point source (PS) pollution and non-point source (NPS) pollution, we explored the methodology of Fluent and AQUATOX to simulate and predict the state of HMLA, and trophic index was used to assess the eutrophication state. Then, we use water compensation optimization and three scenarios to determine the optimal management methodology. Three scenarios include ecological restoration scenario, best management practices (BMPs) scenario, and a scenario combining both. Our results suggest that the maintenance of a healthy ecosystem with ecoremediation is necessary and the BMPs have a far-reaching effect on water reusing and NPS pollution control. This study has implications for eutrophication control and management under development for urbanization in China.

Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

PubMed

Yip, Kenneth; Pang, Suk-King; Chan, Kui-Tim; Chan, Chi-Kuen; Lee, Tsz-Leung

2016-08-08

Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service.

Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial

PubMed Central

Lattimer, Val; Sassi, Franco; George, Steve; Moore, Michael; Turnbull, Joanne; Mullee, Mark; Smith, Helen

2000-01-01

Objective To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. Design Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. Setting General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. Subjects All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). Main outcome measures Costs and savings to the NHS during the trial year. Results The cost of providing nurse telephone consultation was £81 237 per annum. This, however, determined a £94 422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to £123 824 per annum. Savings of only £3728 would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of £16 928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call. Conclusions Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis. PMID:10764368

Self-consistent modeling of CFETR baseline scenarios for steady-state operation

NASA Astrophysics Data System (ADS)

Chen, Jiale; Jian, Xiang; Chan, Vincent S.; Li, Zeyu; Deng, Zhao; Li, Guoqiang; Guo, Wenfeng; Shi, Nan; Chen, Xi; CFETR Physics Team

2017-07-01

Integrated modeling for core plasma is performed to increase confidence in the proposed baseline scenario in the 0D analysis for the China Fusion Engineering Test Reactor (CFETR). The steady-state scenarios are obtained through the consistent iterative calculation of equilibrium, transport, auxiliary heating and current drives (H&CD). Three combinations of H&CD schemes (NB + EC, NB + EC + LH, and EC + LH) are used to sustain the scenarios with q min > 2 and fusion power of ˜70-150 MW. The predicted power is within the target range for CFETR Phase I, although the confinement based on physics models is lower than that assumed in 0D analysis. Ideal MHD stability analysis shows that the scenarios are stable against n = 1-10 ideal modes, where n is the toroidal mode number. Optimization of RF current drive for the RF-only scenario is also presented. The simulation workflow for core plasma in this work provides a solid basis for a more extensive research and development effort for the physics design of CFETR.

Virtual reality simulator for vitreoretinal surgery using integrated OCT data.

PubMed

Kozak, Igor; Banerjee, Pat; Luo, Jia; Luciano, Cristian

2014-01-01

Operative practice using surgical simulators has become a part of training in many surgical specialties, including ophthalmology. We introduce a virtual reality retina surgery simulator capable of integrating optical coherence tomography (OCT) scans from real patients for practicing vitreoretinal surgery using different pathologic scenarios.

Adjacent Channel Interference Reduction for M-WiMAX TDD and WCDMA FDD Coexistence by Utilizing Beamforming in M-WiMAX TDD System

NASA Astrophysics Data System (ADS)

Wang, Yupeng; Chang, Kyunghi

In this paper, we analyze the coexistence issues of M-WiMAX TDD and WCDMA FDD systems. Smart antenna techniques are applied to mitigate the performance loss induced by adjacent channel interference (ACI) in the scenarios where performance is heavily degraded. In addition, an ACI model is proposed to capture the effect of transmit beamforming at the M-WiMAX base station. Furthermore, a MCS-based throughput analysis is proposed, to jointly consider the effects of ACI, system packet error rate requirement, and the available modulation and coding schemes, which is not possible by using the conventional Shannon equation based analysis. From the results, we find that the proposed MCS-based analysis method is quite suitable to analyze the system theoretical throughput in a practical manner.

"By slapping their laps, the patient will know that you truly care for her": A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria.

PubMed

Bohren, Meghan A; Vogel, Joshua P; Tunçalp, Özge; Fawole, Bukola; Titiloye, Musibau A; Olutayo, Akinpelu Olanrewaju; Oyeniran, Agnes A; Ogunlade, Modupe; Metiboba, Loveth; Osunsan, Olubunmi R; Idris, Hadiza A; Alu, Francis E; Oladapo, Olufemi T; Gülmezoglu, A Metin; Hindin, Michelle J

2016-12-01

Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's "disobedience" and "uncooperativeness" during labor for her experience of mistreatment. Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

Developing a top-down land-use management procedure for fish habitat enhancement

NASA Astrophysics Data System (ADS)

Chiang, Li-Chi; Lin, Yu-Pin; Wu, Chen-Huan

2013-04-01

Land-use change can influence stream ecosystem and alter instream physical, chemical and biological habitat. For example, urbanization usually contributes to increasing sediment loadings to streams and inappropriate agricultural management results in degradation of stream water quality. Watershed model is an effective way to forecast the watershed response to different land-use change scenarios. We developed a top-down approach from the watershed scale to the microscale by combining the habitat model, land-use change model and watershed hydrological model. This approach can assist land-use planner to make optimal decisions with fish habitat enhancement. The study was conducted in Datuan Stream, located in Tamsui District, New Taipei City and the target species is monk goby (Sicyopterus japonicus). The spatially explicit land-use change model, CLUE-s was first applied to project several future land-use scenarios and the Soil and Water Assessment Tool (SWAT) was then applied to simulate streamflow for different land-use scenarios. The simulated streamflow were used as input data for simulating river habitat, where Habitat Suitability Analysis is one of the most important processes. The relationship between target species and multiple environmental factors of habitat was first developed using the Habitat suitability index (HSI). In this study, we used fish presence probabilities for each velocity and water depth to establish different HSI functions under 4 flow conditions (slack, riffle, pool and run) using genetic programming (GP). The physical habitat model, River 2D, was then applied to simulate the river section and calculate weighted usable area (WUA). Based on the WUA results for different land-use scenarios, we further evaluated the relationships between WUA and land-use/landscape patterns using a spatial pattern analysis program, Fragstats. The results showed that by using the habitat model for classified flows, the habitat suitability curve which reflects different activities of fish (ex: spawning, preying) is more practical. Moreover, the proposed land-use management procedure can be useful for future land-use planning with fish habitat conservation.

Metamodeling as a tool to size vegetative filter strips for surface runoff pollution control in European watersheds.

NASA Astrophysics Data System (ADS)

Lauvernet, Claire; Muñoz-Carpena, Rafael; Carluer, Nadia

2015-04-01

In Europe, a significant presence of contaminants is found in surface water, partly due to pesticide applications. Vegetative filter strips or buffer zones (VFS), often located along rivers, are a common best management practice (BMP) to reduce non point source pollution of water by reducing surface runoff. However, they need to be adapted to the agro-ecological and climatic conditions, both in terms of position and size, in order to be efficient. The TOPPS-PROWADIS project involves European experts and stakeholders to develop and recommend BMPs to reduce pesticide transfer by drift or runoff in several European countries. In this context, IRSTEA developed a guide accompanying the use of different tools, which allows designing site-specific VFS by simulating their efficiency to limit transfers using the mechanistic model VFSMOD. This method which is very complete assumes that the user provides detailed field knowledge and data, which are not always easily available. The aim of this study is to assist the buffer sizing by using a unique tool with a reduced set of parameters, adapted to the available information from the end-users. In order to fill in the lack of real data in many practical applications, a set of virtual scenarios was selected to encompass a large range of agro-pedo-climatic conditions in Europe, considering both the upslope agricultural field and the VFS characteristics. As a first step first, in this work we present scenarios based on North-West of France climate consisting of different rainfall intensities and durations, hillslope lengths and slopes, humidity conditions, a large set of field rainfall/runoff characteristics for the contributing area, and several shallow water table depths and soil types for the VFS. The sizing method based on the mechanistic model VFSMOD was applied for all these scenarios, and a global sensitivity analysis (GSA) of the VFS optimal length was performed for all the input parameters in order to understand their influence and interactions, and set priorities for data collecting and management. Based on GSA results, we compared several mathematical methods to compute the metamodel, and then validated it on an agricultural watershed with real data in the North-West of France. The analysis procedure allows for a robust and validated metamodel, before extending it on other climatic conditions in order to make the application on a large range of european watersheds possible. The tool will allow comparison of field scenarios, and to validate/improve actual existing placements and VFS sizing.

Interpreting the NLN Jeffries Framework in the context of Nurse Educator preparation.

PubMed

Young, Patricia K; Shellenbarger, Teresa

2012-08-01

The NLN Jeffries Framework describing simulation in nursing education has been used widely to guide construction of human patient simulation scenarios and serve as a theoretical framework for research on the use of simulation. This framework was developed with a focus on prelicensure nursing education. However, use of human patient simulation scenarios is also a way of providing practice experiences for graduate students learning the educator role. High-fidelity human patient simulation offers nurse educator faculty a unique opportunity to cultivate the practical knowledge of teaching in an interactive and dynamic environment. This article describes how the components of The NLN Jeffries Framework can help to guide simulation design for nurse educator preparation. Adapting the components of the framework-which include teacher, student, educational practices, design characteristics, and outcomes-helps to ensure that future faculty gain hands-on experience with nurse educator core competencies. Copyright 2012, SLACK Incorporated.

Variation in Treatment Recommendations for Dupuytren Disease.

PubMed

McMillan, Catherine; Yeung, Celine; Binhammer, Paul

2017-12-01

To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. Little agreement exists on treatment recommendations for common presentations of DD in this sample. Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Does raising type 1 error rate improve power to detect interactions in linear regression models? A simulation study.

PubMed

Durand, Casey P

2013-01-01

Statistical interactions are a common component of data analysis across a broad range of scientific disciplines. However, the statistical power to detect interactions is often undesirably low. One solution is to elevate the Type 1 error rate so that important interactions are not missed in a low power situation. To date, no study has quantified the effects of this practice on power in a linear regression model. A Monte Carlo simulation study was performed. A continuous dependent variable was specified, along with three types of interactions: continuous variable by continuous variable; continuous by dichotomous; and dichotomous by dichotomous. For each of the three scenarios, the interaction effect sizes, sample sizes, and Type 1 error rate were varied, resulting in a total of 240 unique simulations. In general, power to detect the interaction effect was either so low or so high at α = 0.05 that raising the Type 1 error rate only served to increase the probability of including a spurious interaction in the model. A small number of scenarios were identified in which an elevated Type 1 error rate may be justified. Routinely elevating Type 1 error rate when testing interaction effects is not an advisable practice. Researchers are best served by positing interaction effects a priori and accounting for them when conducting sample size calculations.

Content-oriented Approach to Organization of Theories and Its Utilization

NASA Astrophysics Data System (ADS)

Hayashi, Yusuke; Bourdeau, Jacqueline; Mizoguch, Riichiro

In spite of the fact that the relation between theory and practice is a foundation of scientific and technological development, the trend of increasing the gap between theory and practice accelerates in these years. The gap embraces a risk of distrust of science and technology. Ontological engineering as the content-oriented research is expected to contribute to the resolution of the gap. This paper presents the feasibility of organization of theoretical knowledge on ontological engineering and new-generation intelligent systems based on it through an application of ontological engineering in the area of learning/instruction support. This area also has the problem of the gap between theory and practice, and its resolution is strongly required. So far we proposed OMNIBUS ontology, which is a comprehensive ontology that covers different learning/instructional theories and paradigms, and SMARTIES, which is a theory-aware and standard-compliant authoring system for making learning/instructional scenarios based on OMNIBUS ontology. We believe the theory-awareness and standard-compliance bridge the gap between theory and practice because it links theories to practical use of standard technologies and enables practitioners to easily enjoy theoretical support while using standard technologies in practice. The following goals are set in order to achieve it; computers (1) understand a variety of learning/instructional theories based on the organization of them, (2) utilize the understanding for helping authors' learning/instructional scenario making and (3) make such theoretically sound scenarios interoperable within the framework of standard technologies. This paper suggests an ontological engineering solution to the achievement of these three goals. Although the evaluation is far from complete in terms of practical use, we believe that the results of this study address high-level technical challenges from the viewpoint of the current state of the art in the research area of artificial intelligence not only in education but also in general, and therefore we hope that constitute a substantial contribution for organization of theoretical knowledge in many other areas.

The management of thrombophilia during pregnancy: a Canadian survey.

PubMed

Rodger, Marc A; Carrier, Marc; Keely, Erin; Karovitch, Alan; Nimrod, Carl; Walker, Mark; Wells, Philip S

2002-12-01

To determine current Canadian practice patterns in the management of pregnant women with thrombophilia. Physician members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) who provide obstetrical care were invited to complete a closed-ended questionnaire in which they were presented 5 clinical scenarios involving thrombophilic pregnancies and asked to give their management recommendations. The 5 scenarios presented in the survey were of a pregnant woman with (1) asymptomatic factor V Leiden (FVL), (2) asymptomatic FVL and a family history of venous thromboembolism (VTE), (3) FVL and recurrent fetal loss, (4) FVL and a previous VTE, or (5) antiphospholipid antibody syndrome and recurrent fetal loss. Of the 1448 eligible SOGC members invited, 18 had moved with no forwarding address, and 662 (46.3% of the remainder) responded. The majority (65%) of the respondents were obstetricians and 51% of them had a university-affiliated practice. In scenario 1, 26% of physicians indicated they would recommend some form of antepartum thromboprophylaxis, whereas in the remaining four scenarios, 58% to 84% would definitely recommend antepartum thromboprophylaxis. Most clinicians favour intervening with thromboprophylaxis in pregnant thrombophilic women rather than observing without prophylaxis. This tendency spans a wide range of clinical scenarios, despite a lack of evidence to support such decisions. This survey highlights the need to provide clinicians and women with evidence for the safety and effectiveness of prophylaxis, before these interventions become the default recommendation by clinicians caring for this prevalent group of women.

An orthopedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views

PubMed Central

Chua, David; Jaglal, Susan B.; Schatzker, Joseph

1997-01-01

Objective To examine the reasons for practice variation in the treatment of displaced femoral neck fractures. Design A survey, asking surgeons to choose either hemiarthroplasty or internal fixation for 2 different female patients with a displaced femoral neck fracture. Setting The Canadian Orthopaedic Association Meeting, Halifax, May 1995. Patients The scenario in the first patient was of an independent 70-year-old woman with no pre-existing medical conditions. The scenario in the second patient was of a housebound 84-year-old woman with co-morbidity. Main outcome measures Proportion of surgeons choosing either hemiarthroplasty or internal fixation for each case scenario. Distribution of reasons to explain the treatment decision. Results Ninety-nine surgeons responded. For the case of the 70-year-old woman, 47% chose hemiarthroplasty and 53% chose internal fixation (p = 0.60), and for the 84-year-old woman, 96% chose hemiarthroplasty. These findings were consistent within the subgroups of teaching surgeons and community practice surgeons. Surgeons with 10 years or less of practice tended to favour hemiarthroplasty whereas those with more than 15 years’ practice favoured internal fixation. Important reasons for treatment choice were avoidance of reoperation in the hemiarthroplasty group (85%) and better hip function in the fixation group (83%), durability (83%) and ease of revision (77%). Conclusion The surgeon’s interpretation of the importance of reoperation and function underlies the differences in treatment decision regarding the management of femoral neck fractures in elderly patients. PMID:9267295

Land management practices to become important as biofuels use grows |

Science.gov Websites

Media Photos Videos Fact Sheets, Brochures and Reports Summer Science Writing Internship Land management , making land management practices increasingly important, especially under a scenario where cellulosic impact of agricultural land use and management on U.S. carbon budgets," recently published in the

Theoretical Insights for Practical Handling of Pressurized Fluids

ERIC Educational Resources Information Center

Aranda, Alfonso; Rodriguez, Maria del Prado

2006-01-01

The practical scenarios discussed in a chemistry or chemical engineering course that use solid or liquid reactants are presented. Important ideas to be considered when handling pressurized fluids are provided and three typical examples are described to enable students develop secondary skills such as the selective search of data, identification of…

Brief Counseling Scenarios from Fictional Characters for Counselors in Training

ERIC Educational Resources Information Center

Cook, Katrina

2018-01-01

To develop confidence and competence, student counselors need opportunities to practice applying their counseling skills. However, practicing on actual clients before counseling students are developmentally prepared not only can provoke anxiety within students but is also unethical. Counselor educators must find ways to help students practice…

Commentary: Minimizing Evaluation Misuse as Principled Practice

ERIC Educational Resources Information Center

Cousins, J. Bradley

2004-01-01

"Ethical Challenges," in my experience, is invariably interesting, often instructive and sometimes amusing. Some of the most engaging stimulus scenarios raise thorny evaluation practice issues that ultimately lead to disparate points of view about the nature of the issue and how to handle it (Datta, 2002; Smith, 2002). Despite my poor performance…

Agricultural conservation planning framework: 1. Developing multi-practice watershed planning scenarios and assessing nutrient reduction potential

USDA-ARS?s Scientific Manuscript database

We show that spatial data on soils, land use, and high-resolution topography, combined with knowledge of conservation practice effectiveness, can be leveraged to identify and assess alternatives to reduce nutrient discharge from small (HUC12) agricultural watersheds. Databases comprising soil attrib...

Combined and synergistic effects of climate change and urbanization on water quality in the Wolf Bay watershed, southern Alabama.

PubMed

Wang, Ruoyu; Kalin, Latif

2018-02-01

This study investigated potential changes in flow, total suspended solid (TSS) and nutrient (nitrogen and phosphorous) loadings under future climate change, land use/cover (LULC) change and combined change scenarios in the Wolf Bay watershed, southern Alabama, USA. Four Global Circulation Models (GCMs) under three Special Report Emission Scenarios (SRES) of greenhouse gas were used to assess the future climate change (2016-2040). Three projected LULC maps (2030) were employed to reflect different extents of urbanization in future. The individual, combined and synergistic impacts of LULC and climate change on water quantity/quality were analyzed by the Soil and Water Assessment Tool (SWAT). Under the "climate change only" scenario, monthly distribution and projected variation of TSS are expected to follow a pattern similar to streamflow. Nutrients are influenced both by flow and management practices. The variation of Total Nitrogen (TN) and Total Phosphorous (TP) generally follow the flow trend as well. No evident difference in the N:P ratio was projected. Under the "LULC change only" scenario, TN was projected to decrease, mainly due to the shrinkage of croplands. TP will increase in fall and winter. The N:P ratio shows a strong decreasing potential. Under the "combined change" scenario, LULC and climate change effect were considered simultaneously. Results indicate that if future loadings are expected to increase/decrease under any individual scenario, then the combined change will intensify that trend. Conversely, if their effects are in opposite directions, an offsetting effect occurs. Science-based management practices are needed to reduce nutrient loadings to the Bay. Copyright © 2017. Published by Elsevier B.V.

Attitudes of Austrian veterinarians towards euthanasia in small animal practice: impacts of age and gender on views on euthanasia.

PubMed

Hartnack, Sonja; Springer, Svenja; Pittavino, Marta; Grimm, Herwig

2016-02-04

Euthanasia of pets has been described by veterinarians as "the best and the worst" of the profession. The most commonly mentioned ethical dilemmas veterinarians face in small animal practice are: limited treatment options due to financial constraints, euthanizing of healthy animals and owners wishing to continue treatment of terminally ill animals. The aim of the study was to gain insight into the attitudes of Austrian veterinarians towards euthanasia of small animals. This included assessing their agreement with euthanasia in exemplified case scenarios, potentially predicted by demographic variables (e.g. gender, age, working in small animal practice, employment, working in a team, numbers of performed euthanasia). Further describing the veterinarians' agreement with a number of different normative and descriptive statements, including coping strategies. A questionnaire with nine euthanasia scenarios, 26 normative and descriptive statements, and demographic data were sent to all members of the Austrian Chamber of Veterinary Surgeons (n = 2478). In total, 486 veterinarians answered sufficiently completely to enable analyses. Responses were first explored descriptively before being formally analysed using linear regression and additive Bayesian networks - a multivariate regression methodology - in order to identify joint relationships between the demographic variables, the statements and each of the nine euthanasia scenarios. Mutual dependencies between the demographic variables were found, i.e. female compared to male veterinarians worked mostly in small animal practice, and working mostly in small animal practice was linked to performing more euthanasia per month. Gender and age were found to be associated with views on euthanasia: female veterinarians and veterinarians having worked for less years were more likely to disagree with euthanasia in at least some of the convenience euthanasia scenarios. The number of veterinarians working together was found to be the variable with the highest number of links to other variables, demographic as well as ethical statements. This highlights the role of a team potentially providing support in stressful situations. The results are useful for a better understanding of coping strategies for veterinarians with moral stress due to euthanasia of small animals.

Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study.

PubMed

Nosyk, Bohdan; Min, Jeong E; Lima, Viviane D; Hogg, Robert S; Montaner, Julio S G

2015-09-01

Widespread HIV screening and access to highly active antiretroviral treatment (ART) were cost effective in mathematical models, but population-level implementation has led to questions about cost, value, and feasibility. In 1996, British Columbia, Canada, introduced universal coverage of drug and other health-care costs for people with HIV/AIDS and and began extensive scale-up in access to ART. We aimed to assess the cost-effectiveness of ART scale-up in British Columbia compared with hypothetical scenarios of constrained treatment access. Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1997 to 2010. We estimated HIV incidence, prevalence, mortality, costs (in 2010 CAN$), and quality-adjusted life-years (QALYs) for the study period, which was 1997-2010. We calculated incremental cost-effectiveness ratios from societal and third-party-payer perspectives to compare actual practice (true numbers of individuals accessing ART) to scenarios of constrained expansion (75% and 50% probability of accessing ART). We also investigated structural and parameter uncertainty. Actual practice resulted in 263 averted incident cases compared with 75% of observed access and 676 averted cases compared with 50% of observed access to ART. From a third-party-payer perspective, actual practice resulted in incremental cost-effectiveness ratios of $23 679 per QALY versus 75% access and $24 250 per QALY versus 50% access. From a societal perspective, actual practice was cost saving within the study period. When the model was extended to 2035, current observed access resulted in cumulative savings of $25·1 million compared with the 75% access scenario and $65·5 million compared with the 50% access scenario. ART scale-up in British Columbia has decreased HIV-related morbidity, mortality, and transmission. Resulting incremental cost-effectiveness ratios for actual practice, derived within a limited timeframe, were within established cost-effectiveness thresholds and were cost saving from a societal perspective. BC Ministry of Health, National Institute of Drug Abuse at the US National Institutes of Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving Conflict Alert Performance Using Moving Target Detector Data.

DTIC Science & Technology

1982-06-01

2 L136 IIIII I lIlS 1 1 10 11120 125 11111I ~1.6 MICROCOPY RESOLUTION TEST CHART NATIONAL BUREAU Of SIANDARDg 19bi A DOT/FAA/RD-82/47 DOT/FAA/CT-81...Differences for Stochastic Case 23 7 Illustration of Scenarios for Warning Time Tests 30 8 Illustration of Scenarios Used for Nuisance Alert 35 Area...Nuisance Alert Area Analysis of Scenario 3 with a Target 64 Velocity of 480 Knots and SPMB= SPPB =2.8 nmi 12 Nuisance Alert Area Analysis of Scenario 3

Energy crops on landfills: functional, environmental, and costs analysis of different landfill configurations.

PubMed

Pivato, Alberto; Garbo, Francesco; Moretto, Marco; Lavagnolo, Maria Cristina

2018-02-09

The cultivation of energy crops on landfills represents an important challenge for the near future, as the possibility to use devalued sites for energy production is very attractive. In this study, four scenarios have been assessed and compared with respect to a reference case defined for northern Italy. The scenarios were defined taking into consideration current energy crops issues. In particular, the first three scenarios were based on energy maximisation, phytotreatment ability, and environmental impact, respectively. The fourth scenario was a combination of these characteristics emphasised by the previous scenarios. A multi-criteria analysis, based on economic, energetic, and environmental aspects, was performed. From the analysis, the best scenario resulted to be the fourth, with its ability to pursue several objectives simultaneously and obtain the best score relatively to both environmental and energetic criteria. On the contrary, the economic criterion emerges as weak, as all the considered scenarios showed some limits from this point of view. Important indications for future designs can be derived. The decrease of leachate production due to the presence of energy crops on the top cover, which enhances evapotranspiration, represents a favourable but critical aspect in the definition of the results.

Adaptation of farming practices could buffer effects of climate change on northern prairie wetlands

USGS Publications Warehouse

Voldseth, R.A.; Johnson, W.C.; Guntenspergen, G.R.; Gilmanov, T.; Millett, B.V.

2009-01-01

Wetlands of the Prairie Pothole Region of North America are vulnerable to climate change. Adaptation of farming practices to mitigate adverse impacts of climate change on wetland water levels is a potential watershed management option. We chose a modeling approach (WETSIM 3.2) to examine the effects of changes in climate and watershed cover on the water levels of a semi-permanent wetland in eastern South Dakota. Land-use practices simulated were unmanaged grassland, grassland managed with moderately heavy grazing, and cultivated crops. Climate scenarios were developed by adjusting the historical climate in combinations of 2??C and 4??C air temperature and ??10% precipitation. For these climate change scenarios, simulations of land use that produced water levels equal to or greater than unmanaged grassland under historical climate were judged to have mitigative potential against a drier climate. Water levels in wetlands surrounded by managed grasslands were significantly greater than those surrounded by unmanaged grassland. Management reduced both the proportion of years the wetland went dry and the frequency of dry periods, producing the most dynamic vegetation cycle for this modeled wetland. Both cultivated crops and managed grassland achieved water levels that were equal or greater than unmanaged grassland under historical climate for the 2??C rise in air temperature, and the 2??C rise plus 10% increase in precipitation scenarios. Managed grassland also produced water levels that were equal or greater than unmanaged grassland under historical climate for the 4??C rise plus 10% increase in precipitation scenario. Although these modeling results stand as hypotheses, they indicate that amelioration potential exists for a change in climate up to an increase of 2??C or 4??C with a concomitant 10% increase in precipitation. Few empirical data exist to verify the results of such land-use simulations; however, adaptation of farming practices is one possible mitigation avenue available for prairie wetlands. ?? 2009, The Society of Wetland Scientists.

Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses

PubMed Central

Rideout, Janice; Pritchett-Kelly, Sherry; McDonald, Melissa; Mullins-Richards, Paula; Dubrowski, Adam

2016-01-01

The use of simulation in medical training is quickly becoming more common, with applications in emergency, surgical, and nursing education. Recently, registered nurses working in surgical inpatient units requested a mock code simulation to practice skills, improve knowledge, and build self-confidence in a safe and controlled environment. A simulation scenario using a high-fidelity mannequin was developed and will be discussed herein. PMID:28123919

Assessing cost-effectiveness of bioretention on stormwater in response to climate change and urbanization for future scenarios

NASA Astrophysics Data System (ADS)

Wang, Mo; Zhang, Dongqing; Adhityan, Appan; Ng, Wun Jern; Dong, Jianwen; Tan, Soon Keat

2016-12-01

Bioretention, as a popular low impact development practice, has become more important to mitigate adverse impacts on urban stormwater. However, there is very limited information regarding ensuring the effectiveness of bioretention response to uncertain future challenges, especially when taking into consideration climate change and urbanization. The main objective of this paper is to identify the cost-effectiveness of bioretention by assessing the hydrology performance under future scenarios modeling. First, the hydrology model was used to obtain peak runoff and TSS loads of bioretention with variable scales under different scenarios, i.e., different Representative Concentration Pathways (RCPs) and Shared Socio-economic reference Pathways (SSPs) for 2-year and 10-year design storms in Singapore. Then, life cycle costing (LCC) and life cycle assessment (LCA) were estimated for bioretention, and the cost-effectiveness was identified under different scenarios. Our finding showed that there were different degree of responses to 2-year and 10-year design storms but the general patterns and insights deduced were similar. The performance of bioretenion was more sensitive to urbanization than that for climate change in the urban catchment. In addition, it was noted that the methodology used in this study was generic and the findings could be useful as reference for other LID practices in response to climate change and urbanization.

Novel Cooling Strategies for Military Training and Operations.

PubMed

Lee, Jason K W; Kenefick, Robert W; Cheuvront, Samuel N

2015-11-01

The deleterious effects of environmental heat stress, combined with high metabolic loads and protective clothing and equipment of the modern Warfighter, impose severe heat strain, impair task performance, and increase risk of heat illness, thereby reducing the chance for mission success. Despite the implementation of heat-risk mitigation procedures over the past decades, task performance still suffers and exertional heat illness remains a major military problem. We review 3 novel heat mitigation strategies that may be implemented in the training or operational environment to reduce heat strain and the risk of exertional heat illness. These strategies include ingestion of ice slurry, arm immersion cooling, and microclimate cooling. Each of these strategies is suitable for use in different scenarios and the choice of cooling strategy is contingent on the requirements, circumstances, and constraints of the training and operational scenario. Ingestion of ice slurry and arm immersion cooling are practical strategies that may be implemented during training scenarios; ice slurry can be ingested before and during exercise, whereas arm immersion cooling can be administered after exercise-heat exposure. In the operational environment, existing microclimate cooling can be implemented with retrofitted vehicles and as an unmounted system, and it has the potential for use in many military occupational scenarios. This review will discuss the efficacy, limitations, and practical considerations for field implementation of each strategy.

2nd Generation Reusable Launch Vehicle Potential Commercial Development Scenarios

NASA Technical Reports Server (NTRS)

Creech, Stephen D.; Rogacki, John R. (Technical Monitor)

2001-01-01

The presentation will discuss potential commercial development scenarios for a Second Generation Reusable Launch Vehicle. The analysis of potential scenarios will include commercial rates of return, government return on investment, and market considerations. The presentation will include policy considerations in addition to analysis of Second Generation Reusable Launch Vehicle economics. The data discussed is being developed as a part of NASA's Second Generation Reusable Launch Vehicle Program, for consideration as potential scenarios for enabling a next generation system. Material will include potential scenarios not previously considered by NASA or presented at other conferences. Candidate paper has not been presented at a previous meeting, and conference attendance of the author has been approved by NASA.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 3. Scenario Analysis.

DOT National Transportation Integrated Search

1979-09-01

This is the third volume of a six-volume report documenting the results of a study entitled "Benefit-Cost Analysis of Integrated Paratransit Systems." This volume provides detailed results of a series of scenario analyses designed to determine the im...

Model Performance Evaluation and Scenario Analysis (MPESA)

EPA Pesticide Factsheets

Model Performance Evaluation and Scenario Analysis (MPESA) assesses the performance with which models predict time series data. The tool was developed Hydrological Simulation Program-Fortran (HSPF) and the Stormwater Management Model (SWMM)

Critical, agentic and trans-media: Frameworks and findings from a foresight analysis exercise on audiences

PubMed Central

Das, Ranjana; Ytre-Arne, Brita

2017-01-01

We write this article presenting frameworks and findings from an international network on audience research, as we stand 75 years from Herta Herzog’s classic investigation of radio listeners, published in Lazarsfeld and Stanton’s 1944 war edition of Radio Research. The article aims to contribute to and advance a rich strand of self-reflexive stock-taking and sorting of future research priorities within the transforming field of audience analysis, by drawing on the collective efforts of CEDAR – Consortium on Emerging Directions in Audience Research – a 14-country network (2015–2018) funded by the Arts and Humanities Research Council, United Kingdom, which conducted a foresight analysis exercise on developing current trends and future scenarios for audiences and audience research in the year 2030. First, we wish to present the blueprint of what we did and how we did it – by discussing the questions, contexts and frameworks for our project. We hope this is useful for anyone considering a foresight analysis task, an approach we present as an innovative and rigorous tool for assessing and understanding the future of a field. Second, we present findings from our analysis of pivotal transformations in the field and the future scenarios we constructed for audiences, as media technologies rapidly change with the arrival of the Internet of Things and changes on many levels occur in audience practices. These findings not only make sense of a transformative decade that we have just lived through but they present possibilities for the future, outlining areas for individual and collective intellectual commitment. PMID:29276327

Economic analysis of atmospheric mercury emission control for coal-fired power plants in China.

PubMed

Ancora, Maria Pia; Zhang, Lei; Wang, Shuxiao; Schreifels, Jeremy; Hao, Jiming

2015-07-01

Coal combustion and mercury pollution are closely linked, and this relationship is particularly relevant in China, the world's largest coal consumer. This paper begins with a summary of recent China-specific studies on mercury removal by air pollution control technologies and then provides an economic analysis of mercury abatement from these emission control technologies at coal-fired power plants in China. This includes a cost-effectiveness analysis at the enterprise and sector level in China using 2010 as a baseline and projecting out to 2020 and 2030. Of the control technologies evaluated, the most cost-effective is a fabric filter installed upstream of the wet flue gas desulfurization system (FF+WFGD). Halogen injection (HI) is also a cost-effective mercury-specific control strategy, although it has not yet reached commercial maturity. The sector-level analysis shows that 193 tons of mercury was removed in 2010 in China's coal-fired power sector, with annualized mercury emission control costs of 2.7 billion Chinese Yuan. Under a projected 2030 Emission Control (EC) scenario with stringent mercury limits compared to Business As Usual (BAU) scenario, the increase of selective catalytic reduction systems (SCR) and the use of HI could contribute to 39 tons of mercury removal at a cost of 3.8 billion CNY. The economic analysis presented in this paper offers insights on air pollution control technologies and practices for enhancing atmospheric mercury control that can aid decision-making in policy design and private-sector investments. Copyright © 2015. Published by Elsevier B.V.

The no-project alternative analysis: An early product of the Tahoe Decision Support System

USGS Publications Warehouse

Halsing, David L.; Hessenflow, Mark L.; Wein, Anne

2005-01-01

We report on the development of a No-project alternative analysis (NPAA) or “business as usual” scenario with respect to a 20-year projection of 21 indicators of environmental and socioeconomic conditions in the Lake Tahoe Basin for the Tahoe Regional Planning Agency (TRPA). Our effort was inspired by earlier work that investigated the tradeoffs between an environmental and an economic objective. The NPAA study has implications for a longer term goal of building a Tahoe Decision Support System (TDSS) to assist the TRPA and other Basin agencies in assessing the outcomes of management strategies. The NPAA assumes no major deviations from current management practices or from recent environmental or societal trends and planned Environmental Improvement Program (EIP) projects. Quantitative “scenario generation” tools were constructed to simulate site-specific land uses, various population categories, and associated vehicle miles traveled. Projections of each indicator’s attainment status were made by building visual conceptual models of the relevant natural and social processes, extrapolating trends, and using available models, research, and expert opinion. We present results of the NPAA, projected indicator status, key factors affecting the indicators, indicator functionality, and knowledge gaps. One important result is that current management practices may slow the loss or degradation of environmental qualities but not halt or reverse it. Our analysis also predicts an increase in recreation and commuting into and within the basin, primarily in private vehicles. Private vehicles, which are a critical mechanism by which the Basin population affects the surrounding environment, are a key determinant of air-quality indicators, a source of particulate matter affecting Secchi depth, a source of noise, and a factor in recreational and scenic quality, largely owing to congestion. Key uncertainties in the NPAA include climate change, EIP project effectiveness, and external population, economic activity, and air pollution.

Scenario analysis of the future of medicines.

PubMed Central

Leufkens, H.; Haaijer-Ruskamp, F.; Bakker, A.; Dukes, G.

1994-01-01

Planning future policy for medicines poses difficult problems. The main players in the drug business have their own views as to how the world around them functions and how the future of medicines should be shaped. In this paper we show how a scenario analysis can provide a powerful teaching device to readjust peoples' preconceptions. Scenarios are plausible, not probable or preferable, portraits of alternative futures. A series of four of alternative scenarios were constructed: "sobriety in sufficiency," "risk avoidance," "technology on demand," and "free market unfettered." Each scenario was drawn as a narrative, documented quantitatively wherever possible, that described the world as it might be if particular trends were to dominate development. The medical community and health policy markers may use scenarios to take a long term view in order to be prepared adequately for the future. PMID:7987110

Application of risk analysis in water resourses management

NASA Astrophysics Data System (ADS)

Varouchakis, Emmanouil; Palogos, Ioannis

2017-04-01

A common cost-benefit analysis approach, which is novel in the risk analysis of hydrologic/hydraulic applications, and a Bayesian decision analysis are applied to aid the decision making on whether or not to construct a water reservoir for irrigation purposes. The alternative option examined is a scaled parabolic fine variation in terms of over-pumping violations in contrast to common practices that usually consider short-term fines. Such an application, and in such detail, represents new feedback. The results indicate that the probability uncertainty is the driving issue that determines the optimal decision with each methodology, and depending on the unknown probability handling, each methodology may lead to a different optimal decision. Thus, the proposed tool can help decision makers (stakeholders) to examine and compare different scenarios using two different approaches before making a decision considering the cost of a hydrologic/hydraulic project and the varied economic charges that water table limit violations can cause inside an audit interval. In contrast to practices that assess the effect of each proposed action separately considering only current knowledge of the examined issue, this tool aids decision making by considering prior information and the sampling distribution of future successful audits. This tool is developed in a web service for the easier stakeholders' access.

Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?

PubMed

Manns, Patricia J; Norton, Amy V; Darrah, Johanna

2015-04-01

Curricula changes in physical therapist education programs in Canada emphasize evidence-based practice skills, including literature retrieval and evaluation. Do graduates use these skills in practice? The aim of this study was to evaluate the use of research information in the clinical decision making of therapists with different years of experience and evidence-based practice preparation. Perceptions about evidence-based practice were explored qualitatively. A cross-sectional study with 4 graduating cohorts was conducted. Eighty physical therapists representing 4 different graduating cohorts participated in interviews focused on 2 clinical scenarios. Participants had varying years of clinical experience (range=1-15 years) and academic knowledge of evidence-based practice skills. Therapists discussed the effectiveness of interventions related to the scenarios and identified the sources of information used to reach decisions. Participants also answered general questions related to evidence-based practice knowledge. Recent graduates demonstrated better knowledge of evidence-based practice skills compared with therapists with 6 to 15 years of clinical experience. However, all groups used clinical experience most frequently as their source of information for clinical decisions. Research evidence was infrequently included in decision making. This study used a convenience sample of therapists who agreed to volunteer for the study. The results suggest a knowledge-to-practice gap; graduates are not using the new skills to inform their practice. Tailoring academic evidence-based activities more to the time constraints of clinical practice may help students to be more successful in applying evidence in practice. Academic programs need to do more to create and nurture environments in both academic and clinical settings to ensure students practice using evidence-based practice skills across settings. © 2015 American Physical Therapy Association.

What makes a good LOFT scenario? Issues in advancing current knowledge of scenario design. [Line Oriented Flight Training

NASA Technical Reports Server (NTRS)

Gregorich, Steven E.

1991-01-01

An effort is made to ascertain which combinations of technical demands and crew coordination should be incorporated in training scenarios in order to maximize the effectiveness of training for crew members. Such high-fidelity simulation, which has come to be known as 'line-oriented flight training' or LOFT, involves the practice of both technical and crew coordination skills in a realistic setting, in conjunction with periodic reviews of performance via videotaped feedback. Attention is given to the integration of appropriate information, the measurement of objective task demands, the character of information from LOFT students, and the leeway allowed LOFT instructors.

External Standards or Standard Addition? Selecting and Validating a Method of Standardization

NASA Astrophysics Data System (ADS)

Harvey, David T.

2002-05-01

A common feature of many problem-based laboratories in analytical chemistry is a lengthy independent project involving the analysis of "real-world" samples. Students research the literature, adapting and developing a method suitable for their analyte, sample matrix, and problem scenario. Because these projects encompass the complete analytical process, students must consider issues such as obtaining a representative sample, selecting a method of analysis, developing a suitable standardization, validating results, and implementing appropriate quality assessment/quality control practices. Most textbooks and monographs suitable for an undergraduate course in analytical chemistry, however, provide only limited coverage of these important topics. The need for short laboratory experiments emphasizing important facets of method development, such as selecting a method of standardization, is evident. The experiment reported here, which is suitable for an introductory course in analytical chemistry, illustrates the importance of matrix effects when selecting a method of standardization. Students also learn how a spike recovery is used to validate an analytical method, and obtain a practical experience in the difference between performing an external standardization and a standard addition.

Scheduling admissions and reducing variability in bed demand.

