Sample records for edge thinker clinician

  1. Al-Biruni: A Muslim Critical Thinker

    Directory of Open Access Journals (Sweden)

    Mohammad Noviani Ardi


    Full Text Available As an academic course, critical thinking has emerged in the last century as the one of the important subjects, especially in the second half. But as a kind of thinking and a process of the human reason, it was exist as old as mankind. What are known, nowadays, as (standards of critical thinking or (characteristic of critical thinker were used by some ancient Greek philosophers, e.g. Socrates, Aristotle, as well as great Muslim scholars, e.g. al-Biruni, al-Ghazali, etc. al-Biruni was known as a great Muslim scholar due to objectively scientific method in his works. Moreover, he also was famed in comparative religion which early in history of discipline of comparative religion. However, this study attempts to talk about al-Biruni, one of greatest Muslim scholar in history from another side of previously discussion. It is tries to analyze al-Biruni as a Muslim critical thinker based on his monumental work of Tahqiq ma li al-Hind min Maqulah Maqbulah fi al-‘Aql aw Mardhulah or it is known by Kitab al-Hind.

  2. A thinker's guide to ultrasonic imaging

    International Nuclear Information System (INIS)

    Powis, R.L.; Powis, W.J.


    Bridging the gap between elementary physics and advanced ultrasonographic theory, this book provides the clinician with an indispensable tool for the most effective use of ultrasound equipment. It is directed to every individual who must take a transducer in hand, make an ultrasonic study, and interpret the visual results. It stands between the very rudimentary texts that provide simple basics and texts in advanced ultrasound science and applications. It is designed to provide an intermediate step in the continuing education of both physician and sonographer. Each chapter stands alone, yet is connected with the others by reference and suggested readings

  3. JRC Thinkers ‘N’ Tinkers Makerspace - Concept Note




    In this concept note, we make the case for creating an in-house makerspace oriented towards the engagement of citizens in technoscientific innovations: the JRC Thinkers ‘N’ Tinkers Makerspace. The idea behind the makerspace is to have a space located in the premises of the JRC that promotes critical thinking and tinkering about technoscientific issues relevant for policy files focusing on their societal implications. We view it as a safe space where we can promote dialogues with civil society...

  4. Nasr Hamid Abu Zayd as a Modern Muslim Thinker

    Directory of Open Access Journals (Sweden)



    Full Text Available Nasr Hamid Abu Zayd is a thinker who has produced works in the fields of theology, philosophy, law, politics and humanities. Abu Zayd’s thought, partly on the Quran and its hermeneutics has stirred controversy in Egypt and the Muslim world. This research focuses on the controversy surrounding Nasr Hamid Abu Zayd which led to the declaration of his apostasy by the Supreme Court of Egypt in 1995, as well as his controversial thoughts on the Quran, its method of exegesis and certain fiqh (Islamic jurisprudence issues such as the hijab (veil and polygamy. This paper serves as a literature review which employs the content analysis as a methodology to elaborate on Abu Zayd’s controversial thoughts based on his books, as well as through the views of Muslim and Western scholars on those thoughts.

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

    DEFF Research Database (Denmark)

    Mayland, Karina; Haugegaard, Rikke; Shapiro, Allan


    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...

  6. No religion and an end to war: how thinkers see the future

    CERN Multimedia

    Jha, Alok


    "People's fascination for religion and superstition will disappear within a few decades as television and the internet make it easier to get information, and scientists get closer to discovering a final theroy of everything, leading thinkers argue today." (1,5 page)

  7. Becoming a Thinking Thinker: Metacognition, Self-Reflection, and Classroom Practice (United States)

    Desautel, Daric


    Background/Context: Metacognition has been a subject of study for cognitive theorists, behaviorists, educators, and others. The term metacognition has traditionally and simply been defined as "thinking about thinking," yet it describes a complex process that can result in a nuanced understanding of oneself as a thinker and a learner. Metacognition…

  8. What Is an Ideal Critical Thinker Expected to Conclude about Anthropogenic Global Warming? (United States)

    Guzzo, Guilherme Brambatti; Dall'Alba, Gabriel


    Critical thinking involves the ability to properly assess statements and actions, and it also requires a permanent disposition to appropriately use cognitive skills in the evaluation of any claim. In the present paper, we discuss the characteristics of an ideal critical thinker, and apply them to a contemporary problem, namely anthropogenic global…

  9. Bioethics for clinicians: 27. Catholic bioethics (United States)

    Markwell, Hazel J.; Brown, Barry F.


    THERE IS A LONG TRADITION OF BIOETHICAL REASONING within the Roman Catholic faith, a tradition expressed in scripture, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary Catholic theologians. Catholic bioethics is concerned with a broad range of issues, including social justice and the right to health care, the duty to preserve life and the limits of that duty, the ethics of human reproduction and end-of-life decisions. Fundamental to Catholic bioethics is a belief in the sanctity of life and a metaphysical conception of the person as a composite of body and soul. Although there is considerable consensus among Catholic thinkers, differences in philosophical approach have given rise to some diversity of opinion with respect to specific issues. Given the influential history of Catholic reflection on ethical matters, the number of people in Canada who profess to be Catholic, and the continuing presence of Catholic health care institutions, it is helpful for clinicians to be familiar with the central tenets of this tradition while respecting the differing perspectives of patients who identify themselves as Catholic. PMID:11501460

  10. Non-Reflective Thinkers Are Predisposed to Attribute Supernatural Causation to Uncanny Experiences. (United States)

    Bouvet, Romain; Bonnefon, Jean-François


    For unknown reasons, individuals who are confident in their intuitions are more likely to hold supernatural beliefs. How does an intuitive cognitive style lead one to believe in faith healing, astrology, or extrasensory perception (ESP)? We hypothesize that cognitive style is critically important after one experiences an uncanny event that seems to invite a supernatural explanation. In three studies, we show that irrespective of their prior beliefs in the supernatural, non-reflective thinkers are more likely than reflective thinkers to accept supernatural causation after an uncanny encounter with astrology and ESP. This is the first time that controlled experiments demonstrate the negative dynamics of reflection and supernatural causality attribution. We consider the possible generalization of our findings to religious beliefs and their implications for the social vulnerability of non-reflective individuals. © 2015 by the Society for Personality and Social Psychology, Inc.

  11. Inter-Religious Dialogue: The Perspective of Malaysian Contemporary Muslim Thinkers




    Malaysia is a country that is rich for the diversity of its people. This diversity can be seen from the aspect of faith, ethnicity, language, culture, and so on. In facing a society that is pluralistic in nature, several initiatives have been taken by the government and non-government bodies in ensuring understanding and unity among Malaysians. Among the initiatives taken are interreligious dialogues. In this regard, many among Malaysian thinkers have proposed some approaches and concepts of ...

  12. Inter-Religious Dialogue: The Perspective of Malaysian Contemporary Muslim Thinkers

    Directory of Open Access Journals (Sweden)



    Full Text Available Malaysia is a country that is rich for the diversity of its people. This diversity can be seen from the aspect of faith, ethnicity, language, culture, and so on. In facing a society that is pluralistic in nature, several initiatives have been taken by the government and non-government bodies in ensuring understanding and unity among Malaysians. Among the initiatives taken are interreligious dialogues. In this regard, many among Malaysian thinkers have proposed some approaches and concepts of inter-faith dialogue that should and may be implemented in the context of Malaysia. For that purpose, this paper examined the forms of inter-religious dialogues in Malaysia from the perspective of Malaysian contemporary Muslim thinkers. The methodology utilized in this study is textual analysis, particularly the writings of these thinkers on this issue. This article concludes that there are several forms of inter-religious dialogues that are easily implemented, as well as the difficult ones in the context of Malaysia due to certain obstacles.

  13. '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...

  14. Identifying critical thinking indicators and critical thinker attributes in nursing practice. (United States)

    Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Ming-Chang; Clark, Mary Jo; Tan, Jung-Ying


    Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

  15. Information management for clinicians. (United States)

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


    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.

  16. Transthoracic Ultrasonography for Clinicians

    Directory of Open Access Journals (Sweden)

    Morné Johan Vorster


    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

  17. Edge Matters

    DEFF Research Database (Denmark)

    Earon, Ofri


    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...

  18. 3D scanning and printing as conversation tools: an innovative treatment of a vandalized bronze statue, The Thinker by Rodin

    NARCIS (Netherlands)

    Beentjes, T.; van der Molen, R.; Saunders, D.; Strlic, M.; Korenberg, C.; Luxford, N.; Birkhölzer, K.


    This contribution discusses the innovative treatment of a severely vandalized bronze sculpture, The Thinker by Auguste Rodin, from the Singer Museum in Laren, The Netherlands. Additional aspects of this controversial treatment such as decision making and documentation are also discussed. In 2007 the

  19. Making Sense of Math: How to Help Every Student become a Mathematical Thinker and Problem Solver (ASCD Arias) (United States)

    Seeley, Cathy L.


    In "Making Sense of Math," Cathy L. Seeley, former president of the National Council of Teachers of Mathematics, shares her insight into how to turn your students into flexible mathematical thinkers and problem solvers. This practical volume concentrates on the following areas: (1) Making sense of math by fostering habits of mind that…

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

    Directory of Open Access Journals (Sweden)

    Kathryn B. Francis


    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.


    Directory of Open Access Journals (Sweden)

    Henrieta Anişoara ŞERBAN


    Full Text Available 2016 is an anniversary year, dedicated to the Saint Hierarch Anthim, a multi-faced personality of Georgian origin, but with a Romanian accomplished life. He was a true Orthodox believer, a Hierarch of our Orthodox Church in Wallachia and a deep thinker, who lived through the teachings of the faith. At the same time, he was a good manager and a philanthropist, a scholar, a polyglot, a calligrapher, a typographer, a Church architect, an orator turned writer, a painter and a sculptor. His great homiletic work entitled Didahiile sends to Didache, the oldest post-Bible Christian text, famous at Constantinople, known also as The Teachings of the Twelve Apostles (The Teachings of the Lord to the Gentiles (or Nations by the Twelve Apostles. The study approaches and develops these dimensions of the personality and of the thought of the Saint Hierarch Anthim, in order to emphasize both his life and his work as an esteemed symbol of the Orthodox faith.

  2. Edge Detection, (United States)


    PROJECT. T ASK0 Artificial Inteligence Laboratory AREA It WORK UNIT NUMBERS V 545 Technology Square ( Cambridge, HA 02139 I I* CONTOOL1LIN@4OFFICE NAME...ARD-A1t62 62 EDGE DETECTION(U) NASSACNUSETTS INST OF TECH CAMBRIDGE 1/1 ARTIFICIAL INTELLIGENCE LAB E C HILDRETH SEP 85 AI-M-8 N99SI4-8S-C-6595...used to carry out this analysis. cce~iO a N) ’.~" D LI’BL. P p ------------ Sj. t i MASSACHUSETTS INSTITUTE OF TECHNOLOGY i ARTIFICIAL INTELLIGENCE

  3. Dimensions of personality: clinicians' perspectives

    NARCIS (Netherlands)

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


    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

  4. Living edge

    DEFF Research Database (Denmark)

    Earon, Ofri


    was originally introduced to enhance indoor qualities including light and view. Throughout the paper, it is argued that these ecological motives have grown to architectural and urban dimensions. The paper analyzes the characteristics and potentials of these dimensions and their interconnections. The paper...... on the ground level, but there is a lack of recognition in the significance of communicative characters as well at the higher part of the edge. The city’s planning approach is “Consider urban life before urban space. Consider urban space before buildings” This urban strategy neglects the possible architectural...... contribution to the street atmosphere and its effect on urban life. Bay balcony has been a common architectural element in Copenhagen’s residential buildings, since the end of the twenties. It is a domestic border with an architectural thickness combining window, door, windowsill and balcony. The bay balcony...

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

    Directory of Open Access Journals (Sweden)

    Z. I. Timenyk


    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

  6. The role of technology in clinician-to-clinician communication. (United States)

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


    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.

  7. Mentoring for clinician-educators. (United States)

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


    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.

  8. 'Learning Organizations': a clinician's primer. (United States)

    O'Connor, Nick; Kotze, Beth


    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.

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

    CERN Document Server

    Polkinghorne, John C


    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 ...

  10. Normal tissue complication probability (NTCP), the clinician,s perspective

    International Nuclear Information System (INIS)

    Yeoh, E.K.


    Full text: 3D radiation treatment planning has enabled dose distributions to be related to the volume of normal tissues irradiated. The dose volume histograms thus derived have been utilized to set NTCP dose constraints to facilitate optimization of treatment planning. However, it is not widely appreciated that a number of important variables other than DYH's which determine NTCP in the individual patient. These variables will be discussed under the headings of patient and treatment related as well as tumour related factors. Patient related factors include age, co-morbidities such as connective tissue disease and diabetes mellitus, previous tissue/organ damage, tissue architectural organization (parallel or serial), regional tissue/organ and individual tissue/organ radiosensitivities as well as the development of severe acute toxicity. Treatment related variables which need to be considered include dose per fraction (if not the conventional 1.8012.00 Gy/fraction, particularly for IMRT), number of fractions and total dose, dose rate (particularly if combined with brachytherapy) and concurrent chemotherapy or other biological dose modifiers. Tumour related factors which impact on NTCP include infiltration of normal tissue/organ usually at presentation leading to compromised function but also with recurrent disease after radiation therapy as well as variable tumour radiosensitivities between and within tumour types. Whilst evaluation of DYH data is a useful guide in the choice of treatment plan, the current state of knowledge requires the clinician to make an educated judgement based on a consideration of the other factors.

  11. Stability of edge states and edge magnetism in graphene nanoribbons


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


    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 ...

  12. The clinician and the thyroid

    Energy Technology Data Exchange (ETDEWEB)

    Biersack, H.J.; Hotze, A. (Bonn Univ. (Germany, F.R.). Inst. fuer Klinische und Experimentelle Nuklearmedizin)


    The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.).

  13. The clinician and the thyroid

    International Nuclear Information System (INIS)

    Biersack, H.J.; Hotze, A.


    The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.)

  14. Nanoindentation near the edge (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


    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...

  15. Engaging clinicians in health informatics projects. (United States)

    Caballero Muñoz, Erika; Hullin Lucay Cossio, Carola M


    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.

  16. An edge pedestal model

    International Nuclear Information System (INIS)

    Stacev, W.M.


    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

  17. 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 ...

  18. Improving clinicians' access to cost data. (United States)

    Kenagy, John; Shah, Ben


    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.

  19. Free open access medical education can help rural clinicians deliver 'quality care, out there'. (United States)

    Leeuwenburg, Tim J; Parker, Casey


    Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. Free open access medical education is a new paradigm in continuing professional education. Use of the internet and social media allows a globally accessible crowd-sourced adjunct, providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles and the availability of relevant resources for life-long learning. This markedly reduces knowledge translation (the delay from inception of a new idea to bedside implementation) and allows rural clinicians to further expertise by engaging in discussion of cutting edge concepts with peers worldwide.

  20. 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 ...

  1. Creating a Critical Thinker (United States)

    Piergiovanni, Polly R.


    A college education is expected to improve students' critical thinking skills. Keeping students active in class--through writing activities and class discussion--has been shown to help students think critically. In this article, creative hands-on activities, which are common in engineering courses, are shown to improve students' critical thinking…

  2. Turning attention to clinician engagement in Victoria. (United States)

    Jorm, Christine; Hudson, Robyn; Wallace, Euan


    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.

  3. Edge effects in composites

    International Nuclear Information System (INIS)

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


    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

  4. Edge colouring by total labellings

    DEFF Research Database (Denmark)

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


    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...

  5. Adobe Edge Quickstart Guide

    CERN Document Server

    Labrecque, Joseph


    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

  6. Paths to Theo-Humanity in the Work of Russian Thinkers of the 19th and 20th Century

    Directory of Open Access Journals (Sweden)

    Karel Sládek


    Full Text Available The present study introduces the conception of theo-humanity against the background of the lives of six Russian Christian thinkers (Fyodor Mikhailovich Dostoyevsky, Vladimir Sergeyevich Solovyov, Pavel Alexandrovich Florensky, Sergey Nikolayevich Bulgakov, Pavel Nikolayevich Evdokimov, Vladimir Nikolayevich Lossky, whose experience is integrated in a systematic reflection of their relationship to theo-humanity. The text is divided into three main sections discussing the search for paths to theo-humanity upon experiencing a crisis of the soul among the intelligentsia of czarist Russia, theo-humanity as a way of struggling with evil and theosis by synergy of humanity and theo-humanity in the theology of the new generation of Russian theologians, and finally theo-humanity in the neo-Palamitic synthesis of Russian exiles. Cesty k boholidství u ruských myslitelů 19. a 20. století V předložené studii je představeno pojetí boholidství na pozadí osudů šesti ruských křesťanských myslitelů (Fjodor Michailovič Dostojevskij, Vladimír Sergejevič Solovjov, Pavel Alexandrovič Florenskij, Sergej Nikolajevič Bulgakov, Pavel Nikolajevič Evdokimov, Vladimír Nikolajevič Losskij, přičemž jejich zkušenost bude následně vřazena do systematické reflexe nad jejich vztahem k boholidství. Text je rozdělen na tři hlavní kapitoly sledující: hledání cest k boholidství po prožití vnitřní duševní krize u inteligence carského Ruska, boholidství jako cesta boje se zlem a cesta zbožštění synergií mezi lidstvím a boholidstvím v teologii nové generace ruských teologů a konečně boholidství v neoplamitské syntéze ruských emigrantů.

  7. Adobe Edge Preview 3

    CERN Document Server

    Grover, Chris


    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

  8. Pavement edge treatment. (United States)


    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 ...

  9. 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)


    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.

  10. Clinicians and journalists responding to disasters. (United States)

    Newman, Elana; Shapiro, Bruce


    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.

  11. AphasiaBank: a resource for clinicians. (United States)

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


    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.

  12. The Edge supersonic transport (United States)

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


    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).

  13. Properties on the edge: graphene edge energies, edge stresses, edge warping, and the Wulff shape of graphene flakes

    International Nuclear Information System (INIS)

    Branicio, Paulo S; Jhon, Mark H; Gan, Chee Kwan; Srolovitz, David J


    It has been shown that the broken bonds of an unreconstructed graphene edge generate compressive edge stresses leading to edge warping. Here, we investigate edge energies and edge stresses of graphene nanoribbons with arbitrary orientations from armchair to zigzag, considering both flat and warped edge shapes in the presence and absence of hydrogen. We use the second generation reactive empirical bond order potential to calculate the edge energies and stresses for clean and hydrogenated edges. Using these energies, we perform a Wulff construction to determine the equilibrium shapes of flat graphene flakes as a function of hydrogen chemical potential. While edge stresses for clean, flat edges are compressive, they become tensile if allowed to warp. Conversely, we find that edge energies change little (∼1%) with edge warping. Hydrogenation of the edges virtually eliminates both the edge energy and edge stresses. For warped edges an approximately linear relationship is found between amplitudes and wavelengths. The equilibrium shape of a graphene flake is determined by the value of the hydrogen chemical potential. For very small (and large) values of it the flakes have a nearly hexagonal (dodecagon) shape with zigzag oriented edges, while for intermediate values graphene flakes are found with complex shapes

  14. Disseminating effective clinician communication techniques: Engaging clinicians to want to learn how to engage patients. (United States)

    Pollak, Kathryn I; Back, Anthony L; Tulsky, James A


    Patient-clinician communication that promotes patient engagement enhances health care quality. Yet, disseminating effective communication interventions to practicing clinicians remains challenging. Current methods do not have large and sustainable effects. In this paper, we argue that both top-down approaches (mandated by institutions) should be coupled with bottom-up approaches that address clinician motivation, confidence, and barriers. We need to engage clinicians in the same way we ask them to engage patients - strategically and with empathy. We discuss potentially innovative strategies to integrate top-down and bottom-up approaches in ways that fit clinicians' busy schedules and can inform policy. Copyright © 2017. Published by Elsevier B.V.

  15. Theory of edge radiation

    Energy Technology Data Exchange (ETDEWEB)

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


    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.)

  16. The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: a longitudinal study. (United States)

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


    Effectively managing patient safety and clinicians' emotional exhaustion are important goals of healthcare organizations. Previous cross-sectional studies showed that teamwork is associated with both. However, causal relationships between all three constructs have not yet been investigated. Moreover, the role of different dimensions of teamwork in relation to emotional exhaustion and patient safety is unclear. The current study focused on the long-term development of teamwork, emotional exhaustion, and patient safety in interprofessional intensive care teams by exploring causal relationships between these constructs. A secondary objective was to disentangle the effects of interpersonal and cognitive-behavioral teamwork. We employed a longitudinal study design. Participants were 2100 nurses and physicians working in 55 intensive care units. They answered an online questionnaire on interpersonal and cognitive-behavioral aspects of teamwork, emotional exhaustion, and patient safety at three time points with a 3-month lag. Data were analyzed with cross-lagged structural equation modeling. We controlled for professional role. Analyses showed that emotional exhaustion had a lagged effect on interpersonal teamwork. Furthermore, interpersonal and cognitive-behavioral teamwork mutually influenced each other. Finally, cognitive-behavioral teamwork predicted clinician-rated patient safety. The current study shows that the interrelations between teamwork, clinician burnout, and clinician-rated patient safety unfold over time. Interpersonal and cognitive-behavioral teamwork play specific roles in a process leading from clinician emotional exhaustion to decreased clinician-rated patient safety. Emotionally exhausted clinicians are less able to engage in positive interpersonal teamwork, which might set in motion a vicious cycle: negative interpersonal team interactions negatively affect cognitive-behavioral teamwork and vice versa. Ultimately, ineffective cognitive

  17. Clinicians' Knowledge and Perception of Telemedicine Technology. (United States)

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


    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.

  18. Elder Abuse: What's a Clinician To Do? (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…

  19. Staff Clinician | Center for Cancer Research (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

  20. High Speed Edge Detection (United States)

    Prokop, Norman F (Inventor)


    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.

  1. How can clinician-educator training programs be optimized to match clinician motivations and concerns? (United States)

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


    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.

  2. The Inner Urban Edge (United States)

    Ferebee, Ann; Carpenter, Edward K.


    In this article, renewal of the inner urban edge is discussed. Norfolk (Virginia) is attempting to blur the difference between old and new neighbor hoods through zoning and architectural controls. Cincinnati (Ohio) is developing an environmentally sound hillside design. Reading (Pennsylvania) is utilizing old railyards for greenbelts of hiking and…

  3. Swords with Blunt Edges (United States)

    Popham, W. James


    Many U.S. educators now wonder whether they're teachers or targets. This mentality stems from the specter of their school being sanctioned for failing the state accountability tests mandated under No Child Left Behind (NCLB). According to this author, most of those tests are like blunt-edged swords: They function badly in two directions. While…

  4. Reviewing social media use by clinicians. (United States)

    von Muhlen, Marcio; Ohno-Machado, Lucila


    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.

