How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Science.gov (United States)

McCullough, Brendan; Marton, Gregory E; Ramnanan, Christopher J

2015-01-01

Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Directory of Open Access Journals (Sweden)

McCullough B

2015-01-01

Full Text Available Brendan McCullough, Gregory E Marton, Christopher J Ramnanan Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Background: Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Methods: Review of medical education literature using the terms “attitudes”, “motivations”, “physicians”, “teaching”, and “undergraduate medical education” resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. Results: A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Conclusion: Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education. Keywords: clinician-educators, teaching, undergraduate medical

Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation.

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Sturla, Francesco; Redaelli, Alberto; Puppini, Giovanni; Onorati, Francesco; Faggian, Giuseppe; Votta, Emiliano

2015-06-01

Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edge-to-edge repair technique treats mitral regurgitation by suturing the leaflets together and creating a double-orifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip(®) device. Edge-to-edge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edge-to-edge technique. Image-based structural finite element models of three mitral valves affected by posterior prolapse were derived from cine-cardiac magnetic resonance imaging. The models accounted for the patient-specific 3D geometry of the valve, including leaflet compound curvature pattern, patient-specific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip(®) implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip(®) implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edge-to-edge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that

Once a clinician, always a clinician: a systematic review to develop a typology of clinician-researcher dual-role experiences in health research with patient-participants

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E. Jean C. Hay-Smith

2016-08-01

Full Text Available Abstract Background Many health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clinician-researchers plan and implement methodologically and ethically sound research. Methods Systematic searching of Medline, CINAHL, PsycINFO, Embase and Scopus (inception to 28.07.2014 for primary studies or first-person reflexive reports of clinician-researchers’ dual-role experiences, supplemented by reference list checking and Google Scholar scoping searches. Included articles were loaded in NVivo for analysis. The coding was focused on how dual-role was evidenced for the clinician-researchers in research involving patients. Procedures were completed by one researcher (MB and independently cross-checked by another (JHS. All authors contributed to extensive discussions to resolve all disagreements about initial coding and verify the final themes. Results Database searching located 7135 records, resulting in 29 included studies, with the addition of 7 studies through reference checks and scoping searches. Two overarching themes described the most common catalysts for dual-role experiences – ways a research role can involve patterns of behaviour typical of a clinical role, and the developing connection that starts to resemble a clinician-patient relationship. Five subthemes encapsulated the clinical patterns commonly repeated in research settings (clinical queries, perceived agenda, helping hands, uninvited clinical expert, and research or therapy and five subthemes described concerns about the researcher-participant relationship (clinical assumptions, suspicion and holding back, revelations, over-identification, and manipulation. Clinician-researchers use their clinical skills in health

A clinician-driven home care delivery system.

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August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

1993-12-01

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

The role of technology in clinician-to-clinician communication.

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McElroy, Lisa M; Ladner, Daniela P; Holl, Jane L

2013-12-01

Incomplete, fragmented and poorly organised communications contribute to more than half the errors that lead to adverse and sentinel events. Meanwhile, communication software and devices with expanding capabilities are rapidly proliferating and being introduced into the healthcare setting. Clinicians face a large communication burden, which has been exacerbated by the additional challenge of selecting a mode of communication. In addition to specific communication devices, some hospitals have implemented advanced technological systems to assist with communication. However, few studies have provided empirical evidence of the specific advantages and disadvantages of the different devices used for communication. Given the increasing quantities of information transmitted to and by clinicians, evaluations of how communication methods and devices can improve the quality, safety and outcomes of healthcare are needed.

Thinkering through Experiments: Nurturing Transdisciplinary Approaches to the Design of Testing Tools

Directory of Open Access Journals (Sweden)

Kathryn B. Francis

2017-11-01

Full Text Available In order to assess and understand human behavior, traditional approaches to experimental design incorporate testing tools that are often artificial and devoid of corporeal features. Whilst these offer experimental control in situations in which, methodologically, real behaviors cannot be examined, there is increasing evidence that responses given in these contextually deprived experiments fail to trigger genuine responses. This may result from a lack of consideration regarding the material makeup and associations connected with the fabric of experimental tools. In a two-year collaboration, we began to experiment with the physicality of testing tools using the domain of moral psychology as a case study. This collaboration involved thinkering and prototyping methods that included direct contact and consideration of the materials involved in experimentation. Having explored the embodied nature of morality, we combined approaches from experimental psychology, moral philosophy, design thinking, and computer science to create a new testing tool for simulated moral behavior. Although the testing tool itself generated fruitful results, this paper considers the collaborative methodology through which it was produced as a route to highlight material questions within psychological research.

Stability of edge states and edge magnetism in graphene nanoribbons

OpenAIRE

Kunstmann, Jens; Özdoğan, Cem; Quandt, Alexander; Fehske, Holger

2010-01-01

We critically discuss the stability of edge states and edge magnetism in zigzag edge graphene nanoribbons (ZGNRs). We point out that magnetic edge states might not exist in real systems, and show that there are at least three very natural mechanisms - edge reconstruction, edge passivation, and edge closure - which dramatically reduce the effect of edge states in ZGNRs or even totally eliminate them. Even if systems with magnetic edge states could be made, the intrinsic magnetism would not be ...

The effect of core clinician interpersonal behaviours on depression.

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Barnicot, K; Wampold, B; Priebe, S

2014-01-01

It is well-established that core clinician interpersonal behaviours are important when treating depression, but few studies have evaluated whether outcome is determined by clinicians׳ general behaviour rather than by the perception of the individual being treated. In the NIMH TDCRP, 157 patients rated their clinician׳s genuineness, positive regard, empathy and unconditional regard during cognitive behavioural therapy, interpersonal therapy or clinical management with placebo. The association between averaged ratings for each of 27 clinicians and their patients׳ self- and observer-rated depression outcomes was evaluated, adjusting for the deviation of individual patient ratings from the average for their clinician and other potential confounders. Clinicians in the clinical management condition were rated on average as less genuine and less empathic than those in the psychotherapy conditions. Clinicians׳ average genuineness, positive regard and empathy were significantly associated with lower depression severity during treatment, but not with recovery from depression, after adjusting for the deviation of the individual patient׳s rating of their clinician from the average for that clinician, treatment condition and baseline depression severity. Clinician unconditional regard was not significantly associated with outcome. Using averaged ratings of clinician behaviour likely reduced statistical power. Clinicians׳ ability to demonstrate genuineness, positive regard and empathy may represent a stable personal characteristic that influences the treatment of depression beyond the individual clinician-patient relationship or an individual patient׳s perception of their clinician. However, clinicians׳ ability to demonstrate these behaviours may be poorer when delivering an intervention without a specific rationale or treatment techniques. Copyright © 2014 Elsevier B.V. All rights reserved.

'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents.

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Heflin, Mitchell T; Pinheiro, Sandro; Kaminetzky, Catherine P; McNeill, Diana

2009-06-01

Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer 'resident-as-teacher' programs to assist residents in developing teaching skills, the need exists to expand training opportunities in this area. The authors conducted a workshop at a national meeting to develop a description of essential components of a training pathway for internal medicine residents. Through open discussion and small group work, participants defined the various roles of clinician-educators and described goals, training opportunities, assessment and resource needs for such a program. Workshop participants posited that the clinician-educator has several roles to fulfill beyond that of clinician, including those of teacher, curriculum developer, administrator and scholar. A pathway for residents aspiring to become clinician educators must offer structured training in each of these four areas to empower residents to effectively practice clinical education. In addition, the creation of such a track requires securing time and resources to support resident learning experiences and formal faculty development programs to support institutional mentors and leaders. This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

Thinkers at the Cutting Edge: Innovation in the Danish Special Forces

DEFF Research Database (Denmark)

Mayland, Karina; Haugegaard, Rikke; Shapiro, Allan

2017-01-01

This article is a contribution to the discussions about the unique capacity of Special Operation Forces (SOF). Based on data from interviews and observation in a field study among the Danish Frogman Corps, the Royal Danish Navy Special Operations unit, and the Danish Jaeger Corps, the Danish Army...... Special Operations unit, the article investigates the work environment of the two Special Operations units supporting an innovative capacity. What kind of leadership, processes and work climate support employee-driven innovation in SOF?......This article is a contribution to the discussions about the unique capacity of Special Operation Forces (SOF). Based on data from interviews and observation in a field study among the Danish Frogman Corps, the Royal Danish Navy Special Operations unit, and the Danish Jaeger Corps, the Danish Army...

Engaging clinicians in health informatics projects.

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Caballero Muñoz, Erika; Hullin Lucay Cossio, Carola M

2010-01-01

This chapter gives an educational overview of: * The importance of the engagement of clinicians within a health informatics project * Strategies required for an effective involvement of clinicians throughout a change management process within a clinical context for the implementation of a health informatics project * The critical aspects for a successful implementation of a health informatics project that involves clinicians as end users * Key factors during the administration of changes during the implementation of an informatics project for an information system in clinical practice.

Turning attention to clinician engagement in Victoria.

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Jorm, Christine; Hudson, Robyn; Wallace, Euan

2017-11-16

The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns about the adequacy of clinician engagement in the state of Victoria led the Victorian Department of Health and Human Services to commission a scoping study. During this investigation more than 100 clinicians were spoken with and 1800 responded to surveys. The result was creation of a clear picture of what engagement and disengagement looked like at all levels - from the clinical microsystem to state health policy making. Multiple interventions are possible to enhance clinician engagement and thus the care of future patients. A framework was developed to guide future Victorian work with four elements: setting the agenda, informing, involving and empowering clinicians. Concepts of work or employee engagement that are used in other industries don't directly translate to healthcare and thus the definition of engagement chosen for use centred on involvement. This was designed to encourage system managers to ensure clinicians are full participants in design, planning and evaluation and in all decisions that affect them and their patients.

Improving clinicians' access to cost data.

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Kenagy, John; Shah, Ben

2014-08-01

Bringing clinical and financial data together is critical to effectively running and operating service lines. Helping clinicians use cost data to make decisions requires a shared vision and a partnership between finance leaders and physicians. Hosting a "jam session" of technical, financial, and clinical experts can accelerate an organization's business intelligence strategy. Labor and supply costs represent the most actionable cost data for clinicians. Clinician buy-in hinges on education and support. It is important to focus on easy wins at the beginning of the project.

Postoperative Pain Management: Clinicians' Knowledge and ...

African Journals Online (AJOL)

Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital. ... A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of ...

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

Science.gov (United States)

Ng, Stella L; Phelan, Shanon; Leonard, MaryAnn; Galster, Jason

2017-06-01

Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed

A Genome-Wide Association Study Primer for Clinicians

Directory of Open Access Journals (Sweden)

Tzu-Hao Wang

2009-06-01

Full Text Available Genome-wide association studies (GWAS use high-throughput genotyping technology to relate hundreds of thousands of genetic markers (genotypes to clinical conditions and measurable traits (phenotypes. This review is intended to serve as an introduction to GWAS for clinicians, to allow them to better appreciate the value and limitations of GWAS for genotype-disease association studies. The input of clinicians is vital for GWAS, since disease heterogeneity is frequently a confounding factor that can only really be solved by clinicians. For diseases that are difficult to diagnose, clinicians should ensure that the cases do indeed have the disease; for common diseases, clinicians should ensure that the controls are truly disease-free.

Transaortic Alfieri Edge-to-Edge Repair for Functional Mitral Regurgitation.

Science.gov (United States)

Imasaka, Ken-Ichi; Tayama, Eiki; Morita, Shigeki; Toriya, Ryohei; Tomita, Yukihiro

2018-03-01

There is controversy about handling functional mitral regurgitation in patients undergoing aortic valve or proximal aortic operations. We describe a transaortic Alfieri edge-to-edge repair for functional mitral regurgitation that reduces operative excessive invasion and prolonged cardiopulmonary bypass time. Between May 2013 and December 2016, 10 patients underwent transaortic Alfieri edge-to-edge mitral repair. There were no operative deaths. The severity of mitral regurgitation immediately after the operation by transesophageal echocardiography was none or trivial in all patients. A transaortic Alfieri edge-to-edge repair for functional mitral regurgitation is a simple and safe approach. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Edge-functionalization of armchair graphene nanoribbons with pentagonal-hexagonal edge structures.

Science.gov (United States)

Ryou, Junga; Park, Jinwoo; Kim, Gunn; Hong, Suklyun

2017-06-21

Using density functional theory calculations, we have studied the edge-functionalization of armchair graphene nanoribbons (AGNRs) with pentagonal-hexagonal edge structures. While the AGNRs with pentagonal-hexagonal edge structures (labeled (5,6)-AGNRs) are metallic, the edge-functionalized (5,6)-AGNRs with substitutional atoms opens a band gap. We find that the band structures of edge-functionalized (5,6)-N-AGNRs by substitution resemble those of defect-free (N-1)-AGNR at the Γ point, whereas those at the X point show the original ones of the defect-free N-AGNR. The overall electronic structures of edge-functionalized (5,6)-AGNRs depend on the number of electrons, supplied by substitutional atoms, at the edges of functionalized (5,6)-AGNRs.

Edge passivation induced single-edge ferromagnetism of zigzag MoS_2 nanoribbons

International Nuclear Information System (INIS)

Wang, Rui; Sun, Hui; Ma, Ben; Hu, Jingguo; Pan, Jing

2017-01-01

We performed density functional theory study on electronic structure, magnetic properties and stability of zigzag MoS_2 nanoribbons (ZMoS_2NRs) with and without oxygen (O) passivation. The bare ZMoS_2NRs are magnetic metal with ferromagnetic edge states, edge passivation decreases their magnetism because of the decrease of edge unsaturated electrons. Obviously, the electronic structure and magnetic properties of ZMoS_2NRs greatly depend on edge states. When both edges are passivated by O atoms, ZMoS_2NRs are nonmagnetic metals. When either edge is passivated by O atoms, the systems exhibit single-edge ferromagnetism and magnetism concentrates on the non-passivated edge. Edge passivation can not only tune the magnetism of ZMoS_2NRs, but also enhance their stability by eliminating dangling bonds. These interesting findings on ZMoS_2NRs may open the possibility of their application in nanodevices and spintronics. - Highlights: • Edge passivation for tuning magnetism of zigzag MoS_2 nanoribbons (ZMoS_2NRs) is proposed. • Edge passivation can tune ZMoS_2NRs from nonmagnetic metal to ferromagnetic metal. • When either edge is passivated, the systems exhibit single-edge ferromagnetic states. • These findings may inspire great interest in the community of ZMoS_2NRs and motivate numerous experimental researches.

The clinician factor: Personality characteristics of clinicians and their impact upon clinical outcomes in the management of children and adolescents with type 1 diabetes.

Science.gov (United States)

Cameron, Fergus J; Russell, Ellyn; McCombe, Julia; O'Connell, Michele A; Skinner, Timothy

2018-06-01

The purpose of this study was to estimate clinician qualities that influence metabolic outcomes in youth with type 1 diabetes. Data were gathered over two 3 month periods in a large tertiary diabetes center (1500 patients, 8 clinicians) from patients with type 1 diabetes who received continuous care from each clinician. Data included sex, age, diabetes duration, insulin regimen, body mass index (BMI), insulin dose and episodes of severe hypoglycemia. Clinician data included target blood glucose levels, target glycated hemoglobin (HbA1c), Diabetes Attitude Scale and Big 5 Personality Inventory Scale. Mean HbA1c per clinician was the primary outcome variable. The 8 clinicians saw a total of 464 patients during the first time period, and 603 in the second time period. Lowest to highest mean HbA1c per clinician varied by 0.7%. There were small but statistically significant differences between clinicians with their patients' age at diagnosis, duration of diabetes, age, gender, treatment type and BMI SD score. After controlling for these differences, the clinician characteristics that were associated with lower mean HbA1c were having no lower limit in target HbA1c and being self-reportedly "less agreeable." The impact of these clinician attitudinal traits was equivalent to the combined effects of patient characteristics and treatment type. There was a significant variation in metabolic outcomes between treating clinicians. After controlling for patient clinical differences, clinician mean HbA1c was associated with lower limit in target HbA1c and being "less agreeable." Clinicians who were more demanding and dogmatic appeared to have better outcomes. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Randomised clinical trials with clinician-preferred treatment.

Science.gov (United States)

Korn, E L; Baumrind, S

1991-01-19

The standard design for randomised clinical trials may be inappropriate when the clinician believes that one of the treatments being tested is superior for the patient, or when the clinician has a preference for one of the treatments. For such instances the suggestion is that the patient is randomly allocated to treatment only when there is clinical disagreement about treatment of choice for that patient, and then the patient is assigned to a clinician who had thought that the regimen allocated is the one most appropriate for that patient.

Clinician perspectives of an intensive comprehensive aphasia program.

Science.gov (United States)

Babbitt, Edna M; Worrall, Linda E; Cherney, Leora R

2013-01-01

Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. To describe the experiences of clinicians working in an ICAP. A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

Clinician preferences and the estimation of causal treatment differences

OpenAIRE

Korn, Edward L.; Baumrind, Sheldon

1998-01-01

Clinician treatment preferences affect the ability to perform randomized clinical trials and the ability to analyze observational data for treatment effects. In clinical trials, clinician preferences that are based on a subjective analysis of the patient can make it difficult to define eligibility criteria for which clinicians would agree to randomize all patients who satisfy the criteria. In addition, since each clinician typically has some preference for the choice of treatment for a given ...

Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective.

Science.gov (United States)

Frederick, Natasha N; Campbell, Kevin; Kenney, Lisa B; Moss, Kerry; Speckhart, Ashley; Bober, Sharon L

2018-04-26

Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, the focus of current SRH conversations on fertility, the meaning of "sexual health" as safe sex and contraception only, clinician-reported barriers to SRH conversations, and the need for education and support. Communication barriers included lack of knowledge/experience, lack of resources/referrals, low priority, parents/family, patient discomfort, clinician discomfort, time, and lack of rapport. Clinicians identified resource and support needs, including formal education and SRH education materials for patients and families. Although the study participants identified a role for pediatric oncology clinicians in SRH care for AYA patients with cancer, multiple barriers interfere with such discussions taking place on a regular basis. Future efforts must focus on resource development and provider education and training in SRH to optimize the care provided to this unique patient population. © 2018 Wiley Periodicals, Inc.

The faith of a physicist reflections of a bottom-up thinker : the Gifford lectures for 1993-4

CERN Document Server

Polkinghorne, John C

1994-01-01

Is it possible to think like a scientist and yet have the faith of a Christian? Although many Westerners might say no, there are also many critically minded individuals who entertain what John Polkinghorne calls a "wistful wariness" toward religion--they feel unable to accept religion on rational grounds yet cannot dismiss it completely. Polkinghorne, both a particle physicist and Anglican priest, here explores just what rational grounds there could be for Christian beliefs, maintaining that the quest for motivated understanding is a concern shared by scientists and religious thinkers alike. Anyone who assumes that religion is based on unquestioning certainties, or that it need not take into account empirical knowledge, will be challenged by Polkinghorne's bottom-up examination of Christian beliefs about events ranging from creation to the resurrection. The author organizes his inquiry around the Nicene Creed, an early statement that continues to summarize Christian beliefs. He applies to each of its tenets ...

Power spectrum weighted edge analysis for straight edge detection in images

Science.gov (United States)

Karvir, Hrishikesh V.; Skipper, Julie A.

2007-04-01

Most man-made objects provide characteristic straight line edges and, therefore, edge extraction is a commonly used target detection tool. However, noisy images often yield broken edges that lead to missed detections, and extraneous edges that may contribute to false target detections. We present a sliding-block approach for target detection using weighted power spectral analysis. In general, straight line edges appearing at a given frequency are represented as a peak in the Fourier domain at a radius corresponding to that frequency, and a direction corresponding to the orientation of the edges in the spatial domain. Knowing the edge width and spacing between the edges, a band-pass filter is designed to extract the Fourier peaks corresponding to the target edges and suppress image noise. These peaks are then detected by amplitude thresholding. The frequency band width and the subsequent spatial filter mask size are variable parameters to facilitate detection of target objects of different sizes under known imaging geometries. Many military objects, such as trucks, tanks and missile launchers, produce definite signatures with parallel lines and the algorithm proves to be ideal for detecting such objects. Moreover, shadow-casting objects generally provide sharp edges and are readily detected. The block operation procedure offers advantages of significant reduction in noise influence, improved edge detection, faster processing speed and versatility to detect diverse objects of different sizes in the image. With Scud missile launcher replicas as target objects, the method has been successfully tested on terrain board test images under different backgrounds, illumination and imaging geometries with cameras of differing spatial resolution and bit-depth.

Clinicians and journalists responding to disasters.

Science.gov (United States)

Newman, Elana; Shapiro, Bruce

2014-02-01

Mass casualty events pose dilemmas for community clinicians, often challenging their existing clinical toolkits. However, few clinicians were trained to be experts in explaining the unfolding events to the community, creating resources, and interacting with journalists. The objective of this article is to explain knowledge, skills, and attitudes that mental health professionals need to consider when working with journalists, especially those covering children affected by disaster. In service of these objectives, this article reviews controversies, evidence, and best practices to facilitate effective collaborations and consultations with journalists. Advice includes information on how to be a good source to journalists. Clinicians can ethically and effectively help journalists tell accurate and compelling stories about the psychological effects of disasters when they understand and respect the aims, culture, and ethics of journalism.

Clinician search behaviors may be influenced by search engine design.

Science.gov (United States)

Lau, Annie Y S; Coiera, Enrico; Zrimec, Tatjana; Compton, Paul

2010-06-30

Searching the Web for documents using information retrieval systems plays an important part in clinicians' practice of evidence-based medicine. While much research focuses on the design of methods to retrieve documents, there has been little examination of the way different search engine capabilities influence clinician search behaviors. Previous studies have shown that use of task-based search engines allows for faster searches with no loss of decision accuracy compared with resource-based engines. We hypothesized that changes in search behaviors may explain these differences. In all, 75 clinicians (44 doctors and 31 clinical nurse consultants) were randomized to use either a resource-based or a task-based version of a clinical information retrieval system to answer questions about 8 clinical scenarios in a controlled setting in a university computer laboratory. Clinicians using the resource-based system could select 1 of 6 resources, such as PubMed; clinicians using the task-based system could select 1 of 6 clinical tasks, such as diagnosis. Clinicians in both systems could reformulate search queries. System logs unobtrusively capturing clinicians' interactions with the systems were coded and analyzed for clinicians' search actions and query reformulation strategies. The most frequent search action of clinicians using the resource-based system was to explore a new resource with the same query, that is, these clinicians exhibited a "breadth-first" search behaviour. Of 1398 search actions, clinicians using the resource-based system conducted 401 (28.7%, 95% confidence interval [CI] 26.37-31.11) in this way. In contrast, the majority of clinicians using the task-based system exhibited a "depth-first" search behavior in which they reformulated query keywords while keeping to the same task profiles. Of 585 search actions conducted by clinicians using the task-based system, 379 (64.8%, 95% CI 60.83-68.55) were conducted in this way. This study provides evidence that

AphasiaBank: a resource for clinicians.

Science.gov (United States)

Forbes, Margaret M; Fromm, Davida; Macwhinney, Brian

2012-08-01

AphasiaBank is a shared, multimedia database containing videos and transcriptions of ~180 aphasic individuals and 140 nonaphasic controls performing a uniform set of discourse tasks. The language in the videos is transcribed in Codes for the Human Analysis of Transcripts (CHAT) format and coded for analysis with Computerized Language ANalysis (CLAN) programs, which can perform a wide variety of language analyses. The database and the CLAN programs are freely available to aphasia researchers and clinicians for educational, clinical, and scholarly uses. This article describes the database, suggests some ways in which clinicians and clinician researchers might find these materials useful, and introduces a new language analysis program, EVAL, designed to streamline the transcription and coding processes, while still producing an extensive and useful language profile. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Elastically Deformable Side-Edge Link for Trailing-Edge Flap Aeroacoustic Noise Reduction

Science.gov (United States)

Khorrami, Mehdi R. (Inventor); Lockard, David P. (Inventor); Moore, James B. (Inventor); Su, Ji (Inventor); Turner, Travis L. (Inventor); Lin, John C. (Inventor); Taminger, Karen M. (Inventor); Kahng, Seun K. (Inventor); Verden, Scott A. (Inventor)

2014-01-01

A system is provided for reducing aeroacoustic noise generated by an aircraft having wings equipped with trailing-edge flaps. The system includes a plurality of elastically deformable structures. Each structure is coupled to and along one of the side edges of one of the trailing-edge flaps, and is coupled to a portion of one of the wings that is adjacent to the one of the side edges. The structures elastically deform when the trailing-edge flaps are deployed away from the wings.

Localized Edge Vibrations and Edge Reconstruction by Joule Heating in Graphene Nanostructures

DEFF Research Database (Denmark)

Engelund, Mads; Fürst, Joachim Alexander; Jauho, Antti-Pekka

2010-01-01

Control of the edge topology of graphene nanostructures is critical to graphene-based electronics. A means of producing atomically smooth zigzag edges using electronic current has recently been demonstrated in experiments [Jia et al., Science 323, 1701 (2009)]. We develop a microscopic theory...... for current-induced edge reconstruction using density functional theory. Our calculations provide evidence for localized vibrations at edge interfaces involving unpassivated armchair edges. We demonstrate that these vibrations couple to the current, estimate their excitation by Joule heating, and argue...

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

Science.gov (United States)

Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F

2015-03-01

Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for

Mentoring for clinician-educators.

Science.gov (United States)

Farrell, Susan E; Digioia, Natalie M; Broderick, Kerry B; Coates, Wendy C

2004-12-01

Mentorship has been shown to have a positive impact on academic faculty members in terms of career advancement. The guidance of a mentor has been shown to increase academic outcome measures such as peer-reviewed publications and grant support for junior academic faculty. In addition, career satisfaction of mentored faculty is greater than those with no mentorship. There is little research on the effects of mentorship on the careers of clinician-educators. This group has also been reported to have a lower scholarly productivity rate than the typical research-based faculty. This article addresses the current state of mentorship as it applies specifically to clinician-educators, offers advice on how a potential protégé might seek out a potential mentor, and finally, suggests a possible mentoring system for academic emergency physicians who are focusing on careers in medical education.

Reduction of airfoil trailing edge noise by trailing edge blowing

International Nuclear Information System (INIS)

Gerhard, T; Carolus, T; Erbslöh, S

2014-01-01

The paper deals with airfoil trailing edge noise and its reduction by trailing edge blowing. A Somers S834 airfoil section which originally was designed for small wind turbines is investigated. To mimic realistic Reynolds numbers the boundary layer is tripped on pressure and suction side. The chordwise position of the blowing slot is varied. The acoustic sources, i.e. the unsteady flow quantities in the turbulent boundary layer in the vicinity of the trailing edge, are quantified for the airfoil without and with trailing edge blowing by means of a large eddy simulation and complementary measurements. Eventually the far field airfoil noise is measured by a two-microphone filtering and correlation and a 40 microphone array technique. Both, LES-prediction and measurements showed that a suitable blowing jet on the airfoil suction side is able to reduce significantly the turbulence intensity and the induced surface pressure fluctuations in the trailing edge region. As a consequence, trailing edge noise associated with a spectral hump around 500 Hz could be reduced by 3 dB. For that a jet velocity of 50% of the free field velocity was sufficient. The most favourable slot position was at 90% chord length

Edge printability: techniques used to evaluate and improve extreme wafer edge printability

Science.gov (United States)

Roberts, Bill; Demmert, Cort; Jekauc, Igor; Tiffany, Jason P.

2004-05-01

The economics of semiconductor manufacturing have forced process engineers to develop techniques to increase wafer yield. Improvements in process controls and uniformities in all areas of the fab have reduced film thickness variations at the very edge of the wafer surface. This improved uniformity has provided the opportunity to consider decreasing edge exclusions, and now the outermost extents of the wafer must be considered in the yield model and expectations. These changes have increased the requirements on lithography to improve wafer edge printability in areas that previously were not even coated. This has taxed all software and hardware components used in defining the optical focal plane at the wafer edge. We have explored techniques to determine the capabilities of extreme wafer edge printability and the components of the systems that influence this printability. We will present current capabilities and new detection techniques and the influence that the individual hardware and software components have on edge printability. We will show effects of focus sensor designs, wafer layout, utilization of dummy edge fields, the use of non-zero overlay targets and chemical/optical edge bead optimization.

Clinicians' perception of the preventability of inpatient mortality.

Science.gov (United States)

Nash, Robert; Srinivasan, Ramya; Kenway, Bruno; Quinn, James

2018-03-12

Purpose The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients' mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable. Design/methodology/approach The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality. Findings Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values ( p<0.0001). Clinicians were also more likely to rate the quality of care as "good," and less likely to identify areas of substandard clinical or organizational management. Research limitations/implications The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area. Practical implications There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a "knowledge gap" between reviewers and treating clinicians, or an "objectivity gap" meaning clinicians may not recognize preventability of death of patients under their care. Social implications This study gives some insight into deficiencies in clinical governance processes. Originality/value No similar study has been performed. This has significant implications for the idea of the preventability of mortality.

Towards reinforcing telemedicine adoption amongst clinicians in Nigeria.

Science.gov (United States)

Adenuga, Kayode I; Iahad, Noorminshah A; Miskon, Suraya

2017-08-01

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (ptelemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians. Copyright © 2017. Published by Elsevier B.V.

Edge enhancement improves disruptive camouflage by emphasising false edges and creating pictorial relief.

Science.gov (United States)

Egan, John; Sharman, Rebecca J; Scott-Brown, Kenneth C; Lovell, Paul George

2016-12-06

Disruptive colouration is a visual camouflage composed of false edges and boundaries. Many disruptively camouflaged animals feature enhanced edges; light patches are surrounded by a lighter outline and/or a dark patches are surrounded by a darker outline. This camouflage is particularly common in amphibians, reptiles and lepidopterans. We explored the role that this pattern has in creating effective camouflage. In a visual search task utilising an ultra-large display area mimicking search tasks that might be found in nature, edge enhanced disruptive camouflage increases crypsis, even on substrates that do not provide an obvious visual match. Specifically, edge enhanced camouflage is effective on backgrounds both with and without shadows; i.e. this is not solely due to background matching of the dark edge enhancement element with the shadows. Furthermore, when the dark component of the edge enhancement is omitted the camouflage still provided better crypsis than control patterns without edge enhancement. This kind of edge enhancement improved camouflage on all background types. Lastly, we show that edge enhancement can create a perception of multiple surfaces. We conclude that edge enhancement increases the effectiveness of disruptive camouflage through mechanisms that may include the improved disruption of the object outline by implying pictorial relief.

Edge Matters

DEFF Research Database (Denmark)

Earon, Ofri

2013-01-01

of this container is to separate inside from outside and to protect and provide privacy, psychological as well as physical (Venturi, 1966). But, if dwelling phenomenon takes place both inside and outside the private house – why is the urban house an enclosed box? What is the differentiation between inside...... and outside the contemporary urban house? And what is the interplay between them? The research argues for re-thinking the edge zone between inside and outside the urban house. Therefore, although, residential buildings in the city are the objects of study, the focal point here is the edge zone along...... the building. The research explores and develops the architectural characteristics of correlations between the resident, the singular unit, the building and the given location at the edge zone. It approaches the edge zone of the urban house as a platform for dynamic interactions between these behaviours...

An edge pedestal model

International Nuclear Information System (INIS)

Stacev, W.M.

2001-01-01

A new model for calculation of the gradient scale lengths in the edge pedestal region and of the edge transport barrier width in H-mode tokamak plasmas will be described. Model problem calculations which demonstrate the promise of this model for predicting experimental pedestal properties will be discussed. The density and Prague gradient scale lengths (L) in the edge are calculated from the particle and ion and electron energy radial transport equations, making use of (presumed) known particle and energy fluxes flowing across the edge transport barrier from the core into the SOL and of edge transport coefficients. The average values of the particle and heat fluxes in the edge transport barrier are calculated in terms of the fluxes crossing into the SOL and the atomic physics reaction rates (ionisation, charge-exchange, elastic scattering, impurity radiation) in the edge by integrating the respective transport equations from the pedestal to the separatrix. An important implication of this model is that the pedestal gradient scale lengths depend not just on local pedestal platers properties but also on particle and energy fluxes from the core plasma and on recycling neutral fluxes that penetrate into the plasma edge, both of which in turn depend on the pedestal properties. The MHD edge pressure gradient constraint α≤ α C is used to determine the pressure width of the edge transport barrier, Δ TB = Δ TB (α c ). Three different models for the MHD edge pressure gradient constraint have been investigated: (1) nominal ideal ballooning mode theory, (2) ballooning mode theory taking into account the edge geometry and shear to access He second stability region; and pedestal β-limit theory when the ballooning modes are stabilised by diamagnetic effects. A series of calculations have been made for a DIII-D model problem. The calculated gradient scale lengths and edge transport barrier widths are of the magnitude of values observed experimentally, and certain trends

Clinicians' Knowledge and Perception of Telemedicine Technology.

Science.gov (United States)

Ayatollahi, Haleh; Sarabi, Fatemeh Zahra Pourfard; Langarizadeh, Mostafa

2015-01-01

Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.

Tangential 2-D Edge Imaging for GPI and Edge/Impurity Modeling

International Nuclear Information System (INIS)

Maqueda, Ricardo; Levinton, Fred M.

2011-01-01

Nova Photonics, Inc. has a collaborative effort at the National Spherical Torus Experiment (NSTX). This collaboration, based on fast imaging of visible phenomena, has provided key insights on edge turbulence, intermittency, and edge phenomena such as edge localized modes (ELMs) and multi-faceted axisymmetric radiation from the edge (MARFE). Studies have been performed in all these areas. The edge turbulence/intermittency studies make use of the Gas Puff Imaging diagnostic developed by the Principal Investigator (Ricardo Maqueda) together with colleagues from PPPL. This effort is part of the International Tokamak Physics Activity (ITPA) edge, scrape-off layer and divertor group joint activity (DSOL-15: Inter-machine comparison of blob characteristics). The edge turbulence/blob study has been extended from the current location near the midplane of the device to the lower divertor region of NSTX. The goal of this effort was to study turbulence born blobs in the vicinity of the X-point region and their circuit closure on divertor sheaths or high density regions in the divertor. In the area of ELMs and MARFEs we have studied and characterized the mode structure and evolution of the ELM types observed in NSTX, as well as the study of the observed interaction between MARFEs and ELMs. This interaction could have substantial implications for future devices where radiative divertor regions are required to maintain detachment from the divertor plasma facing components.

What patient characteristics make clinicians recommend brief treatment?

NARCIS (Netherlands)

Schaefer, B. A.; Koeter, M. W. J.; Wouters, L.; Emmelkamp, P. M. G.; Schene, A. H.

2003-01-01

Objective: Assessing self-rated items that might have an impact on clinicians recommending brief treatment (BT) over unlimited or long-term treatment (ULT). Method: On the basis of patient self-report data we compared patients referred by clinicians to BT (n =71) with those referred to ULT (n =145).

Forests on the edge: Microenvironmental drivers of carbon cycle response to edge effects

Science.gov (United States)

Reinmann, A.; Hutyra, L.; Smith, I. A.; Thompson, J.

2017-12-01

Twenty percent of the world's forest is within 100 m of a forest edge, but much of our understanding of forest carbon (C) cycling comes from large, intact ecosystems, which creates an important mismatch between the landscapes we study and those we aim to characterize. The temperate broadleaf forest is the most heavily fragmented forest biome in the world and its growth and carbon storage responses to forest edge effects appear to be the opposite of those in the tropical and boreal regions. We used field measurements to quantify the drivers of temperate forest C cycling response to edge effects, characterizing vegetative growth, respiration, and forest structure. We find large gradients in air and soil temperature from the forest interior to edge (up to 4 and 10° C, respectively) and the magnitude of this gradient is inversely correlated to the size of the forest edge growth enhancement. Further, leaf area index increases with proximity to the forest edge. While we also find increases in soil respiration between the forest interior and edge, this flux is small relative to aboveground growth enhancement near the edge. These findings represent an important advancement in our understanding of forest C cycle response to edge effects and will greatly improve our capacity to constrain biogenic C fluxes in fragmented and heterogeneous landscapes.

Clinician-scientists in Canada: barriers to career entry and progress.

Directory of Open Access Journals (Sweden)

Bryn Lander

Full Text Available BACKGROUND: Clinician-scientists play an important role in translating between research and clinical practice. Significant concerns about a decline in their numbers have been raised. Potential barriers for career entry and progress are explored in this study. METHODS: Case-study research methods were used to identify barriers perceived by clinician-scientists and their research teams in two Canadian laboratories. These perceptions were then compared against statistical analysis of data from Canadian Institutes of Health Research (CIHR databases on grant and award performance of clinician-scientists and non-clinical PhDs for fiscal years 2000 to 2008. RESULTS: Three main barriers were identified through qualitative analysis: research training, research salaries, and research grants. We then looked for evidence of these barriers in the Canada-wide statistical dataset for our study period. Clinician-scientists had a small but statistically significant higher mean number of degrees (3.3 than non-clinical scientists (3.2, potentially confirming the perception of longer training times. But evidence of the other two barriers was equivocal. For example, while overall growth in salary awards was minimal, awards to clinician-scientists increased by 45% compared to 6.3% for non-clinical PhDs. Similarly, in terms of research funding, awards to clinician-scientists increased by more than 25% compared with 5% for non-clinical PhDs. However, clinician-scientist-led grants funded under CIHR's Clinical thematic area decreased significantly from 61% to 51% (p-value<0.001 suggesting that clinician-scientists may be shifting their attention to other research domains. CONCLUSION: While clinician-scientists continue to perceive barriers to career entry and progress, quantitative results suggest improvements over the last decade. Clinician-scientists are awarded an increasing proportion of CIHR research grants and salary awards. Given the translational importance of

Edge modulation of electronics and transport properties of cliff-edge phosphorene nanoribbons

Science.gov (United States)

Guo, Caixia; Wang, Tianxing; Xia, Congxin; Liu, Yufang

2017-12-01

Based on the first-principles calculations, we study the electronic structures and transport properties of cliff-like edge phosphorene nanoribbons (CPNRs), considering different types of edge passivation. The band structures of bare CPNRs possess the metallic features; while hydrogen (H), fluorine (F), chlorine (Cl) and oxygen (O) atoms-passivated CPNRs are semiconductor materials, and the band gap values monotonically decrease when the ribbon width increases. Moreover, the H and F-passivated CPNRs exhibit the direct band gap characteristics, while the Cl and O-passivated cases show the features of indirect band gap. In addition, the edge passivated CPNRs are more energetically stable than bare edge case. Meanwhile, our results also show that the transport properties of the CPNRs can be obviously influenced by the different edge passivation.

Remote clinical decision-making: a clinician's definition.

Science.gov (United States)

Brady, Mike; Northstone, Kate

2017-05-12

Aims Remote clinical decision-making (RCDM), commonly known as 'telephone triage' or 'hear and treat', describes clinicians' non-face-to-face involvement with patient care, and is an established strategy in UK ambulance services for managing increasing demand. However, there is no suitable definition of RCDM that fully explains the roles undertaken by clinicians in 999 hubs, or for its use as an ambulance quality indicator (AQI). The aim of this study, which is part of a larger evaluation of a new RCDM module in higher education, is to determine how clinicians define RCDM. Methods Three participants were asked, during semi-structured interviews, to define RCDM. The interviews were recorded, transcribed and thematically analysed. Results Clinicians do not focus on outcomes when defining RCDM, but on the efficacy of the process and the appropriateness of the determined outcome. Conclusion There is no precise description of the role of healthcare professionals in 999 clinical hubs, but there is a need for role clarity, for employees and organisations. The study questions the suitability of the definition of hear and treat as an AQI, as it does not appear to represent fully the various duties undertaken by 999 clinical hub healthcare professionals. More research is needed to consider the definition of RCDM in all its forms.

Smoothness in Binomial Edge Ideals

Directory of Open Access Journals (Sweden)

Hamid Damadi

2016-06-01

Full Text Available In this paper we study some geometric properties of the algebraic set associated to the binomial edge ideal of a graph. We study the singularity and smoothness of the algebraic set associated to the binomial edge ideal of a graph. Some of these algebraic sets are irreducible and some of them are reducible. If every irreducible component of the algebraic set is smooth we call the graph an edge smooth graph, otherwise it is called an edge singular graph. We show that complete graphs are edge smooth and introduce two conditions such that the graph G is edge singular if and only if it satisfies these conditions. Then, it is shown that cycles and most of trees are edge singular. In addition, it is proved that complete bipartite graphs are edge smooth.

Cutting Edge Localisation in an Edge Profile Milling Head

NARCIS (Netherlands)

Fernandez Robles, Laura; Azzopardi, George; Alegre, Enrique; Petkov, Nicolai

2015-01-01

Wear evaluation of cutting tools is a key issue for prolonging their lifetime and ensuring high quality of products. In this paper, we present a method for the effective localisation of cutting edges of inserts in digital images of an edge profile milling head. We introduce a new image data set of

Edge colouring by total labellings

DEFF Research Database (Denmark)

Brandt, Stephan; Rautenbach, D.; Stiebitz, M.

2010-01-01

We introduce the concept of an edge-colouring total k-labelling. This is a labelling of the vertices and the edges of a graph G with labels 1, 2, ..., k such that the weights of the edges define a proper edge colouring of G. Here the weight of an edge is the sum of its label and the labels of its...

How is the Internet Changing the Way You Think?

CERN Document Server

Brockman, John

2011-01-01

The Internet, in the memorable words of EDGE founder John Brockman, is 'the infinite oscillation of our collective consciousness interacting with itself. It's not about computers. It's not about what it means to be human - in fact, it challenges, renders trite, our cherished assumptions on that score. It is about thinking'. In How is the Internet Changing the Way you Think?, the latest volume in Brockman's cutting-edge Edge questions series, 154 of the world's leading intellectuals - scientists, artists and creative thinkers - explore exactly what it means to think in the new age of the Inter

'Military Thinkers and Academic Thinkers'

DEFF Research Database (Denmark)

Haugegaard, Rikke

Culture analysis seems to create friction when we try to introduce academic concepts relating to culture to military planners. This friction might be related to the fact that officers and academics do their thinking in different 'spaces'. This paper argues the interface or overlapping space between...

Assessment of mood: guides for clinicians.

Science.gov (United States)

Furukawa, Toshi A

2010-06-01

This article is one of the series of review articles aiming to present a convenient guideline for practicing clinicians in their selection of scales for clinical and research purposes. This article focuses on assessment scales for mood (depression, mania). After reviewing the basic principles of clinical psychometrics, we present a selective review of representative scales measuring depressed or manic mood. We reviewed and reported on reliability, validity, interpretability, and feasibility of the following rating scales: Patient Health Questionnaire-9 (PHQ-9), K6, Beck Depression Inventory II (BDI-II), and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) as self-report scales for depressed mood; Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS) as clinician-administered measure for depression; and Young Mania Rating Scale (YMRS) as a clinician-administered instrument for mania. Although the rating scales for mood represent a well-trodden terrain, this brief review of the most frequently used scales in the literature revealed there is still some room for improvement and for further research, especially with regard to their clinical interpretability. Copyright 2010 Elsevier Inc. All rights reserved.

Development of edge effects around experimental ecosystem hotspots is affected by edge density and matrix type

Science.gov (United States)

Ecological edge effects are sensitive to landscape context. In particular, edge effects can be altered by matrix type and by the presence of other nearby edges. We experimentally altered patch configurations in an African savanna to determine how edge density and matrix type influence edge effect de...

Edge effects in composites

International Nuclear Information System (INIS)

Guz, A.N.; Kokhanenko, Yu.V.

1995-01-01

In the present article we survey papers on edge effects investigated by the rigorous approach. We interpret edge effects as stressed states created in a composite as a result of zones in which the stresses exhibit a rapidly changing behavior in comparison with the slow variation of the stresses outside such zones. Here the range of the edge effect is defined as the distance from the point of its inception to the boundary of the edge zone in a given direction. The transition of the stresses to the slowly varying state is determined within prescribed error limits. The size and configuration of the edge zone depends on the tolerated error. Clearly, the main difficulty associated with the rigorous approach is finding solutions of the elasticity problems. The finite-difference approach is suggested for the approximate solution of these problems. In light of the comparative time consumption of the finite-difference approach, it is best directed at certain classes of problems rather than at particular individual problems. Not too many papers on the investigation of edge effects by the rigorous approach have been published to date. Below, following in their footsteps, we formulate edge effect problems in composites, determine classes of problems, and investigate edge effects in composite materials and structural elements using them in Cartesian (planar and three-dimensional problems) and cylindrical (axisymmetric problems) coordinate frames. We note that the division of approaches to the study of edge effects into qualitative (nonrigorous) and quantitative (rigorous) reflects the authors own point of view. Of course, other schemes of classification of the approaches to the investigation of the regions of rapidly varying states in composites are possible

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians.

Science.gov (United States)

Haik, Josef; Brown, Stav; Liran, Alon; Visentin, Denis; Sokolov, Amit; Zilinsky, Isaac; Kornhaber, Rachel

2017-01-01

Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory), depression (PRIME-MD), health-related quality of life (SF-8), and compassion fatigue (Professional Quality of Life version 5). Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2%) among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P =0.017). Additional factors contributing to compassion fatigue were those without children ( P =0.016), divorced ( P =0.035), of a younger age ( P =0.019), and a registered nurse ( P =0.05). Burnout increased clinicians' risk of adverse professional and personal outcomes and correlated with less free time ( P work-home disputes ( P =0.05), increased depression ( P =0.001) and decreased career satisfaction ( P =0.01). Burnout was also associated with higher physical (mean difference =3.8, P <0.001) and lower mental (mean difference =-3.5, P <0.001) Quality of Life scores. Caring for burn survivors can lead to burnout, compassion fatigue, and vicarious trauma. Identifying strategies to abate these issues is essential to ensure improved clinicial environments and patient outcomes.

Interactions between non-physician clinicians and industry: a systematic review.

Directory of Open Access Journals (Sweden)

Quinn Grundy

2013-11-01

Full Text Available BACKGROUND: With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. METHODS AND FINDINGS: We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the

Interactions between non-physician clinicians and industry: a systematic review.

Science.gov (United States)

Grundy, Quinn; Bero, Lisa; Malone, Ruth

2013-11-01

With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis

Professional identity in clinician-scientists: brokers between care and science.

Science.gov (United States)

Kluijtmans, Manon; de Haan, Else; Akkerman, Sanne; van Tartwijk, Jan

2017-06-01

Despite increasing numbers of publications, science often fails to significantly improve patient care. Clinician-scientists, professionals who combine care and research activities, play an important role in helping to solve this problem. However, despite the ascribed advantages of connecting scientific knowledge and inquiry with health care, clinician-scientists are scarce, especially amongst non-physicians. The education of clinician-scientists can be complex because they must form professional identities at the intersection of care and research. The successful education of clinician-scientists requires insight into how these professionals view their professional identity and how they combine distinct practices. This study sought to investigate how recently trained nurse- and physiotherapist-scientists perceive their professional identities and experience the crossing of boundaries between care and research. Semi-structured interviews were conducted with 14 nurse- and physiotherapist-scientists at 1 year after they had completed MSc research training. Interviews were thematically analysed using insights from the theoretical frameworks of dialogical self theory and boundary crossing. After research training, the initial professional identity, of clinician, remained important for novice clinician-scientists, whereas the scientist identity was experienced as additional and complementary. A meta-identity as broker, referred to as a 'bridge builder', seemed to mediate competing demands or tensions between the two positions. Obtaining and maintaining a dual work position were experienced as logistically demanding; nevertheless, it was considered beneficial for crossing the boundaries between care and research because it led to reflection on the health profession, knowledge integration, inquiry and innovation in care, improved data collection, and research with a focus on clinical applicability. Novice clinician-scientists experience dual professional identities as care

Dimensions of personality: clinicians' perspectives

NARCIS (Netherlands)

Mullins-Sweatt, S.N.; Smit, V.; Verheul, R.; Oldham, J.; Widiger, T.A.

