WorldWideScience

Sample records for impact initial adjustment

  1. Expatriate Adjustment Process: The Impact of Accompanying Children on Self-Initiated Expatriates

    OpenAIRE

    Zakariyya, Abdul Hameed

    2011-01-01

    Expatriation as a career choice has been growing and gaining popularity. Even multinational enterprises (MNEs) that once depended entirely on their own staff for postings abroad have begun to recruit from the global self-initiated expatriate (SIE) labour market. Though qualified and competent, SIEs face tremendous challenges in relocation and cross cultural adjustment. Previous research suggests that the greatest challenge both categories of expatriates – businesses backed organizational expa...

  2. Asymmetry of Anticipatory Postural Adjustment During Gait Initiation

    OpenAIRE

    Hiraoka, Koichi; Hatanaka, Ryota; Nikaido, Yasutaka; Jono, Yasutomo; Nomura, Yoshifumi; Tani, Keisuke; Chujo, Yuta

    2014-01-01

    The purpose of this study was to investigate the asymmetry of anticipatory postural adjustment (APA) during gait initiation and to determine whether the process of choosing the initial swing leg affects APA during gait initiation. The participants initiated gait with the leg indicated by a start tone or initiated gait with the leg spontaneously chosen. The dependent variables of APA were not significantly different among the condition of initiating gait with the preferred leg indicated by the...

  3. Asymmetry of Anticipatory Postural Adjustment During Gait Initiation

    Directory of Open Access Journals (Sweden)

    Hiraoka Koichi

    2014-10-01

    Full Text Available The purpose of this study was to investigate the asymmetry of anticipatory postural adjustment (APA during gait initiation and to determine whether the process of choosing the initial swing leg affects APA during gait initiation. The participants initiated gait with the leg indicated by a start tone or initiated gait with the leg spontaneously chosen. The dependent variables of APA were not significantly different among the condition of initiating gait with the preferred leg indicated by the start tone, the condition of initiating gait with the non-preferred leg indicated by the start tone, and the condition of initiating gait with the leg spontaneously chosen. These findings fail to support the view that the process of choosing the initial swing leg affects APA during gait initiation. The lateral displacement of the center of pressure in the period in which shifting the center of pressure to the initial swing phase before initiating gait with the left leg indicated by the external cue was significantly larger than that when initiating gait with the right leg indicated by the external cue, and significantly larger than that when initiating gait with the leg spontaneously chosen. Weight shift to the initial swing side during APA during gait initiation was found to be asymmetrical when choosing the leg in response to an external cue

  4. An Analysis of Missile Systems Cost Growth and Implementation of Acquisition Reform Initiatives Using a Hybrid Adjusted Cost Growth Model

    National Research Council Canada - National Science Library

    Abate, Christopher

    2004-01-01

    ...) data with a hybrid adjusted cost growth (ACG) model. In addition, an analysis of acquisition reform initiatives during the treatment period was conducted to determine if reform efforts impacted missile system cost growth. A pre-reform...

  5. Industry initiatives in impact mitigation

    Energy Technology Data Exchange (ETDEWEB)

    Metz, W.C.

    1982-08-01

    The author concludes that mitigation is the focus of conflicting opinions regarding responsibility, strategy, and effort. There are no hard, fast, or tried and true rules for company involvement in mitigation efforts. Each mitigation effort must be tailored and negotiated to match the unique characteristics of individual projects and circumstances of specific locales. Companies must assume financial responsibility for the temporary impacts and area needs created by their projects. They must also offer financial and technical assistance to impact areas, not just the host political jurisdiction, when local, state, federal, and special fund sources of revenue or technical assistance are not available or insufficient. But, local, state, and federal governments must also recognize their responsibilities and make adjustments in tax jurisdiction boundaries and disbursement formulas so that impacted areas are properly defined and receive an adequate share of lease, royalty, severance tax, permit fee, special use and service charges, and sales tax payments. Laws need to allow innovative uses of tax pre-payments, housing mortgage bonds, changeable debt and bounding limits, industrial loans with delayed prepayment, and revised revenue assistance formulas. Enabling legislation is required in most states to allow impact areas to negotiate the mitigation efforts. A review of 7 types of mitigation effort is presented: transportation; housing; public utilities; health, public safety and recreation; miscellaneous; and company-community interaction. (PBS)

  6. The Impact of Macro-adjustment Programmes on Housing ...

    African Journals Online (AJOL)

    The Impact of Macro-adjustment Programmes on Housing Investment in Kampala City, Uganda: Shelter Implications for the Urban Poor. ... Eastern Africa Social Science Research Review ... The adjustment methodology has side-lined and gravely undermined the housing sector thereby aggravating the shelter problem.

  7. Optimal initial dose adjustment of warfarin in orthopedic patients.

    Science.gov (United States)

    Lenzini, Petra A; Grice, Gloria R; Milligan, Paul E; Gatchel, Susan K; Deych, Elena; Eby, Charles S; Burnett, R Stephen J; Clohisy, John C; Barrack, Robert L; Gage, Brian F

    2007-11-01

    Warfarin sodium is commonly prescribed for the prophylaxis and treatment of venous thromboembolism. Dosing algorithms have not been widely adopted because they require a fixed initial warfarin dose (eg, 5 mg) and are not tailored to other factors that may affect the international normalized ratio (INR). To develop an algorithm that could predict a therapeutic warfarin dose based on drug interactions, INR response after the initial warfarin doses, and other clinical factors. We used stepwise regression to quantify the relationship between these factors in patients beginning prophylactic warfarin therapy immediately prior to joint replacement. In the derivation cohort (n = 271), we separately modeled the therapeutic dose after 2 and 3 initial doses. We prospectively validated these 2 models in an independent cohort (n = 105). About half of the therapeutic dose variability was predictable after 3 days of therapy: R2 was 53% in the derivation cohort and 42% in the validation cohort. INR response after 3 warfarin doses (INR3) inversely correlated with therapeutic dose (p < 0.001). Intraoperative blood loss transiently, but significantly, elevated the postoperative INR values. Other significant (p < 0.03) predictors were the first and second warfarin doses (+7% and +6%, respectively, per 1 mg), and statin use (-15.0%). The model derived after 2 warfarin doses explained 32% of the variability in therapeutic dose. We developed and validated algorithms that estimate therapeutic warfarin doses based on clinical factors and INR response available after 2-3 days of warfarin therapy. The algorithms are implemented online at www.WarfarinDosing.org.

  8. Humans make near-optimal adjustments of control to initial body configuration in vertical squat jumping

    NARCIS (Netherlands)

    Bobbert, M.F.; Casius, L.J.R.; Kistemaker, D.A.

    2013-01-01

    We investigated adjustments of control to initial posture in squat jumping. Eleven male subjects jumped from three initial postures: preferred initial posture (PP), a posture in which the trunk was rotated 18° more backward (BP) and a posture in which it was rotated 15° more forward (FP) than in PP.

  9. Using Green's Functions to initialize and adjust a global, eddying ocean biogeochemistry general circulation model

    Science.gov (United States)

    Brix, H.; Menemenlis, D.; Hill, C.; Dutkiewicz, S.; Jahn, O.; Wang, D.; Bowman, K.; Zhang, H.

    2015-11-01

    exchange parameter differs by only 3% from the baseline value and has little impact (- 0.1 %) on the cost function. The particulate inorganic to organic carbon ratio was increased more than threefold and reduced the cost function by 22% relative to the baseline integration, indicating a significant influence of biology on air-sea gas exchange. The largest contribution to cost reduction (35%) comes from the adjustment of initial conditions. In addition to reducing biases relative to observations, the adjusted simulation exhibits smaller model drift than the baseline. We estimate drift by integrating the model with repeated 2009 atmospheric forcing for seven years and find a volume-weighted drift reduction of, for example, 12.5% for nitrate and 30% for oxygen in the top 300 m. Although there remain several regions with large model-data discrepancies, for example, overly strong carbon uptake in the Southern Ocean, the adjusted simulation is a first step towards a more accurate representation of the ocean carbon cycle at high spatial and temporal resolution.

  10. The Role of Proprioception in the Sagittal Setting of Anticipatory Postural Adjustments During Gait Initiation

    OpenAIRE

    Pereira Marcelo P.; Pelicioni Paulo H. Silva; Gobbi Lilian T.B.

    2015-01-01

    Purpose. Previous studies have studied the role of proprioception on the setting of anticipatory postural adjustments (APA) during gait initiation. However, these studies did not investigate the role of proprioception in the sagittal APA setting. We aimed to investigate the role of proprioception manipulation to induce APA sagittal adaptations on gait initiation. Methods. Fourteen healthy adults performed gait initiation without, and with, vibration applied before movement onset, and during m...

  11. Measuring co-authorship and networking-adjusted scientific impact.

    Directory of Open Access Journals (Sweden)

    John P A Ioannidis

    Full Text Available Appraisal of the scientific impact of researchers, teams and institutions with productivity and citation metrics has major repercussions. Funding and promotion of individuals and survival of teams and institutions depend on publications and citations. In this competitive environment, the number of authors per paper is increasing and apparently some co-authors don't satisfy authorship criteria. Listing of individual contributions is still sporadic and also open to manipulation. Metrics are needed to measure the networking intensity for a single scientist or group of scientists accounting for patterns of co-authorship. Here, I define I(1 for a single scientist as the number of authors who appear in at least I(1 papers of the specific scientist. For a group of scientists or institution, I(n is defined as the number of authors who appear in at least I(n papers that bear the affiliation of the group or institution. I(1 depends on the number of papers authored N(p. The power exponent R of the relationship between I(1 and N(p categorizes scientists as solitary (R>2.5, nuclear (R = 2.25-2.5, networked (R = 2-2.25, extensively networked (R = 1.75-2 or collaborators (R<1.75. R may be used to adjust for co-authorship networking the citation impact of a scientist. I(n similarly provides a simple measure of the effective networking size to adjust the citation impact of groups or institutions. Empirical data are provided for single scientists and institutions for the proposed metrics. Cautious adoption of adjustments for co-authorship and networking in scientific appraisals may offer incentives for more accountable co-authorship behaviour in published articles.

  12. Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

    NARCIS (Netherlands)

    Vrieling, Aline H.; van Keeken, Helco G.; Schoppen, Tanneke; Hof, At L.; Otten, Bert; Halbertsma, Jan P. K.; Postema, Klaas

    Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. Design: Prospective and descriptive study. Subjects: Fourteen subjects with a recent

  13. Humans make near-optimal adjustments of control to initial body configuration in vertical squat jumping.

    Science.gov (United States)

    Bobbert, Maarten F; Richard Casius, L J; Kistemaker, Dinant A

    2013-05-01

    We investigated adjustments of control to initial posture in squat jumping. Eleven male subjects jumped from three initial postures: preferred initial posture (PP), a posture in which the trunk was rotated 18° more backward (BP) and a posture in which it was rotated 15° more forward (FP) than in PP. Kinematics, ground reaction forces and electromyograms (EMG) were collected. EMG was rectified and smoothed to obtain smoothed rectified EMG (srEMG). Subjects showed adjustments in srEMG histories, most conspicuously a shift in srEMG-onset of rectus femoris (REC): from early in BP to late in FP. Jumps from the subjects' initial postures were simulated with a musculoskeletal model comprising four segments and six Hill-type muscles, which had muscle stimulation (STIM) over time as input. STIM of each muscle changed from initial to maximal at STIM-onset, and STIM-onsets were optimized using jump height as criterion. Optimal simulated jumps from BP, PP and FP were similar to jumps of the subjects. Optimal solutions primarily differed in STIM-onset of REC: from early in BP to late in FP. Because the subjects' adjustments in srEMG-onsets were similar to adjustments of the model's optimal STIM-onsets, it was concluded that the former were near-optimal. With the model we also showed that near-maximum jumps from BP, PP and FP could be achieved when STIM-onset of REC depended on initial hip joint angle and STIM-onsets of the other muscles were posture-independent. A control theory that relies on a mapping from initial posture to STIM-onsets seems a parsimonious alternative to theories relying on internal optimal control models. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

  14. Aging effect on step adjustments and stability control in visually perturbed gait initiation.

    Science.gov (United States)

    Sun, Ruopeng; Cui, Chuyi; Shea, John B

    2017-10-01

    Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. The impact of minimum wage adjustments on Vietnamese wage inequality

    DEFF Research Database (Denmark)

    Hansen, Henrik; Rand, John; Torm, Nina

    Using Vietnamese Labour Force Survey data we analyse the impact of minimum wage changes on wage inequality. Minimum wages serve to reduce local wage inequality in the formal sectors by decreasing the gap between the median wages and the lower tail of the local wage distributions. In contrast, local...... wage inequality is increased in the informal sectors. Overall, the minimum wages decrease national wage inequality. Our estimates indicate a decrease in the wage distribution Gini coefficient of about 2 percentage points and an increase in the 10/50 wage ratio of 5-7 percentage points caused...... by the adjustment of the minimum wages from 2011to 2012 that levelled the minimum wage across economic sectors....

  16. Anticipatory postural adjustment patterns during gait initiation across the adult lifespan.

    Science.gov (United States)

    Lu, Chiahao; Amundsen Huffmaster, Sommer L; Harvey, Jack C; MacKinnon, Colum D

    2017-09-01

    Gait initiation involves a complex sequence of anticipatory postural adjustments (APAs) during the transition from steady state standing to forward locomotion. APAs have four core components that function to accelerate the center of mass forwards and towards the initial single-support stance limb. These components include loading of the initial step leg, unloading of the initial stance leg, and excursion of the center of pressure in the posterior and lateral (towards the stepping leg) directions. This study examined the incidence, magnitude, and timing of these components and how they change across the lifespan (ages 20-79). 157 individuals performed five trials of self-paced, non-cued gait initiation on an instrumented walkway. At least one component of the APA was absent in 24% of all trials. The component most commonly absent was loading of the initial step leg (absent in 10% of all trials in isolation, absent in 10% of trials in conjunction with another missing component). Trials missing all four components were rare (1%) and were observed in both younger and older adults. There was no significant difference across decades in the incidence of trials without an APA, the number or type of APA components absent, or the magnitude or timing of the APA components. These data demonstrate that one or more components of the APA sequence are commonly absent in the general population and the spatiotemporal profile of the APA does not markedly change with ageing. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. The Role of Proprioception in the Sagittal Setting of Anticipatory Postural Adjustments During Gait Initiation

    Directory of Open Access Journals (Sweden)

    Pereira Marcelo P.

    2015-12-01

    Full Text Available Purpose. Previous studies have studied the role of proprioception on the setting of anticipatory postural adjustments (APA during gait initiation. However, these studies did not investigate the role of proprioception in the sagittal APA setting. We aimed to investigate the role of proprioception manipulation to induce APA sagittal adaptations on gait initiation. Methods. Fourteen healthy adults performed gait initiation without, and with, vibration applied before movement onset, and during movement. In addition, the effects of two different vibration frequencies (80 and 120Hz were tested. Vibration was applied bilaterally on the tibialis anterior, rectus femoris and trapezius superior. The first step characteristics, ground reaction forces and CoP behaviour were assessed. Results. Vibration improved gait initiation performance regardless of the moment it was applied. CoP velocity during the initial phase of APA was increased by vibration only when it was applied before movement. When vibration was applied to disturb the movement, no effects on the CoP behaviour were observed. Manipulation of vibration frequency had no effects. Conclusions. Rather than proprioception manipulation, the results suggest that post-vibratory effects and attentional mechanisms were responsible for our results. Taken together, the results show that sagittal APA setting is robust to proprioception manipulation.

  18. When Women with Cystic Fibrosis Become Mothers: Psychosocial Impact and Adjustments

    Directory of Open Access Journals (Sweden)

    Sophie L. Cammidge

    2016-01-01

    Full Text Available Advances in the treatment and life expectancy of cystic fibrosis (CF patients mean that motherhood is now a realistic option for many women with CF. This qualitative study explored the psychosocial impact and adjustments made when women with CF become mothers. Women with CF (n=11 were recruited via an online forum and participated in semistructured telephone interviews about their experiences of becoming a mother. Transcriptions were analysed using Grounded Theory. Analysis revealed three core categories: (i “Living with CF”: how becoming a mother impacted on health and treatment adherence, requiring a change in support from the CF team, (ii “Becoming a Mother”: balancing issues common to new mothers with their CF, and (iii “Pooling Personal Resources”: coping strategies in managing the dual demands of child and CF care. Participants experienced a variety of complex psychosocial processes. Most participants acknowledged an initial negative impact on CF care; however over time they reported successful adaptation to managing dual commitments and that adherence and motivation to stay well had improved. This study highlights the need for preconceptual psychosocial counselling and postpartum adjustment to CF care.

  19. The Impact of Financial Sophistication on Adjustable Rate Mortgage Ownership

    Science.gov (United States)

    Smith, Hyrum; Finke, Michael S.; Huston, Sandra J.

    2011-01-01

    The influence of a financial sophistication scale on adjustable-rate mortgage (ARM) borrowing is explored. Descriptive statistics and regression analysis using recent data from the Survey of Consumer Finances reveal that ARM borrowing is driven by both the least and most financially sophisticated households but for different reasons. Less…

  20. The Impact Of Family Structure On Psychosocial Adjustment Of ...

    African Journals Online (AJOL)

    This paper x-ray the psychosocial adjustment of adolescences based on their families structure, hence families were further revealed to include intact family, divorced family, separated family, psychological and none psychological broken homes, as it influence adolescence generally. Under the definition of terms ...

  1. Net Stable Funding Ratio: Impact on Funding Value Adjustment

    OpenAIRE

    Siadat, Medya; Hammarlid, Ola

    2017-01-01

    In this paper we investigate the relationship between Funding Value Adjustment (FVA) and Net Stable Funding Ratio (NSFR). FVA is defined in a consistent way with NSFR such that the new framework of FVA monitors the costs due to keeping NSFR at an acceptable level, as well. In addition, the problem of choosing the optimal funding strategy is formulated as a shortest path problem where the proposed FVA framework is applied in the optimization process. The solution provides us with the optimal f...

  2. The Differential Influence of Authoritative Parenting on the Initial Adjustment of Male and Female Traditional College Freshmen.

    Science.gov (United States)

    Hickman, Gregory P.; Toews, Michelle L.; Andrews, David W.

    2001-01-01

    Surveyed college freshmen to examine the relationship between gender, authoritative parenting, aptitude, self-esteem, initial academic achievement, and overall adjustment. Found that authoritative parenting style was positively related to males' initial grade point average, but not significantly associated with females'. (EV)

  3. Impact of particulate air pollution on quality-adjusted life expectancy in Canada.

    Science.gov (United States)

    Coyle, Douglas; Stieb, Dave; Burnett, Richard T; DeCivita, Paul; Krewski, Daniel; Chen, Yue; Thun, Michael J

    Air pollution and premature death are important public health concerns. Analyses have repeatedly demonstrated that airborne particles are associated with increased mortality and estimates have been used to forecast the impact on life expectancy. In this analysis, we draw upon data from the American Cancer Society (ACS) cohort and literature on utility-based measures of quality of life in relation to health status to more fully quantify the effects of air pollution on mortality in terms of quality-adjusted life expectancy. The analysis was conducted within a decision analytic model using Monte Carlo simulation techniques. Outcomes were estimated based on projections of the Canadian population. A one-unit reduction in sulfate air pollution would yield a mean annual increase in Quality-Adjusted Life Years (QALYs) of 20,960, with gains being greater for individuals with lower educational status and for males compared to females. This suggests that the impact of reductions in sulfate air pollution on quality-adjusted life expectancy is substantial. Interpretation of the results is unclear. However, the potential gains in QALYs from reduced air pollutants can be contrasted to the costs of policies to bring about such reductions. Based on a tentative threshold for the value of health benefits, analysis suggests that an investment in Canada of over 1 billion dollars per annum would be an efficient use of resources if it could be demonstrated that this would reduce sulfate concentrations in ambient air by 1 microg/m(3). Further analysis can assess the efficiency of targeting such initiatives to communities that are most likely to benefit.

  4. The impact of minimum wage adjustments on Vietnamese wage inequality

    DEFF Research Database (Denmark)

    Hansen, Henrik; Rand, John; Torm, Nina

    Using Vietnamese Labour Force Survey data we analyse the impact of minimum wage changes on wage inequality. Minimum wages serve to reduce local wage inequality in the formal sectors by decreasing the gap between the median wages and the lower tail of the local wage distributions. In contrast, local...

  5. Impact of high resolution land surface initialization in Indian summer ...

    Indian Academy of Sciences (India)

    The direct impact of high resolution land surface initialization on the forecast bias in a regional climate model in recent years ... surface initialization using a regional climate model. ...... ization of the snow field in a cloud model; J. Clim. Appl.

  6. Measuring Impact of Stabilization Initiatives Survey Data (MISTI)

    Data.gov (United States)

    US Agency for International Development — The raw data from the Measuring Impact of Stabilization Initiatives (MISTI) project is the largest and most comprehensive evaluations of stabilization interventions...

  7. Impact of Socio-Emotional Adjustment on Academic Achievement of Adolescent Girls in Jammu and Kashmir

    Science.gov (United States)

    Gul, Showkeen Bilal Ahmad

    2015-01-01

    The study examined the impact of socio-emotional adjustment on academic achievement of adolescent girls of Jammu and Kashmir. The purpose of the investigation was to study the relationship and effect of socio-emotional adjustment on academic achievement among adolescent girls. The descriptive survey research method was used for the study and the…

  8. The Impact of TV Viewing Motivations on Psychological and Sociocultural Adjustment.

    Science.gov (United States)

    Chen, Guo-Ming

    A study examined the impact of TV viewing motivations on 126 Asian students' psychological and sociocultural adjustment. Subjects were enrolled in a midsize university in the New England area. TV viewing motivation was measured by A. M. Rubin's TV Viewing Motivations Scale. Psychological adjustment was measured by W. Zung's Self Rating Depression…

  9. Measuring co-authorship and networking-adjusted scientific impact.

    Science.gov (United States)

    Ioannidis, John P A

    2008-07-23

    Appraisal of the scientific impact of researchers, teams and institutions with productivity and citation metrics has major repercussions. Funding and promotion of individuals and survival of teams and institutions depend on publications and citations. In this competitive environment, the number of authors per paper is increasing and apparently some co-authors don't satisfy authorship criteria. Listing of individual contributions is still sporadic and also open to manipulation. Metrics are needed to measure the networking intensity for a single scientist or group of scientists accounting for patterns of co-authorship. Here, I define I(1) for a single scientist as the number of authors who appear in at least I(1) papers of the specific scientist. For a group of scientists or institution, I(n) is defined as the number of authors who appear in at least I(n) papers that bear the affiliation of the group or institution. I(1) depends on the number of papers authored N(p). The power exponent R of the relationship between I(1) and N(p) categorizes scientists as solitary (R>2.5), nuclear (R = 2.25-2.5), networked (R = 2-2.25), extensively networked (R = 1.75-2) or collaborators (Raccountable co-authorship behaviour in published articles.

  10. Stakeholder Pressures, Environmental Impact and Managerial Initiatives of SMEs

    DEFF Research Database (Denmark)

    Madsen, Henning; Ulhøi, John Parm

    2015-01-01

    impact was available in Denmark. Consequently, a longitudinal research project was initiated to enlighten the situation. This study investigates environmentally related initiatives taken in response to the perception of stakeholder pressures and the perceived corporate environmental impact. The empirical......Environmental sustainability has become an issue of uttermost importance for business organisations. Therefore, the implementation of corporate environmental initiatives has been vigorously embraced by industry. Two decades ago, no clear picture of industry initiatives to reduce their environmental...... popularity of self-regulation, voluntary initiatives do not tend to be widely adopted by SMEs, stressing a need for a continuing regulation of industry’s behaviour in relation to environmental issues....

  11. The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries

    International Nuclear Information System (INIS)

    Donnelly, D. W.; Gavin, A.; Hegarty, A.

    2013-01-01

    Cancer incidence rates vary considerably between countries and by socioeconomic status (SES). We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995-2007 were extracted from the cancer registries in Northern Ireland (NI) and Republic of Ireland (RoI). Cancers in the two countries were compared using incidence rate ratios (IRRs) adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84-0.97)), with this difference increasing after adjustment for SES (IRR: 0.85 (0.79-0.92)). For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons.

  12. The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries

    Directory of Open Access Journals (Sweden)

    David W. Donnelly

    2013-01-01

    Full Text Available Background. Cancer incidence rates vary considerably between countries and by socioeconomic status (SES. We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995–2007 were extracted from the cancer registries in Northern Ireland (NI and Republic of Ireland (RoI. Cancers in the two countries were compared using incidence rate ratios (IRRs adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84–0.97, with this difference increasing after adjustment for SES (IRR: 0.85 (0.79–0.92. For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons.

  13. Ramakrishna Mission initiative impact study: final report

    Energy Technology Data Exchange (ETDEWEB)

    Chaurey, A.