PubMed

Bekker, René; Koeleman, Paulien M

2011-09-01

Variability in admissions and lengths of stay inherently leads to variability in bed occupancy. The aim of this paper is to analyse the impact of these sources of variability on the required amount of capacity and to determine admission quota for scheduled admissions to regulate the occupancy pattern. For the impact of variability on the required number of beds, we use a heavy-traffic limit theorem for the G/G/∞ queue yielding an intuitively appealing approximation in case the arrival process is not Poisson. Also, given a structural weekly admission pattern, we apply a time-dependent analysis to determine the mean offered load per day. This time-dependent analysis is combined with a Quadratic Programming model to determine the optimal number of elective admissions per day, such that an average desired daily occupancy is achieved. From the mathematical results, practical scenarios and guidelines are derived that can be used by hospital managers and support the method of quota scheduling. In practice, the results can be implemented by providing admission quota prescribing the target number of admissions for each patient group.

Anticipatory Water Management in Phoenix using Advanced Scenario Planning and Analyses: WaterSim 5

NASA Astrophysics Data System (ADS)

Sampson, D. A.; Quay, R.; White, D. D.; Gober, P.; Kirkwood, C.

2013-12-01

Complexity, uncertainty, and variability are inherent properties of linked social and natural processes; sustainable resource management must somehow consider all three. Typically, a decision support tool (using scenario analyses) is used to examine management alternatives under suspected trajectories in driver variables (i.e., climate forcing's, growth or economic projections, etc.). This traditional planning focuses on a small set of envisioned scenarios whose outputs are compared against one-another in order to evaluate their differing impacts on desired metrics. Human cognition typically limits this to three to five scenarios. However, complex and highly uncertain issues may require more, often much more, than five scenarios. In this case advanced scenario analysis provides quantitative or qualitative methods that can reveal patterns and associations among scenario metrics for a large ensemble of scenarios. From this analysis, then, a smaller set of heuristics that describe the complexity and uncertainty revealed provides a basis to guide planning in an anticipatory fashion. Our water policy and management model, termed WaterSim, permits advanced scenario planning and analysis for the Phoenix Metropolitan Area. In this contribution we examine the concepts of advanced scenario analysis on a large scale ensemble of scenarios using our work with WaterSim as a case study. For this case study we created a range of possible water futures by creating scenarios that encompasses differences in water supplies (our surrogates for climate change, drought, and inherent variability in riverine flows), population growth, and per capital water consumption. We used IPCC estimates of plausible, future, alterations in riverine runoff, locally produced and vetted estimates of population growth projections, and empirical trends in per capita water consumption for metropolitan cities. This ensemble consisted of ~ 30, 700 scenarios (~575 k observations). We compared and contrasted two metropolitan communities that exhibit differing growth projections and water portfolios; moderate growth with a diverse portfolio versus high growth for a more restrictive portfolio. Results illustrate that both communities exhibited an expanding envelope of possible, future water outcomes with rational water management trajectories. However, a more diverse portfolio resulted in a broad, time-insensitive decision space for management interventions. The reverse was true for the more restrictive water portfolio with high growth projections.

Using Qualitative Hazard Analysis to Guide Quantitative Safety Analysis

NASA Technical Reports Server (NTRS)

Shortle, J. F.; Allocco, M.

2005-01-01

Quantitative methods can be beneficial in many types of safety investigations. However, there are many difficulties in using quantitative m ethods. Far example, there may be little relevant data available. This paper proposes a framework for using quantitative hazard analysis to prioritize hazard scenarios most suitable for quantitative mziysis. The framework first categorizes hazard scenarios by severity and likelihood. We then propose another metric "modeling difficulty" that desc ribes the complexity in modeling a given hazard scenario quantitatively. The combined metrics of severity, likelihood, and modeling difficu lty help to prioritize hazard scenarios for which quantitative analys is should be applied. We have applied this methodology to proposed concepts of operations for reduced wake separation for airplane operatio ns at closely spaced parallel runways.

Pharmaceutical company influences on medication prescribing and their potential impact on quality use of medicines.

PubMed

Kyle, G J; Nissen, L M; Tett, S E

2008-10-01

Pharmaceuticals are big business, reporting strong market growth year after year. The 'gatekeepers' of this market are prescribers of medicines, who are the major target of pharmaceutical companies, utilizing direct and indirect influences. This paper draws on previous research investigating pharmaceutical company prescribing influences to develop a qualitative model demonstrating the synergism between commercial influences on prescribing. The generic model was used to explore a realistic but hypothetical scenario to ascertain the applicability of the model. A generic influence model was developed. The model was readily able to be adapted to reflect a realistic practice scenario. Prescriber awareness of the linkages between various seemingly separate marketing techniques could potentially improve medicines usage in an evidence-based practice paradigm.

Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis.

PubMed

Tăut, Diana; Pintea, Sebastian; Roovers, Jan-Paul W R; Mañanas, Miguel-Angel; Băban, Adriana

2017-01-01

Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice. To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background. We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination. There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p <  0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects). While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness.

Insights into future air quality: a multipollutant analysis of future scenarios using the MARKAL model

EPA Science Inventory

In this presentation, we will provide an update on the development and evaluation of the Air Quality Futures (AQF) scenarios. These scenarios represent widely different assumptions regarding the evolution of the U.S. energy system over the next 40 years. The four AQF scenarios di...

Optical eye simulator for laser dazzle events.

PubMed

Coelho, João M P; Freitas, José; Williamson, Craig A

2016-03-20

An optical simulator of the human eye and its application to laser dazzle events are presented. The simulator combines optical design software (ZEMAX) with a scientific programming language (MATLAB) and allows the user to implement and analyze a dazzle scenario using practical, real-world parameters. Contrary to conventional analytical glare analysis, this work uses ray tracing and the scattering model and parameters for each optical element of the eye. The theoretical background of each such element is presented in relation to the model. The overall simulator's calibration, validation, and performance analysis are achieved by comparison with a simpler model based uponCIE disability glare data. Results demonstrate that this kind of advanced optical eye simulation can be used to represent laser dazzle and has the potential to extend the range of applicability of analytical models.

Variables affecting the financial viability of your practice.

PubMed

Binderman, J

2001-01-01

Financial viability of physician practices depends upon multiple variables: capacity of the practice, the mix of managed care contracts, cost of care, make-up of patient population, patient visit rates, and utilization of alternate methods of patient interaction. This article presents an introduction to these ideas; the second in this series will expand on the groundwork with a case scenario for a typical family practice. The articles present basic financial information in a practical manner, utilizing a series of worksheets to determine how these various items affect the bottom line.

MANEMO Routing in Practice: Protocol Selection, Expected Performance, and Experimental Evaluation

NASA Astrophysics Data System (ADS)

Tazaki, Hajime; van Meter, Rodney; Wakikawa, Ryuji; Wongsaardsakul, Thirapon; Kanchanasut, Kanchana; Dias de Amorim, Marcelo; Murai, Jun

Motivated by the deployment of post-disaster MANEMO (MANET for NEMO) composed of mobile routers and stations, we evaluate two candidate routing protocols through network simulation, theoretical performance analysis, and field experiments. The first protocol is the widely adopted Optimized Link State Routing protocol (OLSR) and the second is the combination of the Tree Discovery Protocol (TDP) with Network In Node Advertisement (NINA). To the best of our knowledge, this is the first time that these two protocols are compared in both theoretical and practical terms. We focus on the control overhead generated when mobile routers perform a handover. Our results confirm the correctness and operational robustness of both protocols. More interestingly, although in the general case OLSR leads to better results, TDP/NINA outperforms OLSR both in the case of sparse networks and in highly mobile networks, which correspond to the operation point of a large set of post-disaster scenarios.

Preservice Elementary Teachers' Instructional Practices and the Teaching Science as Argument Framework

NASA Astrophysics Data System (ADS)

Boyer, Elisebeth

2016-12-01

The research reported in this study examines the very first time the participants planned for and enacted science instruction within a "best-case scenario" teacher preparation program. Evidence from this study indicates that, within this context, preservice teachers are capable of implementing several of the discursive practices of science called for in standards documents including engaging students in science investigations and constructing evidence-based explanations. The participants designed experiences that allowed their students to interact with natural phenomena, gather evidence, and craft explanations of natural phenomenon. The study contends that the participants were able to achieve such successes due to their participation in a teacher education program and field placement, which were designed using a comprehensive, conceptual framework. Video of the participant's teaching and annotated self-analysis videos served as the primary data for this study. Implications for future research and elementary science teacher education are discussed.

Critical thinking: a two-phase framework.

PubMed

Edwards, Sharon L

2007-09-01

This article provides a comprehensive review of how a two-phase framework can promote and engage nurses in the concepts of critical thinking. Nurse education is required to integrate critical thinking in their teaching strategies, as it is widely recognised as an important part of student nurses becoming analytical qualified practitioners. The two-phase framework can be incorporated in the classroom using enquiry-based scenarios or used to investigate situations that arise from practice, for reflection, analysis, theorising or to explore issues. This paper proposes a two-phase framework for incorporation in the classroom and practice to promote critical thinking. Phase 1 attempts to make it easier for nurses to organise and expound often complex and abstract ideas that arise when using critical thinking, identify more than one solution to the problem by using a variety of cues to facilitate action. Phase 2 encourages nurses to be accountable and responsible, to justify a decision, be creative and innovative in implementing change.

Enhancing Trifocal Leadership Practices Using Simulation in a Pediatric Charge Nurse Orientation Program.

PubMed

Clark, Teresa J; Yoder-Wise, Patricia S

2015-07-01

A well-established charge nurse orientation program was enhanced with the addition of a simulation, addressing three primary populations (the trifocus) with whom charge nurses interact: patients, patients' parents, and other staff members. In this pilot quality improvement project, 20 staff nurses enrolled in the orientation program and were assigned a mentor. Only one participant used the mentorship opportunity; therefore, it is not discussed here. Twelve nurses completed all charge nurse classes and a simulation scenario of caring for a deteriorating infant. The nurses were given an opportunity to reflect on leadership practices after the simulation. Thematic analysis from qualitative, reflective data supported the enhanced understanding of managing complex patients, a code situation, and teams; guiding a team's novice nurse; leading as a charge nurse; and using clinical and critical thinking skills. All nurses reported that the simulation as experiential learning helped them to meet their leadership goals. Copyright 2015, SLACK Incorporated.

Scenario analysis and path selection of low-carbon transformation in China based on a modified IPAT model.

PubMed

Chen, Liang; Yang, Zhifeng; Chen, Bin

2013-01-01

This paper presents a forecast and analysis of population, economic development, energy consumption and CO2 emissions variation in China in the short- and long-term steps before 2020 with 2007 as the base year. The widely applied IPAT model, which is the basis for calculations, projections, and scenarios of greenhouse gases (GHGs) reformulated as the Kaya equation, is extended to analyze and predict the relations between human activities and the environment. Four scenarios of CO2 emissions are used including business as usual (BAU), energy efficiency improvement scenario (EEI), low carbon scenario (LC) and enhanced low carbon scenario (ELC). The results show that carbon intensity will be reduced by 40-45% as scheduled and economic growth rate will be 6% in China under LC scenario by 2020. The LC scenario, as the most appropriate and the most feasible scheme for China's low-carbon development in the future, can maximize the harmonious development of economy, society, energy and environmental systems. Assuming China's development follows the LC scenario, the paper further gives four paths of low-carbon transformation in China: technological innovation, industrial structure optimization, energy structure optimization and policy guidance.

Scenario Analysis and Path Selection of Low-Carbon Transformation in China Based on a Modified IPAT Model

PubMed Central

Chen, Liang; Yang, Zhifeng; Chen, Bin

2013-01-01

This paper presents a forecast and analysis of population, economic development, energy consumption and CO2 emissions variation in China in the short- and long-term steps before 2020 with 2007 as the base year. The widely applied IPAT model, which is the basis for calculations, projections, and scenarios of greenhouse gases (GHGs) reformulated as the Kaya equation, is extended to analyze and predict the relations between human activities and the environment. Four scenarios of CO2 emissions are used including business as usual (BAU), energy efficiency improvement scenario (EEI), low carbon scenario (LC) and enhanced low carbon scenario (ELC). The results show that carbon intensity will be reduced by 40–45% as scheduled and economic growth rate will be 6% in China under LC scenario by 2020. The LC scenario, as the most appropriate and the most feasible scheme for China’s low-carbon development in the future, can maximize the harmonious development of economy, society, energy and environmental systems. Assuming China's development follows the LC scenario, the paper further gives four paths of low-carbon transformation in China: technological innovation, industrial structure optimization, energy structure optimization and policy guidance. PMID:24204922

Association of Liability Concerns with Decisions to Order Echocardiography and Cardiac Stress Tests with Imaging.

PubMed

Kini, Vinay; Weiner, Rory B; McCarthy, Fenton H; Wiegers, Susan E; Kirkpatrick, James N

2016-12-01

Professional societies have made efforts to curb overuse of cardiac imaging and decrease practice variation by publishing appropriate use criteria. However, little is known about the impact of physician-level determinants such as liability concerns and risk aversion on decisions to order testing. A web-based survey was administered to cardiologists and general practice physicians affiliated with two academic institutions. The survey consisted of four clinical scenarios in which appropriate use criteria rated echocardiography or stress testing as "may be appropriate." Respondents' degree of liability concerns and risk aversion were measured using validated tools. The primary outcome variable was tendency to order imaging, calculated as the average likelihood to order an imaging test across the clinical scenarios (1 = very unlikely, 6 = very likely). Linear regression models were used to evaluate the association between tendency to order imaging and physician characteristics. From 420 physicians invited to participate, 108 complete responses were obtained (26% response rate, 54% cardiologists). There was no difference in tendency to order imaging between cardiologists and general practice physicians (3.46 [95% CI, 3.12-3.81] vs 3.15 [95% CI, 2.79-3.51], P = .22). On multivariate analysis, a higher degree of liability concerns was the only significant predictor of decisions to order imaging (mean difference in tendency to order imaging, 0.36; 95% CI, 0.09-0.62; P = .01). In clinical situations in which performance of cardiac imaging is rated as "may be appropriate" by appropriate use criteria, physicians with higher liability concerns ordered significantly more testing than physicians with lower concerns. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Indirect health costs in ulcerative colitis and Crohn's disease: a systematic review and meta-analysis.

PubMed

Kawalec, Paweł; Malinowski, Krzysztof Piotr

2015-04-01

The aim of this systematic review was to collect all current data on indirect costs related to inflammatory bowel disease as well as assessing homogeneity and comparability, and conducting a meta-analysis. Costs were collected using databases from Medline, Embase and Centre for Reviews and Dissemination databases, then average annual cost per patient was calculated and expressed in 2013-rate USD using the consumer price index and purchasing power parity (scenario 1) and then adjusted to specific gross domestic product (scenario 2) to make them comparable. The studies were then included in quantitative synthesis using the meta-analysis and bootstrap methods. This systematic review was carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. From 18 publications, overall annual indirect costs per patient as a result of the quantitative synthesis among all studies eligible for meta-analysis ranged from US$2425.01-US$9622.15 depending on the scenario and model used for analysis. The cost of presenteeism was assessed in only two studies. Considering heterogeneity among all identified studies random-effect model presented the most accurate results of meta-analysis equal to US$7189.27 and US$9622.15 per patient per year for scenario 1 and scenario 2, respectively. This systematic review revealed the existence of a relatively small number of studies that reported on the great economic burden of the disease upon society. A great variety of methodologies and cost components resulted in a very large discrepancy in indirect costs and made meta-analysis difficult to perform, so two scenarios were considered and meta-analysis conducted in subgroups to make data more comparable.

Design in Practice: Scenarios for Improving Management Education

ERIC Educational Resources Information Center

Schlenker, Lee; Chantelot, Sébastien

2014-01-01

Despite the increasing attention given to design in business, Design Thinking has had little impact on the quality of business school education. Building upon the foundations of long-standing critiques of management education and the potential for student-centric learning, the authors propose that the use of Design in Practice can significantly…

Accessibility-based evaluation of transportation and land-use planning : from laboratory to practice : USDOT Region V Regional University Transportation Center final report.

DOT National Transportation Integrated Search

2016-12-16

The concept of accessibility has made inroads into planning practice, largely at the system level. That is, accessibility is measured or modeled for current or future regional transportation and land-use scenarios for evaluation or broad policy guida...

Blooming Flowers: A Case for Developmentally Appropriate Practice

ERIC Educational Resources Information Center

Vengopal, Kalpana

2015-01-01

Early Childhood Education in India derives its premise from its sociocultural context. In spite of policies in place for developmentally and contextually appropriate Early Childhood Education, the practices are largely detrimental for this age group. The ray of hope, amidst such a scenario are a few initiatives, one such being the rural preschool…

Preservice Elementary Teachers' Instructional Practices and the Teaching Science as Argument Framework

ERIC Educational Resources Information Center

Boyer, Elisebeth

2016-01-01

The research reported in this study examines the very first time the participants planned for and enacted science instruction within a "best-case scenario" teacher preparation program. Evidence from this study indicates that, within this context, preservice teachers are capable of implementing several of the discursive practices of…

Scenario design and basic analysis of the National Data Centre Preparedness Exercise 2013

NASA Astrophysics Data System (ADS)

Ross, Ole; Ceranna, Lars; Hartmann, Gernot; Gestermann, Nicolai; Bönneman, Christian

2014-05-01

The Comprehensive Nuclear-Test-Ban Treaty (CTBT) prohibits all kinds of nuclear explosions. For the detection of treaty violations the International Monitoring System (IMS) operates stations observing seismic, hydroacoustic, and infrasound signals as well as radioisotopes in the atmosphere. While the IMS data is collected, processed and technically analyzed in the International Data Center (IDC) of the CTBT-Organization, National Data Centers (NDC) provide interpretation and advice to their government concerning suspicious detections occurring in IMS data. NDC Preparedness Exercises (NPE) are regularly performed dealing with fictitious treaty violations to practice the combined analysis of CTBT verification technologies and for the mutual exchange of information between NDC and also with the IDC. The NPE2010 and NPE2012 trigger scenarios were based on selected seismic events from the Reviewed Event Bulletin (REB) serving as starting point for fictitious Radionuclide dispersion. The main task was the identification of the original REB event and the discrimination between earthquakes and explosions as source. The scenario design of NPE2013 differs from those of previous NPEs. The waveform event selection is not constrained to events in the REB. The exercise trigger is a combination of a tempo-spatial indication pointing to a certain waveform event and simulated radionuclide concentrations generated by forward Atmospheric Transport Modelling based on a fictitious release. For the waveform event the date (4 Sept. 2013) is given and the region is communicated in a map showing the fictitious state of "Frisia" at the Coast of the North Sea in Central Europe. The synthetic radionuclide detections start in Vienna (8 Sept, I-131) and Schauinsland (11 Sept, Xe-133) with rather low activity concentrations and are most prominent in Stockholm and Spitsbergen mid of September 2013. Smaller concentrations in Asia follow later on. The potential connection between the waveform and radionuclide evidence remains unclear. The verification task is to identify the waveform event and to investigate potential sources of the radionuclide findings. Finally the potential conjunction between the sources and the CTBT-relevance of the whole picture has to be evaluated. The overall question is whether requesting an On-Site-Inspection in "Frisia" would be justified. The poster presents the NPE2013 scenario and gives a basic analysis of the initial situation concerning both waveform detections and atmospheric dispersion conditions in Central Europe in early September 2013. The full NPE2013 scenario will be presented at the NDC Workshop mid of May 2014.

RMP Guidance for Offsite Consequence Analysis

EPA Pesticide Factsheets

Offsite consequence analysis (OCA) consists of a worst-case release scenario and alternative release scenarios. OCA is required from facilities with chemicals above threshold quantities. RMP*Comp software can be used to perform calculations described here.

Assessing green waste route by using Network Analysis

NASA Astrophysics Data System (ADS)

Hasmantika, I. H.; Maryono, M.

2018-02-01

Green waste, such as waste from park need treat proper. One of the main problems of green waste management is how to design optimum collection. This research aims to determine the optimum green waste collection by determining optimum route among park. The route optimum was assessed by using network analysis method. And the region five of Semarang city’s park within 20 parks in chose as case study. To enhancing recycle of green waste, three scenarios of treatment are proposed. Scenario 1 used one integrated treatment facility as terminal for enhancing recycle of green waste, Scenario 2 used two sites and scenario 3 used three sites. According to the assessment, the length of route of scenario 1 is 36.126 km and the time for collection estimated is 46 minutes. In scenario 2, the length of route is 36.471 km with a travel time is 47 minutes. The length of scenario three is 46.934 km and the time of collection is 60 minutes.

Ethical checklist for dental practice.