2009-01-01

Objective: To obtain the opinions and preferences of practising clinicians about the clinical utility of personality scales included within 8 alternative dimensional models of personality disorder for inclusion within an official diagnostic nomenclature. Method: Psychiatrists (n = 226) and

Optically Unraveling the Edge Chirality-Dependent Band Structure and Plasmon Damping in Graphene Edges.

Science.gov (United States)

Duan, Jiahua; Chen, Runkun; Cheng, Yuan; Yang, Tianzhong; Zhai, Feng; Dai, Qing; Chen, Jianing

2018-05-01

The nontrivial topological origin and pseudospinorial character of electron wavefunctions make edge states possess unusual electronic properties. Twenty years ago, the tight-binding model calculation predicted that zigzag termination of 2D sheets of carbon atoms have peculiar edge states, which show potential application in spintronics and modern information technologies. Although scanning probe microscopy is employed to capture this phenomenon, the experimental demonstration of its optical response remains challenging. Here, the propagating graphene plasmon provides an edge-selective polaritonic probe to directly detect and control the electronic edge state at ambient condition. Compared with armchair, the edge-band structure in the bandgap gives rise to additional optical absorption and strongly absorbed rim at zigzag edge. Furthermore, the optical conductivity is reconstructed and the anisotropic plasmon damping in graphene systems is revealed. The reported approach paves the way for detecting edge-specific phenomena in other van der Waals materials and topological insulators. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Clinician characteristics, communication, and patient outcome in oncology: a systematic review.

Science.gov (United States)

De Vries, A M M; de Roten, Y; Meystre, C; Passchier, J; Despland, J-N; Stiefel, F

2014-04-01

The aim of this study was to review the literature on clinician characteristics influencing patient-clinician communication or patient outcome in oncology. Studies investigating the association of clinician characteristics with quality of communication and with outcome for adult cancer patients were systematically searched in MEDLINE, PSYINFO, PUBMED, EMBASE, CINHAL, Web of Science and The Cochrane Library up to November 2012. We used the preferred reporting items for systematic reviews and meta-analyses statement to guide our review. Articles were extracted independently by two of the authors using predefined criteria. Twenty seven articles met the inclusion criteria. Clinician characteristics included a variety of sociodemographic, relational, and personal characteristics. A positive impact on quality of communication and/or patient outcome was reported for communication skills training, an external locus of control, empathy, a socioemotional approach, shared decision-making style, higher anxiety, and defensiveness. A negative impact was reported for increased level of fatigue and burnout and expression of worry. Professional experience of clinicians was not related to communication and/or to patient outcome, and divergent results were reported for clinician gender, age, stress, posture, and confidence or self-efficacy. Various clinician characteristics have different effects on quality of communication and/or patient outcome. Research is needed to investigate the pathways leading to effective communication between clinicians and patients. Copyright © 2013 John Wiley & Sons, Ltd.

Infective endocarditis following transcatheter edge-to-edge mitral valve repair: A systematic review.

Science.gov (United States)

Asmarats, Lluis; Rodriguez-Gabella, Tania; Chamandi, Chekrallah; Bernier, Mathieu; Beaudoin, Jonathan; O'Connor, Kim; Dumont, Eric; Dagenais, François; Paradis, Jean-Michel; Rodés-Cabau, Josep

2018-05-10

To assess the clinical characteristics, management, and outcomes of patients diagnosed with infective endocarditis (IE) after edge-to-edge mitral valve repair with the MitraClip device. Transcatheter edge-to-edge mitral valve repair has emerged as an alternative to surgery in high-risk patients. However, few data exist on IE following transcatheter mitral procedures. Four electronic databases (PubMed, Google Scholar, Embase, and Cochrane Library) were searched for original published studies on IE after edge-to-edge transcatheter mitral valve repair from 2003 to 2017. A total of 10 publications describing 12 patients with definitive IE (median age 76 years, 55% men) were found. The mean logistic EuroSCORE/EuroSCORE II were 41% and 45%, respectively. The IE episode occurred early (within 12 months post-procedure) in nine patients (75%; within the first month in five patients). Staphylococcus aureus was the most frequent (60%) causal microorganism, and severe mitral regurgitation was present in all cases but one. Surgical mitral valve replacement (SMVR) was performed in most (67%) patients, and the mortality associated with the IE episode was high (42%). IE following transcatheter edge-to-edge mitral valve repair is a rare but life-threatening complication, usually necessitating SMVR despite the high-risk profile of the patients. These results highlight the importance of adequate preventive measures and a prompt diagnosis and treatment of this serious complication. © 2018 Wiley Periodicals, Inc.

Nonreference Medical Image Edge Map Measure

Directory of Open Access Journals (Sweden)

Karen Panetta

2014-01-01

Full Text Available Edge detection is a key step in medical image processing. It is widely used to extract features, perform segmentation, and further assist in diagnosis. A poor quality edge map can result in false alarms and misses in cancer detection algorithms. Therefore, it is necessary to have a reliable edge measure to assist in selecting the optimal edge map. Existing reference based edge measures require a ground truth edge map to evaluate the similarity between the generated edge map and the ground truth. However, the ground truth images are not available for medical images. Therefore, a nonreference edge measure is ideal for medical image processing applications. In this paper, a nonreference reconstruction based edge map evaluation (NREM is proposed. The theoretical basis is that a good edge map keeps the structure and details of the original image thus would yield a good reconstructed image. The NREM is based on comparing the similarity between the reconstructed image with the original image using this concept. The edge measure is used for selecting the optimal edge detection algorithm and optimal parameters for the algorithm. Experimental results show that the quantitative evaluations given by the edge measure have good correlations with human visual analysis.

Prison Clinicians' Perceptions of Antisocial Personality Disorder as a Formal Diagnosis.

Science.gov (United States)

Stevens, Gail Flint

1994-01-01

Surveyed and interviewed 53 clinicians who work with prison inmates. Results indicated that clinicians used diagnosis of antisocial personality disorder liberally among inmates and felt majority of inmates could be so diagnosed. Large minority of clinicians went beyond Diagnostic and Statistical Manual of Mental Disorders criteria and reported…

Edge responses are different in edges under natural versus anthropogenic influence: a meta-analysis using ground beetles.

Science.gov (United States)

Magura, Tibor; Lövei, Gábor L; Tóthmérész, Béla

2017-02-01

Most edges are anthropogenic in origin, but are distinguishable by their maintaining processes (natural vs. continued anthropogenic interventions: forestry, agriculture, urbanization). We hypothesized that the dissimilar edge histories will be reflected in the diversity and assemblage composition of inhabitants. Testing this "history-based edge effect" hypothesis, we evaluated published information on a common insect group, ground beetles (Coleoptera: Carabidae) in forest edges. A meta-analysis showed that the diversity-enhancing properties of edges significantly differed according to their history. Forest edges maintained by natural processes had significantly higher species richness than their interiors, while edges with continued anthropogenic influence did not. The filter function of edges was also essentially different depending on their history. For forest specialist species, edges maintained by natural processes were penetrable, allowing these species to move right through the edges, while edges still under anthropogenic interventions were impenetrable, preventing the dispersal of forest specialists out of the forest. For species inhabiting the surrounding matrix (open-habitat and generalist species), edges created by forestry activities were penetrable, and such species also invaded the forest interior. However, natural forest edges constituted a barrier and prevented the invasion of matrix species into the forest interior. Preserving and protecting all edges maintained by natural processes, and preventing anthropogenic changes to their structure, composition, and characteristics are key factors to sustain biodiversity in forests. Moreover, the increasing presence of anthropogenic edges in a landscape is to be avoided, as they contribute to the loss of biodiversity. Simultaneously, edges under continued anthropogenic disturbance should be restored by increasing habitat heterogeneity.

Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians

Science.gov (United States)

Salgado de Souza, Ricardo; Gallego Arias Pecorari, Vanessa; Lauria Dib, Luciano

2018-01-01

The present study assessed the level of dentists' knowledge regarding oral cancer in the city of São Paulo, Brazil. A questionnaire was used to compare the level of knowledge among newly graduated and senior clinicians. A total of 20,154 e-mails were correctly delivered to the dentists registered in the database of the Regional Dentistry Council of São Paulo, and 477 (2.36%) responses were received. This sample consisted of 84 newly graduated clinicians and 105 senior clinicians. For the statistical analysis, the chi-square test and the logistic regression analysis were performed with α = 0.05, and the results were described herein. According to their knowledge level, the results were statistically different between the groups, since 19% of the newly graduated clinicians were evaluated with knowledge grade A (excellent) in comparison to 6.7% of the senior clinicians. In spite of the results indicated that newly graduated clinicians' knowledge regarding oral cancer was 2.1 times higher, 34.5% of the professionals in this group had regular or poor knowledge on the subject, and several questions relating to clinical characteristics and risk factors indicated that there still exist some knowledge gaps, demonstrating that there is a need for further studies and information activities addressing oral cancer. PMID:29666649

Burns education for non-burn specialist clinicians in Western Australia.

Science.gov (United States)

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

2015-03-01

Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Nanoindentation near the edge

Science.gov (United States)

J.E. Jakes; C.R. Frihart; J.F. Beecher; R.J. Moon; P.J. Resto; Z.H. Melgarejo; O.M. Saurez; H. Baumgart; A.A. Elmustafa; D.S. Stone

2009-01-01

Whenever a nanoindent is placed near an edge, such as the free edge of the specimen or heterophase interface intersecting the surface, the elastic discontinuity associated with the edge produces artifacts in the load-depth data. Unless properly handled in the data analysis, the artifacts can produce spurious results that obscure any real trends in properties as...

Edge subdivision and edge multisubdivision versus some domination related parameters in generalized corona graphs

Directory of Open Access Journals (Sweden)

Magda Dettlaff

2016-01-01

Full Text Available Given a graph \\(G=(V,E\\, the subdivision of an edge \\(e=uv\\in E(G\\ means the substitution of the edge \\(e\\ by a vertex \\(x\\ and the new edges \\(ux\\ and \\(xv\\. The domination subdivision number of a graph \\(G\\ is the minimum number of edges of \\(G\\ which must be subdivided (where each edge can be subdivided at most once in order to increase the domination number. Also, the domination multisubdivision number of \\(G\\ is the minimum number of subdivisions which must be done in one edge such that the domination number increases. Moreover, the concepts of paired domination and independent domination subdivision (respectively multisubdivision numbers are defined similarly. In this paper we study the domination, paired domination and independent domination (subdivision and multisubdivision numbers of the generalized corona graphs.

Mortality after percutaneous edge-to-edge mitral valve repair: a contemporary review.

Science.gov (United States)

Kortlandt, Friso A; de Beenhouwer, Thomas; Swaans, Martin J; Post, Marco C; van der Heyden, Jan A S; Eefting, Frank D; Rensing, Benno J W M

2016-04-01

Percutaneous edge-to-edge mitral valve (MV) repair is a relatively new treatment option for mitral regurgitation (MR). After the feasibility and safety having been proved in low-surgical-risk patients, the use of this procedure has shifted more to the treatment of high-risk patients. With the absence of randomized controlled trials (RCT) for this particular subgroup, observational studies try to add evidence to the safety aspect of this procedure. These also provide short- and mid-term mortality figures. Several mortality predictors have been identified, which may help the optimal selection of patients who will benefit most from this technique. In this article we provide an overview of the literature about mortality and its predictors in patients treated with the percutaneous edge-to-edge device.

Adobe Edge Preview 3

CERN Document Server

Grover, Chris

2011-01-01

Want to use an Adobe tool to design animated web graphics that work on iPhone and iPad? You've come to the right book. Adobe Edge Preview 3: The Missing Manual shows you how to build HTML5 graphics using simple visual tools. No programming experience? No problem. Adobe Edge writes the underlying code for you. With this eBook, you'll be designing great-looking web elements in no time. Get to know the workspace. Learn how Adobe Edge Preview 3 performs its magic.Create and import graphics. Make drawings with Edge's tools, or use art you designed in other programs.Work with text. Build menus, lab

Emotional exhaustion and workload predict clinician-rated and objective patient safety

Science.gov (United States)

Welp, Annalena; Meier, Laurenz L.; Manser, Tanja

2015-01-01

Aims: To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios. Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety. PMID:25657627

Emotional Exhaustion and Workload Predict Clinician-Rated and Objective Patient Safety

Directory of Open Access Journals (Sweden)

Annalena eWelp

2015-01-01

Full Text Available Aims: To investigate the role of clinician burnout, demographic and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. (Multilevel regression analysis was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience and organizational (e.g., workload, predictability characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety were associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios.Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables or and support the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety.

Information Needs, Infobutton Manager Use, and Satisfaction by Clinician Type: A Case Study

Science.gov (United States)

Collins, Sarah A.; Currie, Leanne M.; Bakken, Suzanne; Cimino, James J.

2009-01-01

To effectively meet clinician information needs at the point of care, we must understand how their needs are dependent on both context and clinician type. The Infobutton Manager (IM), accessed through a clinical information system, anticipates the clinician's questions and provides links to pertinent electronic resources. We conducted an observational usefulness case study of medical residents (MDs), nurse practitioners (NPs), registered nurses (RNs), and a physician assistant (PA), using the IM in a laboratory setting. Generic question types and success rates for each clinician's information needs were characterized. Question type frequency differed by clinician type. All clinician types asked for institution-specific protocols. The MDs asked about unfamiliar domains, RNs asked about physician order rationales, and NPs asked questions similar to both MDs and RNs. Observational data suggest that IM success rates may be improved by tailoring anticipated questions to clinician type. Clinicians reported that a more visible Infobutton may increase use. PMID:18952943

Experiences of randomization: interviews with patients and clinicians in the SPCG-IV trial.

Science.gov (United States)

Bill-Axelson, Anna; Christensson, Anna; Carlsson, Marianne; Norlén, Bo Johan; Holmberg, Lars

2008-01-01

Recruitment of both patients and clinicians to randomized trials is difficult. Low participation carries the risk of terminating studies early and making them invalid owing to insufficient statistical power. This study investigated patients' and clinicians' experiences of randomization with the aim of facilitating trial participation in the future. This was a qualitative study using content analysis. Patients offered to participate in a randomized trial and randomizing clinicians were interviewed. Five participants, four non-participants and five randomizing clinicians were interviewed, 2-8 years from randomization. Clinicians used strategies in interaction with the patients to facilitate decision making. Patients' attitudes differed and experiences of relatives or friends were often stated as reasons for treatment preferences. Patients described that letting chance decide treatment was a difficult barrier to overcome for randomization. The clinicians used a number of different strategies perceived to make randomization more acceptable to their patients. The clinicians' own motivation for randomizing patients for trials depended on the medical relevance of the study question and the clinicians' major obstacle was to maintain equipoise over time. Regular meetings with the study group helped to maintain equipoise and motivation. To establish a good platform for randomization the clinician needs to know about the patient's treatment preferences and the patient's attitude concerning the role of the clinician to facilitate decision making. The strategies used by the clinicians were perceived as helpful and could be tested in an intervention study.

Bioethics for clinicians: 25. Teaching bioethics in the clinical setting

Science.gov (United States)

McKneally, Martin F.; Singer, Peter A.

2001-01-01

BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn? PMID:11338804

Clinicians' management strategies for patients with dyspepsia: a qualitative approach

Directory of Open Access Journals (Sweden)

Ohlsson Bodil

2005-05-01

Full Text Available Abstract Background Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own. Methods Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted. Results For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced. Conclusion Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate

Leadership, clinician managers and a thing called "hybridity".

Science.gov (United States)

Fulop, Liz

2012-01-01

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the skills and competencies of health professionals. Alternative approaches have been proffered but mainly in the form of post-heroic and distributed forms of leadership. The notion of "hybridity" has emerged to challenge the assumptions of distributed leadership. The paper seeks to explore how the concept of hybridity can be used to re-theorize leadership in healthcare as it relates to clinician managers (or hybrid-professional managers). The theoretical developments are explored and empirical material is presented from research in Australian public hospitals to support the case for the existence of hybridized forms of leadership in healthcare. The paper discusses whether hybridity needs re-theorizing to adequately account for clinician leadership. It contributes to debates surrounding the role of clinician leadership in healthcare reform particularly in relation to those doctors who occupy management positions at the division or unit levels as distinct to CEOs. The study uses qualitative research, i.e. interactive interviews to present accounts of how healthcare professionals describe leadership. It undertakes both deductive and inductive theme analysis of the interview material. There is support for hybridized configurations of leadership in interview materials of healthcare professionals but other aspects were also noted that cannot be explained by this approach alone. The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

The clinician's dilemma: two dimensions of ethical care.

Science.gov (United States)

Gillett, Grant; Chamberlain, Joshua

2013-01-01

There is a continuing intense medico-ethico-legal debate around legalized euthanasia and physician assisted suicide such that ethically informed clinicians often agree with the arguments but feel hesitant about the conclusion, especially when it may bring about a change in law. We argue that this confusion results from the convergence of two continua that underpin the conduct of a clinician and are especially prominent in psychiatry. The two continua concern the duty of care and the importance of patient autonomy and they do not quite map into traditional divides in debates about sanctity of life, paternalism, and autonomy. As ethical dimensions, they come into sharp focus in the psychological complexities of end-of-life care and they form two key factors in most ethical and legal or disciplinary deliberations about a clinician's actions. Whereas both dimensions are important when a clinician reflects on what s/he has done or should do, they need careful balancing in a request for euthanasia or physician assisted suicide where the patient wants to take a decisive role in his or her own end-of-life care. However, end-of-life is also a situation where clinicians often encounter 'cries for help' so that both continua are importantly in play. Balancing these two continua without using blunt legal instruments is often required in psychiatric care in such a way as to problematize the idea that patient decisions should dominate the care options available. A simplistic approach to that issue arguably plays into what has been called an 'impoverished construction of life and death' and, some would say, devalues the basic commitments fundamental to medical care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Child Health Disparities: What Can a Clinician Do?

OpenAIRE

Cheng, Tina L.; Emmanuel, Mickey; Levy, Daniel J.; Jenkins, Renee R.

2015-01-01

Pediatric primary and specialty practice has changed with more to do, more regulation and more family needs. Similarly, the needs of patients have changed with more demographic diversity, family stress and continued health disparities by race, ethnicity and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This paper outlines specific, practical, actionable and evidence-based activities for clinicians t...

Generalized Multi-Edge Analysis for K-Edge Densitometry

International Nuclear Information System (INIS)

Collins, M.

1998-01-01

In K-edge densitometry (KED), a continuous-energy x-ray beam is transmitted through a liquid sample. The actinide content of the sample can be measured through analysis of the transmitted portion of the x-ray beam. Traditional methods for KED analysis allow the simultaneous calculation of, at most, two actinide concentrations. A generalized multi-edge KED analytical method is presented, allowing up to six actinide concentrations to be calculated simultaneously. Applications of this method for hybrid KED/x-ray fluorescence (HKED) systems are discussed. Current HKED systems require the operator to know the approximate actinide content of each sample, and manually select the proper analysis mode. The new multi-edge KED technique allows rapid identification of the major actinide components in a sample, independent of actinide content. The proper HKED analysis mode can be selected automatically, without requiring sample content information from the user. Automatic HKED analysis would be especially useful in an analytical laboratory setting, where samples with truly unknown characteristics are encountered. Because this technique requires no hardware modifications, several facilities that use HKED may eventually benefit from this approach

Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment.

Science.gov (United States)

Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten

2018-04-01

The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from eating disorders. Oppositely to traditional pen-and-paper meal diaries, the app allows for in-app patient-clinician linkage enabling clinicians to access patient app data anytime. The aim of our study was to explore the interdisciplinary clinical perspective on Recovery Record and its impact on treatment. Thirty-one clinicians from a Danish eating disorder treatment facility participated in field studies and 23 of these in interviews. Data were generated and analyzed concurrently applying the inductive methodology of Interpretive Description. We found two overarching themes: "Access to app data between treatment sessions", and "The patient-clinician relationship". Sub-themes associated with the former were "Online obligations" in relation to the added workload of continuously monitoring patient app data, and "Prepared or prejudiced" relating to advantages and disadvantages of using patient app data as preparation for treatment sessions. Sub-themes pertaining to the latter were "Expectation discrepancy" in relation to patients' and clinicians' divergent expectations for app usage, and "Pacified patients" regarding the clinicians' experience that the app potentially compromised the patient initiative in treatment sessions. Recovery Record induced new and affected pre-existing treatment and work conditions for clinicians. Clinicians were preoccupied with challenges associated with the app, for example, an added work load and potential harm to the patient-clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines for patient and clinician app usage. © 2018 Wiley Periodicals, Inc.

Concordance Between Administrator and Clinician Ratings of Organizational Culture and Climate.

Science.gov (United States)

Beidas, Rinad S; Williams, Nathaniel J; Green, Philip D; Aarons, Gregory A; Becker-Haimes, Emily M; Evans, Arthur C; Rubin, Ronnie; Adams, Danielle R; Marcus, Steven C

2018-01-01

Organizational culture and climate are important determinants of behavioral health service delivery for youth. The Organizational Social Context measure is a well validated assessment of organizational culture and climate that has been developed and extensively used in public sector behavioral health service settings. The degree of concordance between administrators and clinicians in their reports of organizational culture and climate may have implications for research design, inferences, and organizational intervention. However, the extent to which administrators' and clinicians' reports demonstrate concordance is just beginning to garner attention in public behavioral health settings in the United States. We investigated the concordance between 73 administrators (i.e., supervisors, clinical directors, and executive directors) and 247 clinicians in 28 child-serving programs in a public behavioral health system. Findings suggest that administrators, compared to clinicians, reported more positive cultures and climates. Organizational size moderated this relationship such that administrators in small programs (climate in contrast to administrators in large programs (≥466 youth clients served annually) who reported more positive cultures and climates than clinicians. We propose a research agenda that examines the effect of concordance between administrators and clinicians on organizational outcomes in public behavioral health service settings.

Canopy gap edge determination and the importance of gap edges for plant diversity

Directory of Open Access Journals (Sweden)

D. Salvador-Van Eysenrode

2002-01-01

Full Text Available Canopy gaps, i.e. openings in the forest cover caused by the fall of structural elements, are considered to be important for the maintenance of diversity and for the forest cycle. A gap can be considered as a young forest patch in the forest matrix, composed of interior surrounded by an edge, both enclosed by a perimeter. Much of the attention has been focused on the gap interior. However, at gap edges the spectrum of regeneration opportunities for plants may be larger than in the interior. Although definitions of gap are still discussed, any definition can describe it in an acceptable way, if justified, but defining edges is complicated and appropriate descriptors should be used. A method to determine gap interior and edge, using light as a descriptor, is presented with an example of gaps from a beech forest (Fagus sylvatica in Belgium. Also, the relevance and implications of gap edges for plant diversity and calculation of forest turnover is discussed.

Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

International Nuclear Information System (INIS)

McQueen, A.S.; Worthy, S.; Keir, M.J.

2008-01-01

Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

Equity of access to elective surgery: reflections from NZ clinicians.

Science.gov (United States)

McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

The Edge supersonic transport

Science.gov (United States)

Agosta, Roxana; Bilbija, Dushan; Deutsch, Marc; Gallant, David; Rose, Don; Shreve, Gene; Smario, David; Suffredini, Brian

1992-01-01

As intercontinental business and tourism volumes continue their rapid expansion, the need to reduce travel times becomes increasingly acute. The Edge Supersonic Transport Aircraft is designed to meet this demand by the year 2015. With a maximum range of 5750 nm, a payload of 294 passengers and a cruising speed of M = 2.4, The Edge will cut current international flight durations in half, while maintaining competitive first class, business class, and economy class comfort levels. Moreover, this transport will render a minimal impact upon the environment, and will meet all Federal Aviation Administration Part 36, Stage III noise requirements. The cornerstone of The Edge's superior flight performance is its aerodynamically efficient, dual-configuration design incorporating variable-geometry wingtips. This arrangement combines the benefits of a high aspect ratio wing at takeoff and low cruising speeds with the high performance of an arrow-wing in supersonic cruise. And while the structural weight concerns relating to swinging wingtips are substantial, The Edge looks to ever-advancing material technologies to further increase its viability. Heeding well the lessons of the past, The Edge design holds economic feasibility as its primary focus. Therefore, in addition to its inherently superior aerodynamic performance, The Edge uses a lightweight, largely windowless configuration, relying on a synthetic vision system for outside viewing by both pilot and passengers. Additionally, a fly-by-light flight control system is incorporated to address aircraft supersonic cruise instability. The Edge will be produced at an estimated volume of 400 aircraft and will be offered to airlines in 2015 at $167 million per transport (1992 dollars).

Lack of school requirements and clinician recommendations for human papillomavirus vaccination

Directory of Open Access Journals (Sweden)

Linda M. Niccolai

2018-04-01

Full Text Available Background: A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations. Design and Methods: Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. Results: Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. Conclusions: The current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.

What motivates senior clinicians to teach medical students?

Directory of Open Access Journals (Sweden)

Owen Cathy

2005-07-01

Full Text Available Abstract Background This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. Methods The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia. Their motivations to teach medical students were assessed applying Q methodology. Results Of the 75 participants, 18 (24% were female and 57 (76% were male. The age distribution was as follows: 30–40 years = 16 participants (21.3%, 41–55 years = 46 participants (61.3% and >55 years = 13 participants (17.3%. Most participants (n = 48, 64% were staff specialists and 27 (36% were visiting medical officers. Half of the participants were internists (n = 39, 52%, 12 (16% were surgeons, and 24 (32% were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41–55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. Conclusion This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

Strengthening the working alliance through a clinician's familiarity with the 12-step approach.

Science.gov (United States)

Dennis, Cory B; Roland, Brian D; Loneck, Barry M

2018-01-01

The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. We investigated how, from the perspective of clients, a clinician's level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician's recovery status. We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. From the perspective of clients with a substance use disorder, clinicians' familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician's recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.

Theory of edge radiation

Energy Technology Data Exchange (ETDEWEB)

Geloni, G.; Kocharyan, V.; Saldin, E.; Schneidmiller, E.; Yurkov, M.

2008-08-15

We formulate a complete theory of Edge Radiation based on a novel method relying on Fourier Optics techniques. Similar types of radiation like Transition UndulatorRadiation are addressed in the framework of the same formalism. Special attention is payed in discussing the validity of approximations upon which the theory is built. Our study makes consistent use of both similarity techniques and comparisons with numerical results from simulation. We discuss both near and far zone. Physical understanding of many asymptotes is discussed. Based on the solution of the field equation with a tensor Green's function technique, we also discuss an analytical model to describe the presence of a vacuum chamber. In particular, explicit calculations for a circular vacuum chamber are reported. Finally, we consider the use of Edge Radiation as a tool for electron beam diagnostics. We discuss Coherent Edge Radiation, Extraction of Edge Radiation by a mirror, and other issues becoming important at high electron energy and long radiation wavelength. Based on this work we also study the impact of Edge Radiation on XFEL setups and we discuss recent results. (orig.)

Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability

Science.gov (United States)

Holloway, Kristi; Riley, Geoffrey; Auret, Kirsten

2013-01-01

Background Online mental health resources have been proposed as an innovative means of overcoming barriers to accessing rural mental health services. However, clinicians tend to express lower satisfaction with online mental health resources than do clients. Objective To understand rural clinicians’ attitudes towards the acceptability of online mental health resources as a treatment option in the rural context. Methods In-depth interviews were conducted with 21 rural clinicians (general practitioners, psychologists, psychiatrists, and clinical social workers). Interviews were supplemented with rural-specific vignettes, which described clinical scenarios in which referral to online mental health resources might be considered. Symbolic interactionism was used as the theoretical framework for the study, and interview transcripts were thematically analyzed using a constant comparative method. Results Clinicians were optimistic about the use of online mental health resources into the future, showing a preference for integration alongside existing services, and use as an adjunct rather than an alternative to traditional approaches. Key themes identified included perceptions of resources, clinician factors, client factors, and the rural and remote context. Clinicians favored resources that were user-friendly and could be integrated into their clinical practice. Barriers to use included a lack of time to explore resources, difficulty accessing training in the rural environment, and concerns about the lack of feedback from clients. Social pressure exerted within professional clinical networks contributed to a cautious approach to referring clients to online resources. Conclusions Successful implementation of online mental health resources in the rural context requires attention to clinician perceptions of acceptability. Promotion of online mental health resources to rural clinicians should include information about resource effectiveness, enable integration with existing

Edge effect on weevils and spiders

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R. Horváth

2002-05-01

Full Text Available The edge effect on weevils and spiders was tested along oak forest – meadow transects using sweep-net samples at the Síkfökút Project in Hungary. For spiders the species richness was significantly higher in the forest edge than either in the meadow or the forest interior. For weevils the species richness of the forest edge was higher than that of the meadow, but the difference was not statistically significant whereas the species richness of the forest interior was significantly lower than that of the forest edge and the meadow. The composition of the spider assemblage of the edge was more similar to the forest, while the composition of weevils in the edge was more similar to the meadow. Our results based on two invertebrate groups operating on different trophic levels suggest that there is a significant edge effect for the studied taxa resulting in higher species richness in the edge.

Frequencies of the Edge-Magnetoplasmon Excitations in Gated Quantum Hall Edges

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Endo, Akira; Koike, Keita; Katsumoto, Shingo; Iye, Yasuhiro

2018-06-01

We have investigated microwave transmission through the edge of quantum Hall systems by employing a coplanar waveguide (CPW) fabricated on the surface of a GaAs/AlGaAs two-dimensional electron gas (2DEG) wafer. An edge is introduced to the slot region of the CPW by applying a negative bias Vg to the central electrode (CE) and depleting the 2DEG below the CE. We observe peaks attributable to the excitation of edge magnetoplasmons (EMP) at a fundamental frequency f0 and at its harmonics if0 (i = 2,3, \\ldots ). The frequency f0 increases with decreasing Vg, indicating that EMP propagates with higher velocity for more negative Vg. The dependence of f0 on Vg is interpreted in terms of the variation in the distance between the edge state and the CE, which alters the velocity by varying the capacitive coupling between them. The peaks are observed to continue, albeit with less clarity, up to the regions of Vg where 2DEG still remains below the CE.

Essential laboratory knowledge for the clinician

African Journals Online (AJOL)

As clinicians place huge emphasis on the numerical values obtained from the clinical ... where clinical management is based on medical decision limits that ... One area of laboratory medicine in which standardisation has been difficult to ...

The clinician-educator track: training internal medicine residents as clinician-educators.

Science.gov (United States)

Smith, C Christopher; McCormick, Ian; Huang, Grace C

2014-06-01

Although resident-as-teacher programs bring postgraduate trainees' teaching skills to a minimum threshold, intensive, longitudinal training is lacking for residents who wish to pursue careers in medical education. The authors describe the development, implementation, and preliminary assessment of the novel track for future clinician-educators that they introduced in the internal medicine residency program at Beth Israel Deaconess Medical Center in 2010. Categorical medical interns with a career interest in medical education apply to participate in the clinician-educator track (CET) at the midpoint of their first postgraduate year. CET residents complete a 2.5-year curriculum in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. They apply these skills in a variety of clinical settings and receive frequent feedback from faculty and peers. All CET residents design and implement at least one medical education research project. A comprehensive evaluation plan to assess the impact of the CET on resident teaching skills, scholarly productivity, career selection, and advancement is under way. A preliminary evaluation demonstrates high satisfaction with the track among the first cohort of CET residents, who graduated in 2012. Compared with residents in the traditional resident-as-teacher program, CET residents reported higher gains in their confidence in core medical education skills. Although these preliminary data are promising, data will be collected over the next several years to explore whether the additional curricular time, faculty time, and costs and potential expansion to other institutions are justified.

Predicted solar cell edge radiation effects

International Nuclear Information System (INIS)

Gates, M.T.

1993-01-01

The Advanced Solar Cell Orbital Test (ASCOT) will test six types of solar cells in a high energy proton environment. During the design of the experiment a question was raised about the effects of proton radiation incident on the edge of the solar cells and whether edge radiation shielding was required. Historical geosynchronous data indicated that edge radiation damage is not detectable over the normal end of life solar cell degradation; however because the ASCOT radiation environment has a much higher and more energetic fluence of protons, considerably more edge damage is expected. A computer analysis of the problem was made by modeling the expected radiation damage at the cell edge and using a network model of small interconnected solar cells to predict degradation in the cell's electrical output. The model indicated that the deepest penetration of edge radiation was at the top of the cell near the junction where the protons have access to the cell through the low density cell/cover adhesive layer. The network model indicated that the cells could tolerate high fluences at their edge as long as there was high electrical resistance between the edge radiated region and the contact system on top of the cell. The predicted edge radiation related loss was less than 2% of maximum power for GaAs/Ge solar cells. As a result, no edge radiation protection was used for ASCOT

Clinicians' recognition and management of emotions during difficult healthcare conversations.

Science.gov (United States)

Martin, Elliott B; Mazzola, Natalia M; Brandano, Jessica; Luff, Donna; Zurakowski, David; Meyer, Elaine C

2015-10-01

To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Clinicians' Choices in Selecting Orthodontic Archwires

Directory of Open Access Journals (Sweden)

Silvia-Izabella Pop

2013-08-01

Full Text Available Objective: The aim of this study was to assess the choices made by clinicians in selecting archwires during the initial, intermediate and final stages of orthodontic treatment with fixed appliances. Methods: We carried out a questionnaire-based study at the Orthodontics and Pedodontics Clinic Târgu Mureș, between March 2012 and September 2012. The questionnaires consisted of two parts: the first included questions related to the dimension, alloy used in fabrication, section (round or rectangular and manufacturer of the archwires used by the orthodontists in their orthodontic practice, the second part was concerned with their personal opinion about the physical properties and disadvantages of the archwires. Results: From a total number of 90 distributed questionnaires, 62 were returned. The majority of clinicians are using stainless steel (SS and nickel-titanium alloy (NiTi wires in their fixed orthodontic treatments, very few are using beta-titanium (Beta Ti, copper nickel-titanium (Co- NiTi and esthetic archwires. The preferred dimension seem to be 0.022 inches in the appliance system. Regarding the wire dimensions, 0.014, 0.016 inch wires are mostly used from the round section group and 0.016 × 0.022 inch, 0.017 × 0.025 inch from the rectangular ones. Conclusions: There is a general lack of agreement between the clinicians surveyed regarding the properties of an ideal archwire and the disadvantages of the used wires. The most frequently used alloys seemed to be the SS and NiTi

The visibility of IQHE at sharp edges: experimental proposals based on interactions and edge electrostatics

International Nuclear Information System (INIS)

Erkarslan, U; Oylumluoglu, G; Grayson, M; Siddiki, A

2012-01-01

The influence of the incompressible strips on the integer quantized Hall effect (IQHE) is investigated, considering a cleaved-edge overgrown (CEO) sample as an experimentally realizable sharp edge system. We propose a set of experiments to clarify the distinction between the large-sample limit when bulk disorder defines the IQHE plateau width and the small-sample limit smaller than the disorder correlation length, when self-consistent edge electrostatics define the IQHE plateau width. The large-sample or bulk quantized Hall (QH) regime is described by the usual localization picture, whereas the small-sample or edge regime is discussed within the compressible/incompressible strips picture, known as the screening theory of QH edges. Utilizing the unusually sharp edge profiles of the CEO samples, a Hall bar design is proposed to manipulate the edge potential profile from smooth to extremely sharp. By making use of a side-gate perpendicular to the two-dimensional electron system, it is shown that the plateau widths can be changed or even eliminated altogether. Hence, the visibility of IQHE is strongly influenced when adjusting the edge potential profile and/or changing the dc current direction under high currents in the nonlinear transport regime. As a second investigation, we consider two different types of ohmic contacts, namely highly transmitting (ideal) and highly reflecting (non-ideal) contacts. We show that if the injection contacts are non-ideal, but still ohmic, it is possible to measure directly the non-quantized transport taking place at the bulk of the CEO samples. The results of the experiments we propose will clarify the influence of the edge potential profile and the quality of the contacts, under QH conditions. (paper)

Data Science Meets the Clinician: Challenges and Future Directions.

Science.gov (United States)

Charitos, Efstratios I; Wilbring, Manuel; Treede, Hendrik

2018-01-01

In the last three decades a profound transformation of the medical profession has taken place. The modern clinician is required to consume vast amounts of information from clinical studies, critically reviewing evidence that may or may not lead to changes in clinical practice. The present article presents some challenges that this era of information poses to clinicians and patients. Georg Thieme Verlag KG Stuttgart · New York.

Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions.

Science.gov (United States)

Losin, Elizabeth A Reynolds; Anderson, Steven R; Wager, Tor D

2017-07-01

Pain is influenced by many factors other than external sources of tissue damage. Among these, the clinician-patient relationship is particularly important for pain diagnosis and treatment. However, the effects of the clinician-patient relationship on pain remain underexamined. We tested the hypothesis that patients who believe they share core beliefs and values with their clinician will report less pain than patients who do not. We also measured feelings of perceived clinician-patient similarity and trust to see if these interpersonal factors influenced pain. We did so by experimentally manipulating perceptions of similarity between participants playing the role of clinicians and participants playing the role of patients in simulated clinical interactions. Participants were placed in 2 groups on the basis of their responses to a questionnaire about their personal beliefs and values, and painful thermal stimulation was used as an analog of a painful medical procedure. We found that patients reported feeling more similarity and trust toward their clinician when they were paired with clinicians from their own group. In turn, patients' positive feelings of similarity and trust toward their clinicians-but not clinicians' feelings toward patients or whether the clinician and patient were from the same group-predicted lower pain ratings. Finally, the most anxious patients exhibited the strongest relationship between their feelings about their clinicians and their pain report. These findings increase our understanding of context-driven pain modulation and suggest that interventions aimed at increasing patients' feelings of similarity to and trust in health care providers may help reduce the pain experienced during medical care. We present novel evidence that the clinician-patient relationship can affect the pain experienced during medical care. We found that "patients" in simulated clinical interactions who reported feeling more similarity and trust toward their

Moving beyond 'not enough time': factors influencing paediatric clinicians' participation in research.

Science.gov (United States)

Paget, Simon P; Caldwell, Patrina H Y; Murphy, Joyce; Lilischkis, Kimberley J; Morrow, Angie M

2017-03-01

Increasing the amount of clinical research that occurs in healthcare settings has been identified as an important mechanism to improve healthcare outcomes. While clinicians are key persons in achieving this aim, research participation amongst clinicians is generally limited. To identify the factors (barriers and facilitators) influencing clinician research participation and determine how professional culture impacts on these factors. Forty clinicians working at a tertiary children's hospital participated in six discipline-specific focus groups. Thematic analysis was performed using an inductive process based in grounded theory. Four major themes (cultural factors, personal factors, resources and solutions) and 16 subthemes were identified. Participants described how the current health system discourages clinician research. They reported that their research participation requires personal sacrifice of their own time; income or career progression. Research participation was seen to compete with other priorities in clinicians' workload and is disadvantaged because of the primacy of clinical work and the lack of immediate tangible benefit from research projects. Solutions suggested by our participants included better alignment of clinical and research goals, improved availability of research mentors and collaborative opportunities. Nurses and allied health professionals reported a changing professional culture that values research. Only doctors identified research participation to be important for career progression. For clinician research participation to flourish, significant changes in healthcare structure and priorities will be required that result in research becoming more embedded in healthcare delivery. Initiatives to improve collaboration between clinicians and universities may also support these aims. © 2016 Royal Australasian College of Physicians.

Edge control in CNC polishing, paper 2: simulation and validation of tool influence functions on edges.

Science.gov (United States)

Li, Hongyu; Walker, David; Yu, Guoyu; Sayle, Andrew; Messelink, Wilhelmus; Evans, Rob; Beaucamp, Anthony

2013-01-14

Edge mis-figure is regarded as one of the most difficult technical issues for manufacturing the segments of extremely large telescopes, which can dominate key aspects of performance. A novel edge-control technique has been developed, based on 'Precessions' polishing technique and for which accurate and stable edge tool influence functions (TIFs) are crucial. In the first paper in this series [D. Walker Opt. Express 20, 19787-19798 (2012)], multiple parameters were experimentally optimized using an extended set of experiments. The first purpose of this new work is to 'short circuit' this procedure through modeling. This also gives the prospect of optimizing local (as distinct from global) polishing for edge mis-figure, now under separate development. This paper presents a model that can predict edge TIFs based on surface-speed profiles and pressure distributions over the polishing spot at the edge of the part, the latter calculated by finite element analysis and verified by direct force measurement. This paper also presents a hybrid-measurement method for edge TIFs to verify the simulation results. Experimental and simulation results show good agreement.

Acyclicity in edge-colored graphs

DEFF Research Database (Denmark)

Gutin, Gregory; Jones, Mark; Sheng, Bin

2017-01-01

A walk W in edge-colored graphs is called properly colored (PC) if every pair of consecutive edges in W is of different color. We introduce and study five types of PC acyclicity in edge-colored graphs such that graphs of PC acyclicity of type i is a proper superset of graphs of acyclicity of type...

Clinicians completion rate of radiology request card in a Nigerian ...

African Journals Online (AJOL)

The importance of adequately completing the radiology request card by the clinicians, in management of patient cannot be overemphasized. Omission of information on the request card may lead to reporting error. This study investigated the compliance rate of filling the radiology request card by clinicians received in a ...

Balancing the edge effects budget: bay scallop settlement and loss along a seagrass edge.

Science.gov (United States)

Carroll, John M; Furman, Bradley T; Tettelbach, Stephen T; Peterson, Bradley J

2012-07-01

Edge effects are a dominant subject in landscape ecology literature, yet they are highly variable and poorly understood. Often, the literature suggests simple models for edge effects-positive (enhancement at the edge), negative (enhancement at the interior), or no effect (neutral)--on a variety of metrics, including abundance, diversity, and mortality. In the marine realm, much of this work has focused on fragmented seagrass habitats due to their importance for a variety of commercially important species. In this study, the settlement, recruitment, and survival of bay scallops was investigated across a variety of seagrass patch treatments. By simultaneously collecting settlers (those viable larvae available to settle and metamorphose) and recruits (those settlers that survive some period of time, in this case, 6 weeks) on the same collectors, we were able to demonstrate a "balance" between positive and negative edge effects, resulting in a net neutral effect. Scallop settlement was significantly enhanced along seagrass edges, regardless of patch type while survival was elevated within patch interiors. However, recruitment (the net result of settlement and post-settlement loss) did not vary significantly from edge to center, representing a neutral effect. Further, results suggest that post-settlement loss, most likely due to predation, appears to be the dominant mechanism structuring scallop abundance, not patterns in settlement. These data illustrate the complexity of edge effects, and suggest that the metric used to investigate the effect (be it abundance, survival, or other metrics) can often influence the magnitude and direction of the perceived effect. Traditionally, high predation along a habitat edge would have indicated an "ecological trap" for the species in question; however, this study demonstrates that, at the population level, an ecological trap may not exist.

Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings.

Science.gov (United States)

Walsh, Cian; Ryan, Patrick; Flynn, Daniel

2018-01-01

This article presents a detailed idiographic analysis of Dialectical Behaviour Therapy (DBT) clinicians' experiences of team consultation meetings. DBT is an evidence-based psychological intervention with a demonstrated efficacy in the treatment of borderline personality disorder (BPD). Team consultation meetings encompass one of the primary components involved in this treatment model; where DBT clinicians regularly meet to discuss client work and enhance further learning. The present study's aim was to assess what are DBT clinicians' experiences of the consultation meeting component and whether it is useful or not. Semi-structured interviews were completed with 11 DBT clinicians (nine females, two males) from three different consultation teams. The research project utilised an interpretative phenomenological analysis (IPA) framework. Audio-recorded interview data was analysed using this framework. Four superordinate themes emerged from the interview data, which included ten subordinate themes. The superordinate themes focused on: (1) the acquisition of DBT technical knowledge and other MDT related expertise (2) participants' emotional experiences of DBT and consultation meetings, and how this can evolve over time (3) the underlying processes that occur in the consultation team including the development of a team bond and the impact of membership changes and (4) the largely consistent and reliable nature of consultation meetings and how they help maintain clinician motivation. Team consultation meetings were found to be supportive; playing an important role in maintaining clinician motivation through the availability of team support, opportunities to reflect and learn, and assistance in regulating emotions. Challenges arose in relation to team membership changes and acclimatisation to the type of feedback utilised in team consultation. The study's implications for practise are considered.

Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review.

Science.gov (United States)

Henry, Stephen G; Matthias, Marianne S

2018-02-01

Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research. © 2018 American Academy of Pain Medicine. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department.

Science.gov (United States)

Nigrovic, Lise E; Bennett, Jonathan E; Balamuth, Fran; Levas, Michael N; Chenard, Rachel L; Maulden, Alexandra B; Garro, Aris C

2017-12-01

To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease. We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease. We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease. Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis. Copyright © 2017 by the American Academy of Pediatrics.

Edge localized modes and edge pedestal in NBI and ICRF heated H, D and T-plasmas in JET

International Nuclear Information System (INIS)

Bhatnagar, V.; Lingertat, J.; Barnsley, R.

1998-12-01

Based on experiments carried out in JET in D:T mixtures varying from 100:0 to 5:95 and those carried out in hydrogen plasmas, the isotopic mass dependence of ELM parameters and the edge pedestal pressure in neutral beam (NBI) and ion cyclotron resonance (ICRF) heated H-mode plasmas is presented. The ELM frequency is found to decrease with the atomic mass number both in ICRH and NBI discharges. However, the frequency in the case of ICRH is about 8 - 10 times higher than in the NBI case. Assuming that ELMs occur at a critical edge pressure gradient, limited by the ballooning instability, the scaling of the maximum edge pressure is most consistent with the assumption that the width of the transport barrier scales as the ion poloidal Larmor radius governed by the average energy of fast ions at the edge. The critical edge pressure in NBI heated discharges increases with the isotopic mass which. is consistent with the higher deduced width of the edge transport, barrier in tritium than in deuterium and hydrogen. The critical edge pressure in ICRH discharges is smaller, presumably, due to the smaller fast-ion contribution to the edge region. As a consequence of the edge pressure scaling with isotopic mass, the edge operational space in the n e - T e diagram increases with operation in tritium. If the evidence that the edge pedestal width is governed by the average energy of fast ions in the edge prevails, the pedestal in ITER would be controlled by the slowing down energy spectrum of α-particles in the edge. (author)

An overview of meta-analysis for clinicians

Science.gov (United States)

Lee, Young Ho

2018-01-01

The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions. PMID:29277096

An overview of meta-analysis for clinicians.

Science.gov (United States)

Lee, Young Ho

2018-03-01

The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions.

Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors.

Science.gov (United States)

Boss, R D; Lemmon, M E; Arnold, R M; Donohue, P K

2017-11-01

Delivering prognostic information to families requires clinicians to forecast an infant's illness course and future. We lack robust empirical data about how prognosis is shared and how that affects clinician-family concordance regarding infant outcomes. Prospective audiorecording of neonatal intensive care unit family conferences, immediately followed by parent/clinician surveys. Existing qualitative analysis frameworks were applied. We analyzed 19 conferences. Most prognostic discussion targeted predicted infant functional needs, for example, medications or feeding. There was little discussion of how infant prognosis would affect infant/family quality of life. Prognostic framing was typically optimistic. Most parents left the conference believing their infant's prognosis to be more optimistic than did clinicians. Clinician approach to prognostic disclosure in these audiotaped family conferences tended to be broad and optimistic, without detail regarding implications of infant health for infant/family quality of life. Families and clinicians left these conversations with little consensus about infant prognosis.