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

    Directory of Open Access Journals (Sweden)

    McCullough B


    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

  6. Assessment of mood: guides for clinicians. (United States)

    Furukawa, Toshi A


    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.

  7. ICRF edge modeling

    International Nuclear Information System (INIS)


    This report describes the technical progress for the DOE sponsored grant, ''ICRF Edge Modeling.'' An emphasis is placed on the progress since the Technical Progress Report (January 10, 1990) was submitted to the Department of Energy. The design of ICRF antennas for C-Mod and TFTR was investigated during this period. In addition, quasilinear models for electron heating were refined and applied to the design of ICRF antennas. The relevant professional activities sponsored by this grant are given. 4 refs., 11 figs

  8. 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.)


    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.).

  9. Smoothness in Binomial Edge Ideals

    Directory of Open Access Journals (Sweden)

    Hamid Damadi


    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.

  10. Clinicians' Choices in Selecting Orthodontic Archwires

    Directory of Open Access Journals (Sweden)

    Silvia-Izabella Pop


    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

  11. CHEST: Home of the Clinician-Educator. (United States)

    Kelly, William F; Niven, Alexander S


    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.

  12. Multimedia reviews: multimedia convergence for clinicians. (United States)

    Taintor, Zebulon


    Introduction by the column editor: In this final column of the year, Dr. Taintor provides an overview of exciting technological developments via his report on the 2003 annual meeting of the American Association for Technology in Psychiatry (AATP). Advances-and convergences-in technology are providing clinicians with increasingly useful tools to enhance the effectiveness of their treatments, increase access to care, reduce errors, and save time. As Dr. Taintor notes, AATP's meeting is traditionally held in conjunction with the annual meeting of the American Psychiatric Association (APA). I hope that his report will encourage APA's members to attend some of next year's informative sessions.

  13. Competing edge networks (United States)

    Parsons, Mark; Grindrod, Peter


    We introduce a model for a pair of nonlinear evolving networks, defined over a common set of vertices, subject to edgewise competition. Each network may grow new edges spontaneously or through triad closure. Both networks inhibit the other's growth and encourage the other's demise. These nonlinear stochastic competition equations yield to a mean field analysis resulting in a nonlinear deterministic system. There may be multiple equilibria; and bifurcations of different types are shown to occur within a reduced parameter space. This situation models competitive communication networks such as BlackBerry Messenger displacing SMS; or instant messaging displacing emails.

  14. Clinician's gaze behaviour in simulated paediatric emergencies. (United States)

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


    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.

  15. Clinician preferences and the estimation of causal treatment differences


    Korn, Edward L.; Baumrind, Sheldon


    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 ...

  16. The effect of core clinician interpersonal behaviours on depression. (United States)

    Barnicot, K; Wampold, B; Priebe, S


    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.

  17. Degenerate band edge laser (United States)

    Veysi, Mehdi; Othman, Mohamed A. K.; Figotin, Alexander; Capolino, Filippo


    We propose a class of lasers based on a fourth-order exceptional point of degeneracy (EPD) referred to as the degenerate band edge (DBE). EPDs have been found in parity-time-symmetric photonic structures that require loss and/or gain; here we show that the DBE is a different kind of EPD since it occurs in periodic structures that are lossless and gainless. Because of this property, a small level of gain is sufficient to induce single-frequency lasing based on a synchronous operation of four degenerate Floquet-Bloch eigenwaves. This lasing scheme constitutes a light-matter interaction mechanism that leads also to a unique scaling law of the laser threshold with the inverse of the fifth power of the laser-cavity length. The DBE laser has the lowest lasing threshold in comparison to a regular band edge laser and to a conventional laser in cavities with the same loaded quality (Q ) factor and length. In particular, even without mirror reflectors the DBE laser exhibits a lasing threshold which is an order of magnitude lower than that of a uniform cavity laser of the same length and with very high mirror reflectivity. Importantly, this novel DBE lasing regime enforces mode selectivity and coherent single-frequency operation even for pumping rates well beyond the lasing threshold, in contrast to the multifrequency nature of conventional uniform cavity lasers.

  18. [Leadership and management courses for clinicians]. (United States)

    Wichelhaus, Daniel; Fischer, Peter


    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

  19. The making of expert clinicians: reflective practice. (United States)

    Maestre, J M; Szyld, D; Del Moral, I; Ortiz, G; Rudolph, J W


    Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice". Copyright © 2013 Elsevier España, S.L. All rights reserved.

  20. Rocky Mountain spotted fever: a clinician's dilemma. (United States)

    Masters, Edwin J; Olson, Gary S; Weiner, Scott J; Paddock, Christopher D


    Rocky Mountain spotted fever is still the most lethal tick-vectored illness in the United States. We examine the dilemmas facing the clinician who is evaluating the patient with possible Rocky Mountain spotted fever, with particular attention to the following 8 pitfalls in diagnosis and treatment: (1) waiting for a petechial rash to develop before diagnosis; (2) misdiagnosing as gastroenteritis; (3) discounting a diagnosis when there is no history of a tick bite; (4) using an inappropriate geographic exclusion; (5) using an inappropriate seasonal exclusion; (6) failing to treat on clinical suspicion; (7) failing to elicit an appropriate history; and (8) failing to treat with doxycycline. Early diagnosis and proper treatment save lives.

  1. Cheating on the edge.

    Directory of Open Access Journals (Sweden)

    Lee Alan Dugatkin


    Full Text Available We present the results of an individual agent-based model of antibiotic resistance in bacteria. Our model examines antibiotic resistance when two strategies exist: "producers"--who secrete a substance that breaks down antibiotics--and nonproducers ("cheats" who do not secrete, or carry the machinery associated with secretion. The model allows for populations of up to 10,000, in which bacteria are affected by their nearest neighbors, and we assume cheaters die when there are no producers in their neighborhood. Each of 10,000 slots on our grid (a torus could be occupied by a producer or a nonproducer, or could (temporarily be unoccupied. The most surprising and dramatic result we uncovered is that when producers and nonproducers coexist at equilibrium, nonproducers are almost always found on the edges of clusters of producers.

  2. Challenges in edge modeling

    International Nuclear Information System (INIS)

    Schneider, R.


    Fluid models like B2, UEDGE or EDGE2D are the working horses for scrape-off layer physics, both for design and experimental support. The concept of a numerical tokamak, aiming at a predictive code for ITER, triggers the need to re-assess the available tools and their necessary extensions. These additional physics issues will be summarized from a personal point-of-view. Depending on the specific problem, several complexity levels of scrape-off layer models will be needed. Therefore, a hierarchy of tools is necessary, which will be discussed. Furthermore, the experience existing in other scientific fields with multi-scale problems and modeling should be used. Here, the coupling of different length and time scales are in particular of interest for fusion problems. (author)

  3. Edge remap for solids

    Energy Technology Data Exchange (ETDEWEB)

    Kamm, James R.; Love, Edward; Robinson, Allen C; Young, Joseph G.; Ridzal, Denis


    We review the edge element formulation for describing the kinematics of hyperelastic solids. This approach is used to frame the problem of remapping the inverse deformation gradient for Arbitrary Lagrangian-Eulerian (ALE) simulations of solid dynamics. For hyperelastic materials, the stress state is completely determined by the deformation gradient, so remapping this quantity effectively updates the stress state of the material. A method, inspired by the constrained transport remap in electromagnetics, is reviewed, according to which the zero-curl constraint on the inverse deformation gradient is implicitly satisfied. Open issues related to the accuracy of this approach are identified. An optimization-based approach is implemented to enforce positivity of the determinant of the deformation gradient. The efficacy of this approach is illustrated with numerical examples.

  4. Playing on the edge

    DEFF Research Database (Denmark)

    Cermak-Sassenrath, Daniel


    and specific ways. For instance, gambling for money, party and drinking games, professional play and show sports, art installations, violent and military propaganda computer games, pervasive/mobile gaming, live-action role playing, festivals, performances, and games such as Ghosting and Planking. It is argued......Everything gets more interesting, challenging, or intense the closer it gets to the edge, and so does play. How edgy can play become and still be play? Based on Huizinga’s notion of play, this chapter discusses how a wide range of playful activities pushes the boundaries of play in different...... that in concert with a number of characteristics that mark an activity as play, play is essentially a subjective perspective and individual decision of the player. Huizinga calls this attitude the play spirit, which informs a player’s actions and is in turn sustained by them. Edgy digital or mobile games do...

  5. Competing edge networks

    International Nuclear Information System (INIS)

    Parsons, Mark; Grindrod, Peter


    We introduce a model for a pair of nonlinear evolving networks, defined over a common set of vertices, subject to edgewise competition. Each network may grow new edges spontaneously or through triad closure. Both networks inhibit the other's growth and encourage the other's demise. These nonlinear stochastic competition equations yield to a mean field analysis resulting in a nonlinear deterministic system. There may be multiple equilibria; and bifurcations of different types are shown to occur within a reduced parameter space. This situation models competitive communication networks such as BlackBerry Messenger displacing SMS; or instant messaging displacing emails. -- Highlights: ► A model for edgewise-competing evolving network pairs is introduced. ► Defined competition equations yield to a mean field analysis. ► Multiple equilibrium states and different bifurcation types can occur. ► The system is sensitive to sparse initial conditions and near unstable equilibriums.

  6. A clinician-driven home care delivery system. (United States)

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


    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.

  7. Cutting Edge Localisation in an Edge Profile Milling Head

    NARCIS (Netherlands)

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


    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

  8. Childhood agricultural injuries: an update for clinicians. (United States)

    Wright, Suzanne; Marlenga, Barbara; Lee, Barbara C


    Every three days a child dies in an agriculture-related incident, and every day 45 children are injured in the United States. These tragedies should not be regarded as "accidents," as they often follow predictable and preventable patterns. Prevention is not only possible, but vital, since many of these injuries are almost immediately fatal. Major sources of fatal injuries are machinery, motor vehicles, and drowning. Tractor injuries alone account for one-third of all deaths. The leading sources of nonfatal injuries are structures and surfaces, animals (primarily horses), and vehicles (primarily all-terrain vehicles [ATVs]). Children living on farms are at a higher risk than hired workers, and are unprotected by child labor laws. Preschool children and older male youth are at the highest risk for fatal injury, while nonfatal injury was most common among boys aged 10-15 years. Multiple prevention strategies have been developed, yet economic and cultural barriers often impede their implementation. Educational campaigns alone are often ineffective, and must be coupled with re-engineering of machines and safety devices to reduce fatalities. Legislation has the potential to improve child safety, yet political and economic pressures often prohibit changes in child labor laws and mandated safety requirements. Clinicians play a pivotal role in injury prevention, and should actively address common rural risk-taking behaviors as part of the routine office visit in order to help prevent these tragedies. Copyright © 2013 Mosby, Inc. All rights reserved.

  9. Better movers and thinkers (BMT): A quasi-experimental study into the impact of physical education on children's cognition—A study protocol (United States)

    Dalziell, Andrew; Boyle, James; Mutrie, Nanette


    This study will extend on a pilot study and will evaluate the impact of a novel approach to PE, Better Movers and Thinkers (BMT), on students' cognition, physical activity habits, and gross motor coordination (GMC). The study will involve six mainstream state schools with students aged 9–11 years. Three schools will be allocated as the intervention condition and three as the control condition. The design of the study is a 16-week intervention with pre-, post- and 6 month follow-up measurements taken using the ‘Cognitive Assessment System (CAS)’ GMC tests, and the ‘Physical Activity Habits Questionnaire for Children (PAQ-C).’ Qualitative data will be gathered using student focus groups and class teacher interviews in each of the six schools. ANCOVA will be used to evaluate any effect of intervention comparing pre-test scores with post-test scores and then pre-test scores with 6 month follow-up scores. Qualitative data will be analysed through an iterative process using grounded theory. This protocol provides the details of the rationale and design of the study and details of the intervention, outcome measures, and the recruitment process. The study will address gaps within current research by evaluating if a change of approach in the delivery of PE within schools has an effect on children's cognition, PA habits, and GMC within a Scottish setting. PMID:26844172

  10. 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)


    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.

  11. Bioethics for clinicians: 25. Teaching bioethics in the clinical setting (United States)

    McKneally, Martin F.; Singer, Peter A.


    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

  12. The edge of space time

    International Nuclear Information System (INIS)

    Hawking, S.


    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

  13. Reduction of airfoil trailing edge noise by trailing edge blowing

    International Nuclear Information System (INIS)

    Gerhard, T; Carolus, T; Erbslöh, S


    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

  14. 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 ...

  15. 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.


    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).

  16. The clinician-educator track: training internal medicine residents as clinician-educators. (United States)

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


    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.

  17. Diffraction at a Straight Edge

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 20; Issue 5. Diffraction at a Straight Edge: A Gem from Sommerfeld's Work in Classical Physics. Rajaram Nityananda. General Article Volume 20 Issue 5 May 2015 pp 389-400 ...

  18. DAVs: Red Edge and Outbursts (United States)

    Luan, Jing


    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.

  19. Edge Fracture in Complex Fluids. (United States)

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


    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.

  20. A Genome-Wide Association Study Primer for Clinicians

    Directory of Open Access Journals (Sweden)

    Tzu-Hao Wang


    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.

  1. 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

    Directory of Open Access Journals (Sweden)

    E. Jean C. Hay-Smith


    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

  2. Moore's Law, disruptive technologies, and the clinician. (United States)

    Vosburgh, Kirby G; Newbower, Ronald S


    networked technologies. In summary, technological "push" will continue in the demanding cutting-edge application areas as always, but the "disruption" will occur through wider application of lower-cost technologies, pulled by the users. The capabilities described by Moore's Law will allow the advancements necessary to facilitate this dissemination of capability and its ultimate benefit, so long sought.

  3. Edge of polar cap patches (United States)

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


    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.

  4. Players and Thinkers and Learners (United States)

    Frye, Jonathan


    The stronghold that games have on our society has made it imperative that educators understand the impact that video games can have. Owens (2012) presented two frames for how the press discussed the popular game "Spore," which incorporates elements of science topics. One frame suggested that the game teaches children about intelligent design,…

  5. Clinician search behaviors may be influenced by search engine design. (United States)

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


    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

  6. Randomised clinical trials with clinician-preferred treatment. (United States)

    Korn, E L; Baumrind, S


    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.

  7. Protected Edge Modes without Symmetry

    Directory of Open Access Journals (Sweden)

    Michael Levin


    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.


    Directory of Open Access Journals (Sweden)

    Aleksey I. Belkin


    Full Text Available Introduction: the article explores the interrelations between science and religion in the context of shaping integrated world outlook of future specialists in the framework of the competence-based approach. Axiological and ethical aspects of the interaction between the two major branches of human culture are considered using the example of works by Russian religious thinkers: Archbishop Luke (V. F. Voyno-Yasenetsky, V. S. Soloviev, N. A. Berdyaev. Materials and Methods: materials and methods: the study employed the method of original sources, i. e. works by N. A. Berdyaev, V. F. Voino-Yasenetsky, V. S. Solovyov, considering the problems of interaction between science and religion. The method of original sources was combined with methods of analysis, synthesis and generalisation. Results: attention is paid to different approaches to addressing this problem over the historical development of human thought. When analysing the works by V. S. Solovyov emphasis is made on the concept of integral knowledge, considering the true knowledge as a result of the interaction of rational, empirical and mystical aspects. Much attention is paid to the interpretation of Archbishop Luke’s thoughts (V. F. Voyno-Yasenetsky who advocated theoretically and practically the idea of the synthesis of the knowledge and belief in their inextricable link to the genuine scientific and philosophical works. When discussing N. A. Berdyaev’s ideas the focus is on the critical analysis of the three types of relationships between science and religion, established in human culture: 1 supremacy of knowledge and denial of faith, 2 supremacy of faith and denial of knowledge, and 3 the dualism of knowledge and faith. The article also gives a thorough account of the philosopher’s idea about the synthesis of knowledge, faith and intuition that contradicts traditional approach. The article presents the arguments of modern science about the importance of interaction between religious

  9. All-graphene edge contacts

    DEFF Research Database (Denmark)

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


    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....

  10. Improving color constancy by photometric edge weighting

    NARCIS (Netherlands)

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


    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

  11. 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.


    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)

  12. Child Health Disparities: What Can a Clinician Do?


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


    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...

  13. Data Science Meets the Clinician: Challenges and Future Directions. (United States)

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


    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.

  14. Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians (United States)

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


    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

  15. Clinician perspectives of an intensive comprehensive aphasia program. (United States)

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


    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.

  16. Equity of access to elective surgery: reflections from NZ clinicians. (United States)

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


    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.

  17. Clinicians' perception of the preventability of inpatient mortality. (United States)

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


    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.

  18. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. (United States)

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


    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.

  19. At the edge of intonation

    DEFF Research Database (Denmark)

    Niebuhr, Oliver


    The paper is concerned with the 'edge of intonation' in a twofold sense. It focuses on utterance-final F0 movements and crosses the traditional segment-prosody divide by investigating the interplay of F0 and voiceless fricatives in speech production. An experiment was performed for German with four...

  20. Capillary Sharp Inner Edge Manufacturing

    Czech Academy of Sciences Publication Activity Database

    Hošek, Jan; Studenovský, K.; Najdek, D.


    Roč. 19, č. 35 (2009), s. 19-25 ISSN 1584-5982. [MECAHITECH 09 /1./. Bukurešť, 08.10.2009-09.10.2009] R&D Projects: GA AV ČR IAA200760905 Institutional research plan: CEZ:AV0Z20760514 Keywords : capillary * edge * manufacturing Subject RIV: JR - Other Machinery

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

  2. 'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents. (United States)

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


    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.

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

    International Nuclear Information System (INIS)

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


    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

  4. Edge-injective and edge-surjective vertex labellings

    DEFF Research Database (Denmark)

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


    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 ...

  5. Generalized Multi-Edge Analysis for K-Edge Densitometry

    International Nuclear Information System (INIS)

    Collins, M.


    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

  6. Clinicians' recognition and management of emotions during difficult healthcare conversations. (United States)

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


    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.

  7. From leader to leadership: clinician managers and where to next? (United States)

    Fulop, Liz; Day, Gary E


    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.

  8. Edge imaging in intense beams

    Directory of Open Access Journals (Sweden)

    S. Bernal


    Full Text Available The appearance of rings of charge observed near the edge of beams from high-perveance guns is described with a simple ray tracing technique inspired by the particle-core model. We illustrate the technique, which has no analog in light optics, with examples from experiments employing solenoid focusing of an electron beam. The rings of charge result from the combined effects of external focusing and space-charge forces acting on paraxial fringe particles with relatively large initial transverse velocities. The model is independent of the physical mechanisms responsible for the fringe particles. Furthermore, the focal length for edge imaging in a uniform focusing channel is derived using a linearized trajectory equation for the motion of fringe particles. Counterintuitively, the focal length decreases as the beam current increases.

  9. Model of critical diagnostic reasoning: achieving expert clinician performance. (United States)

    Harjai, Prashant Kumar; Tiwari, Ruby


    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.

  10. Nonreference Medical Image Edge Map Measure

    Directory of Open Access Journals (Sweden)

    Karen Panetta


    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.

  11. Gyrosheath near the tokamak edge

    International Nuclear Information System (INIS)

    Hazeltine, R.D.; Xiao, H.; Valanju, P.M.


    A new model for the structure of the radial electric field profile in the edge during the H-mode is proposed. Charge separation caused by the difference between electron and ion gyromotion, or more importantly in a tokamak, the banana motion (halo effect) can self-consistently produce an electric dipole moment that causes the sheared radial electric field. The calculated results based on the model are consistent with D-III D and TEXTOR experimental results

  12. Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings. (United States)

    Walsh, Cian; Ryan, Patrick; Flynn, Daniel


    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.

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

    Directory of Open Access Journals (Sweden)

    Ohlsson Bodil


    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

  14. An organizational assessment of disruptive clinician behavior: findings and implications. (United States)

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


    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.

  15. Knife-edge seal for vacuum bagging (United States)

    Rauschl, J. A.


    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.

  16. Environmental Dataset Gateway (EDG) REST Interface (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...

  17. Organizing on the Edge: Appreciation and Critique

    National Research Council Canada - National Science Library

    Scott, W. R


    .... 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...

  18. Edge effect on weevils and spiders

    Directory of Open Access Journals (Sweden)

    R. Horváth


    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.

  19. CFAR Edge Detector for Polarimetric SAR Images

    DEFF Research Database (Denmark)

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


    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...

  20. Energetics of highly kinked step edges

    NARCIS (Netherlands)

    Zandvliet, Henricus J.W.


    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

  1. Acyclicity in edge-colored graphs

    DEFF Research Database (Denmark)

    Gutin, Gregory; Jones, Mark; Sheng, Bin


    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...

  2. Bed occupancy monitoring: data processing and clinician user interface design. (United States)

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


    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.

  3. Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

    African Journals Online (AJOL)


    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.

  4. 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.

  5. Attitude and Perceptions of Clinicians in Lagos to Autopsy Practice ...

    African Journals Online (AJOL)

    Using pretested questionnaire instrument, a cross sectional survey of clinicians working in the Lagos University Teaching Hospital to obtain their attitudes and perception towards autopsy practice. 230 questionnaires were administered and the response rate was 80.7% . 41.5% of respondents often requested for autopsy.

  6. Dysarthria of Motor Neuron Disease: Clinician Judgments of Severity. (United States)

    Seikel, J. Anthony; And Others


    This study investigated the relationship between the temporal-acoustic parameters of the speech of 15 adults with motor neuron disease. Differences in predictions of the progression of the disease and clinician judgments of dysarthria severity were found to relate to the linguistic systems of both speaker and judge. (Author/JDD)

  7. Antiretroviral drug resistance: A guide for the southern African clinician

    African Journals Online (AJOL)

    Both private and public sector see a bewildering clinical array of patients taking failing antiretroviral (ARV) regimens. We intend this article to provide a practical guide to help clinicians understand and manage ARV drug resistance in an African context. ARV resistance is a rapidly evolving field, requiring expertise in dealing ...

  8. Clinician or Witness? The Intervener's Relationship with Traumatized Children (United States)

    Steele, William


    To heal the hurt child, one begins not as a clinician but as a person trying to witness how the child experiences trauma. This requires more than just talking since the child's terrifying memories are stored in the brain's senses and visual imagery, not in rational thoughts and words. The goal is to change these frightening sensory experiences…

  9. Feminist Family Therapy: Ethical Considerations for the Clinician. (United States)

    Costa, Luann; Sorenson, Jody


    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)

  10. Capitalising on leadership fellowships for clinicians in the NHS. (United States)

    Nicol, Edward D


    Clinical leadership has become a primary focus of the NHS with many leadership programmes, particularly those aimed at junior clinicians, being developed. This article illustrates the potential of these programmes but also urges caution when assessing the success of these schemes both from an individual and organisational perspective.