PubMed

Rinchuse, D J; Rinchuse, D J; Deluzio, C

1995-01-01

A checklist for verification of unethical business practices, originally formulated by Drs. Blanchard and Peale, is adapted to dental practice. A scenario is used as a model to demonstrate the applicability of this instrument to dental practice. The instrument asks three questions in regards to an ethical dilemma: 1) Is it legal? 2) Is it fair? 3) How does it make you feel? The paper concludes the giving of gifts to general dentists by dental specialists for the referral of patients is unethical.

Scope of practice: freedom within limits.

PubMed

Schuiling, K D; Slager, J

2000-01-01

"Scope of practice" has a variety of meanings amongst midwives, other health professionals, health organizations, and consumers of midwifery care. For some, it refers to the Standards for the Practice of Midwifery; for others, it encompasses the legal base of practice; still others equate it with the components of the clinical parameters of practice. Because "scope of practice" is dynamic and parameters of practice can be impacted by many variables, succinctly defining "scope of practice" is difficult. This article provides a comprehensive discussion of the concept "scope of practice." Clinical scenarios are provided as case exemplars. The aim of this paper is to provide both new and experienced midwives with a substantive definition of the concept "scope of practice."

Hydrogen Financial Analysis Scenario Tool (H2FAST); NREL (National Renewable Energy Laboratory)

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

Melaina, Marc

This presentation describes the Hydrogen Financial Analysis Scenario Tool, H2FAST, and provides an overview of each of the three H2FAST formats: the H2FAST web tool, the H2FAST Excel spreadsheet, and the H2FAST Business Case Scenario (BCS) tool. Examples are presented to illustrate the types of questions that H2FAST can help answer.

NPE 2010 results - Independent performance assessment by simulated CTBT violation scenarios

NASA Astrophysics Data System (ADS)

Ross, O.; Bönnemann, C.; Ceranna, L.; Gestermann, N.; Hartmann, G.; Plenefisch, T.

2012-04-01

For verification of compliance to the Comprehensive Nuclear-Test-Ban Treaty (CTBT) the global International Monitoring System (IMS) is currently being built up. The IMS is designed to detect nuclear explosions through their seismic, hydroacoustic, infrasound, and radionuclide signature. The IMS data are collected, processed to analysis products, and distributed to the state signatories by the International Data Centre (IDC) in Vienna. The state signatories themselves may operate National Data Centers (NDC) giving technical advice concerning CTBT verification to the government. NDC Preparedness Exercises (NPE) are regularly performed to practice the verification procedures for the detection of nuclear explosions in the framework of CTBT monitoring. The initial focus of the NPE 2010 was on the component of radionuclide detections and the application of Atmospheric Transport Modeling (ATM) for defining the source region of a radionuclide event. The exercise was triggered by fictitious radioactive noble gas detections which were calculated beforehand secretly by forward ATM for a hypothetical xenon release scenario starting at location and time of a real seismic event. The task for the exercise participants was to find potential source events by atmospheric backtracking and to analyze in the following promising candidate events concerning their waveform signals. The study shows one possible way of solution for NPE 2010 as it was performed at German NDC by a team without precedent knowledge of the selected event and release scenario. The ATM Source Receptor Sensitivity (SRS) fields as provided by the IDC were evaluated in a logical approach in order to define probable source regions for several days before the first reported fictitious radioactive xenon finding. Additional information on likely event times was derived from xenon isotopic ratios where applicable. Of the considered seismic events in the potential source region all except one could be identified as earthquakes by seismological analysis. The remaining event at Black Thunder Mine, Wyoming, on 23 Oct at 21:15 UTC showed clear explosion characteristics. It caused also Infrasound detections at one station in Canada. An infrasonic one station localization algorithm led to event localization results comparable in precision to the teleseismic localization. However, the analysis of regional seismological stations gave the most accurate result giving an error ellipse of about 60 square kilometer. Finally a forward ATM simulation was performed with the candidate event as source in order to reproduce the original detection scenario. The ATM results showed a simulated station fingerprint in the IMS very similar to the fictitious detections given in the NPE 2010 scenario which is an additional confirmation that the event was correctly identified. The shown event analysis of the NPE 2010 serves as successful example for Data Fusion between the technology of radionuclide detection supported by ATM and seismological methodology as well as infrasound signal processing.

Scenario and multiple criteria decision analysis for energy and environmental security of military and industrial installations.

PubMed

Karvetski, Christopher W; Lambert, James H; Linkov, Igor

2011-04-01

Military and industrial facilities need secure and reliable power generation. Grid outages can result in cascading infrastructure failures as well as security breaches and should be avoided. Adding redundancy and increasing reliability can require additional environmental, financial, logistical, and other considerations and resources. Uncertain scenarios consisting of emergent environmental conditions, regulatory changes, growth of regional energy demands, and other concerns result in further complications. Decisions on selecting energy alternatives are made on an ad hoc basis. The present work integrates scenario analysis and multiple criteria decision analysis (MCDA) to identify combinations of impactful emergent conditions and to perform a preliminary benefits analysis of energy and environmental security investments for industrial and military installations. Application of a traditional MCDA approach would require significant stakeholder elicitations under multiple uncertain scenarios. The approach proposed in this study develops and iteratively adjusts a scoring function for investment alternatives to find the scenarios with the most significant impacts on installation security. A robust prioritization of investment alternatives can be achieved by integrating stakeholder preferences and focusing modeling and decision-analytical tools on a few key emergent conditions and scenarios. The approach is described and demonstrated for a campus of several dozen interconnected industrial buildings within a major installation. Copyright © 2010 SETAC.

Cervical bracing practices after degenerative cervical surgery: a survey of cervical spine research society members.

PubMed

Lunardini, David J; Krag, Martin H; Mauser, Nathan S; Lee, Joon Y; Donaldson, William H; Kang, James D

2018-05-21

Context: Prior studies have shown common use of post-operative bracing, despite advances in modern day instrumentation rigidity and little evidence of brace effectiveness. To document current practice patterns of brace use after degenerative cervical spine surgeries among members of the Cervical Spine Research Society (CSRS), to evaluate trends, and to identify areas of further study. A questionnaire survey METHODS: A 10 question survey was sent to members of the Cervical Spine Research Society to document current routine bracing practices after various common degenerative cervical spine surgical scenarios, including fusion and non-fusion procedures. The overall bracing rate was 67%. This included 8.4% who used a hard collar in each scenario. Twenty-two percent of surgeons never used a hard collar, while 34% never used a soft collar, and 3.6% (3 respondents) did not use a brace in any surgical scenario. Bracing frequency for specific surgical scenarios varied from 39% after foraminotomy to 88% after multi-level corpectomy with anterior & posterior fixation. After one, two and three level anterior cervical discectomy & fusion (ACDF), bracing rates were 58%, 65% and 76% for an average of 3.3, 4.3 and 5.3 weeks, respectively. After single level corpectomy, 77% braced for an average of 6.2 weeks. After laminectomy and fusion, 72% braced for an average of 5.4 weeks. Significant variation persists among surgeons on the type and length of post-operative brace usage after cervical spine surgeries. Overall rates of bracing have not changed significantly with time. Given the lack evidence in the literature to support bracing, reconsidering use of a brace after certain surgeries may be warranted. Copyright © 2018. Published by Elsevier Inc.

Modelling the dispersion of treated wastewater in a shallow coastal wind-driven environment, Geographe Bay, Western Australia: implications for environmental management.

PubMed

Dunn, Ryan J K; Zigic, Sasha; Shiell, Glenn R

2014-10-01

Numerical models are useful for predicting the transport and fate of contaminants in dynamic marine environments, and are increasingly a practical solution to environmental impact assessments. In this study, a three-dimensional hydrodynamic model and field data were used to validate a far-field dispersion model that, in turn, was used to determine the fate of treated wastewater (TWW) discharged to the ocean via a submarine ocean outfall under hypothetical TWW flows. The models were validated with respect to bottom and surface water current speed and direction, and in situ measurements of total nitrogen and faecal coliforms. Variations in surface and bottom currents were accurately predicted by the model as were nutrient and coliform concentrations. Results indicated that the ocean circulation was predominately wind driven, evidenced by relatively small oscillations in the current speeds along the time-scale of the tide, and that dilution mixing zones were orientated in a predominantly north-eastern direction from the outfall and parallel to the coastline. Outputs of the model were used to determine the 'footprint' of the TWW plume under a differing discharge scenario and, particularly, whether the resultant changes in TWW contaminants, total nitrogen and faecal coliforms would meet local environmental quality objectives (EQO) for ecosystem integrity, shellfish harvesting and primary recreation. Modelling provided a practical solution for predicting the dilution of contaminants under a hypothetical discharge scenario and a means for determining the aerial extent of exclusion zones, where the EQOs for shellfish harvesting and primary recreation may not always be met. Results of this study add to the understanding of regional discharge conditions and provide a practical case study for managing impacts to marine environments under a differing TWW discharge scenario, in comparison to an existing scenario.

Optometric supply and demand in Australia: 2001-2031.

PubMed

Kiely, Patricia M; Healy, Ernest; Horton, Peregrine; Chakman, Joseph

2008-07-01

Major influences on health workforce supply include factors such as graduate numbers, retention rates and immigration. This report presents a model of the relationship of the projected Australian optometric workforce and projected optometric service demand for the period 2001 to 2031. Two contrasting hypothetical optometric supply-side scenarios are presented. Data from the Australian Bureau of Statistics on age and gender of people listing optometry as their major qualification in the 2001 census were projected over a 30-year period, accounting for factors such as ageing, attrition, new graduates and migration. Data were compared to the numbers of optometrists calculated as necessary to meet the demand for services of the Australian population to 2031. The projections indicated that in 2031, there would be 4,072 equivalent full-time optometrists, an excess of 6.9 per cent compared with demand and that of these 38 per cent would be female. Application of a 'high' growth scenario, based on increases in the proportion of optometrists in active practice, working hours by females and graduate and immigrant numbers, resulted in a projected oversupply of up to 30 per cent. Use of a 'low' growth scenario, based on decreases in the proportion of optometrists in active practice, working hours, graduate and immigrant numbers, resulted in a projected undersupply of at least 21.5 per cent. Projected numbers of optometrists using current weightings for mortality, attrition, proportion of optometrists in active practice, working hours, immigration and new graduates indicate that in 2031, there will be adequate numbers of optometrists to meet the demand for services, if service utilisation is maintained at current levels or increased slightly. The adequacy of projected numbers varies considerably if alterations are made to the weighting factors using 'high' and 'low' growth scenarios.

Offsetting the impacts of mining to achieve no net loss of native vegetation.

PubMed

Sonter, L J; Barrett, D J; Soares-Filho, B S

2014-08-01

Offsets are a novel conservation tool, yet using them to achieve no net loss of biodiversity is challenging. This is especially true when using conservation offsets (i.e., protected areas) because achieving no net loss requires avoiding equivalent loss. Our objective was to determine if offsetting the impacts of mining achieves no net loss of native vegetation in Brazil's largest iron mining region. We used a land-use change model to simulate deforestation by mining to 2020; developed a model to allocate conservation offsets to the landscape under 3 scenarios (baseline, no new offsets; current practice, like-for-like [by vegetation type] conservation offsetting near the impact site; and threat scenario, like-for-like conservation offsetting of highly threatened vegetation); and simulated nonmining deforestation to 2020 for each scenario to quantify avoided deforestation achieved with offsets. Mines cleared 3570 ha of native vegetation by 2020. Under a 1:4 offset ratio, mining companies would be required to conserve >14,200 ha of native vegetation, doubling the current extent of protected areas in the region. Allocating offsets under current practice avoided deforestation equivalent to 3% of that caused by mining, whereas allocating under the threat scenario avoided 9%. Current practice failed to achieve no net loss because offsets did not conserve threatened vegetation. Explicit allocation of offsets to threatened vegetation also failed because the most threatened vegetation was widely dispersed across the landscape, making conservation logistically difficult. To achieve no net loss with conservation offsets requires information on regional deforestation trajectories and the distribution of threatened vegetation. However, in some regions achieving no net loss through conservation may be impossible. In these cases, other offsetting activities, such as revegetation, will be required. © 2014 Society for Conservation Biology.

Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery.

PubMed

Zacharias, David G; Lilly, Kevin; Shaw, Cynthia L; Pirundini, Paul; Rizzo, Robert J; Body, Simon C; Longford, Nicholas T

2014-04-01

Near-infrared cerebral oximetry increasingly is used for monitoring during cardiac surgery. Nonetheless, the scientific basis for incorporating this technology into clinical practice, the indications for when to do so, and standard diagnostic and treatment algorithms for defining abnormal values are yet to be rigorously defined. The authors hypothesized that there would be (1) variation in clinical use and practices for near-infrared spectroscopy (NIRS), and (2) variation in management of patients when clinicians are provided with NIRS information. In order to test this hypothesis, they sought to assess the nature and strength of response heterogeneity among anesthesiologists and cardiac perfusionists when provided with cardiac surgery patient scenarios and cerebral oximetry data. A prospectively collected survey. A hospital-based, multi-institutional, multinational study. By e-mail, the authors surveyed the membership of the Society of Cardiovascular Anesthesiologists and the online Cardiovascular Perfusion Forum. This survey was focused on ascertaining what actions clinicians would take in each scenario, given case information and cerebral oximetry tracings. Questions were based on 11 patient scenarios selected to represent small, large, symmetric, or asymmetric decreases in measured regional cerebral oxygen saturation (rScO2) encountered during cardiac surgery. Information on the respondents' (n = 796; 73% anesthesiologists) clinical practice, demography, and cerebral oximetry utilization was collected. An index of dispersion was used to assess response heterogeneity overall and within demographic subgroups. The majority of respondents indicated that cerebral oximetry monitoring was either useful or an essential monitor, especially perfusionists and clinicians who used cerebral oximetry most frequently. There were marked differences in responses between perfusionists and anesthesiologists for 4 of the 6 scenarios (p<0.005 for each of these 4 scenarios) occurring during cardiopulmonary bypass. Scenarios having greatest rScO2 reduction or asymmetry in rScO2 were associated with the highest dispersion, indicating least agreement in management. Scenarios with mild or moderate rScO2 reduction were associated with the lowest dispersion, indicating greater agreement in management. Although experimental data gradually are accumulating to support the role for cerebral oximetry monitoring during cardiac surgery, the results of the present survey support the view that its role remains poorly defined, and consensus for its appropriate use is lacking. Importantly, the authors observed marked variation in the use, perceived utility, and management of patients for 4 of the 6 CPB scenarios between perfusionists and anesthesiologists who share the management of CPB. These findings support the need for well-designed, adequately-powered clinical trials examining the value of this technology. Copyright © 2014 Elsevier Inc. All rights reserved.

The value of best-practice guidelines for OSCEs in a postgraduate program in an Australian remote area setting.

PubMed

Jeffrey, Carol A; Mitchell, Marion L; Henderson, Amanda; Lenthall, Sue; Knight, Sabina; Glover, Pauline; Kelly, Michelle; Nulty, Duncan; Groves, Michele

2014-01-01

Nurses in remote areas of Australia are the primary healthcare professionals, who need to be able to deliver comprehensive and culturally sensitive care to clients, many of whom are Indigenous Australians. Adequate and specific preparation for practice is crucial to the quality of care delivered by remote area nurses (RANs). Objective structured clinical examinations (OSCE) provide an excellent opportunity for student practice in a simulated environment that is safe, authentic, fair and valid when well constructed. Seven integrated best practice guidelines (BPGs), previously developed by project team members to inform OSCEs within educational programs, provided guidance in restructuring the OSCE. This paper provides a detailed analysis of the value of BPGs used in the development, teaching and learning, and evaluation of OSCEs in a rural and remote postgraduate course for RANs. A pre-site visit to the Centre for Remote Health, Alice Springs, Northern Territory, was conducted with modification of the course and previous OSCE according to BPGs. Following delivery of the course and OSCE, evaluations occurred via a mixed method approach. Student surveys (n=15) and focus groups (n=13) and staff interviews (n=5) provided an in-depth analysis of their perceptions of the revised OSCE. Descriptive statistics were used to describe the student sample. The narrative data were transcribed verbatim and analysed using content analysis. Triangulation was achieved with the convergence of the separate data sources focusing on themes and patterns within and between students and tutors. All 15 students and five tutors provided feedback. The majority of student participants had limited experience in working in remote area nursing prior to participation and therefore the opportunities that availed themselves were critical in adequately equipping them with the requisite knowledge, skills and abilities. Three themes emerged from the data: (1) value of common and significant events in OSCE; (2) power of deliberate actions; and (3) learning cultural sensitivity. OSCEs in this setting proved to be a good way for students to learn the skills required by RANs. Overwhelmingly, the modifications using the BPGs were highly valued by students and staff. Three themes emerged and were clearly linked to specific BPGs, indicating the positive impact the BPGs had on the OSCEs and student learning. The authentic content for the scenarios was seen as relevant and motivational for student learning. The practice element of the OSCEs enhanced the learning experience and feedback supported learning. OSCEs developed, taught and assessed using BPGs were highly valued. The BPGs provided an integrated approach with real-life scenarios with a strong cultural perspective - all important features to the RANs' future success in providing individualised care to clients in remote areas of Australia. Further use of BPGs is recommended.

Evaluating the impacts of agricultural land management practices on water resources: A probabilistic hydrologic modeling approach.

PubMed

Prada, A F; Chu, M L; Guzman, J A; Moriasi, D N

2017-05-15

Evaluating the effectiveness of agricultural land management practices in minimizing environmental impacts using models is challenged by the presence of inherent uncertainties during the model development stage. One issue faced during the model development stage is the uncertainty involved in model parameterization. Using a single optimized set of parameters (one snapshot) to represent baseline conditions of the system limits the applicability and robustness of the model to properly represent future or alternative scenarios. The objective of this study was to develop a framework that facilitates model parameter selection while evaluating uncertainty to assess the impacts of land management practices at the watershed scale. The model framework was applied to the Lake Creek watershed located in southwestern Oklahoma, USA. A two-step probabilistic approach was implemented to parameterize the Agricultural Policy/Environmental eXtender (APEX) model using global uncertainty and sensitivity analysis to estimate the full spectrum of total monthly water yield (WYLD) and total monthly Nitrogen loads (N) in the watershed under different land management practices. Twenty-seven models were found to represent the baseline scenario in which uncertainty of up to 29% and 400% in WYLD and N, respectively, is plausible. Changing the land cover to pasture manifested the highest decrease in N to up to 30% for a full pasture coverage while changing to full winter wheat cover can increase the N up to 11%. The methodology developed in this study was able to quantify the full spectrum of system responses, the uncertainty associated with them, and the most important parameters that drive their variability. Results from this study can be used to develop strategic decisions on the risks and tradeoffs associated with different management alternatives that aim to increase productivity while also minimizing their environmental impacts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evolutionary use of nuclear electric propulsion

NASA Technical Reports Server (NTRS)

Hack, K. J.; George, J. A.; Riehl, J. P.; Gilland, J. H.

1990-01-01

Evolving new propulsion technologies through a rational and conscious effort to minimize development costs and program risks while maximizing the performance benefits is intuitively practical. A phased approach to the evolution of nuclear electric propulsion from use on planetary probes, to lunar cargo vehicles, and finally to manned Mars missions with a concomitant growth in technology is considered. Technology levels and system component makeup are discussed for nuclear power systems and both ion and magnetoplasmadynamic thrusters. Mission scenarios are described, which include analysis of a probe to Pluto, a lunar cargo mission, Martian split, all-up, and quick-trip mission options. Evolutionary progression of the use of NEP in such missions is discussed.

Delivering meat carcasses/cuts to craft-butcher shops: an investigation of work characteristics and manual handling hazards.

PubMed

Okunribido, Olanrewaju O; Gingell, Alison

2014-11-01

This study investigated delivery scenarios of service drivers working in the retail meat industry. The methodology included analysis of accident reports, and field investigations of deliveries at craft-butcher shop premises, including semi-structured interviews with managers and workers. The findings provide greater clarity about the hazards in this job, and suggest for peripatetic delivery activities, four main factors on which decisions about risk and good practice may be made: composition of the orders; characteristics of the delivery vehicle/truck; handling method most often used; and, the road/access conditions. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Green supplier selection: a new genetic/immune strategy with industrial application

NASA Astrophysics Data System (ADS)

Kumar, Amit; Jain, Vipul; Kumar, Sameer; Chandra, Charu

2016-10-01

With the onset of the 'climate change movement', organisations are striving to include environmental criteria into the supplier selection process. This article hybridises a Green Data Envelopment Analysis (GDEA)-based approach with a new Genetic/Immune Strategy for Data Envelopment Analysis (GIS-DEA). A GIS-DEA approach provides a different view to solving multi-criteria decision making problems using data envelopment analysis (DEA) by considering DEA as a multi-objective optimisation problem with efficiency as one objective and proximity of solution to decision makers' preferences as the other objective. The hybrid approach called GIS-GDEA is applied here to a well-known automobile spare parts manufacturer in India and the results presented. User validation developed based on specific set of criteria suggests that the supplier selection process with GIS-GDEA is more practical than other approaches in a current industrial scenario with multiple decision makers.