Reviewing social media use by clinicians.

Science.gov (United States)

von Muhlen, Marcio; Ohno-Machado, Lucila

2012-01-01

Adoption studies of social media use by clinicians were systematically reviewed, up to July 26th, 2011, to determine the extent of adoption and highlight trends in institutional responses. This search led to 370 articles, of which 50 were selected for review, including 15 adoption surveys. The definition of social media is evolving rapidly; the authors define it broadly to include social networks and group-curated reference sites such as Wikipedia. Facebook accounts are very common among health science students (64-96%) and less so for professional clinicians (13-47%). Adoption rates have increased sharply in the past 4 years. Wikipedia is widely used as a reference tool. Attempts at incorporating social media into clinical training have met with mixed success. Posting of unprofessional content and breaches of patient confidentiality, especially by students, are not uncommon and have prompted calls for social media guidelines.

Clinicians' perceptions of the benefits and harms of prostate and colorectal cancer screening.

Science.gov (United States)

Elstad, Emily A; Sutkowi-Hemstreet, Anne; Sheridan, Stacey L; Vu, Maihan; Harris, Russell; Reyna, Valerie F; Rini, Christine; Earp, Jo Anne; Brewer, Noel T

2015-05-01

Clinicians' perceptions of screening benefits and harms influence their recommendations, which in turn shape patients' screening decisions. We sought to understand clinicians' perceptions of the benefits and harms of cancer screening by comparing 2 screening tests that differ in their balance of potential benefits to harms: colonoscopy, which results in net benefit for many adults, and prostate-specific antigen (PSA) testing, which may do more harm than good. In this cross-sectional study, 126 clinicians at 24 family/internal medicine practices completed surveys in which they listed and rated the magnitude of colonoscopy and PSA testing benefits and harms for a hypothetical 70-year-old male patient and then estimated the likelihood that these tests would cause harm and lengthen the life of 100 similar men in the next 10 years. We tested the hypothesis that the availability heuristic would explain the association of screening test to perceived likelihood of benefit/harm and a competing hypothesis that clinicians' gist of screening tests as good or bad would mediate this association. Clinicians perceived PSA testing to have a greater likelihood of harm and a lower likelihood of lengthening life relative to colonoscopy. Consistent with our gist hypothesis, these associations were mediated by clinicians' gist of screening (balance of perceived benefits to perceived harms). Generalizability beyond academic clinicians remains to be established. Targeting clinicians' gist of screening, for example through graphical displays that allow clinicians to make gist-based relative magnitude comparisons, may influence their risk perception and possibly reduce overrecommendation of screening. © The Author(s) 2015.

Magnetohydrodynamic stability of tokamak edge plasmas

International Nuclear Information System (INIS)

Connor, J.W.; Hastie, R.J.; Wilson, H.R.; Miller, R.L.

1998-01-01

A new formalism for analyzing the magnetohydrodynamic stability of a limiter tokamak edge plasma is developed. Two radially localized, high toroidal mode number n instabilities are studied in detail: a peeling mode and an edge ballooning mode. The peeling mode, driven by edge current density and stabilized by edge pressure gradient, has features which are consistent with several properties of tokamak behavior in the high confinement open-quotes Hclose quotes-mode of operation, and edge localized modes (or ELMs) in particular. The edge ballooning mode, driven by the pressure gradient, is identified; this penetrates ∼n 1/3 rational surfaces into the plasma (rather than ∼n 1/2 , expected from conventional ballooning mode theory). Furthermore, there exists a coupling between these two modes and this coupling provides a picture of the ELM cycle

Evaluation of the informatician perspective: determining types of research papers preferred by clinicians.

Science.gov (United States)

Ru, Boshu; Wang, Xiaoyan; Yao, Lixia

2017-07-05

To deliver evidence-based medicine, clinicians often reference resources that are useful to their respective medical practices. Owing to their busy schedules, however, clinicians typically find it challenging to locate these relevant resources out of the rapidly growing number of journals and articles currently being published. The literature-recommender system may provide a possible solution to this issue if the individual needs of clinicians can be identified and applied. We thus collected from the CiteULike website a sample of 96 clinicians and 6,221 scientific articles that they read. We examined the journal distributions, publication types, reading times, and geographic locations. We then compared the distributions of MeSH terms associated with these articles with those of randomly sampled MEDLINE articles using two-sample Z-test and multiple comparison correction, in order to identify the important topics relevant to clinicians. We determined that the sampled clinicians followed the latest literature in a timely manner and read papers that are considered landmarks in medical research history. They preferred to read scientific discoveries from human experiments instead of molecular-, cellular- or animal-model-based experiments. Furthermore, the country of publication may impact reading preferences, particularly for clinicians from Egypt, India, Norway, Senegal, and South Africa. These findings provide useful guidance for developing personalized literature-recommender systems for clinicians.

Edge instabilities of topological superconductors

Energy Technology Data Exchange (ETDEWEB)

Hofmann, Johannes S. [Institut fuer Theoretische Physik und Astrophysik, Universitaet Wuerzburg (Germany); Max-Planck-Institut fuer Festkoerperforschung, Stuttgart (Germany); Assaad, Fakher F. [Institut fuer Theoretische Physik und Astrophysik, Universitaet Wuerzburg (Germany); Schnyder, Andreas P. [Max-Planck-Institut fuer Festkoerperforschung, Stuttgart (Germany)

2016-07-01

Nodal topological superconductors display zero-energy Majorana flat bands at generic edges. The flatness of these edge bands, which is protected by time-reversal and translation symmetry, gives rise to an extensive ground state degeneracy and a diverging density of states. Therefore, even arbitrarily weak interactions lead to an instability of the flat-band edge states towards time-reversal and translation-symmetry broken phases, which lift the ground-state degeneracy. Here, we employ Monte Carlo simulations combined with mean-field considerations to examine the instabilities of the flat-band edge states of d{sub xy}-wave superconductors. We find that attractive interactions induce a complex s-wave pairing instability together with a density wave instability. Repulsive interactions, on the other hand, lead to ferromagnetism mixed with spin-triplet pairing at the edge. We discuss the implications of our findings for experiments on cuprate high-temperature superconductors.

Adobe Edge Quickstart Guide

CERN Document Server

Labrecque, Joseph

2012-01-01

Adobe Edge Quickstart Guide is a practical guide on creating engaging content for the Web with Adobe's newest HTML5 tool. By taking a chapter-by-chapter look at each major aspect of Adobe Edge, the book lets you digest the available features in small, easily understandable chunks, allowing you to start using Adobe Edge for your web design needs immediately. If you are interested in creating engaging motion and interactive compositions using web standards with professional tooling, then this book is for you. Those with a background in Flash Professional wanting to get started quickly with Adobe

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians

Directory of Open Access Journals (Sweden)

Haik J

2017-06-01

Full Text Available Josef Haik,1–3 Stav Brown,1,2 Alon Liran,1 Denis Visentin,4 Amit Sokolov,2 Isaac Zilinsky,1,2 Rachel Kornhaber1,4 1Department of Plastic and Reconstruction Surgery, The National Burns Center, Sheba Medical Center, Tel Hashomer, 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 3Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel; 4School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia Abstract: Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory, depression (PRIME-MD, health-related quality of life (SF-8, and compassion fatigue (Professional Quality of Life version 5. Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2% among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P=0.017. Additional factors contributing to compassion fatigue were those without children (P=0.016, divorced (P=0.035, of a younger age (P=0.019, and a registered nurse (P=0.05. Burnout increased clinicians’ risk of adverse professional and personal outcomes and correlated with less free time (P<0.001, increased risk of experiencing work-home disputes (P=0.05, increased depression (P=0

The End-to-end Demonstrator for improved decision making in the water sector in Europe (EDgE)

Science.gov (United States)

Wood, Eric; Wanders, Niko; Pan, Ming; Sheffield, Justin; Samaniego, Luis; Thober, Stephan; Kumar, Rohinni; Prudhomme, Christel; Houghton-Carr, Helen

2017-04-01

High-resolution simulations of water resources from hydrological models are vital to supporting important climate services. Apart from a high level of detail, both spatially and temporally, it is important to provide simulations that consistently cover a range of timescales, from historical reanalysis to seasonal forecast and future projections. In the new EDgE project commissioned by the ECMWF (C3S) we try to fulfill these requirements. EDgE is a proof-of-concept project which combines climate data and state-of-the-art hydrological modelling to demonstrate a water-oriented information system implemented through a web application. EDgE is working with key European stakeholders representative of private and public sectors to jointly develop and tailor approaches and techniques. With these tools, stakeholders are assisted in using improved climate information in decision-making, and supported in the development of climate change adaptation and mitigation policies. Here, we present the first results of the EDgE modelling chain, which is divided into three main processes: 1) pre-processing and downscaling; 2) hydrological modelling; 3) post-processing. Consistent downscaling and bias corrections for historical simulations, seasonal forecasts and climate projections ensure that the results across scales are robust. The daily temporal resolution and 5km spatial resolution ensure locally relevant simulations. With the use of four hydrological models (PCR-GLOBWB, VIC, mHM, Noah-MP), uncertainty between models is properly addressed, while consistency is guaranteed by using identical input data for static land surface parameterizations. The forecast results are communicated to stakeholders via Sectoral Climate Impact Indicators (SCIIs) that have been created in collaboration with the end-user community of the EDgE project. The final product of this project is composed of 15 years of seasonal forecast and 10 climate change projections, all combined with four hydrological

Ex vivo hydrodynamics after central and paracommissural edge-to-edge technique: A further step toward transcatheter tricuspid repair?

Science.gov (United States)

Stock, Sina; Bohm, Heidemarie; Scharfschwerdt, Michael; Richardt, Doreen; Meyer-Saraei, Roza; Tsvelodub, Stanislav; Sievers, Hans-Hinrich

2018-03-01

Transcatheter approaches in heart valve disease became tremendously important and are currently established in the aortic position, but transcatheter tricuspid repair is still in its beginning and remains challenging. Replicating the surgical edge-to-edge technique, for example, with the MitraClip System (Abbott Vascular, Santa Clara, Calif), represents a promising option and has been reported successfully in small numbers of cases. However, up to now, few data considering the edge-to-edge technique as a transcatheter approach are available. This study aims to determine the ex vivo hydrodynamics after the central and paracommissural edge-to-edge technique in different pathologies. Because of basal or apical dislocation of papillary muscles, leaflet prolapse or tethering was simulated in porcine tricuspid valves mounted on a flexible holding device. Central and paracommissural edge-to-edge techniques were evaluated successively in these pathologies. Regurgitant volume and mean transvalvular gradient were determined in a pulse duplicator. In this ex vivo model, the isolated edge-to-edge technique reduced tricuspid regurgitation. In the prolapse model, regurgitant volume decreased significantly after central edge-to-edge technique (from 49.4 ± 13.6 mL/stroke to 39.3 ± 14.1 mL/stroke). In the tethering model, both the central and the paracommissural edge-to-edge techniques led to a significant decrease (from 48.7 ± 13.9 to 43.6 ± 15.6 and to 41.1 ± 13.8 mL/stroke). In all cases, the reduction of regurgitant volume was achieved at the cost of significantly increased mean transvalvular gradient. This study provides a reduction of tricuspid regurgitation after the edge-to-edge technique in the specific experimental setup. Whether this reduction is sufficient to treat tricuspid regurgitation successfully in clinical practice remains to be established. Transcatheter approaches need to be evaluated further, probably with regard to concomitant annuloplasty

Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis.

Science.gov (United States)

Montague, Enid; Xu, Jie; Chen, Ping-Yu; Asan, Onur; Barrett, Bruce P; Chewning, Betty

2011-10-01

The aim of this study was to examine whether lag sequential analysis could be used to describe eye gaze orientation between clinicians and patients in the medical encounter. This topic is particularly important as new technologies are implemented into multiuser health care settings in which trust is critical and nonverbal cues are integral to achieving trust. This analysis method could lead to design guidelines for technologies and more effective assessments of interventions. Nonverbal communication patterns are important aspects of clinician-patient interactions and may affect patient outcomes. The eye gaze behaviors of clinicians and patients in 110 videotaped medical encounters were analyzed using the lag sequential method to identify significant behavior sequences. Lag sequential analysis included both event-based lag and time-based lag. Results from event-based lag analysis showed that the patient's gaze followed that of the clinician, whereas the clinician's gaze did not follow the patient's. Time-based sequential analysis showed that responses from the patient usually occurred within 2 s after the initial behavior of the clinician. Our data suggest that the clinician's gaze significantly affects the medical encounter but that the converse is not true. Findings from this research have implications for the design of clinical work systems and modeling interactions. Similar research methods could be used to identify different behavior patterns in clinical settings (physical layout, technology, etc.) to facilitate and evaluate clinical work system designs.

Edge Simulation Laboratory

Energy Technology Data Exchange (ETDEWEB)

Krasheninnikov, Sergei I. [Univ. of California, San Diego, CA (United States); Angus, Justin [Univ. of California, San Diego, CA (United States); Lee, Wonjae [Univ. of California, San Diego, CA (United States)

2018-01-05

The goal of the Edge Simulation Laboratory (ESL) multi-institutional project is to advance scientific understanding of the edge plasma region of magnetic fusion devices via a coordinated effort utilizing modern computing resources, advanced algorithms, and ongoing theoretical development. The UCSD team was involved in the development of the COGENT code for kinetic studies across a magnetic separatrix. This work included a kinetic treatment of electrons and multiple ion species (impurities) and accurate collision operators.

AliEn - EDG Interoperability in ALICE

CERN Document Server

Bagnasco, S; Buncic, P; Carminati, F; Cerello, P G; Saiz, P

2003-01-01

AliEn (ALICE Environment) is a GRID-like system for large scale job submission and distributed data management developed and used in the context of ALICE, the CERN LHC heavy-ion experiment. With the aim of exploiting upcoming Grid resources to run AliEn-managed jobs and store the produced data, the problem of AliEn-EDG interoperability was addressed and an in-terface was designed. One or more EDG (European Data Grid) User Interface machines run the AliEn software suite (Cluster Monitor, Storage Element and Computing Element), and act as interface nodes between the systems. An EDG Resource Broker is seen by the AliEn server as a single Computing Element, while the EDG storage is seen by AliEn as a single, large Storage Element; files produced in EDG sites are registered in both the EDG Replica Catalogue and in the AliEn Data Catalogue, thus ensuring accessibility from both worlds. In fact, both registrations are required: the AliEn one is used for the data management, the EDG one to guarantee the integrity and...

Energetics of edge oxidization of graphene nanoribbons

Science.gov (United States)

Yasuma, Airi; Yamanaka, Ayaka; Okada, Susumu

2018-06-01

On the basis of the density functional theory, we studied the geometries and energetics of O atoms adsorbed on graphene edges for simulating the initial stage of the edge oxidization of graphene. Our calculations showed that oxygen atoms are preferentially adsorbed onto the graphene edges with the zigzag portion, resulting in a large adsorption energy of about 5 eV. On the other hand, the edges with armchair shape are rarely oxidized, or the oxidization causes substantial structural reconstructions, because of the stable covalent bond at the armchair edge with the triple bond nature. Furthermore, the energetics sensitively depends on the edge angles owing to the inhomogeneity of the charge density at the edge atomic sites.

'Learning Organizations': a clinician's primer.

Science.gov (United States)

O'Connor, Nick; Kotze, Beth

2008-06-01

Most clinicians are poorly informed in relation to the key concepts of organizational learning. Yet the paradigm may offer clinicians a powerful method for using their knowledge and skills to respond to the demands of a changing environment through experimentation and learning. The concept is critically examined. Organizational learning principles are presented, including a conceptual framework for assessing health services as Learning Organizations. Barriers to organizational learning and strategies to overcome these are discussed. The seminal works of Argyris and Senge are reviewed and a framework for assessing organizational learning in health services is proposed. Current area health service actions are evaluated against the 'diagnostic' framework for a Learning Organization. Although critical examination reveals a poor empirical basis for the concept, the metaphor of the Learning Organization provides a useful conceptual framework and tools for individuals and organizations to apply in developing knowledge and effecting change. The Clinical Practice Improvement and Root Cause Analysis programs being conducted across NSW area health services meet the criteria for effective organizational learning. Key concepts from organizational learning theory provide a diagnostic framework for evaluating area health services as Learning Organizations and support two current strategies for overcoming barriers to organizational learning.

Information management for clinicians.

Science.gov (United States)

Mehta, Neil B; Martin, Stephen A; Maypole, Jack; Andrews, Rebecca

2016-08-01

Clinicians are bombarded with information daily by social media, mainstream television news, e-mail, and print and online reports. They usually do not have much control over these information streams and thus are passive recipients, which means they get more noise than signal. Accessing, absorbing, organizing, storing, and retrieving useful medical information can improve patient care. The authors outline how to create a personalized stream of relevant information that can be scanned regularly and saved so that it is readily accessible. Copyright © 2016 Cleveland Clinic.

[Meanings attributed to management as an explanation for clinician managers' attitudes and professional identity].

Science.gov (United States)

Cascón-Pereira, Rosalía; Valverde, Mireia

2014-01-01

To understand the process by which clinician managers construct their professional identities and develop their attitudes toward managing. A qualitative study was performed, based on grounded theory, through in-depth interviews with 20 clinician managers selected through theoretical sampling in two public hospitals of Catalonia (Spain), participant observation, and documentation. Clinician managers' role meanings are constructed by comparing their roles with those of senior managers and clinicians. In this process, clinician managers seek to differentiate themselves from senior managers through the meanings constructed. In particular, they use proximity with reality and clinical knowledge as the main sources of differentiation. This study sheds light on why clinician managers develop adverse attitudes to managing and why they define themselves as clinicians rather than as managers. The explanation lies in the construction of the meanings they assign to managing as the basis of their attitudes to this role and professional identity. These findings have some practical implications for healthcare management. Copyright © 2014. Published by Elsevier Espana.

Electronic medical records and communication with patients and other clinicians: are we talking less?

Science.gov (United States)

O'Malley, Ann S; Cohen, Genna R; Grossman, Joy M

2010-04-01

Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

Acyclicity in edge-colored graphs

DEFF Research Database (Denmark)

Gutin, Gregory; Jones, Mark; Sheng, Bin

2017-01-01

A walk W in edge-colored graphs is called properly colored (PC) if every pair of consecutive edges in W is of different color. We introduce and study five types of PC acyclicity in edge-colored graphs such that graphs of PC acyclicity of type i is a proper superset of graphs of acyclicity of type i......+1, i=1,2,3,4. The first three types are equivalent to the absence of PC cycles, PC closed trails, and PC closed walks, respectively. While graphs of types 1, 2 and 3 can be recognized in polynomial time, the problem of recognizing graphs of type 4 is, somewhat surprisingly, NP-hard even for 2-edge-colored...... graphs (i.e., when only two colors are used). The same problem with respect to type 5 is polynomial-time solvable for all edge-colored graphs. Using the five types, we investigate the border between intractability and tractability for the problems of finding the maximum number of internally vertex...

Edge-effect interactions in fragmented and patchy landscapes.

Science.gov (United States)

Porensky, Lauren M; Young, Truman P

2013-06-01

Ecological edges are increasingly recognized as drivers of landscape patterns and ecosystem processes. In fragmented and patchy landscapes (e.g., a fragmented forest or a savanna with scattered termite mounds), edges can become so numerous that their effects pervade the entire landscape. Results of recent studies in such landscapes show that edge effects can be altered by the presence or proximity of other nearby edges. We considered the theoretical significance of edge-effect interactions, illustrated various landscape configurations that support them and reviewed existing research on this topic. Results of studies from a variety of locations and ecosystem types show that edge-effect interactions can have significant consequences for ecosystems and conservation, including higher tree mortality rates in tropical rainforest fragments, reduced bird densities in grassland fragments, and bush encroachment and reduced wildlife densities in a tropical savanna. To clarify this underappreciated concept and synthesize existing work, we devised a conceptual framework for edge-effect interactions. We first worked to reduce terminological confusion by clarifying differences among terms such as edge intersection and edge interaction. For cases in which nearby edge effects interact, we proposed three possible forms of interaction: strengthening (presence of a second edge causes stronger edge effects), weakening (presence of a second edge causes weaker edge effects), and emergent (edge effects change completely in the presence of a second edge). By clarifying terms and concepts, this framework enables more precise descriptions of edge-effect interactions and facilitates comparisons of results among disparate study systems and response variables. A better understanding of edge-effect interactions will pave the way for more appropriate modeling, conservation, and management in complex landscapes. © 2013 Society for Conservation Biology.

A comparison of clinicians' racial biases in the United States and France.

Science.gov (United States)

Khosla, Natalia N; Perry, Sylvia P; Moss-Racusin, Corinne A; Burke, Sara E; Dovidio, John F

2018-04-13

Clinician bias contributes to racial disparities in healthcare, but its effects may be indirect and culturally specific. The present work aims to investigate clinicians' perceptions of Black versus White patients' personal responsibility for their health, whether this variable predicts racial bias against Black patients, and whether this effect differs between the U.S. and France. American (N = 83) and French (N = 81) clinicians were randomly assigned to report their impressions of an identical Black or White male patient based on a physician's notes. We measured clinicians' views of the patient's anticipated improvement and adherence to treatment and their perceptions concerning how personally responsible the patient was for his health. Whereas French clinicians did not exhibit significant racial bias on the measures of interest, American clinicians rated a hypothetical White patient, compared to an identical Black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health. Moreover, in the U.S., personal responsibility mediated the racial difference in expected improvement, such that as the White patient was seen as more personally responsible for his health, he was also viewed as more likely to improve. The present work indicates that American clinicians displayed less optimistic expectations for the medical treatment and health of a Black male patient, relative to a White male patient, and that this racial bias was related to their view of the Black patient as being less personally responsible for his health relative to the White patient. French clinicians did not show this pattern of racial bias, suggesting the importance of considering cultural influences for understanding racial biases in healthcare and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

From leader to leadership: clinician managers and where to next?

Science.gov (United States)

Fulop, Liz; Day, Gary E

2010-08-01

Individual clinician leadership is at the forefront of health reforms in Australia as well as overseas with many programs run by health departments (and hospitals) generally focus on the development of individual leaders. This paper argues, along with others, that leadership in the clinician management context cannot be understood from an individualistic approach alone. Clinician managers, especially in the ranks of doctors, are usually described as 'hybrid-professional managers' as well as reluctant leaders for whom most leadership theories do not easily apply. Their experiences of leadership development programs run by health departments both in Australia and internationally are likely to be based on an individual leader-focussed approach that is driving health care reforms. These approaches work from three key assumptions: (1) study and fix the person; (2) give them a position or title; and (3) make them responsible for results. Some would argue that the combination of these three approaches equates to heroic and transformational leadership. Several alternative approaches to leadership development are presented to illustrate how reforms in healthcare, and notably in hospitals, must incorporate alternative approaches, such as those based on collective and relational forms of leadership. This does not mean eschewing individual approaches to leadership but rather, thinking of them differently and making them more relevant to the daily experiences of clinician managers. We conclude by highlighting several significant challenges facing leadership development for clinician managers that arise from these considerations.

Transthoracic Ultrasonography for Clinicians

Directory of Open Access Journals (Sweden)

Morné Johan Vorster

2015-04-01

Full Text Available Transthoracic ultrasonography (US has become an essential tool for respiratory, emergency, and critical care physicians. It can be performed with basic equipment and by personnel with minimum training as a modality for the evaluation of a wide range of thoracic pathologies. Its advantages include immediate application at the point of care, low cost, and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumors. Transthoracic US is also useful in visualizing pulmonary pathologies that abut the pleura, such as pneumonic consolidation and interstitial syndromes, including pulmonary edema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and it is useful in diagnosing skeletal abnormalities such as rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, transthoracic US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. Transthoracic US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes and lesions arising from the chest wall, pleura, peripheral lung, and mediastinum are safe to perform and have a high yield in the of hands of experienced clinicians. Transthoracic US can also potentially guide the aspiration and biopsy of diffuse pulmonary infiltrates, consolidations, and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism

Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment

DEFF Research Database (Denmark)

Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten

2018-01-01

Objective: The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from eating disorders. Oppositely to traditional pen-and-paper meal diaries, the app allows for in-app patient–clinician linkage enabling clinicians to access patient app data anytime. The aim of our...... with challenges associated with the app, for example, an added work load and potential harm to the patient–clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines...

Are quantum spin Hall edge modes more resilient to disorder, sample geometry and inelastic scattering than quantum Hall edge modes?

Science.gov (United States)

Mani, Arjun; Benjamin, Colin

2016-04-13

On the surface of 2D topological insulators, 1D quantum spin Hall (QSH) edge modes occur with Dirac-like dispersion. Unlike quantum Hall (QH) edge modes, which occur at high magnetic fields in 2D electron gases, the occurrence of QSH edge modes is due to spin-orbit scattering in the bulk of the material. These QSH edge modes are spin-dependent, and chiral-opposite spins move in opposing directions. Electronic spin has a larger decoherence and relaxation time than charge. In view of this, it is expected that QSH edge modes will be more robust to disorder and inelastic scattering than QH edge modes, which are charge-dependent and spin-unpolarized. However, we notice no such advantage accrues in QSH edge modes when subjected to the same degree of contact disorder and/or inelastic scattering in similar setups as QH edge modes. In fact we observe that QSH edge modes are more susceptible to inelastic scattering and contact disorder than QH edge modes. Furthermore, while a single disordered contact has no effect on QH edge modes, it leads to a finite charge Hall current in the case of QSH edge modes, and thus a vanishing of the pure QSH effect. For more than a single disordered contact while QH states continue to remain immune to disorder, QSH edge modes become more susceptible--the Hall resistance for the QSH effect changes sign with increasing disorder. In the case of many disordered contacts with inelastic scattering included, while quantization of Hall edge modes holds, for QSH edge modes a finite charge Hall current still flows. For QSH edge modes in the inelastic scattering regime we distinguish between two cases: with spin-flip and without spin-flip scattering. Finally, while asymmetry in sample geometry can have a deleterious effect in the QSH case, it has no impact in the QH case.

Are quantum spin Hall edge modes more resilient to disorder, sample geometry and inelastic scattering than quantum Hall edge modes?

International Nuclear Information System (INIS)

Mani, Arjun; Benjamin, Colin

2016-01-01

On the surface of 2D topological insulators, 1D quantum spin Hall (QSH) edge modes occur with Dirac-like dispersion. Unlike quantum Hall (QH) edge modes, which occur at high magnetic fields in 2D electron gases, the occurrence of QSH edge modes is due to spin–orbit scattering in the bulk of the material. These QSH edge modes are spin-dependent, and chiral-opposite spins move in opposing directions. Electronic spin has a larger decoherence and relaxation time than charge. In view of this, it is expected that QSH edge modes will be more robust to disorder and inelastic scattering than QH edge modes, which are charge-dependent and spin-unpolarized. However, we notice no such advantage accrues in QSH edge modes when subjected to the same degree of contact disorder and/or inelastic scattering in similar setups as QH edge modes. In fact we observe that QSH edge modes are more susceptible to inelastic scattering and contact disorder than QH edge modes. Furthermore, while a single disordered contact has no effect on QH edge modes, it leads to a finite charge Hall current in the case of QSH edge modes, and thus a vanishing of the pure QSH effect. For more than a single disordered contact while QH states continue to remain immune to disorder, QSH edge modes become more susceptible—the Hall resistance for the QSH effect changes sign with increasing disorder. In the case of many disordered contacts with inelastic scattering included, while quantization of Hall edge modes holds, for QSH edge modes a finite charge Hall current still flows. For QSH edge modes in the inelastic scattering regime we distinguish between two cases: with spin-flip and without spin-flip scattering. Finally, while asymmetry in sample geometry can have a deleterious effect in the QSH case, it has no impact in the QH case. (paper)

Magnetism of Nanographene-Based Microporous Carbon and Its Applications: Interplay of Edge Geometry and Chemistry Details in the Edge State

Science.gov (United States)

Enoki, Toshiaki; Kiguchi, Manabu

2018-03-01

This paper is a contribution to the Physical Review Applied collection in memory of Mildred S. Dresselhaus. Nanographenes have important edge geometry dependence in their electronic structures. In armchair edges, electron wave interference works to contribute to energetic stability. Meanwhile, zigzag edges possess an edge-localized and spin-polarized nonbonding edge state, which causes electronic, magnetic, and chemical activities. In addition to the geometry dependence, the electronic structures are seriously affected by edge chemistry details. The edge chemistry dependence together with edge geometries on the electronic structures are discussed with samples of randomly networked nanographenes (microporous activated carbon fibers) in pristine state and under high-temperature annealing. In the pristine sample with the edges oxidized in ambient atmospheric conditions, the edge state, which is otherwise unstable, can be stabilized because of the charge transfer from nanographene to terminating oxygen. Nanographene, whose edges consist of a combination of magnetic zigzag edges and nonmagnetic armchair edges, is found to be ferrimagnetic with a nonzero net magnetic moment created under the interplay between a strong intrazigzag-edge ferromagnetic interaction and intermediate-strength interzigzag-edge antiferromagnetic-ferromagnetic interaction. At heat-treatment temperatures just below the fusion start (approximately 1500 K), the edge-terminating structure is changed from oxygen-containing groups to hydrogen in the nanographene network. Additionally, hydrogen-terminated zigzag edges, which are present as the majority and chemically unstable, play a triggering role in fusion above 1500 K. The fusion start brings about an insulator-to-metal transition at TI -M˜1500 K . Local fusions taking place percolatively between nanographenes work to expand the π -bond network, eventually resulting in the development of antiferromagnetic short-range order toward spin glass in the

Improving color constancy by photometric edge weighting

NARCIS (Netherlands)

Gijsenij, A.; Gevers, T.; van de Weijer, J.

2012-01-01

Edge-based color constancy methods make use of image derivatives to estimate the illuminant. However, different edge types exist in real-world images, such as material, shadow, and highlight edges. These different edge types may have a distinctive influence on the performance of the illuminant

Hospital clinicians' information behaviour and attitudes towards the 'Clinical Informationist': an Irish survey.

LENUS (Irish Health Repository)

Flynn, Maura G

2012-02-01

BACKGROUND: Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution. AIMS: This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians\\' perceptions and attitudes to the introduction of a CI into their clinical teams. METHODS: A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics. RESULTS: Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive. CONCLUSION: This paper highlights the factors that characterise and limit hospital clinicians\\' information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care.

Unconventional quantized edge transport in the presence of inter-edge coupling in intercalated graphene

OpenAIRE

Li, Yuanchang

2016-01-01

It is generally believed that the inter-edge coupling destroys the quantum spin Hall (QSH) effect along with the gap opening at the Dirac points. Using first-principles calculations, we find that the quantized edge transport persists in the presence of inter-edge coupling in Ta intercalated epitaxial graphene on SiC(0001), being a QSH insulator with the non-trivial gap of 81 meV. In this case, the band is characterized by two perfect Dirac cones with different Fermi velocities, yet only one m...

Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome.

Science.gov (United States)

Grosman-Rimon, Liza; Clarke, Hance; Chan, Aaron K; Mills, Patricia Branco; Rathbone, Alasdair Timothy Llewelyn; Kumbhare, Dinesh

2017-01-01

Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.

How Forest Inhomogeneities Affect the Edge Flow

DEFF Research Database (Denmark)

Boudreault, Louis-Étienne; Dupont, Sylvain; Bechmann, Andreas

2016-01-01

Most of our knowledge on forest-edge flows comes from numerical and wind-tunnel experiments where canopies are horizontally homogeneous. To investigate the impact of tree-scale heterogeneities (>1 m) on the edge-flow dynamics, the flow in an inhomogeneous forest edge on Falster island in Denmark...... is investigated using large-eddy simulation. The three-dimensional forest structure is prescribed in the model using high resolution helicopter-based lidar scans. After evaluating the simulation against wind measurements upwind and downwind of the forest leading edge, the flow dynamics are compared between...... the scanned forest and an equivalent homogeneous forest. The simulations reveal that forest inhomogeneities facilitate flow penetration into the canopy from the edge, inducing important dispersive fluxes in the edge region as a consequence of the flow spatial variability. Further downstream from the edge...

Irish Clinicians' Views of Interventions for Children with Autistic Spectrum Disorders

Science.gov (United States)

Ridge, Katie; Guerin, Suzanne

2011-01-01

The current study investigated clinicians' perspectives on the effectiveness of interventions designed to support the development of children with autistic spectrum disorders (ASDs). Researchers developed a semi-structured interview which was administered to 11 clinicians involved in the assessment and treatment of ASDs (5 = clinical…

Crystallographic study of grain refinement in aluminum alloys using the edge-to-edge matching model

International Nuclear Information System (INIS)

Zhang, M.-X.; Kelly, P.M.; Easton, M.A.; Taylor, J.A.

2005-01-01

The edge-to-edge matching model for describing the interfacial crystallographic characteristics between two phases that are related by reproducible orientation relationships has been applied to the typical grain refiners in aluminum alloys. Excellent atomic matching between Al 3 Ti nucleating substrates, known to be effective nucleation sites for primary Al, and the Al matrix in both close packed directions and close packed planes containing these directions have been identified. The crystallographic features of the grain refiner and the Al matrix are very consistent with the edge-to-edge matching model. For three other typical grain refiners for Al alloys, TiC (when a = 0.4328 nm), TiB 2 and AlB 2 , the matching only occurs between the close packed directions in both phases and between the second close packed plane of the Al matrix and the second close packed plane of the refiners. According to the model, it is predicted that Al 3 Ti is a more powerful nucleating substrate for Al alloy than TiC, TiB 2 and AlB 2 . This agrees with the previous experimental results. The present work shows that the edge-to-edge matching model has the potential to be a powerful tool in discovering new and more powerful grain refiners for Al alloys

Clinician researcher career pathway for registered nurses and midwives: A proposal.

Science.gov (United States)

Smith, Sheree; Gullick, Janice; Ballard, Jacqueline; Perry, Lin

2018-06-01

To consider clinician researcher career frameworks and propose a new pathway, integrating university and health service components to support research career progression within nursing and midwifery practice. Hospitals with research-active clinicians report fewer adverse events and better patient outcomes. Nursing clinician researcher career development is therefore an international priority, yet positions and expectations associated with this are not always well articulated, with nurses and midwives challenged to accommodate research and clinical careers. This discussion paper describes nurse/midwife clinician researcher career frameworks and a new pathway that aligns academic and nursing role descriptions. The new framework was informed by a brief literature search for international framework documents, three Australian state-based Nurses and Midwives Awards: the Australian Qualifications Framework, publically available University Academic (Research) Award schedules and academic staff descriptions, and state health department and health services publications. The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement. This paper provides a blueprint for clinician researcher career development. It elevates the research domain as an equal alongside clinical, managerial and educational clinical career development. © 2018 John Wiley & Sons Australia, Ltd.

Edge Cut Domination, Irredundance, and Independence in Graphs

OpenAIRE

Fenstermacher, Todd; Hedetniemi, Stephen; Laskar, Renu

2016-01-01

An edge dominating set $F$ of a graph $G=(V,E)$ is an \\textit{edge cut dominating set} if the subgraph $\\langle V,G-F \\rangle$ is disconnected. The \\textit{edge cut domination number} $\\gamma_{ct}(G)$ of $G$ is the minimum cardinality of an edge cut dominating set of $G.$ In this paper we study the edge cut domination number and investigate its relationships with other parameters of graphs. We also introduce the properties edge cut irredundance and edge cut independence.

DAVs: Red Edge and Outbursts

Science.gov (United States)

Luan, Jing

2018-04-01

As established by ground based surveys, white dwarfs with hydrogen atmospheres pulsate as they cool across the temperature range, 12500Kred edge is a two-decade old puzzle. Recently, Kepler discovered a number of cool DAVs exhibiting sporadic outbursts separated by days, each lasting several hours, and releasing \\sim 10^{33}-10^{34} {erg}. We provide quantitative explanations for both the red edge and the outbursts. The minimal frequency for overstable modes rises abruptly near the red edge. Although high frequency overstable modes exist below the red edge, their photometric amplitudes are generally too small to be detected by ground based observations. Nevertheless, these overstable parent modes can manifest themselves through nonlinear mode couplings to damped daughter modes which generate limit cycles giving rise to photometric outbursts.

Child Health Disparities: What Can a Clinician Do?

Science.gov (United States)

Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

2015-11-01

Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

Clinician styles of care: transforming patient care at the intersection of leadership and medicine.

Science.gov (United States)

Huynh, Ho P; Sweeny, Kate

2014-11-01

A key role of clinicians is to motivate their patients to initiate and maintain beneficial health behaviors. This article integrates research on transformational leadership, clinician-patient communication, and health behavior to introduce a novel approach to understanding and improving clinicians' effectiveness as motivators. We describe three dominant clinician styles or patterned approaches to patient care that derive from leadership theory (in order of least to most effective): laissez-faire, transactional, and transformational. Additionally, we suggest potential mediators and effects of the transformational style of care. Finally, we discuss future research directions for the study of clinician styles of care. © The Author(s) 2013.

Transcatheter Treatment of Tricuspid Regurgitation Using Edge-to-Edge Repair: Procedural Results, Clinical Implications and Predictors for Success.

Science.gov (United States)

Lurz, Philipp; Besler, Christian; Noack, Thilo; Forner, Anna Flo; Bevilacqua, Carmine; Seeburger, Joerg; Rommel, Karl-Philipp; Blazek, Stephan; Hartung, Philipp; Zimmer, Marion; Mohr, Friedrich; Schuler, Gerhard; Linke, Axel; Ender, Joerg; Thiele, Holger

2018-04-10

To analyze the feasibility, safety and effectiveness of Tricuspid valve (TV) repair using the MitraClip system in patients at high surgical risk. Forty-two elderly high-risk patients (76.8±7.3 years, EuroScore II 8.1±5.7) with isolated TR or combined TR and mitral regurgitation (MR) underwent edge-to-edge repair of the TV (n=11) or combined edge-to-edge repair of the TV and mitral valve (n=31). Procedural details, success rate, impact on TR severity and predictors for success at 30 day follow-up were analyzed. Successful edge-to-edge repair of TR was achieved in 35/42 patients (83%, 68 clips in total, 94% in the anteroseptal commissure, 6% in the posteroseptal commissure). In 5 patients, grasping of the leaflets was impossible and two patients had no decrease in TR after clipping. In those with procedural success, clipping of the TV led to a reduction in effective regurgitant orifice area by -62,5 % (from 0.8±0.4 to 0.3±0.2 cm2; pEdge-to-edge repair of the TV is feasible with promising reduction in TR, which could result in clinical improvement.

Science discovery in clinician-economist collaboration: legacy and future challenges.

Science.gov (United States)

Wells, Kenneth B

2002-06-01

2002 Carl Taube Lecture at the NIMH Mental Health Economics Meeting. To analyze the contribution and process of clinician/economist collaboration. Personal scientific autobiography, using relationships with three economists as case examples. In joint efforts by clinicians and economists, clinicians bring an interest in case examples and in responding to unmet need, while economists bring structured analysis methods and respect for a societal perspective. Through mutual respect and discovery, both clinicians and economists can define unmet need in clinical and economic terms and help develop models and programs to improve clinical care, while maintaining a societal evaluation perspective. Key to scientific discovery is the principle that the emotions generated by data, such as hope and despair, need to be acknowledged and utilized rather than avoided or buried, provided that such feelings are used in a balanced manner in research. According to the author, collaboration helps maintain such a balance. Collaboration requires and builds trust, and improves the depth of research by combining different personal and disciplinary perspectives and strengths. Young investigators should be encouraged to explore collaboration and to consider their feelings in response to health and economic data as an important scientific and creative resource.

Model of critical diagnostic reasoning: achieving expert clinician performance.

Science.gov (United States)

Harjai, Prashant Kumar; Tiwari, Ruby

2009-01-01

Diagnostic reasoning refers to the analytical processes used to determine patient health problems. While the education curriculum and health care system focus on training nurse clinicians to accurately recognize and rescue clinical situations, assessments of non-expert nurses have yielded less than satisfactory data on diagnostic competency. The contrast between the expert and non-expert nurse clinician raises the important question of how differences in thinking may contribute to a large divergence in accurate diagnostic reasoning. This article recognizes superior organization of one's knowledge base, using prototypes, and quick retrieval of pertinent information, using similarity recognition as two reasons for the expert's superior diagnostic performance. A model of critical diagnostic reasoning, using prototypes and similarity recognition, is proposed and elucidated using case studies. This model serves as a starting point toward bridging the gap between clinical data and accurate problem identification, verification, and management while providing a structure for a knowledge exchange between expert and non-expert clinicians.

[Relationship of personality with job burnout and psychological stress risk in clinicians].

Science.gov (United States)

Huang, Lei; Zhou, Dinglun; Yao, Yongcheng; Lan, Yajia

2015-02-01

To analyze the job burnout and mental health status of clinicians and the relationship of personality with job burnout and psychological stress, and to investigate the direct or indirect effects of personality on psychological stress. Maslach Burnout Inventory-General Survey (MBI-GS), Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RSC), and Kessler 10 Scale were administered to 775 clinicians. Of all clinicians, 29.5% had mild burnout, with a score of 22.7 ± 8.18 for psychological stress risk. The effect of personality on emotional exhaustion and cynicism was greater than that on personal accomplishment. Clinicians with a personality of introversion, neuroticism, and psychoticism suffered a higher risk of psychological stress. Personality had both direct and indirect effects on psychological stress. Neuroticism had the strongest effect on psychological stress, with an effect size of 0.55. Clinicians have a high level of both job burnout and mental psychological stress risk. Personality is significantly correlated with job burnout and psychological stress risk. Measures depending on personality should be taken for effective intervention.

US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review.

Science.gov (United States)

Rosen, Brittany L; Shepard, Allie; Kahn, Jessica A

2018-03-01

Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Energetics of highly kinked step edges

NARCIS (Netherlands)

Zandvliet, Henricus J.W.

2010-01-01

We have determined the step edge free energy, the step edge stiffness and dimensionless inverse step edge stiffness of the highly kinked < 010> oriented step on a (001) surface of a simple square lattice within the framework of a solid-on-solid model. We have found an exact expression for the step

Edge Fracture in Complex Fluids.

Science.gov (United States)

Hemingway, Ewan J; Kusumaatmaja, Halim; Fielding, Suzanne M

2017-07-14

We study theoretically the edge fracture instability in sheared complex fluids, by means of linear stability analysis and direct nonlinear simulations. We derive an exact analytical expression for the onset of edge fracture in terms of the shear-rate derivative of the fluid's second normal stress difference, the shear-rate derivative of the shear stress, the jump in shear stress across the interface between the fluid and the outside medium (usually air), the surface tension of that interface, and the rheometer gap size. We provide a full mechanistic understanding of the edge fracture instability, carefully validated against our simulations. These findings, which are robust with respect to choice of rheological constitutive model, also suggest a possible route to mitigating edge fracture, potentially allowing experimentalists to achieve and accurately measure flows stronger than hitherto possible.

Edge Modeling by Two Blur Parameters in Varying Contrasts.

Science.gov (United States)

Seo, Suyoung

2018-06-01

This paper presents a method of modeling edge profiles with two blur parameters, and estimating and predicting those edge parameters with varying brightness combinations and camera-to-object distances (COD). First, the validity of the edge model is proven mathematically. Then, it is proven experimentally with edges from a set of images captured for specifically designed target sheets and with edges from natural images. Estimation of the two blur parameters for each observed edge profile is performed with a brute-force method to find parameters that produce global minimum errors. Then, using the estimated blur parameters, actual blur parameters of edges with arbitrary brightness combinations are predicted using a surface interpolation method (i.e., kriging). The predicted surfaces show that the two blur parameters of the proposed edge model depend on both dark-side edge brightness and light-side edge brightness following a certain global trend. This is similar across varying CODs. The proposed edge model is compared with a one-blur parameter edge model using experiments of the root mean squared error for fitting the edge models to each observed edge profile. The comparison results suggest that the proposed edge model has superiority over the one-blur parameter edge model in most cases where edges have varying brightness combinations.

Effects of a communication course for clinicians on parents' perception of care

DEFF Research Database (Denmark)

Ammentorp, Jette; Sabroe, Svend; Kofoed, Poul-Erik

2009-01-01

. The intervention group completed a 5-day communication course, whereas the control group had no intervention. The intervention was evaluated using questionnaires measuring parents' perception of the communication and their satisfaction. The questionnaires were filled out by parents to children consulting....... There were no significant differences between the satisfaction of parents visiting clinicians from the intervention group and those visiting clinicians from the control group; however, the proportion of parents who had a positive perception of the communication was up to 9.8% higher in the intervention group...... compared with the control group. For example: 'the clinician told my child what he/she could do in order to feel better'. Discussion: Although no statistically significant differences were found, the study indicates that parents who had visited a clinician from the intervention group have experienced...

The nature of excellent clinicians at an academic health science center: a qualitative study.

Science.gov (United States)

Mahant, Sanjay; Jovcevska, Vesna; Wadhwa, Anupma

2012-12-01

To understand the nature of excellent clinicians at an academic health science center by exploring how and why excellent clinicians achieve high performance. From 2008 to 2010, the authors conducted a qualitative study using a grounded theory approach. Members of the Clinical Advisory Committee in the Department of Pediatrics at the University of Toronto nominated peers whom they saw as excellent clinicians. The authors then conducted in-depth interviews with the most frequently nominated clinicians. They audio-recorded and transcribed the interviews and coded the transcripts to identify emergent themes. From interviews with 13 peer-nominated, excellent clinicians, a model emerged. Dominant themes fell into three categories: (1) core philosophy, (2) deliberate activities, and (3) everyday practice. Excellent clinicians are driven by a core philosophy defined by high intrinsic motivation and passion for patient care and humility. They refine their clinical skills through two deliberate activities-reflective clinical practice and scholarship. Their high performance in everyday practice is characterized by clinical skills and cognitive ability, people skills, engagement, and adaptability. A rich theory emerged explaining how excellent clinicians, driven by a core philosophy and engaged in deliberate activities, achieve high performance in everyday practice. This theory of the nature of excellent clinicians provides a holistic perspective of individual performance, informs medical education, supports faculty career development, and promotes clinical excellence in the culture of academic medicine.

Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study).

Science.gov (United States)

Ignatowicz, Agnieszka; Slowther, Anne-Marie; Elder, Patrick; Bryce, Carol; Hamilton, Kathryn; Huxley, Caroline; Forjaz, Vera; Sturt, Jackie; Griffiths, Frances

2018-02-23

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical

Six-month outcome after transcatheter edge-to-edge repair of severe tricuspid regurgitation in patients with heart failure.