    2000-07-06

    This report has been prepared by the Tata Energy Research Institute (TERI) for the National Renewable Energy Laboratory. It presents the results of the evaluation and impact assessment of solar photovoltaic lighting systems in the region of Sunderbans, West Bengal, that were deployed by a reputable non-governmental organization (Ramakrishna Mission) under the auspices of the INDO-US collaborative project. The objectives of the study were to evaluate the solar photovoltaic systems for their impact on the individual households as well as on the community, to assess the effectiveness of the implementation and financial mechanisms, and to draw a long-term strategy for NREL's activities in Sunderbans based on case studies of similar interventions. Under the project, provision was made to supply 300 domestic lighting systems (DLS) based on 53-Wp module capacity to individual households and a few other systems such as for lighting, medical refrigeration, and pumping water to community centers. For this study, 152 households were surveyed, of which 29 had also been a part of earlier pre- and post-installation surveys, 47 had been a part of the earlier post-installation survey, and 76 were households that were surveyed for the first time. A set of 46, out of the total 152 households, was selected for evaluating the systems for their technical performance with respect to module output, condition of the battery, and daily energy consumption. Of the total 300 modules, 2 had been stolen, 9 out of the total 300 batteries needed to be replaced, and 10 out of the 300 charge controllers were non-functional. The statistics for the surveyed households indicate 32 luminaire-related faults (blackening or flickering of compact fluorescent lights) and 11 other faults related to fuses, switches, etc.

  14. Initial experience with the Codman Certas adjustable valve in the management of patients with hydrocephalus

    DEFF Research Database (Denmark)

    Watt, Sara; Agerlin, Niels; Romner, Bertil

    2012-01-01

    A new adjustable valve, the Codman CertasTM valve for treatment of hydrocephalus was introduced into clinical practice in January 2011. It has 8 different settings with an opening pressure varying from 36 to over 400 mm H2O at a flow rate of 20 mL/h. The 8th setting is designed to provide...

  15. Measuring and Analyzing the Scholarly Impact of Experimental Evaluation Initiatives

    DEFF Research Database (Denmark)

    Angelini, Marco; Ferro, Nicola; Larsen, Birger

    2014-01-01

    Evaluation initiatives have been widely credited with contributing highly to the development and advancement of information access systems, by providing a sustainable platform for conducting the very demanding activity of comparable experimental evaluation in a large scale. Measuring the impact...

  16. Likely social impacts of proposed national-level policy initiatives

    Energy Technology Data Exchange (ETDEWEB)

    Piernot, C.A.; Rothweiler, M.A.; Levine, A.; Crews, R.

    1981-03-01

    The results are described of an investigation of likely social effects of enacting nine proposed national-level policy initiatives to accelerate development and use of solar energy. This study is part of the Technology Assessment of Solar Energy Systems (TASE) project supported by the US Department of Energy. The report presents general social impact information about the variety of ways in which the American people could be affected by enactment of these initiatives. It identifies the effects of each initiative on individuals, groups, organizations, communities, and society as a whole. In addition, it provides a framework for organizing a myriad of impact information into a set of conceptually exclusive impact categories. It illustrates that social impacts means effects on people as individuals, groups, organizations, and communities as well as on the infrastructure of society. Finally, it demonstrates the importance of specifying an audience of impact with a case example from the residential rental market.

  17. Attachment to Parents and Depressive Symptoms in College Students: The Mediating Role of Initial Emotional Adjustment and Psychological Needs

    Directory of Open Access Journals (Sweden)

    Sanja Smojver-Ažić

    2015-04-01

    Full Text Available The aim of the present study was to explore the role of parental attachment in students' depressive symptoms. We have examined wheather initial emotional adjustment and psychological needs would serve as a mediator of the relationship between attachment dimensions (anxiety and avoidance and depressive symptoms.A sample consisted of 219 students (143 females randomly selected from the University of Rijeka, Croatia, with mean age 19.02 years. Participants provided self-report on the Experiences in Close Relationship Inventory and The Student Adaptation to College Questionnaire at the beginning of the first year of college, and The Basic Psychological Needs Satisfaction Scale and Beck Depression Inventory-II at the third year of college.Results of hierarchical regression analyses confirm that emotional adjustment had a full mediation effect on anxiety dimension and partial mediation on avoidance dimension. Only a partial mediation effect of psychological needs for autonomy and relatedness between attachment and depressive symptoms was found.The findings of this study give support to the researches indicating the importance of parental attachment for college students not only through its direct effects on depressive symptoms, but also through effects on the initial emotional adjustment and satisfaction of psychological needs. The results of the mediation analysis suggest that both attachment dimensions and emotional adjustment as well as psychological need satisfaction have a substantial shared variance when predicting depressive symptoms and that each variable also gives a unique contribution to depressive symptoms.

  18. Parental encouragement of initiative-taking and adjustment in Chinese children from rural, urban, and urbanized families.

    Science.gov (United States)

    Chen, Xinyin; Li, Dan

    2012-12-01

    Due to the requirements of the competitive, market-oriented urban society, parents in urban and urbanized families are more likely than parents in rural families to encourage initiative-taking in child rearing in China. The socialization experiences of children from different types of families may be related to their adjustment. This study examined parental socialization attitudes, social and school adjustment, and their relations in Chinese children from rural, urban, and urbanized families. Participants were elementary school students (N = 1,033; M age = 11 years) and their parents in China. Data were obtained from parental reports, peer evaluations, teacher ratings, and school records. A multivariate analysis of variance revealed that parents in urban and urbanized families had higher scores than parents in rural families on encouragement of initiative-taking. Urban children, particularly girls, were more sociable, obtained higher social status, and had fewer school problems than their rural counterparts. Children from urbanized families were different from rural children and similar to urban children in social and school adjustment. Moreover, multigroup invariance tests showed that parental encouragement of initiative-taking was associated more strongly with children's sociable-assertive behavior and social standing in the urban and urbanized groups than in the rural group. The results indicate that particular socialization attitudes may vary in their adaptive value in child development as a function of specific social and cultural requirements in changing societies. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  19. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

    Science.gov (United States)

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

    2010-07-01

    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  20. Impact of Physical, Psychological, and Sexual Violence on Social Adjustment of School Children in India

    Science.gov (United States)

    Deb, Sibnath; Walsh, Kerryann

    2012-01-01

    This study sought to understand the pervasiveness and impact of physical, psychological, and sexual violence on the social adjustment of Grade 8 and 9 school children in the state of Tripura, India. The study participants, 160 boys and 160 girls, were randomly selected from classes in eight English and Bengali medium schools in Agartala city,…

  1. A STUDY ON SOCIAL ADJUSTMENT AMONG HIGHER SECONDARY SCHOOL STUDENTS AND ITS IMPACT ON THEIR ACADEMIC ACHIEVEMENT IN COIMBATORE DISTRICT

    OpenAIRE

    P.Priya Packiaselvi; Ms.Malathi.V.A

    2017-01-01

    Every human being seeks adjustment to various situations. He constantly makes efforts to adjustment himself to his surroundings because a wholesome adjustment is essential for leading a happy life and going satisfaction. Social adjustment to other people is general and to the group with which they are identified is particular. The main motive of the study is to find out the social adjustment among higher secondary school students and its impact on academic achievement in Coimbatore Educationa...

  2. Topology-optimized metasurfaces: impact of initial geometric layout.

    Science.gov (United States)

    Yang, Jianji; Fan, Jonathan A

    2017-08-15

    Topology optimization is a powerful iterative inverse design technique in metasurface engineering and can transform an initial layout into a high-performance device. With this method, devices are optimized within a local design phase space, making the identification of suitable initial geometries essential. In this Letter, we examine the impact of initial geometric layout on the performance of large-angle (75 deg) topology-optimized metagrating deflectors. We find that when conventional metasurface designs based on dielectric nanoposts are used as initial layouts for topology optimization, the final devices have efficiencies around 65%. In contrast, when random initial layouts are used, the final devices have ultra-high efficiencies that can reach 94%. Our numerical experiments suggest that device topologies based on conventional metasurface designs may not be suitable to produce ultra-high-efficiency, large-angle metasurfaces. Rather, initial geometric layouts with non-trivial topologies and shapes are required.

  3. The impact of personality on adult patients' adjustability to orthodontic appliances.

    Science.gov (United States)

    Cooper-Kazaz, Rena; Ivgi, Inbal; Canetti, Laura; Bachar, Eytan; Tsur, Boaz; Chaushu, Stella; Shalish, Miriam

    2013-01-01

    To evaluate the impact of psychological traits on patients' choice of orthodontic appliances and their adjustability to orthodontic treatment. The sample consisted of 68 adult patients divided into three groups (28 buccal, 19 lingual, and 21 clear aligners). Prior to treatment participants filled out the Brief Symptom Inventory to assess symptoms of mental distress and the Narcissistic Vulnerability Scale to assess narcissistic personality traits. During the first week after appliance delivery and on day 14, patients completed a Health-Related Quality of Life questionnaire to assess their perception of pain and four areas of dysfunction. The correlation between personality traits and patients' reaction to treatment was evaluated. Somatization was the only trait that affected the choice of lingual and clear aligner appliance. Reduced self-esteem regulation was associated with increased pain in all patients, while exploitation was associated with pain in lingual patients. Narcissistic vulnerability slightly influenced patients' adaptability to orthodontic appliances. Although adjustability to lingual appliances was the most difficult, only two parameters were affected by personality features. In the buccal group, adjustability was affected by numerous parameters. Adaptation to the clear aligner appliance was relatively uneventful and least affected by psychological features. Anxious individuals tend to prefer lingual and clear aligner appliances. The selection of lingual and clear aligner appliances governs the patient's response and recovery process, leaving little room for the effect of psychological features. On the other hand, the buccal appliance allows for greater impact of personality traits on adjustability.

  4. The impact of calcium assay change on a local adjusted calcium equation.

    Science.gov (United States)

    Davies, Sarah L; Hill, Charlotte; Bailey, Lisa M; Davison, Andrew S; Milan, Anna M

    2016-03-01

    Deriving and validating local adjusted calcium equations is important for ensuring appropriate calcium status classification. We investigated the impact on our local adjusted calcium equation of a change in calcium method by the manufacturer from cresolphthalein complexone to NM-BAPTA. Calcium and albumin results from general practice requests were extracted from the Laboratory Information Management system for a three-month period. Results for which there was evidence of disturbance in calcium homeostasis were excluded leaving 13,482 sets of results for analysis. The adjusted calcium equation was derived following least squares regression analysis of total calcium on albumin and normalized to the mean calcium concentration of the data-set. The revised equation (NM-BAPTA calcium method) was compared with the previous equation (cresolphthalein complexone calcium method). The switch in calcium assay resulted in a small change in the adjusted calcium equation but was not considered to be clinically significant. The calcium reference interval differed from that proposed by Pathology Harmony in the UK. Local adjusted calcium equations should be re-assessed following changes in the calcium method. A locally derived reference interval may differ from the consensus harmonized reference interval. © The Author(s) 2015.

  5. Impact of selected risk factors on quality-adjusted life expectancy in Denmark

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Juel, Knud; Davidsen, Michael

    2007-01-01

    AIMS: The construct quality-adjusted life years (QALYs) combines mortality and overall health status and can be used to quantify the impact of risk factors on population health. The purpose of the study was to estimate the impact of tobacco smoking, high alcohol consumption, physical inactivity...... Health Survey 2000, and Danish EQ-5D values. RESULTS: The quality-adjusted life expectancy of 25-year-olds was 10-11 QALYs shorter for heavy smokers than for those who never smoke. The difference in life expectancy was 9-10 years. Men and women with high alcohol consumption could expect to lose about 5...... and 3 QALYs, respectively. Sedentary persons could expect to have about 7 fewer QALYs than physically active persons. Obesity shortened QALYs by almost 3 for men and 6 for women. CONCLUSIONS: Smoking, high alcohol consumption, physical inactivity, and obesity strongly reduce life expectancy and health...

  6. The Impact of Capital Structure on Economic Capital and Risk Adjusted Performance

    OpenAIRE

    Porteous, Bruce; Tapadar, Pradip

    2008-01-01

    The impact that capital structure and capital asset allocation have on financial services firm economic capital and risk adjusted performance is considered. A stochastic modelling approach is used in conjunction with banking and insurance examples. It is demonstrated that gearing up Tier 1 capital with Tier 2 capital can be in the interests of bank Tier 1 capital providers, but may not always be so for insurance Tier 1 capital providers. It is also shown that, by allocating a bank or insuranc...

  7. Designing, implementing and monitoring social impact mitigation strategies: Lessons from Forest Industry Structural Adjustment Packages

    International Nuclear Information System (INIS)

    Loxton, Edwina A.; Schirmer, Jacki; Kanowski, Peter

    2013-01-01

    Social impact mitigation strategies are implemented by the proponents of policies and projects with the intent of reducing the negative, and increasing the positive social impacts of their activities, and facilitating the achievement of policy/project goals. Evaluation of mitigation strategies is critical to improving their future success and cost-effectiveness. This paper evaluates two Forest Industry Structural Adjustment Packages (FISAP) implemented in Australia in the 1990s to 2000s as part of broader policy changes that reduced access to timber from publicly owned native forests. It assesses the effectiveness of the structure, design, implementation and monitoring of the FISAPs, and highlights the interactions between these four elements and their influence on social impacts. The two FISAPs were found to be effective in terms of reducing negative impacts, encouraging positive impacts and contributing towards policy goals, although they did not mitigate negative impacts in all cases, and sometimes interacted with external factors and additional policy changes to contribute to significant short and long term negative impacts. -- Highlights: ► Mitigation strategies aim to reduce negative and enhance positive social impacts ► Mitigation strategy design, implementation, and monitoring are critical to success ► Effective mitigation enhanced the capacity of recipients to respond to change ► Mitigation strategies influenced multiple interacting positive and negative impacts ► Success required good communication, transparency, support, resources and timing

  8. Autobiographically recalled emotional states impact forward gait initiation as a function of motivational direction.

    Science.gov (United States)

    Fawver, Bradley; Hass, Chris J; Park, Kyoungshin D; Janelle, Christopher M

    2014-12-01

    The impact of self-generated affective states on self-initiated motor behavior remains unspecified. The purpose of the current study was to determine how self-generated emotional states impact forward gait initiation. Participants recalled past emotional experiences (anger, fear, happy, sad, and neutral), "relived" those emotional memories before gait initiation (GI), and then walked ∼4 m across the laboratory floor. Kinetic and kinematic data revealed GI characteristics consistent with a motivational direction hypothesis. Specifically, participants produced greater posterior-lateral displacement and velocity of their center of pressure (COP) during the initial phase of GI after self-generation of happy and anger emotional states relative to sad ones. During the second phase of GI, greater medial displacement of COP was found during the happy condition compared with sad, greater velocity was occasioned during happy and angry trials compared with sad, and greater velocity was exhibited after happy compared with fear memories. Finally, greater anterior velocity was produced by participants during the final phase of GI for happy and angry memories compared with sad ones. Steady state kinetic and kinematic data when recalling happy and angry memories (longer, faster, and more forceful stepping behavior) followed the anticipatory postural adjustments noted during GI. Together the results from GI and steady state gait provide robust evidence that self-generated emotional states impact forward gait behavior based on motivational direction. Endogenous manipulations of emotional states hold promise for clinical and performance interventions aimed at improving self-initiated movement.

  9. The Impact of Deployment on Parental, Family and Child Adjustment in Military Families.

    Science.gov (United States)

    Lester, Patricia; Aralis, Hilary; Sinclair, Maegan; Kiff, Cara; Lee, Kyung-Hee; Mustillo, Sarah; Wadsworth, Shelley MacDermid

    2016-12-01

    Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N = 680) and military (n = 310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10 years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.

  10. Cropping pattern adjustment in China's grain production and its impact on land and water use

    DEFF Research Database (Denmark)

    Li, Tian-xiang; Zhu, Jing; Balezentis, Tomas

    2016-01-01

    This paper aims at decomposing China's grain output changes into three terms, namely area sown effect, pure yield effect, and cropping pattern adjustment effect. Furthermore, the paper analyses the impact of shifts in cropping pattern on water and land use in China's grain production. An index...... adjustments). However, these effects vary across regions: Southeast China experienced land-saving and water-using changes, while other regions underwent land- and water-saving changes. In general, China's grain output growth has increased the total amount of land and water needed, implying more severe...... played an important role in promoting China's grain production, with a contribution of over 15 per cent during 2003-2012. Moreover, such changes enabled to save about 6.8 million hectares of sown areas and 31.06 billion m3 of water in grain production (if compared to the case without cropping pattern...

  11. The hidden cost of investment. The impact of adjustment costs on firm performance measurement and regulation

    International Nuclear Information System (INIS)

    Nick, Sebastian; Wetzel, Heike

    2014-01-01

    In this study, we address a major problem in the measurement of firm performance and the regulation of natural monopolies, namely the intertemporal character of long-term investment decisions. In specific, we focus on the impact of adjustment costs of investments on estimates of firms' technical and cost inefficiency. We apply nonparametric dynamic data envelopment analysis to investigate the dynamic inefficiency of electricity distribution and transmission companies in the US during the years 2004 to 2011 and compare our results with their static counterparts. Our empirical findings reveal that ignoring long-term investments and their corresponding adjustment costs does significantly distort both firm-specific and industrial inefficiency estimates and may thus create misleading incentives for the regulated firms to cut investments.

  12. How have Global Health Initiatives impacted on health equity?

    Science.gov (United States)

    Hanefeld, Johanna

    2008-01-01

    This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs, the US President's Emergency Plan For AIDS Relief (PEPFAR), the World Bank's Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria. All three have leveraged significant amounts of funding for their focal diseases - together these three GHIs provide an estimated two-thirds of external resources going to HIV/AIDS. This paper examines their impact on gender equity. An analysis of these Initiatives finds that they have a significant impact on health equity, including gender equity, through their processes of programme formulation and implementation, and through the activities they fund and implement, including through their impact on health systems and human resources. However, GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. On the basis of this comparative analysis, key recommendations are made. They include a call for equity-sensitive targets, the collection of gender-disaggregated data, the use of policy-making processes for empowerment, programmes that explicitly address causes of health inequity and impact assessments of interventions' effect on social inequities.

  13. Neoliberalism’s legacy in Southern Africa: the economic and social impact of adjustment

    Directory of Open Access Journals (Sweden)

    Eduardo Bidaurrazaga Aurre

    2003-01-01

    Full Text Available This article seeks to provide a better understanding of the problems involved in the processes of economic liberalization undertaken in Africa, specifically in the various economies of Southern Africa, over the last two decades through the application of structural adjustment programs. An examination of the results, particularly the consequences for the most disadvantaged sectors of these societies in terms of social vulnerability and marginalization, makes clear that criticism of the liberalizing model, analysis of the most recently implemented initiatives, and proposals for alternatives that favour the meeting of basic needs among the population, are essential.

  14. Impact of Pre-Initiators on PSA in Research Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Ochirbat, Chimedtseren [KAIST, Daejeon (Korea, Republic of); Kim, Sok Chul [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2014-10-15

    Most of nuclear power plants had already conducted PSA work to examine their plant safety for identifying vulnerability and preparing the mitigating strategies for severe accident. However, the PSA for research reactor has been conducted limitedly comparing with nuclear power plants due to lack of awareness and resources. Most of PSA results demonstrated that human failure events (HFEs) take a major role of risk contributor in terms of core damage frequency. HFEs are categorized as the following three types: pre-initiating event interaction (e.g., maintenance of errors, testing errors, calibration errors), initiating event related interactions (e.g., human error causing loss of power, human error causing system trip), and post-initiating event (e.g., all action actuating manual safety system backup of an automatic system). Lack of resources and utilization of research reactor calls a vicious circle in terms of safety degradation. The safety degradation poses the vulnerability of human failure during research reactor utilization process. Typically, evaluation of pre-initiators related to test and maintenance are not taking into account in PSA for research reactors. This paper aims to investigate the impact of pre-initiating events related to test and maintenance activities on PSA results in terms of core damage frequency for a research reactor.

  15. Impact of Pre-Initiators on PSA in Research Reactor

    International Nuclear Information System (INIS)

    Ochirbat, Chimedtseren; Kim, Sok Chul

    2014-01-01

    Most of nuclear power plants had already conducted PSA work to examine their plant safety for identifying vulnerability and preparing the mitigating strategies for severe accident. However, the PSA for research reactor has been conducted limitedly comparing with nuclear power plants due to lack of awareness and resources. Most of PSA results demonstrated that human failure events (HFEs) take a major role of risk contributor in terms of core damage frequency. HFEs are categorized as the following three types: pre-initiating event interaction (e.g., maintenance of errors, testing errors, calibration errors), initiating event related interactions (e.g., human error causing loss of power, human error causing system trip), and post-initiating event (e.g., all action actuating manual safety system backup of an automatic system). Lack of resources and utilization of research reactor calls a vicious circle in terms of safety degradation. The safety degradation poses the vulnerability of human failure during research reactor utilization process. Typically, evaluation of pre-initiators related to test and maintenance are not taking into account in PSA for research reactors. This paper aims to investigate the impact of pre-initiating events related to test and maintenance activities on PSA results in terms of core damage frequency for a research reactor

  16. Impact of Soil Moisture Initialization on Seasonal Weather Prediction

    Science.gov (United States)

    Koster, Randal D.; Suarez, Max J.; Houser, Paul (Technical Monitor)

    2002-01-01

    The potential role of soil moisture initialization in seasonal forecasting is illustrated through ensembles of simulations with the NASA Seasonal-to-Interannual Prediction Project (NSIPP) model. For each boreal summer during 1997-2001, we generated two 16-member ensembles of 3-month simulations. The first, "AMIP-style" ensemble establishes the degree to which a perfect prediction of SSTs would contribute to the seasonal prediction of precipitation and temperature over continents. The second ensemble is identical to the first, except that the land surface is also initialized with "realistic" soil moisture contents through the continuous prior application (within GCM simulations leading up to the start of the forecast period) of a daily observational precipitation data set and the associated avoidance of model drift through the scaling of all surface prognostic variables. A comparison of the two ensembles shows that soil moisture initialization has a statistically significant impact on summertime precipitation and temperature over only a handful of continental regions. These regions agree, to first order, with regions that satisfy three conditions: (1) a tendency toward large initial soil moisture anomalies, (2) a strong sensitivity of evaporation to soil moisture, and (3) a strong sensitivity of precipitation to evaporation. The degree to which the initialization improves forecasts relative to observations is mixed, reflecting a critical need for the continued development of model parameterizations and data analysis strategies.

  17. Psychological Outcomes and Predictors of Initial Weight Loss Outcomes among Severely Obese Adolescents Receiving Laparoscopic Adjustable Gastric Banding

    Science.gov (United States)

    Sysko, Robyn; Devlin, Michael J.; Hildebrandt, Tom B.; Brewer, Stephanie K.; Zitsman, Jeffrey L.; Walsh, B. Timothy

    2013-01-01

    Objective Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery. The role of mental health providers in this population is not well defined, and the selection of candidates is often the result of clinical judgment alone. The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric banding (LAGB) by: (1) examining changes in depressive symptoms and quality of life in the year following surgery, (2) evaluating the interaction between patterns of change in depression, quality of life, and weight post-surgery, and (3) identifying pre-surgical psychological predictors of initial weight change. Method Participants were 101 severely obese adolescents aged 14 to 18. Measures of height, weight, depressive symptoms, and quality of life were obtained in the first year following surgery. Changes in the Beck Depression Inventory (BDI), Pediatric Quality of Life Inventory (PedsQL), and body mass index were analyzed using latent growth curve modeling. Results Significant changes in total BDI [βslope=−0.885 SE=0.279, psurgery (pAdolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB, and measures of pre-operative binge eating and family conflict affected post-surgery body mass index among youth. PMID:23140654

  18. Initial Examination of Low Velocity Sphere Impact of Glass Ceramics

    Energy Technology Data Exchange (ETDEWEB)

    Morrissey, Timothy G [ORNL; Fox, Ethan E [ORNL; Wereszczak, Andrew A [ORNL; Ferber, Mattison K [ORNL

    2012-06-01

    This report summarizes US Army TARDEC sponsored work at Oak Ridge National Laboratory (ORNL) involving low velocity (< 30 m/s or < 65 mph) sphere impact testing of two materials from the lithium aluminosilicate family reinforced with different amounts of ceramic particulate, i.e., glass-ceramic materials, SCHOTT Resistan{trademark}-G1 and SCHOTT Resistan{trademark}-L. Both materials are provided by SCHOTT Glass (Duryea, PA). This work is a follow-up to similar sphere impact studies completed by the authors on PPG's Starphire{reg_sign} soda-lime silicate glass and SCHOTT BOROFLOAT{reg_sign} borosilicate glass. A gas gun or a sphere-drop test setup was used to produce controlled velocity delivery of silicon nitride (Si{sub 3}N{sub 4}) spheres against the glass ceramic tile targets. Minimum impact velocities to initiate fracture in the glass-ceramics were measured and interpreted in context to the kinetic energy of impact and the elastic property mismatch between sphere and target material. Quasistatic spherical indentation was also performed on both glass ceramics and their contact damage responses were compared to those of soda-lime silicate and borosilicate glasses. Lastly, variability of contact damage response was assessed by performing spherical indentation testing across the area of an entire glass ceramic tile. The primary observations from this low velocity (< 30 m/s or < 65 mph) testing were: (1) Resistan{trademark}-L glass ceramic required the highest velocity of sphere impact for damage to initiate. Starphire{reg_sign} soda-lime silicate glass was second best, then Resistan{trademark}-G1 glass ceramic, and then BOROFLOAT{reg_sign} borosilicate glass. (2) Glass-ceramic Resistan{trademark}-L also required the largest force to initiate ring crack from quasi-static indentation. That ranking was followed, in descending order, by Starphire{reg_sign} soda-lime silicate glass, Resistan{trademark}-G1 glass ceramic, and BOROFLOAT{reg_sign} borosilicate glass

  19. Maine Tidal Power Initiative: Environmental Impact Protocols For Tidal Power

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Michael Leroy [Univ. of Maine, Orono, ME; Zydlewski, Gayle Barbin [Univ. of Maine, Orono, ME; Xue, Huijie [Univ. of Maine, Orono, ME; Johnson, Teresa R. [Univ. of Maine, Orono, ME

    2014-02-02

    The Maine Tidal Power Initiative (MTPI), an interdisciplinary group of engineers, biologists, oceanographers, and social scientists, has been conducting research to evaluate tidal energy resources and better understand the potential effects and impacts of marine hydro-kinetic (MHK) development on the environment and local community. Project efforts include: 1) resource assessment, 2) development of initial device design parameters using scale model tests, 3) baseline environmental studies and monitoring, and 4) human and community responses. This work included in-situ measurement of the environmental and social response to the pre-commercial Turbine Generator Unit (TGU®) developed by Ocean Renewable Power Company (ORPC) as well as considering the path forward for smaller community scale projects.