  11. Remote clinical decision-making: a clinician's definition. (United States)

    Brady, Mike; Northstone, Kate


    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.

  12. A framework for understanding moral distress among palliative care clinicians. (United States)

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


    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.

  13. Edge and coupled core/edge transport modelling in tokamaks

    International Nuclear Information System (INIS)

    Lodestro, L.L.; Casper, T.A.; Cohen, R.H.


    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)

  14. Edge and coupled core-edge transport modelling in tokamaks

    International Nuclear Information System (INIS)

    Lodestro, L.L.; Casper, T.A.; Cohen, R.H.


    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)

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

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


    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

  16. What motivates senior clinicians to teach medical students?

    Directory of Open Access Journals (Sweden)

    Owen Cathy


    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.

  17. Leadership, clinician managers and a thing called "hybridity". (United States)

    Fulop, Liz


    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.

  18. The clinician's dilemma: two dimensions of ethical care. (United States)

    Gillett, Grant; Chamberlain, Joshua


    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.

  19. Clinicians' experiences of becoming a clinical manager: a qualitative study. (United States)

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


    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

  20. Image Edge Tracking via Ant Colony Optimization (United States)

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


    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.

  1. K-edge densitometer (KED)

    Energy Technology Data Exchange (ETDEWEB)

    Sprinkle, J.K.; Hansen, W.J.


    In 1979, a K-edge densitometer (KED) was installed by the Safeguards Assay group from Los Alamos National Laboratory in the PNC reprocessing plant at Tokai-mura, Japan. It uses an active nondestructive assay technique, KED, to measure the plutonium concentration of the product solution. The measurement uncertainty of an assay depends on the count time chosen, but can be 0.5% or better. The computer hardware and software were upgraded in 1992. This manual describes the operation of the instrument, with an emphasis on the user interface to the software.

  2. Instant Adobe Edge Inspect starter

    CERN Document Server

    Khan, Joseph


    Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. This easy-to-understand Starter guide will get you up to speed with Adobe Edge Inspect quickly and with little effort.This book is for frontend web developers and designers who are developing and testing web applications targeted for mobile browsers. It's assumed that you have a basic understanding of creating web applications using HTML, CSS, and JavaScript, as well as being familiar with running web pages from local HTTP servers. Readers are a

  3. How Forest Inhomogeneities Affect the Edge Flow

    DEFF Research Database (Denmark)

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


    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...

  4. Energetics of edge oxidization of graphene nanoribbons (United States)

    Yasuma, Airi; Yamanaka, Ayaka; Okada, Susumu


    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.

  5. Haptic Edge Detection Through Shear (United States)

    Platkiewicz, Jonathan; Lipson, Hod; Hayward, Vincent


    Most tactile sensors are based on the assumption that touch depends on measuring pressure. However, the pressure distribution at the surface of a tactile sensor cannot be acquired directly and must be inferred from the deformation field induced by the touched object in the sensor medium. Currently, there is no consensus as to which components of strain are most informative for tactile sensing. Here, we propose that shape-related tactile information is more suitably recovered from shear strain than normal strain. Based on a contact mechanics analysis, we demonstrate that the elastic behavior of a haptic probe provides a robust edge detection mechanism when shear strain is sensed. We used a jamming-based robot gripper as a tactile sensor to empirically validate that shear strain processing gives accurate edge information that is invariant to changes in pressure, as predicted by the contact mechanics study. This result has implications for the design of effective tactile sensors as well as for the understanding of the early somatosensory processing in mammals.

  6. Predicted solar cell edge radiation effects

    International Nuclear Information System (INIS)

    Gates, M.T.


    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

  7. Financial capacity in older adults: a growing concern for clinicians. (United States)

    Gardiner, Paul A; Byrne, Gerard J; Mitchell, Leander K; Pachana, Nancy A


    Older people with cognitive impairment and/or dementia may be particularly vulnerable to diminished financial decision-making capacity. Financial capacity refers to the ability to satisfactorily manage one's financial affairs in a manner consistent with personal self-interest and values. Impairment of financial capacity makes the older individual vulnerable to financial exploitation, may negatively affect their family's financial situation and places strain on relationships within the family. Clinicians are often on the front line of responding to queries regarding decision-making capacity, and clinical evaluation options are often not well understood. Assessment of financial capacity should include formal objective assessment in addition to a clinical interview and gathering contextual data. Development of a flexible, empirically supported and clinically relevant assessment approach that spans all dimensions of financial capacity yet is simple enough to be used by non-specialist clinicians is needed.

  8. The cultural divide: exploring communication barriers between scientists and clinicians. (United States)

    Restifo, Linda L; Phelan, Gerald R


    Despite remarkable advances in basic biomedical science that have led to improved patient care, there is a wide and persistent gap in the abilities of researchers and clinicians to understand and appreciate each other. In this Editorial, the authors, a scientist and a clinician, discuss the rift between practitioners of laboratory research and clinical medicine. Using their first-hand experience and numerous interviews throughout the United States, they explore the causes of this 'cultural divide'. Members of both professions use advanced problem-solving skills and typically embark on their career paths with a deeply felt sense of purpose. Nonetheless, differences in classroom education, professional training environments, reward mechanisms and sources of drive contribute to obstacles that inhibit communication, mutual respect and productive collaboration. More than a sociological curiosity, the cultural divide is a significant barrier to the bench-to-bedside goals of translational medicine. Understanding its roots is the first step towards bridging the gap.

  9. The cultural divide: exploring communication barriers between scientists and clinicians

    Directory of Open Access Journals (Sweden)

    Linda L. Restifo


    Despite remarkable advances in basic biomedical science that have led to improved patient care, there is a wide and persistent gap in the abilities of researchers and clinicians to understand and appreciate each other. In this Editorial, the authors, a scientist and a clinician, discuss the rift between practitioners of laboratory research and clinical medicine. Using their first-hand experience and numerous interviews throughout the United States, they explore the causes of this ‘cultural divide’. Members of both professions use advanced problem-solving skills and typically embark on their career paths with a deeply felt sense of purpose. Nonetheless, differences in classroom education, professional training environments, reward mechanisms and sources of drive contribute to obstacles that inhibit communication, mutual respect and productive collaboration. More than a sociological curiosity, the cultural divide is a significant barrier to the bench-to-bedside goals of translational medicine. Understanding its roots is the first step towards bridging the gap.

  10. Communication skills in healthcare: academic, clinician and patient perspectives




    This PhD explores healthcare communication skills from the perspectives of academics, clinicians and patients. We know that communication is key to effective healthcare and this research has revealed new approaches for teaching and learning these skills. Findings indicate that we need to consider multiple stakeholders in the design of communication education, we need to develop healthcare professionals’ skills at assessing their own communication and asking for feedback, and workplace teachin...

  11. Child Health Disparities: What Can a Clinician Do? (United States)

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


    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.

  12. Digitizing the Facebow: A Clinician/Technician Communication Tool. (United States)

    Kalman, Les; Chrapka, Julia; Joseph, Yasmin


    Communication between the clinician and the technician has been an ongoing problem in dentistry. To improve the issue, a dental software application has been developed--the Virtual Facebow App. It is an alternative to the traditional analog facebow, used to orient the maxillary cast in mounting. Comparison data of the two methods indicated that the digitized virtual facebow provided increased efficiency in mounting, increased accuracy in occlusion, and lower cost. Occlusal accuracy, lab time, and total time were statistically significant (Ptechnician communication.

  13. An overview of meta-analysis for clinicians. (United States)

    Lee, Young Ho


    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.

  14. Relationships between radiologists and clinicians: Results from three surveys

    International Nuclear Information System (INIS)

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


    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)

  15. Reiki Reduces Burnout Among Community Mental Health Clinicians. (United States)

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


    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.

  16. An overview of meta-analysis for clinicians (United States)

    Lee, Young Ho


    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

  17. Understanding academic clinicians' intent to treat pediatric obesity. (United States)

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


    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.

  18. Factors that influence clinicians' assessment and management of family violence. (United States)

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


    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

  19. Nature & prevalence of stalking among New Zealand mental health clinicians. (United States)

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


    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.

  20. Effect of Physical Therapy Students' Clinical Experiences on Clinician Productivity. (United States)

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


    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.

  1. Conflicts in the ICU: perspectives of administrators and clinicians. (United States)

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


    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.

  2. Ethical decisions at the edge. (United States)

    Gillett, Grant


    Medicine grows incrementally in its ability to treat patients and at the growing edge it poses problems about the appropriateness of treatments that are different from those where good practice conforms to widely agreed standards. The growth of access to medical knowledge and the diversity of contemporary theoretical and clinical medicine have spawned deep divisions in the profession and divergent opinions about what constitutes reasonable care. That hallmark of acceptable practice is also under pressures from the threat of litigation, a highly commercialised contemporary medical environment, patient demands based on medical journalism and the internet and the exponential growth of bio-medical technology. Patient empowerment can result in complaints arising in new and complex areas and expert opinion can often differ markedly depending on where on the medical spectrum the experts are aligned. This column lays out some broad-brush principles to assess the adequacy of medical advice in such a climate.

  3. Imaging edges of nanostructured graphene

    DEFF Research Database (Denmark)

    Kling, Jens; Cagliani, Alberto; Booth, T. J.

    Graphene, as the forefather of 2D-materials, attracts much attention due to its extraordinary properties like transparency, flexibility and outstanding high conductivity, together with a thickness of only one atom. However, graphene also possesses no band gap, which makes it unsuitable for many...... electronic applications like transistors. It has been shown theoretically that by nanostructuring pristine graphene, e.g. with regular holes, the electronic properties can be tuned and a band gap introduced. The size, distance and edge termination of these “defects” influence the adaptability....... Such nanostructuring can be done experimentally, but especially characterization at atomic level is a huge challenge. High-resolution TEM (HRTEM) is used to characterize the atomic structure of graphene. We optimized the imaging conditions used for the FEI Titan ETEM. To reduce the knock-on damage of the carbon atoms...

  4. Magnetohydrodynamic stability of tokamak edge plasmas

    International Nuclear Information System (INIS)

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


    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

  5. Edge and line detection of complicated and blurred objects


    Haugsdal, Kari


    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.

  6. Study of airfoil trailing edge bluntness noise

    DEFF Research Database (Denmark)

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


    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....

  7. Selective Electroless Silver Deposition on Graphene Edges

    DEFF Research Database (Denmark)

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


    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...

  8. Discursive Maps at the Edge of Chaos (United States)


    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

  9. Edge effect on weevils and spiders


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


    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...

  10. Dermatology education and the Internet: traditional and cutting-edge resources. (United States)

    Hanson, Anne H; Krause, L Kendall; Simmons, Rachel N; Ellis, Jeffrey I; Gamble, Ryan G; Jensen, J Daniel; Noble, Melissa N; Orser, Michael L; Suarez, Andrea L; Dellavalle, Robert P


    The number and variety of dermatological medical resources available online has grown exponentially over the past decade. Internet-based resources allow for immediate and easy access to information for both medical education and reference purposes. Although clinicians continue to turn to the Internet for clinical information and still images, tech-savvy medical students are currently accessing a variety of exciting new resources, including discussion boards, wikis, streaming video, podcasts, journal clubs, online communities, and interactive diagnostic experiences to augment their medical education. The objective of this study was to identify traditional and cutting-edge online dermatology resources. We present a sampling of the top dermatology Internet resources, as assessed by a group of medical students in our university dermatology research lab. These resources were ranked by using a matrix derived from the Silberg Criteria, which assessed authorship, attribution, disclosure, currency, and content. Results indicate comparable ranking and approval of cutting-edge resources as traditional online sources. The ranked resources in each category are provided with URLs for readers' use. These cutting-edge online dermatology resources represent excellent sources for continuing education for students and clinicians alike. Resources such as these likely represent the future of medical education, as they allow for self-directed and supplementary education as well as remote access. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  11. Moveable Leading Edge Device for a Wing (United States)

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


    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.

  12. Visible imaging of edge turbulence in NSTX

    International Nuclear Information System (INIS)

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


    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


    Institute of Scientific and Technical Information of China (English)

    纳瑟; 刘重庆


    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.

  14. Object detection using categorised 3D edges

    DEFF Research Database (Denmark)

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


    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...

  15. 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


    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

  16. Bridging the gap between clinicians and systems biologists: from network biology to translational biomedical research. (United States)

    Jinawath, Natini; Bunbanjerdsuk, Sacarin; Chayanupatkul, Maneerat; Ngamphaiboon, Nuttapong; Asavapanumas, Nithi; Svasti, Jisnuson; Charoensawan, Varodom


    With the wealth of data accumulated from completely sequenced genomes and other high-throughput experiments, global studies of biological systems, by simultaneously investigating multiple biological entities (e.g. genes, transcripts, proteins), has become a routine. Network representation is frequently used to capture the presence of these molecules as well as their relationship. Network biology has been widely used in molecular biology and genetics, where several network properties have been shown to be functionally important. Here, we discuss how such methodology can be useful to translational biomedical research, where scientists traditionally focus on one or a small set of genes, diseases, and drug candidates at any one time. We first give an overview of network representation frequently used in biology: what nodes and edges represent, and review its application in preclinical research to date. Using cancer as an example, we review how network biology can facilitate system-wide approaches to identify targeted small molecule inhibitors. These types of inhibitors have the potential to be more specific, resulting in high efficacy treatments with less side effects, compared to the conventional treatments such as chemotherapy. Global analysis may provide better insight into the overall picture of human diseases, as well as identify previously overlooked problems, leading to rapid advances in medicine. From the clinicians' point of view, it is necessary to bridge the gap between theoretical network biology and practical biomedical research, in order to improve the diagnosis, prevention, and treatment of the world's major diseases.

  17. 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


    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.

  18. Saturn's Rings Edge-on (United States)


    In one of nature's most dramatic examples of 'now-you see-them, now-you-don't', NASA's Hubble Space Telescope captured Saturn on May 22, 1995 as the planet's magnificent ring system turned edge-on. This ring-plane crossing occurs approximately every 15 years when the Earth passes through Saturn's ring plane.For comparison, the top picture was taken by Hubble on December 1, 1994 and shows the rings in a more familiar configuration for Earth observers.The bottom picture was taken shortly before the ring plane crossing. The rings do not disappear completely because the edge of the rings reflects sunlight. The dark band across the middle of Saturn is the shadow of the rings cast on the planet (the Sun is almost 3 degrees above the ring plane.) The bright stripe directly above the ring shadow is caused by sunlight reflected off the rings onto Saturn's atmosphere. Two of Saturn's icy moons are visible as tiny starlike objects in or near the ring plane. They are, from left to right, Tethys (slightly above the ring plane) and Dione.This observation will be used to determine the time of ring-plane crossing and the thickness of the main rings and to search for as yet undiscovered satellites. Knowledge of the exact time of ring-plane crossing will lead to an improved determination of the rate at which Saturn 'wobbles' about its axis (polar precession).Both pictures were taken with Hubble's Wide Field Planetary Camera 2. The top image was taken in visible light. Saturn's disk appears different in the bottom image because a narrowband filter (which only lets through light that is not absorbed by methane gas in Saturn's atmosphere) was used to reduce the bright glare of the planet. Though Saturn is approximately 900 million miles away, Hubble can see details as small as 450 miles across.The Wide Field/Planetary Camera 2 was developed by the Jet Propulsion Laboratory and managed by the Goddard Spaced Flight Center for NASA's Office of Space Science.This image and other images and

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

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


    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.

  20. Collaboration in a competitive healthcare system: negotiation 101 for clinicians. (United States)

    Clay-Williams, Robyn; Johnson, Andrew; Lane, Paul; Li, Zhicheng; Camilleri, Lauren; Winata, Teresa; Klug, Michael


    Purpose The purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when. Design/methodology/approach This is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia. Findings Participants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed; suggestions for improving sustainability included provision of refresher training and mentoring. Research limitations/implications Limitations include self-reported data, and interview questions positively elicited examples of training translation. Practical implications The training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical examples of how the skills were used in the workplace are provided. Originality/value To the authors' knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior

  1. Percussion use and training: a survey of music therapy clinicians. (United States)

    Scheffel, Stephanie; Matney, Bill


    Percussion instruments are commonly used in music therapy practice; however, the body of published literature regarding music therapy-related percussion training and practice is limited. The purpose of our survey study was to describe: (a) clinician perspectives of their academic percussion training; (b) use of percussion testing during academic training; (c) clinician perspectives on relevance, adequacy, and importance of academic percussion training; (d) clinician perspectives of their nonacademic percussion training; and (e) current use of percussion in clinical practice. Through comparisons of these parameters, we sought to provide information that may inform future percussion use and training. Participants were selected using an email list from the Certification Board for Music Therapists. Board-certified music therapists (MT-BC) were provided with a researcher-created survey about academic percussion training, nonacademic percussion training, and use of percussion in clinical practice. Survey response rate was 14.4% (611/4234). We used demographic data to address potential nonresponse error and ensure population representation for region of residence and region of academic training. Results revealed concerns about perceived adequacy of percussion training received during music therapy education (14.6% reported receiving no academic percussion training; 40.6% reported training was not adequate), and absence of percussion-specific proficiency exams. Of the training received, 62.8% indicated that training was relevant; however, a majority (76.5%) recommended current music therapy students receive more percussion training on instruments and skills most relevant to clinical practice. Comparisons between academic training, perceived needs in academic training, and clinical usage may inform future training and clinical competency. We provide suggestions for developing future training, as well as for furthering clinical implementation and research. © the American

  2. The clinician's guide to composing effective business plans. (United States)

    Ettinger, Alan B; Blondell, Catherine


    In today's challenging healthcare environment, clinicians need to understand the fundamentals of financial analysis, which are the underpinnings of their clinical programs, especially when seeking administrative support for new initiatives. The business plan for new clinical program initiatives is composed of diverse elements such as the mission statement, market and competitive analyses, operations plan, and financial analysis. Armed with a basic knowledge of financial analysis of clinical programs, as well as forward-looking analysis of an initiative's added value, the healthcare provider can work much more effectively with administration in developing or creating new healthcare program initiatives.

  3. Supporting clinician educators to achieve “work-work balance”

    Directory of Open Access Journals (Sweden)

    Jerry M Maniate


    Full Text Available Clinician Educators (CE have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve “work-work balance.” Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE’s “Four Ps”; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance.

  4. Canary: An NLP Platform for Clinicians and Researchers. (United States)

    Malmasi, Shervin; Sandor, Nicolae L; Hosomura, Naoshi; Goldberg, Matt; Skentzos, Stephen; Turchin, Alexander


    Information Extraction methods can help discover critical knowledge buried in the vast repositories of unstructured clinical data. However, these methods are underutilized in clinical research, potentially due to the absence of free software geared towards clinicians with little technical expertise. The skills required for developing/using such software constitute a major barrier for medical researchers wishing to employ these methods. To address this, we have developed Canary, a free and open-source solution designed for users without natural language processing (NLP) or software engineering experience. It was designed to be fast and work out of the box via a user-friendly graphical interface.

  5. Clinician-patient E-mail communication: challenges for reimbursement. (United States)

    Komives, Eugenie M


    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

  6. November 8, 2016: The day I became a White clinician. (United States)

    Bodnar, Susan


    When Donald Trump became president of the United States, I discovered that my clients who identified as Black saw me as a White clinician. With that came a host of nefarious attributions. To preserve therapeutic efficacy, and the genuine relationships with people about whom I cared, I had to distinguish myself from the president; thus, I learned not only how it feels to be seen through the bias of skin color but what I needed to do to identify as a person rather than a White person. "Welcome to my world," said one African American client. © 2018 Wiley Periodicals, Inc.

  7. Provisional materials: advances lead to extensive options for clinicians. (United States)

    Comisi, John C


    The progression of provisional materials to bis-acrylics has lead to such improvements as easier handling, improved compressive and tensile strength, less water sorption, and less shrinkage. The end-result is more options for clinicians for high-quality chairside provisional restorations. Newer provisional materials are easy to manipulate and bring increased comfort to the patient. This review of current products affirms that the choices of provisional materials available for the dental professional today are quite extensive and have advanced the quality of interim restorations.

  8. Competitive edge through technological innovation

    International Nuclear Information System (INIS)

    Gottlieb, M.


    The vital role of advanced technology in natural gas cost reduction has been described. Among advanced technologies, seismic, drilling and fracturing technologies have been singled out as being the most important. Access to new supply frontiers (aided by the application of advanced technology), and more effective business strategies were considered as the other most influential factors in efficiently exploiting oil and gas resources. In view of predictions of substantially increased demand, advanced technology is poised to be even more important in the future. With this as background, an examination of the level of investment for the development of advanced technology revealed that energy industry R and D expenditures were lowest among industries in the U.S. (only 0.7 per cent of sales). It was concluded that notwithstanding industry's ability to improve output per R and D dollar invested, the achievement of the necessary technological advancements is a strategic imperative for both the industry and the U.S. as a whole. As far as the industry is concerned, its ability to maintain a competitive edge over competing energy forms, will be determined largely on the basis of its willingness to invest in future advanced technology development. 2 refs., 14 figs

  9. CMS kinematic edge from sbottoms

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Peisi; Wagner, Carlos E. M.


    We present two scenarios in the Minimal Supersymmetric Extension of the Standard Model (MSSM) that can lead to an explanation of the excess in the invariant mass distribution of two opposite charged, same flavor leptons, and the corresponding edge at an energy of about 78 GeV, recently reported by the CMS Collaboration. In both scenarios, sbottoms are pair produced, and decay to neutralinos and a b-jet. The heavier neutralinos further decay to a pair of leptons and the lightest neutralino through on-shell sleptons or off-shell neutral gauge bosons. These scenarios are consistent with the current limits on the sbottoms, neutralinos, and sleptons. Assuming that the lightest neutralino is stable we discuss the predicted relic density as well as the implications for darkmatter direct detection. We show that consistency between the predicted and the measured value of the muon anomalous magnetic moment may be obtained in both scenarios. Finally, we define the signatures of these models that may be tested at the 13 TeV run of the LHC

  10. LES tests on airfoil trailing edge serration

    DEFF Research Database (Denmark)

    Zhu, Wei Jun; Shen, Wen Zhong


    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...

  11. Automatic Edging and Trimming of Hardwood Lumber (United States)

    D. Earl Kline; Eugene M. Wengert; Philip A. Araman


    Studies have shown that there is a potential to increase hardwood lumber value by more than 20 percent through optimum edging and trimming. Even a small portion of this percentage can boost the profitability of hardwood lumber manufacturers substantially. The objective of this research project is to develop an automated system which would assist in correct edging and...

  12. Development of planar detectors with active edge

    International Nuclear Information System (INIS)

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


    We report on the first batch of planar active edge sensors fabricated at Fondazione Bruno Kessler (Trento, Italy) on the way to the development of full 3D detectors with active edges. The main design and technological aspects are reported, along with selected results from the electrical characterization of detectors and test structures.