Science.gov (United States)

Orban, Mathias; Besler, Christian; Braun, Daniel; Nabauer, Michael; Zimmer, Marion; Orban, Martin; Noack, Thilo; Mehilli, Julinda; Hagl, Christian; Seeburger, Joerg; Borger, Michael; Linke, Axel; Thiele, Holger; Massberg, Steffen; Ender, Joerg; Lurz, Philipp; Hausleiter, Jörg

2018-06-01

Severe tricuspid regurgitation (TR) is common in patients with right-sided heart failure (HF) and causes substantial morbidity and mortality. Treatment options beyond medical therapy are limited for high-risk patients. Transcatheter edge-to-edge tricuspid valve (TV) repair showed procedural safety and short-term efficacy. Impact on mid-term outcome is unclear. This dual-centre observational study evaluates the mid-term safety, efficacy and clinical outcome after edge-to-edge TV repair for severe TR in patients with HF. Overall, 50 patients with right-sided HF and severe TR were treated with the transcatheter edge-to-edge repair technique; 14 patients were treated for isolated TR and 36 patients for combined mitral regurgitation (MR) and TR. At 6-month follow-up (available for 98% of patients), a persistent reduction of at least one echocardiographic TR grade was achieved in 90% of patients and New York Heart Association class improved in 79% of patients. The 6-minute walk distance increased by 44% (+84 m, P edge-to-edge TV repair for severe TR is safe and effective in reducing TR. It appears to be associated with improved clinical outcome in the majority of patients. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

Staff Clinician | Center for Cancer Research

Science.gov (United States)

The Neuro-Oncology Branch (NOB), Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH) is seeking staff clinicians to provide high-quality patient care for individuals with primary central nervous system (CNS) malignancies.  The NOB is comprised of a multidisciplinary team of physicians, healthcare providers, and scientists who

All-graphene edge contacts

DEFF Research Database (Denmark)

Jacobsen, Kåre Wedel; Falkenberg, Jesper Toft; Papior, Nick Rübner

2016-01-01

Using ab-initio methods we investigate the possibility of three-terminalgraphene "T-junction" devices and show that these all-graphene edge contactsare energetically feasible when the 1D interface itself is free from foreignatoms. We examine the energetics of various junction structures as a func......Using ab-initio methods we investigate the possibility of three-terminalgraphene "T-junction" devices and show that these all-graphene edge contactsare energetically feasible when the 1D interface itself is free from foreignatoms. We examine the energetics of various junction structures...... to be in therange of 1-10 kΩμm which is comparable to the best contact resistance reportedfor edge-contacted graphene-metal contacts. We conclude that conductingall-carbon T-junctions should be feasible....

Edge of polar cap patches

Science.gov (United States)

Hosokawa, K.; Taguchi, S.; Ogawa, Y.

2016-04-01

On the night of 4 December 2013, a sequence of polar cap patches was captured by an all-sky airglow imager (ASI) in Longyearbyen, Norway (78.1°N, 15.5°E). The 630.0 nm airglow images from the ASI of 4 second exposure time, oversampled the emission of natural lifetime (with quenching) of at least ˜30 sec, introduce no observational blurring effects. By using such high-quality ASI images, we succeeded in visualizing an asymmetry in the gradients between the leading/trailing edges of the patches in a 2-D fashion. The gradient in the leading edge was found to be 2-3 times steeper than that in the trailing edge. We also identified fingerlike structures, appearing only along the trailing edge of the patches, whose horizontal scale size ranged from 55 to 210 km. These fingers are considered to be manifestations of plasma structuring through the gradient-drift instability (GDI), which is known to occur only along the trailing edge of patches. That is, the current 2-D observations visualized, for the first time, how GDI stirs the patch plasma and such a mixing process makes the trailing edge more gradual. This result strongly implies a close connection between the GDI-driven plasma stirring and the asymmetry in the large-scale shape of patches and then suggests that the fingerlike structures can be used as markers to estimate the fine-scale structure in the plasma flow within patches.

Magnetism of zigzag edge phosphorene nanoribbons

Energy Technology Data Exchange (ETDEWEB)

Zhu, Zhili, E-mail: zlzhu@zzu.edu.cn, E-mail: jiayu@zzu.edu.cn; Li, Chong; Yu, Weiyang; Chang, Dahu; Sun, Qiang; Jia, Yu, E-mail: zlzhu@zzu.edu.cn, E-mail: jiayu@zzu.edu.cn [International Joint Research Laboratory for Quantum Functional Materials of Henan, and School of Physics and Engineering, Zhengzhou University, Zhengzhou 450001 (China)

2014-09-15

We have investigated, by means of ab initio calculations, the electronic and magnetic structures of zigzag edge phosphorene nanoribbons (ZPNRs) with various widths. The stable magnetic state was found in pristine ZPNRs by allowing the systems to be spin-polarized. The ground state of pristine ZPNRs prefers ferromagnetic order in the same edge but antiferromagnetic order between two opposite edges. The magnetism arises from the dangling bond states as well as edge localized π-orbital states. The presence of a dangling bond is crucial to the formation of the magnetism of ZPNRs. The hydrogenated ZPNRs get nonmagnetic semiconductors with a direct band gap. While, the O-saturated ZPNRs show magnetic ground states due to the weak P-O bond in the ribbon plane between the p{sub z}-orbitals of the edge O and P atoms.

Differences in clinician understanding and management of early menopause after breast cancer.

Science.gov (United States)

Sayakhot, P; Teede, H J; Gibson-Helm, M; Vincent, A

2013-08-01

Investigation of clinicians' understanding of early menopause diagnosis/management in women with breast cancer. A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test. Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed; gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression. This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.

The role of clinician emotion in clinical reasoning: Balancing the analytical process.

Science.gov (United States)

Langridge, Neil; Roberts, Lisa; Pope, Catherine

2016-02-01

This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Working overtime in community mental health: Associations with clinician burnout and perceived quality of care.

Science.gov (United States)

Luther, Lauren; Gearhart, Timothy; Fukui, Sadaaki; Morse, Gary; Rollins, Angela L; Salyers, Michelle P

2017-06-01

Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Magnetotransport Properties of Graphene Nanoribbons with Zigzag Edges

Science.gov (United States)

Wu, Shuang; Liu, Bing; Shen, Cheng; Li, Si; Huang, Xiaochun; Lu, Xiaobo; Chen, Peng; Wang, Guole; Wang, Duoming; Liao, Mengzhou; Zhang, Jing; Zhang, Tingting; Wang, Shuopei; Yang, Wei; Yang, Rong; Shi, Dongxia; Watanabe, Kenji; Taniguchi, Takashi; Yao, Yugui; Wang, Weihua; Zhang, Guangyu

2018-05-01

The determination of the electronic structure by edge geometry is unique to graphene. In theory, an evanescent nonchiral edge state is predicted at the zigzag edges of graphene. Up to now, the approach used to study zigzag-edged graphene has mostly been limited to scanning tunneling microscopy. The transport properties have not been revealed. Recent advances in hydrogen plasma-assisted "top-down" fabrication of zigzag-edged graphene nanoribbons (Z-GNRs) have allowed us to investigate edge-related transport properties. In this Letter, we report the magnetotransport properties of Z-GNRs down to ˜70 nm wide on an h -BN substrate. In the quantum Hall effect regime, a prominent conductance peak is observed at Landau ν =0 , which is absent in GNRs with nonzigzag edges. The conductance peak persists under perpendicular magnetic fields and low temperatures. At a zero magnetic field, a nonlocal voltage signal, evidenced by edge conduction, is detected. These prominent transport features are closely related to the observable density of states at the hydrogen-etched zigzag edge of graphene probed by scanning tunneling spectroscopy, which qualitatively matches the theoretically predicted electronic structure for zigzag-edged graphene. Our study gives important insights for the design of new edge-related electronic devices.

Stigma in the mental health workplace: perceptions of peer employees and clinicians.

Science.gov (United States)

Stromwall, Layne K; Holley, Lynn C; Bashor, Kathy E

2011-08-01

Informed by a structural theory of workplace discrimination, mental health system employees' perceptions of mental health workplace stigma and discrimination against service recipients and peer employees were investigated. Fifty-one peer employees and 52 licensed behavioral health clinicians participated in an online survey. Independent variables were employee status (peer or clinician), gender, ethnicity, years of mental health employment, age, and workplace social inclusion of peer employees. Analysis of covariance on workplace discrimination against service recipients revealed that peer employees perceived more discrimination than clinicians and whites perceived more discrimination than employees of color (corrected model F = 9.743 [16, 87], P = .000, partial ŋ (2) = .644). Analysis of covariance on workplace discrimination against peer employees revealed that peer employees perceived more discrimination than clinicians (F = 4.593, [6, 97], P = .000, partial ŋ (2) = .223).

Gatekeepers or intermediaries? The role of clinicians in commercial genomic testing.

Directory of Open Access Journals (Sweden)

Michelle L McGowan

Full Text Available Many commentators on "direct-to-consumer" genetic risk information have raised concerns that giving results to individuals with insufficient knowledge and training in genomics may harm consumers, the health care system, and society. In response, several commercial laboratories offering genomic risk profiling have shifted to more traditional "direct-to-provider" (DTP marketing strategies, repositioning clinicians as the intended recipients of advertising of laboratory services and as gatekeepers to personal genomic information. Increasing popularity of next generation sequencing puts a premium on ensuring that those who are charged with interpreting, translating, communicating and managing commercial genomic risk information are appropriately equipped for the job. To shed light on their gatekeeping role, we conducted a study to assess how and why early clinical users of genomic risk assessment incorporate these tools in their clinical practices and how they interpret genomic information for their patients.We conducted qualitative in-depth interviews with 18 clinicians providing genomic risk assessment services to their patients in partnership with DNA Direct and Navigenics. Our findings suggest that clinicians learned most of what they knew about genomics directly from the commercial laboratories. Clinicians rely on the expertise of the commercial laboratories without the ability to critically evaluate the knowledge or assess risks.DTP service delivery model cannot guarantee that providers will have adequate expertise or sound clinical judgment. Even if clinicians want greater genomic knowledge, the current market structure is unlikely to build the independent substantive expertise of clinicians, but rather promote its continued outsourcing. Because commercial laboratories have the most "skin in the game" financially, genetics professionals and policymakers should scrutinize the scientific validity and clinical soundness of the process by which

Gatekeepers or intermediaries? The role of clinicians in commercial genomic testing.

Science.gov (United States)

McGowan, Michelle L; Fishman, Jennifer R; Settersten, Richard A; Lambrix, Marcie A; Juengst, Eric T

2014-01-01

Many commentators on "direct-to-consumer" genetic risk information have raised concerns that giving results to individuals with insufficient knowledge and training in genomics may harm consumers, the health care system, and society. In response, several commercial laboratories offering genomic risk profiling have shifted to more traditional "direct-to-provider" (DTP) marketing strategies, repositioning clinicians as the intended recipients of advertising of laboratory services and as gatekeepers to personal genomic information. Increasing popularity of next generation sequencing puts a premium on ensuring that those who are charged with interpreting, translating, communicating and managing commercial genomic risk information are appropriately equipped for the job. To shed light on their gatekeeping role, we conducted a study to assess how and why early clinical users of genomic risk assessment incorporate these tools in their clinical practices and how they interpret genomic information for their patients. We conducted qualitative in-depth interviews with 18 clinicians providing genomic risk assessment services to their patients in partnership with DNA Direct and Navigenics. Our findings suggest that clinicians learned most of what they knew about genomics directly from the commercial laboratories. Clinicians rely on the expertise of the commercial laboratories without the ability to critically evaluate the knowledge or assess risks. DTP service delivery model cannot guarantee that providers will have adequate expertise or sound clinical judgment. Even if clinicians want greater genomic knowledge, the current market structure is unlikely to build the independent substantive expertise of clinicians, but rather promote its continued outsourcing. Because commercial laboratories have the most "skin in the game" financially, genetics professionals and policymakers should scrutinize the scientific validity and clinical soundness of the process by which these laboratories

Reiki Reduces Burnout Among Community Mental Health Clinicians.

Science.gov (United States)

Rosada, Renee M; Rubik, Beverly; Mainguy, Barbara; Plummer, Julie; Mehl-Madrona, Lewis

2015-08-01

Clinicians working in community mental health clinics are at high risk for burnout. Burnout is a problem involving emotional exhaustion, depersonalization, and reduced personal accomplishment. Reiki is a holistic biofield energy therapy beneficial for reducing stress. The purpose of this study was to determine if 30 minutes of healing touch could reduce burnout in community mental health clinicians. We utilized a crossover design to explore the efficacy of Reiki versus sham Reiki, a pseudo treatment designed to mimic true Reiki, as a means to reduce symptoms of burnout. Subjects were randomized to whether they started with Reiki or sham. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Measure Your Medical Outcome Profile Version 2 (MYMOP-2) were used as outcome measures. Multilevel modeling was used to represent the relations among variables. Reiki was statistically significantly better than sham Reiki in reducing burnout among community mental health clinicians (p=0.011). Reiki was significant in reducing depersonalization (pReiki reduced the primary symptom on the MYMOP also only among single people (p=0.03). The effects of Reiki were differentiated from sham Reiki. Reiki could be helpful in community mental health settings for the mental health of the practitioners.

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance.

Science.gov (United States)

Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

2010-06-08

Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Would guidance from a technician be as effective as guidance from a clinician? Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (ptechnician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression. This form of treatment has potential to increase the capacity of existing mental health services. Australian New

Further results for crack-edge mappings by ray methods

International Nuclear Information System (INIS)

Norris, A.N.; Achenbach, J.D.; Ahlberg, L.; Tittman, B.R.

1984-01-01

This chapter discusses further extensions of the local edge mapping method to the pulse-echo case and to configurations of water-immersed specimens and transducers. Crack edges are mapped by the use of arrival times of edge-diffracted signals. Topics considered include local edge mapping in a homogeneous medium, local edge mapping algorithms, local edge mapping through an interface, and edge mapping through an interface using synthetic data. Local edge mapping is iterative, with two or three iterations required for convergence

Urbanization impacts on mammals across urban-forest edges and a predictive model of edge effects.

Science.gov (United States)

Villaseñor, Nélida R; Driscoll, Don A; Escobar, Martín A H; Gibbons, Philip; Lindenmayer, David B

2014-01-01

With accelerating rates of urbanization worldwide, a better understanding of ecological processes at the wildland-urban interface is critical to conserve biodiversity. We explored the effects of high and low-density housing developments on forest-dwelling mammals. Based on habitat characteristics, we expected a gradual decline in species abundance across forest-urban edges and an increased decline rate in higher contrast edges. We surveyed arboreal mammals in sites of high and low housing density along 600 m transects that spanned urban areas and areas turn on adjacent native forest. We also surveyed forest controls to test whether edge effects extended beyond our edge transects. We fitted models describing richness, total abundance and individual species abundance. Low-density housing developments provided suitable habitat for most arboreal mammals. In contrast, high-density housing developments had lower species richness, total abundance and individual species abundance, but supported the highest abundances of an urban adapter (Trichosurus vulpecula). We did not find the predicted gradual decline in species abundance. Of four species analysed, three exhibited no response to the proximity of urban boundaries, but spilled over into adjacent urban habitat to differing extents. One species (Petaurus australis) had an extended negative response to urban boundaries, suggesting that urban development has impacts beyond 300 m into adjacent forest. Our empirical work demonstrates that high-density housing developments have negative effects on both community and species level responses, except for one urban adapter. We developed a new predictive model of edge effects based on our results and the literature. To predict animal responses across edges, our framework integrates for first time: (1) habitat quality/preference, (2) species response with the proximity to the adjacent habitat, and (3) spillover extent/sensitivity to adjacent habitat boundaries. This framework will

Employment-related information for clients receiving mental health services and clinicians.

Science.gov (United States)

King, Joanne; Cleary, Catherine; Harris, Meredith G; Lloyd, Chris; Waghorn, Geoff

2011-01-01

Clients receiving public mental health services and clinicians require information to facilitate client access to suitable employment services. However, little is known about the specific employment-related information needs of these groups. This study aimed to identify employment-related information needs among clients, clinicians and employment specialists, with a view to developing a new vocational information resource. Employment-related information needs were identified via a series of focus group consultations with clients, clinicians, and employment specialists (n=23). Focus group discussions were guided by a common semi-structured interview schedule. Several categories of information need were identified: countering incorrect beliefs about work; benefits of work; disclosure and managing personal information; impact of earnings on welfare entitlements; employment service pathways; job preparation, planning and selection; and managing illness once working. Clear preferences were expressed about effective means of communicating the key messages in written material. This investigation confirmed the need for information tailored to clients and clinicians in order to activate clients' employment journey and to help them make informed decisions about vocational assistance.

Clinicians' beliefs and attitudes toward patient self-management in the Netherlands; translation and testing of the American Clinician Support for Patient Activation Measure (CS-PAM).

Science.gov (United States)

Rademakers, Jany; Jansen, Daphne; van der Hoek, Lucas; Heijmans, Monique

2015-04-03

The aim of this study was to test the Dutch version of the Clinician Support for Patient Activation Measure (CS-PAM), to explore the beliefs of Dutch clinicians about patients' self-management, and to establish whether there are differences in this respect between general practitioners and other primary care providers. The CS-PAM was translated in Dutch and data were collected in a sample of 489 general practitioners and other primary care providers. Statistical analyses (RASCH, Cronbach's α) were performed to establish the psychometric properties of the instrument. The psychometric scores of the Dutch CS-PAM were acceptable to good, and the difficulty level and structure was comparable to that of the original instrument. The average score of Dutch clinicians on the CS-PAM was 65.1 (SD 10.7), somewhat lower compared to their colleagues in the US (69; SD 12.1) and the UK (69, SD 12.8). Dutch general practitioners scored significantly lower on the CS-PAM compared to other primary care providers. The Dutch CS-PAM is a reliable instrument to measure beliefs of clinicians regarding patient self-management. Further validation studies are necessary to establish the distribution of scores in specific provider populations and to assess the clinical relevance of the instrument for different outcomes.

Edge-detect interpolation for direct digital periapical images

International Nuclear Information System (INIS)

Song, Nam Kyu; Koh, Kwang Joon

1998-01-01

The purpose of this study was to aid in the use of the digital images by edge-detect interpolation for direct digital periapical images using edge-deted interpolation. This study was performed by image processing of 20 digital periapical images; pixel replication, linear non-interpolation, linear interpolation, and edge-sensitive interpolation. The obtained results were as follows ; 1. Pixel replication showed blocking artifact and serious image distortion. 2. Linear interpolation showed smoothing effect on the edge. 3. Edge-sensitive interpolation overcame the smoothing effect on the edge and showed better image.

IMAGE ANALYSIS BASED ON EDGE DETECTION TECHNIQUES

Institute of Scientific and Technical Information of China (English)

纳瑟; 刘重庆

2002-01-01

A method that incorporates edge detection technique, Markov Random field (MRF), watershed segmentation and merging techniques was presented for performing image segmentation and edge detection tasks. It first applies edge detection technique to obtain a Difference In Strength (DIS) map. An initial segmented result is obtained based on K-means clustering technique and the minimum distance. Then the region process is modeled by MRF to obtain an image that contains different intensity regions. The gradient values are calculated and then the watershed technique is used. DIS calculation is used for each pixel to define all the edges (weak or strong) in the image. The DIS map is obtained. This help as priority knowledge to know the possibility of the region segmentation by the next step (MRF), which gives an image that has all the edges and regions information. In MRF model,gray level l, at pixel location i, in an image X, depends on the gray levels of neighboring pixels. The segmentation results are improved by using watershed algorithm. After all pixels of the segmented regions are processed, a map of primitive region with edges is generated. The edge map is obtained using a merge process based on averaged intensity mean values. A common edge detectors that work on (MRF) segmented image are used and the results are compared. The segmentation and edge detection result is one closed boundary per actual region in the image.

Image Edge Tracking via Ant Colony Optimization

Science.gov (United States)

Li, Ruowei; Wu, Hongkun; Liu, Shilong; Rahman, M. A.; Liu, Sanchi; Kwok, Ngai Ming

2018-04-01

A good edge plot should use continuous thin lines to describe the complete contour of the captured object. However, the detection of weak edges is a challenging task because of the associated low pixel intensities. Ant Colony Optimization (ACO) has been employed by many researchers to address this problem. The algorithm is a meta-heuristic method developed by mimicking the natural behaviour of ants. It uses iterative searches to find the optimal solution that cannot be found via traditional optimization approaches. In this work, ACO is employed to track and repair broken edges obtained via conventional Sobel edge detector to produced a result with more connected edges.

The quality of interaction between managers and clinicians: a question of trust

NARCIS (Netherlands)

Brown, P.; Alaszewski, A.; Pilgrim, D.; Calnan, M.

2011-01-01

A lack of trust between clinicians and junior/middle managers is well documented in health care systems but under-theorized. Face-to-face interactions between clinicians and managers, through which trust is constructed, are vitally shaped by assumptions drawn from local organizational

Edge and line detection of complicated and blurred objects

OpenAIRE

Haugsdal, Kari

2010-01-01

This report deals with edge and line detection in pictures with complicated and/or blurred objects. It explores the alternatives available, in edge detection, edge linking and object recognition. Choice of methods are the Canny edge detection and Local edge search processing combined with regional edge search processing in the form of polygon approximation.

The edge of space time

International Nuclear Information System (INIS)

Hawking, S.

1993-01-01

What happened at the beginning of the expansion of the universe. Did space time have an edge at the Big Bang. The answer is that, if the boundary conditions of the universe are that it has no boundary, time ceases to be well-defined in the very early universe as the direction ''north'' ceases to be well defined at the North Pole of the Earth. The quantity that we measure as time has a beginning but that does not mean spacetime has an edge, just as the surface of the Earth does not have an edge at the North Pole. 8 figs

Edge-Matching Problems with Rotations

DEFF Research Database (Denmark)

Ebbesen, Martin; Fischer, Paul; Witt, Carsten

2011-01-01

Edge-matching problems, also called puzzles, are abstractions of placement problems with neighborhood conditions. Pieces with colored edges have to be placed on a board such that adjacent edges have the same color. The problem has gained interest recently with the (now terminated) Eternity II...... puzzle, and new complexity results. In this paper we consider a number of settings which differ in size of the puzzles and the manipulations allowed on the pieces. We investigate the effect of allowing rotations of the pieces on the complexity of the problem, an aspect that is only marginally treated so...

Protected Edge Modes without Symmetry

Directory of Open Access Journals (Sweden)

Michael Levin

2013-05-01

Full Text Available We discuss the question of when a gapped two-dimensional electron system without any symmetry has a protected gapless edge mode. While it is well known that systems with a nonzero thermal Hall conductance, K_{H}≠0, support such modes, here we show that robust modes can also occur when K_{H}=0—if the system has quasiparticles with fractional statistics. We show that some types of fractional statistics are compatible with a gapped edge, while others are fundamentally incompatible. More generally, we give a criterion for when an electron system with Abelian statistics and K_{H}=0 can support a gapped edge: We show that a gapped edge is possible if and only if there exists a subset of quasiparticle types M such that (1 all the quasiparticles in M have trivial mutual statistics, and (2 every quasiparticle that is not in M has nontrivial mutual statistics with at least one quasiparticle in M. We derive this criterion using three different approaches: a microscopic analysis of the edge, a general argument based on braiding statistics, and finally a conformal field theory approach that uses constraints from modular invariance. We also discuss the analogous result for two-dimensional boson systems.

Edge states in quantum Hall effect in graphene

International Nuclear Information System (INIS)

Gusynin, V.P.; Miransky, V.A.; Sharapov, S.G.; Shovkovy, I.A.

2008-01-01

We review recent results concerning the spectrum of edge states in the quantum Hall effect in graphene. In particular, special attention is paid to the derivation of the conditions under which gapless edge states exist in the spectrum of graphene with 'zigzag' and 'armchair' edges. It is found that in the case of a half-plane or a ribbon with zigzag edges, there are gapless edge states only when a spin gap dominates over a Dirac mass gap. In the case of a half-plane with an armchair edge, the existence of the gapless edge states depends on the specific type of Dirac mass gaps. The implications of these results for the dynamics in the quantum Hall effect in graphene are discussed

Ethical issues faced by clinician/managers in resource-allocation decisions.

Science.gov (United States)

Lemieux-Charles, L; Meslin, E M; Aird, C; Baker, R; Leatt, P

1993-01-01

This article explores the ethical issues faced by clinicians with management responsibilities (clinician/managers) when making decisions related to resource allocation and utilization at a Canadian teaching hospital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recurred throughout the discussions included fairness, concern with preventing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyzed from two perspectives--a theory of professional-bureaucratic roles and of obligation--that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for clinician/managers and that a better understanding of these issues can be obtained using an interdisciplinary perspective.

Physics-based edge evaluation for improved color constancy

NARCIS (Netherlands)

Gijsenij, A.; Gevers, T.; van de Weijer, J.

2009-01-01

Edge-based color constancy makes use of image derivatives to estimate the illuminant. However, different edge types exist in real-world images such as shadow, geometry, material and highlight edges. These different edge types may have a distinctive influence on the performance of the illuminant

Clinician identification of elevated symptoms of depression among individuals seeking treatment for substance misuse.

Science.gov (United States)

Hobden, Breanne; Carey, Mariko; Bryant, Jamie; Sanson-Fisher, Rob; Oldmeadow, Christopher

2017-12-01

Depression is common among those experiencing alcohol and other drug (AOD) disorders. It has been suggested that identifying depressive symptoms among this group is important for case management. Despite this, there is a lack of research examining how well clinicians perform this task within this setting. To determine the: (i) accuracy of clinician identified elevated symptoms of depression among clients seeking treatment for AOD misuse as compared to a standardized self-report psychiatric screening tool; and (ii) clinician and client characteristics associated with accurate identification of elevated symptoms of depression. The study used a descriptive cohort design. Participants from two Australian AOD outpatient clinics reported demographic data and completed the Patient Health Questionnaire (PHQ-9) to identify elevated symptoms of depression. Clinicians were asked to indicate the presence or absence of depression for individual clients. Client and clinician data were compared. Sensitivity of clinician identified elevated symptoms of depression, compared with the PHQ-9, was moderate at 73.0% (95% CI=63.7, 81.0) and specificity was low with 49.5% (95% CI=39.9, 61.2) accurately identified as not having elevated symptoms of depression. AOD clinicians' years' of experience, clients' main substance and length of treatment were associated with accuracy of identification. Clinicians identify elevated symptoms of depression with moderate accuracy amongst individuals with AOD disorders. There is a tendency to over-identify which may contribute to inaccuracies. Routine screening may assist in improving identification of depressive symptoms and place greater focus on mental health comorbidities. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers.

Science.gov (United States)

Daniels, Tracey; Goodacre, Lynne; Sutton, Chris; Pollard, Kim; Conway, Steven; Peckham, Daniel

2011-08-01

People with cystic fibrosis have a high treatment burden. While uncertainty remains about individual patient level of adherence to medication, treatment regimens are difficult to tailor, and interventions are difficult to evaluate. Self- and clinician-reported measures are routinely used despite criticism that they overestimate adherence. This study assessed agreement between rates of adherence to prescribed nebulizer treatments when measured by self-report, clinician report, and electronic monitoring suitable for long-term use. Seventy-eight adults with cystic fibrosis were questioned about their adherence to prescribed nebulizer treatments over the previous 3 months. Self-report was compared with clinician report and stored adherence data downloaded from the I-Neb nebulizer system. Adherence measures were expressed as a percentage of the prescribed regimen, bias was estimated by the paired difference in mean (95% CI) patient and clinician reported and actual adherence. Agreement between adherence measures was calculated using intraclass correlation coefficients (95% CI), and disagreements for individuals were displayed using Bland-Altman plots. Patient-identified prescriptions matched the medical record prescription. Median self-reported adherence was 80% (interquartile range, 60%-95%), whereas median adherence measured by nebulizer download was 36% (interquartile range, 5%-84.5%). Nine participants overmedicated and underreported adherence. Median clinician report ranged from 50% to 60%, depending on profession. Extensive discrepancies between self-report and clinician report compared with nebulizer download were identified for individuals. Self- and clinician-reporting of adherence does not provide accurate measurement of adherence when compared with electronic monitoring. Using inaccurate measures has implications for treatment burden, clinician prescribing practices, cost, and accuracy of trial data.

Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership.

Science.gov (United States)

Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L

2017-09-01

The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Clinicians' experiences of becoming a clinical manager: a qualitative study.

Science.gov (United States)

Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

2012-11-22

There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms

Science.gov (United States)

De Los Reyes, Andres; Marsh, Jessecae K.

2011-01-01

The purpose of this study was to examine whether contextual information about patients' clinical presentations affected clinicians' judgments of conduct disorder symptoms. Forty-five clinicians read vignettes describing hypothetical patients who displayed one conduct disorder symptom alongside information about the patients' home, school, and peer…

Edge and core dynamics in harness

International Nuclear Information System (INIS)

Ball, R.

2007-01-01

Resistive kink oscillations in tokamak plasmas are usually treated as core localized events, yet there there are several mechanisms by which they may interact with the edge dynamics. This suggests that we may regulate edge oscillatory behaviour, or ELMs, by harnessing the natural or contrived sawtooth period and amplitude. In this work I investigate core-edge oscillatory entrainment through direct propagation of heat pulses, inductive coupling, and global higher order resonance effects. In the core of auxiliary heated tokamak plasmas the ineluctable rhythm of slow buildup and rapid conversion of potential energy governs electron and heat radial transport. The growth phase of the sawtooth is accompanied by significant reconnection, then during the collapse the temperature and density in the core fall dramatically. There is evidence from experiments in reversed field pinch devices that ensuing energy fluxes can affect flow shear and confinement at the edge. The basis for this study is the dynamical (BDS) model for edge plasma behavior that was derived from electrostatic resistive MHD equations. The BDS model reflects the major qualitative features of edge dynamics that have been observed, such as L-H transitions and associated ELMs, hysteresis, and spontaneous reversal of poloidal shear flow. Under poorly dissipative conditions the transient behavior of the model can exhibit period-doubling, blue-sky, homoclinic, and other exotic bifurcations. Thus we might ask questions such as: Is it possible to mode-lock the edge dynamics to the core sawteeth? Can we induce, or prevent, a change in direction of shear flow? What about MHD effects? Is core-edge communication one way or is there some feedback? In the simplest prototype for coupled core-edge dynamics I model the sawtooth crash as a periodic power input to the edge potential energy reservoir. This is effected by coupling the BDS model to the dynamical system u = u(1 - u 2 - x 2 ) - ω s x, x = x(1-u 2 -x 2 ) + ω s u

Going private: clinicians' experience of working in UK independent sector treatment centres.

Science.gov (United States)

Waring, Justin; Bishop, Simon

2012-02-01

With increased possibility that public healthcare services in the UK will be outsourced to the private sector, this study investigates how clinicians working in Independent Sector Treatment Centres perceive the differences between public and private sectors. Qualitative interviews with 35 clinicians recruited from two ISTCs. All participants were transferred to the independent sector from the public National Health Service. Interview data were analysed to identify shared experience about the variable organisation and delivery of services. Clinicians perceived differences between public and independent sectors in the areas of 'environment and facilities', 'management', 'work organisation and care delivery', and 'patient experience'. The independent sector was described as offering a positive alternative to public services in regard to service environment and patient experience, but there were concerns about management priorities and the reconfiguration of work. Clinicians' experience of moving between sectors reveals mixed experiences. Although some improvements might legitimise the growing role of the independent sector, there remain doubts about the commercialisation of services, the motives of managers and the impact of clinical roles and capabilities. With policies looking to expand the mixed economy of public healthcare services, the study suggests clinicians will not automatically embrace a move between sectors. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Selby, Warwick; Salkeld, Glenn

to quantify, document, and suggest how future dyadic decisions can be enhanced by criterion prioritisation. Associations between patient’s MDQ-W before, and MDQ-R after consultation with their clinician were analysed along with patient scores from the Satisfaction With Decision (SWD) instrument. Results...... and clinician using the dually-personalised decomposable MyDecisionQuality (MDQ) instrument. This has the potential to guide future work on optimising dyad-specific patient-clinician communication for shared decision making and informed consent....

Edge states of a three-dimensional topological insulator

International Nuclear Information System (INIS)

Deb, Oindrila; Sen, Diptiman; Soori, Abhiram

2014-01-01

We use the bulk Hamiltonian for a three-dimensional topological insulator such as Bi 2 Se 3 to study the states which appear on its various surfaces and along the edge between two surfaces. We use both analytical methods based on the surface Hamiltonians (which are derived from the bulk Hamiltonian) and numerical methods based on a lattice discretization of the bulk Hamiltonian. We find that the application of a potential barrier along an edge can give rise to states localized at that edge. These states have an unusual energy-momentum dispersion which can be controlled by applying a potential along the edge; in particular, the velocity of these states can be tuned to zero. The scattering and conductance across the edge is studied as a function of the edge potential. We show that a magnetic field in a particular direction can also give rise to zero energy states on certain edges. We point out possible experimental ways of looking for the various edge states. (paper)

Parameters Influencing Sulfur Speciation in Environmental Samples Using Sulfur K-Edge X-Ray Absorption Near-Edge Structure

Directory of Open Access Journals (Sweden)

Siwatt Pongpiachan

2012-01-01

Full Text Available This paper aims to enhance the credibility of applying the sulfur K-edge XANES spectroscopy as an innovative “fingerprint” for characterizing environmental samples. The sensitivities of sulfur K-edge XANES spectra of ten sulfur compound standards detected by two different detectors, namely, Lytle detector (LyD and Germanium detector (GeD, were studied and compared. Further investigation on “self-absorption” effect revealed that the maximum sensitivities of sulfur K-edge XANES spectra were achieved when diluting sulfur compound standards with boron nitride (BN at the mixing ratio of 0.1%. The “particle-size” effect on sulfur K-edge XANES spectrum sensitivities was examined by comparing signal-to-noise ratios of total suspended particles (TSP and particulate matter of less than 10 millionths of a meter (PM10 collected at three major cities of Thailand. The analytical results have demonstrated that the signal-to-noise ratios of sulfur K-edge XANES spectra were positively correlated with sulfate content in aerosols and negatively connected with particle sizes. The combination of hierarchical cluster analysis (HCA and principal component analysis (PCA has proved that sulfur K-edge XANES spectrum can be used to characterize German terrestrial soils and Andaman coastal sediments. In addition, this study highlighted the capability of sulfur K-edge XANES spectra as an innovative “fingerprint” to distinguish tsunami backwash deposits (TBD from typical marine sediments (TMS.

Bed occupancy monitoring: data processing and clinician user interface design.

Science.gov (United States)

Pouliot, Melanie; Joshi, Vilas; Goubran, Rafik; Knoefel, Frank

2012-01-01

Unobtrusive and continuous monitoring of patients, especially at their place of residence, is becoming a significant part of the healthcare model. A variety of sensors are being used to monitor different patient conditions. Bed occupancy monitoring provides clinicians a quantitative measure of bed entry/exit patterns and may provide information relating to sleep quality. This paper presents a bed occupancy monitoring system using a bed pressure mat sensor. A clinical trial was performed involving 8 patients to collect bed occupancy data. The trial period for each patient ranged from 5-10 weeks. This data was analyzed using a participatory design methodology incorporating clinician feedback to obtain bed occupancy parameters. The parameters extracted include the number of bed exits per night, the bed exit weekly average (including minimum and maximum), the time of day of a particular exit, and the amount of uninterrupted bed occupancy per night. The design of a clinical user interface plays a significant role in the acceptance of such patient monitoring systems by clinicians. The clinician user interface proposed in this paper was designed to be intuitive, easy to navigate and not cause information overload. An iterative design methodology was used for the interface design. The interface design is extendible to incorporate data from multiple sensors. This allows the interface to be part of a comprehensive remote patient monitoring system.

The influence of framing on clinicians' judgments of the biological basis of behaviors.

Science.gov (United States)

Kim, Nancy S; Ahn, Woo-kyoung; Johnson, Samuel G B; Knobe, Joshua

2016-03-01

Practicing clinicians frequently think about behaviors both abstractly (i.e., in terms of symptoms, as in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., DSM-5; American Psychiatric Association, 2013) and concretely (i.e., in terms of individual clients, as in DSM-5 Clinical Cases; Barnhill, 2013). Does abstract/concrete framing influence clinical judgments about behaviors? Practicing mental health clinicians (N = 74) were presented with hallmark symptoms of 6 disorders framed abstractly versus concretely, and provided ratings of their biological and psychological bases (Experiment 1) and the likely effectiveness of medication and psychotherapy in alleviating them (Experiment 2). Clinicians perceived behavioral symptoms in the abstract to be more biologically and less psychologically based than when concretely described, and medication was viewed as more effective for abstractly than concretely described symptoms. These findings suggest a possible basis for miscommunication and misalignment of views between primarily research-oriented and primarily practice-oriented clinicians; furthermore, clinicians may accept new neuroscience research more strongly in the abstract than for individual clients. (c) 2016 APA, all rights reserved).

How edge-reinforced random walk arises naturally

NARCIS (Netherlands)

Rolles, S.W.W.

2003-01-01

We give a characterization of a modified edge-reinforced random walk in terms of certain partially exchangeable sequences. In particular, we obtain a characterization of an edge-reinforced random walk (introduced by Coppersmith and Diaconis) on a 2-edge-connected graph. Modifying the notion of

Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment.

Science.gov (United States)

Jochems, Eline C; van Dam, Arno; Duivenvoorden, Hugo J; Scheffer, Sylvia C M; van der Feltz-Cornelis, Christina M; Mulder, Niels L

2016-09-01

The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician-rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd. Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a

Notifications of hospital events to outpatient clinicians using health information exchange: a post-implementation survey

Directory of Open Access Journals (Sweden)

Richard Altman

2013-09-01

Full Text Available Background The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients’ encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients’ emergency department (ED visits and inpatient admissions and discharges using health information exchange can inform outpatient clinicians of patients’ hospital-based events.Objective Assess outpatient clinicians’ impressions of a new, secure messaging-based, patient event notification system.Methods Twenty outpatient clinicians receiving notifications of hospital-based events were recruited and 14 agreed to participate. Using a semi-structured interview, clinicians were asked about their use of notifications and the impact on their practices.Results Nine of 14 interviewed clinicians (64% thought that without notifications, they would have heard about fewer than 10% of ED visits before the patient’s next visit. Nine clinicians (64% thought that without notifications, they would have heard about fewer than 25% of inpatient admissions and discharges before the patient’s next visit. Six clinicians (43% reported that they call the inpatient team more often because of notifications. Eight users (57% thought that notifications improved patient safety by increasing their awareness of the patients’ clinical events and their medication changes. Key themes identified were the importance of workflow integration and a desire for more clinical information in notifications.Conclusions The notification system is perceived by clinicians to be of value. These findings should instigate further message-oriented use of health information exchange and point to refinements that can lead to even greater benefits.

Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App.

Science.gov (United States)

Miller, Katherine E; Kuhn, Eric; Owen, Jason E; Taylor, Katherine; Yu, Jessica S; Weiss, Brandon J; Crowley, Jill J; Trockel, Mickey

2017-11-09

Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians' needs, the complexity, the innovation's trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tools and improving patient engagement. Of those not using the app, 83% endorsed intention to use it. Reasons for nonuse were lack of patient access to smart phones, not being aware of the app, not having time to learn it, and inability to directly access app data. Those who reported using CBT-I Coach had more favorable perceptions across all constructs (p CBT-I Coach, as well as study if reported benefits can be evidenced more directly.

Australian clinicians and chemoprevention for women at high familial risk for breast cancer

Directory of Open Access Journals (Sweden)

Keogh Louise A

2009-05-01

Full Text Available Abstract Objectives Effective chemoprevention strategies exist for women at high risk for breast cancer, yet uptake is low. Physician recommendation is an important determinant of uptake, but little is known about clinicians' attitudes to chemoprevention. Methods Focus groups were conducted with clinicians at five Family Cancer Centers in three Australian states. Discussions were recorded, transcribed and analyzed thematically. Results Twenty three clinicians, including genetic counselors, clinical geneticists, medical oncologists, breast surgeons and gynaecologic oncologists, participated in six focus groups in 2007. The identified barriers to the discussion of the use of tamoxifen and raloxifene for chemoprevention pertained to issues of evidence (evidence for efficacy not strong enough, side-effects outweigh benefits, oophorectomy superior for mutation carriers, practice (drugs not approved for chemoprevention by regulatory authorities and not government subsidized, chemoprevention not endorsed in national guidelines and not many women ask about it, and perception (clinicians not knowledgeable about chemoprevention and women thought to be opposed to hormonal treatments. Conclusion The study demonstrated limited enthusiasm for discussing breast cancer chemoprevention as a management option for women at high familial risk. Several options for increasing the likelihood of clinicians discussing chemoprevention were identified; maintaining up to date national guidelines on management of these women and education of clinicians about the drugs themselves, the legality of "off-label" prescribing, and the actual costs of chemopreventive medications.

Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service.

Science.gov (United States)

Raspollini, E; Pappalettera, M; Riccardi, D; Parravicini, A; Sestili, S; Rebulla, P; Sirchia, G

1997-01-01

Limited information is available on the level of satisfaction of clinicians with services delivered by blood banks. The purpose of this study was to evaluate the satisfaction of clinicians with our blood transfusion service. We prepared a questionnaire based on SERVQUAL, a method used to measure customers' appreciation of quality of service, by assessing the gap between perceived and expected quality. The questionnaire consisted of 14 items grouped according to five dimensions of quality of service: assurance, empathy, responsiveness, reliability, tangibles. Clinicians were asked to give two scores on a scale from 1 to 7 for each item, score (e) representing what they expected from an 'excellent' service, score (r) how they graded the service received. We considered wide differences in scores of service expectation and receipt for a question to be indicative of either service above expected levels (r > e) or service below expectation (r SERVQUAL was useful to gather information on the level of clinicians' satisfaction with our transfusion service.

Visible imaging of edge turbulence in NSTX

International Nuclear Information System (INIS)

Zweben, S.; Maqueda, R.; Hill, K.; Johnson, D.

2000-01-01

Edge plasma turbulence in tokamaks and stellarators is believed to cause the radical heat and particle flux across the separatrix and into the scrape-off-layers of these devices. This paper describes initial measurements of 2-D space-time structure of the edge density turbulence made using a visible imaging diagnostic in the National Spherical Torus Experiment (NSTX). The structure of the edge turbulence is most clearly visible using a method of gas puff imaging to locally illuminate the edge density turbulence

Visible imaging of edge turbulence in NSTX

International Nuclear Information System (INIS)

S. Zweben; R. Maqueda; K. Hill; D. Johnson; S. Kaye; H. Kugel; F. Levinton; R. Maingi; L. Roquemore; S. Sabbagh; G. Wurden

2000-01-01

Edge plasma turbulence in tokamaks and stellarators is believed to cause the radial heat and particle flux across the separatrix and into the scrape-off-layers of these devices. This paper describes initial measurements of 2-D space-time structure of the edge density turbulence made using a visible imaging diagnostic in the National Spherical Torus Experiment (NSTX). The structure of the edge turbulence is most clearly visible using a method of ''gas puff imaging'' to locally illuminate the edge density turbulence

CFAR Edge Detector for Polarimetric SAR Images

DEFF Research Database (Denmark)

Schou, Jesper; Skriver, Henning; Nielsen, Allan Aasbjerg

2003-01-01

Finding the edges between different regions in an image is one of the fundamental steps of image analysis, and several edge detectors suitable for the special statistics of synthetic aperture radar (SAR) intensity images have previously been developed. In this paper, a new edge detector for polar...

The effect of edge and impurities sites properties on their localized states in semi-infinite zigzag edged 2D honeycomb graphene sheet

OpenAIRE

Ahmed, Maher

2011-01-01

In this work, the tridiagonal method is used to distinguish between edges modes and area modes to study the edge sites properties effect on edge localized states of semi-infinite zigzag 2D honeycomb graphene sheet. The results show a realistic behavior for the dependance of edge localized states of zigzag graphene on the edge sites properties which explaining the experimental results of measured local density of states at the edge of graphene, while at the same time removing the inconsistence...

Effect of ion temperature gradient driven turbulence on the edge-core connection for transient edge temperature sink

International Nuclear Information System (INIS)

Miyato, Naoaki

2014-01-01

Ion temperature gradient (ITG) driven turbulence simulation for a transient edge temperature sink localized in the poloidal plane is performed using a global Landau-fluid code in the electrostatic limit. Pressure perturbations with (m, n) = (±1, 0) are induced by the edge sink, where m and n are poloidal and toroidal mode numbers, respectively. It was found in the previous simulation that the nonlinear dynamics of these perturbations are responsible for the nonlocal plasma response/transport connecting edge and core in a toroidal plasma. Present simulation shows, however, that the ITG turbulence in the core region dissipates the large-scale (m, n) = (±1, 0) perturbations and weakens the edge-core connection observed in the previous simulation. (author)

What's happening at the edge of tokamaks

International Nuclear Information System (INIS)

Crandall, D.H.

1987-01-01

Handling the power deposition at the walls of a plasma fusion device and controlling the particle fueling of the plasma originated the interest in the edge of the plasma by magnetic fusion scientists. Recently this interest has intensified because of clear evidence that the quality of the central plasma confinement depends in unexpected ways on details of how the edge plasma is managed. Significant efforts are being pursued to understand and exploit the improved plasma confinement observed in the 'H-mode' obtained with divertors and in the 'super-shots' obtained with low neutral particle flux from the edge of TFTR limiter plasmas. The controls, that determine whether or not these well-confined plasmas are obtained, are applied in the edge plasma where a wealth of atomic and molecular processes occur. A qualitative overview of current research related to plasma edge and desirable features is presented to guide thoughts about atomic processes to be included in modeling and interpreting the plasma edge of tokamaks. (orig.)

First-principles study of graphene edge properties and flake shapes

OpenAIRE

Gan, Chee Kwan; Srolovitz, David J.

2009-01-01

We use density functional theory to determine the equilibrium shape of graphene flakes, through the calculation of the edge orientation dependence of the edge energy and edge stress of graphene nanoribbons. The edge energy is a nearly linear function of edge orientation angle; increasing from the armchair orientation to the zigzag orientation. Reconstruction of the zigzag edge lowers its energy to less than that of the armchair edge. The edge stress for all edge orientations is compressive, h...

Influence of Wafer Edge Geometry on Removal Rate Profile in Chemical Mechanical Polishing: Wafer Edge Roll-Off and Notch

Science.gov (United States)

Fukuda, Akira; Fukuda, Tetsuo; Fukunaga, Akira; Tsujimura, Manabu

2012-05-01

In the chemical mechanical polishing (CMP) process, uniform polishing up to near the wafer edge is essential to reduce edge exclusion and improve yield. In this study, we examine the influences of inherent wafer edge geometries, i.e., wafer edge roll-off and notch, on the CMP removal rate profile. We clarify the areas in which the removal rate profile is affected by the wafer edge roll-off and the notch, as well as the intensity of their effects on the removal rate profile. In addition, we propose the use of a small notch to reduce the influence of the wafer notch and present the results of an examination by finite element method (FEM) analysis.

Urbanization impacts on mammals across urban-forest edges and a predictive model of edge effects.

Directory of Open Access Journals (Sweden)

Nélida R Villaseñor

Full Text Available With accelerating rates of urbanization worldwide, a better understanding of ecological processes at the wildland-urban interface is critical to conserve biodiversity. We explored the effects of high and low-density housing developments on forest-dwelling mammals. Based on habitat characteristics, we expected a gradual decline in species abundance across forest-urban edges and an increased decline rate in higher contrast edges. We surveyed arboreal mammals in sites of high and low housing density along 600 m transects that spanned urban areas and areas turn on adjacent native forest. We also surveyed forest controls to test whether edge effects extended beyond our edge transects. We fitted models describing richness, total abundance and individual species abundance. Low-density housing developments provided suitable habitat for most arboreal mammals. In contrast, high-density housing developments had lower species richness, total abundance and individual species abundance, but supported the highest abundances of an urban adapter (Trichosurus vulpecula. We did not find the predicted gradual decline in species abundance. Of four species analysed, three exhibited no response to the proximity of urban boundaries, but spilled over into adjacent urban habitat to differing extents. One species (Petaurus australis had an extended negative response to urban boundaries, suggesting that urban development has impacts beyond 300 m into adjacent forest. Our empirical work demonstrates that high-density housing developments have negative effects on both community and species level responses, except for one urban adapter. We developed a new predictive model of edge effects based on our results and the literature. To predict animal responses across edges, our framework integrates for first time: (1 habitat quality/preference, (2 species response with the proximity to the adjacent habitat, and (3 spillover extent/sensitivity to adjacent habitat boundaries. This

Effects of Shame and Guilt on Error Reporting Among Obstetric Clinicians.