  20. The medicine that might kill the patient: Structural Adjustment and its impacts on health care in Bangladesh.

    Science.gov (United States)

    Hossen, Md Abul; Westhues, Anne

    2012-01-01

    Over the past decade, reforms of the health sector have evolved as a global phenomenon. There is, by now, a fair literature on the relationship between globalization and health. Within this literature, however, there is relatively little attention given to the Structural Adjustment Program (SAP), one aspect of globalization, and its impact on health. It can be observed that the SAP has had a dramatic impact on the status of education, health, the environment, and women and children in many developing countries. The restructuring of the health sector has led to the collapse of preventive and curative care due to the lack of medical equipment, supplies, poor working conditions, low pay of medical personnel, and the resulting low morale in Ghana, Philippines, and Zimbabwe. User fees in primary health care have led to the exclusion of a large section of the population from accessing health services as they are unable to pay. This article discusses the health specific impact of the SAP and the economic reforms initiated under it in Bangladesh. In particular, it will analyze how these policies affect the health care delivery system in Bangladesh in relation to geographic accessibility, affordability, quality of services, administrative efficiency, the rural urban service gap, public provision of health care, and donor influence on health policy.

  1. Impact of regulated price adjustments on price variability in a very low inflation transition economy: Case of Armenia

    Directory of Open Access Journals (Sweden)

    Aghassi Mkrtchyan

    2005-06-01

    Full Text Available This paper examines the impact of monetary policy and administrative price adjustments on price variability in a low inflation economy characterized by relatively frequent administrative price adjustments. Fluctuations of market determined prices, prices of agricultural goods in particular, are linked to poor synchronization between administrative price changes and monetary policy. If monetary policy does not account for expected changes in administrative prices, demand for free goods shifts, causing fluctuation of prices for agricultural goods, because the supply of these goods is highly inelastic in Armenia. The findings contribute to a better understanding of agricultural price variability during 1998-2002. The impact of macroeconomic policy and structural adjustments on income distribution and rural poverty incidence are also examined. This research has immediate policy implications, since Armenia will continue to undergo major upward price adjustments of regulated prices, which may have a negative impact on income distribution unless aggregate demand management is changed.

  2. New-onset diabetes after hemodialysis initiation: impact on survival.

    Science.gov (United States)

    Salifu, Moro O; Abbott, Kevin C; Aytug, Serhat; Hayat, Amir; Haria, Dhiren M; Shah, Syed; Friedman, Eli A; Delano, Barbara G; McFarlane, Samy I; Hurst, Frank P; Flom, Peter L; Jindal, Rahul M

    2010-01-01

    The incidence of new-onset diabetes after initiation of hemodialysis (NODAD) and its impact on survival is not known. We used data from the United States Renal Data System (USRDS) from January 2000 to December 2001, with at least 3 years of follow-up for this study. Patients aged 18-80 years were included. NODAD was defined as two Medicare institutional claims for diabetes in patients with no history of diabetes prior to starting hemodialysis (HD). Incidence (per 1,000 patient-years), prevalence (%) and hazard ratios for mortality in patients with NODAD were calculated. There were 59,340 incident patients with no history of diabetes prior to starting HD, of which 3,853 met criteria for NODAD. The overall incidence and prevalence of NODAD were 20 per 1,000 patient-years and 7.6%, respectively. In a cohort of 444 patients without diabetes and documented glycosylated hemoglobin A1c, diabetes after initiation of HD. NODAD was associated with a significantly increased risk of death as compared to non-diabetes patients (hazard ratio 1.20, 95% confidence interval 1.14-1.25). The USRDS showed a high incidence of NODAD, associated with significantly higher mortality compared to those who did not develop NODAD. The mechanism of NODAD needs to be explored further in experimental and clinical studies. 2010 S. Karger AG, Basel.

  3. Impact initiation of explosives and propellants via statistical crack mechanics

    Science.gov (United States)

    Dienes, J. K.; Zuo, Q. H.; Kershner, J. D.

    2006-06-01

    A statistical approach has been developed for modeling the dynamic response of brittle materials by superimposing the effects of a myriad of microcracks, including opening, shear, growth and coalescence, taking as a starting point the well-established theory of penny-shaped cracks. This paper discusses the general approach, but in particular an application to the sensitivity of explosives and propellants, which often contain brittle constituents. We examine the hypothesis that the intense heating by frictional sliding between the faces of a closed crack during unstable growth can form a hot spot, causing localized melting, ignition, and fast burn of the reactive material adjacent to the crack. Opening and growth of a closed crack due to the pressure of burned gases inside the crack and interactions of adjacent cracks can lead to violent reaction, with detonation as a possible consequence. This approach was used to model a multiple-shock experiment by Mulford et al. [1993. Initiation of preshocked high explosives PBX-9404, PBX-9502, PBX-9501, monitored with in-material magnetic gauging. In: Proceedings of the 10th International Detonation Symposium, pp. 459-467] involving initiation and subsequent quenching of chemical reactions in a slab of PBX 9501 impacted by a two-material flyer plate. We examine the effects of crack orientation and temperature dependence of viscosity of the melt on the response. Numerical results confirm our theoretical finding [Zuo, Q.H., Dienes, J.K., 2005. On the stability of penny-shaped cracks with friction: the five types of brittle behavior. Int. J. Solids Struct. 42, 1309-1326] that crack orientation has a significant effect on brittle behavior, especially under compressive loading where interfacial friction plays an important role. With a reasonable choice of crack orientation and a temperature-dependent viscosity obtained from molecular dynamics calculations, the calculated particle velocities compare well with those measured using

  4. The Predictive Nature of Humor, Authoritative Parenting Style, and Academic Achievement on Indices of Initial Adjustment and Commitment to College among College Freshmen

    Science.gov (United States)

    Hickman, Gregory P.; Crossland, Garnet L.

    2004-01-01

    Through the administration of self-report surveys, this study examined the relationships among a) parenting styles, b) family structure, c) academic achievement, d) birth order, e) gender, and f) humor on the initial personal-emotional, social, academic, and commitment to college adjustment among 257 first-quarter college freshmen. Multiple…

  5. Impact of Generalist Physician Initiatives on Residency Selection

    Directory of Open Access Journals (Sweden)

    Michael H. Malloy

    2001-10-01

    Full Text Available Objective:To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies. Background:In the fall of 1994 a first year Community Continuity Experience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education. Design/Methods:We examined the residency selections of cohorts of graduating medical students before (1992-1996 and after (1997-1999 the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not. Results:Prior to the implementation of the programs, 45%(425/950 of students graduating selected primary care residencies compared to 45% (210/465 of students participating in the programs (p=0.88. At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53% were more likely to select a primary care residency than non-minority students (40%; students in the two lowest grade point average quartiles (55% and 50% selected primary care residencies compared to 37% and 38% of students in the top 2

  6. The Impact of Dynamic RTS Threshold Adjustment for IEEE 802.11 MAC Protocol

    Directory of Open Access Journals (Sweden)

    Mostafa Mjidi

    2009-01-01

    Full Text Available In recent years, wireless technologies and application received great attention. The Medium Access Control (MAC protocol is the main element that determines the efficiency in sharing the limited communication bandwidth of the wireless channel in wireless local area networks (WLANs. IEEE 802.11 introduced the optional RTS/CTS handshaking mechanism to address the hidden terminal problem as well as to reduces the chance of collision in case of higher node density and traffic. RTS Threshold (RT determines when RTS/CTS mechanism should be used and proved to be an important parameter for performance characteristics in data transmission. We first investigate to find a meaningful threshold value according to the network situation and determine the impact of using or disengaging the RTS/CTS optional mechanism and dynamically adjust the RTS Threshold to maximize data transmission. The results show a significant improvement over existing CSMA/CA and RTS/CTS schemes. Our adaptive scheme performed even better when data rate increases. We verify our proposed scheme both analytically and with extensive network simulation using ns-2.

  7. Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets.

    Science.gov (United States)

    Heijink, Richard; van Baal, Pieter; Oppe, Mark; Koolman, Xander; Westert, Gert

    2011-06-23

    The validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated. In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. Our goal was to quantify and decompose international differences in health expectancy based on health-related quality of life (HRQoL). We focused on the impact of value set choice on cross-country variation. We calculated Quality Adjusted Life Expectancy (QALE) at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE. QALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries. The choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers of differences in health-state values across populations. This

  8. Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets

    Directory of Open Access Journals (Sweden)

    Oppe Mark

    2011-06-01

    Full Text Available Abstract Background The validity, reliability and cross-country comparability of summary measures of population health (SMPH have been persistently debated. In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. Our goal was to quantify and decompose international differences in health expectancy based on health-related quality of life (HRQoL. We focused on the impact of value set choice on cross-country variation. Methods We calculated Quality Adjusted Life Expectancy (QALE at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE. Results QALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries. Conclusions The choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers

  9. Arm-trunk coordination in wheelchair initiation displacement: A study of anticipatory and compensatory postural adjustments during different speeds and directions of propulsion.

    Science.gov (United States)

    Chikh, Soufien; Garnier, Cyril; Faupin, Arnaud; Pinti, Antonio; Boudet, Samuel; Azaiez, Fairouz; Watelain, Eric

    2018-03-13

    Arm-trunk coordination during the initiation of displacement in manual wheelchair is a complex task. The objective of this work is to study the arm-trunk coordination by measuring anticipatory and compensatory postural adjustments. Nine healthy subjects participated in the study after being trained in manual wheelchair. They were asked to initiate a displacement in manual wheelchair in three directions (forward vs. left vs. right), with two speeds (spontaneous vs. maximum) and with two initial hand's positions (hands on thighs vs. hands on handrails). Muscular activities in the trunk (postural component) and the arms (focal component) were recorded bilaterally. The results show two strategies for trunk control: An anticipatory adjustment strategy and a compensatory adjustment strategy with a dominance of compensation. These two strategies are influenced by the finalities of displacement in terms of speed and direction depending on the hands positions. Arm-trunk coordination is characterized by an adaptability of anticipatory and compensatory postural adjustments. The study of this type of coordination for subjects with different levels of spinal cord injury could be used to predict the forthcoming displacement and thus assist the user in a complex task. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Impacts of Pre-Retirement Guidance and Family Involvement on Retirement Adjustment of Retirees in Nigeria

    Directory of Open Access Journals (Sweden)

    O.O. Olatomide

    2017-12-01

    Full Text Available The study examined retirement adjustment of teacher-retirees in Osun State, and explored the interaction effects of pre-retirement guidance and family in-volvement on retirement adjustment. Exposit-facto design was used. The population comprised retirees from public, civil and private establishments from which 122 teacher-retirees were selected using a multi-stage sampling technique. An instrument: Family Involvement, Pre-retirement Guidance and Retirement Adjustment Questionnaire was used for data collection. Three research questions and three hypotheses guided the study. Data were analyzed using descriptive and inferential statistics. Results revealed that retirees in Osun State are not optimally adjusted, and positive significant interaction effect was found between family involvement and pre-retirement guidance on retirees adjustment, among others. Appropriate policy implications are outlined.

  11. Neurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures.

    Science.gov (United States)

    Crulli, Benjamin; Khebir, Mariam; Toledano, Baruch; Vobecky, Suzanne; Poirier, Nancy; Emeriaud, Guillaume

    2018-02-01

    After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit. The number and duration of NAVA episodes were described. For the first period of invasive NAVA in each subject, detailed clinical and ventilator data in the 4 h before and after the start of NAVA were extracted. 33 postoperative courses were included in 28 subjects with a median age of 3 [interquartile range (IQR) 1-12] months. NAVA was used invasively in 27 courses for a total duration of 87 (IQR 15-334) h per course. Peak inspiratory pressures and mean airway pressures decreased significantly after the start of NAVA (mean differences of 5.8 cm H 2 O (95% CI 4.1-7.5) and 2.0 cm H 2 O (95% CI 1.2-2.8), respectively, P < .001 for both). There was no significant difference in vital signs or blood gas values. NAVA was used noninvasively in 14 subjects, over 79 (IQR 25-137) h. NAVA could be used in pediatric subjects after cardiac surgery. The significant decrease in airway pressures observed after transition to NAVA could have a beneficial impact in this specific population, which should be investigated in future interventional studies. Copyright © 2018 by Daedalus Enterprises.

  12. An Empirical Investigation of the Impact of the Anchor and Adjustment Heuristic on the Audit Judgment Process

    Science.gov (United States)

    1988-01-01

    Pe ~ ** . . . ’ S .- ..% - - -- - - An Empirical Investigation of the Impact of the Anchor and Adjustment Heuristic on the Audit Judgment Process A...1 Introduction ....... ............... 1 Audit Opinion Process ... ............ 2 Professional Judgment ..... ........... 5 Heuristics in the Audit Process...to evaluating the results of analytic reviews and internal control compliance tests (Felix and Kinney 1982, also Libby 1981). Decomposing the audit opinion

  13. Overall impact of speed-related initiatives and factors on crash outcomes.

    Science.gov (United States)

    D'Elia, A; Newstead, S; Cameron, M

    2007-01-01

    From December 2000 until July 2002 a package of speed-related initiatives and factors took place in Victoria, Australia. The broad aim of this study was to evaluate the overall impact of the package on crash outcomes. Monthly crash counts and injury severity proportions were assessed using Poisson and logistic regression models respectively. The model measured the overall effect of the package after adjusting as far as possible for non-speed road safety initiatives and socio-economic factors. The speed-related package was associated with statistically significant estimated reductions in casualty crashes and suggested reductions in injury severity with trends towards increased reductions over time. From December 2000 until July 2002, three new speed enforcement initiatives were implemented in Victoria, Australia. These initiatives were introduced in stages and involved the following key components: More covert operations of mobile speed cameras, including flash-less operations; 50% increase in speed camera operating hours; and lowering of cameras' speed detection threshold. In addition, during the period 2001 to 2002, the 50 km/h General Urban Speed Limit (GUSL) was introduced (January 2001), there was an increase in speed-related advertising including the "Wipe Off 5" campaign, media announcements were made related to the above enforcement initiatives and there was a speeding penalty restructure. The above elements combine to make up a package of speed-related initiatives and factors. The package represents a broad, long term program by Victorian government agencies to reduce speed based on three linked strategies: more intensive Police enforcement of speed limits to deter potential offenders, i.e. the three new speed enforcement initiatives just described - supported by higher penalties; a reduction in the speed limit on local streets throughout Victoria from 60 km/h to 50 km/h; and provision of information using the mass media (television, radio and billboard) to

  14. Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

    Science.gov (United States)

    Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

    2015-08-01

    When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. HIV quality report cards: impact of case-mix adjustment and statistical methods.

    Science.gov (United States)

    Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

    2014-10-15

    There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  16. Initial uncertainty impacts statistical learning in sound sequence processing.

    Science.gov (United States)

    Todd, Juanita; Provost, Alexander; Whitson, Lisa; Mullens, Daniel

    2016-11-01

    This paper features two studies confirming a lasting impact of first learning on how subsequent experience is weighted in early relevance-filtering processes. In both studies participants were exposed to sequences of sound that contained a regular pattern on two different timescales. Regular patterning in sound is readily detected by the auditory system and used to form "prediction models" that define the most likely properties of sound to be encountered in a given context. The presence and strength of these prediction models is inferred from changes in automatically elicited components of auditory evoked potentials. Both studies employed sound sequences that contained both a local and longer-term pattern. The local pattern was defined by a regular repeating pure tone occasionally interrupted by a rare deviating tone (p=0.125) that was physically different (a 30msvs. 60ms duration difference in one condition and a 1000Hz vs. 1500Hz frequency difference in the other). The longer-term pattern was defined by the rate at which the two tones alternated probabilities (i.e., the tone that was first rare became common and the tone that was first common became rare). There was no task related to the tones and participants were asked to ignore them while focussing attention on a movie with subtitles. Auditory-evoked potentials revealed long lasting modulatory influences based on whether the tone was initially encountered as rare and unpredictable or common and predictable. The results are interpreted as evidence that probability (or indeed predictability) assigns a differential information-value to the two tones that in turn affects the extent to which prediction models are updated and imposed. These effects are exposed for both common and rare occurrences of the tones. The studies contribute to a body of work that reveals that probabilistic information is not faithfully represented in these early evoked potentials and instead exposes that predictability (or conversely

  17. The Impact of Religiosity on Midshipman Adjustment and Feelings of Acceptance

    National Research Council Canada - National Science Library

    Krauz, Matthew B

    2006-01-01

    ... in and practice of religion affects the overall adjustment and experience of midshipmen at the U.S. Naval Academy. Data were collected through focus groups with first and second class midshipmen...

  18. Aerobic composting of distilled grain waste eluted from a Chinese spirit-making process: The effects of initial pH adjustment.

    Science.gov (United States)

    Wang, Shi-Peng; Zhong, Xiao-Zhong; Wang, Ting-Ting; Sun, Zhao-Yong; Tang, Yue-Qin; Kida, Kenji

    2017-12-01

    Aerobic composting of distilled grain waste (DGW) at different initial pH values adjusted by CaO addition was investigated. Three pH-adjusted treatments with initial pH values of 4 (R1), 5 (R2) and 6 (R3) and a control treatment (R0) with a pH value of 3.5 were conducted simultaneously. The results showed that R0 had an unsuccessful start-up of composting. However, the pH-adjusted treatments produced remarkable results, with a relatively high initial pH being beneficial for the start-up. Within 65days of composting, the degradation of volatile solids (VS) and the physicochemical properties of R2 and R3 displayed similar tendencies, and both produced a mature end-product, while R1 exhibited a lower VS degradation rate, and some of its physicochemical properties indicated the end-product was immature. Quantitative PCR analysis of ammonia oxidizers indicated that the occurrence of nitrification during the composting of DGW could be attributed to the activity of ammonia-oxidizing bacteria. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. The impact of lateral variations in lithospheric thickness on glacial isostatic adjustment in West Antarctica

    Science.gov (United States)

    Nield, Grace A.; Whitehouse, Pippa L.; van der Wal, Wouter; Blank, Bas; O'Donnell, John Paul; Stuart, Graham W.

    2018-04-01

    Differences in predictions of Glacial Isostatic Adjustment (GIA) for Antarctica persist due to uncertainties in deglacial history and Earth rheology. The Earth models adopted in many GIA studies are defined by parameters that vary in the radial direction only and represent a global average Earth structure (referred to as 1D Earth models). Over-simplifying actual Earth structure leads to bias in model predictions in regions where Earth parameters differ significantly from the global average, such as West Antarctica. We investigate the impact of lateral variations in lithospheric thickness on GIA in Antarctica by carrying out two experiments that use different rheological approaches to define 3D Earth models that include spatial variations in lithospheric thickness. The first experiment defines an elastic lithosphere with spatial variations in thickness inferred from seismic studies. We compare the results from this 3D model with results derived from a 1D Earth model that has a uniform lithospheric thickness defined as the average of the 3D lithospheric thickness. Irrespective of deglacial history and sub-lithospheric mantle viscosity, we find higher gradients of present-day uplift rates (i.e. higher amplitude and shorter wavelength) in West Antarctica when using the 3D models, due to the thinner-than-1D-average lithosphere prevalent in this region. The second experiment uses seismically-inferred temperature as input to a power-law rheology thereby allowing the lithosphere to have a viscosity structure. Modelling the lithosphere with a power-law rheology results in behaviour that is equivalent to a thinner-lithosphere model, and it leads to higher amplitude and shorter wavelength deformation compared with the first experiment. We conclude that neglecting spatial variations in lithospheric thickness in GIA models will result in predictions of peak uplift and subsidence that are biased low in West Antarctica. This has important implications for ice-sheet modelling

  20. Impact of Structural Adjustment Programmes on National Food Security in Kenya

    International Nuclear Information System (INIS)

    Oduol, A.B.

    2002-01-01

    Per capita food production in sub-Saharan Africa including Kenya has been declining over the past three decades.Despite the available efforts made by the governments in sub-Saharan Africa, food insecurity remains one of the most crucial issues.In Kenya, agriculture accounts for about 26 per cent of overall GDP, 60 per cent of foreign exchange earnings and employs about 70 per cent of the rural population. Agriculture therefore remains the main source of food security for a majority of Kenya's population. Kenya has been going through nearly a decade of transition in agriculture whereby the role of the state in production and marketing has been reduced allowing the public sector institutions to concentrate on doing a narrow range of tasks better. However concerns has arisen as to wether this transformation from state-led model of service provision to that of the private sector would result in the vibrant growth in agricultural production that was experienced in the 1960s and early 1970s. This study sought to determine the impact of policy reforms on national food security with a major focus on agricultural production of rural farmers in Kenya. The study also aimed at suggesting posssible recommendations to improve agricultural production while taking into consideration the fiscal constraint faced by the the country. By using descriptive analysis to compare changes in production of maize, coffee and tea as well as in the food security situation before and after policy reforms, the study revealed that maize production had declined in the post-reform period. Although the total contribution of tea and coffee to total agricultural export had increased in the pos-reform period, production of coffee showed a downward trend unlike that of tea. The results further revealed that food production had deteriorated in the post-reform period while dependence on food imports and food aid had increased. In conclusion, the structural adjustment programmes coupled with organisational

  1. How large are the impacts of carbon-motivated border tax adjustments on China and how to mitigate them?

    International Nuclear Information System (INIS)

    Li, Aijun; Zhang, Aizhen; Cai, Hongbo; Li, Xingfeng; Peng, Shishen

    2013-01-01

    There have been growing clamours for carbon-motivated border tax adjustments (CBTAs) targeted at countries that do not accept the carbon emission reduction targets. Currently, China is the largest carbon emitter with large annual incremental carbon emissions and might have to face the challenge of CBTA. Therefore, it is a pressing policy challenge for the government to get prepared for mitigating the negative impacts of CBTAs on China. In this article, we compare the impacts of CBTAs across large developing economies and compare the performances of different policy options to mitigate the negative impacts. The main findings are as follows. First, CBTA would affect different economies and different sectors differently. CBTA would result in a shift of production across sectors and relocation of output from the target countries to CBTA users. Second, CBTA would contribute to world's emissions reduction, but less than expected due to carbon leakage. Finally, policy options, which could reduce the present distorting effects, would be preferred to other policy options that would add additional distorting effects to the economy. Looking ahead, the Chinese government should get prepared for mitigating the negative impacts of CBTAs because its economy could be adversely affected. - Highlights: • We compare impacts of carbon-motivated border tax adjustments (CBTAs) across large emerging countries. • We test effectiveness of different policy options to mitigate the negative impacts. • We investigate how to design policy mix to mitigate negative impacts of CBTAs

  2. Initial surface deformations during impact on a liquid pool

    NARCIS (Netherlands)

    Bouwhuis, W.; Hendrix, M.H.W.; van der Meer, Roger M.; Snoeijer, Jacobus Hendrikus

    2015-01-01

    A tiny air bubble can be entrapped at the bottom of a solid sphere that impacts onto a liquid pool. The bubble forms due to the deformation of the liquid surface by a local pressure buildup inside the surrounding gas, as also observed during the impact of a liquid drop on a solid wall. Here, we

  3. 20 CFR 418.1305 - What is not an initial determination regarding your income-related monthly adjustment amount?

    Science.gov (United States)

    2010-04-01

    ... Amount Determinations and the Administrative Review Process § 418.1305 What is not an initial... process as provided by §§ 418.1320 through 418.1325 and §§ 418.1340 through 418.1355, and they are not subject to judicial review. These actions include, but are not limited to, our dismissal of a request for...

  4. Initial results of India's environmental impact assessment of nodule mining

    Digital Repository Service at National Institute of Oceanography (India)

    Desa, E.

    The Indian Deepsea Experiment (INDEX) was intiated in 1995, with the objective of predicting the environmental impact of nodule mining, in the Central Indian Basin. More than 20 scientists and technical staff of the National Institute...

  5. Differential impact of fathers' authoritarian parenting on early adolescent adjustment in conservative protestant versus other families.

    Science.gov (United States)

    Gunnoe, Marjorie Lindner; Hetherington, E Mavis; Reiss, David

    2006-12-01

    The purpose of the study was to determine whether well-established associations between authoritarian parenting and adolescent adjustment pertain to conservative Protestant (CP) families. Structural equation modeling was used to test paths from biological fathers' authoritarian parenting to adolescent adjustment in 65 CP versus 170 comparison families in the Nonshared Environment and Adolescent Development Study (NEAD; D. Reiss et al., 1994). The hypothesis that adolescents in CP families would be less harmed by authoritarian parenting than would adolescents in control families was partially supported: Authoritarian parenting directly predicted greater externalizing and internalizing for adolescents in control families but not for adolescents in CP families. In contrast, parents' religious affiliation failed to moderate the negative associations between authoritarian parenting and positive adjustment. Understanding family processes specific to the CP subculture is important for helping these families raise competent children. (c) 2006 APA, all rights reserved.