  13. Development of planar detectors with active edge

    Energy Technology Data Exchange (ETDEWEB)

    Povoli, M., E-mail: [Dipartimento di Ingegneria e Scienza dell' Informazione, Universita di Trento, Via Sommarive, 14, I-38123 Povo di Trento (Italy); INFN, Sezione di Padova (Gruppo Collegato di Trento) (Italy); Bagolini, A.; Boscardin, M. [Fondazione Bruno Kessler, Centro per i Materiali e i Microsistemi (FBK-CMM), Via Sommarive, 18, I-38123 Povo di Trento (Italy); Dalla Betta, G.-F. [Dipartimento di Ingegneria e Scienza dell' Informazione, Universita di Trento, Via Sommarive, 14, I-38123 Povo di Trento (Italy); INFN, Sezione di Padova (Gruppo Collegato di Trento) (Italy); Giacomini, G.; Vianello, E.; Zorzi, N. [Fondazione Bruno Kessler, Centro per i Materiali e i Microsistemi (FBK-CMM), Via Sommarive, 18, I-38123 Povo di Trento (Italy)


    We report on the first batch of planar active edge sensors fabricated at Fondazione Bruno Kessler (Trento, Italy) on the way to the development of full 3D detectors with active edges. The main design and technological aspects are reported, along with selected results from the electrical characterization of detectors and test structures.

  14. Annotated Bibliography of EDGE2D Use

    Energy Technology Data Exchange (ETDEWEB)

    J.D. Strachan and G. Corrigan


    This annotated bibliography is intended to help EDGE2D users, and particularly new users, find existing published literature that has used EDGE2D. Our idea is that a person can find existing studies which may relate to his intended use, as well as gain ideas about other possible applications by scanning the attached tables.

  15. Annotated Bibliography of EDGE2D Use

    International Nuclear Information System (INIS)

    Strachan, J.D.; Corrigan, G.


    This annotated bibliography is intended to help EDGE2D users, and particularly new users, find existing published literature that has used EDGE2D. Our idea is that a person can find existing studies which may relate to his intended use, as well as gain ideas about other possible applications by scanning the attached tables

  16. Magnetism of zigzag edge phosphorene nanoribbons

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

  17. 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.


    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)

  18. Optimal utilization of a breast care advanced practice clinician. (United States)

    Russell, Katie W; Mone, Mary C; Serpico, Victoria J; Ward, Cori; Lynch, Joanna; Neumayer, Leigh A; Nelson, Edward W


    Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team. An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction. During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development. Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Premenstrual dysphoric disorder. A guide for the treating clinician. (United States)

    Elliott, Hal


    Up to 75% of women report some premenstrual symptoms, but less than 10% have symptoms severe enough to qualify for a diagnosis of PMDD. A key to diagnosis is establishing a pattern of typical PMDD symptoms that recur during the late luteal phase of the menstrual cycle and remit after menses. Underlying psychiatric and medical disorders that might mimic PMDD should be ruled out or addressed. The clinician should recognize that severe PMS and PMDD are most likely caused by sensitivity to hormonal cycling rather than an abnormality of hormone levels. Current treatment is based on the hypothesis that serotonin depletion is responsible for the premenstrual irritability, dysphoria, and poor impulse control in PMDD. There is some evidence that GABA, endogenous opiates, allopregenolone, and various vitamins and minerals might play roles in severe PMS and PMDD. Treatment with oral contraceptives or supplementary progesterone or estrogen has not been effective. For the treating clinician, a reasonable approach to the patient with severe PMS or PMDD is shown in Table 2.

  20. Patient satisfaction with clinicians in colorectal 2-week wait clinics. (United States)

    Cock, Karen; Kent, Bridie


    To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics. A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach's alpha=0.91). The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more 'strongly agree' responses than the doctor-led cohort (ppatient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research.

  1. Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients. (United States)

    Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C


    At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

  2. Eye dosimetry and protective eye wear for interventional clinicians

    International Nuclear Information System (INIS)

    Martin, C.J.; Magee, J.S.; Sandblom; Almen, A.; Lundh, C.


    Doses to the eyes of interventional clinicians can exceed 20 mSv. Various protective devices can afford protection to the eyes with the final barrier being protective eye wear. The protection provided by lead glasses is difficult to quantify, and the majority of dosimeters are not designed to be worn under lead glasses. This study has measured dose reduction factors (DRFs) equal to the ratio of the dose with no protection, divided by that when lead glasses are worn. Glasses have been tested in X-ray fields using anthropomorphic phantoms to simulate the patient and clinician. DRFs for X-rays incident from the front vary from 5.2 to 7.6, while values for orientations reminiscent of clinical practice are between 1.4 and 5.2. Results suggest that a DRF of two is a conservative factor that could be applied to personal dosimeter measurements to account for the dose reduction provided by most types of lead glasses. (authors)

  3. Information Needs, Infobutton Manager Use, and Satisfaction by Clinician Type: A Case Study (United States)

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


    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

  4. Elastically Deformable Side-Edge Link for Trailing-Edge Flap Aeroacoustic Noise Reduction (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)


    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.

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

    DEFF Research Database (Denmark)

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


    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...

  6. Edge-functionalization of armchair graphene nanoribbons with pentagonal-hexagonal edge structures. (United States)

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


    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.

  7. Prison Clinicians' Perceptions of Antisocial Personality Disorder as a Formal Diagnosis. (United States)

    Stevens, Gail Flint


    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…

  8. Power deposition on misaligned edges in COMPASS

    Directory of Open Access Journals (Sweden)

    R. Dejarnac


    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.

  9. AliEn - EDG Interoperability in ALICE

    CERN Document Server

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


    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...

  10. Outcomes achieved by and police and clinician perspectives on a joint police officer and mental health clinician mobile response unit. (United States)

    Lee, Stuart J; Thomas, Phillipa; Doulis, Chantelle; Bowles, Doug; Henderson, Kathryn; Keppich-Arnold, Sandra; Perez, Eva; Stafrace, Simon


    Despite their limited mental health expertise, police are often first to respond to people experiencing a mental health crisis. Often the person in crisis is then transported to hospital for care, instead of receiving more immediate assessment and treatment in the community. The current study conducted an evaluation of an Australian joint police-mental health mobile response unit that aimed to improve the delivery of a community-based crisis response. Activity data were audited to demonstrate utilization and outcomes for referred people. Police officers and mental health clinicians in the catchment area were also surveyed to measure the unit's perceived impact. During the 6-month pilot, 296 contacts involving the unit occurred. Threatened suicide (33%), welfare concerns (22%) and psychotic episodes (18%) were the most common reasons for referral. The responses comprised direct admission to a psychiatric unit for 11% of contacts, transportation to a hospital emergency department for 32% of contacts, and community management for the remainder (57%). Police officers were highly supportive of the model and reported having observed benefits of the unit for consumers and police and improved collaboration between services. The joint police-mental health clinician unit enabled rapid delivery of a multi-skilled crisis response in the community. © 2015 Australian College of Mental Health Nurses Inc.

  11. Prediction of mandibular rotation: an empirical test of clinician performance. (United States)

    Baumrind, S; Korn, E L; West, E E


    An experiment was conducted in an attempt to determine empirically how effective a number of expert clinicians were at differentiating "backward rotators" from "forward rotators" on the basis of head-film information which might reasonably have been available to them prior to instituting treatment for the correction of Class II malocclusion. As a result of a previously reported ongoing study, pre- and posttreatment head films were available for 188 patients treated in the mixed dentition for the correction of Class II malocclusion and for 50 untreated Class II subjects. These subjects were divided into 14 groups (average size of group, 17; range, 6 to 23) solely on the basis of type of treatment and the clinician from whose clinic the records had originated. From within each group, we selected the two or three subjects who had exhibited the most extreme backward rotation and the two or three subjects who had exhibited the most extreme forward rotation of the mandible during the interval between films. The sole criterion for classification was magnitude of change in the mandibular plane angle of Downs between the pre- and posttreatment films of each patient. The resulting sample contained 32 backward-rotator subjects and 32 forward-rotator subjects. Five expert judges (mean clinical experience, 28 years) were asked to identify the backward-rotator subjects by examination of the pretreatment films. The findings may be summarized as follows: (1) No judge performed significantly better than chance. (2) There was strong evidence that the judges used a shared, though relatively ineffective, set of rules in making their discriminations between forward and backward rotators. (3) Statistical analysis of the predictive power of a set of standard cephalometric measurements which had previously been made for this set of subjects indicated that the numerical data also failed to identify potential backward rotators at a rate significantly better than chance. We infer from these

  12. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. (United States)

    Taveras, Elsie M; Capra, Angela M; Braveman, Paula A; Jensvold, Nancy G; Escobar, Gabriel J; Lieu, Tracy A


    Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations. The current, national breastfeeding continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of 50%. The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support, maternal physical and mental health status, workplace issues, and other factors amenable to intervention. A prospective cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression modeling was performed to assess the independent effects of the predictors of interest, adjusting for sociodemographic and other confounding variables. Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646 (55%) were breastfeeding at the 12-week interview. In the final multivariate models, breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), early breastfeeding problems (OR: 1.5; 95% CI: 1.1-1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and lower maternal education (OR: 1.5; 95% CI: 1.2-1.9). Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: 0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: 1.01-1.37) and returning to work or school by 12 weeks postpartum (OR: 2.4; 95% CI: 1.8-3.3). Our results indicate

  13. Edge-Disjoint Fibonacci Trees in Hypercube

    Directory of Open Access Journals (Sweden)

    Indhumathi Raman


    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.

  14. Natural and artificial spectral edges in exoplanets (United States)

    Lingam, Manasvi; Loeb, Abraham


    Technological civilizations may rely upon large-scale photovoltaic arrays to harness energy from their host star. Photovoltaic materials, such as silicon, possess distinctive spectral features, including an 'artificial edge' that is characteristically shifted in wavelength shortwards of the 'red edge' of vegetation. Future observations of reflected light from exoplanets would be able to detect both natural and artificial edges photometrically, if a significant fraction of the planet's surface is covered by vegetation or photovoltaic arrays, respectively. The stellar energy thus tapped can be utilized for terraforming activities by transferring heat and light from the day side to the night side on tidally locked exoplanets, thereby producing detectable artefacts.

  15. Adobe Edge Animate CC for dummies

    CERN Document Server

    Rohde, Michael


    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

  16. Edge-Matching Problems with Rotations

    DEFF Research Database (Denmark)

    Ebbesen, Martin; Fischer, Paul; Witt, Carsten


    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...

  17. Action and resistance mechanisms of antibiotics: A guide for clinicians

    Directory of Open Access Journals (Sweden)

    Garima Kapoor


    Full Text Available Infections account for a major cause of death throughout the developing world. This is mainly due to the emergence of newer infectious agents and more specifically due to the appearance of antimicrobial resistance. With time, the bacteria have become smarter and along with it, massive imprudent usage of antibiotics in clinical practice has resulted in resistance of bacteria to antimicrobial agents. The antimicrobial resistance is recognized as a major problem in the treatment of microbial infections. The biochemical resistance mechanisms used by bacteria include the following: antibiotic inactivation, target modification, altered permeability, and “bypass” of metabolic pathway. Determination of bacterial resistance to antibiotics of all classes (phenotypes and mutations that are responsible for bacterial resistance to antibiotics (genetic analysis are helpful. Better understanding of the mechanisms of antibiotic resistance will help clinicians regarding usage of antibiotics in different situations. This review discusses the mechanism of action and resistance development in commonly used antimicrobials.

  18. [Quo vadis pathologia? An elderly clinicians meditations about autopsies]. (United States)

    Iványi, J


    Relying on his own experience and the relevant literature of the past 15 years, the author analyzes the causes of the decrease in the number of autopsies. He disagrees with those who, referring to the application of state-of-the art examination methods, dismiss "the ultimate audit" as unnecessary and only suggest selection. Careful autopsies can still be rendered an authentic and reliable picture of treatment of the deceased on the one hand, and provide information about diagnostic difficulties as well as the possible mistakes and errors on the other. This is especially true of the elderly deceased usually with multimorbidity. As well as several aspects of the cooperation between the pathologist and the clinician there is the didactic importance of autopsies that should also be emphasized.

  19. Creating safety by strengthening clinicians' capacity for reflexivity (United States)


    This commentary explores the nature of creating safety in the here-and-now. Creating safety encompasses two dimensions: revisiting specific behaviours by focusing on substandard performance (reflection), and a more broad-ranging attention to everyday behaviours that are taken as given (reflexivity). The piece pays particular attention to this second dimension of creating safety. Two techniques that promote reflexivity are discussed: video-filming real-time, everyday clinical practice and inviting clinicians' feedback about their own footage, and reflecting on the knowledge and questions that patients and families have about their care, and about unexpected outcomes and clinical incidents. The piece concludes that feedback about everyday practice using these methods is critical to enhancing the safety of everyday activity. PMID:21450780

  20. Approach to Peripheral Neuropathy for the Primary Care Clinician. (United States)

    Doughty, Christopher T; Seyedsadjadi, Reza


    Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and disability. The clinical presentation of neuropathy is diverse, with possible symptoms including weakness, sensory abnormalities, and autonomic dysfunction. Accordingly, the primary care clinician must be comfortable using the neurologic examination-including the assessment of motor function, multiple sensory modalities, and deep tendon reflexes-to recognize and characterize neuropathy. Although the causes of peripheral neuropathy are numerous and diverse, careful review of the medical and family history coupled with limited, select laboratory testing can often efficiently lead to an etiologic diagnosis. This review offers an approach for evaluating suspected neuropathy in the primary care setting. It will describe the most common causes, suggest an evidence-based workup to aid in diagnosis, and highlight recent evidence that allows for selection of symptomatic treatment of patients with neuropathy. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. A clinician's artificial organ? Instant messaging applications in medical care. (United States)

    Tazegul, Gokhan; Bozoglan, Humeyra; Ogut, Tahir S; Balcı, Mustafa K


    After the development of the first phone at the end of 19th century, communication technologies took a great leap forward in the 20th century. With the birth of the "smartphone" in the 21st century, communication technologies exponentially evolved and became an important part of our daily routine. Effective communications between clinicians is critical in medical care and miscommunications are a source of errors. Although telecommunication technologies have proliferated dramatically in the last decade, there is scarce evidence-based information on the use of this technology in medical care. For the purposes of medical communication, we can now consult each other about patients individually and within a group via instant messaging applications by using text messages, photos, audio messages and even videos. In this review, we examine the uses and drawbacks of instant messaging applications in medical communications.

  2. Online Continuing Education for Expanding Clinicians' Roles in Breastfeeding Support. (United States)

    Edwards, Roger A; Colchamiro, Rachel; Tolan, Ellen; Browne, Susan; Foley, Mary; Jenkins, Lucia; Mainello, Kristen; Vallu, Rohith; Hanley, Lauren E; Boisvert, Mary Ellen; Forgit, Julie; Ghiringhelli, Kara; Nordstrom, Christina


    Lack of health professional support is an important variable affecting mothers' achievement of breastfeeding goals. Online continuing education is a recognized pathway for disseminating content for improving clinicians' knowledge and supporting efforts to change practices. At the time we developed our project, free, accredited continuing education for physicians related to breastfeeding management that could be easily accessed using portable devices (via tablets/smartphones) was not available. Such resources were in demand, especially for facilities pursuing designation through the Baby-Friendly Hospital Initiative. We assembled a government, academic, health care provider, and professional society partnership to create such a tutorial that would address the diverse content needed for supporting breastfeeding mothers postdischarge in the United States. Our 1.5-hour-long continuing medical and nursing education was completed by 1606 clinicians (1172 nurses [73%] and 434 physicians [27%]) within 1 year. More than 90% of nurses and over 98% of physicians said the tutorial achieved its 7 learning objectives related to breastfeeding physiology, broader factors in infant feeding decisions and practices, the American Academy of Pediatrics' policy statement, and breastfeeding management/troubleshooting. Feedback received from the tutorial led to the creation of a second tutorial consisting of another 1.5 hours of continuing medical and nursing education related to breast examination and assessment prior to delivery, provision of anticipatory guidance to pregnant women interested in breastfeeding, maternity care practices that influence breastfeeding outcomes, breastfeeding preterm infants, breastfeeding's role in helping address disparities, and dispelling common myths. The tutorials contribute to achievement of 8 Healthy People 2020 Maternal, Infant and Child Health objectives. © The Author(s) 2015.

  3. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis

    Directory of Open Access Journals (Sweden)

    Fry Margaret


    Full Text Available Abstract Background Venous Thromboembolism (VTE is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results Analysis of interviews revealed that barriers to evidence based practice include i the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.

  4. Paramedic literature search filters: optimised for clinicians and academics. (United States)

    Olaussen, Alexander; Semple, William; Oteir, Alaa; Todd, Paula; Williams, Brett


    Search filters aid clinicians and academics to accurately locate literature. Despite this, there is no search filter or Medical Subject Headings (MeSH) term pertaining to paramedics. Therefore, the aim of this study was to create two filters to meet to different needs of paramedic clinicians and academics. We created a gold standard from a reference set, which we measured against single terms and search filters. The words and phrases used stemmed from selective exclusion of terms from the previously published Prehospital Search Filter 2.0 as well as a Delphi session with an expert panel of paramedic researchers. Independent authors deemed articles paramedic-relevant or not following an agreed definition. We measured sensitivity, specificity, accuracy and number needed to read (NNR). We located 2102 articles of which 431 (20.5%) related to paramedics. The performance of single terms was on average of high specificity (97.1% (Standard Deviation 7.4%), but of poor sensitivity (12.0%, SD 18.7%). The NNR ranged from 1 to 8.6. The sensitivity-maximising search filter yielded 98.4% sensitivity, with a specificity of 74.3% and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and thus a NNR of 1.48. We have created the first two paramedic specific search filters, one optimised for sensitivity and one optimised for specificity. The sensitivity-maximising search filter yielded 98.4% sensitivity, and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and a NNR of 1.48. A paramedic MeSH term is needed.

  5. Clinician styles of care: transforming patient care at the intersection of leadership and medicine. (United States)

    Huynh, Ho P; Sweeny, Kate


    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.

  6. Edge enhancement improves disruptive camouflage by emphasising false edges and creating pictorial relief. (United States)

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


    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.

  7. Flow distortion at a dense forest edge

    DEFF Research Database (Denmark)

    Dellwik, Ebba; Bingöl, Ferhat; Mann, Jakob


    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...

  8. Floquet edge states in germanene nanoribbons

    KAUST Repository

    Tahir, Muhammad; Zhang, Qingyun; Schwingenschlö gl, Udo


    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

  9. Edge energies and shapes of nanoprecipitates.

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, John C.


    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.

  10. Thermal stability of the tokamak plasma edge

    International Nuclear Information System (INIS)

    Stacey, W.M.


    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)

  11. 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.

  12. Cover Art: River's Edge: Downward, Outward, Upward

    Directory of Open Access Journals (Sweden)

    Jonee Kulman Brigham


    Full Text Available Artist's Statement for the cover art of IJPS volume 4, issue 3: River's Edge: Downward, Outward, Upward, 2015. Mixed Media: photograph, inkjet printed on presentation matte of colored pencil over photograph.

  13. Experiences of randomization: interviews with patients and clinicians in the SPCG-IV trial. (United States)

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


    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.

  14. Edge and core dynamics in harness

    International Nuclear Information System (INIS)

    Ball, R.


    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

  15. Numerical simulation of edge plasma in tokamak

    International Nuclear Information System (INIS)

    Chen Yiping; Qiu Lijian


    The transport process and transport property of plasma in edge layer of Tokamak are simulated by solving numerically two-dimensional and multi-fluid plasma transport equations using suitable simulation code. The simulation results can show plasma parameter distribution characteristics in the area of edge layer, especially the characteristics near the first wall and divertor target plate. The simulation results play an important role in the design of divertor and first wall of Tokamak. (2 figs)

  16. Edge on Impact Simulations and Experiments


    Leavy, R. Brian; Clayton, John D.; Strack, O. Erik; Brannon, Rebecca M.; Strassburger, Elmar


    In the quest to understand damage and failure of ceramics in ballistic events, simplified experiments have been developed to benchmark behavior. One such experiment is known as edge on impact (EOI). In this experiment, an impactor strikes the edge of a thin square plate, and damage and cracking that occur on the free surface are captured in real time with high speed photography. If the material of interest is transparent, additional information regarding damage and wave mechanics within the s...

  17. Integrated core-edge-divertor modeling studies

    International Nuclear Information System (INIS)

    Stacey, W.M.


    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

  18. Presheath profiles in simulated tokamak edge plasmas

    International Nuclear Information System (INIS)

    LaBombard, B.; Conn, R.W.; Hirooka, Y.; Lehmer, R.; Leung, W.K.; Nygren, R.E.; Ra, Y.; Tynan, G.


    The PISCES plasma surface interaction facility at UCLA generates plasmas with characteristics similar to those found in the edge plasmas of tokamaks. Steady state magnetized plasmas produced by this device are used to study plasma-wall interaction phenomena which are relevant to tokamak devices. We report here progress on some detailed investigations of the presheath region that extends from a wall surface into these /open quotes/simulated tokamak/close quotes/ edge plasma discharges along magnetic field lines

  19. What's happening at the edge of tokamaks

    International Nuclear Information System (INIS)

    Crandall, D.H.


    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.)

  20. Unsteady phenomena in the edge tone

    International Nuclear Information System (INIS)

    Paal, G.; Vaik, I.


    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

  1. Edge effect correction using ion beam figuring. (United States)

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


    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.

  2. Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions. (United States)

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


    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

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

    Directory of Open Access Journals (Sweden)

    Magda Dettlaff


    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.

  4. Transaortic Alfieri Edge-to-Edge Repair for Functional Mitral Regurgitation. (United States)

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


    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.

  5. 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. (United States)

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


    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

  6. 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.


    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

  7. Forests on the edge: Microenvironmental drivers of carbon cycle response to edge effects (United States)

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


    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.