RMP Guidance for Warehouses - Chapter 4: Offsite Consequence Analysis

EPA Pesticide Factsheets

Offsite consequence analysis (OCA) informs government and the public about potential consequences of an accidental toxic or flammable chemical release at your facility, and consists of a worst-case release scenario and alternative release scenarios.

Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

PubMed Central

Bhadra, Arup K.; Altman, Roy; Dasa, Vinod; Myrick, Karen; Rosen, Jeffrey; Vad, Vijay; Vitanzo, Peter; Bruno, Michelle; Kleiner, Hillary; Just, Caryn

2016-01-01

Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA. PMID:28618868

Stabilization of atmospheric carbon dioxide via zero emissions—An alternative way to a stable global environment. Part 2: A practical zero-emissions scenario

PubMed Central

MATSUNO, Taroh; MARUYAMA, Koki; TSUTSUI, Junichi

2012-01-01

Following Part 1, a comparison of CO2-emissions pathways between “zero-emissions stabilization (Z-stabilization)” and traditional stabilization is made under more realistic conditions that take into account the radiative forcings of other greenhouse gases and aerosols with the constraint that the temperature rise must not exceed 2 ℃ above the preindustrial level. It is shown that the findings in Part 1 on the merits of Z-stabilization hold under the more realistic conditions. The results clarify the scientific basis of the policy claim of 50% reduction of the world CO2 emissions by 2050. Since the highest greenhouse gas (GHG) concentration and temperature occur only temporarily in Z-stabilization pathways, we may slightly relax the upper limit of the temperature rise. We can then search for a scenario with larger emissions in the 21st century; such a scenario may have potential for practical application. It is suggested that in this Z-stabilization pathway, larger emissions in the near future may be important from a socioeconomic viewpoint. PMID:22850728

Practices and perceptions on water resource sustainability in ecovillages

NASA Astrophysics Data System (ADS)

de Moura Leite, Flavia Brunale Vilela; Bertolo, Lídia Sanches; Santos, Rozely Ferreira

2016-08-01

In many areas of the world, groups of people have attempted to create urban landscapes that follow the principles of environmental sustainability. To this end, groups have devised alternative models, such as ecovillages, where low-impact handling is used and a way of life different from that of large population centers is adopted. Although these villages exist, their efficiency in the conservation of natural resources has not been effectively evaluated. This study evaluated the practices used by two Brazilian ecovillages to conserve water resources to assess whether this new concept of living is indeed successful in meeting sustainability goals. We selected 25 indicators of water sustainability, and using the compromise programming method, we quantified the distance between those landscapes self-referenced as sustainable and an ideal hypothetical scenario. We also interpreted the communities perceptions using the distance between the current situations and the envisioned scenario. We concluded that both ecovillage are far from technically ideal scenario, but the communities have a strong sense of their limitations in implementing water resources conservation. The communities attributed this fact primarily to deficiencies in the shared management.

Stabilization of atmospheric carbon dioxide via zero emissions--an alternative way to a stable global environment. Part 2: a practical zero-emissions scenario.

PubMed

Matsuno, Taroh; Maruyama, Koki; Tsutsui, Junichi

2012-01-01

Following Part 1, a comparison of CO(2)-emissions pathways between "zero-emissions stabilization (Z-stabilization)" and traditional stabilization is made under more realistic conditions that take into account the radiative forcings of other greenhouse gases and aerosols with the constraint that the temperature rise must not exceed 2 °C above the preindustrial level. It is shown that the findings in Part 1 on the merits of Z-stabilization hold under the more realistic conditions. The results clarify the scientific basis of the policy claim of 50% reduction of the world CO(2) emissions by 2050. Since the highest greenhouse gas (GHG) concentration and temperature occur only temporarily in Z-stabilization pathways, we may slightly relax the upper limit of the temperature rise. We can then search for a scenario with larger emissions in the 21st century; such a scenario may have potential for practical application. It is suggested that in this Z-stabilization pathway, larger emissions in the near future may be important from a socioeconomic viewpoint.

Analysis of LNG peakshaving-facility release-prevention systems

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

Pelto, P.J.; Baker, E.G.; Powers, T.B.

1982-05-01

The purpose of this study is to provide an analysis of release prevention systems for a reference LNG peakshaving facility. An overview assessment of the reference peakshaving facility, which preceeded this effort, identified 14 release scenarios which are typical of the potential hazards involved in the operation of LNG peakshaving facilities. These scenarios formed the basis for this more detailed study. Failure modes and effects analysis and fault tree analysis were used to estimate the expected frequency of each release scenario for the reference peakshaving facility. In addition, the effectiveness of release prevention, release detection, and release control systems weremore » evaluated.« less

Application of the BRAFO tiered approach for benefit-risk assessment to case studies on heat processing contaminants.

PubMed

Schütte, Katrin; Boeing, Heiner; Hart, Andy; Heeschen, Walther; Reimerdes, Ernst H; Santare, Dace; Skog, Kerstin; Chiodini, Alessandro

2012-11-01

The aim of the European Funded Project BRAFO (benefit-risk analysis of foods) project was to develop a framework that allows quantitative comparison of human health risks and benefits of foods based on a common scale of measurement. This publication describes the application of the BRAFO methodology to three different case studies: the formation of acrylamide in potato and cereal based products, the formation of benzo(a)pyrene through smoking and grilling of meat and fish and the heat-treatment of milk. Reference, alternative scenario and target population represented the basic structure to test the tiers of the framework. Various intervention methods intended to reduce acrylamide in potato and cereal products were evaluated against the historical production methods. In conclusion the benefits of the acrylamide-reducing measures were considered prevailing. For benzo(a)pyrene, three illustrated alternative scenarios were evaluated against the most common smoking practice. The alternative scenarios were assessed as delivering benefits, introducing only minimal potential risks. Similar considerations were made for heat treatment of milk where the comparison of the microbiological effects of heat treatment, physico-chemical changes of milk constituents with positive and negative health effects was assessed. In general, based on data available, benefits of the heat treatment were outweighing any risks. Copyright © 2012 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

Do technical skills correlate with non-technical skills in crisis resource management: a simulation study.

PubMed

Riem, N; Boet, S; Bould, M D; Tavares, W; Naik, V N

2012-11-01

Both technical skills (TS) and non-technical skills (NTS) are key to ensuring patient safety in acute care practice and effective crisis management. These skills are often taught and assessed separately. We hypothesized that TS and NTS are not independent of each other, and we aimed to evaluate the relationship between TS and NTS during a simulated intraoperative crisis scenario. This study was a retrospective analysis of performances from a previously published work. After institutional ethics approval, 50 anaesthesiology residents managed a simulated crisis scenario of an intraoperative cardiac arrest secondary to a malignant arrhythmia. We used a modified Delphi approach to design a TS checklist, specific for the management of a malignant arrhythmia requiring defibrillation. All scenarios were recorded. Each performance was analysed by four independent experts. For each performance, two experts independently rated the technical performance using the TS checklist, and two other experts independently rated NTS using the Anaesthetists' Non-Technical Skills score. TS and NTS were significantly correlated to each other (r=0.45, P<0.05). During a simulated 5 min resuscitation requiring crisis resource management, our results indicate that TS and NTS are related to one another. This research provides the basis for future studies evaluating the nature of this relationship, the influence of NTS training on the performance of TS, and to determine whether NTS are generic and transferrable between crises that require different TS.

Using SAFRAN Software to Assess Radiological Hazards from Dismantling of Tammuz-2 Reactor Core at Al-tuwaitha Nuclear Site

NASA Astrophysics Data System (ADS)

Abed Gatea, Mezher; Ahmed, Anwar A.; jundee kadhum, Saad; Ali, Hasan Mohammed; Hussein Muheisn, Abbas

2018-05-01

The Safety Assessment Framework (SAFRAN) software has implemented here for radiological safety analysis; to verify that the dose acceptance criteria and safety goals are met with a high degree of confidence for dismantling of Tammuz-2 reactor core at Al-tuwaitha nuclear site. The activities characterizing, dismantling and packaging were practiced to manage the generated radioactive waste. Dose to the worker was considered an endpoint-scenario while dose to the public has neglected due to that Tammuz-2 facility is located in a restricted zone and 30m berm surrounded Al-tuwaitha site. Safety assessment for dismantling worker endpoint-scenario based on maximum external dose at component position level in the reactor pool and internal dose via airborne activity while, for characterizing and packaging worker endpoints scenarios have been done via external dose only because no evidence for airborne radioactivity hazards outside the reactor pool. The in-situ measurements approved that reactor core components are radiologically activated by Co-60 radioisotope. SAFRAN results showed that the maximum received dose for workers are (1.85, 0.64 and 1.3mSv/y) for activities dismantling, characterizing and packaging of reactor core components respectively. Hence, the radiological hazards remain below the low level hazard and within the acceptable annual dose for workers in radiation field

Moisture content prediction in poultry litter using artificial intelligence techniques and Monte Carlo simulation to determine the economic yield from energy use.

PubMed

Rico-Contreras, José Octavio; Aguilar-Lasserre, Alberto Alfonso; Méndez-Contreras, Juan Manuel; López-Andrés, Jhony Josué; Cid-Chama, Gabriela

2017-11-01

The objective of this study is to determine the economic return of poultry litter combustion in boilers to produce bioenergy (thermal and electrical), as this biomass has a high-energy potential due to its component elements, using fuzzy logic to predict moisture and identify the high-impact variables. This is carried out using a proposed 7-stage methodology, which includes a statistical analysis of agricultural systems and practices to identify activities contributing to moisture in poultry litter (for example, broiler chicken management, number of air extractors, and avian population density), and thereby reduce moisture to increase the yield of the combustion process. Estimates of poultry litter production and heating value are made based on 4 different moisture content percentages (scenarios of 25%, 30%, 35%, and 40%), and then a risk analysis is proposed using the Monte Carlo simulation to select the best investment alternative and to estimate the environmental impact for greenhouse gas mitigation. The results show that dry poultry litter (25%) is slightly better for combustion, generating 3.20% more energy. Reducing moisture from 40% to 25% involves considerable economic investment due to the purchase of equipment to reduce moisture; thus, when calculating financial indicators, the 40% scenario is the most attractive, as it is the current scenario. Thus, this methodology proposes a technology approach based on the use of advanced tools to predict moisture and representation of the system (Monte Carlo simulation), where the variability and uncertainty of the system are accurately represented. Therefore, this methodology is considered generic for any bioenergy generation system and not just for the poultry sector, whether it uses combustion or another type of technology. Copyright © 2017 Elsevier Ltd. All rights reserved.

An analysis of ranibizumab treatment and visual outcomes in real-world settings: the UNCOVER study.

PubMed

Eldem, Bora; Lai, Timothy Y Y; Ngah, Nor Fariza; Vote, Brendan; Yu, Hyeong Gon; Fabre, Alban; Backer, Arthur; Clunas, Nathan J

2018-05-01

To describe intravitreal ranibizumab treatment frequency, clinical monitoring, and visual outcomes (including mean central retinal thickness [CRT] and visual acuity [VA] changes from baseline) in neovascular age-related macular degeneration (nAMD) in real-world settings across three ranibizumab reimbursement scenarios in the Middle East, North Africa, and the Asia-Pacific region. Non-interventional multicenter historical cohort study of intravitreal ranibizumab use for nAMD in routine clinical practice between April 2010 and April 2013. Eligible patients were diagnosed with nAMD, received at least one intravitreal ranibizumab injection during the study period, and had been observed for a minimum of 1 year (up to 3 years). Reimbursement scenarios were defined as self-paid, partially-reimbursed, and fully-reimbursed. More than three-fourths (n = 2521) of the analysis population was partially-reimbursed for ranibizumab, while 16.4% (n = 532) was fully-reimbursed, and 5.8% was self-paid (n = 188). The average annual ranibizumab injection frequency was 4.1 injections in the partially-reimbursed, 4.7 in the fully-reimbursed and 2.6 in the self-paid populations. The average clinical monitoring frequency was estimated to be 6.7 visits/year, with similar frequencies observed across reimbursement categories. On average, patients experienced VA reduction of -0.7 letters and a decrease in CRT of -44.4 μm. The greatest mean CRT change was observed in the self-paid group, with -92.6 μm. UNCOVER included a large, heterogeneous ranibizumab-treated nAMD population in real-world settings. Patients in all reimbursement scenarios attained vision stability on average, indicating control of disease activity.

Snapshots of Authentic Scientific Inquiry and Teacher Preparation: Undergraduate STEM Courses, Preservice and Inservice Teachers' Experiences

NASA Astrophysics Data System (ADS)

French, Debbie Ann

In this dissertation, the researcher describes authentic scientific inquiry (ASI) within three stages of teacher preparation and development: a1) undergraduate STEM courses, b2) preservice secondary science education methods courses, and c3) inservice teacher professional development (PD). Incorporating (ASI)-- pedagogy closely modeling the research practices of scientists--is at the forefront of national science, technology, engineering, and mathematics (STEM) initiatives and the Next Generation Science Standards (NGSS). In the first of three research articles, 42 students participated in an introductory astronomy course which employed inquiry-based pedagogy. The researcher administered the Test Of Astronomy STandards (TOAST) pre/post instruction. In the second article, 56 preservice secondary science teachers completed ideal lesson plan scenarios before and after 80 hours of methods instruction. The researcher scored the scenarios using a rubrirubric developedc according to the NGSS Science and Engineering Practices, and analyzed the components from the scenarios. The third article surveyed 63 inservice STEM teachers with prior research and industry experience. The researcher highlights teacher ASI perspectives. Overall, teachers incorporated opportunities for K-20 students to use scientific instrumentation and technology to collect and analyze data, work collaboratively, and develop evidence-based conclusions. Few teachers provided opportunities for students to ask scientific questions or disseminate results, suggesting the need that teachers (at all levels) need scaffolded instruction in these areas. The researcher argues that while ASI and STEM PDs are effective for teachers, developing similar interest, on-going communities of practice may provide support for teacher to implement the ASI practices in their classrooms.

Research for the advancement of green chemistry practice: Studies in atmospheric and educational chemistry

NASA Astrophysics Data System (ADS)

Cullipher, Steven Gene

Green chemistry is a philosophy of chemistry that emphasizes a decreasing dependence on limited non-renewable resources and an increasing focus on preventing pollution byproducts of the chemical industry. In short, it is the discipline of chemistry practiced through the lens of environmental stewardship. In an effort to advance the practice of green chemistry, three studies will be described that have ramifications for the practice. The first study examines the atmospheric oxidation of a hydrofluorinated ether, a third-generation CFC replacement compound with primarily unknown atmospheric degradation products. Determination of these products has the potential to impact decisions on refrigerant usage in the future. The second study examines chemistry students' development of understanding benefits-costs-risks analysis when presented with two real-world scenarios: refrigerant choice and fuel choice. By studying how benefits-costs-risks thinking develops, curricular materials and instructional approaches can be designed to better foster the development of an ability that is both necessary for green chemists and important in daily decision-making for non-chemists. The final study uses eye tracking technology to examine students' abilities to interpret molecular properties from structural information in the context of global warming. Such abilities are fundamental if chemists are to appropriately assess risks and hazards of chemistry practice.

The effectiveness of a simulated scenario to teach nursing students how to perform a bed bath: A randomized clinical trial.

PubMed

Miranda, Renata Pinto Ribeiro; de Cássia Lopes Chaves, Érika; Silva Lima, Rogério; Braga, Cristiane Giffoni; Simões, Ivandira Anselmo Ribeiro; Fava, Silvana Maria Coelho Leite; Iunes, Denise Hollanda

2017-10-01

Simulation allows students to develop several skills during a bed bath that are difficult to teach only in traditional classroom lectures, such as problem-solving, student interactions with the simulator (patient), reasoning in clinical evaluations, evaluation of responses to interventions, teamwork, communication, security and privacy. This study aimed to evaluate the effectiveness of a simulated bed bath scenario on improving cognitive knowledge, practical performance and satisfaction among nursing students. Randomized controlled clinical trial. Nursing students that were in the fifth period from two educational institutions in Brazil. Nursing students (n=58). The data were collected using the assessments of cognitive knowledge, practical performance and satisfaction were made through a written test about bed baths, an Objective Structured Clinical Examination (OSCE) and a satisfaction questionnaire. We identified that the acquisition and assimilation of cognitive knowledge was significantly higher in the simulation group (p=0.001). The performance was similar in both groups regardless of the teaching strategy (p=0.435). At follow-up, the simulation group had significantly more satisfaction with the teaching method than the control group (p=0.007). The teaching strategy based on a simulated scenario of a bed bath proved to be effective for the acquisition of cognitive knowledge regarding bed baths in clinical practice and improved student satisfaction with the teaching process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Teaching medical management and operations engineering for systems-based practice to radiology residents.

PubMed

Brandon, Catherine J; Mullan, Patricia B

2013-03-01

To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services.

PubMed

Stiel, Stephanie; Nurnus, Mareike; Ostgathe, Christoph; Klein, Carsten

2018-03-13

Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany. Data sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% (n = 187; 90.8%) and B) higher than 16% (n = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi 2 / Fisher Exact Tests and considered significant (*) at two-sided p < .05. Organisations in group B report that they discuss PS for a higher proportion of patients (38.5%/10.2%, p < 0.000**), rate agitation more often as an indications for PS (78.9%/ 53.5%, p = 0.050*), and are more likely to use Lorazepam (63.2%/ 37.4%, p = 0.047*), Promethazin (26.3%/ 9.6%, p = 0.044*), and (Es-)Ketamin (31.6%/ 12.8%, p = 0.039*) than representatives in group A. Both groups differ significantly in their allocation of three case scenarios to different types of PS. Both definitions and patterns of clinical practice between palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.

Model Performance Evaluation and Scenario Analysis (MPESA) Tutorial

EPA Science Inventory

This tool consists of two parts: model performance evaluation and scenario analysis (MPESA). The model performance evaluation consists of two components: model performance evaluation metrics and model diagnostics. These metrics provides modelers with statistical goodness-of-fit m...

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

Accounting for personal and professional choices for pandemic influenza vaccination amongst English healthcare workers.

PubMed

Marcu, Afrodita; Rubinstein, Helena; Michie, Susan; Yardley, Lucy

2015-05-05

Healthcare workers (HCWs) are encouraged to get vaccinated during influenza pandemics to reduce their own, and patients', risk of infection, and to encourage their patients to get immunised. Despite extensive research on HCWs' receipt of vaccination, little is known about how HCWs articulate pandemic influenza vaccination advice to patients. To explore HCWs' uptake of the A/H1N1 vaccine during the pandemic of 2009-2010, their recommendations to patients at the time, and their anticipated choices around influenza vaccination under different pandemic scenarios. We conducted semi-structured interviews and focus groups with eight vaccinated and seventeen non-vaccinated HCWs from primary care practices in England. The data was analysed using thematic analysis. The HCWs constructed their receipt of vaccination as a personal choice informed by personal health history and perceptions of vaccine safety, while they viewed patients' vaccination as choices made following informed consent and medical guidelines. Some HCWs received the A/H1N1 vaccine under the influence of their local practice organizational norms and values. While non-vaccinated HCWs regarded patients' vaccination as patients' choice, some vaccinated HCWs saw it also as a public health issue. The non-vaccinated HCWs emphasised that they would not allow their personal choices to influence the advice they gave to patients, whereas some vaccinated HCWs believed that by getting vaccinated themselves they could provide a reassuring example to patients, particularly those who have concerns about influenza vaccination. All HCWs indicated they would accept vaccination under the severe pandemic scenario. However, most non-vaccinated HCWs expressed reticence to vaccinate under the mild pandemic scenario. Providing evidence-based arguments about the safety of new vaccines and the priority of public health over personal choice, and creating strong social norms for influenza vaccination as part of the organizational culture, should increase uptake of influenza vaccination among primary care HCWs and their patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

PubMed

Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

2017-10-01

The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

Lay people's and health professionals' views about breaking bad news to children.