  6. Factors Impacting the Psychological Adjustment of Saudi Arabian International Students in the United States: Self-Esteem, Social Support, and Discrimination

    Science.gov (United States)

    Rundles, Kyle

    2013-01-01

    International populations face difficulties adjusting to a new culture. This is especially true for international students, who have to adjust to a new country and face academic demands concurrently. Research has explored various factors that impact psychological adjustment of international students and show the influence of self-esteem and social…

  7. Gender Identity and Adjustment: Understanding the Impact of Individual and Normative Differences in Sex Typing

    Science.gov (United States)

    Lurye, Leah E.; Zosuls, Kristina M.; Ruble, Diane N.

    2009-01-01

    The relationship among gender identity, sex typing, and adjustment has attracted the attention of social and developmental psychologists for many years. However, they have explored this issue with different assumptions and different approaches. Generally the approaches differ regarding whether sex typing is considered adaptive versus maladaptive, measured as an individual or normative difference, and whether gender identity is regarded as a unidimensional or multidimensional construct. In this chapter, we consider both perspectives and suggest that the developmental timing and degree of sex typing, as well as the multidimensionality of gender identity, be considered when examining their relationship to adjustment. PMID:18521861

  8. Impact of Psychological Problems and Marital Adjustment of Iranian Veterans on Their Children's Quality of Life and Happiness

    Science.gov (United States)

    Zargar, Fatemeh

    2014-01-01

    Background: The Iran-Iraq war during the 1980-1988 has left many consequences on veterans and their families that persist long after the war ended. Objectives: The aim of this study was to evaluate the impact of psychological problems and marital adjustment of Iranian veterans on their children's quality of life and happiness 24 years after the war ended. Patients and Methods: The sample was all children of veterans in Isfahan city that registered by Veterans and Martyrs Affair Foundation (VMAF). One hundred sixty-three veterans were selected by systematic randomized sampling and the symptom checklist-90-revised (SCL-90-R) and dyadic adjustment scale (DAS) were administered for them. Their wives filled out the DAS and their children answered to World Health Organization Quality of Life-Brief version (WHOQOL-BREF) and Oxford Happiness Inventory (OHI). The data from questionnaires completed by 149 families were analyzed using the multiple regressions analysis. Results: Global Severity Index (GSI) scores of veterans and veteran's age were inversely correlated with the scores of children's quality of life, while marital adjustment of parents and number of rooms in house were positively correlated. Mother's age was inversely correlated with the scores of children's happiness, while marital adjustment of the parents, the number of rooms in their house and the number of children were positively correlated. Conclusions: In veterans' family, psychological health of the veterans and marital adjustment of the parents have a significant relationship with their children's quality of life and happiness. PMID:25599063

  9. The impact of statistical adjustment on conditional standard errors of measurement in the assessment of physician communication skills.

    Science.gov (United States)

    Raymond, Mark R; Clauser, Brian E; Furman, Gail E

    2010-10-01

    The use of standardized patients to assess communication skills is now an essential part of assessing a physician's readiness for practice. To improve the reliability of communication scores, it has become increasingly common in recent years to use statistical models to adjust ratings provided by standardized patients. This study employed ordinary least squares regression to adjust ratings, and then used generalizability theory to evaluate the impact of these adjustments on score reliability and the overall standard error of measurement. In addition, conditional standard errors of measurement were computed for both observed and adjusted scores to determine whether the improvements in measurement precision were uniform across the score distribution. Results indicated that measurement was generally less precise for communication ratings toward the lower end of the score distribution; and the improvement in measurement precision afforded by statistical modeling varied slightly across the score distribution such that the most improvement occurred in the upper-middle range of the score scale. Possible reasons for these patterns in measurement precision are discussed, as are the limitations of the statistical models used for adjusting performance ratings.

  10. Psychological Availability between Self-Initiated Expatriates and Host Country Nationals during Their Adjustment: The Moderating Role of Supportive Supervisor Relations

    Science.gov (United States)

    Jannesari, Milad; Wang, Zhongming; McCall, Jacob; Zheng, Boyang

    2017-01-01

    This research examined the role of psychological availability as a means of psychological engagement between self-initiated expatriates (SIEs) and their host-country nationals (HCNs) colleagues during their work and interaction adjustment. To reveal this process, this study presented the concept of psychological availability, which refers to an individual’s belief that they are physically, cognitively, and emotionally ready or confident to engage the self with their colleagues, as a mediator between proactive personality and adjustment. Also, it investigated the relationship between proactive personality and psychological availability and how it was moderated by supportive supervisor relations. We hypothesized, this relationship would be weakened/strengthened when SIEs and HCNs received low/high level of support from their supervisor. This study was conducted as a quantitative study, data was used from 342 SIEs and 342 HCNs working in mainland China. Our finding supported the hypothesis that psychological availability mediated the relationship between proactive personality and their adjustment to an international work environment; in addition, the relationship between proactive personality and psychological availability would be stronger when the level of superiors relations support is high between SIEs and HCNs. This study demonstrated the value of proactive personality as an antecedent effect and supportive supervisor relations as a moderating effect, and investigated how these factors can lead to a sense of psychological availability and boost psychological engagement between SIEs and HCNs in order to improve the adjustment between them. PMID:29225587

  11. Psychological Availability between Self-Initiated Expatriates and Host Country Nationals during Their Adjustment: The Moderating Role of Supportive Supervisor Relations

    Directory of Open Access Journals (Sweden)

    Milad Jannesari

    2017-11-01

    Full Text Available This research examined the role of psychological availability as a means of psychological engagement between self-initiated expatriates (SIEs and their host-country nationals (HCNs colleagues during their work and interaction adjustment. To reveal this process, this study presented the concept of psychological availability, which refers to an individual’s belief that they are physically, cognitively, and emotionally ready or confident to engage the self with their colleagues, as a mediator between proactive personality and adjustment. Also, it investigated the relationship between proactive personality and psychological availability and how it was moderated by supportive supervisor relations. We hypothesized, this relationship would be weakened/strengthened when SIEs and HCNs received low/high level of support from their supervisor. This study was conducted as a quantitative study, data was used from 342 SIEs and 342 HCNs working in mainland China. Our finding supported the hypothesis that psychological availability mediated the relationship between proactive personality and their adjustment to an international work environment; in addition, the relationship between proactive personality and psychological availability would be stronger when the level of superiors relations support is high between SIEs and HCNs. This study demonstrated the value of proactive personality as an antecedent effect and supportive supervisor relations as a moderating effect, and investigated how these factors can lead to a sense of psychological availability and boost psychological engagement between SIEs and HCNs in order to improve the adjustment between them.

  12. Beyond the Individual: The Impact of Ethnic Context and Classroom Behavioral Norms on Victims' Adjustment

    Science.gov (United States)

    Bellmore, Amy D.; Witkow, Melissa R.; Graham, Sandra; Juvonen, Jaana

    2004-01-01

    With a sample of 1,630 sixth-grade students from 77 classrooms, the authors used hierarchical linear modeling to examine how ethnicity within context and classroom social disorder influenced the association between peer victimization and social-psychological adjustment (loneliness and social anxiety). Victimized students in classrooms where many…

  13. Impact of Group Support on Adjustment to Divorce by Single, Custodial Fathers.

    Science.gov (United States)

    Tedder, Sandra L.; And Others

    1984-01-01

    Discusses the effects of a support group for single, custodial fathers (N=36) on measures of divorce adjustment, loneliness, and self-concept. Results indicated that men who attended the group meetings made more positive changes than those who did not attend and indicated a desire for support, sharing, and discussion. (JAC)

  14. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    Science.gov (United States)

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  15. Research on the Impacts of Expensive Food and Luxury Goods Import Tariff Adjustment on Chinese Economy and Related Measures

    OpenAIRE

    Qishen Zhou; Mingxing Yang

    2013-01-01

    This study aims to investigate the impacts of expensive food and luxury goods import tariff adjustment on Chinese economy and related measures. Nowadays, Asia especially China has been the world’s biggest expensive food and luxury goods market. However, due to relatively higher luxury import tariff in China, most consumers have chosen to purchase expensive food and luxury goods abroad which leads to a large of domestic consumption cash outflow. Therefore, whether to cut the luxury import tari...

  16. The Impact and Feasibility of Introducing Height-Adjustable Desks on Adolescents’ Sitting in a Secondary School Classroom

    Directory of Open Access Journals (Sweden)

    Rick Baldock

    2016-05-01

    Full Text Available Children spend over 60% of their school day sitting; much of this occurs in the classroom. Emerging research has examined the impact of environmental interventions on classroom sitting. While this research is promising, it has predominantly focused on the primary school setting. This study examined the impact and feasibility of height-adjustable desks on time spent sitting/standing during classroom lessons in a secondary school. Traditional desks in a Melbourne secondary school classroom were replaced with 27 height-adjustable desks (intervention classroom. Forty-three adolescents (51% male; mean age 13.7 ± 1.4 years from Grades 7, 9 and 10 wore an inclinometer and accelerometer for schooldays and completed a survey after using the desks during lessons for seven weeks. Ten teachers (50% male completed a survey. Time spent sitting, standing, and the length of sitting bouts were compared between periods when adolescents were in the intervention classroom versus traditional classrooms (matched on teacher and subject. Compared to the traditional classroom, adolescents spent 25% less time sitting and 24% more time standing in the intervention classroom (effect size > 0.8, and had a greater frequency of short sitting bouts and fewer longer bouts. The majority of teachers (71% and students (70% reported wanting to continue to use the height-adjustable desks. When standing during lessons, adolescents reported working well (69%; however, a third reported difficulties paying attention (28% and becoming distracted (36%. Few teachers reported negative influences on adolescents’ ability to work (14% and concentrate (14%. Half the adolescents reported leg, or back pain with standing. Introducing height-adjustable desks resulted in lower levels of sitting compared with traditional classrooms, was acceptable and had some adverse effects on concentration and discomfort. The study provides preliminary evidence that height-adjustable desks may help reduce

  17. Self-initiated expatriates' cross-cultural training and adjustment: a closer look at norwegian engineers : what kind of cross cultural training does self-initiated expatriate engineers in Norway receive and does this affect their cross cultural adjustment? Are the theories related to company expatriates applicable?

    OpenAIRE

    Carsten, Mona Skogseid

    2014-01-01

    Masteroppgave i økonomi og administrasjon – Universitetet i Agder 2014 Today many people move on their own initiative to foreign countries to work as a result of increased globalization and human mobility. At arrival in the new culture the self-initiated expatriate m meet a culture that might be different from what they are used too. Cross-cultural training can provide the expatriates with tools and information that can enable the self-initiated expatriates to more easily adjust. This ...

  18. Impacts of initial convective structure on subsequent squall line evolution

    Science.gov (United States)

    Varble, A.; Morrison, H.; Zipser, E. J.

    2017-12-01

    A Weather Research and Forecasting simulation of the 20 May 2011 MC3E squall line using 750-m horizontal grid spacing produces wide convective regions with strongly upshear tilted convective updrafts and mesoscale bowing segments that are not produced in radar observations. Similar features occur across several different bulk microphysics schemes, despite surface observations exhibiting cold pool equivalent potential temperature drops that are similar to and pressure rises that are greater than those in the simulation. Observed rear inflow remains more elevated than simulated, partly counteracting the cold pool circulation, whereas the simulated rear inflow descends to low levels, maintaining its strength and reinforcing the cold pool circulation that overpowers the pre-squall line low level vertical wind shear. The descent and strength of the simulated rear inflow is fueled by strong latent cooling caused by large ice water contents detrained from upshear tilted convective cores that accumulate at the rear of the stratiform region. This simulated squall evolution is sensitive to model resolution, which is too coarse to resolve individual convective drafts. Nesting a 250-m horizontal grid spacing domain into the 750-m domain substantially alters the initial convective cells with reduced latent cooling, weaker convective downdrafts, and a weaker initial cold pool. As the initial convective cells develop into a squall line, the rear inflow remains more elevated in the 250-m domain with a cold pool that eventually develops to be just as strong and deeper than the one in the 750-m run. Despite this, the convective cores remain more upright in the 250-m run with the rear inflow partly counteracting the cold pool circulation, whereas the 750-m rear inflow near the surface reinforces the shallower cold pool and causes bowing in the squall line. The different structure in the 750-m run produces excessive mid-level front-to-rear detrainment that widens the convective region

  19. Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care-Sensitive Conditions in Germany.

    Science.gov (United States)

    Pollmanns, Johannes; Romano, Patrick S; Weyermann, Maria; Geraedts, Max; Drösler, Saskia E

    2018-04-01

    To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons. County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative ambulatory diagnosis data were used. A retrospective cross-sectional study using in- and outpatient secondary data was performed. Hospitalization data for hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, and asthma were obtained from the German Diagnosis Related Groups (DRG) database. Prevalence estimates were obtained from the German Central Research Institute of Ambulatory Health Care. Crude hospitalization rates varied substantially across counties (coefficients of variation [CV] 28-37 percent across conditions); this variation was reduced by prevalence adjustment (CV 21-28 percent). Prevalence explained 40-50 percent of the observed variation (r = 0.65-0.70) in ACSH rates for all conditions except asthma (r = 0.07). Between 30 percent and 38 percent of areas moved into or outside condition-specific control limits with prevalence adjustment. Unadjusted ACSH rates should be used with caution for high-stakes public reporting as differences in prevalence may have a marked impact. Prevalence adjustment should be considered in models analyzing ACSH. © Health Research and Educational Trust.

  20. Initial studies to assess microbial impacts on nuclear waste disposal

    International Nuclear Information System (INIS)

    Horn, J.M.; Meike, A.; McCright, R.D.; Economides, B.

    1996-01-01

    The impacts of the native and introduced bacteria on the performance of geologic nuclear waste disposal facilities should be evaluated because these bacteria could promote corrosion of repository components and alteration of chemical and hydrological properties of the surrounding engineered and rock barriers. As a first step towards investigating these potentialities, native and introduced bacteria obtained from post-construction Yucca Mountain (YM) rock were isolated under varying conditions, including elevated temperature, low nutrient availability, and the absence of available oxygen. Individual isolates are being screened for activities associated with microbially induced corrosion of metals (MIC). Preliminary determination of growth rates of whole YM microbial communities under varying conditions was also undertaken

  1. Land Tenure Adjustment Project. Preliminary Draft Environmental Impact Statement/Report

    Science.gov (United States)

    1987-04-16

    southern California render the probability of major agricultural produrtion in the impact area unlikely. Extractive industry in the impact area is neither...American Indians, Vol. 8: California, ed. Robert F. Heizer . Smithsonian Institution, Washington, D.C. Bean, Lowell John, and Sylvia Brakke Vane. 1979...American Indians, Vol. 8: California, ed. Robert F. Heizer , pp. 567-569. Smithsonian Institution, Washington, D.C. LTA REVISION 2 B-2 California Air

  2. Impact of initial surface parameters on the final quality of laser micro-polished surfaces

    Science.gov (United States)

    Chow, Michael; Bordatchev, Evgueni V.; Knopf, George K.

    2012-03-01

    Laser micro-polishing (LμP) is a new laser-based microfabrication technology for improving surface quality during a finishing operation and for producing parts and surfaces with near-optical surface quality. The LμP process uses low power laser energy to melt a thin layer of material on the previously machined surface. The polishing effect is achieved as the molten material in the laser-material interaction zone flows from the elevated regions to the local minimum due to surface tension. This flow of molten material then forms a thin ultra-smooth layer on the top surface. The LμP is a complex thermo-dynamic process where the melting, flow and redistribution of molten material is significantly influenced by a variety of process parameters related to the laser, the travel motions and the material. The goal of this study is to analyze the impact of initial surface parameters on the final surface quality. Ball-end micromilling was used for preparing initial surface of samples from H13 tool steel that were polished using a Q-switched Nd:YAG laser. The height and width of micromilled scallops (waviness) were identified as dominant parameter affecting the quality of the LμPed surface. By adjusting process parameters, the Ra value of a surface, having a waviness period of 33 μm and a peak-to-valley value of 5.9 μm, was reduced from 499 nm to 301 nm, improving the final surface quality by 39.7%.

  3. Exploring technology impacts of Healthcare 2.0 initiatives.

    Science.gov (United States)

    Randeree, Ebrahim

    2009-04-01

    As Internet access proliferates and technology becomes more accessible, the number of people online has been increasing. Web 2.0 and the social computing phenomena (such as Facebook, Friendster, Flickr, YouTube, Blogger, and MySpace) are creating a new reality on the Web: Users are changing from consumers of Web-available information and resources to generators of information and content. Moving beyond telehealth and Web sites, the push toward Personal Health Records has emerged as a new option for patients to take control of their medical data and to become active participants in the push toward widespread digitized healthcare. There is minimal research on the impact of Web 2.0 in healthcare. This paper reviews the changing patient-physician relationship in the Healthcare 2.0 environment, explores the technological challenges, and highlights areas for research.

  4. The impact of structural adjustment policies on women's and children's health in Tanzania.

    Science.gov (United States)

    Lugalla, J L

    1995-03-01

    Since 1981, the government of Tanzania has adopted a variety of policy measures including the National Economic Survival Plan (NESP), Structural Adjustment Program (SAP), Economic Recovery Program (ERP) I, ERP II, Economic and Social Action Plan (ESAP), and Priority Social Action Plan (PSAP) to deal with the country's present social and economic crisis dating back to the late 1970s. The main objective of the these adjustment measures has been to attain macroeconomic balance by bringing national expenditure into line with national income to reduce inflation and to increase exports. Other objectives have been to maintain egalitarian income distribution and the provision of basic social services to the majority of the population. To realize these objectives, the government has been controlling credit and removed subsidies on certain food items and agricultural inputs, introduced a system of progressive devaluation, liberalized trade, and has been trying to reduce government expenditure by introducing cost sharing measures in the education and health sector. The author concludes that the erosion of real incomes and increased poverty have had a devastating effect upon women and children. Rural women have heavier workloads as males migrate to urban areas in search of work, there is increased maternal mortality, and chronic malnutrition and poverty make it difficult to implement HIV/AIDS intervention strategies.

  5. Adjusting export tax rebates to reduce the environmental impacts of trade: Lessons from China.

    Science.gov (United States)

    Song, Peng; Mao, Xianqiang; Corsetti, Gabriel

    2015-09-15

    Export tax rebates are an important policy instrument for stimulating exports, which many developing countries make use of. However, excessive export tax rebates and inappropriate structural arrangements can lead to over-production in highly polluting industries and cause the environment to deteriorate. This paper, taking China as the study case, tests and verifies the statistical significance of the causal relationship between export tax rebates and pollution emissions. With a computable general equilibrium modeling, the current study further analyzes the effectiveness of export tax rebate adjustments aimed at alleviating environmental pressure for different time periods. It is found that before 2003, export tax rebates primarily promoted exports and boosted foreign exchange reserves, and highly polluting sectors enjoyed above-average export tax rebates, which led to increased pollution emissions. Between 2003 and 2010, the export tax rebate system was reformed to reduce support for the highly polluting export sectors, which led to decreases in emissions. Canceling export tax rebates for highly polluting sectors is shown to be the most favorable policy choice for improving the environmental performance of China's international trade. This study can serve as reference for other developing countries which similarly rely on export tax rebates, so that they can adjust their policies so as to combine economic growth with pollution control. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. The Impact of AUC-Based Monitoring on Pharmacist-Directed Vancomycin Dose Adjustments in Complicated Methicillin-Resistant Staphylococcus aureus Infection.

    Science.gov (United States)

    Stoessel, Andrew M; Hale, Cory M; Seabury, Robert W; Miller, Christopher D; Steele, Jeffrey M

    2018-01-01

    This study aimed to assess the impact of area under the curve (AUC)-based vancomycin monitoring on pharmacist-initiated dose adjustments after transitioning from a trough-only to an AUC-based monitoring method at our institution. A retrospective cohort study of patients treated with vancomycin for complicated methicillin-resistant Staphylococcus aureus (MRSA) infection between November 2013 and December 2016 was conducted. The frequency of pharmacist-initiated dose adjustments was assessed for patients monitored via trough-only and AUC-based approaches for trough ranges: 10 to 14.9 mg/L and 15 to 20 mg/L. Fifty patients were included: 36 in the trough-based monitoring and 14 in the AUC-based-monitoring group. The vancomycin dose was increased in 71.4% of patients when troughs were 10 to 14.9 mg/L when a trough-only approach was used and in only 25% of patients when using AUC estimation ( P = .048). In the AUC group, the dose was increased only when AUC/minimum inhibitory concentration (MIC) AUC/MIC ≥400. The AUC-based monitoring did not significantly increase the frequency of dose reductions when trough concentrations were 15 to 20 mg/L (AUC: 33.3% vs trough: 4.6%; P = .107). The AUC-based monitoring resulted in fewer patients with dose adjustments when trough levels were 10 to 14.9 mg/L. The AUC-based monitoring has the potential to reduce unnecessary vancomycin exposure and warrants further investigation.

  7. Impact of sexual harassment victimization by peers on subsequent adolescent victimization and adjustment: a longitudinal study.

    Science.gov (United States)

    Chiodo, Debbie; Wolfe, David A; Crooks, Claire; Hughes, Ray; Jaffe, Peter

    2009-09-01

    To examine gender differences in prevalence and types of sexual harassment victimization experienced in grade 9 and how it contributes to relationship victimization and psychological adjustment 2.5 years later. A total of 1734 students from 23 schools completed self-report surveys at entry to grade 9 and end of grade 11. Self-report data were collected on victimization experiences (sexual harassment, physical dating violence, peer violence, and relational victimization) and adjustment (emotional distress, problem substance use, self-harm, suicidal thoughts, maladaptive dieting, feeling unsafe at school, and perpetration of violent delinquency). Separate analyses by sex were prespecified. Sexual harassment victimization was common among boys (42.4%) and girls (44.1%) in grade 9, with girls reporting more sexual jokes, comments, and unwanted touch than among boys, and with boys reporting more homosexual slurs or receiving unwanted sexual content. For girls, sexual harassment victimization in grade 9 was associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use, and feeling unsafe at school. A similar pattern of risk was found for boys, with the exception of dieting and self-harm behaviors. Adjusted odds ratios (AOR) indicated these students were significantly more likely than nonharassed students to report victimization by peers and dating partners 2.5 years later (AOR for boys and girls, respectively; all p harassment (AOR: 2.45; 2.9), physical dating violence (AOR: 2.02; 3.73), and physical peer violence (AOR: 2.75; 2.79). Gr 9 sexual harassment also contributed significantly to emotional distress (AOR: 2.09; 2.24), problem substance use (AOR: 1.79; 2.04), and violent delinquency perpetration (AOR: 2.1; 3.34) 2.5 years later (boys and girls, respectively; all p harassment at the beginning of high school is a strong predictor of future victimization by peers and dating partners for both girls and boys, and

  8. The impact of a healthy lifestyle on Disability-Adjusted Life Years: a prospective cohort study.

    Science.gov (United States)

    May, Anne M; Struijk, Ellen A; Fransen, Heidi P; Onland-Moret, N Charlotte; de Wit, G Ardine; Boer, Jolanda M A; van der Schouw, Yvonne T; Hoekstra, Jeljer; Bueno-de-Mesquita, H Bas; Peeters, Petra H M; Beulens, Joline W J

    2015-02-27

    The association between single health behaviours and incidence of and premature mortality from major chronic diseases, including myocardial infarction, stroke, diabetes mellitus, and cancer, has been demonstrated thoroughly. However, the association of several healthy behaviours with Disability-Adjusted Life Years (DALYs), which is a measure for total health combining Years Lost due to Disability and the Years of Life Lost due to premature mortality, has not been studied yet. A prospective cohort study was conducted among 33,066 healthy men and women aged 20 to 70 years recruited into the EPIC-NL study during 1993 to 1997. Participants' smoking status, BMI, physical activity, and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a simple health behaviour score ranging from 0 to 4. Participants were followed until the end of 2007 for occurrence of and mortality from the most important chronic diseases. The association between lifestyle (separate lifestyle factors and a simple health behaviour score) and DALYs were adjusted for relevant confounders. After a median follow-up of 12.4 years, 6,647 disease incidences and 1,482 deaths were documented. Non-smoking, low BMI (BMI healthy lifestyle characteristics lived a minimum of 2 years longer in good health (DALYs: -2.13; 95% CI: -2.65 to -1.62) than persons with none. Due to our non-extinct cohort, the total number of DALYs, and consequently the estimates, is underestimated. Therefore, true lifetime health benefits of a healthy lifestyle will be even larger. Non-smoking, a low BMI, being physically active, and adherence to a Mediterranean diet were associated with a lower disease burden. Each additional healthy lifestyle factor contributed to a longer life in good health.