  8. Cardiovascular magnetic resonance physics for clinicians: part I. (United States)

    Ridgway, John P


    There are many excellent specialised texts and articles that describe the physical principles of cardiovascular magnetic resonance (CMR) techniques. There are also many texts written with the clinician in mind that provide an understandable, more general introduction to the basic physical principles of magnetic resonance (MR) techniques and applications. There are however very few texts or articles that attempt to provide a basic MR physics introduction that is tailored for clinicians using CMR in their daily practice. This is the first of two reviews that are intended to cover the essential aspects of CMR physics in a way that is understandable and relevant to this group. It begins by explaining the basic physical principles of MR, including a description of the main components of an MR imaging system and the three types of magnetic field that they generate. The origin and method of production of the MR signal in biological systems are explained, focusing in particular on the two tissue magnetisation relaxation properties (T1 and T2) that give rise to signal differences from tissues, showing how they can be exploited to generate image contrast for tissue characterisation. The method most commonly used to localise and encode MR signal echoes to form a cross sectional image is described, introducing the concept of k-space and showing how the MR signal data stored within it relates to properties within the reconstructed image. Before describing the CMR acquisition methods in detail, the basic spin echo and gradient pulse sequences are introduced, identifying the key parameters that influence image contrast, including appearances in the presence of flowing blood, resolution and image acquisition time. The main derivatives of these two pulse sequences used for cardiac imaging are then described in more detail. Two of the key requirements for CMR are the need for data acquisition first to be to be synchronised with the subject's ECG and to be fast enough for the subject

  9. Effectiveness of teaching quality improvement to clinicians: a systematic review. (United States)

    Boonyasai, Romsai T; Windish, Donna M; Chakraborti, Chayan; Feldman, Leonard S; Rubin, Haya R; Bass, Eric B


    Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes

  10. Do self- reported intentions predict clinicians' behaviour: a systematic review

    Directory of Open Access Journals (Sweden)

    Dickinson Heather O


    Full Text Available Abstract Background Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice. Several interventions have been shown to be effective in changing health care professionals' behaviour, but heterogeneity within interventions, targeted behaviours, and study settings make generalisation difficult. Therefore, it is necessary to identify the 'active ingredients' in professional behaviour change strategies. Theories of human behaviour that feature an individual's "intention" to do something as the most immediate predictor of their behaviour have proved to be useful in non-clinical populations. As clinical practice is a form of human behaviour such theories may offer a basis for developing a scientific rationale for the choice of intervention to use in the implementation of new practice. The aim of this review was to explore the relationship between intention and behaviour in clinicians and how this compares to the intention-behaviour relationship in studies of non-clinicians. Methods We searched: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Science/Social science citation index, Current contents (social & behavioural med/clinical med, ISI conference proceedings, and Index to Theses. The reference lists of all included papers were checked manually. Studies were eligible for inclusion if they had: examined a clinical behaviour within a clinical context, included measures of both intention and behaviour, measured behaviour after intention, and explored this relationship quantitatively. All titles and abstracts retrieved by electronic searching were screened independently by two reviewers, with disagreements resolved by discussion. Discussion Ten studies were found that examined the relationship between intention and clinical behaviours in 1623 health professionals. The proportion of variance in behaviour explained by

  11. Strengthening the working alliance through a clinician's familiarity with the 12-step approach. (United States)

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


    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.

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

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


    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.

  13. What is good medical ethics? A clinician's perspective. (United States)

    Kong, Wing May


    Speaking from the perspective of a clinician and teacher, good medical ethics needs to make medicine better. Over the past 50 years medical ethics has helped shape the culture in medicine and medical practice for the better. However, recent healthcare scandals in the UK suggest more needs to be done to translate ethical reasoning into ethical practice. Focusing on clinical practice and individual patient care, I will argue that, to be good, medical ethics needs to become integral to the activities of health professionals and healthcare organisations. Ethics is like a language which brings a way of thinking and responding to the world. For ethics to become embedded in clinical practice, health professionals need to progress from classroom learners to fluent social speakers through ethical dialogue, ethical reflection and ethical actions. I will end by discussing three areas that need to be addressed to enable medical ethics to flourish and bring about change in everyday clinical care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. In utero fuel homeostasis: Lessons for a clinician

    Directory of Open Access Journals (Sweden)

    P. N Suman Rao


    Full Text Available Fetus exists in a complex, dynamic, and yet intriguing symbiosis with its mother as far as fuel metabolism is concerned. Though the dependence on maternal fuel is nearly complete to cater for its high requirement, the fetus is capable of some metabolism of its own. The first half of gestation is a period of maternal anabolism and storage whereas the second half results in exponential fetal growth where maternal stores are mobilized. Glucose is the primary substrate for energy production in the fetus though capable of utilizing alternate sources like lactate, ketoacids, amino acids, fatty acids, and glycogen as fuel under special circumstances. Key transporters like glucose transporters (GLUT are responsible for preferential transfers, which are in turn regulated by complex interaction of maternal and fetal hormones. Amino acids are preferentially utilized for growth and essential fatty acids for development of brain and retina. Insulin, insulin like growth factors, glucagon, catecholamines, and letpin are the hormones implicated in this fascinating process. Hormonal regulation of metabolic substrate utilization and anabolism in the fetus is secondary to the supply of nutrient substrates. The knowledge of fuel homeostasis is crucial for a clinician caring for pregnant women and neonates to manage disorders of metabolism (diabetes, growth (intrauterine growth restriction, and transitional adaptation (hypoglycemia.

  15. The Clinician as Leader: Why, How, and When. (United States)

    Stoller, James K


    Clinicians are inveterate leaders. We lead patients through the difficult maze of illness, families through the travails of ill loved ones, and physicians-in-training through the gauntlet of learning medicine. Yet, in the context of a range of leadership styles that effective leaders must be able to deploy situationally, physician leaders have traditionally defaulted to a "command and control" style that fosters the concept of physicians as "Viking warriors" or "heroic lone healers." The perverse effects of "command and control" are that this style conspires against collaboration and tends to be perpetuated as aspiring leaders emulate their predecessors. Because healthcare faces challenges of cost, access, and quality and is in the throes of change, the current landscape requires effective leadership. Though still relatively uncommon among healthcare organizations, frontrunner organizations are offering leadership development programs. The design of such programs requires clarity about requisite leadership competencies and about how and when to best to deliver such curricula. As one example, the American Thoracic Society has launched its Emerging Leaders Program (ELP), which is currently offering a leadership development curriculum to 18 selected emerging leaders. The ATS ELP curriculum focuses on awareness of self and system and incorporates highly participatory sessions on emotional intelligence, teambuilding, change management, situational leadership, appreciative inquiry, process and quality improvement, strategic planning, and organizational culture. Short-term deliverables are the development and presentation of business plans for innovations proposed by the group. Hoped for longer-term outcomes include an enhanced leadership pipeline for global respiratory health.

  16. Martha Wollstein: A pioneer American female clinician-scientist. (United States)

    Abrams, Jeanne; Wright, James R


    Martha Wollstein was not only the first fully specialized pediatric perinatal pathologist practicing exclusively in a North America children's hospital, she also blazed another pathway as a very early pioneer female clinician-scientist. Wollstein provided patient care at Babies Hospital of New York City from 1891 until her retirement in 1935, and also simultaneously worked for many years as a basic scientist at the prestigious Rockefeller Institute for Medical Research. Wollstein published over 65 papers, many frequently cited, during her career on a wide range of topics including pediatric and infectious diseases. Wollstein was a rare female in the field of pathology in an era when just a relatively small number of women became doctors in any medical specialty. Wollstein was born into an affluent Jewish American family in New York City in 1868 and graduated from the Women's Medical College in 1889. This paper explores her family support and ethnic and religious background, which helped facilitate her professional success. During her time, she was recognized internationally for her research and was respected for her medical and scientific skills; unfortunately today her important career has been largely forgotten.

  17. An integrated billing application to streamline clinician workflow. (United States)

    Vawdrey, David K; Walsh, Colin; Stetson, Peter D


    Between 2008 and 2010, our academic medical center transitioned to electronic provider documentation using a commercial electronic health record system. For attending physicians, one of the most frustrating aspects of this experience was the system's failure to support their existing electronic billing workflow. Because of poor system integration, it was difficult to verify the supporting documentation for each bill and impractical to track whether billable notes had corresponding charges. We developed and deployed in 2011 an integrated billing application called "iCharge" that streamlines clinicians' documentation and billing workflow, and simultaneously populates the inpatient problem list using billing diagnosis codes. Each month, over 550 physicians use iCharge to submit approximately 23,000 professional service charges for over 4,200 patients. On average, about 2.5 new problems are added to each patient's problem list. This paper describes the challenges and benefits of workflow integration across disparate applications and presents an example of innovative software development within a commercial EHR framework.

  18. Front-line ordering clinicians: matching workforce to workload. (United States)

    Fieldston, Evan S; Zaoutis, Lisa B; Hicks, Patricia J; Kolb, Susan; Sladek, Erin; Geiger, Debra; Agosto, Paula M; Boswinkel, Jan P; Bell, Louis M


    Matching workforce to workload is particularly important in healthcare delivery, where an excess of workload for the available workforce may negatively impact processes and outcomes of patient care and resident learning. Hospitals currently lack a means to measure and match dynamic workload and workforce factors. This article describes our work to develop and obtain consensus for use of an objective tool to dynamically match the front-line ordering clinician (FLOC) workforce to clinical workload in a variety of inpatient settings. We undertook development of a tool to represent hospital workload and workforce based on literature reviews, discussions with clinical leadership, and repeated validation sessions. We met with physicians and nurses from every clinical care area of our large, urban children's hospital at least twice. We successfully created a tool in a matrix format that is objective and flexible and can be applied to a variety of settings. We presented the tool in 14 hospital divisions and received widespread acceptance among physician, nursing, and administrative leadership. The hospital uses the tool to identify gaps in FLOC coverage and guide staffing decisions. Hospitals can better match workload to workforce if they can define and measure these elements. The Care Model Matrix is a flexible, objective tool that quantifies the multidimensional aspects of workload and workforce. The tool, which uses multiple variables that are easily modifiable, can be adapted to a variety of settings. © 2014 Society of Hospital Medicine.

  19. Patient- and clinician- reported outcome in eating disorders. (United States)

    Winkler, Laura Al-Dakhiel; Frølich, Jacob Stampe; Gudex, Claire; Hørder, Kirsten; Bilenberg, Niels; Støving, René Klinkby


    Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs. We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark. Patient-reported measures included the Eating Disorder Inventory-2 (EDI-2) and the Short Form 36 (SF-36), and clinical data included remission status and body mass index (BMI). We found a positive association between BMI and EDI-2 scores for anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS), reflecting increasing ED symptomatology with increasing BMI. This association was not observed in bulimia nervosa (BN). We did not find a correlation between SF-36 scores and BMI in any of the diagnostic groups. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. PubMed searches: overview and strategies for clinicians. (United States)

    Lindsey, Wesley T; Olin, Bernie R


    PubMed is a biomedical and life sciences database maintained by a division of the National Library of Medicine known as the National Center for Biotechnology Information (NCBI). It is a large resource with more than 5600 journals indexed and greater than 22 million total citations. Searches conducted in PubMed provide references that are more specific for the intended topic compared with other popular search engines. Effective PubMed searches allow the clinician to remain current on the latest clinical trials, systematic reviews, and practice guidelines. PubMed continues to evolve by allowing users to create a customized experience through the My NCBI portal, new arrangements and options in search filters, and supporting scholarly projects through exportation of citations to reference managing software. Prepackaged search options available in the Clinical Queries feature also allow users to efficiently search for clinical literature. PubMed also provides information regarding the source journals themselves through the Journals in NCBI Databases link. This article provides an overview of the PubMed database's structure and features as well as strategies for conducting an effective search.

  1. Human babesiosis in Europe: what clinicians need to know. (United States)

    Hildebrandt, A; Gray, J S; Hunfeld, K-P


    Although best known as an animal disease, human babesiosis is attracting increasing attention as a worldwide emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways of transmission are transplacental, perinatal and transfusion-associated. Infection of the human host can cause a very severe host-mediated pathology including fever, and hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure. In recent years, apparently owing to increased medical awareness and better diagnostic methods, the number of reported cases in humans is rising steadily worldwide. Hitherto unknown zoonotic Babesia spp. are now being reported from geographic areas where babesiosis was not previously known to occur and the growing numbers of travelers and immunocompromised individuals suggest that the frequency of cases in Europe will also continue to rise. Our review is intended to provide clinicians with practical information on the clinical management of this rare, but potentially life-threatening zoonotic disease. It covers epidemiology, phylogeny, diagnostics and treatment of human babesiosis and the potential risk of transfusion-transmitted disease with a special focus on the European situation.

  2. Integrating virtual reality video games into practice: clinicians' experiences. (United States)

    Levac, Danielle E; Miller, Patricia A


    The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

  3. Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education. (United States)

    Creighton, Francis X; Hapner, Edie; Klein, Adam; Rosen, Ami; Jinnah, Hyder A; Johns, Michael M


    Spasmodic dysphonia (SD) is a rare but often debilitating disease. Due to lack of awareness among practitioners and lack of well-defined diagnostic criteria, it can be difficult for patients with SD to receive a diagnosis and subsequent treatment. There is currently no literature documenting the efficacy of the medical community in recognizing and diagnosing this disorder. We aimed to quantify the patients' experiences with obtaining a diagnosis of SD. One hundred seven consecutive patients with SD completed questionnaires about their experiences with SD. Patients were recruited either during outpatient laryngology visits or during participation in a National Institutes of Health funded study investigating SD. It took patients an average of 4.43 years (53.21 months) to be diagnosed with SD after first going to a physician with vocal symptoms. Patients had to see an average of 3.95 physicians to receive a diagnosis of SD. Patients (31.4%) had been prescribed medications other than botulinum toxin to treat their symptoms. Patients (30%) attempted alternative therapies for treatment of SD, such as chiropractor or dietary modification. Despite advances in diagnostic modalities in medicine, the diagnosis of SD still remains elusive. Objective criteria for the diagnosis of SD and increased clinician education are warranted to address this diagnostic delay. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Edge Modeling by Two Blur Parameters in Varying Contrasts. (United States)

    Seo, Suyoung


    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.

  5. Power spectrum weighted edge analysis for straight edge detection in images (United States)

    Karvir, Hrishikesh V.; Skipper, Julie A.


    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.

  6. Edge strength of CAD/CAM materials. (United States)

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


    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.

  7. Acyclicity in edge-colored graphs

    DEFF Research Database (Denmark)

    Gutin, Gregory; Jones, Mark; Sheng, Bin


    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...

  8. Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors. (United States)

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


    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.

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


    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.

  10. 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.


    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

  11. Edge printability: techniques used to evaluate and improve extreme wafer edge printability (United States)

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


    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.

  12. Topological edge modes in multilayer graphene systems

    KAUST Repository

    Ge, Lixin


    Plasmons can be supported on graphene sheets as the Dirac electrons oscillate collectively. A tight-binding model for graphene plasmons is a good description as the field confinement in the normal direction is strong. With this model, the topological properties of plasmonic bands in multilayer graphene systems are investigated. The Zak phases of periodic graphene sheet arrays are obtained for different configurations. Analogous to Su-Schrieffer-Heeger (SSH) model in electronic systems, topological edge plasmon modes emerge when two periodic graphene sheet arrays with different Zak phases are connected. Interestingly, the dispersion of these topological edge modes is the same as that in the monolayer graphene and is invariant as the geometric parameters of the structure such as the separation and period change. These plasmonic edge states in multilayer graphene systems can be further tuned by electrical gating or chemical doping. © 2015 Optical Society of America.

  13. Performance of active edge pixel sensors (United States)

    Bomben, M.; Ducourthial, A.; Bagolini, A.; Boscardin, M.; Bosisio, L.; Calderini, G.; D'Eramo, L.; Giacomini, G.; Marchiori, G.; Zorzi, N.; Rummler, A.; Weingarten, J.


    To cope with the High Luminosity LHC harsh conditions, the ATLAS inner tracker has to be upgraded to meet requirements in terms of radiation hardness, pile up and geometrical acceptance. The active edge technology allows to reduce the insensitive area at the border of the sensor thanks to an ion etched trench which avoids the crystal damage produced by the standard mechanical dicing process. Thin planar n-on-p pixel sensors with active edge have been designed and produced by LPNHE and FBK foundry. Two detector module prototypes, consisting of pixel sensors connected to FE-I4B readout chips, have been tested with beams at CERN and DESY. In this paper the performance of these modules are reported. In particular the lateral extension of the detection volume, beyond the pixel region, is investigated and the results show high hit efficiency also at the detector edge, even in presence of guard rings.

  14. Floquet edge states in germanene nanoribbons

    KAUST Repository

    Tahir, Muhammad


    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.

  15. Controllable edge feature sharpening for dental applications. (United States)

    Fan, Ran; Jin, Xiaogang


    This paper presents a new approach to sharpen blurred edge features in scanned tooth preparation surfaces generated by structured-light scanners. It aims to efficiently enhance the edge features so that the embedded feature lines can be easily identified in dental CAD systems, and to avoid unnatural oversharpening geometry. We first separate the feature regions using graph-cut segmentation, which does not require a user-defined threshold. Then, we filter the face normal vectors to propagate the geometry from the smooth region to the feature region. In order to control the degree of the sharpness, we propose a feature distance measure which is based on normal tensor voting. Finally, the vertex positions are updated according to the modified face normal vectors. We have applied the approach to scanned tooth preparation models. The results show that the blurred edge features are enhanced without unnatural oversharpening geometry.

  16. Controllable Edge Feature Sharpening for Dental Applications

    Directory of Open Access Journals (Sweden)

    Ran Fan


    Full Text Available This paper presents a new approach to sharpen blurred edge features in scanned tooth preparation surfaces generated by structured-light scanners. It aims to efficiently enhance the edge features so that the embedded feature lines can be easily identified in dental CAD systems, and to avoid unnatural oversharpening geometry. We first separate the feature regions using graph-cut segmentation, which does not require a user-defined threshold. Then, we filter the face normal vectors to propagate the geometry from the smooth region to the feature region. In order to control the degree of the sharpness, we propose a feature distance measure which is based on normal tensor voting. Finally, the vertex positions are updated according to the modified face normal vectors. We have applied the approach to scanned tooth preparation models. The results show that the blurred edge features are enhanced without unnatural oversharpening geometry.

  17. Edge database analysis for extrapolation to ITER

    International Nuclear Information System (INIS)

    Shimada, M.; Janeschitz, G.; Stambaugh, R.D.


    An edge database has been archived to facilitate cross-machine comparisons of SOL and edge pedestal characteristics, and to enable comparison with theoretical models with an aim to extrapolate to ITER. The SOL decay lengths of power, density and temperature become broader for increasing density and q 95 . The power decay length is predicted to be 1.4-3.5 cm (L-mode) and 1.4-2.7 cm (H-mode) at the midplane in ITER. Analysis of Type I ELMs suggests that each giant ELM on ITER would exceed the ablation threshold of the divertor plates. Theoretical models are proposed for the H-mode transition, for Type I and Type III ELMs and are compared with the edge pedestal database. (author)

  18. Long coherence times for edge spins (United States)

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


    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.

  19. Preparation of edge states by shaking boundaries

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Z.C. [Department of Physics, Fuzhou University, Fuzhou 350002 (China); Center for Quantum Sciences and School of Physics, Northeast Normal University, Changchun 130024 (China); Hou, S.C. [Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang, Sichuan (China); Wang, L.C. [School of Physics and Optoelectronic Technology, Dalian University of Technology, Dalian 116024 (China); Yi, X.X., E-mail: [Center for Quantum Sciences and School of Physics, Northeast Normal University, Changchun 130024 (China)


    Preparing topological states of quantum matter, such as edge states, is one of the most important directions in condensed matter physics. In this work, we present a proposal to prepare edge states in Aubry–André–Harper (AAH) model with open boundaries, which takes advantage of Lyapunov control to design operations. We show that edge states can be obtained with almost arbitrary initial states. A numerical optimalization for the control is performed and the dependence of control process on the system size is discussed. The merit of this proposal is that the shaking exerts only on the boundaries of the model. As a by-product, a topological entangled state is achieved by elaborately designing the shaking scheme.

  20. Evolution of Edge Pedestal Profiles Between ELMs (United States)

    Floyd, J. P.; Stacey, W. M.; Groebner, R. J.


    The measured edge profile evolution in DIII-D discharges is analyzed in terms of the implied thermal diffusivities, ion diffusion coefficients and pinch velocities, using the momentum-balance methodology of Ref. [1], extended to take into account ion orbit loss and X-point loss. The evolution of the density, temperature, rotation and radial electric field profiles in the edge pedestal between edge localized modes (ELMs) provides information of these diffusive and non-diffusive transport processes in the pedestal of H-mode plasmas. This methodology is incorporated in the GTEDGE code developed for DIII-D data interpretation. Using a smaller integration time for the charge exchange recombination measurements than in Ref. [1] allows a more detailed examination of the time evolution of the ion temperature and rotation profiles. 6pt [1] W.M. Stacey and R.J. Groebner, Nucl. Fusion 51, 063024 (2011).

  1. Edge effects in composites by moire interferometry (United States)

    Czarnek, R.; Post, D.; Herakovich, C.


    The very high sensitivity of moire interferometry has permitted the present edge effect experiments to be conducted at a low average stress and strain level, assuring linear and elastic behavior in the composite material samples tested. Sensitivity corresponding to 2450 line/mm moire was achieved with a 0.408 micron/fringe. Simultaneous observations of the specimen face and edge displacement fields showed good fringe definition despite the 1-mm thickness of the specimens and the high gradients, and it is noted that the use of a carrier pattern and optical filtering was effective in even these conditions. Edge effects and dramatic displacement gradients were confirmed in angle-ply composite laminates.

  2. Properties of the tokamak edge plasma

    International Nuclear Information System (INIS)

    Wolff, H.


    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)

  3. Leading-edge vortex lifts swifts. (United States)

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


    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.

  4. Edge modulation of electronics and transport properties of cliff-edge phosphorene nanoribbons (United States)

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


    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.

  5. Physics-based edge evaluation for improved color constancy

    NARCIS (Netherlands)

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


    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

  6. Edge detection in landing budgerigars (Melopsittacus undulatus.

    Directory of Open Access Journals (Sweden)

    Partha Bhagavatula

    Full Text Available BACKGROUND: While considerable scientific effort has been devoted to studying how birds navigate over long distances, relatively little is known about how targets are detected, obstacles are avoided and smooth landings are orchestrated. Here we examine how visual features in the environment, such as contrasting edges, determine where a bird will land. METHODOLOGY/PRINCIPAL FINDINGS: Landing in budgerigars (Melopsittacus undulatus was investigated by training them to fly from a perch to a feeder, and video-filming their landings. The feeder was placed on a grey disc that produced a contrasting edge against a uniformly blue background. We found that the birds tended to land primarily at the edge of the disc and walk to the feeder, even though the feeder was in the middle of the disc. This suggests that the birds were using the visual contrast at the boundary of the disc to target their landings. When the grey level of the disc was varied systematically, whilst keeping the blue background constant, there was one intermediate grey level at which the budgerigar's preference for the disc boundary disappeared. The budgerigars then landed randomly all over the test surface. Even though this disc is (for humans clearly distinguishable from the blue background, it offers very little contrast against the background, in the red and green regions of the spectrum. CONCLUSIONS: We conclude that budgerigars use visual edges to target and guide landings. Calculations of photoreceptor excitation reveal that edge detection in landing budgerigars is performed by a color-blind luminance channel that sums the signals from the red and green photoreceptors, or, alternatively, receives input from the red double-cones. This finding has close parallels to vision in honeybees and primates, where edge detection and motion perception are also largely color-blind.