Science.gov (United States)

Zabari, Mara Lynne; Southern, Nancy L

2018-04-17

To understand how the experiences of shame and guilt, coupled with organizational factors, affect error reporting by obstetric clinicians. Descriptive cross-sectional. A sample of 84 obstetric clinicians from three maternity units in Washington State. In this quantitative inquiry, a variant of the Test of Self-Conscious Affect was used to measure proneness to guilt and shame. In addition, we developed questions to assess attitudes regarding concerns about damaging one's reputation if an error was reported and the choice to keep an error to oneself. Both assessments were analyzed separately and then correlated to identify relationships between constructs. Interviews were used to identify organizational factors that affect error reporting. As a group, mean scores indicated that obstetric clinicians would not choose to keep errors to themselves. However, bivariate correlations showed that proneness to shame was positively correlated to concerns about one's reputation if an error was reported, and proneness to guilt was negatively correlated with keeping errors to oneself. Interview data analysis showed that Past Experience with Responses to Errors, Management and Leadership Styles, Professional Hierarchy, and Relationships With Colleagues were influential factors in error reporting. Although obstetric clinicians want to report errors, their decisions to report are influenced by their proneness to guilt and shame and perceptions of the degree to which organizational factors facilitate or create barriers to restore their self-images. Findings underscore the influence of the organizational context on clinicians' decisions to report errors. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis.

Science.gov (United States)

Schwebke, Jane R; Gaydos, Charlotte A; Nyirjesy, Paul; Paradis, Sonia; Kodsi, Salma; Cooper, Charles K

2018-06-01

Vaginitis is a common complaint, diagnosed either empirically or using Amsel's criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States). Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis Clinician diagnosis and in-clinic testing (Amsel's test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes. All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2 , and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing. The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis. Copyright © 2018 Schwebke et al.

Environmental Dataset Gateway (EDG) REST Interface

Data.gov (United States)

U.S. Environmental Protection Agency — Use the Environmental Dataset Gateway (EDG) to find and access EPA's environmental resources. Many options are available for easily reusing EDG content in other...

Edge-injective and edge-surjective vertex labellings

DEFF Research Database (Denmark)

Brandt, Stephan; Rautenbach, D.; Regen, F.

2010-01-01

For a graph G = (V, E) we consider vertex-k-labellings f : V → {1,2, ,k} for which the induced edge weighting w : E → {2, 3,., 2k} with w(uv) = f(u) + f(v) is injective or surjective or both. We study the relation between these labellings and the number theoretic notions of an additive basis and ...

X-ray absorption near edge spectroscopy at the Mn K-edge in highly homogeneous GaMnN diluted magnetic semiconductors

Energy Technology Data Exchange (ETDEWEB)

Sancho-Juan, O.; Cantarero, A.; Garro, N.; Cros, A. [Materials Science Institute, University of Valencia, PO Box 22085, 46071 Valencia (Spain); Martinez-Criado, G.; Salome, M.; Susini, J. [ESRF, Polygone Scientifique Louis Neel, 6 rue Jules Horowitz, 38000 Grenoble (France); Olguin, D. [Dept. de Fisica, CINVESTAV-IPN, 07300 Mexico D.F. (Mexico); Dhar, S.; Ploog, K. [Paul Drude Institute, Hausvogteiplatz 5-7, 10117 Berlin (Germany)

2006-06-15

We have studied by X-ray absorption spectroscopy the local environment of Mn in highly homogeneous Ga{sub 1-x}Mn{sub x}N (0.06edges. In this report, we focus our attention to the X-ray absorption near edge spectroscopy (XANES) results. The comparison of the XANES spectra corresponding to the Ga and Mn edges indicates that Mn is substitutional to Ga in all samples studied. The XANES spectra measured at the Mn absorption edge shows in the near-edge region a double peak and a shoulder below the absorption edge and the main absorption peak after the edge, separated around 15 eV above the pre-edge structure. We have compared the position of the edge with that of MnO (Mn{sup 2+}) and Mn{sub 2}O{sub 3} (Mn{sup 3+}). All samples studied present the same Mn oxidation state, 2{sup +}. In order to interprete the near-edge structure, we have performed ab initio calculations with a 2 x 2 x 1supercell ({proportional_to}6% Mn) using the full potential linear augmented plane wave method as implemented in the Wien2k code. The calculations show the appearance of Mn anti-bonding t{sub 2g} bands, which are responsible for the pre-edge absorption. The shoulder and main absorption peaks are due to transitions from the valence band 1s-states of Mn to the p-contributions of the conduction bands. (copyright 2006 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

Edge separation using diffraction anomalous fine structure

International Nuclear Information System (INIS)

Ravel, B.; Bouldin, C.E.; Renevier, H.; Hodeau, J.L.; Berar, J.F.

1999-01-01

We exploit the crystallographic sensitivity of the Diffraction Anomalous Fine-Structure (DAFS) measurement to separate the fine structure contributions of different atomic species with closely spaced resonant energies. In BaTiO 3 the Ti K edge and Ba Lm edges are separated by 281 eV, or about 8.2 Angstrom -1 ), thus severely limiting the information content of the Ti K edge signal. Using the site selectivity of DAFS we can separate the two fine structure spectra using an iterative Kramers-Kronig method, thus extending the range of the Ti K edge spectrum. This technique has application to many rare earth/transition metal compounds, including many magnetic materials of technological significance for which K and L edges overlap in energy. (au)

Edge strength of CAD/CAM materials.

Science.gov (United States)

Pfeilschifter, Maria; Preis, Verena; Behr, Michael; Rosentritt, Martin

2018-05-16

To investigate the edge force of CAD/CAM materials as a function of (a) material, (b) thickness, and (c) distance from the margin. Materials intended for processing with CAD/CAM were investigated: eight resin composites, one resin-infiltrated ceramic, and a clinically proven lithiumdisilicate ceramic (reference). To measure edge force (that is, load to failure/crack), plates (d = 1 mm) were fixed and loaded with a Vickers diamond indenter (1 mm/min, Zwick 1446) at a distance of 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 1.0 mm from the edge. Edge force was defined as a loading force at a distance of 0.5 mm. The type of failure was determined. To investigate the influence of the thickness, all data were determined on 1-mm and 2-mm plates. To test the influence of bonding and an underlying dentin, individual 1-mm plates were bonded to a 1-mm-thick dentin-like (concerning modulus of elasticity) resin composite. For the 1-mm plates, edge force varied between 64.4 ± 24.2 N (Shofu Block HC) and 183.2 ± 63.3 N (ceramic reference), with significant (p ≤ 0.001) differences between the materials. For the 2-mm plates, values between 129.2 ± 32.5 N (Lava Ultimate) and 230.3 ± 67.5 N (Cerasmart) were found. Statistical comparison revealed no significant differences (p > 0.109) between the materials. Brilliant Crios (p = 0.023), Enamic (p = 0.000), Shofu Blocks HC (p = 0.009), and Grandio Bloc (p = 0.002) showed significantly different edge force between the 1-mm- and 2-mm-thick plates. The failure pattern was either cracking, (severe) chipping, or fracture. Material, material thickness, and distance from the edge impact the edge force of CAD/CAM materials. CAD/CAM materials should be carefully selected on the basis of their individual edge force and performance during milling. Copyright © 2018 Elsevier Ltd. All rights reserved.

High-resolution Al L2,3-edge x-ray absorption near edge structure spectra of Al-containing crystals and glasses: coordination number and bonding information from edge components

International Nuclear Information System (INIS)

Weigel, C; Calas, G; Cormier, L; Galoisy, L; Henderson, G S

2008-01-01

High-resolution Al L 2,3 -edge x-ray absorption near edge structure (XANES) spectra have been measured in selected materials containing aluminium in 4-, 5- and 6-coordination. A shift of 1.5 eV is observed between the onset of [4] Al and [6] Al L 2,3 -edge XANES, in agreement with the magnitude of the shift observed at the Al K-edge. The differences in the position and shape of low-energy components of Al L 2,3 -edge XANES spectra provide a unique fingerprint of the geometry of the Al site and of the nature of Al-O chemical bond. The high resolution allows the calculation of electronic parameters such as the spin-orbit coupling and exchange energy using intermediate coupling theory. The electron-hole exchange energy decreases in tetrahedral as compared to octahedral symmetry, in relation with the increased screening of the core hole in the former. Al L 2,3 -edge XANES spectra confirm a major structural difference between glassy and crystalline NaAlSi 2 O 6 , with Al in 4- and 6-coordination, respectively, Al coordination remaining unchanged in NaAl 1-x Fe x Si 2 O 6 glasses, as Fe is substituted for Al

Lyme Disease in West Virginia: An Assessment of Distribution and Clinicians' Knowledge of Disease and Surveillance.

Science.gov (United States)

Singh, Sarah; Parker, David; Mark-Carew, Miguella; White, Robert; Fisher, Melanie

2016-01-01

Lyme disease case misclassification, a top public health concern, may be attributed to the current disconnect between clinical diagnosis and surveillance. This study examines Lyme disease distribution in West Virginia (WV) and determines clinicians' knowledge of both disease and surveillance. Lyme disease surveillance data for 2013 were obtained from the WV Bureau for Public Health. A validated survey, distributed to clinicians at an academic medical center, assessed clinicians' knowledge of disease diagnosis and surveillance. There were 297 adult Lyme disease cases of which 83 were confirmed. Clinician survey responses resulted in a correct response rate of 70% for Lyme disease knowledge questions. Fewer than half of all clinicians were aware of the surveillance criteria for confirming Lyme disease cases. Neither medical specialty nor previous treatment of patients with Lyme disease were significantly associated with clinicians' knowledge of the disease. Clinicians in WV are familiar with symptoms and clinical management of Lyme disease. However, they are less knowledgeable about diagnosis and public health surveillance comprising reporting and confirming cases of the disease. Clinicians and public health authorities should collaborate more closely to promote education and awareness as a key step to successfully reducing the burden of Lymne disease.

Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

Science.gov (United States)

Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

2012-06-01

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) =5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10

Balancing treatment allocations by clinician or center in randomized trials allows unacceptable levels of treatment prediction.

Science.gov (United States)

Hills, Robert K; Gray, Richard; Wheatley, Keith

2009-08-01

Randomized controlled trials are the standard method for comparing treatments because they avoid the selection bias that might arise if clinicians were free to choose which treatment a patient would receive. In practice, allocation of treatments in randomized controlled trials is often not wholly random with various 'pseudo-randomization' methods, such as minimization or balanced blocks, used to ensure good balance between treatments within potentially important prognostic or predictive subgroups. These methods avoid selection bias so long as full concealment of the next treatment allocation is maintained. There is concern, however, that pseudo-random methods may allow clinicians to predict future treatment allocations from previous allocation history, particularly if allocations are balanced by clinician or center. We investigate here to what extent treatment prediction is possible. Using computer simulations of minimization and balanced block randomizations, the success rates of various prediction strategies were investigated for varying numbers of stratification variables, including the patient's clinician. Prediction rates for minimization and balanced block randomization typically exceed 60% when clinician is included as a stratification variable and, under certain circumstances, can exceed 80%. Increasing the number of clinicians and other stratification variables did not greatly reduce the prediction rates. Without clinician as a stratification variable, prediction rates are poor unless few clinicians participate. Prediction rates are unacceptably high when allocations are balanced by clinician or by center. This could easily lead to selection bias that might suggest spurious, or mask real, treatment effects. Unless treatment is blinded, randomization should not be balanced by clinician (or by center), and clinician-center effects should be allowed for instead by retrospectively stratified analyses. © 2009 Blackwell Publishing Asia Pty Ltd and Chinese

Size effect model for the edge strength of glass with cut and ground edge finishing

NARCIS (Netherlands)

Vandebroek, M.; Louter, C.; Caspeele, R.; Ensslen, F.; Belis, J.L.I.F.

2014-01-01

The edge strength of glass is influenced by the size of the surface (near the edge) which is subjected to tensile stresses. To quantify this size effect, 8 series of single layer annealed glass beam specimens (as-received glass) were subjected to in-plane four-point bending with linearly increased

Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know?

Science.gov (United States)

Perkins, Matthew B; Jensen, Peter S; Jaccard, James; Gollwitzer, Peter; Oettingen, Gabriele; Pappadopulos, Elizabeth; Hoagwood, Kimberly E

2007-03-01

Despite major recent research advances, large gaps exist between accepted mental health knowledge and clinicians' real-world practices. Although hundreds of studies have successfully utilized basic behavioral science theories to understand, predict, and change patients' health behaviors, the extent to which these theories-most notably the theory of reasoned action (TRA) and its extension, the theory of planned behavior (TPB)-have been applied to understand and change clinician behavior is unclear. This article reviews the application of theory-driven approaches to understanding and changing clinician behaviors. MEDLINE and PsycINFO databases were searched, along with bibliographies, textbooks on health behavior or public health, and references from experts, to find article titles that describe theory-driven approaches (TRA or TPB) to understanding and modifying health professionals' behavior. A total of 19 articles that detailed 20 studies described the use of TRA or TPB and clinicians' behavior. Eight articles describe the use of TRA or TPB with physicians, four relate to nurses, three relate to pharmacists, and two relate to health workers. Only two articles applied TRA or TPB to mental health clinicians. The body of work shows that different constructs of TRA or TPB predict intentions and behavior among different groups of clinicians and for different behaviors and guidelines. The number of studies on this topic is extremely limited, but they offer a rationale and a direction for future research as well as a theoretical basis for increasing the specificity and efficiency of clinician-targeted interventions.

Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

Science.gov (United States)

Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

2013-01-01

Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual

Use of laboratory test results in patient management by clinicians in Malawi.

Science.gov (United States)

Moyo, Kundai; Porter, Carol; Chilima, Ben; Mwenda, Reuben; Kabue, Mark; Zungu, Lutho; Sarr, Abdoulaye

2015-11-18

Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment. To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. A cross-sectional study was conducted in 2012 to survey practising clinicians. Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these, 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%), followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility ( P management. Key informants reported that the quality of laboratory services was good and useful, but that services were often unavailable. Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain, reduce turn-around times, improve the test menu and improve the laboratory infrastructure.

Moveable Leading Edge Device for a Wing

Science.gov (United States)

Pitt, Dale M. (Inventor); Eckstein, Nicholas Stephen (Inventor)

2013-01-01

A method and apparatus for managing a flight control surface system. A leading edge section on a wing of an aircraft is extended into a deployed position. A deformable section connects the leading edge section to a trailing section. The deformable section changes from a deformed shape to an original shape when the leading edge section is moved into the deployed position. The leading edge section on the wing is moved from the deployed position to an undeployed position. The deformable section changes to the deformed shape inside of the wing.

Strength on cut edge and ground edge glass beams with the failure analysis method

Directory of Open Access Journals (Sweden)

Stefano Agnetti

2013-10-01

Full Text Available The aim of this work is the study of the effect of the finishing of the edge of glass when it has a structural function. Experimental investigations carried out for glass specimens are presented. Various series of annealed glass beam were tested, with cut edge and with ground edge. The glass specimens are tested in four-point bending performing flaw detection on the tested specimens after failure, in order to determine glass strength. As a result, bending strength values are obtained for each specimen. Determining some physical parameter as the depth of the flaw and the mirror radius of the fracture, after the failure of a glass element, it could be possible to calculate the failure strength of that.The experimental results were analyzed with the LEFM theory and the glass strength was analyzed with a statistical study using two-parameter Weibull distribution fitting quite well the failure stress data. The results obtained constitute a validation of the theoretical models and show the influence of the edge processing on the failure strength of the glass. Furthermore, series with different sizes were tested in order to evaluate the size effect.

Power deposition on misaligned edges in COMPASS

Directory of Open Access Journals (Sweden)

R. Dejarnac

2017-08-01

Full Text Available If the decision is made not to apply a toroidal chamfer to tungsten monoblocks at ITER divertor vertical targets, exposed leading edges will arise as a result of assembly tolerances between adjacent plasma-facing components. Then, the advantage of glancing magnetic field angles for spreading plasma heat flux on top surfaces is lost at the misaligned edges with an interaction occurring at near normal incidence, which can drive melting for the expected inter-ELM heat fluxes. A dedicated experiment has been performed on the COMPASS tokamak to thoroughly study power deposition on misaligned edges using inner-wall limited discharges on a special graphite tile presenting gaps and leading edges directly viewed by a high resolution infra-red camera. The parallel power flux deducted from the unperturbed measurement far from the gap is fully consistent with the observed temperature increase at the leading edge, respecting the power balance. All the power flowing into the gap is deposited at the leading edge and no mitigation factor is required to explain the thermal response. Particle-in-cell simulations show that the ion Larmor smoothing effect is weak and that the power deposition on misaligned edges is well described by the optical approximation because of an electron dominated regime associated with non-ambipolar parallel current flow.

Orientations of infinite graphs with prescribed edge-connectivity

DEFF Research Database (Denmark)

Thomassen, Carsten

2016-01-01

We prove a decomposition result for locally finite graphs which can be used to extend results on edge-connectivity from finite to infinite graphs. It implies that every 4k-edge-connected graph G contains an immersion of some finite 2k-edge-connected Eulerian graph containing any prescribed vertex...... set (while planar graphs show that G need not containa subdivision of a simple finite graph of large edge-connectivity). Also, every 8k-edge connected infinite graph has a k-arc-connected orientation, as conjectured in 1989....

Attitudes of Medical Students, Clinicians and Sports Scientists Towards Exercise Counselling

OpenAIRE

Gnanendran, Abbyrhamy; Pyne, David B.; Fallon, Kieran E.; Fricker, Peter A.

2011-01-01

We compared the amount of exercise undertaken by medical students, clinicians, and sport scientists with the National Australian Physical Activity (NAPA) Guidelines. A second aim was to compare attitudes to exercise counselling as preventive medicine between university- and clinic-based professionals. The research setting was a university medical school and a sports science sports medicine centre. A 20-item questionnaire was completed by 216 individuals (131 medical students, 43 clinicians an...

Edge effect on weevils and spiders

OpenAIRE

Horváth, R.; Magura, T.; Péter, G.; Tóthmérész, B.

2002-01-01

The edge effect on weevils and spiders was tested along oak forest – meadow transects using sweep-net samples at the Síkfökút Project in Hungary. For spiders the species richness was significantly higher in the forest edge than either in the meadow or the forest interior. For weevils the species richness of the forest edge was higher than that of the meadow, but the difference was not statistically significant whereas the species richness of the forest...

Integrated core-edge-divertor modeling studies

International Nuclear Information System (INIS)

Stacey, W.M.

2001-01-01

An integrated calculation model for simulating the interaction of physics phenomena taking place in the plasma core, in the plasma edge and in the SOL and divertor of tokamaks has been developed and applied to study such interactions. The model synthesises a combination of numerical calculations (1) the power and particle balances for the core plasma, using empirical confinement scaling laws and taking into account radiation losses (2), the particle, momentum and power balances in the SOL and divertor, taking into account the effects of radiation and recycling neutrals, (3) the transport of feeling and recycling neutrals, explicitly representing divertor and pumping geometry, and (4) edge pedestal gradient scale lengths and widths, evaluation of theoretical predictions (5) confinement degradation due to thermal instabilities in the edge pedestals, (6) detachment and divertor MARFE onset, (7) core MARFE onsets leading to a H-L transition, and (8) radiative collapse leading to a disruption and evaluation of empirical fits (9) power thresholds for the L-H and H-L transitions and (10) the width of the edge pedestals. The various components of the calculation model are coupled and must be iterated to a self-consistent convergence. The model was developed over several years for the purpose of interpreting various edge phenomena observed in DIII-D experiments and thereby, to some extent, has been benchmarked against experiment. Because the model treats the interactions of various phenomena in the core, edge and divertor, yet is computationally efficient, it lends itself to the investigation of the effects of different choices of various edge plasma operating conditions on overall divertor and core plasma performance. Studies of the effect of feeling location and rate, divertor geometry, plasma shape, pumping and over 'edge parameters' on core plasma properties (line average density, confinement, density limit, etc.) have been performed for DIII-D model problems. A

Strain-activated edge reconstruction of graphene nanoribbons

KAUST Repository

Cheng, Yingchun

2012-02-17

The edge structure and width of graphene nanoribbons (GNRs) are crucial factors for the electronic properties. A combination of experiment and first-principles calculations allows us to determine the mechanism of the hexagon-hexagon to pentagon-heptagon transformation. GNRs thinner than 2 nm have been fabricated by bombardment of graphene with high-energetic Au clusters. The edges of the GNRs are modified in situ by electron irradiation. Tensile strain along the edge decreases the transformation energy barrier. Antiferromagnetism and a direct band gap are found for a zigzag GNR, while a fully reconstructed GNR shows an indirect band gap. A GNR reconstructed on only one edge exhibits ferromagnetism. We propose that strain is an effective method to tune the edge and, therefore, the electronic structure of thin GNRs for graphene-based electronics.

Strain-activated edge reconstruction of graphene nanoribbons

KAUST Repository

Cheng, Yingchun; Han, Yu; Schwingenschlö gl, Udo; Wang, H. T.; Zhang, Xixiang; Zhu, Y. H.; Zhu, Zhiyong

2012-01-01

The edge structure and width of graphene nanoribbons (GNRs) are crucial factors for the electronic properties. A combination of experiment and first-principles calculations allows us to determine the mechanism of the hexagon-hexagon to pentagon-heptagon transformation. GNRs thinner than 2 nm have been fabricated by bombardment of graphene with high-energetic Au clusters. The edges of the GNRs are modified in situ by electron irradiation. Tensile strain along the edge decreases the transformation energy barrier. Antiferromagnetism and a direct band gap are found for a zigzag GNR, while a fully reconstructed GNR shows an indirect band gap. A GNR reconstructed on only one edge exhibits ferromagnetism. We propose that strain is an effective method to tune the edge and, therefore, the electronic structure of thin GNRs for graphene-based electronics.

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians.

Science.gov (United States)

Berry, Marc P; Martí, Joan-Daniel; Ntoumenopoulos, George

2016-10-01

Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full

Bridging the gap between basic science and clinical practice: The role of organizations in addressing clinician barriers

Directory of Open Access Journals (Sweden)

Taylor Stephanie

2011-04-01

Full Text Available Abstract Background New National Institutes of Health policies call for expansion of practice-based research to improve the clinical research enterprise and facilitate dissemination of evidence-based medicine. Objective This paper describes organizational strategies that influence clinicians' decisions to participate in clinical research. Design We reviewed the literature and interviewed over 200 clinicians and stakeholders. Results The most common barriers to community clinician participation in clinical research relate to beliefs that clinical research is too burdensome and has little benefit for the participating clinician or patient. We identified a number of approaches healthcare organizations can use to encourage clinicians to participate in research, including an outreach campaign to promote the benefits of clinical research; selection of study topics of interest to clinicians; establishment and enforcement of a set of research principles valuing the clinician and patient; development of a transparent schedule of reimbursement for research tasks; provision of technological and technical assistance to practices as needed; and promotion of a sense of community among clinicians involved in practice-based research. Conclusions Many types of existing healthcare organizations could provide the technical and intellectual assistance community clinicians need to participate in clinical research. Multiple approaches are possible.

Gait alterations can reduce the risk of edge loading.

Science.gov (United States)

Wesseling, Mariska; Meyer, Christophe; De Groote, Friedl; Corten, Kristoff; Simon, Jean-Pierre; Desloovere, Kaat; Jonkers, Ilse

2016-06-01

Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069-1076, 2016. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Total edge irregularity strength of (n,t)-kite graph

Science.gov (United States)

Winarsih, Tri; Indriati, Diari

2018-04-01

Let G(V, E) be a simple, connected, and undirected graph with vertex set V and edge set E. A total k-labeling is a map that carries vertices and edges of a graph G into a set of positive integer labels {1, 2, …, k}. An edge irregular total k-labeling λ :V(G)\\cup E(G)\\to \\{1,2,\\ldots,k\\} of a graph G is a labeling of vertices and edges of G in such a way that for any different edges e and f, weights wt(e) and wt(f) are distinct. The weight wt(e) of an edge e = xy is the sum of the labels of vertices x and y and the label of the edge e. The total edge irregularity strength of G, tes(G), is defined as the minimum k for which a graph G has an edge irregular total k-labeling. An (n, t)-kite graph consist of a cycle of length n with a t-edge path (the tail) attached to one vertex of a cycle. In this paper, we investigate the total edge irregularity strength of the (n, t)-kite graph, with n > 3 and t > 1. We obtain the total edge irregularity strength of the (n, t)-kite graph is tes((n, t)-kite) = \\lceil \\frac{n+t+2}{3}\\rceil .

Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department.

Science.gov (United States)

Pun, Jack Kh; Chan, Engle Angela; Murray, Kristen A; Slade, Diana; Matthiessen, Christian Mim

2017-11-01

To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a

Edge Minority Heating Experiment in Alcator C-Mod

International Nuclear Information System (INIS)

Zweben, S.J.; Terry, J.L.; Bonoli, P.; Budny, R.; Chang, C.S.; Fiore, C.; Schilling, G.; Wukitch, S.; Hughes, J.; Lin, Y.; Perkins, R.; Porkolab, M.; Alcator C-Mod Team

2005-01-01

An attempt was made to control global plasma confinement in the Alcator C-Mod tokamak by applying ion cyclotron resonance heating (ICRH) power to the plasma edge in order to deliberately create a minority ion tail loss. In theory, an edge fast ion loss could modify the edge electric field and so stabilize the edge turbulence, which might then reduce the H-mode power threshold or improve the H-mode barrier. However, the experimental result was that edge minority heating resulted in no improvement in the edge plasma parameters or global stored energy, at least at power levels of P RF (le) 5.5 MW. A preliminary analysis of these results is presented and some ideas for improvement are discussed

Edge effect correction using ion beam figuring.

Science.gov (United States)

Yang, Bing; Xie, Xuhui; Li, Furen; Zhou, Lin

2017-11-10

The edge effect is regarded as one of the most difficult technical issues for fabricating large primary mirrors, as it can greatly reduce the key performance of the optical system. Ion beam figuring (IBF) has the advantage of no edge effect, so we can use it to remove high points on the edge and improve surface accuracy. The edge local correction method (ELCM) of IBF processes only the surface edge zone, and is very different from the current full caliber figuring method (FCFM). Therefore, it is necessary to study the ELCM of IBF. In this paper, the key factors of ELCM are analyzed, such as dwell time algorithm, edge data extension methods, and the outward dimension of the starting figuring point. At the same time, the distinctions between ELCM and FCFM are compared. Finally, a 142 mm diameter fused silica mirror is fabricated to verify the validity of the theoretical of ELCM. The experimental results indicate that the figuring precision and efficiency can be obviously improved by ELCM.

Measuring the Edge Recombination Velocity of Monolayer Semiconductors.

Science.gov (United States)

Zhao, Peida; Amani, Matin; Lien, Der-Hsien; Ahn, Geun Ho; Kiriya, Daisuke; Mastandrea, James P; Ager, Joel W; Yablonovitch, Eli; Chrzan, Daryl C; Javey, Ali

2017-09-13

Understanding edge effects and quantifying their impact on the carrier properties of two-dimensional (2D) semiconductors is an essential step toward utilizing this material for high performance electronic and optoelectronic devices. WS 2 monolayers patterned into disks of varying diameters are used to experimentally explore the influence of edges on the material's optical properties. Carrier lifetime measurements show a decrease in the effective lifetime, τ effective , as a function of decreasing diameter, suggesting that the edges are active sites for carrier recombination. Accordingly, we introduce a metric called edge recombination velocity (ERV) to characterize the impact of 2D material edges on nonradiative carrier recombination. The unpassivated WS 2 monolayer disks yield an ERV ∼ 4 × 10 4 cm/s. This work quantifies the nonradiative recombination edge effects in monolayer semiconductors, while simultaneously establishing a practical characterization approach that can be used to experimentally explore edge passivation methods for 2D materials.

ICRF edge modeling studies

Energy Technology Data Exchange (ETDEWEB)

Lehrman, I.S. (Grumman Corp. Research Center, Princeton, NJ (USA)); Colestock, P.L. (Princeton Univ., NJ (USA). Plasma Physics Lab.)

1990-04-01

Theoretical models have been developed, and are currently being refined, to explain the edge plasma-antenna interaction that occurs during ICRF heating. The periodic structure of a Faraday shielded antenna is found to result in strong ponderomotive force in the vicinity of the antenna. A fluid model, which incorporates the ponderomotive force, shows an increase in transport to the Faraday shield. A kinetic model shows that the strong antenna near fields act to increase the energy of deuterons which strike the shield, thereby increasing the sputtering of shield material. Estimates of edge impurity harmonic heating show no significant heating for either in or out-of-phase antenna operation. Additionally, a particle model for electrons near the shield shows that heating results from the parallel electric field associated with the fast wave. A quasilinear model for edge electron heating is presented and compared to the particle calculations. The models' predictions are shown to be consistent with measurements of enhanced transport. (orig.).

Care provision to prevent chronic disease by community mental health clinicians.

Science.gov (United States)

Bartlem, Kate M; Bowman, Jennifer A; Freund, Megan; Wye, Paula M; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H

2014-12-01

People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Independent component analysis of edge information for face recognition

CERN Document Server

Karande, Kailash Jagannath

2013-01-01

The book presents research work on face recognition using edge information as features for face recognition with ICA algorithms. The independent components are extracted from edge information. These independent components are used with classifiers to match the facial images for recognition purpose. In their study, authors have explored Canny and LOG edge detectors as standard edge detection methods. Oriented Laplacian of Gaussian (OLOG) method is explored to extract the edge information with different orientations of Laplacian pyramid. Multiscale wavelet model for edge detection is also propos

Understanding academic clinicians' intent to treat pediatric obesity.

Science.gov (United States)

Frankfurter, Claudia; Cunningham, Charles; Morrison, Katherine M; Rimas, Heather; Bailey, Karen

2017-02-08

To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians' intent to treat pediatric obesity. A multi-disciplinary panel iteratively devised a Likert scale survey based on the constructs of the TPB applied to a set of pediatric obesity themes. A cross-sectional electronic survey was then administered to academic clinicians at tertiary care centers across Canada from January to April 2012. Descriptive statistics were used to summarize demographic and item agreement data. A hierarchical linear regression analysis controlling for demographic variables was conducted to examine the extent to which the TPB subscales predicted intent to treat pediatric obesity. A total of 198 physicians, surgeons, and allied health professionals across Canada (British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, Ontario and Quebec) completed the survey. On step 1, demographic factors accounted for 7.4% of the variance in intent scores. Together in step 2, demographic variables and TPB subscales predicted 56.9% of the variance in a measure of the intent to treat pediatric obesity. Perceived behavioral control, that is, confidence in one's ability to manage pediatric obesity, and subjective norms, congruent with one's context of practice, were the most significant predictors of the intent to treat pediatric obesity. Attitudes and barriers did not predict the intent to treat pediatric obesity in this context. Enhancing self-confidence in the ability to treat pediatric obesity and the existence of supportive treatment environments are important to increase clinician's intent to treat pediatric obesity.

Shared Decision Making: The Need For Patient-Clinician Conversation, Not Just Information.

Science.gov (United States)

Hargraves, Ian; LeBlanc, Annie; Shah, Nilay D; Montori, Victor M

2016-04-01

The growth of shared decision making has been driven largely by the understanding that patients need information and choices regarding their health care. But while these are important elements for patients who make decisions in partnership with their clinicians, our experience suggests that they are not enough to address the larger issue: the need for the patient and clinician to jointly create a course of action that is best for the individual patient and his or her family. The larger need in evidence-informed shared decision making is for a patient-clinician interaction that offers conversation, not just information, and care, not just choice. Project HOPE—The People-to-People Health Foundation, Inc.

Object detection using categorised 3D edges

DEFF Research Database (Denmark)

Kiforenko, Lilita; Buch, Anders Glent; Bodenhagen, Leon

2015-01-01

is made possible by the explicit use of edge categories in the feature descriptor. We quantitatively compare our approach with the state-of-the-art template based Linemod method, which also provides an effective way of dealing with texture-less objects, tests were performed on our own object dataset. Our...... categorisation algorithm for describing objects in terms of its different edge types. Relying on edge information allow our system to deal with objects with little or no texture or surface variation. We show that edge categorisation improves matching performance due to the higher level of discrimination, which...

Rising to the challenge: Training the next generation of clinician scientists for South Africa

Directory of Open Access Journals (Sweden)

B Kramer

2015-12-01

Full Text Available Background. A shortage of clinician scientists globally, particularly in the developing world, including Africa and South Africa (SA, is well known and was recently highlighted in a consensus report by the Academy of Science of South Africa. There is a need to find innovative ways to develop and advance clinician scientists in SA. Objective. To provide opportunities for young clinicians to develop research skills through enrolling for a PhD. Method. To address this need in SA, we developed an innovative programme over 2 years in collaboration with the Carnegie Corporation of New York to support and train young specialist clinicians in research as the next generation of clinician scientists, through a full-time PhD programme. Results. Since initiation of the programme in March 2011, 16 such specialists have been enrolled at intervals in the Fellowship programme, 5 have qualified with PhDs, while a further 3 are expected to qualify shortly. Publications and presentations at congresses have been recorded as well as grant applications. Discussion. Although the programme is seen as an important initial step in addressing the shortage of clinician scientists, its dependence on donor funding and the lack of a secure career path for clinicians wishing to spend more of their career in research pose problems for the programme’s sustainability. It is hoped that the positive outcomes of this experience will initiate further programmes of this kind at academic institutions and attract the attention of funders and universities in order to sustain and enlarge this initiative.

Research on reducing the edge effect in magnetorheological finishing.

Science.gov (United States)

Hu, Hao; Dai, Yifan; Peng, Xiaoqiang; Wang, Jianmin

2011-03-20

The edge effect could not be avoided in most optical manufacturing methods based on the theory of computer controlled optical surfacing. The difference between the removal function at the workpiece edge and that inside it is also the primary cause for edge effect in magnetorheological finishing (MRF). The change of physical dimension and removal ratio of the removal function is investigated through experiments. The results demonstrate that the situation is different when MRF "spot" is at the leading edge or at the trailing edge. Two methods for reducing the edge effect are put into practice after analysis of the processing results. One is adopting a small removal function for dealing with the workpiece edge, and the other is utilizing the removal function compensation. The actual processing results show that these two ways are both effective on reducing the edge effect in MRF.

Concordance between patient and clinician assessment of dry eye severity and treatment response in Taiwan.

Science.gov (United States)

Yeh, Po-Ting; Chien, Hsu-Chih; Ng, Kwong; Tseng, Sung-Huei; Chen, Wei-Li; Hou, Yu-Chih; Wang, I-Jong; Chu, Hsiao-Sung; Kao Yang, Yea-Huei; Hu, Fung-Rong

2015-05-01

Accurate diagnosis and early recognition of dry eye symptoms are important in the management of dry eye disease (DED). This study aimed to evaluate concordance between patient and clinician assessment of DED severity and treatment response. This cross-sectional study was conducted in 2 ophthalmology clinics in Taiwan. Clinicians assessed severity based on the Dry Eye Workshop severity grading (levels 1-4; where 4 = most severe), whereas patients completed the Ocular Surface Disease Index questionnaire. To evaluate the treatment response, patients completed the Subject Global Assessment scale, and clinicians independently assessed patients using the Clinical Global Impression scale. A total of 466 patients were included. Clinicians graded 88.3% of patients as level 1/2, 9.0% as level 3, and 2.7% as level 4 Dry Eye Workshop severity, whereas 44.9% of patients reported normal/mild symptoms, 17.1% with moderate severity, and 38.0% with severe DED. Patients were primarily treated with artificial tears. The clinician assessed 10.3% of patients as unchanged on disease severity after treatment and 88.0% as improved, whereas 49.2% of patients reported dry eye symptoms being almost the same after treatment and 34.6% reported improved symptoms. There was low agreement between clinician and patient assessments in terms of disease severity (rho = 0.17, P treatment response (rho = 0.22, P treatment response between patient and clinician assessment. Clinicians may underestimate DED severity and persistence of dry eye symptoms after treatment with artificial tears.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01942226.

Knife-edge seal for vacuum bagging

Science.gov (United States)

Rauschl, J. A.

1980-01-01

Cam actuated clamps pinch bagging material between long knife edge (mounted to clamps) and high temperature rubber cushion bonded to baseplate. No adhesive, tape, or sealing groove is needed to seal edge of bagging sheet against base plate.

Collaborative research between clinicians and researchers: a multiple case study of implementation

Directory of Open Access Journals (Sweden)

Edlund Carrie

2010-10-01

Full Text Available Abstract Background Bottom-up, clinician-conceived and directed clinical intervention research, coupled with collaboration from researcher experts, is conceptually endorsed by the participatory research movement. This report presents the findings of an evaluation of a program in the Veterans Health Administration meant to encourage clinician-driven research by providing resources believed to be critical. The evaluation focused on the extent to which funded projects: maintained integrity to their original proposals; were methodologically rigorous; were characterized by collaboration between partners; and resulted in sustained clinical impact. Methods Researchers used quantitative (survey and archival and qualitative (focus group data to evaluate the implementation, evaluation, and sustainability of four clinical demonstration projects at four sites. Fourteen research center mentors and seventeen clinician researchers evaluated the level of collaboration using a six-dimensional model of participatory research. Results Results yielded mixed findings. Qualitative and quantitative data suggested that although the process was collaborative, clinicians' prior research experience was critical to the quality of the projects. Several challenges were common across sites, including subject recruitment, administrative support and logistics, and subsequent dissemination. Only one intervention achieved lasting clinical effect beyond the active project period. Qualitative analyses identified barriers and facilitators and suggested areas to improve sustainability. Conclusions Evaluation results suggest that this participatory research venture was successful in achieving clinician-directed collaboration, but did not produce sustainable interventions due to such implementation problems as lack of resources and administrative support.

Edge-Disjoint Fibonacci Trees in Hypercube

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Indhumathi Raman

2014-01-01

Full Text Available The Fibonacci tree is a rooted binary tree whose number of vertices admit a recursive definition similar to the Fibonacci numbers. In this paper, we prove that a hypercube of dimension h admits two edge-disjoint Fibonacci trees of height h, two edge-disjoint Fibonacci trees of height h-2, two edge-disjoint Fibonacci trees of height h-4 and so on, as subgraphs. The result shows that an algorithm with Fibonacci trees as underlying data structure can be implemented concurrently on a hypercube network with no communication latency.

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

Science.gov (United States)

Elwyn, Glyn; Rasmussen, Julie; Kinsey, Katharine; Firth, Jill; Marrin, Katy; Edwards, Adrian; Wood, Fiona

2018-02-01

Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. © 2016 John Wiley & Sons, Ltd.

Feminist Family Therapy: Ethical Considerations for the Clinician.

Science.gov (United States)

Costa, Luann; Sorenson, Jody

1993-01-01

Notes the traditional minimization of gender and power issues in the cultural context by systemic family therapists. Presents five questions that can serve as guidelines in examining ethical and personal issues and provides ethical considerations for the clinician. (Author/NB)

Silicon K-edge XANES spectra of silicate minerals

Science.gov (United States)

Li, Dien; Bancroft, G. M.; Fleet, M. E.; Feng, X. H.

1995-03-01

Silicon K-edge x-ray absorption near-edge structure (XANES) spectra of a selection of silicate and aluminosilicate minerals have been measured using synchrotron radiation (SR). The spectra are qualitatively interpreted based on MO calculation of the tetrahedral SiO{4/4-}cluster. The Si K-edge generally shifts to higher energy with increased polymerization of silicates by about 1.3 eV, but with considerable overlap for silicates of different polymerization types. The substitution of Al for Si shifts the Si K-edge to lower energy. The chemical shift of Si K-edge is also sensitive to cations in more distant atom shells; for example, the Si K-edge shifts to lower energy with the substitution of Al for Mg in octahedral sites. The shifts of the Si K-edge show weak correlation with average Si-O bond distance (dSi-O), Si-O bond valence (sSi-O) and distortion of SiO4 tetrahedra, due to the crystal structure complexity of silicate minerals and multiple factors effecting the x-ray absorption processes.

Antichiral Edge States in a Modified Haldane Nanoribbon

Science.gov (United States)

Colomés, E.; Franz, M.

2018-02-01

Topological phases of fermions in two dimensions are often characterized by chiral edge states. By definition, these propagate in opposite directions at the two parallel edges when the sample geometry is that of a rectangular strip. We introduce here a model which exhibits what we call "antichiral" edge modes. These propagate in the same direction at both parallel edges of the strip and are compensated by counterpropagating modes that reside in the bulk. General arguments and numerical simulations show that backscattering is suppressed even when strong disorder is present in the system. We propose a feasible experimental realization of a system showing such antichiral edge modes in transition metal dichalcogenide monolayers.

The knife-edge chamber

International Nuclear Information System (INIS)

Barasch, E.F.; Bowcock, T.J.V.; Drew, M.M.; Elliott, S.M.; Lee, B.; McIntyre, P.M.; Pang, Y.; Popovic, M.; Smith, D.D.

1990-01-01

In this paper the design for a new technology for particle track detectors is described. Using standard IC fabrication techniques, a pattern of microscopic knife edges and field-shaping electrodes can be fabricated on a silicon substrate. The knife-edge chamber uniquely offers attractive performance for the track chambers required for SSC detectors, for which no present technology is yet satisfactory. Its features include: excellent radiation hardness (10 Mrad), excellent spatial resolution (∼20 μm), short drift time (20 ns), and large pulse height (1 mV)

A framework for understanding moral distress among palliative care clinicians.

Science.gov (United States)

Rushton, Cynda H; Kaszniak, Alfred W; Halifax, Joan S

2013-09-01

Palliative care clinicians confront suffering as they care for people living with life-limiting conditions. When the degree of suffering becomes unjustified, moral distress can ensue. Promising work from neuroscience and social psychology has yet to be applied to clinical practice. Our objective was to expand a social psychology model focusing on empathy and compassion in response to suffering to include an ethical dimension and to examine how the interrelationships of its proposed components can assist clinicians in understanding their responses to morally distressing situations. In the clinical context, responses to distressing events are thought to include four dimensions: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). These dynamically intertwined dimensions create the preconditions for how clinicians respond to a triggering event instigated by an ethical conflict or dilemma. We postulate that if the four dimensions are highly aligned, the intensity and valence of emotional arousal will influence ethical appraisal and discernment by engaging a robust view of the ethical issues, conflicts, and possible solutions and cultivating compassionate action and resilience. In contrast, if they are not, ethical appraisal and discernment will be deficient, creating emotional disregulation and potentially leading to personal and moral distress, self-focused behaviors, unregulated moral outrage, burnout, and secondary stress. The adaptation and expansion of a conceptual framework offers a promising approach to designing interventions that help clinicians mitigate the detrimental consequences of unregulated moral distress and to build the resilience necessary to sustain themselves in clinical service.

Why patients have a moral obligation to give care to clinicians.

Science.gov (United States)

Buetow, Stephen

2014-12-01

Progress is being made in transitioning from clinicians who are torn between caring for patients and populations, to clinicians who are partnering with patients to care for patients as people. However, the focus is still on what patients and others can do for patients, however defined. For clinicians whose interests must be similarly respected for their own sake and because they are integrally related to those of patients, what can and should patients do? Patients can be exempted from some normal social roles but are generally recognized to have moral obligations in health care. One of these obligations is caregiving to clinicians within the limits of each patient's capability. My paper moves this obligation beyond the ceremonial order of etiquette characterizing public statements on how patients should relate to others. It goes beyond a patient-centred ethic that is consumerist in nature, to a person-centred one that recognizes patients typically as moral agents who are dignified by recognizing the obligation to give as well as receive care as sincere benevolence. This obligation derives objective justification from divine command. It is also consistent, however, both with what people, if ignorant of their social role, would objectively produce for a hypothetical social contract, and with virtues constitutive of human nature and a relational and communitarian understanding of what it is to be a person. Including sentiment (intuition) and personal conscience, this relational identity makes caregiving intrinsically meaningful, yet caregiving also has an instrumental value to patients and clinicians. Its self-enforcement by patients will depend on their moral code and on society making caregiving achievable for them. A moral obligation for patient caregiving may then be specified to require patients to reflect on and invest in relationships in which they can feel and show care for others sincerely and respectfully. © 2014 John Wiley & Sons, Ltd.

Elder Abuse: What's a Clinician To Do?

Science.gov (United States)

Reis, Bruce E.

Incidence rates are critically examined in light of varying definitions of what constitutes elder abuse. It is suggested that the clinician's position of mandatory reporting is an unrealistic response in many cases of elder abuse due to the lack of adequate support services for either the abuser or the elder. Outcome studies are used to support…

Bridging the gap between basic science and clinical practice: a role for community clinicians

Directory of Open Access Journals (Sweden)

Cho Michelle

2011-04-01

Full Text Available Abstract Background Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans. Methods We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program. Results Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior. Conclusions A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.

[Leadership and management courses for clinicians].

Science.gov (United States)

Wichelhaus, Daniel; Fischer, Peter

2017-08-01

The aim of the present study was to evaluate the benefit of Leadership and Management Courses for clinicians, specifically which leadership and management contents are beneficial to their daily clinical work and whether these contents support their individual career. E-mail invitations to participate in the study were sent to all 543 medical doctors of the University Hospital Hanover, Germany, who had taken part in one of the leadership and management courses offered between June 2005 and June 2015. The enquiry was carried out between June 1 and June 30, 2015. 84 e-mail addresses were no longer active; and so, N=459 clinicians actually received the invitation. Of these, 104 participated (22.7%). The study included 59 items. Six were free text items, twelve items were closed questions which could be answered by choosing from a drop down menu, and 41 were answered on a Likert scale from 0 (not fitting at all) to 10 (perfect fit). Based on the items answered on a Likert scale, the following scales and mean values were deduced: Job Satisfaction (M=7.44); Leadership (M=7.77); Trust (M=7.22); Striving for Power (M=7,45); negative Affect (M=4,91); Target Achievement Motivation (M=8.19); Communication (M=8.30) and Management (M=6.48). Regression analysis showed that Job- and Team Satisfaction can predict to what extent the participants regard themselves as good leaders. The study participants defined the following topics as very important: leadership and management style, managerial functions, team management, human resources development and project management. Further topics included rhetoric skills, presentation techniques, as well as basic economics such as understanding balance sheets, profit & loss statements and contribution margin calculation. 55% of the course contents were described as being directly applicable to their daily working environment. In the clinicians' view, the ideal leader acts as a role model (passing on values like respect, appreciation, honesty

Emergent properties of patch shapes affect edge permeability to animals.