PubMed

Muñoz Sastre, M T; Sorum, P C; Mullet, E

2014-01-01

Bad health news is difficult to communicate, especially when parents must give bad news to their children. We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth). Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%). Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children. © 2012 John Wiley & Sons Ltd.

A group decision-making tool for the application of membrane technologies in different water reuse scenarios.

PubMed

Sadr, S M K; Saroj, D P; Kouchaki, S; Ilemobade, A A; Ouki, S K

2015-06-01

A global challenge of increasing concern is diminishing fresh water resources. A growing practice in many communities to supplement diminishing fresh water availability has been the reuse of water. Novel methods of treating polluted waters, such as membrane assisted technologies, have recently been developed and successfully implemented in many places. Given the diversity of membrane assisted technologies available, the current challenge is how to select a reliable alternative among numerous technologies for appropriate water reuse. In this research, a fuzzy logic based multi-criteria, group decision making tool has been developed. This tool has been employed in the selection of appropriate membrane treatment technologies for several non-potable and potable reuse scenarios. Robust criteria, covering technical, environmental, economic and socio-cultural aspects, were selected, while 10 different membrane assisted technologies were assessed in the tool. The results show this approach capable of facilitating systematic and rigorous analysis in the comparison and selection of membrane assisted technologies for advanced wastewater treatment and reuse. Copyright © 2015 Elsevier Ltd. All rights reserved.

Open Standards in Practice: An OGC China Forum Initiative

NASA Astrophysics Data System (ADS)

Yue, Peng; Zhang, Mingda; Taylor, Trevor; Xie, Jibo; Zhang, Hongping; Tong, Xiaochong; Yu, Jinsongdi; Huang, Juntao

2016-11-01

Open standards like OGC standards can be used to improve interoperability and support machine-to-machine interaction over the Web. In the Big Data era, standard-based data and processing services from various vendors could be combined to automate the extraction of information and knowledge from heterogeneous and large volumes of geospatial data. This paper introduces an ongoing OGC China forum initiative, which will demonstrate how OGC standards can benefit the interaction among multiple organizations in China. The ability to share data and processing functions across organizations using standard services could change traditional manual interactions in their business processes, and provide on-demand decision support results by on-line service integration. In the initiative, six organizations are involved in two “MashUp” scenarios on disaster management. One “MashUp” is to derive flood maps in the Poyang Lake, Jiangxi. And the other one is to generate turbidity maps on demand in the East Lake, Wuhan, China. The two scenarios engage different organizations from the Chinese community by integrating sensor observations, data, and processing services from them, and improve the automation of data analysis process using open standards.

Integration of production and financial models to analyse the financial impact of livestock diseases: a case study of Schmallenberg virus disease on British and French dairy farms

PubMed Central

Häsler, Barbara; Alarcon, Pablo; Raboisson, Didier; Waret-Szkuta, Agnes; Rushton, Jonathan

2015-01-01

Aims and objectives The aim of the study was to investigate and compare the financial impact of Schmallenberg disease for different dairy production types in the United Kingdom and France. Materials and methods Integrated production and financial models for dairy cattle were developed and applied to Schmallenberg virus (SBV) disease in a British and French context. The five main production systems that prevail in these two countries were considered. Their respective gross margins measuring the holding's profitability were calculated based on public benchmarking, literature and expert opinion data. A partial budget analysis was performed within each production model to estimate the impact of SBV in the systems modelled. Two disease scenarios were simulated: low impact and high impact. Results The model gross margin obtained per cow space and year ranged from £1014 to £1484 for the UK and from £1037 to £1890 for France depending on the production system considered. In the UK, the net SBV disease costs in £/cow space/year for an average dairy farm with 100 milking spaces were estimated between £16.3 and £51.4 in the high-impact scenario and between £8.2 and £25.9 in the low-impact scenario. For France, the net SBV disease costs in £/cow space/year ranged from £19.6 to £48.6 in the high-impact scenario and £9.7 to £22.8 in the low-impact scenario, respectively. Conclusion The study illustrates how the combination of production and financial models allows assessing disease impact taking into account differing management and husbandry practices and associated price structures in the dairy sector. It supports decision-making of farmers and veterinarians who are considering disease control measures as it provides an approach to estimate baseline disease impact in common dairy production systems in the UK and France. PMID:26392883

Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS

PubMed Central

Saposnik, Gustavo; Maurino, Jorge; Sempere, Angel P; Ruff, Christian C; Tobler, Philippe N

2017-01-01

Purpose Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS. Methods We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding. Results Out of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P=0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01–1.14). Conversely, physician’s age, gender, years of practice, setting of practice, or risk preferences were not associated with herding. Conclusion Herding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may affect medical decisions and lead to poorer outcomes in the management of MS. PMID:28203061

Designing Peace and Conflict Exercises: Level of Analysis, Scenario, and Role Specification

ERIC Educational Resources Information Center

Bartels, Elizabeth; McCown, Margaret; Wilkie, Timothy

2013-01-01

Attentiveness to and transparency about the methodological implications of the level of analysis selected for peace and conflict exercises constitute essential elements of good game design. The article explores the impact of level of analysis choices in the context of two key portions of exercises, scenario construction and role specification. It…

The Practical Concept of an Evaluator and Its Use in the Design of Training Systems.

ERIC Educational Resources Information Center

Gibbons, Andrew S.; Rogers, Dwayne H.

1991-01-01

The evaluator is an instructional system product that provides practice, testing capability, and feedback in a way not yet seen in computer-assisted instruction. Training methods using an evaluator contain scenario-based simulation exercises, followed by a critique of performance. A focus on competency-based education and performance makes the…

Linking global scenarios to national assessments: Experiences from the Resources Planning Act (RPA) Assessment

Treesearch

Linda L. Langner; Peter J. Ince

2012-01-01

The Resources Planning Act (RPA) Assessment provides a nationally consistent analysis of the status and trends of the Nation's renewable forest resources. A global scenario approach was taken for the 2010 RPA Assessment to provide a shared world view of potential futures. The RPA Assessment scenarios were linked to the global scenarios and climate projections used...

Accuracy Analysis and Parameters Optimization in Urban Flood Simulation by PEST Model

NASA Astrophysics Data System (ADS)

Keum, H.; Han, K.; Kim, H.; Ha, C.

2017-12-01

The risk of urban flooding has been increasing due to heavy rainfall, flash flooding and rapid urbanization. Rainwater pumping stations, underground reservoirs are used to actively take measures against flooding, however, flood damage from lowlands continues to occur. Inundation in urban areas has resulted in overflow of sewer. Therefore, it is important to implement a network system that is intricately entangled within a city, similar to the actual physical situation and accurate terrain due to the effects on buildings and roads for accurate two-dimensional flood analysis. The purpose of this study is to propose an optimal scenario construction procedure watershed partitioning and parameterization for urban runoff analysis and pipe network analysis, and to increase the accuracy of flooded area prediction through coupled model. The establishment of optimal scenario procedure was verified by applying it to actual drainage in Seoul. In this study, optimization was performed by using four parameters such as Manning's roughness coefficient for conduits, watershed width, Manning's roughness coefficient for impervious area, Manning's roughness coefficient for pervious area. The calibration range of the parameters was determined using the SWMM manual and the ranges used in the previous studies, and the parameters were estimated using the automatic calibration method PEST. The correlation coefficient showed a high correlation coefficient for the scenarios using PEST. The RPE and RMSE also showed high accuracy for the scenarios using PEST. In the case of RPE, error was in the range of 13.9-28.9% in the no-parameter estimation scenarios, but in the scenario using the PEST, the error range was reduced to 6.8-25.7%. Based on the results of this study, it can be concluded that more accurate flood analysis is possible when the optimum scenario is selected by determining the appropriate reference conduit for future urban flooding analysis and if the results is applied to various rainfall event scenarios and parameter optimization. Keywords: Parameters Optimization; PEST model; Urban area Acknowledgement This research was supported by a grant (17AWMP-B079625-04) from Water Management Research Program funded by Ministry of Land, Infrastructure and Transport of Korean government.

Theoretical Impact of Replacing Whole Cow's Milk by Young-Child Formula on Nutrient Intakes of UK Young Children: Results of a Simulation Study.

PubMed

Eussen, Simone R B M; Pean, Josephine; Olivier, Leanne; Delaere, Fabien; Lluch, Anne

2015-01-01

Research into the role of young-child formulae (YCF) in a child's diet is limited and there is no consensual recommendation on its use. We evaluated the theoretical nutritional impact of replacing the existing practice of consuming cow's milk by YCF. From the UK Diet and Nutrition Survey of Infants and Young Children, whole cow's milk consumers, aged 12-18 months (n = 591) were selected for simulation scenarios. In Scenario 1, we tested the replacement of all whole cow's milk (434 ± 187 ml/day) by a matching volume of YCF, and in Scenario 2, all whole cow's milk was replaced by the on-pack recommended daily intake of 300 ml. Nutrient intakes before and after simulation scenarios were compared and evaluated against nutrient recommendations. Intakes of protein and saturated fatty acids were significantly decreased, whereas essential fatty acid intakes were increased. The prevalence of nutrient inadequacy before simulation was 95.2% for vitamin D and 53.8% for iron. After simulation, inadequacy decreased to 4.9% (Scenario 1) and 0% (Scenario 2) for vitamin D and to 2.7% (Scenario 1) and 1.1% (Scenario 2) for iron. Replacement of habitual cow's milk intake by a matching volume or 300 ml of YCF may lead to nutritional intakes more in line with recommendations in young children. © 2015 S. Karger AG, Basel.

Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

PubMed

Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

2016-01-01

The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

The UKNEQAS scheme for cerebrospinal fluid haem pigments: a paradigm for service improvement.

PubMed

Beetham, Robert; Egner, William; Patel, Dina

2011-11-01

We describe the programme of an established External Quality Assurance (EQA) provider and a Specialist Advisory Group (SAG) to develop a successful EQA scheme for cerebrospinal fluid (CSF) haem pigments as an example of a professionally led, unfunded initiative with the real potential to benefit patients. Within three years, we had assured sample stability, stoichiometry, and published best practice guidelines, enabling both analytical results and interpretation to be assessed and reported with an educative summary of the desired responses. Misclassification scoring of analysis and interpretation was introduced. Following audit, guidelines were modified and republished. The outcomes were as follows: Participant numbers increased from 63 at inception to 150 10 years later; The percentage of participants using visual inspection, a poor practice indicator, decreased from 27% to less than 1%; In all, 94-100% of participants consistently detected minor increases in bilirubin over the last four years of the scheme; More than 93% of participants were able to interpret analytical results linked to straightforward clinical scenarios; Misclassification scoring demonstrated that more complex scenarios repeatedly posed problems and is the next challenge to address. Scheme success is attributed to the experience of the operator and the formation of a voluntary expert advisory group, with both concerned to advance science and patient safety and thus contribute unpaid time and effort in order to succeed. In times of fiscal constraint, such resource may not be so readily available, yet is a vital part of continuous quality improvement for the benefit of patients.

Telling better stories: strengthening the story in story and simulation

NASA Astrophysics Data System (ADS)

Kemp-Benedict, Eric

2012-12-01

The scenarios of the IPCC Special Report on Emissions Scenarios (SRES) (Nakicenovic and Swart 2000) are both widely cited and widely criticized. This combination of censure and regard reflects their importance, as they provide both a point of reference and a point of departure for those wishing to understand the long-term implications of policies and human activities for the climate and adaptive capacity. The paper by Schweizer and Kriegler in this issue (Schweizer and Kriegler 2012) reports a unique and interesting critique of the SRES scenarios. The authors find several results, including that the path the world may now be on (labeled by them 'coal-powered growth') is under-represented in the SRES scenarios. While such post-hoc critiques are easy to dismiss, Schweizer and Kriegler were careful to use only the information available to the SRES authors, and they applied a technique that (if it had been available) could have been carried out at that time. In this way they demonstrate that not only was coal-powered growth a clearly discernible possible future at the time of the SRES, but variants on the theme dominate the handful of highly consistent and robust scenarios as identified by their method. Their paper is well-timed because a new round of climate scenarios is now under development (Kriegler et al 2012, van Vuuren et al 2012), and it could learn from evaluations of the SRES process and scenarios. Schweizer and Kriegler (2012) construct a consistent scenario logic using a relatively new foresight technique, cross-impact balances (CIB) (Weimer-Jehle 2006). As explained above, to sharpen their critique and properly evaluate the method, they apply CIB to the information that the authors of the SRES had at their disposal at the time they constructed their scenarios. Their study is therefore anachronistic, in that the CIB method was not published when the SRES was released, but historically faithful in that Schweizer and Kriegler limit themselves to the information available at that time, based on statements that appear in the SRES itself. The CIB method is a technique for constructing internally consistent qualitative scenarios. Global-scale scenario exercises, in particular climate scenarios, typically include both qualitative (narrative) and quantitative (model) elements. As noted by Schweizer and Kriegler, the dominant method for such studies, which Alcamo (2001, 2008) formalized and named the 'story and simulation' (SAS) approach, relies at least in part on quantitative modeling to ensure consistency. Schweizer and Kriegler rightly criticize the idea that models alone can ensure consistency of a scenario narrative. By itself, this critique is not new. Indeed, if asked, both Alcamo and Raskin et al (Raskin et al 2005), whom Schweizer and Kriegler (2012) cite, would probably agree with them; both sources emphasize the need for qualitative storylines that go beyond what models can provide. However, Schweizer and Kriegler correctly point out that these sources provide little or no guidance to those responsible for the narratives beyond a dialog with the model outputs. The CIB method addresses this problem, and Schweizer and Kriegler's application of the method shows that even the best narrative-writing teams can benefit from this guidance. While the paper of Schweizer and Kriegler makes a compelling argument for using CIB in global scenarios, it should be used in combination with other methods. A scenario exercise has several aims, of which consistency is one. Another important goal is diversity: given a set of internally consistent scenarios, a diverse set covers the space of possibilities, and thereby helps users of the scenarios avoid underestimating or overestimating the potential for change in one or another key factor (e.g., see (Carlsen 2009)). From this point of view, the SRES authors could legitimately respond to Schweizer and Kriegler's finding that the SRES scenarios excluded interesting variants on coal-fueled growth by arguing that they did include some variants, and to include more would have conflicted with a legitimate goal of breadth. In this imagined dialog, Schweizer and Kriegler could concede the point, but then point out that several of the SRES scenarios were revealed to be either marginally or very inconsistent by their exercise. Thus, CIB and a technique that helps ensure breadth can usefully complement one another. The CIB method is also liable to a form of specification error, in that the worldviews of the people filling in the cross-impact table influence the results. This is a problem with many foresight techniques, but it is masked by the formalism of CIB, and there is a danger it will go unnoticed. For example, Schweizer and Kriegler's paper suggests that the A1T2 scenario is (marginally) internally consistent. It has relatively low carbon emissions, low rates of population growth, very high GDP per capita growth rates, low primary energy intensity, very low carbon intensity, high fossil-fuel availability, global economic policy focus, and mixed global and regional energy policy focus. It has been argued by Jackson (2009) and Victor (2008), among others, that the evidence is slim that we ever will decouple carbon emissions from GDP to any meaningful extent. Thus, they would presumably argue that this is an inconsistent scenario, and might very well have done so at the time the SRES was written. That is not by itself a reason to reject the scenario, but it suggests that a CIB exercise could be run assuming the qualitative models implied by different worldviews, and the results contrasted. Such an exercise would go beyond the sensitivity analysis that Schweizer and Kriegler report in their paper. The cross-impact balance method should be a useful tool for constructing the next round of climate scenarios. It will be even more useful if combined with techniques that ensure a diversity of scenarios. This could include formal techniques such as 'scenario diversity analysis', which maximizes a quantitative measure of the spread of a set of qualitative scenarios defined by states of driving forces (Carlsen 2009). It could also include a survey of different worldviews, and the qualitative models that they imply, such as that carried out by Sunderlin (Sunderlin 2003). Futures studies has moved forward from the time the SRES was published, and new techniques are now available that can help us to tell better stories of the future. References Alcamo J 2001 Scenarios as Tools for International Environmental Assessments (Cophenhagen: European Environment Agency) Alcamo J 2008 The SAS approach: combining qualitative and quantitative knowledge in environmental scenarios Environmental Futures—The Practice of Environmental Scenario Analysis vol 2, ed J Alcamo (Amsterdam: Elsevier) pp 123-50 Carlsen H 2009 Climate change and the construction of scenario sets that span the range of societal uncertainties Paper for International Studies Association Annual Convention 2009 (New York City, February) Jackson T 2009 Prosperity Without Growth: Economics for a Finite Planet (London: Earthscan) Kriegler E, O'Neill B C, Hallegatte S, Kram T, Lempert R J, Moss R H and Wilbanks T 2012 The need for and use of socio-economic scenarios for climate change analysis: a new approach based on shared socio-economic pathways Glob. Environ. Change 22 807-22 Nakicenovic N and Swart R (eds) 2000 Special Report on Emissions Scenarios (Cambridge: Cambridge University Press) Raskin P, Monks F, Ribeiro T, van Vuuren D and Zurek M 2005 Global scenarios in historical perspective Ecosystems and Human Well-Being: Scenarios: Findings of the Scenarios Working Group vol 2, ed S R Carpenter et al (Washington, DC: Island) pp 35-44 Schweizer V J and Kriegler E 2012 Improving environmental change research with systematic techniques for qualitative scenarios Environ. Res. Lett. 7 044011 Sunderlin W D 2003 Ideology, Social Theory, and the Environment (Lanham, MD: Rowman & Littlefield) van Vuuren D P et al 2012 A proposal for a new scenario framework to support research and assessment in different climate research communities Glob. Environ. Change 22 21-35 Victor P A 2008 Managing Without Growth: Slower by Design, Not Disaster (Advances in Ecological Economics Series) (Cheltenham: Edward Elgar) Weimer-Jehle W 2006 Cross-impact balances: a system—theoretical approach to cross-impact analysis Technol. Forecast. Social Change 73 334-61

Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders.

PubMed

Idriss, Mohamad; Tannous, Halim; Istrate, Dan; Perrochon, Anaick; Salle, Jean-Yves; Ho Ba Tho, Marie-Christine; Dao, Tien-Tuan

2017-07-04

The progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called "serious game for functional rehabilitation." Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario. The objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines. A two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game. The case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games. It is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders. ©Mohamad Idriss, Halim Tannous, Dan Istrate, Anaick Perrochon, Jean-Yves Salle, Marie-Christine Ho Ba Tho, Tien-Tuan Dao. Originally published in JMIR Serious Games (http://games.jmir.org), 04.07.2017.

Assessing the Benefits of Global Climate Stabilization Within an Integrated Modeling Framework

NASA Astrophysics Data System (ADS)

Beach, R. H.

2015-12-01

Increasing atmospheric carbon dioxide levels, higher temperatures, altered precipitation patterns, and other climate change impacts have already begun to affect US agriculture and forestry, with impacts expected to become more substantial in the future. There have been a number of studies of climate change impacts on agriculture or forestry. However, relatively few studies explore climate change impacts on both agriculture and forests simultaneously, including the interactions between alternative land uses and implications for market outcomes. Additionally, there is a lack of detailed analyses of the effects of stabilization scenarios relative to unabated emissions scenarios. Such analyses are important for developing estimates of the benefits of those stabilization scenarios, which can play a vital role in assessing tradeoffs associated with allocating resources across alternative mitigation and adaptation activities. We provide an analysis of the potential benefits of global climate change mitigation for US agriculture and forestry through 2100, accounting for landowner decisions regarding land use, crop mix, and management practices. The analytic approach involves a combination of climate models, a crop process model (EPIC), a dynamic vegetation model used for forests (MC1), and an economic model of the US forestry and agricultural sector (FASOM-GHG). We find substantial impacts on productivity, commodity markets, and consumer and producer welfare for the stabilization scenario relative to unabated climate change, though the magnitude and direction of impacts vary across regions and commodities. Although there is variability in welfare impacts across climate simulations, we find positive net benefits from stabilization in all cases, with cumulative impacts ranging from 32.7 billion to 54.5 billion over the period 2015-2100. Our estimates contribute to the literature on potential benefits of GHG mitigation and can help inform policy decisions weighing alternative mitigation and adaptation actions.

An integrated modeling approach for estimating hydrologic responses to future urbanization and climate changes in a mixed-use midwestern watershed.