  7. Third molar surgery: the patient's and the clinician's perspective

    Directory of Open Access Journals (Sweden)

    Jerjes Waseem


    Full Text Available Abstract Background In this report, the problems of third molar surgery have been reviewed from the perspective of both patient and clinician; additionally an overall analysis of preoperative imaging investigations was carried out. Specifically, three main areas of interest were investigated: the prediction of surgical difficulty and potential complications; the assessment of stress and anxiety and finally the assessment of postoperative complications and the surgeon's experience. Findings In the first study, the prediction of surgical difficulty and potential injury to the inferior alveolar nerve was assessed. This was achieved by examining the patient's orthopantomograms and by using the Pederson Difficulty Index (PDI. Several radiological signs were identified and a classification tree was created to help predict the incidence of such event. In the second study, a prospective assessment addressing the patient's stress and anxiety pre-, intra- and postoperatively was employed. Midazolam was the active drug used against placebo. Objective and subjective parameters were assessed, including measuring the cortisol level in saliva. Midazolam was found to significantly reduce anxiety levels and salivary cortisol was identified as an accurate anxiety marker. In the third study, postoperative complications and the surgeon's experience were examined. Few patients in this study suffered permanent nerve dysfunction. Junior surgeons reported a higher complication rate particularly in trismus, alveolar osteitis, infection and paraesthesia over the distributions of the inferior alveolar and lingual nerves. In apparent contrast, senior surgeons reported higher incidence of postoperative bleeding. Discussion These studies if well employed can lead to favourable alteration in patient management and might have a positive impact on future healthcare service.

  8. Development and Integration of Professional Core Values Among Practicing Clinicians. (United States)

    McGinnis, Patricia Quinn; Guenther, Lee Ann; Wainwright, Susan F


    The physical therapy profession has adopted professional core values, which define expected values for its members, and developed a self-assessment tool with sample behaviors for each of the 7 core values. However, evidence related to the integration of these core values into practice is limited. The aims of this study were: (1) to gain insight into physical therapists' development of professional core values and (2) to gain insight into participants' integration of professional core values into clinical practice. A qualitative design permitted in-depth exploration of the development and integration of the American Physical Therapy Association's professional core values into physical therapist practice. Twenty practicing physical therapists were purposefully selected to explore the role of varied professional, postprofessional, and continuing education experiences related to exposure to professional values. The Core Values Self-Assessment and résumé sort served as prompts for reflection via semistructured interviews. Three themes were identified: (1) personal values were the foundation for developing professional values, which were further shaped by academic and clinical experiences, (2) core values were integrated into practice independent of practice setting and varied career paths, and (3) participants described the following professional core values as well integrated into their practice: integrity, compassion/caring, and accountability. Social responsibility was an area consistently identified as not being integrated into their practice. The Core Values Self-Assessment tool is a consensus-based document developed through a Delphi process. Future studies to establish reliability and construct validity of the tool may be warranted. Gaining an in-depth understanding of how practicing clinicians incorporate professional core values into clinical practice may shed light on the relationship between core values mastery and its impact on patient care. Findings may

  9. Emergency contraception: A multispecialty survey of clinician knowledge and practices. (United States)

    Batur, Pelin; Cleland, Kelly; McNamara, Megan; Wu, Justine; Pickle, Sarah


    To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. The final sample included 1684 providers (response rate=51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide LNG EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide LNG, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods [UPA and copper intrauterine device (IUD)] were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. In our sample of 1684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of EC (UPA and the copper IUD) are far lower than for LNG EC. Women should be offered the

  10. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bradley Yudelowitz


    Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

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

    DEFF Research Database (Denmark)

    Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten


    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...

  12. Plasma edge modelling with ICRF coupling

    Directory of Open Access Journals (Sweden)

    Zhang Wei


    Full Text Available The physics of Radio-Frequency (RF wave heating in the Ion Cyclotron Range of Frequencies (ICRF in the core plasmas of fusion devices are relatively well understood while those in the Scrape-Off Layer (SOL remain still unresolved. This paper is dedicated to study the ICRF interactions with the plasma edge, mainly from the theoretical and numerical point of view, in particular with the 3D edge plasma fluid and neutral transport code EMC3-EIRENE and various wave codes. Here emphasis is given to the improvement of ICRF coupling with local gas puffing and to the ICRF induced density convection in the SOL.

  13. CO2 fluxes near a forest edge

    DEFF Research Database (Denmark)

    Sogachev, Andrey; Leclerc, Monique Y.; Zhang, Gensheng


    In contrast with recent advances on the dynamics of the flow at a forest edge, few studies have considered its role on scalar transport and, in particular, on CO2 transfer. The present study addresses the influence of the abrupt roughness change on forest atmosphere CO2 exchange and contrasts...... as a function of both sources/sinks distribution and the vertical structure of the canopy. Results suggest that the ground source plays a major role in the formation of wave-like vertical CO2 flux behavior downwind of a forest edge, despite the fact that the contribution of foliage sources/sinks changes...

  14. Edge detection techniques for iris recognition system

    International Nuclear Information System (INIS)

    Tania, U T; Motakabber, S M A; Ibrahimy, M I


    Nowadays security and authentication are the major parts of our daily life. Iris is one of the most reliable organ or part of human body which can be used for identification and authentication purpose. To develop an iris authentication algorithm for personal identification, this paper examines two edge detection techniques for iris recognition system. Between the Sobel and the Canny edge detection techniques, the experimental result shows that the Canny's technique has better ability to detect points in a digital image where image gray level changes even at slow rate

  15. Radiative edge layers in limiter tokamaks

    International Nuclear Information System (INIS)

    Monier-Garbet, P.


    The characteristics of the highly radiative edge layers produced in the limiter configuration and with an open ergodic divertor are reviewed, with emphasis on the results obtained in TEXTOR and Tore Supra. In these two experiments an impurity injection technique is used to obtain highly radiating homogeneous peripheral layers. This requires that the peripheral radiation capability be maximized, while at the same time avoiding plasma core contamination; it is also necessary to insure the stability of the radiating layer. These physics issues, governing the success of the highly radiative edge scenario, are discussed. (orig.)

  16. Wing Leading Edge Concepts for Noise Reduction (United States)

    Shmilovich, Arvin; Yadlin, Yoram; Pitera, David M.


    This study focuses on the development of wing leading edge concepts for noise reduction during high-lift operations, without compromising landing stall speeds, stall characteristics or cruise performance. High-lift geometries, which can be obtained by conventional mechanical systems or morphing structures have been considered. A systematic aerodynamic analysis procedure was used to arrive at several promising configurations. The aerodynamic design of new wing leading edge shapes is obtained from a robust Computational Fluid Dynamics procedure. Acoustic benefits are qualitatively established through the evaluation of the computed flow fields.

  17. X-point effect on edge stability

    International Nuclear Information System (INIS)

    Saarelma, S; Kirk, A; Kwon, O J


    We study the effects of the X-point configuration on edge localized mode (ELM) triggering peeling and ballooning modes using fixed boundary equilibria and modifying the plasma shape to approach the limit of a true X-point. The current driven pure peeling modes are asymptotically stabilized by the X-point while the stabilizing effect on ballooning modes depends on the poloidal location of the X-point. The coupled peeling-ballooning modes experience the elimination of the peeling component as the X-point is introduced. This can significantly affect the edge stability diagrams used to analyse the ELM triggering mechanisms.

  18. Edge Cut Domination, Irredundance, and Independence in Graphs


    Fenstermacher, Todd; Hedetniemi, Stephen; Laskar, Renu


    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.

  19. Cutting off Mediation. Agamben as Master Thinker

    Directory of Open Access Journals (Sweden)

    Astrid Deuber-Mankowsky


    Full Text Available Agamben’s Homo Sacer turns centrally upon “bare life”. However, the following subjects are not thematized: natality, gender, sexuality, the relation of the sexes, the heterosexual character of the symbolic order and political culture, the interest of women in the reproduction of life. The entire question of sexual difference —like that of the difference between victim and perpetrator, between witnesses and those born afterwards— is banned from Agamben’s horizon. Thus a deep unease remains, which this paper is intended to explore. It will first present the methodological and theoretical inspirations, which Homo Sacer owes to the thought of Carl Schmitt. Secondly it will show that Schmitt’s concepts of nomos and the state of exception cannot provide a suitable basis for rewriting Foucault’s concept of biopolitics.

  20. To Innovate Better, Find Divergent Thinkers

    DEFF Research Database (Denmark)

    Poetz, Marion; Hippel, Eric von


    The article discusses the practice of seeking advice and ideas from practitioners in analogous fields. It references a study on search methodologies by Marion Poetz and colleagues at the Copenhagen Business School and Zeppelin University. Poetz and colleagues used a pyramid search methodology dev...

  1. "STL" Guiding the 21st Century Thinker (United States)

    Kelley, Todd R.


    Members of the technology and engineering education community have provided a clear message that (Standards for Technological Literacy) STL provides multiple opportunities to teach engineering concepts within K-12 education. This article will review recent research within technology education and the technological literacy standards…

  2. Thinkers and feelers: Emotion and giving. (United States)

    Corcoran, Katie E


    Voluntary organizations, such as religious congregations, ask their members to contribute money as a part of membership and rely on these contributions for their survival. Yet often only a small cadre of members provides the majority of the contributions. Past research on congregational giving focuses on cognitive rational processes, generally neglecting the role of emotion. Extending Collins' (2004) interaction ritual theory, I predict that individuals who experience positive emotions during religious services will be more likely to give a higher proportion of their income to their congregation than those who do not. Moreover, I argue that this effect will be amplified in congregational contexts characterized by high aggregate levels of positive emotion, strictness, dense congregational networks, and expressive rituals. Using data from the 2001 U.S. Congregational Life Survey and multilevel modeling, I find support for several of these hypotheses. The findings suggest that both cognitive and emotional processes underlie congregational giving. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Adam Smith : Systematic Philosopher and Public Thinker

    NARCIS (Netherlands)

    Schliesser, E.


    This book treats Adam Smith as a systematic philosopher. Smith was a giant of the Scottish Enlightenment with polymath interests. The book explores Smith’s economics and ethics in light of his other commitments on the nature of knowledge, the theory of emotions, the theory of mind, his account of

  4. Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment. (United States)

    Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten


    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.

  5. Balancing treatment allocations by clinician or center in randomized trials allows unacceptable levels of treatment prediction. (United States)

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


    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

  6. Optically Unraveling the Edge Chirality-Dependent Band Structure and Plasmon Damping in Graphene Edges. (United States)

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


    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.

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

    International Nuclear Information System (INIS)

    Maqueda, Ricardo; Levinton, Fred M.


    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.

  8. Edge control in CNC polishing, paper 2: simulation and validation of tool influence functions on edges. (United States)

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


    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.

  9. Smallpox vaccination and adverse reactions. Guidance for clinicians. (United States)

    Cono, Joanne; Casey, Christine G; Bell, David M


    , vaccination during pregnancy should not ordinarily be a reason to consider termination of pregnancy. No known indication exists for routine, prophylactic use of VIG in an unintentionally vaccinated pregnant woman; however, VIG should not be withheld if a pregnant woman develops a condition where VIG is needed. Other less-common adverse events after smallpox vaccination have been reported to occur in temporal association with smallpox vaccination, but causality has not been established. Prophylactic treatment with VIG is not recommended for persons or close contacts with contraindications to smallpox vaccination who are inadvertently inoculated or exposed. These persons should be followed closely for early recognition of adverse reactions that might develop, and clinicians are encouraged to enroll these persons in the CDC registry by calling the Clinician Information Line at 877-554-4625. To request clinical consultation and IND therapies for vaccinia-related adverse reactions for civilians, contact your state health department or CDC's Clinician Information Line (877-554-4625). Clinical evaluation tools are available at http.// Clinical specimen-collection guidance is available at Physicians at military medical facilities can request VIG or cidofovir by calling the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at 301-619-2257 or 888-USA-RIID.

  10. Edge currents in frustrated Josephson junction ladders (United States)

    Marques, A. M.; Santos, F. D. R.; Dias, R. G.


    We present a numerical study of quasi-1D frustrated Josephson junction ladders with diagonal couplings and open boundary conditions, in the large capacitance limit. We derive a correspondence between the energy of this Josephson junction ladder and the expectation value of the Hamiltonian of an analogous tight-binding model, and show how the overall superconducting state of the chain is equivalent to the minimum energy state of the tight-binding model in the subspace of one-particle states with uniform density. To satisfy the constraint of uniform density, the superconducting state of the ladder is written as a linear combination of the allowed k-states of the tight-binding model with open boundaries. Above a critical value of the parameter t (ratio between the intra-rung and inter-rung Josephson couplings) the ladder spontaneously develops currents at the edges, which spread to the bulk as t is increased until complete coverage is reached. Above a certain value of t, which varies with ladder size (t = 1 for an infinite-sized ladder), the edge currents are destroyed. The value t = 1 corresponds, in the tight-binding model, to the opening of a gap between two bands. We argue that the disappearance of the edge currents with this gap opening is not coincidental, and that this points to a topological origin for these edge current states.

  11. Superconducting Metallic Glass Transition-Edge-Sensors (United States)

    Hays, Charles C. (Inventor)


    A superconducting metallic glass transition-edge sensor (MGTES) and a method for fabricating the MGTES are provided. A single-layer superconducting amorphous metal alloy is deposited on a substrate. The single-layer superconducting amorphous metal alloy is an absorber for the MGTES and is electrically connected to a circuit configured for readout and biasing to sense electromagnetic radiation.

  12. Edge maps: Representing flow with bounded error

    KAUST Repository

    Bhatia, Harsh


    Robust analysis of vector fields has been established as an important tool for deriving insights from the complex systems these fields model. Many analysis techniques rely on computing streamlines, a task often hampered by numerical instabilities. Approaches that ignore the resulting errors can lead to inconsistencies that may produce unreliable visualizations and ultimately prevent in-depth analysis. We propose a new representation for vector fields on surfaces that replaces numerical integration through triangles with linear maps defined on its boundary. This representation, called edge maps, is equivalent to computing all possible streamlines at a user defined error threshold. In spite of this error, all the streamlines computed using edge maps will be pairwise disjoint. Furthermore, our representation stores the error explicitly, and thus can be used to produce more informative visualizations. Given a piecewise-linear interpolated vector field, a recent result [15] shows that there are only 23 possible map classes for a triangle, permitting a concise description of flow behaviors. This work describes the details of computing edge maps, provides techniques to quantify and refine edge map error, and gives qualitative and visual comparisons to more traditional techniques. © 2011 IEEE.

  13. Nonlinear neoclassical transport in toroidal edge plasmas

    International Nuclear Information System (INIS)

    Fueloep, T.


    Edge plasma processes play a critical role for the global confinement of the plasma in a tokamak. In the edge region, where impurity ions are abundant and the temperature and density gradients are large, the assumptions of standard neoclassical theory break down. This paper reviews recent extensions of neoclassical theory to treat this problem, in particular our own work, which focuses on the nonlinear aspects of transport in a plasma with heavy impurity ions. In this theory, the pressure and temperature gradients are allowed to be steeper than in conventional theory neoclassical theory, so that the friction force between the bulk ions and heavy impurities is comparable to the parallel impurity pressure gradient. The impurity ions are then found to undergo a spontaneous rearrangement on each flux surface. This reduces their parallel friction with the bulk ions and causes the neoclassical ion flux to become a non-monotonic function of the gradients for plasma parameters typical of the tokamak edge. Thus, the neoclassical confinement is improved in regions where the gradients are large, such as in the edge pedestal. (orig.)

  14. Nonlinear neoclassical theory for toroidal edge plasmas

    International Nuclear Information System (INIS)

    Fueloep, T.; Helander, P.


    Edge plasma processes play a critical role for the global confinement of the plasma. In the edge region, where impurity ions are abundant and the temperature and density gradients are large, the assumptions of the standard neoclassical theory break down. We have extended the theory of neoclassical transport in an impure plasma with arbitrary cross section and aspect ratio to allow for steeper pressure and temperature gradients than are usually considered in the conventional theory. The gradients are allowed to be so large that the friction force between the bulk ions and heavy impurities is comparable to the parallel impurity pressure gradient. In this case the impurity ions are found to undergo a spontaneous rearrangement on each flux surface. This reduces their parallel friction with the bulk ions and causes the neoclassical ion flux to become a non-monotonic function of the gradients for plasma parameters typical of the tokamak edge. Thus, the neoclassical confinement is improved in regions where the gradients are large, such as in the edge pedestal. The theoretical predictions are compared with experimental data from several tokamaks. (orig.)

  15. The SKED: speckle knife edge detector

    International Nuclear Information System (INIS)

    Sharpies, S D; Light, R A; Achamfuo-Yeboah, S O; Clark, M; Somekh, M G


    The knife edge detector—also known as optical beam deflection—is a simple and robust method of detecting ultrasonic waves using a laser. It is particularly suitable for detection of high frequency surface acoustic waves as the response is proportional to variation of the local tilt of the surface. In the case of a specular reflection of the incident laser beam from a smooth surface, any lateral movement of the reflected beam caused by the ultrasonic waves is easily detected by a pair of photodiodes. The major disadvantage of the knife edge detector is that it does not cope well with optically rough surfaces, those that give a speckled reflection. The optical speckles from a rough surface adversely affect the efficiency of the knife edge detector, because 'dark' speckles move synchronously with 'bright' speckles, and their contributions to the ultrasonic signal cancel each other out. We have developed a new self-adapting sensor which can cope with the optical speckles reflected from a rough surface. It is inelegantly called the SKED—speckle knife edge detector—and like its smooth surface namesake it is simple, cheap, compact, and robust. We describe the theory of its operation, and present preliminary experimental results validating the overall concept and the operation of the prototype device

  16. The SKED: speckle knife edge detector (United States)

    Sharpies, S. D.; Light, R. A.; Achamfuo-Yeboah, S. O.; Clark, M.; Somekh, M. G.


    The knife edge detector—also known as optical beam deflection—is a simple and robust method of detecting ultrasonic waves using a laser. It is particularly suitable for detection of high frequency surface acoustic waves as the response is proportional to variation of the local tilt of the surface. In the case of a specular reflection of the incident laser beam from a smooth surface, any lateral movement of the reflected beam caused by the ultrasonic waves is easily detected by a pair of photodiodes. The major disadvantage of the knife edge detector is that it does not cope well with optically rough surfaces, those that give a speckled reflection. The optical speckles from a rough surface adversely affect the efficiency of the knife edge detector, because 'dark' speckles move synchronously with 'bright' speckles, and their contributions to the ultrasonic signal cancel each other out. We have developed a new self-adapting sensor which can cope with the optical speckles reflected from a rough surface. It is inelegantly called the SKED—speckle knife edge detector—and like its smooth surface namesake it is simple, cheap, compact, and robust. We describe the theory of its operation, and present preliminary experimental results validating the overall concept and the operation of the prototype device.

  17. Anomalous transport in the tokamak edge

    International Nuclear Information System (INIS)

    Vayakis, G.


    The tokamak edge has been studied with arrays of Langmuir and magnetic probes on the DITE and COMPASS-C devices. Measurements of plasma parameters such as density, temperature and radial magnetic field were taken in order to elucidate the character, effect on transport and origin of edge fluctuations. The tokamak edge is a strongly-turbulent environment, with large electrostatic fluctuation levels and broad spectra. The observations, including direct correlation measurements, are consistent with a picture in which the observed magnetic field fluctuations are driven by the perturbations in electrostatic parameters. The propagation characteristics of the turbulence, investigated using digital spectral techniques, appear to be dominated by the variation of the radial electric field, both in limiter and divertor plasmas. A shear layer is formed, associated in each case with the last closed flux surface. In the shear layer, the electrostatic wavenumber spectra are significantly broader. The predictions of a drift wave model (DDGDT) and of a family of models evolving from the rippling mode (RGDT group), are compared with experimental results. RGDT, augmented by impurity radiation effects, is shown to be the most reasonable candidate to explain the nature of the edge turbulence, only failing in its estimate of the wavenumber range. (Author)

  18. Edge Sheared Flows and Blob Dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Myra, J.; D' Ippolito, D.; Russell, D., E-mail: [Lodestar Research Corporation, Boulder (United States); Davis, W. M.; Zweben, S. [Princeton Plasma Physics Laboratory, Princeton (United States); Terry, J.; LaBombard, B. [Massachusetts Institute of Technology, Cambridge (United States)


    Full text: A study of sheared flows in the edge and scrape-off layer (SOL) and their interaction with blob-filaments is presented. Edge sheared flows are believed to be important for the L-H, and H-L transitions. Blob generation and dynamics impacts both the (near-separatrix) scrape-off-layer (SOL) width critical for power handling in the divertor, and the interaction of plasma in the far SOL with plasma-facing components. These topics are critical for ITER and future devices. A fluid-based 2D curvature-interchange model embedded in the SOLT code is employed to study these issues. Sheared binormal flows both regulate the power flux crossing the separatrix and control the character of emitted turbulence structures such as blob-filaments. At a critical power level (depending on parameters) the laminar flows containing intermittent, but bound, structures give way to full-blown blob emissions signifying a transition from quasi-diffusive to convective transport. In order to diagnose sheared flows in experiments and assess their interaction with blobs, a blob-tracking algorithm has been developed and applied to both NSTX and Alcator C-Mod data. Blob motion and ellipticity can be affected by sheared flows, and are diagnosed and compared with seeded blob simulations. A picture of the interaction of blobs and sheared flows is emerging from advances in the theory and simulation of edge turbulence, combined with ever-improving capabilities for edge diagnostics and their analysis. (author)

  19. Edge Delamination of Monolayer Transition Metal Dichalcogenides. (United States)

    Ly, Thuc Hue; Yun, Seok Joon; Thi, Quoc Huy; Zhao, Jiong


    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.

  20. Evaluation of alternative snow plow cutting edges. (United States)


    With approximately 450 snow plow trucks, the Maine Department of Transportation (MaineDOT) uses in : excess of 10,000 linear feet of plow cutting edges each winter season. Using the 2008-2009 cost per linear : foot of $48.32, the Departments total co...

  1. Edge diagnostics for tandem mirror machines

    International Nuclear Information System (INIS)

    Allen, S.L.


    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

  2. Commercial Technology at the Tactical Edge (United States)


    Software defined Networking ( SDN ), Autonomic Networking , and Cognitive Radios for Spectrum Sharing. Software defined 41 Pan, P., “ Software Defined Network ( SDN ) Problem Statement and Use Cases for Data Center Applications,” IETF, 2011, at the tactical edge in the near future. These include software defined networking , autonomous networks , cognitive

  3. Acoustic streaming of a sharp edge. (United States)

    Ovchinnikov, Mikhail; Zhou, Jianbo; Yalamanchili, Satish


    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.