  9. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    Science.gov (United States)

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  10. Residential satisfaction close to highways : The impact of accessibility, nuisances and highway adjustment projects

    NARCIS (Netherlands)

    Hamersma, Marije; Tillema, Taede; Sussman, Joseph; Arts, Jos

    In this paper we focus on gaining insight into the residential satisfaction of households near highways, based on survey data collected among 1225 respondents in the Netherlands living within 1000 m from a highway. Ordinal regression was used to study the impact of highway externalities on

  11. Initial studies on temperature impact of humic acid

    International Nuclear Information System (INIS)

    Pashalidis, I.; Colocassidou, C.; Costa, C.N.; Efstathiou, A.M.; Buckau, G.

    2004-01-01

    The impact of temperature on the stability of the humic acid Gohy-573(HA) is studied. The studies are made both in order to add general knowledge about humic acid but also in order to provide the basis for experimental setup of studies, and judgment of published data, on the metal ion humate complexation as a function of temperature. Methods applied are mass spectroscopy as a function of temperature elevation up to 240 C, and UV/Vis spectroscopy. Mass spectroscopy is conducted under inertgas atmosphere in order to avoid burning with air oxygen. UV/Vis spectra are measured after storage of humic acid solution (pH=6.0, I=0.1 M NaClO 4 ) at temperatures up to 95 C. The reversibility of changes is also studied by UV/Vis spectroscopy after subsequent storage at room temperature. Already at 50 C release of water is observed from dried humic acid with a peak around 60 C. A second large water release is found with the maximum around 100 C. Above 100 C also carbon dioxide is released, followed by release of carbon monoxide above 130 C. The carbon monoxide and dioxide releases show two distinct maxima at around 180 and 210 C. The UV/Vis spectra show an increase in the absorption towards short wavelengths with increasing temperature and storage time. Already at 60 C, considerable changes occur after storage for one week. At 95 C the change in the spectral feature after 24 h is in the order of that found for 1 week storage at 80 C. After storage at elevated temperatures, the changes in the spectra remain even after 1 week of storage at room temperature. Release of water, carbon monoxide and carbon dioxide at high temperature is certainly related to oxidation with the high oxygen inventory in humic acid. The nature of the water release and changes in the UV/Vis spectra at lower temperature is not fully clear. Further experiments, including complexation properties, fluorescence spectroscopy and IR-reflection spectroscopy at elevated temperature are under consideration. (orig.)

  12. The impact of structural adjustment and the changing nature of women's work in the People's Republic of China.

    Science.gov (United States)

    Roy, S

    2000-01-01

    This paper examines the impact of structural adjustment and the changing nature of women's work in the People's Republic of China (PRC). It is noted that more than two-thirds of the developing countries have adopted structural adjustment policy packages as an answer to the economic crisis they are facing. Such an adjustment is a conscious change in the fundamental nature of economic relationships within a society. In relation to women, the structural changes have resulted to the collapse of many small and home-based industries, thus changing the role of women in economy. It is noted that although the policy shifts have created a wide range of job opportunities for women in other countries, in PRC gender inequalities exist in the economic area wherein women experience low employment and lack of work benefits. In addition, the fact that the rate of women's employment in China is higher than other developing and some developed countries worsens the situation as it indicates that more women suffer under the discriminatory employment system.

  13. Contribution of the supplementary motor area and the cerebellum to the anticipatory postural adjustments and execution phases of human gait initiation.

    Science.gov (United States)

    Richard, Aliénor; Van Hamme, Angèle; Drevelle, Xavier; Golmard, Jean-Louis; Meunier, Sabine; Welter, Marie-Laure

    2017-09-01

    Several brain structures including the brainstem, the cerebellum and the frontal cortico-basal ganglia network, with the primary and premotor areas have been shown to participate in the functional organization of gait initiation and postural control in humans, but their respective roles remain poorly understood. The aim of this study was to better understand the role of the supplementary motor area (SMA) and posterior cerebellum in the gait initiation process. Gait initiation parameters were recorded in 22 controls both before and after continuous theta burst transcranial stimulation (cTBS) of the SMA and cerebellum, and were compared to sham stimulation, using a randomized double-blind design study. The two phases of gait initiation process were analyzed: anticipatory postural adjustments (APAs) and execution, with recordings of soleus and tibialis anterior muscles. Functional inhibition of the SMA led to a shortened APA phase duration with advanced and increased muscle activity; during execution, it also advanced muscle co-activation and decreased the duration of stance soleus activity. Cerebellar functional inhibition did not influence the APA phase duration and amplitude but increased muscle co-activation, it decreased execution duration and showed a trend to increase velocity, with increased swing soleus muscle duration and activity. The results suggest that the SMA contributes to both the timing and amplitude of the APAs with no influence on step execution and the posterior cerebellum in the coupling between the APAs and execution phases and leg muscle activity pattern during gait initiation. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

  14. Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress.

    Science.gov (United States)

    Hayward, Christopher S; Salamonsen, Robert; Keogh, Anne M; Woodard, John; Ayre, Peter; Prichard, Roslyn; Kotlyar, Eugene; Macdonald, Peter S; Jansz, Paul; Spratt, Phillip

    2015-09-01

    Left ventricular assist devices are crucial in rehabilitation of patients with end-stage heart failure. Whether cardiopulmonary function is enhanced with higher pump output is unknown. 10 patients (aged 39±16 years, mean±SD) underwent monitored adjustment of pump speed to determine minimum safe low speed and maximum safe high speed at rest. Patients were then randomized to these speed settings and underwent three 6-minute walk tests (6MWT) and symptom-limited cardiopulmonary stress tests (CPX) on separate days. Pump speed settings (low, normal and high) resulted in significantly different resting pump flows of 4.43±0.6, 5.03±0.94, and 5.72±1.2 l/min (Pexercise (Pexercise time (p=.27). Maximum workload achieved and peak oxygen consumption were significantly different comparing low to high pump speed settings only (Prelease was significantly reduced at higher pump speed with exercise (Prelease consistent with lower myocardial wall stress. This did not, however, improve exercise tolerance.

  15. Normalized impact factor (NIF): an adjusted method for calculating the citation rate of biomedical journals.

    Science.gov (United States)

    Owlia, P; Vasei, M; Goliaei, B; Nassiri, I

    2011-04-01

    The interests in journal impact factor (JIF) in scientific communities have grown over the last decades. The JIFs are used to evaluate journals quality and the papers published therein. JIF is a discipline specific measure and the comparison between the JIF dedicated to different disciplines is inadequate, unless a normalization process is performed. In this study, normalized impact factor (NIF) was introduced as a relatively simple method enabling the JIFs to be used when evaluating the quality of journals and research works in different disciplines. The NIF index was established based on the multiplication of JIF by a constant factor. The constants were calculated for all 54 disciplines of biomedical field during 2005, 2006, 2007, 2008 and 2009 years. Also, ranking of 393 journals in different biomedical disciplines according to the NIF and JIF were compared to illustrate how the NIF index can be used for the evaluation of publications in different disciplines. The findings prove that the use of the NIF enhances the equality in assessing the quality of research works produced by researchers who work in different disciplines. Copyright © 2010 Elsevier Inc. All rights reserved.

  16. Prevalence and impact of initial misclassification of pediatric type 1 diabetes mellitus.

    Science.gov (United States)

    Tripathi, Avnish; Rizvi, Ali A; Knight, Lisa M; Jerrell, Jeanette M

    2012-10-01

    To characterize rates of initial misclassification of type 1 diabetes mellitus as type 2/unspecified diabetes mellitus in a cohort of children/adolescents and to examine the impact of misclassification on the risk of diabetes-related complications. An 11-year dataset (1996-2006) was analyzed. Inclusion criteria included age 17 years and younger, enrollees in South Carolina State Medicaid, and diagnosis of type 2/unspecified or type 1 diabetes mellitus for at least two visits, 15 days apart. Survival analysis was used to assess the association of "misclassification" with the incidence of diabetic ketoacidosis (DKA), and the cumulative incidence of neuropathy, nephropathy, and cardiovascular complications, after controlling for individual risk factors and comorbid conditions. A total of 1130 individuals meeting the inclusion criteria were studied for a median of 7 years. Of the 1130 individuals, 669 (59.2%) maintained a diagnosis of type 2/unspecified diabetes mellitus, 205 (18.1%) were consistently diagnosed as type 1 diabetes mellitus, and the remaining 256 individuals (22.7%) were misclassified. Insulin treatment was used in 100% of the type 1 diabetes mellitus group and 73% of the misclassified group. Compared with the type 2 diabetes mellitus group, being misclassified was associated with earlier development of DKA (adjusted hazard ratio [aHR] 5.08, 95% confidence interval [CI] 3.09-8.37), neuropathy (aHR 1.94, CI 1.31-2.88), and nephropathy (aHR 1.72, CI 1.19-2.50), whereas being consistently classified with type 1 diabetes mellitus was associated only with earlier development of DKA (aHR 4.96, CI 2.56-9.61). Proper categorization of pediatric diabetes can be challenging, especially with comorbid obesity. Failure to ascertain type 1 diabetes mellitus in a timely manner in a pediatric population may increase the risk of substandard care and diabetes-related complications.

  17. Investigation of Rheological Impacts on Sludge Batch 3 as Insoluble Solids and Wash Endpoints are Adjusted

    International Nuclear Information System (INIS)

    Fellinger, T. L.

    2005-01-01

    The Defense Waste Processing Facility (DWPF) is currently processing and immobilizing radioactive sludge slurry into a durable borosilicate glass. The DWPF has already processed three sludge batches (Sludge Batch 1A, Sludge Batch 1B, and Sludge Batch 2) and is currently processing the fourth sludge batch (Sludge Batch 3). A sludge batch is defined as a single tank of sludge slurry or a combination of sludge slurries from different tanks that has been or will be qualified before being transferred to DWPF. As a part of the Sludge Batch 3 (SB3) qualification task, rheology measurements of the sludge slurry were requested at different insoluble solids loadings. These measurements were requested in order to gain insight into potential processing problems that may occur as the insoluble solids are adjusted up or down (by concentration or dilution) during the process. As a part of this study, a portion of the ''as received'' SB3 sample was washed with inhibited water (0.015 M NaOH and 0.015 M NaNO2) to target 0.5M Na versus a measured 1M Na in the supernate. The purpose of the ''washing'' step was to allow a comparison of the SB3 rheological data to the rheological data collected for Sludge Batch 2 (SB2) and to determine if there was a dependence of the yield stress and consistency as a function of washing. The ''as received'' SB3 rheology data was also compared to SB3 simulants prepared by the Simulant Development Program in order to provide guidance for selecting a simulant that is more representative of the rheological properties of the radioactive sludge slurry. A summary of the observations, conclusions are: (1) The yield stress and plastic viscosity increased as the weight percent insoluble solids were increased for the ''as received'' and ''washed'' SB3 samples, at a fixed pH. (2) For the same insoluble solids loading, the yield stress for the SB2 sample is approximately a factor of three higher than the ''as received'' SB3 sample. There also appears to be small

  18. Perceived impact of the Medicare policy to adjust payment for health care-associated infections

    Science.gov (United States)

    Lee, Grace M.; Hartmann, Christine W.; Graham, Denise; Kassler, William; Linn, Maya Dutta; Krein, Sarah; Saint, Sanjay; Goldmann, Donald A.; Fridkin, Scott; Horan, Teresa; Jernigan, John; Jha, Ashish

    2014-01-01

    Background In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. Methods A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. Results Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0–5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3–0.8; P = .005). Conclusion Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear. PMID:22541855

  19. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol

    Directory of Open Access Journals (Sweden)

    Hollywood Amelia

    2012-04-01

    Full Text Available Abstract Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities. A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected. The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes. Methods/Design The study is a randomised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery. Follow up measures of weight loss and psychological issues will be taken at baseline (2 weeks preoperatively, 3, 6 and 12 months postoperatively. The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups (BOSPA & WLSinfo. This study will take place in St Richard's Hospital in Chichester in the UK. Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life, dietary control, self esteem, coping and

  20. Maternal Employment and Perceived Stress: Their Impact on Children's Adjustment and Mother-Child Interaction in Young Divorced and Married Families.

    Science.gov (United States)

    Pett, Marjorie A.; And Others

    1994-01-01

    Examined impact of maternal employment, marital status, and perceived maternal stress on children's adjustment and mother-preschool child interaction in 104 married and 99 divorced families. Results indicated that maternal employment had little impact on these variables. Maternal stress, in form of divorce and daily maternal hassles, demonstrated…

  1. View from Silicon Valley: Maximizing the Scientific Impact of Global Brain Initiatives through Entrepreneurship.

    Science.gov (United States)

    Joshi, Pushkar S; Ghosh, Kunal K

    2016-11-02

    In this era of technology-driven global neuroscience initiatives, the role of the neurotechnology industry remains woefully ambiguous. Here, we explain why industry is essential to the success of these global initiatives, and how it can maximize the scientific impact of these efforts by (1) scaling and ultimately democratizing access to breakthrough neurotechnologies, and (2) commercializing technologies as part of integrated, end-to-end solutions that accelerate neuroscientific discovery. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    1992-01-01

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

  3. Impacts of model initialization on an integrated surface water - groundwater model

    KAUST Repository

    Ajami, Hoori

    2015-04-01

    Integrated hydrologic models characterize catchment responses by coupling the subsurface flow with land surface processes. One of the major areas of uncertainty in such models is the specification of the initial condition and its influence on subsequent simulations. A key challenge in model initialization is that it requires spatially distributed information on model states, groundwater levels and soil moisture, even when such data are not routinely available. Here, the impact of uncertainty in initial condition was explored across a 208 km2 catchment in Denmark using the ParFlow.CLM model. The initialization impact was assessed under two meteorological conditions (wet vs dry) using five depth to water table and soil moisture distributions obtained from various equilibrium states (thermal, root zone, discharge, saturated and unsaturated zone equilibrium) during the model spin-up. Each of these equilibrium states correspond to varying computation times to achieve stability in a particular aspect of the system state. Results identified particular sensitivity in modelled recharge and stream flow to the different initializations, but reduced sensitivity in modelled energy fluxes. Analysis also suggests that to simulate a year that is wetter than the spin-up period, an initialization based on discharge equilibrium is adequate to capture the direction and magnitude of surface water–groundwater exchanges. For a drier or hydrologically similar year to the spin-up period, an initialization based on groundwater equilibrium is required. Variability of monthly subsurface storage changes and discharge bias at the scale of a hydrological event show that the initialization impacts do not diminish as the simulations progress, highlighting the importance of robust and accurate initialization in capturing surface water–groundwater dynamics.

  4. The impact of ART initiation on household food security over time.

    Science.gov (United States)

    Patenaude, Bryan N; Chimbindi, Natsayi; Pillay, Deenan; Bärnighausen, Till

    2018-02-01

    While evidence suggests that adequate nutrition contributes to the efficacy of ART, the potential causal impact of ART initiation on household food security has not been thoroughly examined. In this study, we present some of the first causal evidence of the impact of ART initiation on household food security. We employ a quasi-experimental design, regression discontinuity, over 5540 individuals from an ongoing population cohort study in KwaZulu-Natal, South Africa, by utilizing the CD4 count-based ART eligibility threshold to examine the impact of ART initiation on household food security. We find that ART initiation causes a significant increase in the probability of food insecurity in the first year, which diminishes to zero within three years of initiation. Within the first year, ART initiation was found to significantly increase the probabilities that (1) the surveyed adult had missed any food in the past month by 10.2 percentage points (coefficient = 0.102, 95%CI = [0.039, 0.166]); (2) any adult in the household had missed a meal in the past month by 15.2 percentage points (coefficient = 0.152, 95%CI = [0.073, 0.231]); and (3) any child in the household had missed a meal in the past month by 8.9 percentage points (coefficient = 0.0898, 95%CI = [0.0317, 0.148]). While we cannot definitively isolate the mechanistic pathways from ART to household food security, our results are consistent with ART affecting food security through household resource strain and patient appetite recovery. Several policies could mitigate the negative impact of ART on food security, in particular food parcels or food vouchers for ART patients in the first two years after treatment initiation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2018-06-01

    The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group

  6. Approaches to evaluating climate change impacts on species: A guide to initiating the adaptation planning process

    Science.gov (United States)

    Erika L. Rowland; Jennifer E. Davison; Lisa J. Graumlich

    2011-01-01

    Assessing the impact of climate change on species and associated management objectives is a critical initial step for engaging in the adaptation planning process. Multiple approaches are available. While all possess limitations to their application associated with the uncertainties inherent in the data and models that inform their results, conducting and incorporating...

  7. Impact of Advocacy Initiatives on Nurses' Motivation to Sustain Momentum in Public Policy Advocacy.

    Science.gov (United States)

    Taylor, Melissa R S

    2016-01-01

    The purpose of this study is to elicit insight from the public policy leaders of 2 regional professional nursing organizations on key qualities of their current advocacy initiatives that motivate nurses to sustain momentum in public policy advocacy beyond a single episode. The goal is to inform quality improvement in the development of future advocacy initiatives to increase sustained engagement of nurses. Social cognitive theory was used as the rationale for this qualitative, descriptive study. A purposive convenience sample of executive leadership and board committee members from 2 regional professional nursing organizations were recruited to complete an initial Web-based electronic survey, followed by separate semistructured interview focus groups. One organization was composed primarily of advanced practice registered nurses, and the other group composed of diverse, multispecialty nursing members with varied educational levels. Nine themes emerged, categorized as facilitators or challenges to the positive impact of advocacy initiatives on nurses' motivation. Highlighting and marketing facilitators to the positive impact of advocacy initiatives on nurses' motivation to sustain momentum in public policy advocacy, while designing and testing new initiatives that address the challenges, may increase the number of nurses who sustain engagement in the policy advocacy process. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Nonlinear Coupled Dynamics of a Rod Fastening Rotor under Rub-Impact and Initial Permanent Deflection

    Directory of Open Access Journals (Sweden)

    Liang Hu

    2016-10-01

    Full Text Available A nonlinear coupled dynamic model of a rod fastening rotor under rub-impact and initial permanent deflection was developed in this paper. The governing motion equation was derived by the D’Alembert principle considering the contact characteristic between disks, nonlinear oil-film force, rub-impact force, unbalance mass, etc. The contact effects between disks was modeled as a flexural spring with cubical nonlinear stiffness. The coupled nonlinear dynamic phenomena of the rub-impact rod fastening rotor bearing system with initial permanent deflection were investigated by the fourth-order Runge-Kutta method. Bifurcation diagram, vibration waveform, frequency spectrum, shaft orbit and Poincaré map are used to illustrate the rich diversity of the system response with complicated dynamics. The studies indicate that the coupled dynamic responses of the rod fastening rotor bearing system under rub-impact and initial permanent deflection exhibit a rich nonlinear dynamic diversity, synchronous periodic-1 motion, multiple periodic motion, quasi-periodic motion and chaotic motion can be observed under certain conditions. Larger radial stiffness of the stator will simplify the system motion and make the oil whirl weaker or even disappear at a certain rotating speed. With the increase of initial permanent deflection length, the instability speed of the system gradually rises, and the chaotic motion region gets smaller and smaller. The corresponding results can provide guidance for the fault diagnosis of a rub-impact rod fastening rotor with initial permanent deflection and contribute to the further understanding of the nonlinear dynamic characteristics of the rod fastening rotor bearing system.

  9. The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis.

    Science.gov (United States)

    Wickström, Anne; Fagerström, Maria; Wickström, Lucas; Granåsen, Gabriel; Dahle, Charlotte; Vrethem, Magnus; Sundström, Peter

    2017-07-01

    Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability. To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations. Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years. The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population ( p work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population ( p = 0.042). Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.

  10. Assessing the impact of area-based initiatives in deprived neighborhoods

    DEFF Research Database (Denmark)

    Alves, Sonia

    2017-01-01

    assumptions, and social and spatial effects of these initiatives. Among other inter-related issues, the paper discusses the impact of conflicting ideologies upon processes of radical strategy shift and of social and territorial marginalization, and appeals to the need for more pluralistic approaches......Whilst there have been many area-based initiatives to regenerate rundown areas in numerous cities around the world, many of them involving the demolition of stigmatized housing estates, far fewer attempts have been made to assess the effects of these initiatives upon the fortunes of displaced...... households and those who remain in these areas. By presenting the results of an empirical in-depth case study on the effects of an area based initiative targeted at one of the most deprived neighborhoods in Porto, this paper raises several epistemological concerns related to the goals, ideological...

  11. Green initiative impact on stock prices: A quantitative study of the clean energy industry

    Science.gov (United States)

    Jurisich, John M.

    The purpose of this quantitative ex post facto research study was to explore the relationship between green initiative expense disclosures and stock prices of 46 NASDAQ listed Clean Edge Green Energy global companies from 2007 to 2010. The independent variables were sales and marketing, environmental, customer and supplier, community, and corporate governance practices that were correlated with the dependent variable in the study of stock prices. Expense disclosures were examined in an effort to measure the impact of green initiative programs and to expose the interrelationships between green initiative expense disclosures and fluctuations of stock prices. The data for the research was secondary data from existing annual reports. A statistically significant relationship was revealed between environmental practices and changes in stock prices. The study results also provided substantial evidence for leadership and managerial decision making to reduce or increase green initiative practices to maximize shareholder wealth of their respective organizations.

  12. Impact of combination antiretroviral therapy initiation on adherence to antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Marlene Knight

    2015-10-01

    Full Text Available Background: Healthcare workers are often reluctant to start combination antiretroviral therapy (ART in patients receiving tuberculosis (TB treatment because of the fear of high pill burden, immune reconstitution inflammatory syndrome, and side-effects. Object: To quantify changes in adherence to tuberculosis treatment following ART initiation. Design: A prospective observational cohort study of ART-naïve individuals with baseline CD4 count between 50 cells/mm3 and 350 cells/mm3 at start of TB treatment at a primary care clinic in Johannesburg, South Africa. Adherence to TB treatment was measured by pill count,self-report, and electronic Medication Event Monitoring System (eMEMS before and after initiation of ART. Results: ART tended to negatively affect adherence to TB treatment, with an 8% – 10% decrease in the proportion of patients adherent according to pill count and an 18% – 22% decrease in the proportion of patients adherent according to eMEMS in the first month following ART initiation, independent of the cut-off used to define adherence (90%, 95% or 100%. Reasons for non-adherence were multi factorial, and employment was the only predictor for optimal adherence (adjusted odds ratio 4.11, 95% confidence interval 1.06–16.0. Conclusion: Adherence support in the period immediately following ART initiation could optimise treatment outcomes for people living with TB and HIV.

  13. Initial Northwest Power Act Power Sales Contracts : Final Environmental Impact Statement. Volume 4, Comments and Responses.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1992-01-01

    This volume of the Initial Northwest Power Act Power Sales Contracts Final Environmental Impact Statement (Final EIS) contains public comments addressing the Initial Northwest Power Act Power Sales Contracts Draft EIS, August 1990 and Bonneville Power Administration`s (BPA) responses. The Introduction provides information about the process BPA follows in addressing these comments. Part I contains a listing of the Alternative Actions evaluated in the Final EIS; Part II is organized by Alternatives and includes summaries of the comments and BPA responses; Part III provides copies of the original comments letters, and, for ease of identification, are coded in the margins according to the alternative(s) addressed.

  14. The impact of highway base-saturation flow rate adjustment on Kuwait's transport and environmental parameters estimation.

    Science.gov (United States)

    AlRukaibi, Fahad; AlKheder, Sharaf; Al-Rukaibi, Duaij; Al-Burait, Abdul-Aziz

    2018-03-23

    Traditional transportation systems' management and operation mainly focused on improving traffic mobility and safety without imposing any environmental concerns. Transportation and environmental issues are interrelated and affected by the same parameters especially at signalized intersections. Additionally, traffic congestion at signalized intersections has a major contribution in the environmental problem as related to vehicle emission, fuel consumption, and delay. Therefore, signalized intersections' design and operation is an important parameter to minimize the impact on the environment. The design and operation of signalized intersections are highly dependent on the base saturation flow rate (BSFR). Highway Capacity Manual (HCM) uses a base-saturation flow rate of 1900-passenger car/h/lane for areas with a population intensity greater than or equal to 250,000 and a value of 1750-passenger car/h/lane for less populated areas. The base-saturation flow rate value in HCM is derived from a field data collected in developed countries. The adopted value in Kuwait is 1800passengercar/h/lane, which is the value that used in this analysis as a basis for comparison. Due to the difference in behavior between drivers in developed countries and their fellows in Kuwait, an adjustment was made to the base-saturation flow rate to represent Kuwait's traffic and environmental conditions. The reduction in fuel consumption and vehicles' emission after modifying the base-saturation flow rate (BSFR increased by 12.45%) was about 34% on average. Direct field measurements of the saturation flow rate were used while using the air quality mobile lab to calculate emissions' rates. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  16. Impact of an emergency medicine pharmacist on initial antibiotic prophylaxis for open fractures in trauma patients.

    Science.gov (United States)

    Harvey, Somer; Brad Hall, A; Wilson, Kayla

    2018-02-01

    Targeted antibiotic treatment reduces the infection risk of open fractures when soft tissue and bone are exposed to the environment. The risk of infection increases with higher degrees of injury. The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures. The objective of this study was to determine the impact of an emergency medicine pharmacist on initial antibiotic selection and timing in trauma patients with open fractures. This was a retrospective cohort study. Trauma alerts with open fractures from May 1, 2014 to June 30, 2016 were eligible for inclusion. The primary outcome was to determine if pharmacist participation during trauma resuscitation was associated with an increased proportion of initial antibiotic selection meeting guideline recommendations. The secondary outcome was the door-to-antibiotic administration time during resuscitation. Initial prophylactic antibiotic recommendations were met in 81% of trauma resuscitations when a pharmacist was present versus 47% without a pharmacist present (pfractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Initial validation of the Mini-Mental Adjustment to Cancer (Mini-MAC) scale: study of Portuguese end-of-life cancer patients.