PubMed

Sunde, Michael G; He, Hong S; Hubbart, Jason A; Urban, Michael A

2018-08-15

Future urban development and climatic changes are likely to affect hydrologic regimes in many watersheds. Quantifying potential water regime changes caused by these stressors is therefore crucial for enabling decision makers to develop viable environmental management strategies. This study presents an approach that integrates mid-21st century impervious surface growth estimates derived from the Imperviousness Change Analysis Tool with downscaled climate model projections and a hydrologic model Soil and Water Assessment Tool to characterize potential water regime changes in a mixed-use watershed in central Missouri, USA. Results for the climate change only scenario showed annual streamflow and runoff decreases (-10.7% and -9.2%) and evapotranspiration increases (+6.8%), while results from the urbanization only scenario showed streamflow and runoff increases (+3.8% and +9.3%) and evapotranspiration decreases (-2.4%). Results for the combined impacts scenario suggested that climatic changes could have a larger impact than urbanization on annual streamflow, (overall decrease of -6.1%), and could largely negate surface runoff increases caused by urbanization. For the same scenario, climatic changes exerted a stronger influence on annual evapotranspiration than urbanization (+3.9%). Seasonal results indicated that the relative influences of urbanization and climatic changes vary seasonally. Climatic changes most greatly influenced streamflow and runoff during winter and summer, and evapotranspiration during summer. During some seasons the directional change for hydrologic processes matched for both stressors. This work presented a practicable approach for investigating the relative influences of mid-21st century urbanization and climatic changes on the hydrology of a representative mixed-use watershed, adding to a limited body of research on this topic. This was done using a transferrable approach that can be adapted for watersheds in other regions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders

PubMed Central

Istrate, Dan; Perrochon, Anaick; Salle, Jean-Yves; Ho Ba Tho, Marie-Christine

2017-01-01

Background The progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called “serious game for functional rehabilitation.” Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario. Objective The objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines. Methods A two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game. Results The case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games. Conclusions It is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders. PMID:28676468

An approach to the preliminary evaluation of Closed Ecological Life Support System (CELSS) scenarios and control strategies

NASA Technical Reports Server (NTRS)

Stahr, J. D.; Auslander, D. M.; Spear, R. C.; Young, G. E.

1982-01-01

Life support systems for manned space missions are discussed. A scenario analysis method was proposed for the initial step of comparing possible partial or total recycle scenarios. The method is discussed in detail.

Pharmacists Views and Practices in Regard to Sales of Antibiotics Without a Prescription in Madinah, Saudi Arabia.

PubMed

Bahnassi, Anas

2016-09-01

The aim of this study was to investigate pharmacists views and practices in Madinah, Saudi Arabia, through conducting direct interviews including direct questions and hypothetical scenarios. A purposeful sample of 150 community pharmacists of different ethnic and educational backgrounds were approached to participate in the study. Semistructured interviews including general questions and 5 hypothetical scenarios were used for the investigation. Complete transcripts of the interviews were prepared. All transcripts were coded and categorized into main themes using a computer software. Fifty-four pharmacists agreed to participate (response rate, 36%). Sale of antibiotics without prescription is commonly practiced in Saudi Arabia. Lack of legislation enforcement has exacerbated this practice. Economic hardship, patient's age, emotional factors, and pharmacists' self confidence in diagnosing and prescribing medications in general and antibiotics in particular were the themes included in the interviews and influenced pharmacists' decision to sell antibiotics without a prescription.Many pharmacists did not see the practice as a problem and felt capable of continuing to dispense antibiotics without a prescription. Pharmacists who saw the practice as a problem sees legislation enforcement to be the solution of the problem. Pharmacist views and practices are alarming. The results of this study show that this practice will continue to spread unless strict enforcement is put in place, Lack of clear understanding of the limitations of pharmacist's scope of practice. Results of these studies can be extrapolated to other countries in the region and other countries of the similar social and professional development status.

A space-time multifractal analysis on radar rainfall sequences from central Poland

NASA Astrophysics Data System (ADS)

Licznar, Paweł; Deidda, Roberto

2014-05-01

Rainfall downscaling belongs to most important tasks of modern hydrology. Especially from the perspective of urban hydrology there is real need for development of practical tools for possible rainfall scenarios generation. Rainfall scenarios of fine temporal scale reaching single minutes are indispensable as inputs for hydrological models. Assumption of probabilistic philosophy of drainage systems design and functioning leads to widespread application of hydrodynamic models in engineering practice. However models like these covering large areas could not be supplied with only uncorrelated point-rainfall time series. They should be rather supplied with space time rainfall scenarios displaying statistical properties of local natural rainfall fields. Implementation of a Space-Time Rainfall (STRAIN) model for hydrometeorological applications in Polish conditions, such as rainfall downscaling from the large scales of meteorological models to the scale of interest for rainfall-runoff processes is the long-distance aim of our research. As an introduction part of our study we verify the veracity of the following STRAIN model assumptions: rainfall fields are isotropic and statistically homogeneous in space; self-similarity holds (so that, after having rescaled the time by the advection velocity, rainfall is a fully homogeneous and isotropic process in the space-time domain); statistical properties of rainfall are characterized by an "a priori" known multifractal behavior. We conduct a space-time multifractal analysis on radar rainfall sequences selected from the Polish national radar system POLRAD. Radar rainfall sequences covering the area of 256 km x 256 km of original 2 km x 2 km spatial resolution and 15 minutes temporal resolution are used as study material. Attention is mainly focused on most severe summer convective rainfalls. It is shown that space-time rainfall can be considered with a good approximation to be a self-similar multifractal process. Multifractal analysis is carried out assuming Taylor's hypothesis to hold and the advection velocity needed to rescale the time dimension is assumed to be equal about 16 km/h. This assumption is verified by the analysis of autocorrelation functions along the x and y directions of "rainfall cubes" and along the time axis rescaled with assumed advection velocity. In general for analyzed rainfall sequences scaling is observed for spatial scales ranging from 4 to 256 km and for timescales from 15 min to 16 hours. However in most cases scaling break is identified for spatial scales between 4 and 8, corresponding to spatial dimensions of 16 km to 32 km. It is assumed that the scaling break occurrence at these particular scales in central Poland conditions could be at least partly explained by the rainfall mesoscale gap (on the edge of meso-gamma, storm-scale and meso-beta scale).

Time-dependent neo-deterministic seismic hazard scenarios for the 2016 Central Italy earthquakes sequence

NASA Astrophysics Data System (ADS)

Peresan, Antonella; Kossobokov, Vladimir; Romashkova, Leontina; Panza, Giuliano F.

2017-04-01

Predicting earthquakes and related ground shaking is widely recognized among the most challenging scientific problems, both for societal relevance and intrinsic complexity of the problem. The development of reliable forecasting tools requires their rigorous formalization and testing, first in retrospect, and then in an experimental real-time mode, which imply a careful application of statistics to data sets of limited size and different accuracy. Accordingly, the operational issues of prospective validation and use of time-dependent neo-deterministic seismic hazard scenarios are discussed, reviewing the results in their application in Italy and surroundings. Long-term practice and results obtained for the Italian territory in about two decades of rigorous prospective testing, support the feasibility of earthquake forecasting based on the analysis of seismicity patterns at the intermediate-term middle-range scale. Italy is the only country worldwide where two independent, globally tested, algorithms are simultaneously applied, namely CN and M8S, which permit to deal with multiple sets of seismic precursors to allow for a diagnosis of the intervals of time when a strong event is likely to occur inside a given region. Based on routinely updated space-time information provided by CN and M8S forecasts, an integrated procedure has been developed that allows for the definition of time-dependent seismic hazard scenarios, through the realistic modeling of ground motion by the neo-deterministic approach (NDSHA). This scenario-based methodology permits to construct, both at regional and local scale, scenarios of ground motion for the time interval when a strong event is likely to occur within the alerted areas. CN and M8S predictions, as well as the related time-dependent ground motion scenarios associated with the alarmed areas, are routinely updated since 2006. The issues and results from real-time testing of the integrated NDSHA scenarios are illustrated, with special emphasis on the sequence of destructive earthquakes that struck Central Italy starting on August 2016. The results obtained so far evidence the validity of the proposed methodology in anticipating ground shaking from approaching strong earthquakes and prove that the information provided by time-dependent NDSHA can be useful in assigning priorities for timely and effective mitigation actions.

Development and Application of Percent Annual Chance Coastal Inundation Maps to Support Decision-Making in the Northern Gulf of Mexico

NASA Astrophysics Data System (ADS)

Bilskie, M. V.; Hagen, S. C.; Irish, J. L.; Yoskowitz, D.; Del Angel, D. C.

2017-12-01

Rising sea levels increase the vulnerability, exposure, probability, and thus risk associated with hurricane storm surge flooding across low-gradient coastal landscapes. In the U.S., flood risk assessments commonly employ the delineation of the 1% annual chance flood (100-year return period) that guide coastal policy and planning. As many coastal communities now include climate change effects on future development activities, the need to provide scientifically sound and scenario-based data products are becoming increasingly essential. Implementing bio-geo-physical models to study the effects of sea level rise (SLR) on coastal flooding under a variety of scenarios can be a powerful tool. However, model results alone are not appropriate for use by the broader coastal management community and thus must be further refined. For example, developing return period inundations maps or examining the potential economic damages are vital to translate scientific finding and extend their practicality to coastal resources managers, stakeholders, and governmental agencies. This work employs a collection of high-resolution wind-wave and hurricane storm surge models forced by a suite of synthetic storms to derive the 1% and 0.2% annual chance floodplain under four SLR scenarios (0.2, m, 0.5 m, 1.2 m, and 2.0 m) across the northern Gulf of Mexico (NGOM) coast, which include Mississippi, Alabama, and the Florida panhandle. The models represent the potential outlook of the coastal landscape for each of the scenarios and contains changes to the salt marsh, barrier islands, shoreline position, dune elevations, and land use land cover. Simulated surge data are fed into a hazard assessment tool that provides estimates of potential future damages and costs for each SLR scenario. Results provide evidence that the present 500-year floodplain becomes the 100-year floodplain under the 0.5 m SLR scenario by the end of the century along the Alabama and the Florida panhandle coast. Across Mississippi, the current 500-year floodplain becomes the 100-year floodplain under the 1.2 m SLR scenario. Furthermore, an economic impact analysis has begun to determine economic damages from greater surge depths and new regions that become part of the coastal floodplain.

The FORE-SCE model: a practical approach for projecting land cover change using scenario-based modeling

USGS Publications Warehouse

Sohl, Terry L.; Sayler, Kristi L.; Drummond, Mark A.; Loveland, Thomas R.

2007-01-01

A wide variety of ecological applications require spatially explicit, historic, current, and projected land use and land cover data. The U.S. Land Cover Trends project is analyzing contemporary (1973–2000) land-cover change in the conterminous United States. The newly developed FORE-SCE model used Land Cover Trends data and theoretical, statistical, and deterministic modeling techniques to project future land cover change through 2020 for multiple plausible scenarios. Projected proportions of future land use were initially developed, and then sited on the lands with the highest potential for supporting that land use and land cover using a statistically based stochastic allocation procedure. Three scenarios of 2020 land cover were mapped for the western Great Plains in the US. The model provided realistic, high-resolution, scenario-based land-cover products suitable for multiple applications, including studies of climate and weather variability, carbon dynamics, and regional hydrology.

Information Science Panel joint meeting with Imaging Science Panel

NASA Technical Reports Server (NTRS)

1982-01-01

Specific activity in information extraction science (taken to include data handling) is needed to: help identify the bounds of practical missions; identify potential data handling and analysis scenarios; identify the required enabling technology; and identify the requirements for a design data base to be used by the disciplines in determining potential parameters for future missions. It was defined that specific analysis topics were a function of the discipline involved, and therefore no attempt was made to define any specific analysis developments required. Rather, it was recognized that a number of generic data handling requirements exist whose solutions cannot be typically supported by the disciplines. The areas of concern were therefore defined as: data handling aspects of system design considerations; enabling technology for data handling, with specific attention to rectification and registration; and enabling technology for analysis. Within each of these areas, the following topics were addressed: state of the art (current status and contributing factors); critical issues; and recommendations for research and/or development.

Emergy Analysis and Sustainability Efficiency Analysis of Different Crop-Based Biodiesel in Life Cycle Perspective

PubMed Central

Ren, Jingzheng; Manzardo, Alessandro; Mazzi, Anna; Fedele, Andrea; Scipioni, Antonio

2013-01-01

Biodiesel as a promising alternative energy resource has been a hot spot in chemical engineering nowadays, but there is also an argument about the sustainability of biodiesel. In order to analyze the sustainability of biodiesel production systems and select the most sustainable scenario, various kinds of crop-based biodiesel including soybean-, rapeseed-, sunflower-, jatropha- and palm-based biodiesel production options are studied by emergy analysis; soybean-based scenario is recognized as the most sustainable scenario that should be chosen for further study in China. DEA method is used to evaluate the sustainability efficiencies of these options, and the biodiesel production systems based on soybean, sunflower, and palm are considered as DEA efficient, whereas rapeseed-based and jatropha-based scenarios are needed to be improved, and the improved methods have also been specified. PMID:23766723

Alternative Futures Analysis Of Farmington Bay Wetlands In The Great Salt Lake Ecosystem

EPA Science Inventory

An Alternative Futures Analysis (AFA) was conducted to evaluate tradeoffs between landscape design scenarios and ecological services for Farmington Bay, Great Salt Lake (GSL), wetlands. Model scenarios included both plan trend and conservation "futures" projected to 2030. Scena...

Best Practices for Management of Biocontaminated Waste ...

EPA Pesticide Factsheets

Report The purpose of these best practices is to provide federal, state, territorial, and local waste management entities information on techniques and methodologies that have the potential to improve the handling and management of biocontaminated waste streams after a biological agent incident. These best practices are intended to be general in nature serving as a resource to a variety of biological agents in a variety of situations; however, these best practices also present a specific homeland security scenario – a biological attack with Bacillus anthracis (B. anthracis) – to help illustrate specific waste management considerations.

Construct and face validity of the educational computer-based environment (ECE) assessment scenarios for basic endoneurosurgery skills.

PubMed

Cagiltay, Nergiz Ercil; Ozcelik, Erol; Sengul, Gokhan; Berker, Mustafa

2017-11-01

In neurosurgery education, there is a paradigm shift from time-based training to criterion-based model for which competency and assessment becomes very critical. Even virtual reality simulators provide alternatives to improve education and assessment in neurosurgery programs and allow for several objective assessment measures, there are not many tools for assessing the overall performance of trainees. This study aims to develop and validate a tool for assessing the overall performance of participants in a simulation-based endoneurosurgery training environment. A training program was developed in two levels: endoscopy practice and beginning surgical practice based on four scenarios. Then, three experiments were conducted with three corresponding groups of participants (Experiment 1, 45 (32 beginners, 13 experienced), Experiment 2, 53 (40 beginners, 13 experienced), and Experiment 3, 26 (14 novices, 12 intermediate) participants). The results analyzed to understand the common factors among the performance measurements of these experiments. Then, a factor capable of assessing the overall skill levels of surgical residents was extracted. Afterwards, the proposed measure was tested to estimate the experience levels of the participants. Finally, the level of realism of these educational scenarios was assessed. The factor formed by time, distance, and accuracy on simulated tasks provided an overall performance indicator. The prediction correctness was very high for the beginners than the one for experienced surgeons in Experiments 1 and 2. When non-dominant hand is used in a surgical procedure-based scenario, skill levels of surgeons can be better predicted. The results indicate that the scenarios in Experiments 1 and 2 can be used as an assessment tool for the beginners, and scenario-2 in Experiment 3 can be used as an assessment tool for intermediate and novice levels. It can be concluded that forming the balance between perceived action capacities and skills is critical for better designing and developing skill assessment surgical simulation tools.

The relationship between intolerance of uncertainty in chiropractic students and their treatment intervention choices.

PubMed

Innes, Stanley I; Leboeuf-Yde, Charlotte; Walker, Bruce F

2017-01-01

Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students' intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief. Between October and November of 2016, students from two Australian chiropractic programs ( N  = 444) answered a questionnaire on measures of IU levels, patient case scenarios for neck and low back pain, and questions about self-ratings of their future chiropractic abilities and perceived need for the adoption of a chiropractic technique system. Associations were tested by the IU score and the therapeutic choices relating to a) a neck pain case scenario, b) a low back pain scenario, c) various technique systems, and d) the self-rated competence level treating the IU score both as a continuous and a categorical variable. There was an overall response rate of 53%. Those students who were high in levels of IU were significantly more likely to make incorrect clinical decisions than those with normal or low levels of IU for the neck pain case scenario. No differences were found on the low back pain scenario, on preferences to use a technique system in the future, or on predicted self-rating of competence after graduation. Psychological factors, such as IU, may have an impact on chiropractic students' clinical decisions. However, it does not impact on all aspects of practice. This finding has implications for chiropractic educators, especially when dealing with neck pain. However, it may be relevant to continue the search for specific personality profiles in relation to various favourable and unfavourable practice patterns, as it is unknown whether these dynamics are important for other aspects of chiropractic education.

Lunar base surface mission operations. Lunar Base Systems Study (LBSS) task 4.1

NASA Technical Reports Server (NTRS)

1987-01-01

The purpose was to perform an analysis of the surface operations associated with a human-tended lunar base. Specifically, the study defined surface elements and developed mission manifests for a selected base scenario, determined the nature of surface operations associated with this scenario, generated a preliminary crew extravehicular and intravehicular activity (EVA/IVA) time resource schedule for conducting the missions, and proposed concepts for utilizing remotely operated equipment to perform repetitious or hazardous surface tasks. The operations analysis was performed on a 6 year period of human-tended lunar base operation prior to permanent occupancy. The baseline scenario was derived from a modified version of the civil needs database (CNDB) scenario. This scenario emphasizes achievement of a limited set of science and exploration objectives while emplacing the minimum habitability elements required for a permanent base.

Supercomputing resources empowering superstack with interactive and integrated systems

NASA Astrophysics Data System (ADS)

Rückemann, Claus-Peter

2012-09-01

This paper presents the results from the development and implementation of Superstack algorithms to be dynamically used with integrated systems and supercomputing resources. Processing of geophysical data, thus named geoprocessing, is an essential part of the analysis of geoscientific data. The theory of Superstack algorithms and the practical application on modern computing architectures was inspired by developments introduced with processing of seismic data on mainframes and within the last years leading to high end scientific computing applications. There are several stacking algorithms known but with low signal to noise ratio in seismic data the use of iterative algorithms like the Superstack can support analysis and interpretation. The new Superstack algorithms are in use with wave theory and optical phenomena on highly performant computing resources for huge data sets as well as for sophisticated application scenarios in geosciences and archaeology.

The effectiveness of risk management: an analysis of project risk planning across industries and countries.

PubMed

Zwikael, Ofer; Ahn, Mark

2011-01-01

This article examines the effectiveness of current risk management practices to reduce project risk using a multinational, multi-industry study across different scenarios and cultures. A survey was administered to 701 project managers, and their supervisors, in seven industries and three diverse countries (New Zealand, Israel, and Japan), in multiple languages during the 2002-2007 period. Results of this study show that project context--industry and country where a project is executed--significantly impacts perceived levels of project risk, and the intensity of risk management processes. Our findings also suggest that risk management moderates the relationship between risk level and project success. Specifically, we found that even moderate levels of risk management planning are sufficient to reduce the negative effect risk levels have on project success. © 2010 Society for Risk Analysis.

Molecular Diagnostic Analysis of Outbreak Scenarios

ERIC Educational Resources Information Center

Morsink, M. C.; Dekter, H. E.; Dirks-Mulder, A.; van Leeuwen, W. B.

2012-01-01

In the current laboratory assignment, technical aspects of the polymerase chain reaction (PCR) are integrated in the context of six different bacterial outbreak scenarios. The "Enterobacterial Repetitive Intergenic Consensus Sequence" (ERIC) PCR was used to analyze different outbreak scenarios. First, groups of 2-4 students determined optimal…

The development of English primary care group governance. A scenario analysis.

PubMed

Sheaff, R

1999-01-01

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general practitioners (GPs) will react to the formation of PCTs and how the UK government will then respond in turn. A scenario analysis suggests three possible lines of development. The base (likeliest) scenario predicts a mainly networked form of PCT governance. An alternative scenario is of PCT governance resembling the former National Health Service internal market. A third scenario predicts 'franchise model' PCTs employing some GPs and subcontracting others. To different degrees all three scenarios predict that PCTs will retain elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may prove only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance.