  4. Edge-disjoint Hamiltonian cycles in hypertournaments

    DEFF Research Database (Denmark)

    Thomassen, Carsten


    We introduce a method for reducing k-tournament problems, for k >= 3, to ordinary tournaments, that is, 2-tournaments. It is applied to show that a k-tournament on n >= k + 1 + 24d vertices (when k >= 4) or on n >= 30d + 2 vertices (when k = 3) has d edge-disjoint Hamiltonian cycles if and only...

  5. Leading-Edge Vortex lifts swifts

    NARCIS (Netherlands)

    Videler, JJ; Stamhuis, EJ; Povel, GDE


    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 60degrees sweep of the sharp hand-wing leading edge were tested in a water tunnel.

  6. Zone edge effects with variable rate irrigation (United States)

    Variable rate irrigation (VRI) systems may offer solutions to enhance water use efficiency by addressing variability within a field. However, the design of VRI systems should be considered to maximize application uniformity within sprinkler zones, while minimizing edge effects between such zones alo...

  7. Robotic edge machining using elastic abrasive tool (United States)

    Sidorova, A. V.; Semyonov, E. N.; Belomestnykh, A. S.


    The article describes a robotic center designed for automation of finishing operations, and analyzes technological aspects of an elastic abrasive tool applied for edge machining. Based on the experimental studies, practical recommendations on the application of the robotic center for finishing operations were developed.

  8. Simultaneous embedding: edge orderings, relative positions, cutvertices

    NARCIS (Netherlands)

    Bläsius, T.; Karrer, A.; Rutter, I.

    A simultaneous embedding (with fixed edges) of two graphs (Formula presented.) and (Formula presented.) with common graph (Formula presented.) is a pair of planar drawings of (Formula presented.) and (Formula presented.) that coincide on G. It is an open question whether there is a polynomial-time

  9. Increased heat fluxes near a forest edge

    NARCIS (Netherlands)

    Klaassen, W; van Breugel, PB; Moors, EJ; Nieveen, JP


    Observations of sensible and latent heat flux above forest downwind of a forest edge show these fluxes to be larger than the available energy over the forest. The enhancement averages to 56 W m(-2), or 16% of the net radiation, at fetches less than 400 m, equivalent to fetch to height ratios less

  10. Increased heat fluxes near a forest edge

    NARCIS (Netherlands)

    Klaassen, W.; Breugel, van P.B.; Moors, E.J.; Nieveen, J.P.


    Observations of sensible and latent heat flux above forest downwind of a forest edge show these fluxes to be larger than the available energy over the forest. The enhancement averages to 56 W mm2, or 16 f the net radiation, at fetches less than 400 m, equivalent to fetch to height ratios less than

  11. Plasma edge cooling during RF heating

    International Nuclear Information System (INIS)

    Suckewer, S.; Hawryluk, R.J.


    A new approach to prevent the influx of high-Z impurities into the core of a tokamak discharge by using RF power to modify the edge plasma temperature profile is presented. This concept is based on spectroscopic measurements on PLT during ohmic heating and ATC during RF heating. A one dimensional impurity transport model is used to interpret the ATC results

  12. 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


    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)

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


    Li, Yuanchang


    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...

  14. Mapping Forest Edge Using Aerial Lidar (United States)

    MacLean, M. G.


    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.

  15. Evaluation of the informatician perspective: determining types of research papers preferred by clinicians. (United States)

    Ru, Boshu; Wang, Xiaoyan; Yao, Lixia


    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.

  16. Moving beyond 'not enough time': factors influencing paediatric clinicians' participation in research. (United States)

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


    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.

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

    NARCIS (Netherlands)

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


    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

  18. Irish Clinicians' Views of Interventions for Children with Autistic Spectrum Disorders (United States)

    Ridge, Katie; Guerin, Suzanne


    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…

  19. The nature of excellent clinicians at an academic health science center: a qualitative study. (United States)

    Mahant, Sanjay; Jovcevska, Vesna; Wadhwa, Anupma


    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.

  20. Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms (United States)

    De Los Reyes, Andres; Marsh, Jessecae K.


    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…

  1. Clinician characteristics, communication, and patient outcome in oncology: a systematic review. (United States)

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


    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.

  2. 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.


    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

  3. Lyme Disease in West Virginia: An Assessment of Distribution and Clinicians' Knowledge of Disease and Surveillance. (United States)

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


    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.

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

    International Nuclear Information System (INIS)

    Gecaga, W.


    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)

  5. The relationship between clinician turnover and adolescent treatment outcomes: An examination from the client perspective (United States)

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


    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

  6. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K


    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

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


    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.

  8. Edge-effect interactions in fragmented and patchy landscapes. (United States)

    Porensky, Lauren M; Young, Truman P


    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.

  9. Working overtime in community mental health: Associations with clinician burnout and perceived quality of care. (United States)

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


    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).

  10. Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians. (United States)

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


    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.

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


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


    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...

  12. Balancing the edge effects budget: bay scallop settlement and loss along a seagrass edge. (United States)

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


    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.

  13. Independent component analysis of edge information for face recognition

    CERN Document Server

    Karande, Kailash Jagannath


    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

  14. Edge-detect interpolation for direct digital periapical images

    International Nuclear Information System (INIS)

    Song, Nam Kyu; Koh, Kwang Joon


    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.

  15. Edge states in a ferromagnetic honeycomb lattice with armchair boundaries (United States)

    Pantaleón, Pierre A.; Xian, Y.


    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.

  16. 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.


    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

  17. GSGG edge cladding development: Final technical report

    International Nuclear Information System (INIS)

    Izumitani, T.; Meissner, H.E.; Toratani, H.


    The objectives of this project have been: (1) Investigate the possibility of chemical etching of GSGG crystal slabs to obtain increased strength. (2) Design and construct a simplified mold assembly for casting cladding glass to the edges of crystal slabs of different dimensions. (3) Conduct casting experiments to evaluate the redesigned mold assembly and to determine stresses as function of thermal expansion coefficient of cladding glass. (4) Clad larger sizes of GGG slabs as they become available. These tasks have been achieved. Chemical etching of GSGG slabs does not appear possible with any other acid than H 3 PO 4 at temperatures above 300 0 C. A mold assembly has been constructed which allowed casting cladding glass around the edges of the largest GGG slabs available (10 x 20 x 160 mm) without causing breakage through the annealing step

  18. Quantum nature of edge magnetism in graphene. (United States)

    Golor, Michael; Wessel, Stefan; Schmidt, Manuel J


    It is argued that the subtle crossover from decoherence-dominated classical magnetism to fluctuation-dominated quantum magnetism is experimentally accessible in graphene nanoribbons. We show that the width of a nanoribbon determines whether the edge magnetism is on the classical side, on the quantum side, or in between. In the classical regime, decoherence is dominant and leads to static spin polarizations at the ribbon edges, which are well described by mean-field theories. The quantum Zeno effect is identified as the basic mechanism which is responsible for the spin polarization and thereby enables the application of graphene in spintronics. On the quantum side, however, the spin polarization is destroyed by dynamical processes. The great tunability of graphene magnetism thus offers a viable route for the study of the quantum-classical crossover.

  19. 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.

  20. Gaining the Edge: Connecting with the Millennials (United States)


    Cleaver’s and Partridge’s) entered Americans’ living rooms nightly. The Osmond’s and Beatles captivated music of the Boomer’s youth. Powerful...AIR WAR COLLEGE AIR UNIVERSITY GAINING THE EDGE: CONNECTING WITH THE MILLENNIALS by Kay A. Smith, Lt Col, USAF A Research Report Submitted to... the Faculty In Partial Fulfillment of the Graduation Requirements 1 December 2008 DISCLAIMER The views expressed in this academic research

  1. Lived citizenship on the edge of society

    DEFF Research Database (Denmark)

    work. Drawing on the notion of intimate citizenship and an understanding of citizenship as socio-spatial, the theoretical framework addresses the challenges of enhancing the agency of social work clients and of promoting inclusive citizenship, and how these challenges are shaped by emotions, affect......, rationality, materiality, power relations, policies and managerial strategies. Lived Citizenship on the Edge of Society will be of interest to students and scholars across a range of disciplines including social policy and social work....

  2. Images of Edge Turbulence in NSTX

    International Nuclear Information System (INIS)

    Zweben, S.J.; Bush, C.E.; Maqueda, R.; Munsat, T.; Stotler, D.; Lowrance, J.; Mastracola, V.; Renda, G.


    The 2-D structure of edge plasma turbulence has been measured in the National Spherical Torus Experiment (NSTX) by viewing the emission of the Da spectral line of deuterium. Images have been made at framing rates of up to 250,000 frames/sec using an ultra-high speed CCD camera developed by Princeton Scientific Instruments. A sequence of images showing the transition between L-mode and H-mode states is shown

  3. Transport in the tokamak plasma edge

    International Nuclear Information System (INIS)

    Vold, E.L.


    Experimental observations characterize the edge plasma or boundary layer in magnetically confined plasmas as a region of great complexity. Evidence suggests the edge physics plays a key role in plasma confinement although the mechanism remains unresolved. This study focuses on issues in two areas: observed poloidal asymmetries in the Scrape Off Layer (SOL) edge plasma and the physical nature of the plasma-neutral recycling. A computational model solves the coupled two dimensional partial differential equations governing the plasma fluid density, parallel and radial velocities, electron and ion temperatures and neutral density under assumptions of toroidal symmetry, ambipolarity, anomalous diffusive radial flux, and neutral-ion thermal equilibrium. Drift flow and plasma potential are calculated as dependent quantities. Computational results are compared to experimental data for the CCT and TEXTOR:ALT-II tokamak limiter cases. Comparisons show drift flux is a major component of the poloidal flow in the SOL along the tangency/separatrix. Plasma-neutral recycling is characterized in several tokamak divertors, including the C-MOD device using magnetic flux surface coordinates. Recycling is characterized by time constant, τ rc , on the order of tens of milliseconds. Heat flux transients from the core into the edge on shorter time scales significantly increase the plasma temperatures at the target and may increase sputtering. Recycling conditions in divertors vary considerably depending on recycled flux to the core. The high density, low temperature solution requires that the neutral mean free path be small compared to the divertor target to x-point distance. The simulations and analysis support H-mode confinement and transition models based on the recycling divertor solution bifurcation

  4. The transition-edge microbolometer (TREMBOL)

    International Nuclear Information System (INIS)

    Wentworth, S.M.; Neikirk, D.P.


    The TREMBOL (transition-edge microbolometer) and the composite TREMBOL are introduced as detectors for FIR imaging arrays. The TREMBOL uses a superconductor's sharp change in resistance at the normal conduction to superconduction transition. The structure of the composite TREMBOL enables heating of the individual detectors in an array up to their transition temperature, and can thus be used in multiplexing, which would be very advantageous for two-dimensional arrays. 23 refs

  5. Multi-scale Regions from Edge Fragments

    DEFF Research Database (Denmark)

    Kazmi, Wajahat; Andersen, Hans Jørgen


    In this article we introduce a novel method for detecting multi-scale salient regions around edges using a graph based image compression algorithm. Images are recursively decomposed into triangles arranged into a binary tree using linear interpolation. The entropy of any local region of the image......), their performance is comparable to SIFT (Lowe, 2004).We also show that when they are used together with MSERs (Matas et al., 2002), the performance of MSERs is boosted....

  6. Edge rotational magnons in magnonic crystals

    International Nuclear Information System (INIS)

    Lisenkov, Ivan; Kalyabin, Dmitry; Nikitov, Sergey


    It is predicted that in 2D magnonic crystals the edge rotational magnons of forward volume magnetostatic spin waves can exist. Under certain conditions, locally bounded magnons may appear within the crystal consisting of the ferromagnetic matrix and periodically inserted magnetic/non-magnetic inclusions. It is also shown that interplay of different resonances in 2D magnonic crystal may provide conditions for spin wave modes existence with negative group velocity

  7. Edge modelling for W7-X

    International Nuclear Information System (INIS)

    Schneider, R.; Borchardt, M.; Riemann, J.; Bonnin, X.; Nuehrenberg, J.; Mutzke, A.


    The edge modelling activities for W7-X are summarized. The status of the new 3D SOL transport code BoRiS is presented, including an algorithm for calculation of magnetic coordinates and metric coefficients. In addition, the analysis of a toroidally averaged island topology with respect to the effect of drift and currents is discussed using the 2D B2-solps5.0 code. (author)

  8. ICRF/edge physics research on TEXTOR

    International Nuclear Information System (INIS)

    Oost, G. van; Nieuwenhove, R. van; Koch, R.; Messiaen, A.M.; Vandenplas, P.E.; Weynants, R.R.; Dippel, K.H.; Finken, K.H.; Lie, Y.T.; Pospieszczyk, A.; Samm, U.; Schweer, B.; Conn, R.W.; Corbett, W.J.; Goebel, D.M.; Moyer, R.A.; California Univ., Los Angeles


    Extensive investigations of ICRF-induced effects on the edge plasma and on plasma-wall interaction were conducted on TEXTOR under different wall- and limiter as well as plasma- and heating conditions. Several strong effects of ICRF on the edge parameters were observed on TEXTOR, such as density rise, instantaneous electron heating, modification of SOL profiles, influx of ligth and/or heavy impurities, increased heat flux to the limiters, and production of energetic ions in the SOL. The fast response time of some of the changes and the observation of a maximum in the SOL profile of electron temperature, heat flux and metal sputtering clearly demonstrated that RF power is directly absorbed in the SOL. Estimates of this power amount to several percent of the total RF power launched into the plasma. Plasma-wall interaction during ICRF was substantially reduced by an appropriate choice of the wall conditioning procedures (wall carbonization with liner at 400degC or, above all, boronization). As a result record low values of the radiated power fraction were achieved during ICRF and long pulse, high power, low impurity operation was possible. Further improvement was obtained by ICRF antenna phasing. When ICRF power is coupled to the plasma, several effects on the core and edge plasma influence the operation of the toroidal pump limiter ALT-II. Experimental and theoretical studies were performed to elucidate the mechanisms responsible for the ICRF-induced effects, including the propagation of plasma waves in the edge plasma and nonlinear phenomena such as parametric decay, important changes in the DC current between the antenna structure and the liner due to the sheath effect at the antennas, and the generation of waves at harmonics of the RF generator frequency. Radial profiles of the DC radial and poloidal electric fields as well as a localized RF electric field structure were measured in the SOL using a fast scanning probe. (orig.)

  9. Depth from Edge and Intensity Based Stereo. (United States)


    a Mars Viking vehicle, and a random dotted coffee jar. Assessment of the algorithm is a bit difficult: it uses a fairly simple control structure with...correspondences. This use of an evaluation function estimator allowed the introduction of the extensive pruning of a branch and bound algorithm. Even with it...Figure 3-6). This is the edge reversal constraint, and was integral to the pruning . As it happens, this same constraint is the key to the use of the

  10. Canny edge-based deformable image registration. (United States)

    Kearney, Vasant; Huang, Yihui; Mao, Weihua; Yuan, Baohong; Tang, Liping


    This work focuses on developing a 2D Canny edge-based deformable image registration (Canny DIR) algorithm to register in vivo white light images taken at various time points. This method uses a sparse interpolation deformation algorithm to sparsely register regions of the image with strong edge information. A stability criterion is enforced which removes regions of edges that do not deform in a smooth uniform manner. Using a synthetic mouse surface ground truth model, the accuracy of the Canny DIR algorithm was evaluated under axial rotation in the presence of deformation. The accuracy was also tested using fluorescent dye injections, which were then used for gamma analysis to establish a second ground truth. The results indicate that the Canny DIR algorithm performs better than rigid registration, intensity corrected Demons, and distinctive features for all evaluation matrices and ground truth scenarios. In conclusion Canny DIR performs well in the presence of the unique lighting and shading variations associated with white-light-based image registration.

  11. DIII-D edge physics database

    International Nuclear Information System (INIS)

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


    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)

  12. The edge plasma and divertor in TIBER

    Energy Technology Data Exchange (ETDEWEB)

    Barr, W.L.


    An open divertor configuration has been adopted for TIBER. Most recent designs, including DIII-D, NET and CIT use open configurations and rely on a dense edge plasma to shield the plasma from the gas produced at the neutralizer plate. Experiments on ASDEX, PDX, D-III, and recently on DIII-D have shown that a dense edge plasma can be produced by re-ionizing most of the gas produced at the plate. This high recycling mode allows a large flux of particles to carry the heat to the plate, so that the mean energy per particle can be low. Erosion of the plate can be greatly reduced if the average impact energy of the ions at the plate can be reduced to near or below the threshold for sputtering of the plate material. The present configuration allows part of the flux of edge plasma ions to be neutralized at the entrance to the pumping duct so that helium is pumped as well as hydrogen. 7 refs., 3 figs.

  13. Bilayer graphene: gap tunability and edge properties

    International Nuclear Information System (INIS)

    Castro, Eduardo V; Santos, J M B Lopes dos; Peres, N M R; Guinea, F; Castro Neto, A H


    Bilayer graphene - two coupled single graphene layers stacked as in graphite - provides the only known semiconductor with a gap that can be tuned externally through electric field effect. Here we use a tight binding approach to study how the gap changes with the applied electric field. Within a parallel plate capacitor model and taking into account screening of the external field, we describe real back gated and/or chemically doped bilayer devices. We show that a gap between zero and midinfrared energies can be induced and externally tuned in these devices, making bilayer graphene very appealing from the point of view of applications. However, applications to nanotechnology require careful treatment of the effect of sample boundaries. This being particularly true in graphene, where the presence of edge states at zero energy - the Fermi level of the undoped system - has been extensively reported. Here we show that also bilayer graphene supports surface states localized at zigzag edges. The presence of two layers, however, allows for a new type of edge state which shows an enhanced penetration into the bulk and gives rise to band crossing phenomenon inside the gap of the biased bilayer system.

  14. The edge plasma and divertor in TIBER

    International Nuclear Information System (INIS)

    Barr, W.L.


    An open divertor configuration has been adopted for TIBER. Most recent designs, including DIII-D, NET and CIT use open configurations and rely on a dense edge plasma to shield the plasma from the gas produced at the neutralizer plate. Experiments on ASDEX, PDX, D-III, and recently on DIII-D have shown that a dense edge plasma can be produced by re-ionizing most of the gas produced at the plate. This high recycling mode allows a large flux of particles to carry the heat to the plate, so that the mean energy per particle can be low. Erosion of the plate can be greatly reduced if the average impact energy of the ions at the plate can be reduced to near or below the threshold for sputtering of the plate material. The present configuration allows part of the flux of edge plasma ions to be neutralized at the entrance to the pumping duct so that helium is pumped as well as hydrogen. 7 refs., 3 figs

  15. Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis. (United States)

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


    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.

  16. Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting. (United States)

    Martin, T; Daffern, M


    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.

  17. Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know? (United States)

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


    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.

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

    LENUS (Irish Health Repository)

    Flynn, Maura G


    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.

  19. [Meanings attributed to management as an explanation for clinician managers' attitudes and professional identity]. (United States)

    Cascón-Pereira, Rosalía; Valverde, Mireia


    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.

  20. Lack of school requirements and clinician recommendations for human papillomavirus vaccination

    Directory of Open Access Journals (Sweden)

    Linda M. Niccolai


    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.

  1. Electronic medical records and communication with patients and other clinicians: are we talking less? (United States)

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


    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.

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Richard Altman


    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.

  4. 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


    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

  5. Research on reducing the edge effect in magnetorheological finishing. (United States)

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


    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.

  6. Environmental Dataset Gateway (EDG) CS-W Interface (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...

  7. Urbanization impacts on mammals across urban-forest edges and a predictive model of edge effects. (United States)

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


    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

  8. 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

  9. 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....

  10. Transformational leadership in primary care: Clinicians' patterned approaches to care predict patient satisfaction and health expectations. (United States)

    Huynh, Ho Phi; Sweeny, Kate; Miller, Tricia


    Clinicians face the complex challenge of motivating their patients to achieve optimal health while also ensuring their satisfaction. Inspired by transformational leadership theory, we proposed that clinicians' motivational behaviors can be organized into three patient care styles (transformational, transactional, and passive-avoidant) and that these styles differentially predict patient health outcomes. In two studies using patient-reported data and observer ratings, we found that transformational patient care style positively predicted patients' satisfaction and health expectations above and beyond transactional and passive-avoidant patient care style. These findings provide initial support for the patient care style approach and suggest novel directions for the study of clinicians' motivational behaviors.

  11. Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents. (United States)

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


    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.

  12. Education Confronts Changing Demographics. The Challenge to Edge Cities. (United States)

    Tushnet, Naida C.

    This monograph introduces a conference addressing the educational issues of the edge cities of the urban Pacific Southwest. Edge cities on the outside of urban cores (edge cities) are currently facing many of the problems formerly experienced only in urban areas. Of the 30 fastest-growing cities of over 100,000 residents in the country, 19 are…

  13. Polarimetric Edge Detector Based on the Complex Wishart Distribution

    DEFF Research Database (Denmark)

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


    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...

  14. Edge-based correlation image registration for multispectral imaging (United States)

    Nandy, Prabal [Albuquerque, NM


    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.

  15. Image-Based Edge Bundles : Simplified Visualization of Large Graphs

    NARCIS (Netherlands)

    Telea, A.; Ersoy, O.


    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

  16. Gait alterations can reduce the risk of edge loading. (United States)

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


    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.

  17. The use of edge habitats by commuting and foraging bats

    NARCIS (Netherlands)

    Verboom, B.


    Travelling routes and foraging areas of many bat species are mainly along edge habitats, such as treelines, hedgerows, forest edges, and canal banks. This thesis deals with the effects of density, configuration, and structural features of edge habitats on the occurrence of bats. Four

  18. Edge and line oriented contour detection : State of the art

    NARCIS (Netherlands)

    Papari, Giuseppe; Petkov, Nicolai

    We present an overview of various edge and line oriented approaches to contour detection that have been proposed in the last two decades. By edge and line oriented we mean methods that do not rely on segmentation. Distinction is made between edges and contours. Contour detectors are divided in local

  19. Total edge irregularity strength of (n,t)-kite graph (United States)

    Winarsih, Tri; Indriati, Diari


    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 .

  20. 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 ...

  1. Bulk Versus Edge in the Quantum Hall Effect


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


    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.

  2. 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

  3. How edge-reinforced random walk arises naturally

    NARCIS (Netherlands)

    Rolles, S.W.W.


    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

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

    Directory of Open Access Journals (Sweden)

    D. Salvador-Van Eysenrode


    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.

  5. 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


    ...), 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...

  6. 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). (United States)

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


    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.