    Science.gov (United States)

    Pereira, Filomena Moreira Pinto; Santos, Célia Samarina Vilaça de Brito

    2014-10-01

    The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) is a 29-item instrument designed to evaluate the responses developed by cancer patients during their mental adjustment to diagnosis and treatment. This study aims to validate the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) translated and adapted to the Portuguese language and culture, in end-of-life cancer patients receiving palliative care. The instrument was administered to 346 Portuguese end-of-life cancer patients, receiving care through outpatient visits or admitted into palliative care units, without cognitive symptoms and with symptoms under control. A cross-sectional validation study using orthogonal rotation through the varimax method followed by convergent and discriminant validity. The analysis of the main components confirms the existence of five factors, demonstrating the validity of the construct, with good internal consistency in the subscales and Cronbach's alpha values between 0.78 and 0.93. Good test-retest reliability was also found, and r values for subscales ranged from 0.62 to 0.99. The instrument proved to be a reliable, valid and sensitive measure in the study of mental adjustment of Portuguese end-of-life patients with cancer receiving palliative care. Nurses can use the Mini-MAC Scale in research and clinical practice in order to evaluate the mental adjustment of Portuguese end-of-life cancer patients receiving palliative care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Effect of microstructure on the nucleation and initiation of adiabatic shear bands (ASBs) during impact

    Energy Technology Data Exchange (ETDEWEB)

    Boakye Yiadom, Solomon, E-mail: boakyeys@cc.umanitoba.ca; Khaliq Khan, Abdul, E-mail: abdulkhaliq.khan@umanitoba.ca; Bassim, Nabil, E-mail: nabil.bassim@ad.umanitoba.ca

    2014-10-06

    While instability may occur homogenously during plastic deformation, the formation of adiabatic shear band (ASBs) does not follow a homogenous instability during impact. Geometrical stress concentration sites and/or microstructural inhomogeneities result in the nucleation and initiation of shear strain localization. In this study, initial microstructural inhomogeneity was found to produce nucleation sites for the initiation of ASBs. It was observed that double misfit interfaces and boundary layers with random arrangement of atomic columns are formed around precipitated carbides and they increase the volume fraction of dislocation sources within the specimens. The AISI 4340 steel specimens which were tempered at the lowest temperature had smaller precipitated carbides with high aspect ratios densely distributed within the matrix and were easily susceptible to the formation of ASBs. As the tempering temperature increased, the relative sizes of the carbides increased with a corresponding reduction in their aspect ratios and their distribution density within the matrix and thus were more resistant to the formation of ASBs. In this study, it is demonstrated that the intersection of an activated dislocation source with the direction of maximum shear (regions of stress concentrations) within the specimens during impact, is a necessary condition for the point of intersection to act as a possible site for the nucleation of ASBs, depending on the rate of dislocation generation, local strain and strain rate. At a constant carbide volume fraction, the higher susceptibility of the tempered specimens to the initiation of ASBs is attributed to the volume fraction of the points of intersection between activated dislocation sources and direction of maximum shear during impact. Additionally, the smaller carbides, with their higher aspect ratios and distribution densities, accentuate the effect of strain gradients and the microstructural inhomogeneities associated with the tempered

  19. The impact of adjustment latitude on self-assessed work ability in regard to gender and occupational type

    OpenAIRE

    Johansson, Gun; Hultin, Hanna; Möller, Jette; Hallqvist, Johan; Kjellberg, Katarina

    2012-01-01

    Objective: Adjustment latitude describes opportunities to change demands at work when ill and may affect work ability. The aim here is to study the association between adjustment latitude and self-assessed work ability among men and women and employees from different occupational sectors. Methods: This cross-sectional study used data from a questionnaire sent to 3020 employees in three occupational sectors in Sweden; 1430 responded. Subjects were divided into: full, moderately reduced, and gr...

  20. Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

    Science.gov (United States)

    Martsolf, Grant R; Barrett, Marguerite L; Weiss, Audrey J; Kandrack, Ryan; Washington, Raynard; Steiner, Claudia A; Mehrotra, Ateev; SooHoo, Nelson F; Coffey, Rosanna

    2016-08-17

    Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods. Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals. Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting. Prognostic Level III. See instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  1. Asking for work adjustments or initiating behavioural changes - what makes a 'problematic co-worker' score Brownie points? An experimental study on the reactions towards colleagues with a personality disorder.

    Science.gov (United States)

    Muschalla, Beate; Fay, Doris; Seemann, Anne

    2016-10-01

    People with mental disorders, especially personality disorders, often face low acceptance at work. This is particularly problematic when returning to work after sick leave, because it impedes reintegration into the former workplace. This study explores colleagues' reactions towards a problematic worker dependent on the returning person's reintegration strategy: The returning person undertaking changes in their behaviour is compared with the person requesting adjustments of the workplace. In an experimental study, 188 employed persons read one of four vignettes that described a return-to-work-situation of a problematic co-worker. Across all vignettes, the co-worker was depicted as having previously caused problems in the work team. In the first vignette, the co-worker did not change anything (control condition) when she returned to work; in the second, she asked for workplace adjustments; in the third vignette she initiated efforts to change her own behaviour; and the fourth vignette combined both workplace adjustments and behavioural change. Study participants were asked for their reactions towards the problematic co-worker. Vignettes that included a behavioural change evoked more positive reactions towards the co-worker than vignettes without any behavioural change. Asking for workplace adjustments alone did not yield more positive reactions compared to not initiating any change. When preparing employees with interactional problems for their return to work, it is not effective to only instruct them on their statutory entitlement for workplace adjustments. Instead, it is advisable to encourage them to proactively strive for behaviour changes.

  2. Changes in Attitudes, Beliefs and Behaviour: A Critical Review of Research into the Impacts of Environmental Education Initiatives

    Science.gov (United States)

    Gralton, Anna; Sinclair, Mark; Purnell, Ken

    2004-01-01

    This paper reviews research literature on the impact of environmental education initiatives on learners' attitudes, beliefs and behaviours. The review focuses on initiatives involving learners of all ages and school-aged learners in particular. The review shows two things. There is some evidence that environmental education initiatives are…

  3. Magnitude and Spatial Distribution of Impact Intensity Under the Foot Relates to Initial Foot Contact Pattern.

    Science.gov (United States)

    Breine, Bastiaan; Malcolm, Philippe; Segers, Veerle; Gerlo, Joeri; Derie, Rud; Pataky, Todd; Frederick, Edward C; De Clercq, Dirk

    2017-12-01

    In running, foot contact patterns (rear-, mid-, or forefoot contact) influence impact intensity and initial ankle and foot kinematics. The aim of the study was to compare impact intensity and its spatial distribution under the foot between different foot contact patterns. Forty-nine subjects ran at 3.2 m·s -1 over a level runway while ground reaction forces (GRF) and shoe-surface pressures were recorded and foot contact pattern was determined. A 4-zone footmask (forefoot, midfoot, medial and lateral rearfoot) assessed the spatial distribution of the vertical GRF under the foot. We calculated peak vertical instantaneous loading rate of the GRF (VILR) per foot zone as the impact intensity measure. Midfoot contact patterns were shown to have the lowest, and atypical rearfoot contact patterns the highest impact intensities, respectively. The greatest local impact intensity was mainly situated under the rear- and midfoot for the typical rearfoot contact patterns, under the midfoot for the atypical rearfoot contact patterns, and under the mid- and forefoot for the midfoot contact patterns. These findings indicate that different foot contact patterns could benefit from cushioning in different shoe zones.

  4. Perturbations in the initial soil moisture conditions: Impacts on hydrologic simulation in a large river basin

    Science.gov (United States)

    Niroula, Sundar; Halder, Subhadeep; Ghosh, Subimal

    2018-06-01

    Real time hydrologic forecasting requires near accurate initial condition of soil moisture; however, continuous monitoring of soil moisture is not operational in many regions, such as, in Ganga basin, extended in Nepal, India and Bangladesh. Here, we examine the impacts of perturbation/error in the initial soil moisture conditions on simulated soil moisture and streamflow in Ganga basin and its propagation, during the summer monsoon season (June to September). This provides information regarding the required minimum duration of model simulation for attaining the model stability. We use the Variable Infiltration Capacity model for hydrological simulations after validation. Multiple hydrologic simulations are performed, each of 21 days, initialized on every 5th day of the monsoon season for deficit, surplus and normal monsoon years. Each of these simulations is performed with the initial soil moisture condition obtained from long term runs along with positive and negative perturbations. The time required for the convergence of initial errors is obtained for all the cases. We find a quick convergence for the year with high rainfall as well as for the wet spells within a season. We further find high spatial variations in the time required for convergence; the region with high precipitation such as Lower Ganga basin attains convergence at a faster rate. Furthermore, deeper soil layers need more time for convergence. Our analysis is the first attempt on understanding the sensitivity of hydrological simulations of Ganga basin on initial soil moisture conditions. The results obtained here may be useful in understanding the spin-up requirements for operational hydrologic forecasts.

  5. The impact of source initialization on performance of the FMBMC-ICEU algorithm

    International Nuclear Information System (INIS)

    Wenner, Michael T.; Haghighat, Alireza

    2011-01-01

    Recent work in the completely fission matrix based Monte Carlo (FMBMC) eigenvalue methodology showed that the fission matrix coefficients are independent of the source eigenvector in the limit of small mesh sizes. As a result, fission matrix element autocorrelation should be insignificant. We have developed a modified fission matrix based Monte Carlo methodology for achieving unbiased solutions even for high Dominance Ratio (DR) problems. This methodology utilizes an initial source from a deterministic calculation using the PENTRAN 3-D Parallel SN code, autocorrelation and normality tests, and a Monte Carlo Iterated Confidence Interval (ICI) formulation for estimation of uncertainties in the fundamental eigenvalue and eigenfunction. This methodology is referred to as Fission Matrix Based Monte Carlo Initial-source Controlled Elements with Uncertainties (FMBMC-ICEU). In this paper, we will investigate the impact of different starting sources (PENTRAN initialized with a flat source and a boundary source) on the final results of a test problem with high source correlation. It is shown that although the fission matrix element correlation is significantly reduced, a good initial guess is still important within the framework of the FMBMC-ICEU methodology since the FMBMC-ICEU methodology still utilizes a standard source iteration scheme. (author)

  6. Simulation of the Initial 3-D Instability of an Impacting Drop Vortex Ring

    DEFF Research Database (Denmark)

    Sigurdson, Lorenz; Wiwchar, Justin; Walther, Jens Honore

    2013-01-01

    , a Rayleigh centrifugal instability, or a vortex breakdown-type instability. Simulations which simply have a perturbed solitary ring result in an instability similar to that seen experimentally. Waviness of the core which would be expected from a Widnall instability is not visible. Adding an opposite......-signed secondary vortex ring or an image vortex ring to the initial conditions, to trigger a Rayleigh or breakdown respectively, does not appear to significantly change the instability from what is seen with a solitary ring. This suggests that a Rayleigh or vortex breakdown-type instability are not likely at work......Computational vortex particle method simulations of a perturbed vortex ring are performed to recreate and understand the instability seen in impacting water drop experiments. Three fundamentally different initial vorticity distributions are used to attempt to trigger a Widnall instability...

  7. Initial foot contact and related kinematics affect impact loading rate in running.

    Science.gov (United States)

    Breine, Bastiaan; Malcolm, Philippe; Van Caekenberghe, Ine; Fiers, Pieter; Frederick, Edward C; De Clercq, Dirk

    2017-08-01

    This study assessed kinematic differences between different foot strike patterns and their relationship with peak vertical instantaneous loading rate (VILR) of the ground reaction force (GRF). Fifty-two runners ran at 3.2 m · s -1 while we recorded GRF and lower limb kinematics and determined foot strike pattern: Typical or Atypical rearfoot strike (RFS), midfoot strike (MFS) of forefoot strike (FFS). Typical RFS had longer contact times and a lower leg stiffness than Atypical RFS and MFS. Typical RFS showed a dorsiflexed ankle (7.2 ± 3.5°) and positive foot angle (20.4 ± 4.8°) at initial contact while MFS showed a plantar flexed ankle (-10.4 ± 6.3°) and more horizontal foot (1.6 ± 3.1°). Atypical RFS showed a plantar flexed ankle (-3.1 ± 4.4°) and a small foot angle (7.0 ± 5.1°) at initial contact and had the highest VILR. For the RFS (Typical and Atypical RFS), foot angle at initial contact showed the highest correlation with VILR (r = -0.68). The observed higher VILR in Atypical RFS could be related to both ankle and foot kinematics and global running style that indicate a limited use of known kinematic impact absorbing "strategies" such as initial ankle dorsiflexion in MFS or initial ankle plantar flexion in Typical RFS.

  8. The Impact of Attention-Deficit/Hyperactivity Disorder on Preadolescent Adjustment May Be Greater for Girls than for Boys

    Science.gov (United States)

    Elkins, Irene J.; Malone, Steve; Keyes, Margaret; Iacono, William G.; McGue, Matt

    2011-01-01

    Whether gender differences exist in the impairment associated with attention-deficit/hyperactivity disorder (ADHD) is still largely unknown, because most samples have few affected girls or include only one sex. The current study evaluated whether ADHD affects adjustment differently for girls than boys in a population-based cohort of 11-year-olds…

  9. Measuring Risk-adjusted Customer Lifetime Value and its Impact on Relationship Marketing Strategies and Shareholder Value

    OpenAIRE

    Ryals, Lynette; Knox, Simon

    2005-01-01

    The calculations which underlie efforts to balance marketing spending on customer acquisition and customer retention are usually based on either single- period customer profitability or forecasts of customer lifetime value (CLTV). This paper argues instead for risk-adjusted CLTV, which is termed the economic value (EV) of a customer, as the means for marketing to assess both customer profitability and shareholder value gains.

  10. Productivity growth in outpatient child and adolescent mental health services: the impact of case-mix adjustment.

    Science.gov (United States)

    Halsteinli, Vidar; Kittelsen, Sverre A; Magnussen, Jon

    2010-02-01

    The performance of health service providers may be monitored by measuring productivity. However, the policy value of such measures may depend crucially on the accuracy of input and output measures. In particular, an important question is how to adjust adequately for case-mix in the production of health care. In this study, we assess productivity growth in Norwegian outpatient child and adolescent mental health service units (CAMHS) over a period characterized by governmental utilization of simple productivity indices, a substantial increase in capacity and a concurrent change in case-mix. We analyze the sensitivity of the productivity growth estimates using different specifications of output to adjust for case-mix differences. Case-mix adjustment is achieved by distributing patients into eight groups depending on reason for referral, age and gender, as well as correcting for the number of consultations. We utilize the nonparametric Data Envelopment Analysis (DEA) method to implicitly calculate weights that maximize each unit's efficiency. Malmquist indices of technical productivity growth are estimated and bootstrap procedures are performed to calculate confidence intervals and to test alternative specifications of outputs. The dataset consist of an unbalanced panel of 48-60 CAMHS in the period 1998-2006. The mean productivity growth estimate from a simple unadjusted patient model (one single output) is 35%; adjusting for case-mix (eight outputs) reduces the growth estimate to 15%. Adding consultations increases the estimate to 28%. The latter reflects an increase in number of consultations per patient. We find that the governmental productivity indices strongly tend to overestimate productivity growth. Case-mix adjustment is of major importance and governmental utilization of performance indicators necessitates careful considerations of output specifications. Copyright 2009 Elsevier Ltd. All rights reserved.

  11. Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor.

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2013-10-01

    According to the international guidelines, a multidisciplinary approach is currently advised for the optimal care of patients with a gastroenteropancreatic neuroendocrine tumor (GEP NET). In our institution (tertiary care center), a systematic multidisciplinary approach was established in May 2007. In this study, we have aimed to assess the initial impact of establishing a systematic multidisciplinary approach to the management of GEP NET patients. We have collected and compared the biochemical, imaging, and pathological data and the therapeutic strategies in GEP NET patients diagnosed, treated, or followed-up from January 1993 to April 2007 versus GEP NET patients attending our institution after the multidisciplinary approach starting, from May 2007 to October 2008. Data of 91 patients before and 42 patients after the establishment of the multidisciplinary approach (total: 133 consecutive GEP NET patients) have been finally collected and analyzed. Before the establishment of the multidisciplinary approach, a lack of consistency in the biochemical, imaging, and pathological findings before treatment initiation as well as during follow-up of GEP NET patients was identified. These inconsistencies have been reduced by the systematic multidisciplinary approach. In addition, the therapeutic management of GEP NET patients has been altered by the multidisciplinary approach and became more consistent with recommended guidelines. We think that a systematic multidisciplinary approach significantly impacts on GEP NET patient care and should be established in all centers dealing with these tumors.

  12. BUILDING HUMAN CAPITAL: THE IMPACT OF PARENTS´ INITIAL EDUCATIONAL LEVEL AND LIFELONG LEARNING ON THEIR CHILDREN

    Directory of Open Access Journals (Sweden)

    FISCHER, Jakub

    2013-12-01

    Full Text Available The aim of this paper is to examine the impact of parents´ educational level on lifelong learning of children and relationship between parents´ and student´ lifelong learning including language skills and computer literacy. This intergenerational transmission, if proven, could influence the investments into the human capital in the long run. We used data from Adult Education Survey 2011 (AES to test the hypothesis that the parental attained level of education has a significant impact on the initial educational level of their children as well as on their lifelong learning participation. Furthermore, using data from AES, we tested the association between parental educational level and children´s language skills and reading activity and between parental non-formal as well as informal education and students´ lifelong learning. We have found that the parental effect on lifelong learning participation is slightly weaker than the effect of initial adult´s education. Nevertheless, the intergenerational transmission mechanism obviously works. The relationship between parental and students computer literacy is statistically significant, nevertheless weak. As for the nominal and ordinal character of the data, we used mainly the standard statistical methods including nonparametric tests, logit model and correspondence analysis.

  13. Impact of initial tumor volume on radiotherapy outcome in patients with T2 glottic cancer

    International Nuclear Information System (INIS)

    Rutkowski, T.

    2014-01-01

    The aim of this study was to quantify the impact of initial tumor volume (TV) on radiotherapy (RT) outcome in patients with T2 glottic cancer. Initial TV was calculated for 115 consecutive patients with T2 glottic cancer who had been treated with definitive RT alone at a single institution. The results showed strong correlations of TV with 3-year local tumor control (LTC) and disease-free survival (DFS). For TV ≤ 0.7 cm 3 , 3-year LTC was 83 %; for TV 0.7-3.6 cm 3 this was 70 % and for TV 3.6-17 cm 3 44 %. Analysis of total dose vs. initial TV showed that larger T2 glottic tumors with a TV of around 5 cm 3 (2-2.5 cm in diameter with 10 10 cancer cells) need an extra 6.5 Gy to achieve similar 3-year LTC rates as for small tumors with a TV of 0.5 cm 3 (∝1 cm in diameter with 10 9 cancer cells). Although classification of tumors according to TV cannot replace TNM staging in daily practice, it could represent a valuable numerical supplement for planning the optimal dose fractionation scheme for individual patients. (orig.)

  14. Financing urban adaptation to climate change impacts mapping of existing initiatives

    International Nuclear Information System (INIS)

    Eschalier, Claire; Leseur, Alexia; Archambault, Sabrina; Joubert, Marion; Larrue, Clement; Rossin, Nicolas; Salenson, Irene

    2015-01-01

    In June 2015, CDC Climat research, in partnership with AFD, published a mapping of the types of initiatives available for the financing of urban adaptation to climate change, offering additional options to more conventional sources of funding for climate change and sustainable development (national budget transfers, Official Development Aid, etc.). Based on the review of 27 main initiatives, the report shows a strong prevalence of initiatives supporting soft adaptation measures (strategy planning, capacity building, project design, technical assistance, etc). These are in a position to help support the development of a coherent portfolio of bankable projects. The mapping also reveals that local intermediaries (regional and local banks, national development funds, etc.) play a significant role in financing urban adaptation to climate change. Several key factor of success for the cities' access to these sources of funding are also identified, among which liaising with international development stakeholders (such as multilateral and bilateral donors) at the local level, and the identification of various co-benefits and synergies between the economic, environmental and climate impacts. (authors)

  15. Leveraging Agriculture for Nutrition Impact through the Feed the Future Initiative.

    Science.gov (United States)

    Du, Lidan; Pinga, Victor; Klein, Alyssa; Danton, Heather

    2015-01-01

    Nutrition is a multisectoral problem; current state of empirical evidence for agricultural interventions' impacts on nutrition is weak. In the past 10 years, both agriculture and nutrition have risen on the global policy agenda. Several recent international movements have created great momentum for nutrition among global political leaders and policymakers. The 2008 world food price crisis prompted larger investment pledges to agricultural development. The U.S. Government launched the Feed the Future initiative in 2009 to address global hunger and food security, with a primary goal to reduce poverty and undernutrition by simultaneously promoting inclusive agriculture sector growth and improved nutritional status for women and children. With operations in 19 focus countries, Feed the Future provides an important laboratory of learning where efforts can be effective and, once proven, taken to scale to make agriculture work for nutrition. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project has been conducting a series of research on the Feed the Future initiative. This chapter will first provide a review of the nutrition narrative in relation to food and nutrition, introduce the current understanding of linkages between agriculture and nutrition and the Feed the Future initiative's efforts to strengthen the nutritional impact of agricultural and economic growth activities, and describe an extensive review of how the design and early implementation of Feed the Future activities linked agriculture and nutrition. Finally, the chapter presents an updated framework that incorporates ways to improve nutrition outcomes of agricultural programming in the broader context of food system. © 2015 Elsevier Inc. All rights reserved.

  16. Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome.

    Science.gov (United States)

    Ruotsalainen, Hanna K; Pihkala, Jaana; Salminen, Jukka; Hornberger, Lisa K; Sairanen, Heikki; Ojala, Tiina

    2017-08-01

    We investigated the impact of initial shunt type, a Blalock-Taussig (BT) shunt versus a right ventricle to pulmonary artery conduit (RV-PA) on myocardial function at different stages of surgical palliation in patients with hypoplastic left heart syndrome (HLHS). A population-based cohort of 63 Finnish children with HLHS (BT n  = 23, RV-PA n  = 40) born between 2003 and 2010 were studied retrospectively by echocardiography prior to Stages 1, 2 and 3 palliation and 0.5-3 years after Stage 3. For comparison of systolic myocardial function, we evaluated the RV fractional area change (FAC), strain, strain rate and mechanical synchrony from the apical 4-chamber view by velocity vector imaging. There were no intergroup differences in demographics during the study period. At baseline, no intergroup differences were detected in RV systolic myocardial function. Before Stage 2, RV FAC was higher ( P  = 0.03) in the RV-PA conduit group. At Stage 3, an increase in all systolic myocardial functional parameters was observed in the BT shunt group. After Stage 3, the BT shunt group had better RV systolic function. In multiple regression analysis, the shunt type and the stage of palliation had an impact on myocardial function. Although patients with HLHS initially palliated with a BT shunt demonstrate lower RV FAC after Stage I, RV FAC improves after Stage 2 with better systolic performance after Stage 3 compared with those initially palliated with an RV-PA conduit. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms☆

    Science.gov (United States)

    Menéndez, Cammie Chaumont; Amick, Benjamin C.; Robertson, Michelle; Bazzani, Lianna; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2016-01-01

    Objective Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite. Methods A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses. Results Both the training only intervention (p office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability. PMID:22030069

  18. A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms.

    Science.gov (United States)

    Menéndez, Cammie Chaumont; Amick, Benjamin C; Robertson, Michelle; Bazzani, Lianna; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2012-07-01

    Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite. A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses. Both the training only intervention (poffice ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability. Published by Elsevier Ltd.

  19. An evaluation of the process and initial impact of disseminating a nursing e-thesis.

    Science.gov (United States)

    Macduff, Colin

    2009-05-01

    This paper is a report of a study conducted to evaluate product, process and outcome aspects of the dissemination of a nursing PhD thesis via an open-access electronic institutional repository. Despite the growth of university institutional repositories which make theses easily accessible via the world wide web, nursing has been very slow to evaluate related processes and outcomes. Drawing on Stake's evaluation research methods, a case study design was adopted. The case is described using a four-phase structure within which key aspects of process and impact are reflexively analysed. In the conceptualization/re-conceptualization phase, fundamental questions about the purpose, format and imagined readership for a published nursing PhD were considered. In the preparation phase, seven key practical processes were identified that are likely to be relevant to most e-theses. In the dissemination phase email invitations were primarily used to invite engagement. The evaluation phase involved quantitative indicators of initial impact, such as page viewing and download statistics and qualitative feedback on processes and product. Analysis of process and impact elements of e-thesis dissemination is likely to have more than intrinsic value. The advent of e-theses housed in web-based institutional repositories has the potential to transform thesis access and use. It also offers potential to transform the nature and scope of thesis production and dissemination. Nursing scholars can exploit and evaluate such opportunities.