Directory of Open Access Journals (Sweden)

Vilis O Nams

Full Text Available Animal travel between habitat patches affects populations, communities and ecosystems. There are three levels of organization of edge properties, and each of these can affect animals. At the lowest level are the different habitats on each side of an edge, then there is the edge itself, and finally, at the highest level of organization, is the geometry or structure of the edge. This study used computer simulations to (1 find out whether effects of edge shapes on animal behavior can arise as emergent properties solely due to reactions to edges in general, without the animals reacting to the shapes of the edges, and to (2 generate predictions to allow field and experimental studies to test mechanisms of edge shape response. Individual animals were modeled traveling inside a habitat patch that had different kinds of edge shapes (convex, concave and straight. When animals responded edges of patches, this created an emergent property of responding to the shape of the edge. The response was mostly to absolute width of the shapes, and not the narrowness of them. When animals were attracted to edges, then they tended to collect in convexities and disperse from concavities, and the opposite happened when animals avoided edges. Most of the responses occurred within a distance of 40% of the perceptual range from the tip of the shapes. Predictions were produced for directionality at various locations and combinations of treatments, to be used for testing edge behavior mechanisms. These results suggest that edge shapes tend to either concentrate or disperse animals, simply because the animals are either attracted to or avoid edges, with an effect as great as 3 times the normal density. Thus edge shape could affect processes like pollination, seed predation and dispersal and predator abundance.

Clinician-patient E-mail communication: challenges for reimbursement.

Science.gov (United States)

Komives, Eugenie M

2005-01-01

Clinicians are rapidly gaining experience with online clinician-patient consultation, and more tools are becoming available to support these efforts. In addition, we now have evidence that using electronic communication is cost-effective to payers and appealing to patients and providers. At present, there appear to be few barriers to the adoption of these solutions for practices that use other online services. Security concerns can easily be overcome by using programs described in this commentary. Larger and longer studies that evaluate the benefits and cost savings in more detail may help convince other payers and providers of the utility of the Web-based programs. More studies are needed to understand the effect of dinician-patient electronic communication on the costs of caring for chronic illness. When these solutions also include support tools, such as electronic prescribing, which could improve patient safety and quality of care, they should be encouraged. In their article entitled, "Electrons in Flight-Email between Doctors and Patients," Delbanco and Sands postulate that the future of e-communication in medicine will be integrated with a patient-controlled health record and will include secure synchronous and asynchronous communication, video conferencing and messaging, instant transcription into the written record, full-patient access to the record, translation into different languages, connectivity to multiple data sources, incorporation of multi-media educational materials. It-will also allow data from home-based diagnostic technology to be sent to clinicians. "Electronic communication will move medicine inexorably toward such transparency, enabling doctors and patients to share knowledge, responsibility, and decision-making more equally. We need to explore rapidly how this change will affect the quality of care for patients and the quality of life for doctors." The widespread dependence on Internet-based electronic communication to support a variety of

Edge energies and shapes of nanoprecipitates.

Energy Technology Data Exchange (ETDEWEB)

Hamilton, John C.

2006-01-01

In this report we present a model to explain the size-dependent shapes of lead nano-precipitates in aluminum. Size-dependent shape transitions, frequently observed at nanolength scales, are commonly attributed to edge energy effects. This report resolves an ambiguity in the definition and calculation of edge energies and presents an atomistic calculation of edge energies for free clusters. We also present a theory for size-dependent shapes of Pb nanoprecipitates in Al, introducing the concept of ''magic-shapes'' defined as precipitate shapes having near zero elastic strains when inserted into similarly shaped voids in the Al matrix. An algorithm for constructing a complete set of magic-shapes is presented. The experimental observations are explained by elastic strain energies and interfacial energies; edge energies play a negligible role. We replicate the experimental observations by selecting precipitates having magic-shapes and interfacial energies less than a cutoff value.

Scanning tunneling microscopy and spectroscopy studies of graphite edges

International Nuclear Information System (INIS)

Niimi, Y.; Matsui, T.; Kambara, H.; Tagami, K.; Tsukada, M.; Fukuyama, Hiroshi

2005-01-01

We studied experimentally and theoretically the electronic local density of states (LDOS) near single-step edges at the surface of exfoliated graphite. In scanning tunneling microscopy measurements, we observed the (3x3)R30 o and honeycomb superstructures extending over 3-4-bar nm both from the zigzag and armchair edges. Calculations based on a density-functional-derived non-orthogonal tight-binding model show that these superstructures can coexist if the two types of edges admix each other in real graphite step edges. Scanning tunneling spectroscopy measurements near the zigzag edge reveal a clear peak in the LDOS at an energy below the Fermi energy by 20-bar meV. No such a peak was observed near the armchair edge. We concluded that this peak corresponds to the 'edge state' theoretically predicted for graphene ribbons, since a similar prominent LDOS peak due to the edge state is obtained by the first principles calculations

Clinicians, security and information technology support services in practice settings--a pilot study.

Science.gov (United States)

Fernando, Juanita

2010-01-01

This case study of 9 information technology (IT) support staff in 3 Australian (Victoria) public hospitals juxtaposes their experiences at the user-level of eHealth security in the Natural Hospital Environment with that previously reported by 26 medical, nursing and allied healthcare clinicians. IT support responsibilities comprised the entire hospital, of which clinician eHealth security needs were only part. IT staff believed their support tasks were often fragmented while work responsibilities were hampered by resources shortages. They perceived clinicians as an ongoing security risk to private health information. By comparison clinicians believed IT staff would not adequately support the private and secure application of eHealth for patient care. Preliminary data analysis suggests the tension between these cohorts manifests as an eHealth environment where silos of clinical work are disconnected from silos of IT support work. The discipline-based silos hamper health privacy outcomes. Privacy and security policies, especially those influencing the audit process, will benefit by further research of this phenomenon.

Role of edges in the electronic and magnetic structures of nanographene

International Nuclear Information System (INIS)

Enoki, Toshiaki

2012-01-01

In graphene edges or nanographene, the presence of edges strongly affects the electronic structure depending on their edge shape (zigzag and armchair edges) as observed with the electron wave interference and the creation of non-bonding π-electron state (edge state). We investigate the edge-inherent electronic features and the magnetic properties of edge-sate spins in nanographene/graphene edges. Graphene nanostructures are fabricated by heat-induced conversion/fabrication of nanodiamond particles/graphite step edges; single-layer nanographene islands (mean size 10 nm) and armchair-edged nanographene ribbons (width 8 nm). Scanning tunneling microscopy (STM)/scanning tunneling spectroscopy observations demonstrate that edge states are created in zigzag edges in spite of the absence of such states in armchair edges. In addition, zigzag edges tend to be short and defective, whereas armchair edges are long and continuous in general. These findings suggest that a zigzag edge has lower aromatic stability than an armchair edge, consistent with Clar's aromatic sextet rule. The manner in which electron wave scattering takes place is different between zigzag and armchair edges. In the vicinity of an armchair edge, a honeycomb superlattice is observed in STM images together with a fine structure of threefold symmetry, in spite of the (√3×√3 )R30 o superlattice at a zigzag edge. The honeycomb lattice is a consequence of the intervalley K-K' transition that accompanies the electron wave interference taking place at the armchair edge. The Raman G-band is also affected by the interference, showing polarization angle dependence specifically at armchair edges. The magnetism of a three-dimensional disordered network of nanographene sheets is understood on the basis of the ferrimagnetic structure of the edge-state spins in individual constituent nanographene sheets. The strengthening of the inter-nanographene-sheet magnetic interaction brings about a spin glass state.

A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity.

Science.gov (United States)

Thomas, Tessy A; Thammasitboon, Satid; Balmer, Dorene F; Roy, Kevin; McCullough, Laurence B

2016-07-01

Our study objectives were to explore moral distress among pediatric team clinicians within the context of resuscitation experiences, and determine whether there were any distinctively ethical perspectives on moral distress that could be conceptualized as challenges to professional integrity, rather than to previously described psychological responses of clinicians. Descriptive, exploratory qualitative study. A large tertiary pediatric academic hospital in Houston, TX. Twenty-five PICU resuscitation team clinicians were interviewed from December 2012 to April 2013. None. All clinicians reported experiencing moral distress during certain resuscitations. Twenty-one of 25 clinicians reflected and acknowledged that their sense of professional integrity had been challenged during those resuscitation events. Four main components of resuscitation experience that induced moral distress were identified: 1) experiences where there was lack of understanding of the big picture; 2) experiences where there was suboptimal team leadership; 3) experiences where there was variable meanings to the word "resuscitation"; and 4) experiences were there was uncertainty of role responsibility. The perception of moral distress exists among pediatric clinicians during resuscitations and could be conceptualized as challenges to professional integrity. This ethical framework offers an alternative approach to understanding and investigating the complex layers of moral distress.

Knowledge, Attitude, and Practice of Clinicians Practicing at the Kenyatta National Hospital on Ionizing Radiation

International Nuclear Information System (INIS)

Gecaga, W.

2015-01-01

The Clinicians practicing is to determine the level of knowledge on ionizing radiation (IR) and their attitudes and practice. All the cadres of clinicians faired poorly when it came to estimating the radiation dose when imaging different body parts. There were no statistically significant differences in unnecessary referrals between health workers who reported having trained in IR 33/53 (62.3%) compared those who had not trained in IR 61/109 (56%), chi = 0.58 (df= 1), p = 0.45. The Clinicians lack knowledge on ionizing radiation. There is a significant knowledge gap between the senior clinicians and junior clinicians when it comes to some aspects of ionizing radiation. Health workers with no IR training are less likely to correctly identify all the techniques that use ionizing radiation compared to those with IR training (50.9% versus 27.5%; OR = 0.37, 95% CI 0.18-0.72)

Spatial-Spectral Approaches to Edge Detection in Hyperspectral Remote Sensing

Science.gov (United States)

Cox, Cary M.

This dissertation advances geoinformation science at the intersection of hyperspectral remote sensing and edge detection methods. A relatively new phenomenology among its remote sensing peers, hyperspectral imagery (HSI) comprises only about 7% of all remote sensing research - there are five times as many radar-focused peer reviewed journal articles than hyperspectral-focused peer reviewed journal articles. Similarly, edge detection studies comprise only about 8% of image processing research, most of which is dedicated to image processing techniques most closely associated with end results, such as image classification and feature extraction. Given the centrality of edge detection to mapping, that most important of geographic functions, improving the collective understanding of hyperspectral imagery edge detection methods constitutes a research objective aligned to the heart of geoinformation sciences. Consequently, this dissertation endeavors to narrow the HSI edge detection research gap by advancing three HSI edge detection methods designed to leverage HSI's unique chemical identification capabilities in pursuit of generating accurate, high-quality edge planes. The Di Zenzo-based gradient edge detection algorithm, an innovative version of the Resmini HySPADE edge detection algorithm and a level set-based edge detection algorithm are tested against 15 traditional and non-traditional HSI datasets spanning a range of HSI data configurations, spectral resolutions, spatial resolutions, bandpasses and applications. This study empirically measures algorithm performance against Dr. John Canny's six criteria for a good edge operator: false positives, false negatives, localization, single-point response, robustness to noise and unbroken edges. The end state is a suite of spatial-spectral edge detection algorithms that produce satisfactory edge results against a range of hyperspectral data types applicable to a diverse set of earth remote sensing applications. This work

Implementing Edge Organizations: Exploiting Complexity. (Part 1: A Framework for the Characterization of Edge Organizations and their Environments)

National Research Council Canada - National Science Library

Alston, Anthony; Beautement, Patrick; Dodd, Lorraine

2005-01-01

...), which would display exceptional agility. Key to implementing and employing Edge Organisations is achieving an understanding of the types of arrangements which would enable Edge Organisations to work in this manner...

Unsteady phenomena in the edge tone

International Nuclear Information System (INIS)

Paal, G.; Vaik, I.

2007-01-01

Despite its geometrical simplicity, the edge tone displays a remarkably complex behaviour. A plane jet oscillates around the wedge-shaped object with a relatively stable frequency and under certain circumstances emits an audible tone. This configuration plays a central role in the sound production of several wind instruments but occurs in industrial situations too. The flow exhibits various interesting nonlinear phenomena reported in the literature which are not entirely explained. In this paper, detailed high precision numerical simulations of the flow are reported under various conditions. Several phenomena are reproduced in agreement with the literature such as the existence of 'stages', the dependence of oscillation frequency on the outflow velocity and the orifice-edge distance within one stage, the pressure distribution on the edge surface, etc. A criterion for the appropriate time step for constant accuracy has been derived. The location of force action is surprisingly stable; it remains in a very narrow region of the wedge surface independently of the Reynolds number and the orifice-edge distance but it is much further behind the edge tip than reported in the literature. The various stages can coexist in different ways: jumping back and forth between stages or being superposed on each other. Regardless of the form, the first stage continues to be dominant even when the second and third stage appears. The question of disturbance propagation velocity and disturbance wavelength is also investigated. The development of higher harmonics of a single stage along the orifice-edge tip distance is presented

Plasmons on the edge of MoS2 nanostructures

DEFF Research Database (Denmark)

Andersen, Kirsten; Jacobsen, Karsten Wedel; Thygesen, Kristian Sommer

2014-01-01

Using ab initio calculations we predict the existence of one-dimensional (1D), atomically confined plasmons at the edges of a zigzag MoS2 nanoribbon. The strongest plasmon originates from a metallic edge state localized on the sulfur dimers decorating the Mo edge of the ribbon. A detailed analysis...... of the dielectric function reveals that the observed deviations from the ideal 1D plasmon behavior result from single-particle transitions between the metallic edge state and the valence and conduction bands of the MoS2 sheet. The Mo and S edges of the ribbon are clearly distinguishable in calculated spatially...... resolved electron energy loss spectrum owing to the different plasmonic properties of the two edges. The edge plasmons could potentially be utilized for tuning the photocatalytic activity of MoS2 nanoparticles....

Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy.

Science.gov (United States)

Levita, Liat; Salas Duhne, Paulina Gonzalez; Girling, Carla; Waller, Glenn

2016-02-01

Psychological therapists commonly fail to adhere to treatment protocols in everyday clinical practice. In part, this pattern of drift is attributable to anxious therapists being less likely to undertake some elements of evidence-based therapies - particularly the exposure-based elements. This study considers what facets of anxiety (cognitive, behavioral, physiological) are related to junior clinicians' reported use of cognitive-behavioral therapy techniques. Thirty-two clinicians (mean age = 28.9 years; mean length of CBT experience = 1.5 years; 23 female, nine male) who offered CBT were assessed for their cognitive, behavioral and physiological characteristics (Intolerance of Uncertainty scale; risk taking; skin conductance response and heart rate variability). While the three different facets of anxiety were relatively poorly associated with each other, as is usual in this literature, each facet was linked differently to the reported delivery of CBT techniques (P behavioral or cognitive methods. Of the three facets of anxiety, only physiological reactivity showed an association with the clinicians' temporal characteristics, with more experienced therapists being more likely to have greater skin conductance responses to positive and negative outcomes. These findings suggest that clinicians who are more anxious are less likely to deliver the full evidence-based form of CBT and to focus instead on less challenging elements of the therapy. Potential ways of overcoming this limitation are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications.

Science.gov (United States)

Alpert, Jordan M; Krist, Alex H; Aycock, Rebecca A; Kreps, Gary L

2017-03-01

Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology.

A qualitative analysis of oncology clinicians' perceptions and barriers for physical activity counseling in breast cancer survivors.

Science.gov (United States)

Fong, Angela J; Faulkner, Guy; Jones, Jennifer M; Sabiston, Catherine M

2018-03-24

Few breast cancer survivors (BCS) engage in sufficient physical activity (PA) to gain physical and mental health benefits. This may be due to a lack of appropriate PA information and support. While key messengers of PA information could be oncology clinicians, many do not consistently counsel their patients on PA. To examine factors affecting PA counseling in clinicians and inform future strategies. Focus groups were conducted with clinicians (N = 27) at four cancer hospitals to better understand factors that affect PA counseling. Focus group discussions were transcribed verbatim and analyzed using inductive thematic analysis. Clinicians perceived a lack of training and knowledge related to PA and BCS. Clinicians also discussed being unsure of when to integrate PA counseling into different phases of survivorship. Similarly, clinicians experienced barriers from hospital administration to maintain patient flow in-clinic, which decreased opportunities for PA counseling. Additionally, lack of awareness of community-based programs within large areas served by hospitals also decreased clinicians' self-efficacy for counseling. In order to facilitate PA counseling, clinicians wanted resources that promote patient-managed PA, available on multiple platforms (e.g., printed and online). Continued education, highlighting recent research and effective implementation of PA, was noted as an important facilitator. Researchers are encouraged to develop research agendas and test educational strategies that are integrated into current practice, empirically test barriers that developed from this study with a larger, representative sample to determine salient barriers and develop PA counseling strategies that are clinician-initiated but not dependent on clinicians.

Leading-edge vortex lifts swifts.

Science.gov (United States)

Videler, J J; Stamhuis, E J; Povel, G D E

2004-12-10

The current understanding of how birds fly must be revised, because birds use their hand-wings in an unconventional way to generate lift and drag. Physical models of a common swift wing in gliding posture with a 60 degrees sweep of the sharp hand-wing leading edge were tested in a water tunnel. Interactions with the flow were measured quantitatively with digital particle image velocimetry at Reynolds numbers realistic for the gliding flight of a swift between 3750 and 37,500. The results show that gliding swifts can generate stable leading-edge vortices at small (5 degrees to 10 degrees) angles of attack. We suggest that the flow around the arm-wings of most birds can remain conventionally attached, whereas the swept-back hand-wings generate lift with leading-edge vortices.

Parallel Algorithms for Switching Edges in Heterogeneous Graphs.

Science.gov (United States)

Bhuiyan, Hasanuzzaman; Khan, Maleq; Chen, Jiangzhuo; Marathe, Madhav

2017-06-01

An edge switch is an operation on a graph (or network) where two edges are selected randomly and one of their end vertices are swapped with each other. Edge switch operations have important applications in graph theory and network analysis, such as in generating random networks with a given degree sequence, modeling and analyzing dynamic networks, and in studying various dynamic phenomena over a network. The recent growth of real-world networks motivates the need for efficient parallel algorithms. The dependencies among successive edge switch operations and the requirement to keep the graph simple (i.e., no self-loops or parallel edges) as the edges are switched lead to significant challenges in designing a parallel algorithm. Addressing these challenges requires complex synchronization and communication among the processors leading to difficulties in achieving a good speedup by parallelization. In this paper, we present distributed memory parallel algorithms for switching edges in massive networks. These algorithms provide good speedup and scale well to a large number of processors. A harmonic mean speedup of 73.25 is achieved on eight different networks with 1024 processors. One of the steps in our edge switch algorithms requires the computation of multinomial random variables in parallel. This paper presents the first non-trivial parallel algorithm for the problem, achieving a speedup of 925 using 1024 processors.

Edge effects on the electronic properties of phosphorene nanoribbons

International Nuclear Information System (INIS)

Peng, Xihong; Copple, Andrew; Wei, Qun

2014-01-01

Two dimensional few-layer black phosphorus crystal structures have recently been fabricated and have demonstrated great potential in electronic applications. In this work, we employed first principles density functional theory calculations to study the edge and quantum confinement effects on the electronic properties of the phosphorene nanoribbons (PNR). Different edge functionalization groups, such as H, F, Cl, OH, O, S, and Se, in addition to a pristine case were studied for a series of ribbon widths up to 3.5 nm. It was found that the armchair-PNRs (APNRs) are semiconductors for all edge groups considered in this work. However, the zigzag-PNRs (ZPNRs) show either semiconductor or metallic behavior in dependence on their edge chemical species. Family 1 edges (i.e., H, F, Cl, OH) form saturated bonds with P atoms in the APNRs and ZPNRs, and the edge states keep far away from the band gap. However, Family 2 edges (pristine, O, S, Se) form weak unsaturated bonds with the p z orbital of the phosphorus atoms and bring edge states within the band gap of the ribbons. For the ZPNRs, the edge states of Family 2 are present around the Fermi level within the band gap, which close up the band gap of the ZPNRs. For the APNRs, these edge states are located at the bottom of the conduction band and result in a reduced band gap.

Edge effects on the electronic properties of phosphorene nanoribbons

Energy Technology Data Exchange (ETDEWEB)

Peng, Xihong, E-mail: xihong.peng@asu.edu [School of Letters and Sciences, Arizona State University, Mesa, Arizona 85212 (United States); Copple, Andrew [Department of Physics, Arizona State University, Tempe, Arizona 85287 (United States); Wei, Qun [School of Letters and Sciences, Arizona State University, Mesa, Arizona 85212 (United States); School of Physics and Optoelectronic Engineering, Xidian University, Xi' an 710071 (China)

2014-10-14

Two dimensional few-layer black phosphorus crystal structures have recently been fabricated and have demonstrated great potential in electronic applications. In this work, we employed first principles density functional theory calculations to study the edge and quantum confinement effects on the electronic properties of the phosphorene nanoribbons (PNR). Different edge functionalization groups, such as H, F, Cl, OH, O, S, and Se, in addition to a pristine case were studied for a series of ribbon widths up to 3.5 nm. It was found that the armchair-PNRs (APNRs) are semiconductors for all edge groups considered in this work. However, the zigzag-PNRs (ZPNRs) show either semiconductor or metallic behavior in dependence on their edge chemical species. Family 1 edges (i.e., H, F, Cl, OH) form saturated bonds with P atoms in the APNRs and ZPNRs, and the edge states keep far away from the band gap. However, Family 2 edges (pristine, O, S, Se) form weak unsaturated bonds with the p{sub z} orbital of the phosphorus atoms and bring edge states within the band gap of the ribbons. For the ZPNRs, the edge states of Family 2 are present around the Fermi level within the band gap, which close up the band gap of the ZPNRs. For the APNRs, these edge states are located at the bottom of the conduction band and result in a reduced band gap.

Thermal stability of the tokamak plasma edge

International Nuclear Information System (INIS)

Stacey, W.M.

1997-01-01

The general linear, fluid, thermal instability theory for the plasma edge has been extended. An analysis of a two-dimensional fluid model of the plasma edge has identified the importance of many previously unappreciated phenomena associated with parallel and gyroviscous forces in the presence of large radial gradients, with large radial or parallel flows, with the temperature dependence of transport coefficients, and with the coupling of temperature, flow and density perturbations. The radiative condensation effect is generalized to include a further destabilizing condensation effect associated with radial heat conduction. Representative plasma edge neutral and impurity densities are found to be capable of driving thermal instabilities in the edge transport barrier and radiative mantle, respectively. (author)

Ukrainian thinkers on philosophical and religious ideas of revelation and transfiguration: metodological prinsiples

Directory of Open Access Journals (Sweden)

Z. I. Timenyk

2016-10-01

Full Text Available The article has been based on legacy of Ukrainian thinkers of 1840s-1960s. The author has highlighted how the discussed ideas function in close proximity to analogous ideas. For instance, the idea of God has been reviewed from the viewpoint of human and world structure, with the idea of interaction between good-evil, light-darkness. While interpreting the topic of the article, the reasonable interdependence of principles, ratios and other constructs has been justified by researcher. A complex of such processes creates a so-called “cascade” in which elements of (interreligious communications and multidisciplinary space become a reality through harmonized temporhythmics from various dimensions. At the same time, essential features of the revelation of nature and God on the borderline of paganism and Christianity have been distinguished in a systemic manner. Under the above-mentioned circumstances, “religious logics” demonstrates its possibilities. It is indispensable during the analysis of given ideas. When we think about the regularity of stage-by-stage transformation of the very concepts “revelation”, “transfiguration” comes to the said borderline. Big attention has been paid by the researcher to manifestations of partiality or wholeness of these notions from the standpoint of their harmony. Real functioning of “religious logics” gave ground to the introduction of such new notions as “inter-religious consciousness”, “revelation studies”. Not only their expediency have been justified. They are also used directly to elicit philosophical and religious ideas. One of the arguments in favor of these ideas is the necessity to expand terminological lexis, which is insufficient in modern studies. The introduction of new terms with the terms which were had not been used for a long time, has been combined by the author. This is, namely, the aforementioned “religious logics” as well as “divine dialectics”. Due to this

Magnesium 1993 Maternal-Fetal Toxicology. A Clinician's Guide ...

African Journals Online (AJOL)

I S I G I 0 I M I. Maternal-Fetal Toxicology. A Clinician's. Guide. 2nd edition. Ed. by Gideon Koren. Pp. 824 ... analysis is presented, and survival curve ideas for effects over time. Final chapters ... SPSS-PC+, SAS and Nanostat. Several important.

Study on edge-extraction of remote sensing image

International Nuclear Information System (INIS)

Wen Jianguang; Xiao Qing; Xu Huiping

2005-01-01

Image edge-extraction is an important step in image processing and recognition, and also a hot spot in science study. In this paper, based on primary methods of the remote sensing image edge-extraction, authors, for the first time, have proposed several elements which should be considered before processing. Then, the qualities of several methods in remote sensing image edge-extraction are systematically summarized. At last, taking Near Nasca area (Peru) as an example the edge-extraction of Magmatic Range is analysed. (authors)

Clinician perceptions of virtual reality to assess and treat returning veterans.

Science.gov (United States)

Kramer, Teresa L; Pyne, Jeffrey M; Kimbrell, Timothy A; Savary, Patricia E; Smith, Jeffrey L; Jegley, Susan M

2010-11-01

Implementation of evidence-based, innovative treatments is necessary to address posttraumatic stress disorder (PTSD) and related mental health problems of Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF) military service personnel. The purpose of this study was to characterize mental health clinicians' perceptions of virtual reality as an assessment tool or adjunct to exposure therapy. Focus groups were conducted with 18 prescribing and nonprescribing mental health clinicians within the Veterans Health Administration. Group discussion was digitally recorded, downloaded into Ethnograph software, and coded to arrive at primary, secondary, and tertiary themes. Most frequently mentioned barriers pertained to aspects of virtual reality, followed by veteran characteristics. Organizational barriers were more relevant when implementing virtual reality as a treatment adjunct. Although the study demonstrated that use of virtual reality as a therapy was feasible and acceptable to clinicians, successful implementation of the technology as an assessment and treatment tool will depend on consideration of the facilitators and barriers that were identified.

Edge diagnostics for tandem mirror machines

International Nuclear Information System (INIS)

Allen, S.L.

1984-01-01

The edge plasma in a tandem mirror machine shields the plasma core from cold neutral gas and impurities. A variety of diagnostics are used to measure the fueling, shielding, and confinement of the edge plasma in both the end plug and central cell regions. Fast ion gauges and residual gas analyzers measure the gas pressure and composition outside of the plasma. An array of Langmuir probes is used to measure the electron density and temperature. Extreme ultraviolet (euv) and visible spectroscopy are used to measure both the impurity and deuterium densities and to estimate the shielding factor for the core plasma. The linear geometry of a tandem mirror also allows direct measurements of the edge plasma by sampling the ions and electrons lost but the ends of the machine. Representative data obtained by these diagnostics during operation of the Tandem Mirror Experiment (TMX) and Tandem Mirror Experiment-Upgrade (TMX-U) experiments are presented. Diagnostics that are currently being developed to diagnose the edge plasma are also discussed

Optimal Scale Edge Detection Utilizing Noise within Images

Directory of Open Access Journals (Sweden)

Adnan Khashman

2003-04-01

Full Text Available Edge detection techniques have common problems that include poor edge detection in low contrast images, speed of recognition and high computational cost. An efficient solution to the edge detection of objects in low to high contrast images is scale space analysis. However, this approach is time consuming and computationally expensive. These expenses can be marginally reduced if an optimal scale is found in scale space edge detection. This paper presents a new approach to detecting objects within images using noise within the images. The novel idea is based on selecting one optimal scale for the entire image at which scale space edge detection can be applied. The selection of an ideal scale is based on the hypothesis that "the optimal edge detection scale (ideal scale depends on the noise within an image". This paper aims at providing the experimental evidence on the relationship between the optimal scale and the noise within images.

Subharmonic edge waves on a large, shallow island

Science.gov (United States)

Foda, Mostafa A.

1988-08-01

Subharmonic resonance of edge waves by incident and reflected waves has been studied thus far for the case of a plane infinite beach. The analysis will be extended here to the case of a curved coastline, with a large radius of curvature and slowly varying beach slope in the longshore direction. It will be shown that the effects of such slow beach slope changes on a propagating edge wave are similar to the familiar shoaling effects on incident waves. The case of subharmonic edge wave generation on large shallow islands will be discussed in detail. The nonlinear analysis will show that within a certain range of island sizes, the generation mechanism can produce a stable standing edge wave around the island. For larger islands the solution disintegrates into two out-of-phase envelopes of opposite-going edge waves. For still larger islands, the generated progressive edge waves become unstable to sideband modulations.

Acoustic analog of monolayer graphene and edge states

International Nuclear Information System (INIS)

Zhong, Wei; Zhang, Xiangdong

2011-01-01

Acoustic analog of monolayer graphene has been designed by using silicone rubber spheres of honeycomb lattices embedded in water. The dispersion of the structure has been studied theoretically using the rigorous multiple-scattering method. The energy spectra with the Dirac point have been verified and zigzag edge states have been found in ribbons of the structure, which are analogous to the electronic ones in graphene nanoribbons. The guided modes along the zigzag edge excited by a point source have been numerically demonstrated. The open cavity and 'Z' type edge waveguide with 60 o corners have also been realized by using such edge states. -- Highlights: → Acoustic analog of monolayer graphene has been designed. → The energy spectra with the Dirac point have been verified. → The zigzag edge states have been found in ribbons of the structure. → The guided modes excited by a point source have been demonstrated. → The open cavity and 'Z' type edge waveguide have been realized.

The relationship between clinician turnover and adolescent treatment outcomes: An examination from the client perspective

Science.gov (United States)

Garner, Bryan R.; Funk, Rodney R.; Hunter, Brooke D.

2012-01-01

The turnover of substance use disorder (SUD) treatment staff has been assumed to adversely impact treatment effectiveness, yet only limited research has empirically examined this assumption. Representing an extension of prior organizational-level analyses of the impact of staff turnover on client outcomes, this study examined the impact of SUD clinician turnover on adolescent treatment outcomes using a client perspective. Multilevel regression analysis did reveal that relative to those adolescents who did not experience clinician turnover, adolescents who experienced both direct and indirect clinician turnover reported a significantly higher percentage of days using alcohol or drugs at 6-month follow-up. However, clinician turnover was not found to have significant associations (negative or positive) with the other five treatment outcomes examined (e.g., substance-related problems, involvement in illegal activity). Thus, consistent with our prior findings, the current study provides additional evidence that turnover of SUD clinicians is not necessarily associated with adverse treatment outcomes. PMID:23083980

Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting.

Science.gov (United States)

Martin, T; Daffern, M

2006-02-01

Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

Science.gov (United States)

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

Discursive Maps at the Edge of Chaos

Science.gov (United States)

2017-05-25

Discursive Maps at the Edge of Chaos A Monograph by Major Mathieu Primeau Canadian Army, Royal Canadian Engineer School of Advanced Military...Master’s Thesis 3. DATES COVERED (From - To) JUN 2016 – MAY 2017 4. TITLE AND SUBTITLE Discursive Maps at the Edge of Chaos 5a. CONTRACT NUMBER 5b...meaning of boundaries and polarize conflict towards violence. The edge of chaos is the fine line between disorder and coherence. Discursive maps

High Speed Edge Detection

Science.gov (United States)

Prokop, Norman F (Inventor)

2016-01-01

Analog circuits for detecting edges in pixel arrays are disclosed. A comparator may be configured to receive an all pass signal and a low pass signal for a pixel intensity in an array of pixels. A latch may be configured to receive a counter signal and a latching signal from the comparator. The comparator may be configured to send the latching signal to the latch when the all pass signal is below the low pass signal minus an offset. The latch may be configured to hold a last negative edge location when the latching signal is received from the comparator.

The presence of radiological features on chest radiographs: How well do clinicians agree?

Energy Technology Data Exchange (ETDEWEB)

Edwards, M. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Lawson, Z. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Morris, S.; Evans, A.; Harrison, S.; Isaac, R. [Department of Paediatric Radiology, University Hospital of Wales, Cardiff (United Kingdom); Crocker, J. [Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Powell, C., E-mail: powellc7@cardiff.ac.uk [Department of Child Health, School of Medicine, Cardiff University (United Kingdom)

2012-07-15

Aim: To compare levels of agreement amongst paediatric clinicians with those amongst consultant paediatric radiologists when interpreting chest radiographs (CXRs). Materials and methods: Four paediatric radiologists used picture archiving and communication system (PACS) workstations to evaluate the presence of five radiological features of infection, independently in each of 30 CXRs. The radiographs were obtained over 1 year (2008) from children with fever and signs of respiratory distress, aged 6 months to <16 years. The same CXRs were interpreted a second time by the paediatric radiologists and by 21 clinicians with varying experience levels, using the Web 1000 viewing system and a projector. Intra- and interobserver agreement within groups, split by grade and specialty, were analysed using free-marginal multi-rater kappa. Results: Normal CXRs were identified consistently amongst all 25 participants. The four paediatric radiologists showed high levels of intraobserver agreement between methods (kappa scores between 0.53 and 1.00) and interobserver agreement for each method (kappa scores between 0.67 and 0.96 for PACS assessment). The 21 clinicians showed varying levels of agreement from 0.21 to 0.89. Conclusion: Paediatric radiologists showed high levels of agreement for all features. In general, the clinicians had lower levels of agreement than the radiologists. This study highlights the need for improved training in interpreting CXRs for clinicians and the timely reporting of CXRs by radiologists to allow appropriate patient management.

Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya.

Science.gov (United States)

Hooft, Anneka M; Ripp, Kelsey; Ndenga, Bryson; Mutuku, Francis; Vu, David; Baltzell, Kimberly; Masese, Linnet N; Vulule, John; Mukoko, Dunstan; LaBeaud, A Desiree

2017-09-20

Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing

Relationships between radiologists and clinicians: Results from three surveys

International Nuclear Information System (INIS)

Dalla Palma, L.; Stacul, F.; Meduri, S.; Geitung, J. Te.

2000-01-01

AIM: To analyse reasons for and the nature of clinico-radiological contacts and their clinical impact. MATERIALS AND METHODS: Three different surveys were performed. (1) Data concerning contacts between staff radiologists (n = 20) and clinicians during 10 consecutive working days were collected; (2) staff clinicians (n = 174) filled in a questionnaire asking for their opinions about relationships with radiologists; (3) staff radiologists collected data about contacts with clinicians related to more urgent/complicated cases. Radiologists assessed the clinical impact of the radiological procedure and of the consultation. RESULTS: (1) During 220 working days 20 radiologists had a mean of 3.95 contacts per day (48.2% personal contacts, 51.8% telephone contacts), amounting to a personal total of 21.65 min per day. These contacts amounted to a total of 7.08 h per day, roughly one whole-time equivalent radiologist. (2) These consultations helped to refine the diagnostic strategy often (12.6%) or sometimes (71.4%) and to alter therapeutic decisions often (10.4%) or sometimes (56.6%). (3) The initial clinical diagnosis was changed in 50% of cases and the therapy was substantially changed on the basis of further radiological investigations and clinical-radiological discussion in 60% of cases. CONCLUSION: Clinical-radiological consultations are time consuming but have a beneficial diagnostic and therapeutic impact. Dalla Palma, L. (2000)

ON f-EDGE COVER-COLOURING OF SIMPLE GRAPHS

Institute of Scientific and Technical Information of China (English)

Song Huimin; Liu Guizhen

2005-01-01

An f-edge cover-colouring of a graph G = (V, E) is an assignment of colours to the edges of G such that every colour appears at each vertex υ∈ V at least f(υ) times.The maximum number of colours needed to f-edge cover colour G is called the f-edge cover chromatic index of G, denoted by χfc(G). This paper gives that min[d(ν)-1/f(ν)] ≤χfc(G) ≤min[d(υ)/f(υ)].

Factors that influence clinicians' assessment and management of family violence.

Science.gov (United States)

Tilden, V P; Schmidt, T A; Limandri, B J; Chiodo, G T; Garland, M J; Loveless, P A

1994-01-01

OBJECTIVES. High rates of family violence and low rates of detection, report, and therapeutic intervention by health professionals are well documented. This study was undertaken to determine what factors influence clinicians' decision making about identifying abuse and intervening with victims. METHODS. Survey data about clinicians' experiences with and attitudes toward family violence were gathered by mailed questionnaire from a random sample of practicing clinicians in six disciplines (n = 1521). RESULTS. Data showed similarities within and wide differences among three groups of subjects: dentists/dental hygienists, nurses/physicians, and psychologists/social workers. Overall, a third of subjects reported having received no educational content on child, spouse, or elder abuse in their professional training programs. Subjects with education on the topic more commonly suspected abuse in their patients than those without; among all subjects, spouse abuse was suspected more often than child abuse while elder abuse was suspected infrequently. Significant numbers of subjects did not view themselves as responsible for dealing with problems of family violence. Subjects indicated low confidence in and low compliance with mandatory reporting laws. CONCLUSIONS. There is a need for educators to expand curricula on family violence and for legislators to reexamine mandatory reporting laws. PMID:8154568

Nature & prevalence of stalking among New Zealand mental health clinicians.

Science.gov (United States)

Hughes, Frances A; Thom, Katey; Dixon, Robyn

2007-04-01

Stalking involves recurrent and persistent unwanted communication or contact that generates fear for safety in the victims. This pilot study evaluated the nature and prevalence of stalking among New Zealand nurses and physicians working in mental health services. An anonymous questionnaire asking respondents to describe their experiences with 12 stalking behaviors was distributed to 895 clinicians. Results indicated that regardless of discipline, women were more likely than men to have experienced one or more stalking behaviors, including receiving unwanted telephone calls, letters, and approaches; receiving personal threats: and being followed, spied on, or subject to surveillance. Women also reported higher levels of fearfulness as a consequence of stalking behaviors. Nearly half of the stalkers were clients; the remaining were former partners, colleagues, or acquaintances. In client-related cases, the majority of respondents told their colleagues and supervisors first, and the majority found them to be the most helpful resource. The results of this pilot study indicate a need for further research focused on the stalking of mental health clinicians in New Zealand and for development of workplace policies for adequate response to the stalking of mental health clinicians.

Understanding the edge effect in wetting: a thermodynamic approach.

Science.gov (United States)

Fang, Guoping; Amirfazli, A

2012-06-26

Edge effect is known to hinder spreading of a sessile drop. However, the underlying thermodynamic mechanisms responsible for the edge effect still is not well-understood. In this study, a free energy model has been developed to investigate the energetic state of drops on a single pillar (from upright frustum to inverted frustum geometries). An analysis of drop free energy levels before and after crossing the edge allows us to understand the thermodynamic origin of the edge effect. In particular, four wetting cases for a drop on a single pillar with different edge angles have been determined by understanding the characteristics of FE plots. A wetting map describing the four wetting cases is given in terms of edge angle and intrinsic contact angle. The results show that the free energy barrier observed near the edge plays an important role in determining the drop states, i.e., (1) stable or metastable drop states at the pillar's edge, and (2) drop collapse by liquid spilling over the edge completely or staying at an intermediate sidewall position of the pillar. This thermodynamic model presents an energetic framework to describe the functioning of the so-called "re-entrant" structures. Results show good consistency with the literature and expand the current understanding of Gibbs' inequality condition.

Slim edges in double-sided silicon 3D detectors

International Nuclear Information System (INIS)

Povoli, M; Dalla Betta, G-F; Bagolini, A; Boscardin, M; Giacomini, G; Vianello, E; Zorzi, N

2012-01-01

Minimization of the insensitive edge area is one of the key requirements for silicon radiation detectors to be used in future silicon trackers. In 3D detectors this goal can be achieved with the active edge, at the expense of a high fabrication process complexity. In the framework of the ATLAS 3D sensor collaboration, we produced modified 3D silicon sensors with a double-sided technology. While this approach is not suitable to obtain active edges, because it does not use a support wafer, it allows for a new type of edge termination, the slim edge. In this paper we report on the development of the slim edge, from numerical simulations to design and testing, proving that it works effectively without increasing the fabrication complexity of silicon 3D detectors, and that it could be further optimized to reduce the insensitive edge region to less than 100 μm.

X-ray imaging characterization of active edge silicon pixel sensors

International Nuclear Information System (INIS)

Ponchut, C; Ruat, M; Kalliopuska, J

2014-01-01

The aim of this work was the experimental characterization of edge effects in active-edge silicon pixel sensors, in the frame of X-ray pixel detectors developments for synchrotron experiments. We produced a set of active edge pixel sensors with 300 to 500 μm thickness, edge widths ranging from 100 μm to 150 μm, and n or p pixel contact types. The sensors with 256 × 256 pixels and 55 × 55 μm 2 pixel pitch were then bump-bonded to Timepix readout chips for X-ray imaging measurements. The reduced edge widths makes the edge pixels more sensitive to the electrical field distribution at the sensor boundaries. We characterized this effect by mapping the spatial response of the sensor edges with a finely focused X-ray synchrotron beam. One of the samples showed a distortion-free response on all four edges, whereas others showed variable degrees of distortions extending at maximum to 300 micron from the sensor edge. An application of active edge pixel sensors to coherent diffraction imaging with synchrotron beams is described

Environmental Dataset Gateway (EDG) CS-W Interface

Data.gov (United States)

U.S. Environmental Protection Agency — Use the Environmental Dataset Gateway (EDG) to find and access EPA's environmental resources. Many options are available for easily reusing EDG content in other...

An organizational assessment of disruptive clinician behavior: findings and implications.

Science.gov (United States)

Walrath, Jo M; Dang, Deborah; Nyberg, Dorothy

2013-01-01

This study investigated registered nurses' (RNs) and physicians' (MD) experiences with disruptive behavior, triggers, responses, and impacts on clinicians, patients, and the organization. Using the Disruptive Clinician Behavior Survey for Hospital Settings, it was found that RNs experienced a significantly higher frequency of disruptive behaviors and triggers than MDs; MDs (45% of 295) and RNs (37% of 689) reported that their peer's disruptive behavior affected them most negatively. The most frequently occurring trigger was pressure from high census, volume, and patient flow; 189 incidences of harm to patients as a result of disruptive behavior were reported. Findings provide organizational leaders with evidence to customize interventions to strengthen the culture of safety.

The effect of defocus on edge contrast sensitivity

NARCIS (Netherlands)

Jansonius, NM; Kooijman, AC

The effect of optical blur (defocus) on edge contrast sensitivity was studied. Edge contrast sensitivity detoriates with fairly small amounts of blur (similar to 0.5 D) and is roughly reduced by half for each dioptre of blur. The effect of blur on edge contrast sensitivity equals the effect of blur

Network Unfolding Map by Vertex-Edge Dynamics Modeling.

Science.gov (United States)

Verri, Filipe Alves Neto; Urio, Paulo Roberto; Zhao, Liang

2018-02-01

The emergence of collective dynamics in neural networks is a mechanism of the animal and human brain for information processing. In this paper, we develop a computational technique using distributed processing elements in a complex network, which are called particles, to solve semisupervised learning problems. Three actions govern the particles' dynamics: generation, walking, and absorption. Labeled vertices generate new particles that compete against rival particles for edge domination. Active particles randomly walk in the network until they are absorbed by either a rival vertex or an edge currently dominated by rival particles. The result from the model evolution consists of sets of edges arranged by the label dominance. Each set tends to form a connected subnetwork to represent a data class. Although the intrinsic dynamics of the model is a stochastic one, we prove that there exists a deterministic version with largely reduced computational complexity; specifically, with linear growth. Furthermore, the edge domination process corresponds to an unfolding map in such way that edges "stretch" and "shrink" according to the vertex-edge dynamics. Consequently, the unfolding effect summarizes the relevant relationships between vertices and the uncovered data classes. The proposed model captures important details of connectivity patterns over the vertex-edge dynamics evolution, in contrast to the previous approaches, which focused on only vertex or only edge dynamics. Computer simulations reveal that the new model can identify nonlinear features in both real and artificial data, including boundaries between distinct classes and overlapping structures of data.

Should the practice of medicine be a deontological or utilitarian enterprise?

Science.gov (United States)

Garbutt, Gerard; Davies, Peter

2011-05-01

There is currently an unrecognised conflict between the utilitarian nature of the overall NHS and the basic deontology of the doctor-patient interaction. This conflict leads to mistrust and misunderstanding between managers and clinicians. This misunderstanding is bad for both doctors and managers, and also leads to waste of time and resources, and poorer services to patients. The utilitarian thinkers (mainly managers and politicians) tend to value finite, short term, evidence based technical interventions, delivered according to specifications and contracts. They appear happy to break care up into smaller pieces, which can then be commissioned from multiple providers. The deontological thinkers (mainly doctors and other clinicians) tend to think about care delivered through a long term continuous relationship, and regard that relationship as therapeutic and salutogenic in itself. To them breaking care up into smaller fragments is a denial of what caring is really about. Very rarely are either or both sides of this debate fully aware of where their powerfully felt and often well argued positions start from. In this paper we offer an appraisal of the strengths and weaknesses of both moral viewpoints as applied in the UK NHS context and we suggest a way in which they can be reconciled, provided neither is pushed too far or too hard against the other. We believe this reconciliation would be good for patients, doctors, managers and improve the service as a whole.

Adobe Edge Animate CC for dummies

CERN Document Server

Rohde, Michael

2013-01-01

The easy way to build HTML5 mobile and web apps using Adobe's new Edge Animate CC Edge Animate CC is an approachable WYSIWYG alternative for leveraging the power of languages like HTML5, CSS3, and JavaScript to design and develop for the web and mobile devices, even if you have no programming experience. Written by Michael Rohde, the book calls on this seasoned web developer's wealth of experience using Edge Animate CC, and a companion website includes all code from the book to help you apply what you learn as you go. Features an easy-to-use interface, with a propert

Study of airfoil trailing edge bluntness noise

DEFF Research Database (Denmark)

Zhu, Wei Jun; Shen, Wen Zhong; Sørensen, Jens Nørkær

2010-01-01

This paper deals with airfoil trailing edge noise with special focus on airfoils with blunt trailing edges. Two methods are employed to calculate airfoil noise: The flow/acoustic splitting method and the semi-empirical method. The flow/acoustic splitting method is derived from compressible Navier...... design or optimization. Calculations from both methods are compared with exist experiments. The airfoil blunt noise is found as a function of trailing edge bluntness, Reynolds number, angle of attack, etc....

Organizing on the Edge: Appreciation and Critique

National Research Council Canada - National Science Library

Scott, W. R

2006-01-01

.... Hayes, "Power to the Edge: Command, Control in the Information Age" (2003). The author places the "edge" perspective in the broader context of organizational studies, noting both its strengths and limitations...

Clinician's gaze behaviour in simulated paediatric emergencies.

Science.gov (United States)

McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

2018-03-07

Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patient selection, echocardiographic screening and treatment strategies for interventional tricuspid repair using the edge-to-edge repair technique.

Science.gov (United States)

Hausleiter, Jörg; Braun, Daniel; Orban, Mathias; Latib, Azeem; Lurz, Philipp; Boekstegers, Peter; von Bardeleben, Ralph Stephan; Kowalski, Marek; Hahn, Rebecca T; Maisano, Francesco; Hagl, Christian; Massberg, Steffen; Nabauer, Michael

2018-04-24

Severe tricuspid regurgitation (TR) has long been neglected despite its well known association with mortality. While surgical mortality rates remain high in isolated tricuspid valve surgery, interventional TR repair is rapidly evolving as an alternative to cardiac surgery in selected patients at high surgical risk. Currently, interventional edge-to-edge repair is the most frequently applied technique for TR repair even though the device has not been developed for this particular indication. Due to the inherent differences in tricuspid and mitral valve anatomy and pathology, percutaneous repair of the tricuspid valve is challenging due to a variety of factors including the complexity and variability of tricuspid valve anatomy, echocardiographic visibility of the valve leaflets, and device steering to the tricuspid valve. Furthermore, it remains to be clarified which patients are suitable for a percutaneous tricuspid repair and which features predict a successful procedure. On the basis of the available experience, we describe criteria for patient selection including morphological valve features, a standardized process for echocardiographic screening, and a strategy for clip placement. These criteria will help to achieve standardization of valve assessment and the procedural approach, and to further develop interventional tricuspid valve repair using either currently available devices or dedicated tricuspid edge-to-edge repair devices in the future. In summary, this manuscript will provide guidance for patient selection and echocardiographic screening when considering edge-to-edge repair for severe TR.