  7. Are quantum spin Hall edge modes more resilient to disorder, sample geometry and inelastic scattering than quantum Hall edge modes? (United States)

    Mani, Arjun; Benjamin, Colin


    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.

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

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


    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.

  9. 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


    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)

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

    NARCIS (Netherlands)

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

    CONTEXT: 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

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

    DEFF Research Database (Denmark)

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


    . 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...

  12. Focus on Exercise: Client and Clinician Perspectives on Exercise in Individuals with Serious Mental Illness. (United States)

    Browne, Julia; Mihas, Paul; Penn, David L


    The health benefits of exercise are well established, yet individuals with serious mental illness (SMI) have a shorter life expectancy due in large part to physical health complications associated with poor diet and lack of exercise. There is a paucity of research examining exercise in this population with the majority of studies having examined interventions with limited feasibility and sustainability. Before developing an intervention, a thorough exploration of client and clinician perspectives on exercise and its associated barriers is warranted. Twelve clients and fourteen clinicians participated in focus groups aimed at examining exercise, barriers, incentives, and attitudes about walking groups. Results indicated that clients and clinicians identified walking as the primary form of exercise, yet barriers impeded consistent participation. Distinct themes arose between groups; however, both clients and clinicians reported interest in a combination group/pedometer based walking program for individuals with SMI. Future research should consider examining walking programs for this population.

  13. Expediting Clinician Adoption of Safety Practices: The UCSF Venous Access Patient Safety Interdisciplinary Education Project

    National Research Council Canada - National Science Library

    Donaldson, Nancy E; Plank, Rosemary K; Williamson, Ann; Pearl, Jeffrey; Kellogg, Jerry; Ryder, Marcia


    ...) Venous Access Device (VAD) Patient Safety Interdisciplinary Education Project was to develop a 30-hour/one clinical academic unit VAD patient safety course with the aim of expediting clinician adoption of critical concepts...

  14. Stigma in the mental health workplace: perceptions of peer employees and clinicians. (United States)

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


    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).

  15. Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service. (United States)

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


    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.

  16. Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions. (United States)

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


    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

  17. First-principles study of graphene edge properties and flake shapes


    Gan, Chee Kwan; Srolovitz, David J.


    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...

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


    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

  19. Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment. (United States)

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


    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

  20. Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department. (United States)

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


    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

  1. Emotional exhaustion and workload predict clinician-rated and objective patient safety (United States)

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


    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

  2. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. (United States)

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


    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 ( 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

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


    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: Unique identifier: NCT01942226.

  4. Clinician identification of elevated symptoms of depression among individuals seeking treatment for substance misuse. (United States)

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


    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.

  5. Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians. (United States)

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


    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

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


    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


    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. ...

  7. Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury. (United States)

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


    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.

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


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


    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...

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

    Directory of Open Access Journals (Sweden)

    Annalena eWelp


    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.

  10. Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability (United States)

    Holloway, Kristi; Riley, Geoffrey; Auret, Kirsten


    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

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

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


    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.

  12. Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers. (United States)

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


    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.

  13. Inexperienced clinicians can extract pathoanatomic information from MRI narrative reports with high reproducability for use in research/quality assurance

    DEFF Research Database (Denmark)

    Kent, Peter; Briggs, Andrew M; Albert, Hanne Birgit


    Background Although reproducibility in reading MRI images amongst radiologists and clinicians has been studied previously, no studies have examined the reproducibility of inexperienced clinicians in extracting pathoanatomic information from magnetic resonance imaging (MRI) narrative reports and t...

  14. A portable and independent edge fluctuation diagnostic

    International Nuclear Information System (INIS)

    Tsui, H.Y.W.; Ritz, C.P.; Wootton, A.J.


    The measurements of fluctuations and its associated transport with Langmuir probes have provided essential experimental information for some understanding of the turbulent transport. While such measurements have been conducted in the edge region of several tokamaks, only limited effort has been devoted to link and to consolidate these results: such effort can provide information for a more global understanding of the transport process. The purpose of this project is to provide a portable diagnostic facility to measure the edge turbulence on different devices, a signal processing package to analyze the data in a systematic manner and a database to consolidate the experimental results. The end product which provides a collection of information for the comparisons with the theoretical models may lead to a more global understanding of the transport process. A compact self contained portable system has been designed and developed to diagnose the edge plasma of devices with a wide range of sizes and configurations. The system is capable of measuring both the mean and the fluctuation quantities of density, temperature and potential from a standardized Langmuir probe array using a fast reciprocating probe drive. The system can also be used for other fluctuation diagnostics, such as magnetic probes, if necessary. The data acquisition and analysis is performed on a Macintosh 2fx which provides a user-friendly environment. The results obtained by the signal processing routines are stored in a tabloid format to allow comparative studies. The database is a core part of the portable signal analysis system. It allows a fast display of shot data versus each other, as well as comparison between different devices

  15. Edge Simulation Laboratory Progress and Plans

    International Nuclear Information System (INIS)

    Cohen, R


    The Edge Simulation Laboratory (ESL) is a project to develop a gyrokinetic code for MFE edge plasmas based on continuum (Eulerian) techniques. ESL is a base-program activity of OFES, with an allied algorithm research activity funded by the OASCR base math program. ESL OFES funds directly support about 0.8 FTE of career staff at LLNL, a postdoc and a small fraction of an FTE at GA, and a graduate student at UCSD. In addition the allied OASCR program funds about 1/2 FTE each in the computations directorates at LBNL and LLNL. OFES ESL funding for LLNL and UCSD began in fall 2005, while funding for GA and the math team began about a year ago. ESL's continuum approach is a complement to the PIC-based methods of the CPES Project, and was selected (1) because of concerns about noise issues associated with PIC in the high-density-contrast environment of the edge pedestal, (2) to be able to exploit advanced numerical methods developed for fluid codes, and (3) to build upon the successes of core continuum gyrokinetic codes such as GYRO, GS2 and GENE. The ESL project presently has three components: TEMPEST, a full-f, full-geometry (single-null divertor, or arbitrary-shape closed flux surfaces) code in E, μ (energy, magnetic-moment) coordinates; EGK, a simple-geometry rapid-prototype code, presently of; and the math component, which is developing and implementing algorithms for a next-generation code. Progress would be accelerated if we could find funding for a fourth, computer science, component, which would develop software infrastructure, provide user support, and address needs for data handing and analysis. We summarize the status and plans for the three funded activities

  16. Two-Dimensional Edge Detection by Guided Mode Resonant Metasurface (United States)

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


    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.

  17. Orientations of infinite graphs with prescribed edge-connectivity

    DEFF Research Database (Denmark)

    Thomassen, Carsten


    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....

  18. Antichiral Edge States in a Modified Haldane Nanoribbon (United States)

    Colomés, E.; Franz, M.


    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.

  19. Ion transport in turbulent edge plasmas

    International Nuclear Information System (INIS)

    Helander, P.; Massachusetts Inst. of Tech., Cambridge, MA; Hazeltine, R.D.; Catto, P.J.


    Edge plasmas, such as the tokamak scrape-off layer, exist as a consequence of a balance between cross-field diffusion and parallel losses. The former is usually anomalous, and is widely thought to be driven by strong electrostatic turbulence. It is shown that the anomalous diffusion affects the parallel ion transport by giving rise to a new type of thermal force between different ion species. This force is parallel to the magnetic field, but arises entirely because of perpendicular gradients, and could be important for impurity retention in the tokamak divertor. (author)

  20. Modification of tokamak edge turbulence using feedback

    International Nuclear Information System (INIS)

    Richards, B.; Uckan, T.; Wootton, A.J.; Carreras, B.A.; Bengtson, R.D.; Hurwitz, P.; Li, G.X.; Lin, H.; Rowan, W.L.; Tsui, H.Y.W.; Sen, A.K.; Uglum, J.


    Using active feedback, the turbulent fluctuation levels have been reduced by as much as a factor of 2 in the edge of the Texas Experimental Tokamak (TEXT) [K. W. Gentle, Nucl. Fusion Technol. 1, 479 (1981)]. A probe system was used to drive a suppressor wave in the TEXT limiter shadow. A decrease in the local turbulence-induced particle flux has been seen, but a global change in the particle transport at the present time has not been observed. By changing the phase shift and gain of the feedback network, the amplitude of the turbulence was increased by a factor of 10

  1. Tensor voting for robust color edge detection


    Moreno, Rodrigo; García, Miguel Ángel; Puig, Domenec


    The final publication is available at Springer via This chapter proposes two robust color edge detection methods based on tensor voting. The first method is a direct adaptation of the classical tensor voting to color images where tensors are initialized with either the gradient or the local color structure tensor. The second method is based on an extension of tensor voting in which the encoding and voting processes are specifically tailored to ...

  2. Refining Nodes and Edges of State Machines

    DEFF Research Database (Denmark)

    Hallerstede, Stefan; Snook, Colin


    State machines are hierarchical automata that are widely used to structure complex behavioural specifications. We develop two notions of refinement of state machines, node refinement and edge refinement. We compare the two notions by means of examples and argue that, by adopting simple conventions...... refinement theory and UML-B state machine refinement influences the style of node refinement. Hence we propose a method with direct proof of state machine refinement avoiding the detour via Event-B that is needed by UML-B....

  3. Viscosity in the edge of tokamak plasmas

    International Nuclear Information System (INIS)

    Stacey, W.M.


    A fluid representation of viscosity has been incorporated into a set of fluid equations that are maximally ordered in the ''short-radial-gradient-scale-length'' (srgsl) ordering that is appropriate for the edge of tokamak plasmas. The srgsl ordering raises viscous drifts and other viscous terms to leading order and fundamentally alters the character of the fluid equations. A leasing order viscous drift is identified. Viscous-driven radial particle and energy fluxes in the scrape-off layer and divertor channel are estimated to have an order unity effect in reducing radial peaking of energy fluxes transported along the field lines to divertor collector plates

  4. Plasma Edge Control in Tore Supra

    International Nuclear Information System (INIS)

    Evans, T.E.; Mioduszewski, P.K.; Foster, C.; Haste, G.; Horton, L.; Grosman, A.; Ghendrih, P.; Chatelier, M.; Capes, H.; Michelis, C. De; Fall, T.; Geraud, A.; Grisolia, C.; Guilhem, D.; Hutter, T.


    TORE SUPRA is a large superconducting tokamak designed for sustaining long inductive pulses (t∼ 30 s). In particular, all the first wall components have been designed for steady-state heat and particle exhaust, particle injection, and additional heating. In addition to these technological assets, a strict control of the plasma-wall interactions is required. This has been done at low power: experiments with ohmic heating have been mainly devoted to the pump limiter, ergodic divertor and pellet injection experiments. Some specific problems arising in large tokamaks are encountered; the pump limiter and the ergodic divertor yield the expected effects on the plasma edge. The effects on the bulk are discussed

  5. Laser Surface Hardening of Groove Edges (United States)

    Hussain, A.; Hamdani, A. H.; Akhter, R.; Aslam, M.


    Surface hardening of groove-edges made of 3Cr13 Stainless Steel has been carried out using 500 W CO2 laser with a rectangular beam of 2.5×3 mm2. The processing speed was varied from 150-500 mm/min. It was seen that the hardened depth increases with increase in laser interaction time. A maximum hardened depth of around 1mm was achieved. The microhardness of the transformed zone was 2.5 times the hardness of base metal. The XRD's and microstructural analysis were also reported.

  6. Bending energy of buckled edge dislocations (United States)

    Kupferman, Raz


    The study of elastic membranes carrying topological defects has a longstanding history, going back at least to the 1950s. When allowed to buckle in three-dimensional space, membranes with defects can totally relieve their in-plane strain, remaining with a bending energy, whose rigidity modulus is small compared to the stretching modulus. In this paper we study membranes with a single edge dislocation. We prove that the minimum bending energy associated with strain-free configurations diverges logarithmically with the size of the system.

  7. A competitive edge in France around EDF?

    International Nuclear Information System (INIS)

    Glachant, J.M.; Saguan, M.


    The French electric reform displays a rather particular case of creation of a competitive market around a former very large integrated monopoly that retains all of its industrial assets. This new market is growing like a competitive edge around the former monopoly The prevailing operator, which has mainly nuclear and hydraulic production equipment, could withstand all pressures from competitors during the initial price decrease phase, without openly abusing its market power. As a result, apart from the hypothesis of gigantic public offerings, the French market trend towards an ordinary competitive system does not seem likely to happen soon or spontaneously. (authors)

  8. Near edge x-ray spectroscopy theory

    International Nuclear Information System (INIS)


    We propose to develop a quantitative theory of x-ray spectroscopies in the near edge region, within about 100 eV of threshold. These spectroscopies include XAFS (X-ray absorption fine structure), photoelectron diffraction (PD), and diffraction anomalous fine structure (DAFS), all of which are important tools for structural studies using synchrotron radiation x-ray sources. Of primary importance in these studies are many-body effects, such as the photoelectron self-energy, and inelastic losses. A better understanding of these quantities is needed to obtain theories without adjustable parameters. We propose both analytical and numerical calculations, the latter based on our x-ray spectroscopy codes FEFF

  9. Thermal physics of transition edge sensor arrays

    International Nuclear Information System (INIS)

    Hoevers, H.F.C.


    Thermal transport in transition edge sensor (TES)-based microcalorimeter arrays is reviewed. The fundamentals of thermal conductance in Si 3 N 4 membranes are discussed and the magnitude of the electron-phonon coupling and Kapitza coupling in practical devices is summarized. Next, the thermal transport in high-stopping power and low-heat capacity absorbers, required for arrays of TES microcalorimeters, is discussed in combination with a performance analysis of detectors with mushroom-absorbers. Finally, the phenomenology of unexplained excess noise, observed in both Mo- and Ti-based TESs, is briefly summarized and related with the coupling of the TES to the heat bath

  10. Flow Control Over Sharp-Edged Wings (United States)


    Gad-el-Hak (2001) as the ability to actively or passively manipulate a flow field to effect a desired change. The challenge is to achieve that change...combinations. Been able to independently control both is a great challenge . These requirements may appear too stringent for the sharp- edged airfoils...06 0𔄁 08 09 lic Vlc Figure 22: Pressure distributions for Model B at a=13 °. Stations I (left); 2 (right) 1 , -2 1 F - [12 1 -6a -16 08 -08 06 -06

  11. Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome. (United States)

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


    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.

  12. Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App. (United States)

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


    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.

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Cho Michelle


    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.

  15. Differences in clinician understanding and management of early menopause after breast cancer. (United States)

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


    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.

  16. Patient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers. (United States)

    Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David H


    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.

  17. A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity. (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Keogh Louise A


    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.

  19. Burns education for non-burn specialist clinicians in Western Australia. (United States)

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


    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.

  20. Green's function asymptotics near the internal edges of spectra of periodic elliptic operators. Spectral edge case

    KAUST Repository

    Kuchment, Peter


    Precise asymptotics known for the Green\\'s function of the Laplace operator have found their analogs for periodic elliptic operators of the second order at and below the bottom of the spectrum. Due to the band-gap structure of the spectra of such operators, the question arises whether similar results can be obtained near or at the edges of spectral gaps. As the result of this work shows, this is possible at a spectral edge when the dimension d ≥ 3. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. Green's function asymptotics near the internal edges of spectra of periodic elliptic operators. Spectral edge case

    KAUST Repository

    Kuchment, Peter; Raich, Andrew


    Precise asymptotics known for the Green's function of the Laplace operator have found their analogs for periodic elliptic operators of the second order at and below the bottom of the spectrum. Due to the band-gap structure of the spectra of such operators, the question arises whether similar results can be obtained near or at the edges of spectral gaps. As the result of this work shows, this is possible at a spectral edge when the dimension d ≥ 3. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Magnetotransport Properties of Graphene Nanoribbons with Zigzag Edges (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


    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.

  3. Measuring the Edge Recombination Velocity of Monolayer Semiconductors. (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


    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.

  4. Plasmons on the edge of MoS2 nanostructures

    DEFF Research Database (Denmark)

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


    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....

  5. 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


    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.

  6. Local Thermometry of Neutral Modes on the Quantum Hall Edge (United States)

    Hart, Sean; Venkatachalam, Vivek; Pfeiffer, Loren; West, Ken; Yacoby, Amir


    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.

  7. Aerodynamic Analysis of Trailing Edge Enlarged Wind Turbine Airfoils

    DEFF Research Database (Denmark)

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


    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...

  8. Using new edges for anomaly detection in computer networks (United States)

    Neil, Joshua Charles


    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.

  9. 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.


    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

  10. Forensic mental health clinician's experiences with and assessment of alliance regarding the patient's readiness to be released from mechanical restraint

    DEFF Research Database (Denmark)

    Nielsen, Lea Deichmann; Gildberg, Frederik Alkier; Bech, Per


    One of the main reasons for prolonged duration of mechanical restraint is patient behaviour in relation to the clinician-patient alliance. This article reports on the forensic mental health clinicians experiences of the clinician-patient alliance during mechanical restraint, and their assessment...

  11. Converging social classes through humanized urban edges (United States)

    Abuan, M. V.; Galingan, Z. D.


    Urban open spaces are created to be used by people. It is a place of convergence and social activity. However, these places have transformed into places of divergence. When spaces become dehumanized, it separates social classes. As a result, underused spaces contribute to urban decay. Particularly an urban edge, the JP Rizal Makati Waterfront Area is the center of this paper. The JP Rizal Makati Waterfront Area is a waterfront development situated along the banks of one of Metro Manila’s major water thoroughfare --- Pasig River. The park and its physical form, urban design and landscape tend to deteriorate over time --- creating a further division of social convergence. Social hostility, crime, negligent maintenance and poor urban design are contributing factors to this sprawling decay in what used to be spaces of bringing people together. Amidst attempts to beautify and renew this portion of Makati City’s edge, the urban area still remains misspent.This paper attempts to re-humanize the waterfront development. It uses the responsive environment design principles to be able to achieve this goal.

  12. Edge detection and texture classification by cuttlefish. (United States)

    Zylinski, Sarah; Osorio, Daniel; Shohet, Adam J


    Cephalopod mollusks including octopus and cuttlefish are adept at adaptive camouflage, varying their appearance to suit the surroundings. This behavior allows unique access into the vision of a non-human species because one can ask how these animals use spatial information to control their coloration pattern. There is particular interest in factors that affect the relative levels of expression of the Mottle and the Disruptive body patterns. Broadly speaking, the Mottle is displayed on continuous patterned surfaces whereas the Disruptive is used on discrete objects such as pebbles. Recent evidence from common cuttlefish, Sepia officinalis, suggests that multiple cues are relevant, including spatial scale, contrast, and depth. We analyze the body pattern responses of juvenile cuttlefish to a range of checkerboard stimuli. Our results suggest that the choice of camouflage pattern is consistent with a simple model of how cuttlefish classify visual textures, according to whether they are Uniform or patterned, and whether the pattern includes visual edges. In particular, cuttlefish appear to detect edges by sensing the relative spatial phases of two spatial frequency components (e.g., fundamental and the third harmonic Fourier component in a square wave). We discuss the relevance of these findings to vision and camouflage in aquatic environments.

  13. Edge plasma fluctuations in STOR-M

    International Nuclear Information System (INIS)

    Zhang, W.; Hirose, A.; Zhang, L.; Xiao, C.; Conway, G.D.; Skarsgard, H.M.


    In the STOR-M tokamak, the coherence and propagation nature of the density (n e ) and magnetic (B r ) fluctuations are investigated both in the scrape-off layer (SOL, r/a > 1) and at the plasma edge (r/a -2 is of the order of the reverse electron skin depth kθ ≅ ω pe /c. In terms of the hybrid ion Larmor radius ρ s = c s /Ω i , it corresponds to k θρ s ≅ 0.1. These observations support the skin size electromagnetic drift mode which predicts that a low β tokamak discharge is unstable against the skin size electromagnetic instability with a phase velocity significantly smaller than the electron diamagnetic drift velocity. Edge fluctuations observed in STOR-M appear to propagate at the local E x B drift, and the phase velocity in the plasma from is υ theta ≅ 5 x 10 4 cm/sec, compared with the local electron diamagnetic drift, υ e ≅ 2.5 x 10 5 cm/sec. In the SOL region, the density fluctuations propagate in the ion diamagnetic drift, but still with the local E x B drift because E r changes its sign at r/a ≅ 1

  14. LES tests on airfoil trailing edge serration

    International Nuclear Information System (INIS)

    Zhu, Wei Jun; Shen, Wen Zhong


    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 of our in-house incompressible flow solver EllipSys3D. The flow solution is first obtained from the Large Eddy Simulation (LES), the acoustic part is then carried out based on the instantaneous hydrodynamic pressure and velocity field. To obtain the time history data of sound pressure, the flow quantities are integrated around the airfoil surface through the FWH approach. For all the simulations, the chord based Reynolds number is around 1.5x10 6 . In the test matrix, the effects from angle of attack, the TE flap angle, the length/width of the TES are investigated. Even though the airfoil under investigation is already optimized for low noise emission, most numerical simulations and wind tunnel experiments show that the noise level is further decreased by adding the TES device. (paper)

  15. 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

  16. Photon Counting Using Edge-Detection Algorithm (United States)

    Gin, Jonathan W.; Nguyen, Danh H.; Farr, William H.


    New applications such as high-datarate, photon-starved, free-space optical communications require photon counting at flux rates into gigaphoton-per-second regimes coupled with subnanosecond timing accuracy. Current single-photon detectors that are capable of handling such operating conditions are designed in an array format and produce output pulses that span multiple sample times. In order to discern one pulse from another and not to overcount the number of incoming photons, a detection algorithm must be applied to the sampled detector output pulses. As flux rates increase, the ability to implement such a detection algorithm becomes difficult within a digital processor that may reside within a field-programmable gate array (FPGA). Systems have been developed and implemented to both characterize gigahertz bandwidth single-photon detectors, as well as process photon count signals at rates into gigaphotons per second in order to implement communications links at SCPPM (serial concatenated pulse position modulation) encoded data rates exceeding 100 megabits per second with efficiencies greater than two bits per detected photon. A hardware edge-detection algorithm and corresponding signal combining and deserialization hardware were developed to meet these requirements at sample rates up to 10 GHz. The photon discriminator deserializer hardware board accepts four inputs, which allows for the ability to take inputs from a quadphoton counting detector, to support requirements for optical tracking with a reduced number of hardware components. The four inputs are hardware leading-edge detected independently. After leading-edge detection, the resultant samples are ORed together prior to deserialization. The deserialization is performed to reduce the rate at which data is passed to a digital signal processor, perhaps residing within an FPGA. The hardware implements four separate analog inputs that are connected through RF connectors. Each analog input is fed to a high-speed 1

  17. 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). (United States)

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


    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

  18. Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study. (United States)

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


    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

  19. Frequencies of the Edge-Magnetoplasmon Excitations in Gated Quantum Hall Edges (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Stefano Agnetti


    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.