  20. Impact of Age at Smoking Initiation on Smoking-Related Morbidity and All-Cause Mortality.

    Science.gov (United States)

    Choi, Seung Hee; Stommel, Manfred

    2017-07-01

    Using a nationally representative sample of U.S. adults, the aims of this study were to examine the impact of early smoking initiation on the development of self-reported smoking-related morbidity and all-cause mortality. National Health Interview Survey data from 1997 through 2005 were linked to the National Death Index with follow-up to December 31, 2011. Two primary dependent variables were smoking-related morbidity and all-cause mortality; the primary independent variable was age of smoking initiation. The analyses included U.S. population of current and former smokers aged ≥30 years (N=90,278; population estimate, 73.4 million). The analysis relied on fitting logistic regression and Cox proportional hazards models. Among the U.S. population of smokers, 7.3% started smoking before age 13 years, 11.0% at ages 13-14 years, 24.2% at ages 15-16 years, 24.5% at ages 17-18 years, 14.5% at ages 19-20 years, and 18.5% at ages ≥21 years. Early smoking initiation before age 13 years was associated with increased risks for cardiovascular/metabolic (OR=1.67) and pulmonary (OR=1.79) diseases as well as smoking-related cancers (OR=2.1) among current smokers; the risks among former smokers were cardiovascular/metabolic (OR=1.38); pulmonary (OR=1.89); and cancers (OR=1.44). Elevated mortality was also related to early smoking initiation among both current (hazard ratio, 1.18) and former smokers (hazard ratio, 1.19). Early smoking initiation increases risks of experiencing smoking-related morbidities and all-cause mortality. These risks are independent of demographic characteristics, SES, health behaviors, and subsequent smoking intensity. Comprehensive tobacco control programs should be implemented to prevent smoking initiation and promote cessation among youth. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Initiation and Maintenance of Weight Loss after Laparoscopic Adjustable Gastric Banding. The role of Outcome Expectation and Satisfaction with the Psychosocial Outcome

    NARCIS (Netherlands)

    Zijlstra, H.; Larsen, J.K.; Ridder, D.T.D. de; Ramshorst, B. van; Geenen, R.

    2009-01-01

    A premise of this study was that different psychological processes would predict the initiation and maintenance of weight loss after surgery for morbid obesity. Our aim was to examine whether more favorable preoperative expectations of psychosocial outcomes predict weight loss in the first year

  2. Modifying mixing and instability growth through the adjustment of initial conditions in a high-energy-density counter-propagating shear experiment on OMEGA

    International Nuclear Information System (INIS)

    Merritt, E. C.; Doss, F. W.; Loomis, E. N.; Flippo, K. A.; Kline, J. L.

    2015-01-01

    Counter-propagating shear experiments conducted at the OMEGA Laser Facility have been evaluating the effect of target initial conditions, specifically the characteristics of a tracer foil located at the shear boundary, on Kelvin-Helmholtz instability evolution and experiment transition toward nonlinearity and turbulence in the high-energy-density (HED) regime. Experiments are focused on both identifying and uncoupling the dependence of the model initial turbulent length scale in variable-density turbulence models of k-ϵ type on competing physical instability seed lengths as well as developing a path toward fully developed turbulent HED experiments. We present results from a series of experiments controllably and independently varying two initial types of scale lengths in the experiment: the thickness and surface roughness (surface perturbation scale spectrum) of a tracer layer at the shear interface. We show that decreasing the layer thickness and increasing the surface roughness both have the ability to increase the relative mixing in the system, and thus theoretically decrease the time required to begin transitioning to turbulence in the system. We also show that we can connect a change in observed mix width growth due to increased foil surface roughness to an analytically predicted change in model initial turbulent scale lengths

  3. The Western Energy Corridor Initiative: Unconventional Fuel Development Issues, Impacts, and Management Assessment

    Science.gov (United States)

    Wolfsberg, A.; Hagood, M.; Pasqualini, D.; Wood, T.; Wilson, C.; Witkowski, M.; Levitt, D.; Pawar, R.; Keating, G.; Ziock, H.

    2008-12-01

    The United States is increasingly dependent on imported oil and gas; commodities for which other nations are competing and for which future supply may be inadequate to support our transportation fuel needs. Therefore, a renewed interest in 'harder-to-get' unconventional fuels has emerged in both industry and government with directed focus on world class hydrocarbon resources within a corridor extending from Canada southward through the Rocky Mountain States. Within this Western Energy Corridor, co-located with significant conventional hydrocarbon and renewable energy resources, lie some of the world's richest unconventional hydrocarbon resources in oil shales, oil sands and coal for coal-to-liquid conversion. However, development of these resources poses substantial environmental concerns as well as increasing competition for limited resources of water and habitat. With large-scale energy development in the predominantly rural region, local communities, infrastructures, and economies will face increasing demands for roads, electricity, law enforcement, labor, and other support services. The Western Energy Corridor Initiative (WECI) seeks to develop an integrated assessment of the impacts of unconventional fuel development, the interrelationships of planned energy developments in different basins, and the resultant demands placed on the region. This initial WECI study focuses on two of the most important current issues for industry, regulators, and stakeholders -- the assessment of carbon and water resources issues, impacts, and management strategies. Through scenario analyses using coupled systems and process level models, this study investigates the viability of integrated development of multiple energy resources in a carbon neutral and environmentally acceptable manner, and the interrelationships of various energy resource development plans. The modeling framework is designed to extend to include infrastructure, employment, training, fiscal and economic demands

  4. Tropical cyclone losses in the USA and the impact of climate change - A trend analysis based on data from a new approach to adjusting storm losses

    International Nuclear Information System (INIS)

    Schmidt, Silvio; Kemfert, Claudia; Hoeppe, Peter

    2009-01-01

    Economic losses caused by tropical cyclones have increased dramatically. Historical changes in losses are a result of meteorological factors (changes in the incidence of severe cyclones, whether due to natural climate variability or as a result of human activity) and socio-economic factors (increased prosperity and a greater tendency for people to settle in exposed areas). This paper aims to isolate the socio-economic effects and ascertain the potential impact of climate change on this trend. Storm losses for the period 1950-2005 have been adjusted to the value of capital stock in 2005 so that any remaining trend cannot be ascribed to socio-economic developments. For this, we introduce a new approach to adjusting losses based on the change in capital stock at risk. Storm losses are mainly determined by the intensity of the storm and the material assets, such as property and infrastructure, located in the region affected. We therefore adjust the losses to exclude increases in the capital stock of the affected region. No trend is found for the period 1950-2005 as a whole. In the period 1971-2005, since the beginning of a trend towards increased intense cyclone activity, losses excluding socio-economic effects show an annual increase of 4% per annum. This increase must therefore be at least due to the impact of natural climate variability but, more likely than not, also due to anthropogenic forcings.

  5. Gender influences the initial impact of subarachnoid hemorrhage: an experimental investigation.

    Directory of Open Access Journals (Sweden)

    Victor Friedrich

    Full Text Available Aneurysmal subarachnoid hemorrhage (SAH carries high early patient mortality. More women than men suffer from SAH and the average age of female SAH survivors is greater than that of male survivors; however, the overall mortality and neurological outcomes are not better in males despite their younger age. This pattern suggests the possibility of gender differences in the severity of initial impact and/or in subsequent pathophysiology. We explored gender differences in survival and pathophysiology following subarachnoid hemorrhage induced in age-matched male and female rats by endovascular puncture. Intracranial pressure (ICP, cerebral blood flow (CBF, blood pressure (BP and cerebral perfusion pressure (CPP were recorded at and after induction of SAH. Animals were sacrificed 3 hours after lesion and studied for subarachnoid hematoma size, vascular pathology (collagen and endothelium immunostaining, inflammation (platelet and neutrophil immunostaining, and cell death (TUNEL assay. In a second cohort, 24-hour survival was determined. Subarachnoid hematoma, post-hemorrhage ICP peak, BP elevation, reduction in CPP, intraluminal platelet aggregation and neutrophil accumulation, loss of vascular collagen, and neuronal and non-neuronal cell death were greater in male than in female rats. Hematoma size did not correlate with the number of apoptotic cells, platelet aggregates or neutrophil. The ICP peak correlated with hematoma size and with number of apoptotic cells but not with platelet aggregates and neutrophil number. This suggests that the intensity of ICP rise at SAH influences the severity of apoptosis but not of inflammation. Mortality was markedly greater in males than females. Our data demonstrate that in rats gender influences the initial impact of SAH causing greater bleed and early injury in males as compared to females.

  6. ICT Integration in Mathematics Initial Teacher Training and Its Impact on Visualization: The Case of GeoGebra

    Science.gov (United States)

    Dockendorff, Monika; Solar, Horacio

    2018-01-01

    This case study investigates the impact of the integration of information and communications technology (ICT) in mathematics visualization skills and initial teacher education programmes. It reports on the influence GeoGebra dynamic software use has on promoting mathematical learning at secondary school and on its impact on teachers' conceptions…

  7. Technology-Enhanced Science Partnership Initiative: Impact on Secondary Science Teachers

    Science.gov (United States)

    Ng, Wan; Fergusson, Jennifer

    2017-07-01

    The issue of student disengagement in school science continues to pose a threat to lifting the participation rates of students undertaking STEM courses and careers in Australia and other countries globally. In Australia, several science initiatives to reverse the problem have been funded over the last two decades. Many of these initiatives involve partnerships with scientists, science educators and with industries, as is the case in this paper. The research in this paper investigated a recent partnership initiative between secondary science teachers, scientists and an educational technology company to produce science e-modules on adaptive learning platforms, enabling students to engage in personalised, inquiry-based learning and the investigation of real-world problems. One of the objectives of the partnership project was to build theoretical and pedagogical skills in teachers to deliver science by exposing them to new ways of engaging students with new digital tools, for example analytics. Using a mixed methods approach, the research investigated science teachers' pedagogical involvement in the partnership project and their perceptions of the project's impact on their teaching and students' learning. The findings indicate that the teachers believed that new technology could enhance their teaching and students' learning and that while their students were motivated by the online modules, there was still a need for scaffolding for many of the students. The effectiveness of this would depend on the teachers' ability to internalise the new technological and content knowledge resulting from the partnership and realign them with their existing pedagogical framework. The research is significant in identifying elements for successful partnership projects as well as challenges that need to be considered. It is significant in facilitating continuous discourse about new evidence-based pedagogical approaches to science education in engaging students to learn STEM subjects in a

  8. Formation and adjustment of typhoon-impacted reef islands interpreted from remote imagery: Nadikdik Atoll, Marshall Islands

    Science.gov (United States)

    Ford, Murray R.; Kench, Paul S.

    2014-06-01

    In 1905, a devastating typhoon hit Nadikdik Atoll (5°54‧ N and 172°09‧ E) in the southern Marshall Islands. Evidence suggests that large sections of reef islands on Nadikdik were overwashed and destroyed. Comparison of aerial photographs taken in 1945 and modern satellite imagery provides a unique record of the geomorphic adjustment of islands after the typhoon. Between 1945 and 2010 the vegetated area of islands on Nadikdik grew from 0.74 to 0.90 km2. Observed changes to Nadikdik reef islands manifested through a range of styles and were largely accretionary. Of note, the formation of a new island was tracked from an embryonic deposit to a fully vegetated and stable island over a 61 year period. Similarly, a number of previously discrete islands have agglomerated and formed a single larger island. These changes were rapid and indicate that reef island formation can occur quickly. Evidence suggests that despite the typhoon occurring over a century ago the geomorphic adjustment of islands is still on-going.

  9. The impact of social constraints and sense of coherence on the psychological adjustment of adolescents and young adults with CF

    Directory of Open Access Journals (Sweden)

    Kaya L. Beinke

    2015-12-01

    Full Text Available In the last two decades, the medical understanding of Cystic Fibrosis (CF has dramatically improved, however, there are still significant gaps in our understanding of the psychological adjustment of families coping with CF. We examined the utility of the Social Cognitive Processing (SCP Model in understanding the interactions of parents and young people with CF. We also examined the relationship between social constraints, a key construct in the SCP model, sense of coherence (SOC and other psychological adjustment indicators for young people with CF. Participants comprised 49 individuals with CF, aged 16–25, recruited through state-based CF organisations in Australia. The results indicated that participant ratings of difficulties with communication (social constraints were positively associated with ratings of depression, anxiety, and stress and negatively related to ratings of positive affect and seeing life challenges as predictable, manageable and meaningful (SOC. Ratings of SOC were also positively related to ratings of positive affect and negatively related to ratings of depression, anxiety and stress. A significant mediating effect of SOC was also identified in the relationships between social constraints and positive affect and social constraints and stress. The theoretical and clinical implications of these findings are discussed.

  10. Psychological impact on house staff of an initial versus subsequent emergency medicine rotation.

    Science.gov (United States)

    Alagappan, K; Grlic, N; Steinberg, M; Pollack, S

    2001-01-01

    The objective of this study was to assess the psychological impact of a 4-week emergency medicine (EM) rotation on residents undergoing their first EM experience. These findings were compared to the psychological impact the rotation had on residents with prior EM experience. Data were obtained from a post hoc analysis of a previous study. Prerotation and postrotation psychological distress levels were assessed over a 4-week EM rotation. Anxiety and depressive symptoms were evaluated by the Brief Symptom Inventory and the Dissociative Experience Scale that together comprise a total of 14 psychometric scales. All scales were given at the beginning and end of the initial EM rotation for the academic year of 1994-1995. All information was coded and confidential. Eighteen junior residents (9/18 EM [50%]) were analyzed as a group and compared to 53 residents (34/51 EM [66%]) with prior exposure to the authors' emergency department. Residents doing their first EM rotation (N = 18) showed improvement in 13 of 14 scales (P = .002). Of the 13 scales that improved, 3 improved significantly: Brief Symptom Inventory = anxiety (P = .002) and Dissociative Experience Scale = absorption (P = .001) and other (P = .001). Residents with prior EM experience (N = 53) displayed worsening in 9 of 13 scales (P = not significant) and no change in 1. Residents undergoing their first EM rotation showed a significant decrease in psychological distress over the 4-week period. Residents with prior EM experience did not show a similar change.

  11. Activities of NASA's Global Modeling Initiative (GMI) in the Assessment of Subsonic Aircraft Impact

    Science.gov (United States)

    Rodriquez, J. M.; Logan, J. A.; Rotman, D. A.; Bergmann, D. J.; Baughcum, S. L.; Friedl, R. R.; Anderson, D. E.

    2004-01-01

    The Intergovernmental Panel on Climate Change estimated a peak increase in ozone ranging from 7-12 ppbv (zonal and annual average, and relative to a baseline with no aircraft), due to the subsonic aircraft in the year 2015, corresponding to aircraft emissions of 1.3 TgN/year. This range of values presumably reflects differences in model input (e.g., chemical mechanism, ground emission fluxes, and meteorological fields), and algorithms. The model implemented by the Global Modeling Initiative allows testing the impact of individual model components on the assessment calculations. We present results of the impact of doubling the 1995 aircraft emissions of NOx, corresponding to an extra 0.56 TgN/year, utilizing meteorological data from NASA's Data Assimilation Office (DAO), the Goddard Institute for Space Studies (GISS), and the Middle Atmosphere Community Climate Model, version 3 (MACCM3). Comparison of results to observations can be used to assess the model performance. Peak ozone perturbations ranging from 1.7 to 2.2 ppbv of ozone are calculated using the different fields. These correspond to increases in total tropospheric ozone ranging from 3.3 to 4.1 Tg/Os. These perturbations are consistent with the IPCC results, due to the difference in aircraft emissions. However, the range of values calculated is much smaller than in IPCC.

  12. Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Lisa M. Wilson

    2012-01-01

    Full Text Available Background. Policymakers need estimates of the impact of tobacco control (TC policies to set priorities and targets for reducing tobacco use. We systematically reviewed the independent effects of TC policies on smoking behavior. Methods. We searched MEDLINE (through January 2012 and EMBASE and other databases through February 2009, looking for studies published after 1989 in any language that assessed the effects of each TC intervention on smoking prevalence, initiation, cessation, or price participation elasticity. Paired reviewers extracted data from studies that isolated the impact of a single TC intervention. Findings. We included 84 studies. The strength of evidence quantifying the independent effect on smoking prevalence was high for increasing tobacco prices and moderate for smoking bans in public places and antitobacco mass media campaigns. Limited direct evidence was available to quantify the effects of health warning labels and bans on advertising and sponsorship. Studies were too heterogeneous to pool effect estimates. Interpretations. We found evidence of an independent effect for several TC policies on smoking prevalence. However, we could not derive precise estimates of the effects across different settings because of variability in the characteristics of the intervention, level of policy enforcement, and underlying tobacco control environment.

  13. Impact of initial lipid content and oxygen supply on alcoholic fermentation in champagne-like musts.

    Science.gov (United States)

    Ochando, Thomas; Mouret, Jean-Roch; Humbert-Goffard, Anne; Sablayrolles, Jean-Marie; Farines, Vincent

    2017-08-01

    Available nitrogen, lipids, or oxygen are nutrients with major impact on the kinetics of winemaking fermentation. Assimilable nitrogen is usually the growth-limiting nutrient which availability determines the fermentation rate and therefore the fermentation duration. In some particular cases, as in Champagne, grape musts have high available nitrogen content and low turbidity, i.e., below 50 Nephelometric Turbidity Unit (NTU). In the case of low turbidity, the availability of lipids, particularly phytosterols, becomes limiting. In this situation, control of oxygenation, which is necessary for lipid synthesis by yeast, is particularly crucial during fermentation. To mimic and understand these situations, a synthetic medium simulating the average composition of a Champagne must was used. This medium contained phytosterol (mainly β-sitosterol) concentrations ranging from 0 to 8mg/L corresponding to turbidity between 10 and 90 NTU. Population reached during the stationary phase and the maximum fermentation rate are conditioned by the initial phytosterol concentration determining the amount of nitrogen consumption. An early loss of viability was observed when the lipid concentrations were very low. For example, the viability continuously decreased during the stationary phase to a final value of 50% for an initial phytosterol concentration of 1mg/L. In some fermentations, 10mg/L oxygen were added at the end of the growth phase to combine the effects of initial content of phytosterols in the musts and the de novo synthesis of ergosterol and unsaturated fatty acids induced by oxygen addition. Effect of oxygen supply on the fermentation kinetics was particularly significant for media with low phytosterol contents. For example, the maximum fermentation rate was increased by 1.4-fold and the fermentation time was 70h shorter with oxygen addition in the medium containing 2mg/L of phytosterols. As a consequence of the oxygen supply, for the media containing 3, 5 and 8mg/L of

  14. Mapping longitudinal scientific progress, collaboration and impact of the Alzheimer's disease neuroimaging initiative.

    Directory of Open Access Journals (Sweden)

    Xiaohui Yao

    Full Text Available Alzheimer's disease neuroimaging initiative (ADNI is a landmark imaging and omics study in AD. ADNI research literature has increased substantially over the past decade, which poses challenges for effectively communicating information about the results and impact of ADNI-related studies. In this work, we employed advanced information visualization techniques to perform a comprehensive and systematic mapping of the ADNI scientific growth and impact over a period of 12 years.Citation information of ADNI-related publications from 01/01/2003 to 05/12/2015 were downloaded from the Scopus database. Five fields, including authors, years, affiliations, sources (journals, and keywords, were extracted and preprocessed. Statistical analyses were performed on basic publication data as well as journal and citations information. Science mapping workflows were conducted using the Science of Science (Sci2 Tool to generate geospatial, topical, and collaboration visualizations at the micro (individual to macro (global levels such as geospatial layouts of institutional collaboration networks, keyword co-occurrence networks, and author collaboration networks evolving over time.During the studied period, 996 ADNI manuscripts were published across 233 journals and conference proceedings. The number of publications grew linearly from 2008 to 2015, so did the number of involved institutions. ADNI publications received much more citations than typical papers from the same set of journals. Collaborations were visualized at multiple levels, including authors, institutions, and research areas. The evolution of key ADNI research topics was also plotted over the studied period.Both statistical and visualization results demonstrate the increasing attention of ADNI research, strong citation impact of ADNI publications, the expanding collaboration networks among researchers, institutions and ADNI core areas, and the dynamic evolution of ADNI research topics. The visualizations

  15. Asymmetric adjustment

    NARCIS (Netherlands)

    2010-01-01

    A method of adjusting a signal processing parameter for a first hearing aid and a second hearing aid forming parts of a binaural hearing aid system to be worn by a user is provided. The binaural hearing aid system comprises a user specific model representing a desired asymmetry between a first ear

  16. Adjustment of web-building initiation to high humidity: a constraint by humidity-dependent thread stickiness in the spider Cyrtarachne.

    Science.gov (United States)

    Baba, Yuki G; Kusahara, Miki; Maezono, Yasunori; Miyashita, Tadashi

    2014-07-01

    Cyrtarachne is an orb-weaving spider belonging to the subfamily Cyrtarachninae (Araneidae) which includes triangular-web-building Pasilobus and bolas spiders. The Cyrtarachninae is a group of spiders specialized in catching moths, which is thought to have evolved from ordinary orb-weaving araneids. Although the web-building time of nocturnal spiders is in general related to the time of sunset, anecdotal evidence has suggested variability of web-building time in Cyrtarachne and its closely related genera. This study has examined the effects of temperature, humidity, moonlight intensity, and prey (moths) availability on web-building time of Cyrtarachne bufo, Cyrtarachne akirai, and Cyrtarachne nagasakiensis. Generalized linear mixed model (GLMM) have revealed that humidity, and not prey availability, was the essential variable that explained the daily variability of web-building time. Experiments measuring thread stickiness under different humidities showed that, although the thread of Cyrtarachne was found to have strong stickiness under high humidity, low humidity caused a marked decrease of thread stickiness. By contrast, no obvious change in stickiness was seen in an ordinary orb-weaving spider, Larinia argiopiformis. These findings suggest that Cyrtarachne adjusts its web-building time to favorable conditions of high humidity maintaining strong stickiness, which enables the threads to work efficiently for capturing prey.

  17. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    Science.gov (United States)

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

  18. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  19. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  20. [Impact of care pathway on the delay for initiation of antituberculosis treatment in Conakry, Guinea].

    Science.gov (United States)

    Camara, A; Bah-Sow, O Y; Baldé, N M; Camara, L M; Barry, I S; Bah, B; Diallo, M; Chaperon, J; Riou, F

    2009-06-01

    Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.

  1. The impact of training problem-solving skills on self-esteem and behavioral adjustment in teenage girls who have irresponsible parents or no parents.

    Science.gov (United States)

    Shahgholy Ghahfarokhi, F; Moradi, N; Alborzkouh, P; Radmehr, S; Zainali, M

    2015-01-01

    Proper psychological interventions are of great importance because they help enhancing psychological and public health in adolescents with irresponsible parents or no parents. The current research aimed to examine the impact of training problem-solving experiment on self-esteem and behavioral adjustment in teenage girls with irresponsible parents or no parents. Methodology: The approach of the present research was a semi-test via a post-test-pre-test model and a check team. Hence, in Tehran, 40 girls with irresponsible parents or no parents were chosen by using the Convenience modeling, and they were classified into 2 teams: control and experiment. Both groups were pre-tested by using a demography questionnaire, Rosenberg's self-esteem scale, and a behavioral adjustment questionnaire. Afterwards, both groups were post-tested, and the obtained data were examined by using inferential and descriptive methods through SPSS 21. Findings: Findings indicated that the training problem-solving skills significantly increased the self-esteem and the behavioral adjustment in teenage girls with irresponsible parents or no parents (P < 0/ 001). Conclusion: The conclusion of this research was that training problem-solving methods greatly helps endangered people such as teenage girls with irresponsible parents or no parents, because these methods are highly efficient especially when they are performed in groups, as they are cheap and accepted by different people.

  2. Shaft adjuster

    Science.gov (United States)

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  3. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results.

    Science.gov (United States)

    Gustavsson, Johanna; Bonander, Carl; Andersson, Ragnar; Nilson, Finn

    2015-10-01

    Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents. The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments. During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)). This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Adjustable collimator

    International Nuclear Information System (INIS)

    Carlson, R.W.; Covic, J.; Leininger, G.

    1981-01-01

    In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

  5. The initial impact of EU ETS verification events on stock prices

    International Nuclear Information System (INIS)

    Brouwers, Roel; Schoubben, Frederiek; Van Hulle, Cynthia; Van Uytbergen, Steve

    2016-01-01

    This paper studies the impact of verified emissions publications in the European Emissions Trading Scheme (EU ETS) on the market value of participating companies. Using event study methodology on a unique sample of 368 listed companies, we show that verified emissions only resulted in statistically significant market responses when the carbon price was high and allowance scarcity was anticipated. The cross-section analysis of abnormal returns surrounding the publication of verified emissions shows that share prices decrease when actual emissions relative to allocated emissions increase. This negative relationship between allocation shortfalls and firm value is only significant for firms that are either carbon-intensive, compared to sector peers, or are less likely to pass through carbon-related costs in their product prices. The results suggest that although the EU ETS has been deemed unsuccessful so far due to over-allocation and low carbon price, shareholders initially perceived allowance holdings as value relevant. Our results highlight that a significant carbon market price and addressing pass-through costing are essential for successful future reforms of the EU ETS and other analogous carbon cap-and-trade systems implemented or planned worldwide. - Highlights: •We study the impact of EU ETS verified emissions disclosure on firms' market value. •Disclosure is relevant if carbon price is high and permits scarcity is anticipated. •We find a negative relationship between allocation shortfalls and firm value. •Stronger relationship for carbon – intensive and no cost pass-through firms. •High carbon price and addressing cost pass-through are crucial for EU ETS reforms.