Clinicians and their cameras: policy, ethics and practice in an Australian tertiary hospital.

Science.gov (United States)

Burns, Kara; Belton, Suzanne

2013-09-01

Medical photography illustrates what people would prefer to keep private, is practiced when people are vulnerable, and has the power to freeze a moment in time. Given it is a sensitive area of health, lawful and ethical practice is paramount. This paper recognises and seeks to clarify the possibility of widespread clinician-taken medical photography in a tertiary hospital in northern Australia, examining the legal and ethical implications of this practice. A framework of Northern Territory law, state Department of Health policy and human rights theory were used to argue the thesis. Clinicians from 13 purposively chosen wards were asked to participate in an anonymous survey and confidential in-depth interviews. Questions were generated from the literature and local knowledge on the topics of 'occurrence', 'image use', 'quality of consent', 'cameras and technology', 'confidentiality', 'data storage and security', 'hospital policy and law' and 'cultural issues'. One hundred and seventy surveys and eights interviews were analysed using descriptive statistics and theme and content analysis, then triangulated for similarity, difference and unique responses. Forty-eight percent of clinicians surveyed take medical photographs, with the majority using hospital-owned cameras. However, one-fifth of clinicians reported photographing with personal mobile phones. Non-compliance with written consent requirements articulated in policy was endemic, with most clinicians surveyed obtaining only verbal consent. Labeling, storage, copyright and cultural issues were generally misunderstood, with a significant number of clinicians risking the security of patient information by storing images on personal devices. If this tertiary hospital does not develop a clinical photography action plan to address staff lack of knowledge, and noncompliance with policy and mobile phone use, patients' data is at risk of being distributed into the public domain where unauthorised publication may cause

Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study.

Science.gov (United States)

Hollenbach, Jessica P; Cushing, Anna; Melvin, Emilie; McGowan, Bryanna; Cloutier, Michelle M; Manice, Melissa

2017-09-01

Mobile technology for childhood asthma can provide real-time data to enhance care. What real-time adherence information clinicians want, how they may use it, and if the data meet their clinical needs have not been fully explored. Our goal was to determine whether pediatric primary care and pulmonary clinicians believe if a sensor-based mobile intervention is useful in caring for patients with asthma. We recruited participants from 3 urban, primary care and 1 pulmonary practice from July to September 2015 in Hartford, CT. Forty-one participated in four focus groups, which included a demonstration of the technology. Participants were probed with open-ended questions on the type, frequency, and format of inter-visit patient information they found useful. 41 participants (mean age 49 (±13.7) years) were board-certified clinicians (41% MDs and 20% mid-level practitioners), practiced medicine on an average of 19 (±14) years, were primarily white (59%) and women (78%). Clinicians wanted 1) adherence to prescribed inhaler therapy and 2) data on inhaler technique. Clinicians wanted it at the time of a scheduled clinic visit but also wanted inter-visit alerts for excessive use of rescue therapy. Pulmonologists liked the mobile spirometer's provision of inter-visit lung function data; pediatricians did not share this view. Concerns with data accuracy were raised due to families who shared inhalers, access to smartphones, and protection of health information. Overall, clinicians view an asthma mobile health technology as enhancing the patient-centered medical home. Pediatric primary care clinicians and pulmonologists want different information from a mobile app.

High Precision Edge Detection Algorithm for Mechanical Parts

Science.gov (United States)

Duan, Zhenyun; Wang, Ning; Fu, Jingshun; Zhao, Wenhui; Duan, Boqiang; Zhao, Jungui

2018-04-01

High precision and high efficiency measurement is becoming an imperative requirement for a lot of mechanical parts. So in this study, a subpixel-level edge detection algorithm based on the Gaussian integral model is proposed. For this purpose, the step edge normal section line Gaussian integral model of the backlight image is constructed, combined with the point spread function and the single step model. Then gray value of discrete points on the normal section line of pixel edge is calculated by surface interpolation, and the coordinate as well as gray information affected by noise is fitted in accordance with the Gaussian integral model. Therefore, a precise location of a subpixel edge was determined by searching the mean point. Finally, a gear tooth was measured by M&M3525 gear measurement center to verify the proposed algorithm. The theoretical analysis and experimental results show that the local edge fluctuation is reduced effectively by the proposed method in comparison with the existing subpixel edge detection algorithms. The subpixel edge location accuracy and computation speed are improved. And the maximum error of gear tooth profile total deviation is 1.9 μm compared with measurement result with gear measurement center. It indicates that the method has high reliability to meet the requirement of high precision measurement.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications

Science.gov (United States)

Krist, Alex H.; Aycock, Rebecca A.; Kreps, Gary L.

2017-01-01

Abstract Background: Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). Materials and Methods: In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Results: Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Conclusions: Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology. PMID:27333468

Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors.

Science.gov (United States)

Back, Anthony L; Steinhauser, Karen E; Kamal, Arif H; Jackson, Vicki A

2016-08-01

For palliative care (PC) clinicians, the work of caring for patients with serious illness can put their own well-being at risk. What they often do not learn in training, because of the relative paucity of evidence-based programs, are practical ways to mitigate this risk. Because a new study indicates that burnout in PC clinicians is increasing, we sought to design an acceptable, scalable, and testable intervention tailored to the needs of PC clinicians. In this article, we describe our paradigm for approaching clinician resilience, our conceptual model, and curriculum for a workplace resilience intervention for hospital-based PC teams. Our paradigm for approaching resilience is based on upstream, early intervention. Our conceptual model posits that clinician well-being is influenced by personal resources and work demands. Our curriculum for increasing clinician resilience is based on training in eight resilience skills that are useful for common challenges faced by clinicians. To address workplace issues, our intervention also includes material for the team leader and a clinician perception survey of work demands and workplace engagement factors. The intervention will focus on individual skill building and will be evaluated with measures of resilience, coping, and affect. For PC clinicians, resilience skills are likely as important as communication skills and symptom management as foundations of expertise. Future work to strengthen clinician resilience will likely need to address system issues more directly. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

A heuristic approach to edge detection in on-line portal imaging

International Nuclear Information System (INIS)

McGee, Kiaran P.; Schultheiss, Timothy E.; Martin, Eric E.

1995-01-01

Purpose: Portal field edge detection is an essential component of several postprocessing techniques used in on-line portal imaging, including field shape verification, selective contrast enhancement, and treatment setup error detection. Currently edge detection of successive fractions in a multifraction portal image series involves the repetitive application of the same algorithm. As the number of changes in the field is small compared to the total number of fractions, standard edge detection algorithms essentially recalculate the same field shape numerous times. A heuristic approach to portal edge detection has been developed that takes advantage of the relatively few changes in the portal field shape throughout a fractionation series. Methods and Materials: The routine applies a standard edge detection routine to calculate an initial field edge and saves the edge information. Subsequent fractions are processed by applying an edge detection operator over a small region about each point of the previously defined contour, to determine any shifts in the field shape in the new image. Failure of this edge check indicates that a significant change in the field edge has occurred, and the original edge detection routine is applied to the image. Otherwise the modified edge contour is used to define the new edge. Results: Two hundred and eighty-one portal images collected from an electronic portal imaging device were processed by the edge detection routine. The algorithm accurately calculated each portal field edge, as well as reducing processing time in subsequent fractions of an individual portal field by a factor of up to 14. Conclusions: The heuristic edge detection routine is an accurate and fast method for calculating portal field edges and determining field edge setup errors

An edge index for the quantum spin-Hall effect

International Nuclear Information System (INIS)

Prodan, Emil

2009-01-01

Quantum spin-Hall systems are topological insulators displaying dissipationless spin currents flowing at the edges of the samples. In contradistinction to the quantum Hall systems where the charge conductance of the edge modes is quantized, the spin conductance is not and it remained an open problem to find the observable whose edge current is quantized. In this paper, we define a particular observable and the edge current corresponding to this observable. We show that this current is quantized and that the quantization is given by the index of a certain Fredholm operator. This provides a new topological invariant that is shown to take the generic values 0 and 2, in line with the Z 2 topological classification of time-reversal invariant systems. The result gives an effective tool for the investigation of the edge structure in quantum spin-Hall systems. Based on a reasonable assumption, we also show that the edge conducting channels are not destroyed by a random edge. (fast track communication)

Aerodynamic Analysis of Trailing Edge Enlarged Wind Turbine Airfoils

DEFF Research Database (Denmark)

Xu, Haoran; Shen, Wen Zhong; Zhu, Wei Jun

2014-01-01

characteristics of blunt trailing edge airfoils are caused by blunt body vortices at low angles of attack, and by the combined effect of separation and blunt body vortices at large angles of attack. With the increase of thickness of blunt trailing edge, the vibration amplitudes of lift and drag curves increase......The aerodynamic performance of blunt trailing edge airfoils generated from the DU- 91-W2-250, DU-97-W-300 and DU-96-W-350 airfoils by enlarging the thickness of trailing edge symmetrically from the location of maximum thickness to chord to the trailing edge were analyzed by using CFD and RFOIL...... methods at a chord Reynolds number of 3 × 106. The goal of this study is to analyze the aerodynamic performance of blunt trailing edge airfoils with different thicknesses of trailing edge and maximum thicknesses to chord. The steady results calculated by the fully turbulent k-ω SST, transitional k-ω SST...

Using new edges for anomaly detection in computer networks

Science.gov (United States)

Neil, Joshua Charles

2015-05-19

Creation of new edges in a network may be used as an indication of a potential attack on the network. Historical data of a frequency with which nodes in a network create and receive new edges may be analyzed. Baseline models of behavior among the edges in the network may be established based on the analysis of the historical data. A new edge that deviates from a respective baseline model by more than a predetermined threshold during a time window may be detected. The new edge may be flagged as potentially anomalous when the deviation from the respective baseline model is detected. Probabilities for both new and existing edges may be obtained for all edges in a path or other subgraph. The probabilities may then be combined to obtain a score for the path or other subgraph. A threshold may be obtained by calculating an empirical distribution of the scores under historical conditions.

A teachable moment communication process for smoking cessation talk: description of a group randomized clinician-focused intervention

Directory of Open Access Journals (Sweden)

Flocke Susan A

2012-05-01

Full Text Available Abstract Background Effective clinician-patient communication about health behavior change is one of the most important and most overlooked strategies to promote health and prevent disease. Existing guidelines for specific health behavior counseling have been created and promulgated, but not successfully adopted in primary care practice. Building on work focused on creating effective clinician strategies for prompting health behavior change in the primary care setting, we developed an intervention intended to enhance clinician communication skills to create and act on teachable moments for smoking cessation. In this manuscript, we describe the development and implementation of the Teachable Moment Communication Process (TMCP intervention and the baseline characteristics of a group randomized trial designed to evaluate its effectiveness. Methods/Design This group randomized trial includes thirty-one community-based primary care clinicians practicing in Northeast Ohio and 840 of their adult patients. Clinicians were randomly assigned to receive either the Teachable Moments Communication Process (TMCP intervention for smoking cessation, or the delayed intervention. The TMCP intervention consisted of two, 3-hour educational training sessions including didactic presentation, skill demonstration through video examples, skills practices with standardized patients, and feedback from peers and the trainers. For each clinician enrolled, 12 patients were recruited for two time points. Pre- and post-intervention data from the clinicians, patients and audio-recorded clinician‒patient interactions were collected. At baseline, the two groups of clinicians and their patients were similar with regard to all demographic and practice characteristics examined. Both physician and patient recruitment goals were met, and retention was 96% and 94% respectively. Discussion Findings support the feasibility of training clinicians to use the Teachable Moments

Mothers' and Clinicians' Priorities for Obesity Prevention Among Black, High-Risk Infants.

Science.gov (United States)

Virudachalam, Senbagam; Gruver, Rachel S; Gerdes, Marsha; Power, Thomas J; Magge, Sheela N; Shults, Justine; Faerber, Jennifer A; Kalra, Gurpreet K; Bishop-Gilyard, Chanelle T; Suh, Andrew W; Berkowitz, Robert I; Fiks, Alexander G

2016-07-01

Despite many recommended strategies for obesity prevention during infancy, effectively delivering recommendations to parents in clinical settings is challenging, especially among high-risk populations. This study describes and compares mothers' and clinicians' priorities for obesity prevention during infancy, to facilitate more-effective obesity prevention messaging. A discrete choice experiment using maximum difference scaling was administered in 2013 and analyzed in 2013-2014. Twenty-nine low-income, obese mothers of infants and 30 pediatric clinicians from three urban primary care practices rated the relative importance of 16 items relevant to obesity prevention during infancy, in response to this question: Which topic would be most helpful [for new mothers] to learn about to prevent your [their] child from becoming overweight? Response options encompassed the domains of feeding, sleep, parenting (including physical activity and screen time), and maternal self-care. Mothers (all Medicaid-enrolled and black; mean age, 27 years; mean BMI, 35 kg/m(2)) and clinicians (97% female, 87% pediatricians, 13% nurse practitioners) both highly prioritized recognizing infant satiety and hunger cues, and appropriate feeding volume. Mothers rated infant physical activity and maintaining regular routines as 3.5 times more important than clinicians did (presponsive to these priorities. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Edges in CNC polishing: from mirror-segments towards semiconductors, paper 1: edges on processing the global surface.

Science.gov (United States)

Walker, David; Yu, Guoyu; Li, Hongyu; Messelink, Wilhelmus; Evans, Rob; Beaucamp, Anthony

2012-08-27

Segment-edges for extremely large telescopes are critical for observations requiring high contrast and SNR, e.g. detecting exo-planets. In parallel, industrial requirements for edge-control are emerging in several applications. This paper reports on a new approach, where edges are controlled throughout polishing of the entire surface of a part, which has been pre-machined to its final external dimensions. The method deploys compliant bonnets delivering influence functions of variable diameter, complemented by small pitch tools sized to accommodate aspheric mis-fit. We describe results on witness hexagons in preparation for full size prototype segments for the European Extremely Large Telescope, and comment on wider applications of the technology.

Urbanization Impacts on Mammals across Urban-Forest Edges and a Predictive Model of Edge Effects

OpenAIRE

Villaseñor, Nélida R.; Driscoll, Don A.; Escobar, Martín A. H.; Gibbons, Philip; Lindenmayer, David B.

2014-01-01

With accelerating rates of urbanization worldwide, a better understanding of ecological processes at the wildland-urban interface is critical to conserve biodiversity. We explored the effects of high and low-density housing developments on forest-dwelling mammals. Based on habitat characteristics, we expected a gradual decline in species abundance across forest-urban edges and an increased decline rate in higher contrast edges. We surveyed arboreal mammals in sites of high and low housing den...

Strain-Dependent Edge Structures in MoS2 Layers.

Science.gov (United States)

Tinoco, Miguel; Maduro, Luigi; Masaki, Mukai; Okunishi, Eiji; Conesa-Boj, Sonia

2017-11-08

Edge structures are low-dimensional defects unavoidable in layered materials of the transition metal dichalcogenides (TMD) family. Among the various types of such structures, the armchair (AC) and zigzag (ZZ) edge types are the most common. It has been predicted that the presence of intrinsic strain localized along these edges structures can have direct implications for the customization of their electronic properties. However, pinning down the relation between local structure and electronic properties at these edges is challenging. Here, we quantify the local strain field that arises at the edges of MoS 2 flakes by combining aberration-corrected transmission electron microscopy (TEM) with the geometrical-phase analysis (GPA) method. We also provide further insight on the possible effects of such edge strain on the resulting electronic behavior by means of electron energy loss spectroscopy (EELS) measurements. Our results reveal that the two-dominant edge structures, ZZ and AC, induce the formation of different amounts of localized strain fields. We also show that by varying the free edge curvature from concave to convex, compressive strain turns into tensile strain. These results pave the way toward the customization of edge structures in MoS 2 , which can be used to engineer the properties of layered materials and thus contribute to the optimization of the next generation of atomic-scale electronic devices built upon them.

The decision to extract: part II. Analysis of clinicians' stated reasons for extraction.

Science.gov (United States)

Baumrind, S; Korn, E L; Boyd, R L; Maxwell, R

1996-04-01

In a recently reported study, the pretreatment records of each subject in a randomized clinical trial of 148 patients with Class I and Class II malocclusions presenting for orthodontic treatment were evaluated independently by five experienced clinicians (drawn from a panel of 14). The clinicians displayed a higher incidence of agreement with each other than had been expected with respect to the decision as to whether extraction was indicated in each specific case. To improve our understanding of how clinicians made their decisions on whether to extract or not, the records of a subset of 72 subjects randomly selected from the full sample of 148, have now been examined in greater detail. In 21 of these cases, all five clinicians decided to treat without extraction. Among the remaining 51 cases, there were 202 decisions to extract (31 unanimous decision cases and 20 split decision cases). The clinicians cited a total of 469 reasons to support these decisions. Crowding was cited as the first reason in 49% of decisions to extract, followed by incisor protrusion (14%), need for profile correction (8%), Class II severity (5%), and achievement of a stable result (5%). When all the reasons for extraction in each clinician's decision were considered as a group, crowding was cited in 73% of decisions, incisor protrusion in 35%, need for profile correction in 27%, Class II severity in 15% and posttreatment stability in 9%. Tooth size anomalies, midline deviations, reduced growth potential, severity of overjet, maintenance of existing profile, desire to close the bite, periodontal problems, and anticipation of poor cooperation accounted collectively for 12% of the first reasons and were mentioned in 54% of the decisions, implying that these considerations play a consequential, if secondary, role in the decision-making process. All other reasons taken together were mentioned in fewer than 20% of cases. In this sample at least, clinicians focused heavily on appearance

A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians.

Science.gov (United States)

Patel, Drasti; Koehmstedt, Christine; Jones, Rebecca; Coffey, Nathan T; Cai, Xinsheng; Garfinkel, Steven; Shaewitz, Dahlia M; Weinstein, Ali A

2017-01-01

Research examining the utilization of evidence-based practice (EBP) specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice. A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed. There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information. Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur.

Selective Electroless Silver Deposition on Graphene Edges

DEFF Research Database (Denmark)

Durhuus, D.; Larsen, M. V.; Andryieuski, Andrei

2015-01-01

We demonstrate a method of electroless selective silver deposition on graphene edges or between graphene islands without covering the surface of graphene. Modifications of the deposition recipe allow for decoration of graphene edges with silver nanoparticles or filling holes in damaged graphene...... on silica substrate and thus potentially restoring electric connectivity with minimal influence on the overall graphene electrical and optical properties. The presented technique could find applications in graphene based transparent conductors as well as selective edge functionalization and can be extended...

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners.

Science.gov (United States)

Kilgour, Catherine; Bogossian, Fiona Elizabeth; Callaway, Leonie; Gallois, Cindy

2018-05-04

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Purposive sampling and convergent interviews explored participants' communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Clinicians who provided maternity care at a tertiary referral hospital (n=13) in Queensland, Australia, and general practitioners (n=16) who provided maternity shared care with that hospital between December 2012 and July 2013. Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights

Edge-Based Image Compression with Homogeneous Diffusion

Science.gov (United States)

Mainberger, Markus; Weickert, Joachim

It is well-known that edges contain semantically important image information. In this paper we present a lossy compression method for cartoon-like images that exploits information at image edges. These edges are extracted with the Marr-Hildreth operator followed by hysteresis thresholding. Their locations are stored in a lossless way using JBIG. Moreover, we encode the grey or colour values at both sides of each edge by applying quantisation, subsampling and PAQ coding. In the decoding step, information outside these encoded data is recovered by solving the Laplace equation, i.e. we inpaint with the steady state of a homogeneous diffusion process. Our experiments show that the suggested method outperforms the widely-used JPEG standard and can even beat the advanced JPEG2000 standard for cartoon-like images.

Two-Dimensional Edge Detection by Guided Mode Resonant Metasurface

Science.gov (United States)

Saba, Amirhossein; Tavakol, Mohammad Reza; Karimi-Khoozani, Parisa; Khavasi, Amin

2018-05-01

In this letter, a new approach to perform edge detection is presented using an all-dielectric CMOS-compatible metasurface. The design is based on guided-mode resonance which provides a high quality factor resonance to make the edge detection experimentally realizable. The proposed structure that is easy to fabricate, can be exploited for detection of edges in two dimensions due to its symmetry. Also, the trade-off between gain and resolution of edge detection is discussed which can be adjusted by appropriate design parameters. The proposed edge detector has also the potential to be used in ultrafast analog computing and image processing.

Edge-based correlation image registration for multispectral imaging

Science.gov (United States)

Nandy, Prabal [Albuquerque, NM

2009-11-17

Registration information for images of a common target obtained from a plurality of different spectral bands can be obtained by combining edge detection and phase correlation. The images are edge-filtered, and pairs of the edge-filtered images are then phase correlated to produce phase correlation images. The registration information can be determined based on these phase correlation images.

Bulk Versus Edge in the Quantum Hall Effect

OpenAIRE

Kao, Y. -C.; Lee, D. -H.

1996-01-01

The manifestation of the bulk quantum Hall effect on edge is the chiral anomaly. The chiral anomaly {\\it is} the underlying principle of the ``edge approach'' of quantum Hall effect. In that approach, $\\sxy$ should not be taken as the conductance derived from the space-local current-current correlation function of the pure one-dimensional edge problem.

Pavement edge treatment.

Science.gov (United States)

2013-01-01

Four projects were built over two construction seasons using special devices attached to the paving machine that produces a 30 slope on the outside pavement edge instead of the near vertical drop-off common with conventional paving equipment. This ...

CHEST: Home of the Clinician-Educator.

Science.gov (United States)

Kelly, William F; Niven, Alexander S

2018-03-01

Many hands can build a house; it takes trust to make that house a home. Trust has two main components: credibility (worthiness based on preparation and past performance) and empathy (the ability to understand and share another person's values). CHEST has maintained its credibility and empathy as the global leader in clinical pulmonary, critical care, and sleep medical education. It follows that the leader in chest clinical education would also be the home of the clinician-educator. You are that educator. Published by Elsevier Inc.

Acoustic streaming of a sharp edge.

Science.gov (United States)

Ovchinnikov, Mikhail; Zhou, Jianbo; Yalamanchili, Satish

2014-07-01

Anomalous acoustic streaming is observed emanating from sharp edges of solid bodies that are vibrating in fluids. The streaming velocities can be orders of magnitude higher than expected from the Rayleigh streaming at similar amplitudes of vibration. Acoustic velocity of fluid relative to a solid body diverges at a sharp edge, giving rise to a localized time-independent body force acting on the fluid. This force results in a formation of a localized jet. Two-dimensional numerical simulations are performed to predict acoustic streaming for low amplitude vibration using two methods: (1) Steady-state solution utilizing perturbation theory and (2) direct transient solution of the Navier-Stokes equations. Both analyses agree with each other and correctly predict the streaming of a sharp-edged vibrating blade measured experimentally. The origin of the streaming can be attributed to the centrifugal force of the acoustic fluid flow around a sharp edge. The dependence of this acoustic streaming on frequency and velocity is examined using dimensional analysis. The dependence law is devised and confirmed by numerical simulations.

Influence of the plasma edge on tokamak performance

International Nuclear Information System (INIS)

Wilson, H.R.; Connor, J.W.; Field, A.R.; Fielding, S.J.; Hastie, R.J.; Taylor, J.B.; Miller, R.L.

2000-01-01

A number of edge plasma physics phenomena are considered to determine tokamak performance: transport barrier, edge MHD instabilities and plasma flow. These phenomena are thought to be causally related: a spontaneous increase in the plasma flow (actually, its radial variation) suppresses heat and particle fluxes at the plasma edge to form a transport barrier; the edge pressure gradient steepens until limited by MHD instabilities, resulting in a temperature pedestal at the top of the steep gradient region; a number of core transport models predict enhanced confinement for higher values of the temperature pedestal. The article examines these phenomena and their interaction. (author)

Influence of the plasma edge on tokamak performance

International Nuclear Information System (INIS)

Wilson, H.R.; Connor, J.W.; Field, A.R.; Fielding, S.J.; Hastie, R.J.; Taylor, J.B.; Miller, R.L.

1999-01-01

A number of edge plasma physics phenomena are considered to determine tokamak performance: transport barrier, edge magneto-hydrodynamic (MHD) instabilities, plasma flow. These phenomena are thought to be causally related: a spontaneous increase in the plasma flow (actually, its radial variation) suppresses heat and particle fluxes at the plasma edge, to form a transport barrier; the edge pressure gradient steepens until limited by MHD instabilities, resulting in a temperature pedestal at the top of the steep gradient region; a number of core transport models predict enhanced confinement for higher values of the temperature pedestal. This paper examines these phenomena and their interaction. (author)

Optimizing 3D Triangulations to Recapture Sharp Edges

DEFF Research Database (Denmark)

Bærentzen, Jakob Andreas

2006-01-01

In this report, a technique for optimizing 3D triangulations is proposed. The method seeks to minimize an energy defined as a sum of energy terms for each edge in a triangle mesh. The main contribution is a novel per edge energy which strikes a balance between penalizing dihedral angle yet allowing...... sharp edges. The energy is minimized using edge swapping, and this can be done either in a greedy fashion or using simulated annealing. The latter is more costly, but effectively avoids local minima. The method has been used on a number of models. Particularly good results have been obtained on digital...

Influence of the plasma edge on tokamak performance

International Nuclear Information System (INIS)

Wilson, H.R.; Connor, J.W.; Field, A.R.; Fielding, S.J.; Hastie, R.J.; Taylor, J.B.; Miller, R.L.

2001-01-01

A number of edge plasma physics phenomena are considered to determine tokamak performance: transport barrier, edge magneto-hydrodynamic (MHD) instabilities, plasma flow. These phenomena are thought to be causally related: a spontaneous increase in the plasma flow (actually, its radial variation) suppresses heat and particle fluxes at the plasma edge, to form a transport barrier; the edge pressure gradient steepens until limited by MHD instabilities, resulting in a temperature pedestal at the top of the steep gradient region; a number of core transport models predict enhanced confinement for higher values of the temperature pedestal. This paper examines these phenomena and their interaction. (author)

Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents.

Science.gov (United States)

Mendoza, Dexter; Peterson, Ryan; Ho, Christopher; Harri, Peter; Baumgarten, Deborah; Mullins, Mark E

2018-05-03

Effective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident "clinician-educator tracks" or "teaching tracks" should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Long coherence times for edge spins

Science.gov (United States)

Kemp, Jack; Yao, Norman Y.; Laumann, Christopher R.; Fendley, Paul

2017-06-01

We show that in certain one-dimensional spin chains with open boundary conditions, the edge spins retain memory of their initial state for very long times, even at infinite temperature. The long coherence times do not require disorder, only an ordered phase. In the integrable Ising and XYZ chains, the presence of a strong zero mode means the coherence time is infinite. When Ising is perturbed by interactions breaking the integrability, the coherence time remains exponentially long in the perturbing couplings. We show that this is a consequence of an edge ‘almost’ strong zero mode that almost commutes with the Hamiltonian. We compute this operator explicitly, allowing us to estimate accurately the plateau value of edge spin autocorrelator.

User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination.

Science.gov (United States)

Henninger, Michelle L; Mcmullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

2017-01-01

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings.

Edge effects and geometric constraints: a landscape-level empirical test.

Science.gov (United States)

Ribeiro, Suzy E; Prevedello, Jayme A; Delciellos, Ana Cláudia; Vieira, Marcus Vinícius

2016-01-01

Edge effects are pervasive in landscapes yet their causal mechanisms are still poorly understood. Traditionally, edge effects have been attributed to differences in habitat quality along the edge-interior gradient of habitat patches, under the assumption that no edge effects would occur if habitat quality was uniform. This assumption was questioned recently after the recognition that geometric constraints tend to reduce population abundances near the edges of habitat patches, the so-called geometric edge effect (GEE). Here, we present the first empirical, landscape-level evaluation of the importance of the GEE in shaping abundance patterns in fragmented landscapes. Using a data set on the distribution of small mammals across 18 forest fragments, we assessed whether the incorporation of the GEE into the analysis changes the interpretation of edge effects and the degree to which predictions based on the GEE match observed responses. Quantitative predictions were generated for each fragment using simulations that took into account home range, density and matrix use for each species. The incorporation of the GEE into the analysis changed substantially the interpretation of overall observed edge responses at the landscape scale. Observed abundances alone would lead to the conclusion that the small mammals as a group have no consistent preference for forest edges or interiors and that the black-eared opossum Didelphis aurita (a numerically dominant species in the community) has on average a preference for forest interiors. In contrast, incorporation of the GEE suggested that the small mammal community as a whole has a preference for forest edges, whereas D. aurita has no preference for forest edges or interiors. Unexplained variance in edge responses was reduced by the incorporation of GEE, but remained large, varying greatly on a fragment-by-fragment basis. This study demonstrates how to model and incorporate the GEE in analyses of edge effects and that this

High Precision Edge Detection Algorithm for Mechanical Parts

Directory of Open Access Journals (Sweden)

Duan Zhenyun

2018-04-01

Full Text Available High precision and high efficiency measurement is becoming an imperative requirement for a lot of mechanical parts. So in this study, a subpixel-level edge detection algorithm based on the Gaussian integral model is proposed. For this purpose, the step edge normal section line Gaussian integral model of the backlight image is constructed, combined with the point spread function and the single step model. Then gray value of discrete points on the normal section line of pixel edge is calculated by surface interpolation, and the coordinate as well as gray information affected by noise is fitted in accordance with the Gaussian integral model. Therefore, a precise location of a subpixel edge was determined by searching the mean point. Finally, a gear tooth was measured by M&M3525 gear measurement center to verify the proposed algorithm. The theoretical analysis and experimental results show that the local edge fluctuation is reduced effectively by the proposed method in comparison with the existing subpixel edge detection algorithms. The subpixel edge location accuracy and computation speed are improved. And the maximum error of gear tooth profile total deviation is 1.9 μm compared with measurement result with gear measurement center. It indicates that the method has high reliability to meet the requirement of high precision measurement.

A Double-Edged Sword: A Review of Benefits and Risks of Online Nonsuicidal Self-Injury Activities.

Science.gov (United States)

Lewis, Stephen P; Seko, Yukari

2016-03-01

This review aimed to synthesize current evidence on the perceived benefits and risks of online activity pertinent to nonsuicidal self-injury (NSSI). A systematic literature search was conducted to identify peer-reviewed articles, which yielded a total of 27 articles published between 2005 and 2015. Following this, a thematic analysis was employed to identify perceived benefits and risks of online NSSI activity. Our thematic analysis identified 4 potential benefits (mitigation of social isolation, recovery encouragement, emotional self-disclosure, curbing NSSI urges) and 3 potential risks (NSSI reinforcement, triggering NSSI urges, stigmatization of NSSI) associated with online NSSI activities. Given the double-edged effect of online NSSI activities, clinicians may benefit from incorporating clients' online NSSI activity in the context of NSSI assessment and treatment. Future research ought to directly examine the link between online NSSI activity and NSSI behavior to better understand the nature of these benefits and risks. © 2015 Wiley Periodicals, Inc.

How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care.

Science.gov (United States)

Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W

2017-11-04

Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

Sn-L3 EDGE and Fe K edge XANES spectra of the surface layer of ancient Chinese black mirror Heiqigu

International Nuclear Information System (INIS)

Gaowei Mengjia; Liu Yuzhen; Chu Wangsheng; Wu Ziyu; Wang Changsui

2009-01-01

The Chinese ancient black mirror known as Heiqigu was studied by x-ray-absorption near-edge structure spectroscopy and results were reported. The Sn-L 3 edge and Fe K edge spectra further confirmed the Schottky-type defect model in the Heiqigu surface system. And it was suggested that the surface layer of the mirror was a combined structure of oxidation of Sn(IV) and Sn(II). (authors)

Conflicts in the ICU: perspectives of administrators and clinicians.

Science.gov (United States)

Danjoux Meth, Nathalie; Lawless, Bernard; Hawryluck, Laura

2009-12-01

The purpose of this study is to understand conflicts in the ICU setting as experienced by clinicians and administrators and explore methods currently used to resolve such conflicts when there may be discordance between clinicians and families, caregivers or administration. Qualitative case study methodology using semi-structured interviews was used. The sample included community and academic health science centres in 16 hospitals from across the province of Ontario, Canada. A total of 42 participants including hospital administrators and ICU clinicians were interviewed. Participants were sampled purposively to ensure representation. The most common source of conflict in the ICU is a result of disagreement about the goals of treatment. Such conflicts arise between the ICU and referring teams (inter-team), among members of the ICU team (intra-team), and between the ICU team and patients' family/substitute decision-maker (SDM). Inter- and intra-team conflicts often contribute to conflicts between the ICU team and families. Various themes were identified as contributing factors that may influence conflict resolution practices as well as the various consequences and challenges of conflict situations. Limitations of current conflict resolution policies were revealed as well as suggested strategies to improve practice. There is considerable variability in dealing with conflicts in the ICU. Greater attention is needed at a systems level to support a culture aimed at prevention and resolution of conflicts to avoid increased sources of anxiety, stress and burnout.

Clinicians' Judgments of the Clinical Utility of Personality Disorder Trait Descriptions.

Science.gov (United States)

Crego, Cristina; Sleep, Chelsea E; Widiger, Thomas A

2016-01-01

Proposed for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was a five-domain, 25-dimensional trait model that would have constituted a significant part of the diagnostic criteria for each personality disorder. A primary concern with respect to the proposal was that clinicians might find such an approach to be unacceptable. This study provides results from three independent data collections that compared clinicians' clinical utility ratings for each iteration of the DSM-5 dimensional trait assignments, along with an alternative list of traits derived from the Five Factor Form (FFF). The clinicians considered the final trait assignments that were posted for the avoidant, narcissistic, obsessive-compulsive, and schizoid personality disorders to be significantly less acceptable than the original assignments. They also considered the FFF trait assignments to be preferable to the DSM-5 final postings with respect to the avoidant, narcissistic, obsessive-compulsive, dependent, and histrionic personality disorders. The implications of these results for future editions of the diagnostic manual are discussed.

Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance.

Science.gov (United States)

Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

2010-06-03

Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (ptechnician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for GAD. This form of treatment has potential to increase the

Diagnosing phenotypes of single-sample individuals by edge biomarkers.

Science.gov (United States)

Zhang, Wanwei; Zeng, Tao; Liu, Xiaoping; Chen, Luonan

2015-06-01

Network or edge biomarkers are a reliable form to characterize phenotypes or diseases. However, obtaining edges or correlations between molecules for an individual requires measurement of multiple samples of that individual, which are generally unavailable in clinical practice. Thus, it is strongly demanded to diagnose a disease by edge or network biomarkers in one-sample-for-one-individual context. Here, we developed a new computational framework, EdgeBiomarker, to integrate edge and node biomarkers to diagnose phenotype of each single test sample. By applying the method to datasets of lung and breast cancer, it reveals new marker genes/gene-pairs and related sub-networks for distinguishing earlier and advanced cancer stages. Our method shows advantages over traditional methods: (i) edge biomarkers extracted from non-differentially expressed genes achieve better cross-validation accuracy of diagnosis than molecule or node biomarkers from differentially expressed genes, suggesting that certain pathogenic information is only present at the level of network and under-estimated by traditional methods; (ii) edge biomarkers categorize patients into low/high survival rate in a more reliable manner; (iii) edge biomarkers are significantly enriched in relevant biological functions or pathways, implying that the association changes in a network, rather than expression changes in individual molecules, tend to be causally related to cancer development. The new framework of edge biomarkers paves the way for diagnosing diseases and analyzing their molecular mechanisms by edges or networks in one-sample-for-one-individual basis. This also provides a powerful tool for precision medicine or big-data medicine. © The Author (2015). Published by Oxford University Press on behalf of Journal of Molecular Cell Biology, IBCB, SIBS, CAS. All rights reserved.

ESIM: Edge Similarity for Screen Content Image Quality Assessment.

Science.gov (United States)

Ni, Zhangkai; Ma, Lin; Zeng, Huanqiang; Chen, Jing; Cai, Canhui; Ma, Kai-Kuang

2017-10-01

In this paper, an accurate full-reference image quality assessment (IQA) model developed for assessing screen content images (SCIs), called the edge similarity (ESIM), is proposed. It is inspired by the fact that the human visual system (HVS) is highly sensitive to edges that are often encountered in SCIs; therefore, essential edge features are extracted and exploited for conducting IQA for the SCIs. The key novelty of the proposed ESIM lies in the extraction and use of three salient edge features-i.e., edge contrast, edge width, and edge direction. The first two attributes are simultaneously generated from the input SCI based on a parametric edge model, while the last one is derived directly from the input SCI. The extraction of these three features will be performed for the reference SCI and the distorted SCI, individually. The degree of similarity measured for each above-mentioned edge attribute is then computed independently, followed by combining them together using our proposed edge-width pooling strategy to generate the final ESIM score. To conduct the performance evaluation of our proposed ESIM model, a new and the largest SCI database (denoted as SCID) is established in our work and made to the public for download. Our database contains 1800 distorted SCIs that are generated from 40 reference SCIs. For each SCI, nine distortion types are investigated, and five degradation levels are produced for each distortion type. Extensive simulation results have clearly shown that the proposed ESIM model is more consistent with the perception of the HVS on the evaluation of distorted SCIs than the multiple state-of-the-art IQA methods.

Edge-based compression of cartoon-like images with homogeneous diffusion

DEFF Research Database (Denmark)

Mainberger, Markus; Bruhn, Andrés; Weickert, Joachim

2011-01-01

Edges provide semantically important image features. In this paper a lossy compression method for cartoon-like images is presented, which is based on edge information. Edges together with some adjacent grey/colour values are extracted and encoded using a classical edge detector, binary compressio...

The Edge Detectors Suitable for Retinal OCT Image Segmentation

Directory of Open Access Journals (Sweden)

Su Luo

2017-01-01

Full Text Available Retinal layer thickness measurement offers important information for reliable diagnosis of retinal diseases and for the evaluation of disease development and medical treatment responses. This task critically depends on the accurate edge detection of the retinal layers in OCT images. Here, we intended to search for the most suitable edge detectors for the retinal OCT image segmentation task. The three most promising edge detection algorithms were identified in the related literature: Canny edge detector, the two-pass method, and the EdgeFlow technique. The quantitative evaluation results show that the two-pass method outperforms consistently the Canny detector and the EdgeFlow technique in delineating the retinal layer boundaries in the OCT images. In addition, the mean localization deviation metrics show that the two-pass method caused the smallest edge shifting problem. These findings suggest that the two-pass method is the best among the three algorithms for detecting retinal layer boundaries. The overall better performance of Canny and two-pass methods over EdgeFlow technique implies that the OCT images contain more intensity gradient information than texture changes along the retinal layer boundaries. The results will guide our future efforts in the quantitative analysis of retinal OCT images for the effective use of OCT technologies in the field of ophthalmology.

Evaluation of potential substrates for restenosis and thrombosis in overlapped versus edge-to-edge juxtaposed bioabsorbable scaffolds: Insights from a computed fluid dynamic study.

Science.gov (United States)

Rigatelli, Gianluca; Zuin, Marco; Dell'Avvocata, Fabio; Cardaioli, Paolo; Vassiliev, Dobrin; Ferenc, Miroslaw; Nghia, Nguyen Tuan; Nguyen, Thach; Foin, Nicholas

2018-04-01

Multiple BRSs and specifically the Absorb scaffold (BVS) (Abbott Vascular, Santa Clara, CA USA) have been often used to treat long diffuse coronary artery lesions. We evaluate by a computational fluid dynamic(CFD) study the impact on the intravascular fluid rheology on multiple bioabsorbable scaffolds (BRS) by standard overlapping versus edge-to-edge technique. We simulated the treatment of a real long significant coronary lesion (>70% luminal narrowing) involving the left anterior descending artery (LAD) treated with a standard or edge-to-edge technique, respectively. Simulations were performed after BVS implantations in two different conditions: 1) Edge-to-edge technique, where the scaffolds are kissed but not overlapped resulting in a luminal encroachment of 0.015cm (150μm); 2) Standard overlapping, where the scaffolds are overlapped resulting in a luminal encroachment of 0.030cm (300μm). After positioning the BVS across the long lesion, the implantation procedure was performed in-silico following all the usual procedural steps. Analysis of the wall shear stress (WSS) suggested that at the vessel wall level the WSS were lower in the overlapping zones overlapping compared to the edge-to-edge zone (∆=0.061Pa, p=0.01). At the struts level the difference between the two WSS was more striking (∆=1.065e-004 p=0.01) favouring the edge-to-edge zone. Our study suggested that at both vessel wall and scaffold struts levels, there was lowering WSS when multiple BVS were implanted with the standard overlapping technique compared to the "edge-to-edge" technique. This lower WSS might represent a substrate for restenosis, early and late BVS thrombosis, potentially explaining at least in part the recent evidences of devices poor performance. Copyright © 2017 Elsevier Inc. All rights reserved.

Accuracy of Clinicians in Predicting the Bacterial Cause of Clinical Bovine Mastitis

OpenAIRE

White, Maurice E.; Glickman, Lawrence T.; Barnes-Pallesen, Frances D.; Stem, Edgar S.; Dinsmore, Page; Powers, Michael S.; Powers, Pamela; Smith, Mary C.; Jasko, David

1986-01-01

We examined the ability of clinicians to predict the causative organism of bovine mastitis in our practice. We obtained 118 milk culture results from 112 mastitic cows and compared the culture results to the predictions of clinicians at the time of milk sample collection. Sixty of 118 culture results were accurately predicted. The positive predictive value for coliform mastitis was 42% and the negative predictive value was 79% in a study population with a 31% prevalence of coliform mastitis. ...

Effect of Physical Therapy Students' Clinical Experiences on Clinician Productivity.

Science.gov (United States)

Pivko, Susan E; Abbruzzese, Laurel D; Duttaroy, Pragati; Hansen, Ruth L; Ryans, Kathryn

2016-01-01

Physical therapy clinical education experiences (CEEs) are difficult to secure, particularly first-level CEEs. Our purpose was to determine 1) what impact student full-time CEEs have on PT clinician productivity and 2) whether there is a productivity difference between first vs final CEEs. Productivity logs, including possible factors impacting productivity, were distributed to clinician-student pairings on first and final CEEs. Two-week baseline data (without a student) were compared to weeks 1 and 6 (with a student) for 31 logs using a 2x4 repeated-measures ANOVA. In a subset of 17 logs for CEEs 8 weeks or longer, a 2x5 repeated-measures ANOVA was performed. There was a significant increase in the number of patients seen and CPT units billed by both levels of CEEs comparing weeks 1 and 6. In the subset of CEEs, 8 weeks or longer, there was a significant increase in the number of patients treated per hour at week 6 and a trend toward a change at week 8 when compared to baseline week A. The factors selected as impacting productivity were census (59%) and staffing (32%). Physical therapy clinician-student pairings showed an overall increase in productivity during both full-time first and final level CEEs.

Material Discrimination Based on K-edge Characteristics

Directory of Open Access Journals (Sweden)

Peng He

2013-01-01

Full Text Available Spectral/multienergy CT employing the state-of-the-art energy-discriminative photon-counting detector can identify absorption features in the multiple ranges of photon energies and has the potential to distinguish different materials based on K-edge characteristics. K-edge characteristics involve the sudden attenuation increase in the attenuation profile of a relatively high atomic number material. Hence, spectral CT can utilize material K-edge characteristics (sudden attenuation increase to capture images in available energy bins (levels/windows to distinguish different material components. In this paper, we propose an imaging model based on K-edge characteristics for maximum material discrimination with spectral CT. The wider the energy bin width is, the lower the noise level is, but the poorer the reconstructed image contrast is. Here, we introduce the contrast-to-noise ratio (CNR criterion to optimize the energy bin width after the K-edge jump for the maximum CNR. In the simulation, we analyze the reconstructed image quality in different energy bins and demonstrate that our proposed optimization approach can maximize CNR between target region and background region in reconstructed image.

DIII-D edge physics database

International Nuclear Information System (INIS)

Jong, R.A.; Porter, G.D.; Hill, D.N.; Buchenauer, D.A.; Bramson, G.

1992-03-01

We have developed an edge-physics database containing data for the plasma in the divertor region and the scrape-off layer (SOL) for the DIII-D tokamak. The database provides many of the parameters necessary to model the power flow to the divertor and other plasma processes in the plasma edge. It will also facilitate the analysis of DIII-D data for comparison with other divertor tokamaks. In addition to the core plasma parameters, edge-specific data are included in this database. Initial results using the database show good agreement between the pressure profiles measured by the Langmuir probes and those determined from the Thomson data for the inner strike point, but not for the outer strike point region. We also find that the ratio of separatrix density to average core density, as well as the in/out asymmetry in the SOL power at the divertor in DIII-D do not agree with values currently assumed in modeling the International Thermonuclear Experimental Reactor (ITER)

New approach in two-dimensional fluid modeling of edge plasma transport with high intermittency due to blobs and edge localized modes

International Nuclear Information System (INIS)

Pigarov, A. Yu.; Krasheninnikov, S. I.; Rognlien, T. D.

2011-01-01

A new approach is proposed to simulate intermittent, non-diffusive plasma transport (via blobs and filaments of edge localized modes (ELMs)) observed in the tokamak edge region within the framework of two-dimensional transport codes. This approach combines the inherently three-dimensional filamentary structures associated with an ensemble of blobs into a macro-blob in the two-dimensional poloidal cross-section and advects the macro-blob ballistically across the magnetic field, B. Intermittent transport is represented as a sequence of macro-blobs appropriately seeded in the edge plasma according to experimental statistics. In this case, the code is capable of reproducing both the long-scale temporal evolution of the background plasma and the fast spatiotemporal dynamics of blobs. We report the results from a two-dimensional edge plasma code modeling of a single macro-blob dynamics, and its interaction with initially stationary background plasma as well as with material surfaces. The mechanisms of edge plasma particle and energy losses from macro-blobs are analyzed. The effects of macro-blob sizes and advection velocity on edge plasma profiles are studied. The macro-blob impact on power loading and sputtering rates on the chamber wall and on inner and outer divertor plates is discussed. Temporal evolution of particle inventory of the edge plasma perturbed by macro-blobs is analyzed. Application of macro-blobs to ELM modeling is highlighted.

Knowledge transfer to clinicians and consumers by the Cochrane Musculoskeletal Group.

Science.gov (United States)

Santesso, Nancy; Maxwell, Lara; Tugwell, Peter S; Wells, George A; O'connor, Annette M; Judd, Maria; Buchbinder, Rachelle

2006-11-01

The Cochrane Musculoskeletal Group (CMSG) is one of 50 groups of the Cochrane Collaboration that prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. Once systematic reviews are completed, the next challenge is presenting the results in useful formats to be integrated into the healthcare decisions of clinicians and consumers. The CMSG recommends 3 methods to aid knowledge translation and exchange between clinicians and patients: produce clinical relevance tables, create graphical displays using face figures, and write consumer summaries and patient decision aids. Accordingly, CMSG has developed specific guidelines to help researchers and authors convert the pooled estimates of metaanalyses in the systematic reviews to user-friendly numbers. First, clinical relevance tables are developed that include absolute and relative benefits or harms and the numbers needed to treat. Next, the numbers from the clinical relevance tables are presented graphically using faces. The faces represent a group of 100 people and are shaded according to how many people out of 100 benefited or were harmed by the interventions. The user-friendly numbers are also included in short summaries and decision aids written for patients. The different levels of detail in the summaries and decision aids provide patients with tools to prepare them to discuss treatment options with their clinicians. Methods to improve the effects and usability of systematic reviews by providing results in more clinically relevant formats are essential. Both clinicians and consumers can use these products to use evidence-based information in individual and shared decision-making.