Seismic probabilistic tsunami hazard: from regional to local analysis and use of geological and historical observations

NASA Astrophysics Data System (ADS)

Tonini, R.; Lorito, S.; Orefice, S.; Graziani, L.; Brizuela, B.; Smedile, A.; Volpe, M.; Romano, F.; De Martini, P. M.; Maramai, A.; Selva, J.; Piatanesi, A.; Pantosti, D.

2016-12-01

Site-specific probabilistic tsunami hazard analyses demand very high computational efforts that are often reduced by introducing approximations on tsunami sources and/or tsunami modeling. On one hand, the large variability of source parameters implies the definition of a huge number of potential tsunami scenarios, whose omission could easily lead to important bias in the analysis. On the other hand, detailed inundation maps computed by tsunami numerical simulations require very long running time. When tsunami effects are calculated at regional scale, a common practice is to propagate tsunami waves in deep waters (up to 50-100 m depth) neglecting non-linear effects and using coarse bathymetric meshes. Then, maximum wave heights on the coast are empirically extrapolated, saving a significant amount of computational time. However, moving to local scale, such assumptions drop out and tsunami modeling would require much greater computational resources. In this work, we perform a local Seismic Probabilistic Tsunami Hazard Analysis (SPTHA) for the 50 km long coastal segment between Augusta and Siracusa, a touristic and commercial area placed along the South-Eastern Sicily coast, Italy. The procedure consists in using the outcomes of a regional SPTHA as input for a two-step filtering method to select and substantially reduce the number of scenarios contributing to the specific target area. These selected scenarios are modeled using high resolution topo-bathymetry for producing detailed inundation maps. Results are presented as probabilistic hazard curves and maps, with the goal of analyze, compare and highlight the different results provided by regional and local hazard assessments. Moreover, the analysis is enriched by the use of local observed tsunami data, both geological and historical. Indeed, tsunami data-sets available for the selected target areas are particularly rich with respect to the scarce and heterogeneous data-sets usually available elsewhere. Therefore, they can represent valuable benchmarks for testing and strengthening the results of such kind of studies. The work is funded by the Italian Flagship Project RITMARE, the two EC FP7 projects ASTARTE (Grant agreement 603839) and STREST (Grant agreement 603389), and the INGV-DPC Agreement.

Exploring sustainability transitions in households: insights from real-life experiments

NASA Astrophysics Data System (ADS)

Baedeker, Carolin; Buhl, Johannes; Greiff, Kathrin; Hasselkuß, Marco; Liedtke, Christa; Lukas, Melanie

2016-04-01

Societal transformation towards sustainable consumption and production, especially in urban areas, is a key challenge. The design and implementation of sustainable product service systems (PSS) might be the initial point, in which private households play a major role. The Sustainable LivingLab research infrastructure was developed as an experimental setting for investigating consumption and production patterns in private households, especially to explore socio-technical innovations which are helpful to guide sustainability transitions. The suggested presentation describes results of several real-life experiments conducted in German households, e.g. the project SusLabNRW (North-Rhine Westphalia as part of the European SusLabNWE-Project), the EnerTransRuhr project as well as the PATHWAYS project that explore patterns of action, time use, social practices and the related resource use in private households. The presentation gives an overview of the employed methods and analysed data (qualitative interviews, social network analysis, survey on household activities and inventories and a sustainability assessment (resource profiles - MIPS household analysis). Households' resource consumption was calculated in all fields of activity to analyse social practices' impact. The presentation illustrates how aggregated data can inform scenario analysis and concludes with an outlook onto transition pathways at household level and socio-technical innovations in the fields of housing, nutrition and mobility.

Scenario analysis for integrated water resources planning and management under uncertainty in the Zayandehrud river basin

NASA Astrophysics Data System (ADS)

Safavi, Hamid R.; Golmohammadi, Mohammad H.; Sandoval-Solis, Samuel

2016-08-01

The goal of this study is to develop and analyze three scenarios in the Zayandehrud river basin in Iran using a model already built and calibrated by Safavi et al. (2015) that has results for the baseline scenario. Results from the baseline scenario show that water demands will be supplied at the cost of depletion of surface and ground water resources, making this scenario undesirable and unsustainable. Supply Management, Demand Management, and Meta (supply and demand management) scenarios are the selected scenarios in this study. They are to be developed and declared into the Zayandehrud model to assess and evaluate the imminent status of the basin. Certain strategies will be employed for this purpose to improve and rectify the current management policies. The five performance criteria of time-based and volumetric reliability, resilience, vulnerability, and maximum deficit will be employed in the process of scenario analysis and evaluation. The results obtained from the performance criteria will be summed up into a so-called 'Water Resources Sustainability Index' to facilitate comparison among the likely trade-offs. Uncertainties arising from historical data, management policies, rainfall-runoff model, demand priorities, and performance criteria are considered in the proposed conceptual framework and modeled by appropriate approaches. Results show that the Supply Management scenario can be used to improve upon the demand supply but that it has no tangible effects on the improvement of the resources in the study region. In this regard, the Demand Management scenario is found to be more effective than the water supply one although it still remains unacceptable. Results of the Meta scenario indicate that both the supply and demand management scenarios must be applied if the water resources are to be safeguarded against degradation and depletion. In other words, the supply management scenario is necessary but not adequate; rather, it must be coupled to the demand management scenario. Finally, it will be shown that applying the Meta scenario will improve the water resources from sustainably.

A Multi-Objective Decision-Making Model for Resources Allocation in Humanitarian Relief

DTIC Science & Technology

2007-03-01

Applied Mathematics and Computation 163, 2005, pp756 19. Malczewski, J., GIS and Multicriteria Decision Analysis , John Wiley and Sons, New York... used when interpreting the results of the analysis . (Raimo et al. 2002) (7) Sensitivity analysis Sensitivity analysis in a DA process answers...Budget Scenario Analysis The MILP is solved ( using LINDO 6.1) for high, medium and low budget scenarios in both damage degree levels. Tables 17 and

Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice.

PubMed

Goldberg, A; Silverman, E; Samuelson, S; Katz, D; Lin, H M; Levine, A; DeMaria, S

2015-05-01

Anaesthetists may fail to recognize and manage certain rare intraoperative events. Simulation has been shown to be an effective educational adjunct to typical operating room-based education to train for these events. It is yet unclear, however, why simulation has any benefit. We hypothesize that learners who are allowed to manage a scenario independently and allowed to fail, thus causing simulated morbidity, will consequently perform better when re-exposed to a similar scenario. Using a randomized, controlled, observer-blinded design, 24 first-year residents were exposed to an oxygen pipeline contamination scenario, either where patient harm occurred (independent group, n=12) or where a simulated attending anaesthetist intervened to prevent harm (supervised group, n=12). Residents were brought back 6 months later and exposed to a different scenario (pipeline contamination) with the same end point. Participants' proper treatment, time to diagnosis, and non-technical skills (measured using the Anaesthetists' Non-Technical Skills Checklist, ANTS) were measured. No participants provided proper treatment in the initial exposure. In the repeat encounter 6 months later, 67% in the independent group vs 17% in the supervised group resumed adequate oxygen delivery (P=0.013). The independent group also had better ANTS scores [median (interquartile range): 42.3 (31.5-53.1) vs 31.3 (21.6-41), P=0.015]. There was no difference in time to treatment if proper management was provided [602 (490-820) vs 610 (420-800) s, P=0.79]. Allowing residents to practise independently in the simulation laboratory, and subsequently, allowing them to fail, can be an important part of simulation-based learning. This is not feasible in real clinical practice but appears to have improved resident performance in this study. The purposeful use of independent practice and its potentially negative outcomes thus sets simulation-based learning apart from traditional operating room learning. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

In situ medical simulation investigation of emergency department procedural sedation with randomized trial of experimental bedside clinical process guidance intervention.

PubMed

Siegel, Nathan A; Kobayashi, Leo; Dunbar-Viveiros, Jennifer A; Devine, Jeffrey; Al-Rasheed, Rakan S; Gardiner, Fenwick G; Olsson, Krister; Lai, Stella; Jones, Mark S; Dannecker, Max; Overly, Frank L; Gosbee, John W; Portelli, David C; Jay, Gregory D

2015-06-01

Patient safety during emergency department procedural sedation (EDPS) can be difficult to study. Investigators sought to delineate and experimentally assess EDPS performance and safety practices of senior-level emergency medicine residents through in situ simulation. Study sessions used 2 pilot-tested EDPS scenarios with critical action checklists, institutional forms, embedded probes, and situational awareness questionnaires. An experimental informatics system was separately developed for bedside EDPS process guidance. Postgraduate year 3 and 4 subjects completed both scenarios in randomized order; only experimental subjects were provided with the experimental system during second scenarios. Twenty-four residents were recruited into a control group (n = 12; 6.2 ± 7.4 live EDPS experience) and experimental group (n = 12; 11.3 ± 8.2 live EDPS experience [P = 0.10]). Critical actions for EDPS medication selection, induction, and adverse event recognition with resuscitation were correctly performed by most subjects. Presedation evaluations, sedation rescue preparation, equipment checks, time-outs, and documentation were frequently missed. Time-outs and postsedation assessments increased during second scenarios in the experimental group. Emergency department procedural sedation safety probe detection did not change across scenarios in either group. Situational awareness scores were 51% ± 7% for control group and 58% ± 12% for experimental group. Subjects using the experimental system completed more time-outs and scored higher Simulation EDPS Safety Composite Scores, although without comprehensive improvements in EDPS practice or safety. Study simulations delineated EDPS and assessed safety behaviors in senior emergency medicine residents, who exhibited the requisite medical knowledge base and procedural skill set but lacked some nontechnical skills that pertain to emergency department microsystem functions and patient safety. The experimental system exhibited limited impact only on in-simulation time-out compliance.

Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.

PubMed Central

Naylor, C D; Williams, J I

1996-01-01

OBJECTIVES--To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN--Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING--Ontario, Canada. MAIN MEASURES--Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS--Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS--These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery. PMID:10157268

Spatiotemporal data visualisation for homecare monitoring of elderly people.

PubMed

Juarez, Jose M; Ochotorena, Jose M; Campos, Manuel; Combi, Carlo

2015-10-01

Elderly people who live alone can be assisted by home monitoring systems that identify risk scenarios such as falls, fatigue symptoms or burglary. Given that these systems have to manage spatiotemporal data, human intervention is required to validate automatic alarms due to the high number of false positives and the need for context interpretation. The goal of this work was to provide tools to support human action, to identify such potential risk scenarios based on spatiotemporal data visualisation. We propose the MTA (multiple temporal axes) model, a visual representation of temporal information of the activity of a single person at different locations. The main goal of this model is to visualize the behaviour of a person in their home, facilitating the identification of health-risk scenarios and repetitive patterns. We evaluate the model's insight capacity compared with other models using a standard evaluation protocol. We also test its practical suitability of the MTA graphical model in a commercial home monitoring system. In particular, we implemented 8VISU, a visualization tool based on MTA. MTA proved to be more than 90% accurate in identify non-risk scenarios, independently of the length of the record visualised. When the spatial complexity was increased (e.g. number of rooms) the model provided good accuracy form up to 5 rooms. Therefore, user preferences and user performance seem to be balanced. Moreover, it also gave high sensitivity levels (over 90%) for 5-8 rooms. Fall is the most recurrent incident for elderly people. The MTA model outperformed the other models considered in identifying fall scenarios (66% of correctness) and was the second best for burglary and fatigue scenarios (36% of correctness). Our experiments also confirm the hypothesis that cyclic models are the most suitable for fatigue scenarios, the Spiral and MTA models obtaining most positive identifications. In home monitoring systems, spatiotemporal visualization is a useful tool for identifying risk and preventing home accidents in elderly people living alone. The MTA model helps the visualisation in different stages of the temporal data analysis process. In particular, its explicit representation of space and movement is useful for identifying potential scenarios of risk, while the spiral structure can be used for the identification of recurrent patterns. The results of the experiments and the experience using the visualization tool 8VISU proof the potential of the MTA graphical model to mine temporal data and to support caregivers using home monitoring infrastructures. Copyright © 2015 Elsevier B.V. All rights reserved.

Geothermal Impact Analysis | Geothermal Technologies | NREL

Science.gov Websites

on potential geothermal growth scenarios, jobs and economic impacts, clean energy manufacturing geothermal resources. We: Perform resource analysis Develop techno-economic models Quantify environmental growth scenarios across multiple market sectors. Learn more about the GeoVision Study. Jobs and Economic

Micro-Logistics Analysis for Human Space Exploration

NASA Technical Reports Server (NTRS)

Cirillo, William; Stromgren, Chel; Galan, Ricardo

2008-01-01

Traditionally, logistics analysis for space missions has focused on the delivery of elements and goods to a destination. This type of logistics analysis can be referred to as "macro-logistics". While the delivery of goods is a critical component of mission analysis, it captures only a portion of the constraints that logistics planning may impose on a mission scenario. The other component of logistics analysis concerns the local handling of goods at the destination, including storage, usage, and disposal. This type of logistics analysis, referred to as "micro-logistics", may also be a primary driver in the viability of a human lunar exploration scenario. With the rigorous constraints that will be placed upon a human lunar outpost, it is necessary to accurately evaluate micro-logistics operations in order to develop exploration scenarios that will result in an acceptable level of system performance.

Beginning the Principalship: A Practical Guide for New School Leaders. 2nd Edition.

ERIC Educational Resources Information Center

Daresh, John C.

This is a highly practical book for the first-year principal or for the assistant principal looking ahead to promotion. In place of abstract generalities, it offers real-life vignettes and scenarios that may be faced by typical first-year principals. The skill checklists are intended to be realistic and unintimidating. Step-by-step explanations…

Integration of Watershed Model AnnAGNPS and Stream Network Model CCHE1D for the Development of a New GIS-Based BMP Planning Tool

USDA-ARS?s Scientific Manuscript database

This paper presents a new GIS-based Best Management Practice (BMP) Tool developed for watershed managers to assist in the decision making process by simulating various scenarios using various combinations of Best Management Practices (BMPs). The development of this BMPTool is based on the integratio...

Teaching evidence-based medicine using a problem-oriented approach.

PubMed

Hosny, Somaya; Ghaly, Mona S

2014-04-01

Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.

Trade-Off Analysis Report

NASA Technical Reports Server (NTRS)

Dhas, Chris

2000-01-01

NASAs Glenn Research Center (GRC) defines and develops advanced technology for high priority national needs in communications technologies for application to aeronautics and space. GRC tasked Computer Networks and Software Inc. (CNS) to examine protocols and architectures for an In-Space Internet Node. CNS has developed a methodology for network reference models to support NASAs four mission areas: Earth Science, Space Science, Human Exploration and Development of Space (REDS), Aerospace Technology. CNS previously developed a report which applied the methodology, to three space Internet-based communications scenarios for future missions. CNS conceptualized, designed, and developed space Internet-based communications protocols and architectures for each of the independent scenarios. GRC selected for further analysis the scenario that involved unicast communications between a Low-Earth-Orbit (LEO) International Space Station (ISS) and a ground terminal Internet node via a Tracking and Data Relay Satellite (TDRS) transfer. This report contains a tradeoff analysis on the selected scenario. The analysis examines the performance characteristics of the various protocols and architectures. The tradeoff analysis incorporates the results of a CNS developed analytical model that examined performance parameters.

Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program.

PubMed

Shaw-Battista, Jenna; Belew, Cynthia; Anderson, Deborah; van Schaik, Sandrijn

2015-01-01

This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

Future Market Share of Space Solar Electric Power Under Open Competition

NASA Astrophysics Data System (ADS)

Smith, S. J.; Mahasenan, N.; Clarke, J. F.; Edmonds, J. A.

2002-01-01

This paper assesses the value of Space Solar Power deployed under market competition with a full suite of alternative energy technologies over the 21st century. Our approach is to analyze the future energy system under a number of different scenarios that span a wide range of possible future demographic, socio-economic, and technological developments. Scenarios both with, and without, carbon dioxide concentration stabilization policies are considered. We use the comprehensive set of scenarios created for the Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios (Nakicenovic and Swart 2000). The focus of our analysis will be the cost of electric generation. Cost is particularly important when considering electric generation since the type of generation is, from a practical point of view, largely irrelevant to the end-user. This means that different electricity generation technologies must compete on the basis of price. It is important to note, however, that even a technology that is more expensive than average can contribute to the overall generation mix due to geographical and economic heterogeneity (Clarke and Edmonds 1993). This type of competition is a central assumption of the modeling approach used here. Our analysis suggests that, under conditions of full competition of all available technologies, Space Solar Power at 7 cents per kW-hr could comprise 5-10% of global electric generation by the end of the century, with a global total generation of 10,000 TW-hr. The generation share of Space Solar Power is limited due to competition with lower-cost nuclear, biomass, and terrestrial solar PV and wind. The imposition of a carbon constraint does not significantly increase the total amount of power generated by Space Solar Power in cases where a full range of advanced electric generation technologies are also available. Potential constraints on the availability of these other electric generation options can increase the amount of electricity generated by Space Solar Power. In agreement with previous work on this subject, we note that launch costs are a significant impediment for the widespread implementation of Space Solar Power. KEY WORDS: space satellite power, advanced electric generation, electricity price, climate change

Flood risk in a changing world - a coupled transdisciplinary modelling framework for flood risk assessment in an Alpine study area

NASA Astrophysics Data System (ADS)

Huttenlau, Matthias; Schneeberger, Klaus; Winter, Benjamin; Pazur, Robert; Förster, Kristian; Achleitner, Stefan; Bolliger, Janine

2017-04-01

Devastating flood events have caused substantial economic damage across Europe during past decades. Flood risk management has therefore become a topic of crucial interest across state agencies, research communities and the public sector including insurances. There is consensus that mitigating flood risk relies on impact assessments which quantitatively account for a broad range of aspects in a (changing) environment. Flood risk assessments which take into account the interaction between the drivers climate change, land-use change and socio-economic change might bring new insights to the understanding of the magnitude and spatial characteristic of flood risks. Furthermore, the comparative assessment of different adaptation measures can give valuable information for decision-making. With this contribution we present an inter- and transdisciplinary research project aiming at developing and applying such an impact assessment relying on a coupled modelling framework for the Province of Vorarlberg in Austria. Stakeholder engagement ensures that the final outcomes of our study are accepted and successfully implemented in flood management practice. The study addresses three key questions: (i) What are scenarios of land- use and climate change for the study area? (ii) How will the magnitude and spatial characteristic of future flood risk change as a result of changes in climate and land use? (iii) Are there spatial planning and building-protection measures which effectively reduce future flood risk? The modelling framework has a modular structure comprising modules (i) climate change, (ii) land-use change, (iii) hydrologic modelling, (iv) flood risk analysis, and (v) adaptation measures. Meteorological time series are coupled with spatially explicit scenarios of land-use change to model runoff time series. The runoff time series are combined with impact indicators such as building damages and results are statistically assessed to analyse flood risk scenarios. Thus, the regional flood risk can be expressed in terms of expected annual damage and damages associated with a low probability of occurrence. We consider building protection measures explicitly as part of the consequence analysis of flood risk whereas spatial planning measures are already considered as explicit scenarios in the course of land-use change modelling.

An Exploration of Scenarios to Support Sustainable Land Management Using Integrated Environmental Socio-economic Models

NASA Astrophysics Data System (ADS)

Fleskens, L.; Nainggolan, D.; Stringer, L. C.

2014-11-01

Scenario analysis constitutes a valuable deployment method for scientific models to inform environmental decision-making, particularly for evaluating land degradation mitigation options, which are rarely based on formal analysis. In this paper we demonstrate such an assessment using the PESERA-DESMICE modeling framework with various scenarios for 13 global land degradation hotspots. Starting with an initial assessment representing land degradation and productivity under current conditions, options to combat instances of land degradation are explored by determining: (1) Which technologies are most biophysically appropriate and most financially viable in which locations; we term these the "technology scenarios"; (2) how policy instruments such as subsidies influence upfront investment requirements and financial viability and how they lead to reduced levels of land degradation; we term these the "policy scenarios"; and (3) how technology adoption affects development issues such as food production and livelihoods; we term these the "global scenarios". Technology scenarios help choose the best technology for a given area in biophysical and financial terms, thereby outlining where policy support may be needed to promote adoption; policy scenarios assess whether a policy alternative leads to a greater extent of technology adoption; while global scenarios demonstrate how implementing technologies may serve wider sustainable development goals. Scenarios are applied to assess spatial variation within study sites as well as to compare across different sites. Our results show significant scope to combat land degradation and raise agricultural productivity at moderate cost. We conclude that scenario assessment can provide informative input to multi-level land management decision-making processes.