Dynamic Stall Characteristics of Drooped Leading Edge Airfoils

Science.gov (United States)

Sankar, Lakshmi N.; Sahin, Mehmet; Gopal, Naveen

2000-01-01

Helicopters in high-speed forward flight usually experience large regions of dynamic stall over the retreating side of the rotor disk. The rapid variations in the lift and pitching moments associated with the stall process can result in vibratory loads, and can cause fatigue and failure of pitch links. In some instances, the large time lag between the aerodynamic forces and the blade motion can trigger stall flutter. A number of techniques for the alleviation of dynamic stall have been proposed and studied by researchers. Passive and active control techniques have both been explored. Passive techniques include the use of high solidity rotors that reduce the lift coefficients of individual blades, leading edge slots and leading edge slats. Active control techniques include steady and unsteady blowing, and dynamically deformable leading edge (DDLE) airfoils. Considerable amount of experimental and numerical data has been collected on the effectiveness of these concepts. One concept that has not received as much attention is the drooped-leading edge airfoil idea. It has been observed in wind tunnel studies and flight tests that drooped leading edge airfoils can have a milder dynamic stall, with a significantly milder load hysteresis. Drooped leading edge airfoils may not, however, be suitable at other conditions, e.g. in hover, or in transonic flow. Work needs to be done on the analysis and design of drooped leading edge airfoils for efficient operation in a variety of flight regimes (hover, dynamic stall, and transonic flow). One concept that is worthy of investigation is the dynamically drooping airfoil, where the leading edge shape is changed roughly once-per-rev to mitigate the dynamic stall.

On-line ethics education for occupational therapy clinician-educators: a single-group pre-/post-test study.

Science.gov (United States)

VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

2018-05-20

Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators). The Knowledge-to-Action Process informed development and evaluation of the module. Clinician-educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires. Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p ethics education module for clinician-educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology. Implications for Rehabilitation The on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators. Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices. More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators. Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice.

Characteristics of Ir/Au transition edge sensor

International Nuclear Information System (INIS)

Kunieda, Yuichi; Ohno, Masashi; Nakazawa, Masaharu; Takahashi, Hiroyuki; Fukuda, Daiji; Ohkubo, Masataka

2004-01-01

A new type of microcalorimeter has been developed using a transition edge sensor (TES) and an electro-thermal feedback (ETF) method to achieve higher energy resolution and higher count rate. We are developing a superconducting Ir-based transition edge sensor (TES) microcalorimeters. To improve thermal conductivity and achieve higher energy resolution with an Ir-TES, we fabricated an Ir/Au bilayer TES by depositing gold on Ir and investigated the influence of intermediate between superconducting and normal states at the transition edge for signal responses by microscopic observation in the Ir/Au-TES. (T. Tanaka)

Symmetric airfoil geometry effects on leading edge noise.

Science.gov (United States)

Gill, James; Zhang, X; Joseph, P

2013-10-01

Computational aeroacoustic methods are applied to the modeling of noise due to interactions between gusts and the leading edge of real symmetric airfoils. Single frequency harmonic gusts are interacted with various airfoil geometries at zero angle of attack. The effects of airfoil thickness and leading edge radius on noise are investigated systematically and independently for the first time, at higher frequencies than previously used in computational methods. Increases in both leading edge radius and thickness are found to reduce the predicted noise. This noise reduction effect becomes greater with increasing frequency and Mach number. The dominant noise reduction mechanism for airfoils with real geometry is found to be related to the leading edge stagnation region. It is shown that accurate leading edge noise predictions can be made when assuming an inviscid meanflow, but that it is not valid to assume a uniform meanflow. Analytic flat plate predictions are found to over-predict the noise due to a NACA 0002 airfoil by up to 3 dB at high frequencies. The accuracy of analytic flat plate solutions can be expected to decrease with increasing airfoil thickness, leading edge radius, gust frequency, and Mach number.

Isotropic covariance functions on graphs and their edges

DEFF Research Database (Denmark)

Anderes, E.; Møller, Jesper; Rasmussen, Jakob Gulddahl

We develop parametric classes of covariance functions on linear networks and their extension to graphs with Euclidean edges, i.e., graphs with edges viewed as line segments or more general sets with a coordinate system allowing us to consider points on the graph which are vertices or points...... on an edge. Our covariance functions are defined on the vertices and edge points of these graphs and are isotropic in the sense that they depend only on the geodesic distance or on a new metric called the resistance metric (which extends the classical resistance metric developed in electrical network theory...... functions in the spatial statistics literature (the power exponential, Matérn, generalized Cauchy, and Dagum classes) are shown to be valid with respect to the resistance metric for any graph with Euclidean edges, whilst they are only valid with respect to the geodesic metric in more special cases....

An Edge Rotation and Temperature Diagnostic on NSTX

International Nuclear Information System (INIS)

Biewer, T.M.; Bell, R.E.; Feder, R.; Johnson, D.W.; Palladino, R.W.

2003-01-01

A new diagnostic for the National Spherical Torus Experiment (NSTX) is described whose function is to measure ion rotation and temperature at the plasma edge. The diagnostic is sensitive to C III, C IV, and He II intrinsic emission, covering a radial region of 15 cm at the extreme edge of the outboard midplane. Thirteen chords are distributed between toroidal and poloidal views, allowing the toroidal and poloidal rotation and temperature of the plasma edge to be simultaneously measured with 10 ms resolution. Combined with the local pressure gradient and the EFIT code reconstructed magnetic field profile, the edge flow gives a measure of the local radial electric field

Numerical studies of edge localized instabilities in tokamaks

International Nuclear Information System (INIS)

Wilson, H.R.; Snyder, P.B.; Huysmans, G.T.A.; Miller, R.L.

2002-01-01

A new computational tool, edge localized instabilities in tokamaks equilibria (ELITE), has been developed to help our understanding of short wavelength instabilities close to the edge of tokamak plasmas. Such instabilities may be responsible for the edge localized modes observed in high confinement H-mode regimes, which are a serious concern for next step tokamaks because of the high transient power loads which they can impose on divertor target plates. ELITE uses physical insight gained from analytic studies of peeling and ballooning modes to provide an efficient way of calculating the edge ideal magnetohydrodynamic stability properties of tokamaks. This paper describes the theoretical formalism which forms the basis for the code

Obesity perceptions and documentation among primary care clinicians at a rural academic health center.

Science.gov (United States)

Aleem, Sohaib; Lasky, Rosalind; Brooks, W Blair; Batsis, John A

2015-01-01

Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Loyalty in the trenches: practical teleology for office clinicians responding to terrorism.

Science.gov (United States)

Trotter, Griffin

2004-08-01

Were terrorists ever to effectively deploy weapons of mass destruction, medical practice would be quickly transformed. Many ordinary clinicians would be asked or required to treat unfamiliar yet serious medical conditions in a setting of overwhelming urgency and impossible odds. Clinical focus would shift from doing good things for a succession of individual patients to considering many patients at once, a change that could beget loss of trust and rapport with patients. Clinicians might also experience restrictions in personal liberties and appropriation of their property. The purpose of this essay is to develop a teleological framework for undertaking this transformation. In ordinary clinical medicine, the elusiveness of the individual telos (i.e.,the good for the individual) is acknowledged in procedures (such as social history taking,informed consent and outpatient scheduling) designed to protect patients' (and clinicians')prerogatives to interpret the telos for themselves. In mass casualty scenarios, on the other hand, the telos is standardized and regarded as an Immediate Object (usually as a state of affairs in which survival is maximized and permanent disability is minimized). Clinicians who provide mass casualty care will face a number of ethical challenges that can be negotiated by appealing to the political and ethical rationale, and limits, pertaining to the pursuit of aggregate survival as an Immediate Object.

A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder.

Science.gov (United States)

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2017-11-01

This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.

Floquet edge states in germanene nanoribbons

KAUST Repository

Tahir, Muhammad

2016-08-23

We theoretically demonstrate versatile electronic properties of germanene monolayers under circularly, linearly, and elliptically polarized light. We show for the high frequency regime that the edge states can be controlled by tuning the amplitude of the light and by applying a static electric field. For circularly polarized light the band gap in one valley is reduced and in the other enhanced, enabling single valley edge states. For linearly polarized light spin-split states are found for both valleys, being connected by time reversal symmetry. The effects of elliptically polarized light are similar to those of circularly polarized light. The transport properties of zigzag nanoribbons in the presence of disorder confirm a nontrivial nature of the edge states under circularly and elliptically polarized light.

Effect of finite edge radius on ductile fracture ahead of the cutting tool edge in micro-cutting of Al2024-T3

International Nuclear Information System (INIS)

Subbiah, Sathyan; Melkote, Shreyes N.

2008-01-01

Evidence of ductile fracture leading to material separation has been reported recently in ductile metal cutting [S. Subbiah, S.N. Melkote, ASME J. Manuf. Sci. Eng. 28(3) (2006)]. This paper investigates the effect of finite edge radius on such ductile fracture. The basic question of whether such ductile fracture occurs in the presence of a finite edge radius is explored by performing a series of experiments with inserts of different edge radii at various uncut chip thickness values ranging from 15 to 105 μm. Chip-roots are obtained in these experiments using a quick-stop device and examined in a scanning electron microscope. Clear evidence of material separation is seen at the interface zone between the chip and machined surface even when the edge radius is large compared to the uncut chip thickness. Failure is seen to occur at the upper, middle, and/or the lower edges of the interface zone. Based on these observations, a hypothesis is presented for the events leading to the occurrence of this failure when cutting with an edge radius tool. Finite element simulations are performed to study the nature of stress state ahead of the tool edge with and without edge radius. Hydrostatic stress is seen to be tensile in front of the tool and hence favors the occurrence of ductile fracture leading to material separation. The stress components are, however lower than those seen with a sharp tool

Wisps in the outer edge of the Keeler Gap

Science.gov (United States)

Tiscareno, Matthew S.; Arnault, Ethan G.

2015-11-01

Superposed upon the relatively smooth outer edge of the Keeler Gap are a system of "wisps," which appear to be ring material protruding inward into the gap, usually with a sharp trailing edge and a smooth gradation back to the background edge location on the leading side (Porco et al. 2005, Science). The radial amplitude of wisps is usually 0.5 to 1 km, and their azimuthal extent is approximately a degree of longitude (~2400 km). Wisps are likely caused by an interplay between Daphnis (and perhaps other moons) and embedded moonlets within the ring, though the details remain unclear.Aside from the wisps, the Keeler Gap outer edge is the only one of the five sharp edges in the outer part of Saturn's A ring that is reasonably smooth in appearance (Tiscareno et al. 2005, DPS), with occultations indicating residuals less than 1 km upon a possibly non-zero eccentricity (R.G. French, personal communication, 2014). The other four (the inner and outer edges of the Encke Gap, the inner edge of the Keeler Gap, and the outer edge of the A ring itself) are characterized by wavy structure at moderate to high spatial frequencies, with amplitudes ranging from 2 to 30 km (Tiscareno et al. 2005, DPS).We will present a catalogue of wisp detections in Cassini images. We carry out repeated gaussian fits of the radial edge location in order to characterize edge structure and visually scan those fitted edges in order to detect wisps. With extensive coverage in longitude and in time, we will report on how wisps evolve and move, both within an orbit period and on longer timescales. We will also report on the frequency and interpretation of wisps that deviate from the standard morphology. We will discuss the implications of our results for the origin and nature of wisps, and for the larger picture of how masses interact within Saturn's rings.

Edge states in a ferromagnetic honeycomb lattice with armchair boundaries

Science.gov (United States)

Pantaleón, Pierre A.; Xian, Y.

2018-02-01

We investigate the properties of magnon edge states in a ferromagnetic honeycomb lattice with armchair boundaries. In contrast with fermionic graphene, we find novel edge states due to the missing bonds along the boundary sites. After introducing an external on-site potential at the outermost sites we find that the energy spectra of the edge states are tunable. Additionally, when a non-trivial gap is induced, we find that some of the edge states are topologically protected and also tunable. Our results may explain the origin of the novel edge states recently observed in photonic lattices. We also discuss the behavior of these edge states for further experimental confirmations.

Evolution of edge pedestal transport between edge-localized modes in DIII-D

Energy Technology Data Exchange (ETDEWEB)

Floyd, J.-P.; Stacey, W. M.; Mellard, S. C. [Georgia Institute of Technology, Atlanta, Georgia 30332 (United States); Groebner, R. J. [General Atomics, San Diego, California 92186 (United States)

2015-02-15

Evolution of measured profiles of densities, temperatures, and velocities in the edge pedestal region between successive ELM (edge-localized mode) events are analyzed and interpreted in terms of the constraints imposed by particle, momentum and energy balance in order to gain insights regarding the underlying evolution of transport processes in the edge pedestal between ELMs in a series of DIII-D [J. Luxon, Nucl. Fusion 42, 614 (2002)] discharges. The data from successive inter-ELM periods during an otherwise steady-state phase of the discharges were combined into a composite inter-ELM period for the purpose of increasing the number of data points in the analysis. Variation of diffusive and non-diffusive (pinch) particle, momentum, and energy transport over the inter-ELM period are interpreted using the GTEDGE code for discharges with plasma currents from 0.5 to 1.5 MA and inter-ELM periods from 50 to 220 ms. Diffusive transport is dominant for ρ < 0.925, while non-diffusive and diffusive transport are very large and nearly balancing in the sharp gradient region 0.925 < ρ < 1.0. During the inter-ELM period, diffusive transport increases slightly more than non-diffusive transport, increasing total outward transport. Both diffusive and non-diffusive transport have a strong inverse correlation with plasma current.

Full-waveform data for building roof step edge localization

Science.gov (United States)

Słota, Małgorzata

2015-08-01

Airborne laser scanning data perfectly represent flat or gently sloped areas; to date, however, accurate breakline detection is the main drawback of this technique. This issue becomes particularly important in the case of modeling buildings, where accuracy higher than the footprint size is often required. This article covers several issues related to full-waveform data registered on building step edges. First, the full-waveform data simulator was developed and presented in this paper. Second, this article provides a full description of the changes in echo amplitude, echo width and returned power caused by the presence of edges within the laser footprint. Additionally, two important properties of step edge echoes, peak shift and echo asymmetry, were noted and described. It was shown that these properties lead to incorrect echo positioning along the laser center line and can significantly reduce the edge points' accuracy. For these reasons and because all points are aligned with the center of the beam, regardless of the actual target position within the beam footprint, we can state that step edge points require geometric corrections. This article presents a novel algorithm for the refinement of step edge points. The main distinguishing advantage of the developed algorithm is the fact that none of the additional data, such as emitted signal parameters, beam divergence, approximate edge geometry or scanning settings, are required. The proposed algorithm works only on georeferenced profiles of reflected laser energy. Another major advantage is the simplicity of the calculation, allowing for very efficient data processing. Additionally, the developed method of point correction allows for the accurate determination of points lying on edges and edge point densification. For this reason, fully automatic localization of building roof step edges based on LiDAR full-waveform data with higher accuracy than the size of the lidar footprint is feasible.

Patient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers.

Science.gov (United States)

Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David H

2015-01-01

With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient-clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Mobile texting messaging has the potential to play an important role in patient-clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication.

Electron transport in edge-disordered graphene nanoribbons

DEFF Research Database (Denmark)

Saloriutta, Karri; Hancock, Y.; Karkkainen, Asta

2011-01-01

Ab initio methods are used to study the spin-resolved transport properties of graphene nanoribbons (GNRs) that have both chemical and structural edge disorder. Oxygen edge adsorbates on ideal and protruded ribbons are chosen as representative examples, with the protrusions forming the smallest...

Polarimetric Edge Detector Based on the Complex Wishart Distribution

DEFF Research Database (Denmark)

Skriver, Henning; Schou, Jesper; Nielsen, Allan Aasbjerg

2001-01-01

polarimetric edge detector provides a constant false alarm rate and it utilizes the full polarimetric information. The edge detector has been applied to polarimetric SAR data from the Danish dual-frequency, airborne polarimetric SAR, EMISAR. The results show clearly an improved edge detection performance...

Edge and coupled core/edge transport modelling in tokamaks

International Nuclear Information System (INIS)

Lodestro, L.L.; Casper, T.A.; Cohen, R.H.

1999-01-01

Recent advances in the theory and modelling of tokamak edge, scrape-off-layer (SOL) and divertor plasmas are described. The effects of the poloidal E x B drift on inner/outer divertor-plate asymmetries within a 1D analysis are shown to be in good agreement with experimental trends; above a critical v ExB , the model predicts transitions to supersonic flow at the inboard midplane. 2D simulations show the importance of E x B flow in the private-flux region and of ∇ B-drifts. A theory of rough plasma-facing surfaces is given, predicting modifications to the SOL plasma. The parametric dependence of detached-plasma states in slab geometry has been explored; with sufficient pumping, the location of the ionization front can be controlled; otherwise only fronts near the plate or the X-point are stable. Studies with a more accurate Monte-Carlo neutrals model and a detailed non-LTE radiation-transport code indicate various effects are important for quantitative modelling. Detailed simulations of the DIII-D core and edge are presented; impurity and plasma flow are discussed and shown to be well modelled with UEDGE. (author)

Edge and coupled core-edge transport modelling in tokamaks

International Nuclear Information System (INIS)

Lodestro, L.L.; Casper, T.A.; Cohen, R.H.

2001-01-01

Recent advances in the theory and modelling of tokamak edge, scrape-off-layer (SOL) and divertor plasmas are described. The effects of the poloidal ExB drift on inner/outer divertor-plate asymmetries within a 1D analysis are shown to be in good agreement with experimental trends; above a critical v ExB, the model predicts transitions to supersonic SOL flow at the inboard midplane. 2D simulations show the importance of ExB flow in the private-flux region and of ∇ B-drifts. A theory of rough plasma-facing surfaces is given, predicting modifications to the SOL plasma. The parametric dependence of detached-plasma states in slab geometry has been explored; with sufficient pumping, the location of the ionization front can be controlled; otherwise only fronts near the plate or the X-point are stable. Studies with a more accurate Monte-Carlo neutrals model and a detailed non-LTE radiation-transport code indicate various effects are important for quantitative modelling. Detailed simulations of the DIII-D core and edge are presented; impurity and plasma flow are discussed and shown to be well modelled with UEDGE. (author)

Best Practices in Talent Management How the World's Leading Corporations Manage, Develop, and Retain Top Talent

CERN Document Server

Goldsmith, Marshall

2010-01-01

Comprehensive in scope, this book features more than 15 case studies and dozens of competency models, tools, instruments, and training material from the world's best global talent management systems and campaigns that show how thy successfully implemented and maintained talent management programs. Each case study includes tools, templates, competency models, guidelines, and training materials that can easily transfer to the real-world work of HR professionals. In addition the book is written by leading-edge contributions from the top thinkers in the field.

Variation in Local-Scale Edge Effects: Mechanisms and landscape Context

Science.gov (United States)

Therese M. Donovan; Peter W. Jones; Elizabeth M. Annand; Frank R. Thompson III

1997-01-01

Ecological processes near habitat edges often differ from processes away from edges. Yet, the generality of "edge effects" has been hotly debated because results vary tremendously. To understand the factors responsible for this variation, we described nest predation and cowbird distribution patterns in forest edge and forest core habitats on 36 randomly...

Usability testing of two e-learning resources: methods to maximize potential for clinician use.

Science.gov (United States)

Menon, Anita; Korner-Bitensky, Nicol; Chignell, Mark; Straus, Sharon

2012-04-01

Rigorous usability testing of e-learn-ing resources is an important prerequisite to their wide-spread use among clinicians. This study demonstrates the application of an evidence-based approach to usability testing of two stroke-related e-learning resources (StrokEngine). 14 stroke rehabilitation clinicians (occupational therapists and physiotherapists) from Ontario, Canada participated in a 1.5 h in-person testing session. Clinicians navigated StrokEngine in search of information to answer questions on stroke assessment/intervention. Their search patterns were observed and clinicians provided verbal/written feedback about StrokEngine. Content analysis was used to generate themes and categorize them under two broad categories: facilitators and barriers to use. Five key facilitators and three key barriers to Strok-Engine use were identified and related to screen format, layout/organization, ease of navigation, quality of content, likelihood of using StrokEngine in the future, and system dysfunctions. All 14 clinicians were very or extremely satisfied with the layout/organization, quality and clinical relevance of the content, stating that they were likely to use StrokEngine in the future. All identified barriers from this study were addressed with website modifications in order to maximize the usability and navigability of StrokEngine. This rigorous methodology for usability testing can be applied during the design process of any e-learning resource.

Flow distortion at a dense forest edge

DEFF Research Database (Denmark)

Dellwik, Ebba; Bingöl, Ferhat; Mann, Jakob

2014-01-01

The flow near tall forest edges is complex, yet poorly described. A field experiment using two meteorological masts equipped with sonic anemometers and a horizontally staring lidar was performed upwind and downwind of the interface between an open flat farmland and a tall (hc = 24 m) beech forest......, relative to the measurements upwind of the edge. The lidar data taken at several positions between the masts at 1.25hc show that the minimum wind speed occurred just upwind of the edge. At the 1.25hc level, at the forest mast, the momentum flux (\\documentclass...... qualitatively be explained with the concept of eddy‐blocking by the canopy top, which could also explain the observed increase in lateral variance and the decrease in the vertical variance. Despite the short distance to the edge of approximately 1.5hc, the beginning of a new internal boundary layer was visible...

Folded membrane dialyzer with mechanically sealed edges

Energy Technology Data Exchange (ETDEWEB)

Markley, F.W.

A semipermeable membrane is folded in accordion fashion to form a stack of pleats and the edges are sealed so as to isolate the opposite surfaces of the membrane. The stack is contained within a case that provides ports for flow of blood in contact with one surface of the membrane through channels formed by the pleats and also provides ports for flow of a dialysate through channels formed by the pleats in contact with the other surface of the membrane. The serpentine side edges of the membrane are sealed by a solidified plastic material, whereas effective mechanical means are provided to seal the end edges of the folded membrane. The mechanical means include a clamping strip which biases case sealing flanges into a sealed relationship with end portions of the membrane near the end edges, which portions extend from the stack and between the sealing flanges.

Local Thermometry of Neutral Modes on the Quantum Hall Edge

Science.gov (United States)

Hart, Sean; Venkatachalam, Vivek; Pfeiffer, Loren; West, Ken; Yacoby, Amir

2012-02-01

A system of electrons in two dimensions and strong magnetic fields can be tuned to create a gapped 2D system with one dimensional channels along the edge. Interactions among these edge modes can lead to independent transport of charge and heat, even in opposite directions. Measuring the chirality and transport properties of these charge and heat modes can reveal otherwise hidden structure in the edge. Here, we heat the outer edge of such a quantum Hall system using a quantum point contact. By placing quantum dots upstream and downstream along the edge of the heater, we can measure both the chemical potential and temperature of that edge to study charge and heat transport, respectively. We find that charge is transported exclusively downstream, but heat can be transported upstream when the edge has additional structure related to fractional quantum Hall physics.

The impact of edge gradients in the pressure, density, ion temperature, and electron temperature on edge-localized modes

International Nuclear Information System (INIS)

Kleva, Robert G.; Guzdar, Parvez N.

2011-01-01

The magnitude of the energy and particle fluxes in simulations of edge-localized modes (ELMs) is determined by the edge gradients in the pressure, density, ion temperature, and electron temperature. The total edge pressure gradient is the dominant influence on ELMs by far. An increase (decrease) of merely 2% in the pressure gradient results in an increase (decrease) of more than a factor of ten in the size of the ELM bursts. At a fixed pressure gradient, the size of the ELM bursts decreases as the density gradient increases, while the size of the bursts increases as the electron temperature gradient or, especially, the ion temperature gradient increases.

Edge artifact correction for industrial computed tomography images

International Nuclear Information System (INIS)

Cai Yufang; Li Dan; Wang Jue

2013-01-01

To eliminate the edge artifacts of industrial CT images, and improve the identification ability of the image and the precision of the dimension measurement, a coefficient adjusting method for reducing crosstalk noise is proposed. It is concluded from theoretical analysis that crosstalk generated from adjacent detectors by Compton scattering is the major reason for the edge artifacts. According to the mathematic model of the detector crosstalk, we design a special detector system configuration and stair-step phantom for estimating the quantity of crosstalk noise. The relationship between crosstalk ratio and intensity of the incident X-ray is acquired by regressing experimental data with least square method. The experimental result shows that the first-order crosstalk ratio between detectors is about 9.0%, and the second-order crosstalk ratio is about 1.2%. Thus the first-order crosstalk is the main factor causing edge artifacts. The proposed method can reduce the edge artifacts significantly, and meanwhile maintain the detail and edge of CT images. (authors)

Effective Hamiltonian for protected edge states in graphene

International Nuclear Information System (INIS)

Winkler, R.; Deshpande, H.

2017-01-01

Edge states in topological insulators (TIs) disperse symmetrically about one of the time-reversal invariant momenta Λ in the Brillouin zone (BZ) with protected degeneracies at Λ. Commonly TIs are distinguished from trivial insulators by the values of one or multiple topological invariants that require an analysis of the bulk band structure across the BZ. We propose an effective two-band Hamiltonian for the electronic states in graphene based on a Taylor expansion of the tight-binding Hamiltonian about the time-reversal invariant M point at the edge of the BZ. This Hamiltonian provides a faithful description of the protected edge states for both zigzag and armchair ribbons, though the concept of a BZ is not part of such an effective model. In conclusion, we show that the edge states are determined by a band inversion in both reciprocal and real space, which allows one to select Λ for the edge states without affecting the bulk spectrum.

Bulk-edge correspondence in topological transport and pumping

Science.gov (United States)

Imura, Ken-Ichiro; Yoshimura, Yukinori; Fukui, Takahiro; Hatsugai, Yasuhiro

2018-03-01

The bulk-edge correspondence (BEC) refers to a one-to-one relation between the bulk and edge properties ubiquitous in topologically nontrivial systems. Depending on the setup, BEC manifests in different forms and govern the spectral and transport properties of topological insulators and semimetals. Although the topological pump is theoretically old, BEC in the pump has been established just recently [1] motivated by the state-of-the-art experiments using cold atoms [2, 3]. The center of mass (CM) of a system with boundaries shows a sequence of quantized jumps in the adiabatic limit associated with the edge states. Despite that the bulk is adiabatic, the edge is inevitably non-adiabatic in the experimental setup or in any numerical simulations. Still the pumped charge is quantized and carried by the bulk. Its quantization is guaranteed by a compensation between the bulk and edges. We show that in the presence of disorder the pumped charge continues to be quantized despite the appearance of non-quantized jumps.

Improvement of airfoil trailing edge bluntness noise model

Directory of Open Access Journals (Sweden)

Wei Jun Zhu

2016-02-01

Full Text Available In this article, airfoil trailing edge bluntness noise is investigated using both computational aero-acoustic and semi-empirical approach. For engineering purposes, one of the most commonly used prediction tools for trailing edge noise are based on semi-empirical approaches, for example, the Brooks, Pope, and Marcolini airfoil noise prediction model developed by Brooks, Pope, and Marcolini (NASA Reference Publication 1218, 1989. It was found in previous study that the Brooks, Pope, and Marcolini model tends to over-predict noise at high frequencies. Furthermore, it was observed that this was caused by a lack in the model to predict accurately noise from blunt trailing edges. For more physical understanding of bluntness noise generation, in this study, we also use an advanced in-house developed high-order computational aero-acoustic technique to investigate the details associated with trailing edge bluntness noise. The results from the numerical model form the basis for an improved Brooks, Pope, and Marcolini trailing edge bluntness noise model.

Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

African Journals Online (AJOL)

2011-11-28

Nov 28, 2011 ... patients and recognising cardiac arrest, to assess clinicians' ... programmes that are accessible, innovative and inexpensive. .... well as, and sometimes better than, traditional CPR.16 In ... resuscitation training programme resulted in a noticeable ... 31 physicians in Canada whose resuscitation skills were.

An online spaced-education game among clinicians improves their patients' time to blood pressure control: a randomized controlled trial.

Science.gov (United States)

Kerfoot, B Price; Turchin, Alexander; Breydo, Eugene; Gagnon, David; Conlin, Paul R

2014-05-01

Many patients with high blood pressure (BP) do not have antihypertensive medications appropriately intensified at clinician visits. We investigated whether an online spaced-education (SE) game among primary care clinicians can decrease time to BP target among their hypertensive patients. A 2-arm randomized trial was conducted over 52 weeks among primary care clinicians at 8 hospitals. Educational content consisted of 32 validated multiple-choice questions with explanations on hypertension management. Providers were randomized into 2 groups: SE clinicians were enrolled in the game, whereas control clinicians received identical educational content in an online posting. SE game clinicians were e-mailed 1 question every 3 days. Adaptive game mechanics resent questions in 12 or 24 days if answered incorrectly or correctly, respectively. Clinicians retired questions by answering each correctly twice consecutively. Posting of relative performance among peers fostered competition. Primary outcome measure was time to BP target (game was completed by 87% of clinicians (48/55), whereas 84% of control clinicians (47/56) read the online posting. In multivariable analysis of 17 866 hypertensive periods among 14 336 patients, the hazard ratio for time to BP target in the SE game cohort was 1.043 (95% confidence interval, 1.007-1.081; P=0.018). The number of hypertensive episodes needed to treat to normalize one additional patient's BP was 67.8. The number of clinicians needed to teach to achieve this was 0.43. An online SE game among clinicians generated a modest but significant reduction in the time to BP target among their hypertensive patients. http://www.clinicaltrials.gov. Unique identifier: NCT00904007. © 2014 American Heart Association, Inc.

Edge reconstruction effect in pristine and H-passivated zigzag silicon carbide nanoribbons.

Science.gov (United States)

Lou, Ping

2011-10-14

The edge reconstruction effect of the zigzag silicon carbide nanoribbons (zz SiC NRs) to a stable line of alternatively fused seven and five membered rings without and with H passivation have been studied using first principles density functional theory (DFT). The both side's edges of the pristine SiC are respectively terminated by Si and C atoms and are called the Si-edge and the C-edge, respectively. In the un-passivated systems, the C-edge reconstructed (Crc) could effectively lower the edge energy of the system, while the Si-edge reconstructed (Sirc) could raise the edge energy of the system. Thus, the Crc edge is the best edge for the edge reconstruction of the system, while the both edge reconstructed (brc) system is the metastability. Moreover, the brc system has a nonmagnetic metallic state, whereas the Crc system, as well as Sirc system, has a ferromagnetic metallic state. The edge reconstructed destroys the magnetic moment of the corresponding edge atoms. The magnetic moment arises from the unreconstructed zigzag edges. The pristine zz edge system has a ferrimagnetic metallic state. However, in the H-passivated systems, the unreconstructed zigzag edge (zz-H) is the best edge. The Crc-H system is the metastability. The Sirc-H system has only slightly higher energy than the Crc-H system, whereas the brc-H system of the pristine SiC NR has the highest edge energy. Thus, the H passivation would prevent the occurrence of edge reconstruction. Moreover, H passivation induces a metal-semiconductor transition in the zz and brc SiC NRs. Additionally, except for brc-H system which has non-magnetic semiconducting state, the zz-H, Crc-H, and Sirc-H systems have the magnetic state.

Mapping Forest Edge Using Aerial Lidar

Science.gov (United States)

MacLean, M. G.

2014-12-01

Slightly more than 60% of Massachusetts is covered with forest and this land cover type is invaluable for the protection and maintenance of our natural resources and is a carbon sink for the state. However, Massachusetts is currently experiencing a decline in forested lands, primarily due to the expansion of human development (Thompson et al., 2011). Of particular concern is the loss of "core areas" or the areas within forests that are not influenced by other land cover types. These areas are of significant importance to native flora and fauna, since they generally are not subject to invasion by exotic species and are more resilient to the effects of climate change (Campbell et al., 2009). However, the expansion of development has reduced the amount of this core area, but the exact amount is still unknown. Current methods of estimating core area are not particularly precise, since edge, or the area of the forest that is most influenced by other land cover types, is quite variable and situation dependent. Therefore, the purpose of this study is to devise a new method for identifying areas that could qualify as "edge" within the Harvard Forest, in Petersham MA, using new remote sensing techniques. We sampled along eight transects perpendicular to the edge of an abandoned golf course within the Harvard Forest property. Vegetation inventories as well as Photosynthetically Active Radiation (PAR) at different heights within the canopy were used to determine edge depth. These measurements were then compared with small-footprint waveform aerial LiDAR datasets and imagery to model edge depths within Harvard Forest.

Image-Based Edge Bundles : Simplified Visualization of Large Graphs

NARCIS (Netherlands)

Telea, A.; Ersoy, O.

2010-01-01

We present a new approach aimed at understanding the structure of connections in edge-bundling layouts. We combine the advantages of edge bundles with a bundle-centric simplified visual representation of a graph's structure. For this, we first compute a hierarchical edge clustering of a given graph

An Edge-Based Macao License Plate Recognition System

Directory of Open Access Journals (Sweden)

Chi-Man Pun

2011-04-01

Full Text Available This paper presents a system to recognize Macao license plates. Sobel edge detector is employed to extract the vertical edges, and an edge composition algorithm is proposed to combine the edges into candidate plate regions. They are further examined on the existence of the character qMq by a verification algorithm. A row separation algorithm is also proposed to cater both one-row and two-row types of plates. Projection analysis and template matching methods are exploited to segment and recognize the characters. Various pre and post processing steps are proposed other than traditional implementation so as to improve the recognition accuracy. This work achieves a high recognition rate of 95%.

Fast and accurate edge orientation processing during object manipulation

Science.gov (United States)

Flanagan, J Randall; Johansson, Roland S

2018-01-01

Quickly and accurately extracting information about a touched object’s orientation is a critical aspect of dexterous object manipulation. However, the speed and acuity of tactile edge orientation processing with respect to the fingertips as reported in previous perceptual studies appear inadequate in these respects. Here we directly establish the tactile system’s capacity to process edge-orientation information during dexterous manipulation. Participants extracted tactile information about edge orientation very quickly, using it within 200 ms of first touching the object. Participants were also strikingly accurate. With edges spanning the entire fingertip, edge-orientation resolution was better than 3° in our object manipulation task, which is several times better than reported in previous perceptual studies. Performance remained impressive even with edges as short as 2 mm, consistent with our ability to precisely manipulate very small objects. Taken together, our results radically redefine the spatial processing capacity of the tactile system. PMID:29611804

Edge effect modeling and experiments on active lap processing.

Science.gov (United States)

Liu, Haitao; Wu, Fan; Zeng, Zhige; Fan, Bin; Wan, Yongjian

2014-05-05

Edge effect is regarded as one of the most difficult technical issues for fabricating large primary mirrors, especially for large polishing tools. Computer controlled active lap (CCAL) uses a large size pad (e.g., 1/3 to 1/5 workpiece diameters) to grind and polish the primary mirror. Edge effect also exists in the CCAL process in our previous fabrication. In this paper the material removal rules when edge effects happen (i.e. edge tool influence functions (TIFs)) are obtained through experiments, which are carried out on a Φ1090-mm circular flat mirror with a 375-mm-diameter lap. Two methods are proposed to model the edge TIFs for CCAL. One is adopting the pressure distribution which is calculated based on the finite element analysis method. The other is building up a parametric equivalent pressure model to fit the removed material curve directly. Experimental results show that these two methods both effectively model the edge TIF of CCAL.

Carbon K-edge spectra of carbonate minerals.

Science.gov (United States)

Brandes, Jay A; Wirick, Sue; Jacobsen, Chris

2010-09-01

Carbon K-edge X-ray spectroscopy has been applied to the study of a wide range of organic samples, from polymers and coals to interstellar dust particles. Identification of carbonaceous materials within these samples is accomplished by the pattern of resonances in the 280-320 eV energy region. Carbonate minerals are often encountered in the study of natural samples, and have been identified by a distinctive resonance at 290.3 eV. Here C K-edge and Ca L-edge spectra from a range of carbonate minerals are presented. Although all carbonates exhibit a sharp 290 eV resonance, both the precise position of this resonance and the positions of other resonances vary among minerals. The relative strengths of the different carbonate resonances also vary with crystal orientation to the linearly polarized X-ray beam. Intriguingly, several carbonate minerals also exhibit a strong 288.6 eV resonance, consistent with the position of a carbonyl resonance rather than carbonate. Calcite and aragonite, although indistinguishable spectrally at the C K-edge, exhibited significantly different spectra at the Ca L-edge. The distinctive spectral fingerprints of carbonates provide an identification tool, allowing for the examination of such processes as carbon sequestration in minerals, Mn substitution in marine calcium carbonates (dolomitization) and serpentinization of basalts.

Carbon K-edge Spectra of Carbonate Minerals

Energy Technology Data Exchange (ETDEWEB)

Brandes, J.; Wirick, S; Jacobsen, C

2010-01-01

Carbon K-edge X-ray spectroscopy has been applied to the study of a wide range of organic samples, from polymers and coals to interstellar dust particles. Identification of carbonaceous materials within these samples is accomplished by the pattern of resonances in the 280-320 eV energy region. Carbonate minerals are often encountered in the study of natural samples, and have been identified by a distinctive resonance at 290.3 eV. Here C K-edge and Ca L-edge spectra from a range of carbonate minerals are presented. Although all carbonates exhibit a sharp 290 eV resonance, both the precise position of this resonance and the positions of other resonances vary among minerals. The relative strengths of the different carbonate resonances also vary with crystal orientation to the linearly polarized X-ray beam. Intriguingly, several carbonate minerals also exhibit a strong 288.6 eV resonance, consistent with the position of a carbonyl resonance rather than carbonate. Calcite and aragonite, although indistinguishable spectrally at the C K-edge, exhibited significantly different spectra at the Ca L-edge. The distinctive spectral fingerprints of carbonates provide an identification tool, allowing for the examination of such processes as carbon sequestration in minerals, Mn substitution in marine calcium carbonates (dolomitization) and serpentinization of basalts.

Anti-impulse-noise Edge Detection via Anisotropic Morphological Directional Derivatives.

Science.gov (United States)

Shui, Peng-Lang; Wang, Fu-Ping

2017-07-13

Traditional differential-based edge detection suffers from abrupt degradation in performance when images are corrupted by impulse noises. The morphological operators such as the median filters and weighted median filters possess the intrinsic ability to counteract impulse noise. In this paper, by combining the biwindow configuration with weighted median filters, anisotropic morphological directional derivatives (AMDD) robust to impulse noise are proposed to measure the local grayscale variation around a pixel. For ideal step edges, the AMDD spatial response and directional representation are derived. The characteristics and edge resolution of two kinds of typical biwindows are analyzed thoroughly. In terms of the AMDD spatial response and directional representation of ideal step edges, the spatial matched filter is used to extract the edge strength map (ESM) from the AMDDs of an image. The spatial and directional matched filters are used to extract the edge direction map (EDM). Embedding the extracted ESM and EDM into the standard route of the differential-based edge detection, an anti-impulse-noise AMDD-based edge detector is constructed. It is compared with the existing state-of-the-art detectors on a recognized image dataset for edge detection evaluation. The results show that it attains competitive performance in noise-free and Gaussian noise cases and the best performance in impulse noise cases.

On the Total Edge Irregularity Strength of Generalized Butterfly Graph

Science.gov (United States)

Dwi Wahyuna, Hafidhyah; Indriati, Diari

2018-04-01

Let G(V, E) be a connected, simple, and undirected graph with vertex set V and edge set E. A total k-labeling is a map that carries vertices and edges of a graph G into a set of positive integer labels {1, 2, …, k}. An edge irregular total k-labeling λ: V(G) ∪ E(G) → {1, 2, …, k} of a graph G is a total k-labeling such that the weights calculated for all edges are distinct. The weight of an edge uv in G, denoted by wt(uv), is defined as the sum of the label of u, the label of v, and the label of uv. The total edge irregularity strength of G, denoted by tes(G), is the minimum value of the largest label k over all such edge irregular total k-labelings. A generalized butterfly graph, BFn , obtained by inserting vertices to every wing with assumption that sum of inserting vertices to every wing are same then it has 2n + 1 vertices and 4n ‑ 2 edges. In this paper, we investigate the total edge irregularity strength of generalized butterfly graph, BFn , for n > 2. The result is tes(B{F}n)=\\lceil \\frac{4n}{3}\\rceil .

Induced Superconductivity in the Quantum Spin Hall Edge

Science.gov (United States)

Ren, Hechen; Hart, Sean; Wagner, Timo; Leubner, Philipp; Muehlbauer, Mathias; Bruene, Christoph; Buhmann, Hartmut; Molenkamp, Laurens; Yacoby, Amir

2014-03-01

Two-dimensional topological insulators have a gapped bulk and helical edge states, making it a quantum spin Hall insulator. Combining such edge states with superconductivity can be an excellent platform for observing and manipulating localized Majorana fermions. In the context of condensed matter, these are emergent electronic states that obey non-Abelian statistics and hence support fault-tolerant quantum computing. To realize such theoretical constructions, an essential step is to show these edge channels are capable of carrying coherent supercurrent. In our experiment, we fabricate Josephson junctions with HgTe/HgCdTe quantum wells, a two-dimensional material that becomes a quantum spin Hall insulator when the quantum well is thicker than 6.3 nm and the bulk density is depleted. In this regime, we observe supercurrents whose densities are confined to the edges of the junctions, with edge widths ranging from 180 nm to 408 nm. To verify the topological nature of these edges, we measure identical junctions with HgTe/HgCdTe quantum wells thinner than 6.3 nm and observe only uniform supercurrent density across the junctions. This research is supported by Microsoft Corporation Project Q, the NSF DMR-1206016, the DOE SCGF Program, the German Research Foundation, and EU ERC-AG program.

Properties of the tokamak edge plasma

International Nuclear Information System (INIS)

Wolff, H.

1988-01-01

A short review of some features of the edge plasma in limiter tokamaks is given. The limits of the simple one-dimensional scrape-off layer (SOL) model and the relation between the core plasma are discussed. Multifaceted asymmetric radiation from the edge (MARFE) phenomena and detached plasma are closely connected with the particle and energy balance of the SOL. Their occurrence is based on the relation of plasma parameters of the edge plasma to those of the core. Important problems of plasma wall interactions are the detection of the impurity sources and sinks and the study of the impurity transport and shielding. The non-uniform character of plasma wall interactions and their dependence on the discharge performance still renders difficult any theoretical forecast of impurity distribution and transport and calls for better diagnostics. (author)

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users.

Science.gov (United States)

Toro, Maria Luisa; Bird, Emily; Oyster, Michelle; Worobey, Lynn; Lain, Michael; Bucior, Samuel; Cooper, Rory A; Pearlman, Jonathan

2017-11-01

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users. The WMTP and WMT-Q were developed through an iterative process. A convenience sample of clinicians (n = 17), manual wheelchair (n ∞ 5), power wheelchair users (n = 4) and caregivers (n = 4) provided feedback on the training programme. A convenience sample of clinicians (n = 38), manual wheelchair (n = 25), and power wheelchair users (n = 30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1) = 0.48 to ICC(3,1) = 0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p users. This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers. This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown. This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

Online Health Searches and their Perceived Effects on Patients and Patient-Clinician Relationships: A Systematic Review,,✯✯✯.

Science.gov (United States)

Wang, Jane; Ashvetiya, Tamara; Quaye, Emmanuel; Parakh, Kapil; Martin, Seth S

2018-05-03

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from 1 January 1990 to 29 January 2016 for studies in which patients searched online for any aspect of healthcare and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, though the nature of the effect could depend on the clinician's response to patient queries regarding the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship, and commonly raised concerns about accuracy of online content. Significant methodological heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking. Copyright © 2018. Published by Elsevier Inc.

LES tests on airfoil trailing edge serration

DEFF Research Database (Denmark)

Zhu, Wei Jun; Shen, Wen Zhong

2016-01-01

In the present study, a large number of acoustic simulations are carried out for a low noise airfoil with different Trailing Edge Serrations (TES). The Ffowcs Williams-Hawkings (FWH) acoustic analogy is used for noise prediction at trailing edge. The acoustic solver is running on the platform...

Determinants of patient-rated and clinician-rated illness severity in schizophrenia.

Science.gov (United States)

Fervaha, Gagan; Takeuchi, Hiroyoshi; Agid, Ofer; Lee, Jimmy; Foussias, George; Remington, Gary

2015-07-01

The contribution of specific symptoms on ratings of global illness severity in patients with schizophrenia is not well understood. The present study examined the clinical determinants of clinician and patient ratings of overall illness severity. This study included 1,010 patients with a DSM-IV diagnosis of schizophrenia who participated in the baseline visit of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study conducted between January 2001 and December 2004 and who had available symptom severity, side effect burden, cognition, and community functioning data. Both clinicians and patients completed the 7-point Clinical Global Impressions-Severity of Illness scale (CGI-S), the primary measure of interest in the present study. Symptoms were rated using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia, and functional status with the Quality of Life Scale. Neurocognition, insight, and medication-related side effects were also evaluated. Clinicians rated illness severity significantly higher than patients (P negative, disorganized, and depressive symptoms, as well as functional outcome (all P values enhance patient engagement in care and improve outcomes. ClinicalTrials.gov identifier: NCT00014001. © Copyright 2014 Physicians Postgraduate Press, Inc.

Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.

Science.gov (United States)

Catling, C; Petrovska, K; Watts, N; Bisits, A; Homer, C S E

2016-04-01

Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth. A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically. Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper. In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Learning Curve Characteristics for Caesarean Section Among Associate Clinicians : A Prospective Study from Sierra Leone

NARCIS (Netherlands)

Waalewijn, B.P.; van Duinen, A.; Koroma, A. P.; Rijken, M. J.; Elhassein, M.; Bolkan, H. A.

2017-01-01

Background: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to

Edge Delamination of Monolayer Transition Metal Dichalcogenides.

Science.gov (United States)

Ly, Thuc Hue; Yun, Seok Joon; Thi, Quoc Huy; Zhao, Jiong

2017-07-25

Delamination of thin films from the supportive substrates is a critical issue within the thin film industry. The emergent two-dimensional, atomic layered materials, including transition metal dichalcogenides, are highly flexible; thus buckles and wrinkles can be easily generated and play vital roles in the corresponding physical properties. Here we introduce one kind of patterned buckling behavior caused by the delamination from a substrate initiated at the edges of the chemical vapor deposition synthesized monolayer transition metal dichalcogenides, led by thermal expansion mismatch. The atomic force microscopy and optical characterizations clearly showed the puckered structures associated with the strain, whereas the transmission electron microscopy revealed the special sawtooth-shaped edges, which break the geometrical symmetry for the buckling behavior of hexagonal samples. The condition of the edge delamination is in accordance with the fracture behavior of thin film interfaces. This edge delamination and buckling process is universal for most ultrathin two-dimensional materials, which requires more attention in various future applications.

South African Identities on the Edge: Lauren Beukes's Moxyland ...

African Journals Online (AJOL)

We follow the work of various critics and argue that the text presents identity as fractured, riven and characterized by sharp edges. The edges in question refer to the boundaries of personal, corporeal, national and corporate identity. These edges may be considered symptomatic of the individual and social demands placed ...