  6. Different initiatives across Europe to enhance losartan utilization post generics: impact and implications

    Science.gov (United States)

    Moon, James C.; Godman, Brian; Petzold, Max; Alvarez-Madrazo, Samantha; Bennett, Kathleen; Bishop, Iain; Bucsics, Anna; Hesse, Ulrik; Martin, Andrew; Simoens, Steven; Zara, Corinne; Malmström, Rickard E.

    2014-01-01

    Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry. Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance. Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured. Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan. Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related. PMID:25339902

  7. The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program.

    Science.gov (United States)

    Minor, Kyle S; Friedman-Yakoobian, Michelle; Leung, Y Jude; Meyer, Eric C; Zimmet, Suzanna V; Caplan, Brina; Monteleone, Thomas; Bryant, Caitlin; Guyer, Margaret; Keshavan, Matcheri S; Seidman, Larry J

    2015-05-01

    Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points). Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  8. Impact of global health governance on country health systems: the case of HIV initiatives in Nigeria.

    Science.gov (United States)

    Chima, Charles Chikodili; Homedes, Nuria

    2015-06-01

    Three global health initiatives (GHIs) - the US President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi-Country HIV/AIDS Program - finance most HIV services in Nigeria. Critics assert that GHIs burden fragile health systems in resource-poor countries and that health system limitations in these countries constrain the achievement of the objectives of GHIs. This study analyzed interactions between HIV GHIs and the Nigerian Health System and explored how the impact of the GHIs could be optimized. A country case study was conducted using qualitative methods, including: semi-structured interviews, direct observation, and archival review. Semi-structured interviews were held with key informants selected to reach a broad range of stakeholders including policymakers, program managers, service providers, representatives of donor agencies and their implementing partners; the WHO country office in Nigeria; independent consultants; and civil society organizations involved in HIV work. The fieldwork was conducted between June and August 2013. HIV GHIs have had a mixed impact on the health system. They have enhanced availability of and access to HIV services, improved quality of services, and strengthened health information systems and the role of non-state actors in health care. On the negative end, HIV donor funding has increased dependency on foreign aid, widened disparities in access to HIV services, done little to address the sustainability of the services, crowded out non-HIV health services, and led to the development of a parallel supply management system. They have also not invested significantly in the production of new health workers and have not addressed maldistribution problems, but have rather contributed to internal brain drain by luring health workers from the public sector to non-governmental organizations and have increased workload for existing health workers. There is poor policy direction

  9. Impact of Educational Activities in Reducing Pre-Analytical Laboratory Errors: A quality initiative.

    Science.gov (United States)

    Al-Ghaithi, Hamed; Pathare, Anil; Al-Mamari, Sahimah; Villacrucis, Rodrigo; Fawaz, Naglaa; Alkindi, Salam

    2017-08-01

    Pre-analytic errors during diagnostic laboratory investigations can lead to increased patient morbidity and mortality. This study aimed to ascertain the effect of educational nursing activities on the incidence of pre-analytical errors resulting in non-conforming blood samples. This study was conducted between January 2008 and December 2015. All specimens received at the Haematology Laboratory of the Sultan Qaboos University Hospital, Muscat, Oman, during this period were prospectively collected and analysed. Similar data from 2007 were collected retrospectively and used as a baseline for comparison. Non-conforming samples were defined as either clotted samples, haemolysed samples, use of the wrong anticoagulant, insufficient quantities of blood collected, incorrect/lack of labelling on a sample or lack of delivery of a sample in spite of a sample request. From 2008 onwards, multiple educational training activities directed at the hospital nursing staff and nursing students primarily responsible for blood collection were implemented on a regular basis. After initiating corrective measures in 2008, a progressive reduction in the percentage of non-conforming samples was observed from 2009 onwards. Despite a 127.84% increase in the total number of specimens received, there was a significant reduction in non-conforming samples from 0.29% in 2007 to 0.07% in 2015, resulting in an improvement of 75.86% ( P educational activities directed primarily towards hospital nursing staff had a positive impact on the quality of laboratory specimens by significantly reducing pre-analytical errors.

  10. The impact of global health initiatives on the health system in Angola.

    Science.gov (United States)

    Craveiro, Isabel; Dussault, Gilles

    2016-01-01

    We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs' function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.

  11. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

    Science.gov (United States)

    Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.

  12. Prevalent of root resorption of second molar adjustment the impacted third molar in prepiacal and panoramic radiographs

    Directory of Open Access Journals (Sweden)

    Mohammad Ebrahimi Saravi

    2013-10-01

    Full Text Available   Background and Aims: Impacted third molar reduces the bone level in the distal aspect of second molar, and sometimes it can lead to root resorption of the adjacent tooth. The purpose of this study was to determine this resorption using panoramic and periapical radiographs.   Materials and Methods: In this cross-sectional descriptive study 54 patient (28 men, 26 women above 15 years old with the average of 22 years in Oral and Maxillofacial Department of Tehran University were studied. A periapical radiography from the third molar and a panoramic radiograph were taken from each patient (Because of their routine use and evaluation of accuracy of panoramic compared with periapical, and the magnitude of the root resorption for the second molar was determined by 2 observers and written in a questionnaire. Data were analyzed using Fisher test.   Results: The prevalence of the root resorption of the second molar adjacent to the impacted third molar in the panoramic and the periapical radiographies, with respect to the limitation of the sample size were 46.3% and 31.5%, respectively, with 95% confidence(P>0.05. Most of these resorptions were in the cervical third of the second molar roots and in cases in which the third molars were mesially oriented or horizontal. There was also no significant difference between panoramic and periapical radiographs.   Conclusion: Due to the increased risk of the resorption of the second molar adjacent to the third molar, extraction of the impacted third molars, especiall y mesially oriented or horizontal ones are recommended.

  13. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Stamou, Sotiris C; Dullum, Mercedes K C; Hill, Peter C; Haile, Elizabeth; Boyce, Steven W; Bafi, Ammar S; Petro, Kathleen R; Corso, Paul J

    2004-11-01

    Cerebral embolization of atherosclerotic plaque debris caused by aortic manipulation during conventional coronary artery bypass grafting (CABG) is a major mechanism of postoperative cerebrovascular accidents (CVA). Off-pump CABG (OPCABG) reduces stroke rates by minimizing aortic manipulation. Consequently, the effect of different levels of aortic manipulation on neurologic outcomes after CABG surgery was examined. From January 1998 to June 2002, 7,272 patients underwent isolated CABG surgery through three levels of aortic manipulation: full plus tangential (side-biting) aortic clamp application (on-pump surgery; n = 4,269), only tangential aortic clamp application (OPCABG surgery; n = 2,527) or an "aortic no-touch" technique (OPCABG surgery; n = 476). A risk-adjusted logistic regression analysis was performed to establish the likelihood of postoperative stroke with each technique. Preoperative risk factors for stroke from the literature, and those found significant in a univariable model were used. A significant association for postoperative stroke correspondingly increasing with the extent of aortic manipulation was demonstrated by the univariable analysis (CVA incidence respectively increasing from 0.8% to 1.6% to a maximum of 2.2%, p < 0.01). In the logistic regression model, patients who had a full and a tangential aortic clamp applied were 1.8 times more likely to have a stroke versus those without any aortic manipulation (95% confidence interval: 1.15 to 2.74, p < 0.01) and 1.7 times more likely to develop a postoperative stroke than those with only a tangential aortic clamp applied (95% confidence interval: 1.11 to 2.48, p < 0.01). Aortic manipulation during CABG is a contributing mechanism for postoperative stroke. The incidence of postoperative stroke increases with increased levels of aortic manipulation.

  14. Do Community Based Initiatives foster sustainability transitions? Towards a unique Environmental Impact Assessment.

    Science.gov (United States)

    Martellozzo, Federico; Hendrickson, Cary; Gozdowska, Iga; Groß, Helge; Henderson, Charles; Reusser, Dominik

    2015-04-01

    The active participation in Community Based Initiatives (CBI) is a spreading phenomenon that has reached a significant magnitude and - in some cases - CBIs are also supposed to have catalysed social and technological innovation, thus contributing to global transition into low-carbon economy. Generally speaking, CBIs are grassroots initiatives with broad sustainability foci that promote a plethora of activities such as alternative transportation, urban gardening, renewable energy implementation, waste regeneration/reduction, etc. Some advocate that such practices fostered by bottom-up activities, rather than top-down policies, represent a proficient countermeasure to alleviate global environmental change and effectively foster a societal transition towards sustainability. However, thus far most empirical research grounds mainly on anecdotal evidence and little work has been done to quantitatively assess CBIs' "environmental impacts" (EI) or their carbon footprints using comparative methodologies. This research main aim is to frame a methodology to assess univocally CBIs' EIs which are crucial to understanding their role in societal sustainability transition. However, to do so, three main caveats need to be addressed: first, some CBIs do not directly produce tangible measurable outputs, nor have an intelligibly defined set of inputs (e.g. CBIs focusing on environmental education and awareness rising). Thus, calculating their "indirect" EI may represent an intricate puzzle that is very much open to subjective interpretation. Second, CBIs' practices are heterogenic and therefore existing methodologies to make comparisons of their EIs are neither straightforward nor proficient, also given the lack of available data. Third, another issue closely related to the one previously mentioned, is a general lack of consensus among already existing impact-assessment frameworks for certain practices (e.g. composting). A potential way of estimating a CBI's EI is a standard Carbon

  15. The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Smith, Shawna N; Iwashyna, Theodore J; Langa, Kenneth M; Hofer, Timothy P; McMahon, Laurence F

    2017-01-01

    Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. Outcomes measured were readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and 'other' race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status

  16. Initial shifts in nitrogen impact on ecosystem carbon fluxes in an alpine meadow: patterns and causes

    Science.gov (United States)

    Song, Bing; Sun, Jian; Zhou, Qingping; Zong, Ning; Li, Linghao; Niu, Shuli

    2017-09-01

    Increases in nitrogen (N) deposition can greatly stimulate ecosystem net carbon (C) sequestration through positive N-induced effects on plant productivity. However, how net ecosystem CO2 exchange (NEE) and its components respond to different N addition rates remains unclear. Using an N addition gradient experiment (six levels: 0, 2, 4, 8, 16, 32 gN m-2 yr-1) in an alpine meadow on the Qinghai-Tibetan Plateau, we explored the responses of different ecosystem C fluxes to an N addition gradient and revealed mechanisms underlying the dynamic responses. Results showed that NEE, ecosystem respiration (ER), and gross ecosystem production (GEP) all increased linearly with N addition rates in the first year of treatment but shifted to N saturation responses in the second year with the highest NEE (-7.77 ± 0.48 µmol m-2 s-1) occurring under an N addition rate of 8 gN m-2 yr-1. The saturation responses of NEE and GEP were caused by N-induced accumulation of standing litter, which limited light availability for plant growth under high N addition. The saturation response of ER was mainly due to an N-induced saturation response of aboveground plant respiration and decreasing soil microbial respiration along the N addition gradient, while decreases in soil microbial respiration under high N addition were caused by N-induced reductions in soil pH. We also found that various components of ER, including aboveground plant respiration, soil respiration, root respiration, and microbial respiration, responded differentially to the N addition gradient. These results reveal temporal dynamics of N impacts and the rapid shift in ecosystem C fluxes from N limitation to N saturation. Our findings bring evidence of short-term initial shifts in responses of ecosystem C fluxes to increases in N deposition, which should be considered when predicting long-term changes in ecosystem net C sequestration.

  17. Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System.

    Science.gov (United States)

    Perryman, M Ray; Gleghorn, Virginia

    2010-01-01

    To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives. Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%. From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment. The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism

  18. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy

    Directory of Open Access Journals (Sweden)

    Duncan I

    2012-04-01

    Full Text Available Michael Taitel1, Jenny Jiang1, Kristi Rudkin2, Susan Ewing2, Ian Duncan 1Clinical Outcomes and Analytics, Walgreens, 2Corporate Innovation Team, Walgreens, Deerfield, Illinois, USAPurpose: To evaluate the impact of a community-based pharmacist-led face-to-face counseling program on medication adherence for patients who were new to therapy (NTT for statin medications.Patients and methods: This retrospective cohort study evaluated a program that was implemented in 76 national community pharmacies located in the midwest USA. It consisted of two face-to-face patient counseling sessions with a pharmacist that addressed patient barriers to adherence. A group of 2056 NTT statin patients was identified between September 1, 2010 and October 31, 2010, and was followed for 12 months. The intervention group consisted of 586 patients, and the comparison group comprised 516 patients. Outcomes were measured using the continuous medication possession ratio (MPR, categorical MPR, and medication persistency.Results: After adjusting for covariates, the intervention group had statistically greater MPR than the comparison group at every month measured. For example, at 12 months the intervention group had a MPR of 61.8% (CI, 54.5%–69.2% and the comparison group had a MPR of 56.9% (CI, 49.5%–64.3%; this 4.9% difference is significant (P < 0.01. The 12 month categorical MPR also showed significant differences between groups (χ2 = 6.12, P < 0.05; 40.9% of the intervention group and 33.7% of comparison group had a MPR greater than or equal to 80%. Finally, the intervention group had significantly greater persistency with their medication therapy than the comparison group at 60, 90, 120, and 365 days.Conclusion: Patients who participated in brief face-to-face counseling sessions with a community pharmacist at the beginning of statin therapy demonstrated greater medication adherence and persistency than a comparison group. This brief targeted intervention at the

  19. Impact of Reduction Parameters on the Initial Performance and Stability of Ni/(Sc)YSZ Cermet Anodes for SOFCs

    DEFF Research Database (Denmark)

    Ebbehøj, Søren Lyng; Ramos, Tania; Mogensen, Mogens Bjerg

    2012-01-01

    In-situ reduction of Ni cermet anodes produces the porosity and influences the microstructure, performance and stability of the anodes. The impact on initial performance, stability and microstructure of two different reduction procedures currently in use at DTU Energy Conversion with reduction...

  20. Impact and Process Evaluation of the U.S. Department of Energy's Wind Powering America Initiative

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-05-01

    This report presents an evaluation of the impacts and processes of the former Wind Powering America(WPA) initiative sponsored by the U.S. Department of Energy (DOE). WPA has an underlying goal of dramatically increasing the use of wind energy in the U.S.

  1. Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility.

    Science.gov (United States)

    Murray, Meghan T; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

    2016-07-01

    We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

  2. Evaluating the Impact of Open Access at Berkeley: Results from the 2015 Survey of Berkeley Research Impact Initiative (BRII) Funding Recipients

    Science.gov (United States)

    Teplitzky, Samantha; Phillips, Margaret

    2016-01-01

    The Berkeley Research Impact Initiative (BRII) was one of the first campus-based open access (OA) funds to be established in North America and one of the most active, distributing more than $244,000 to support University of California (UC) Berkeley authors. In April 2015, we conducted a qualitative study of 138 individuals who had received BRII…

  3. ICT integration in mathematics initial teacher training and its impact on visualization: the case of GeoGebra

    Science.gov (United States)

    Dockendorff, Monika; Solar, Horacio

    2018-01-01

    This case study investigates the impact of the integration of information and communications technology (ICT) in mathematics visualization skills and initial teacher education programmes. It reports on the influence GeoGebra dynamic software use has on promoting mathematical learning at secondary school and on its impact on teachers' conceptions about teaching and learning mathematics. This paper describes how GeoGebra-based dynamic applets - designed and used in an exploratory manner - promote mathematical processes such as conjectures. It also refers to the changes prospective teachers experience regarding the relevance visual dynamic representations acquire in teaching mathematics. This study observes a shift in school routines when incorporating technology into the mathematics classroom. Visualization appears as a basic competence associated to key mathematical processes. Implications of an early integration of ICT in mathematics initial teacher training and its impact on developing technological pedagogical content knowledge (TPCK) are drawn.

  4. Initial shifts in nitrogen impact on ecosystem carbon fluxes in an alpine meadow: patterns and causes

    Directory of Open Access Journals (Sweden)

    B. Song

    2017-09-01

    Full Text Available Increases in nitrogen (N deposition can greatly stimulate ecosystem net carbon (C sequestration through positive N-induced effects on plant productivity. However, how net ecosystem CO2 exchange (NEE and its components respond to different N addition rates remains unclear. Using an N addition gradient experiment (six levels: 0, 2, 4, 8, 16, 32 gN m−2 yr−1 in an alpine meadow on the Qinghai–Tibetan Plateau, we explored the responses of different ecosystem C fluxes to an N addition gradient and revealed mechanisms underlying the dynamic responses. Results showed that NEE, ecosystem respiration (ER, and gross ecosystem production (GEP all increased linearly with N addition rates in the first year of treatment but shifted to N saturation responses in the second year with the highest NEE (−7.77 ± 0.48 µmol m−2 s−1 occurring under an N addition rate of 8 gN m−2 yr−1. The saturation responses of NEE and GEP were caused by N-induced accumulation of standing litter, which limited light availability for plant growth under high N addition. The saturation response of ER was mainly due to an N-induced saturation response of aboveground plant respiration and decreasing soil microbial respiration along the N addition gradient, while decreases in soil microbial respiration under high N addition were caused by N-induced reductions in soil pH. We also found that various components of ER, including aboveground plant respiration, soil respiration, root respiration, and microbial respiration, responded differentially to the N addition gradient. These results reveal temporal dynamics of N impacts and the rapid shift in ecosystem C fluxes from N limitation to N saturation. Our findings bring evidence of short-term initial shifts in responses of ecosystem C fluxes to increases in N deposition, which should be considered when predicting long-term changes in ecosystem net C sequestration.

  5. Videoconferencing for site initiations in clinical studies: Mixed methods evaluation of usability, acceptability, and impact on recruitment.

    Science.gov (United States)

    Randell, Rebecca; Backhouse, Michael R; Nelson, E Andrea

    2016-12-01

    A critical issue for multicentre clinical studies is conducting site initiations, ensuring sites are trained in study procedures and comply with relevant governance requirements before they begin recruiting patients. How technology can support site initiations has not previously been explored. This study sought to evaluate use of off-the-shelf web-based videoconferencing to deliver site initiations for a large national multicentre study. Participants in the initiations, including podiatrists, diabetologists, trial coordinators, and research nurses, completed an online questionnaire based on the System Usability Scale (SUS) (N = 15). This was followed by semi-structured interviews, with a consultant diabetologist, a trial coordinator, and three research nurses, exploring perceived benefits and limitations of videoconferencing. The mean SUS score for the videoconferencing platform was 87.2 (SD = 13.7), suggesting a good level of usability. Interview participants perceived initiations delivered by videoconferencing as being more interactive and easier to follow than those delivered by teleconference. In comparison to face-to-face initiations, videoconferencing takes less time, easily fitting in with the work of staff at the local sites. Perceptions of impact on communication varied according to the hardware used. Off-the-shelf videoconferencing is a viable alternative to face-to-face site initiations and confers advantages over teleconferencing.

  6. Impact of initial pulse shape on the nonlinear spectral compression in optical fibre

    Science.gov (United States)

    Boscolo, Sonia; Chaussard, Frederic; Andresen, Esben; Rigneault, Hervé; Finot, Christophe

    2018-02-01

    We theoretically study the effects of the temporal intensity profile of the initial pulse on the nonlinear propagation spectral compression process arising from nonlinear propagation in an optical fibre. Various linearly chirped input pulse profiles are considered, and their dynamics is explained with the aid of time-frequency representations. While initially parabolic-shaped pulses show enhanced spectral compression compared to Gaussian pulses, no significant spectral narrowing occurs when initially super-Gaussian pulses are used. Triangular pulses lead to a spectral interference phenomenon similar to the Fresnel bi-prism experiment.

  7. Applying the disability-adjusted life year to track health impact of social franchise programs in low- and middle-income countries.

    Science.gov (United States)

    Montagu, Dominic; Ngamkitpaiboon, Lek; Duvall, Susan; Ratcliffe, Amy

    2013-01-01

    Developing effective methods for measuring the health impact of social franchising programs is vital for demonstrating the value of this innovative service delivery model, particularly given its rapid expansion worldwide. Currently, these programs define success through patient volume and number of outlets, widely acknowledged as poor reflections of true program impact. An existing metric, the disability-adjusted life years averted (DALYs averted), offers promise as a measure of projected impact. Country-specific and service-specific, DALYs averted enables impact comparisons between programs operating in different contexts. This study explores the use of DALYs averted as a social franchise performance metric. Using data collected by the Social Franchising Compendia in 2010 and 2011, we compared franchise performance, analyzing by region and program area. Coefficients produced by Population Services International converted each franchise's service delivery data into DALYs averted. For the 32 networks with two years of data corresponding to these metrics, a paired t-test compared all metrics. Finally, to test data reporting quality, we compared services provided to patient volume. Social franchising programs grew considerably from 2010 to 2011, measured by services provided (215%), patient volume (31%), and impact (couple-years of protection (CYPs): 86% and DALYs averted: 519%), but not by the total number of outlets. Non-family planning services increased by 857%, with diversification centered in Asia and Africa. However, paired t-test comparisons showed no significant increase within the networks, whether categorized as family planning or non-family planning. The ratio of services provided to patient visits yielded considerable range, with one network reporting a ratio of 16,000:1. In theory, the DALYs averted metric is a more robust and comprehensive metric for social franchising than current program measures. As social franchising spreads beyond family planning

  8. Applying the disability-adjusted life year to track health impact of social franchise programs in low- and middle-income countries

    Science.gov (United States)

    2013-01-01

    Background Developing effective methods for measuring the health impact of social franchising programs is vital for demonstrating the value of this innovative service delivery model, particularly given its rapid expansion worldwide. Currently, these programs define success through patient volume and number of outlets, widely acknowledged as poor reflections of true program impact. An existing metric, the disability-adjusted life years averted (DALYs averted), offers promise as a measure of projected impact. Country-specific and service-specific, DALYs averted enables impact comparisons between programs operating in different contexts. This study explores the use of DALYs averted as a social franchise performance metric. Methods Using data collected by the Social Franchising Compendia in 2010 and 2011, we compared franchise performance, analyzing by region and program area. Coefficients produced by Population Services International converted each franchise's service delivery data into DALYs averted. For the 32 networks with two years of data corresponding to these metrics, a paired t-test compared all metrics. Finally, to test data reporting quality, we compared services provided to patient volume. Results Social franchising programs grew considerably from 2010 to 2011, measured by services provided (215%), patient volume (31%), and impact (couple-years of protection (CYPs): 86% and DALYs averted: 519%), but not by the total number of outlets. Non-family planning services increased by 857%, with diversification centered in Asia and Africa. However, paired t-test comparisons showed no significant increase within the networks, whether categorized as family planning or non-family planning. The ratio of services provided to patient visits yielded considerable range, with one network reporting a ratio of 16,000:1. Conclusion In theory, the DALYs averted metric is a more robust and comprehensive metric for social franchising than current program measures. As social

  9. The Autism Impact Measure (AIM): Initial Development of a New Tool for Treatment Outcome Measurement

    Science.gov (United States)

    Kanne, Stephen M.; Mazurek, Micah O.; Sikora, Darryn; Bellando, Jayne; Branum-Martin, Lee; Handen, Benjamin; Katz, Terry; Freedman, Brian; Powell, Mary Paige; Warren, Zachary

    2014-01-01

    The current study describes the development and psychometric properties of a new measure targeting sensitivity to change of core autism spectrum disorder (ASD) symptoms, the Autism Impact Measure (AIM). The AIM uses a 2-week recall period with items rated on two corresponding 5-point scales (frequency and impact). Psychometric properties were…

  10. Impacts of model initialization on an integrated surface water - groundwater model

    KAUST Repository

    Ajami, Hoori; McCabe, Matthew; Evans, Jason P.

    2015-01-01

    Integrated hydrologic models characterize catchment responses by coupling the subsurface flow with land surface processes. One of the major areas of uncertainty in such models is the specification of the initial condition and its influence

  11. Evaluating the impact of the Extractive Industries Transparency Initiative (EITI) on corruption in Zambia

    NARCIS (Netherlands)

    P. Fenton Villar (Paul); E. Papyrakis (Elissaios)

    2016-01-01

    textabstractThe Extractive Industries Transparency Initiative (EITI) is internationally recognised as a leading anti-corruption scheme, which promotes transparency, accountability and good governance of public oil, gas, and mining revenues. This article provides the first rigorous quantitative

  12. Automatic Generation of Least-Possible-Impact Traffic Management Initiatives, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Weather accounts for 70% of the annual cost of air traffic delays and cancellations, of which about 60% are estimated to be avoidable. Traffic Management Initiatives...

  13. Clean Energy Policy Analysis: Impact Analysis of Potential Clean Energy Policy Options for the Hawaii Clean Energy Initiative (HCEI)

    Energy Technology Data Exchange (ETDEWEB)

    Busche, S.; Doris, E.; Braccio, R.; Lippert, D.; Finch, P.; O' Toole, D.; Fetter, J.

    2010-04-01

    This report provides detailed analyses of 21 clean energy policy options considered by the Hawaii Clean Energy Initiative working groups for recommendation to the 2010 Hawaii State Legislature. The report considers the impact each policy may have on ratepayers, businesses, and the state in terms of energy saved, clean energy generated, and the financial costs and benefits. The analyses provide insight into the possible impacts, both qualitative and quantitative, that these policies may have in Hawaii based on the experience with these policies elsewhere. As much as possible, the analyses incorporate Hawaii-specific context to reflect the many unique aspects of energy use in the State of Hawaii.

  14. Modelling the potential impact of a sugar-sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa

    Directory of Open Access Journals (Sweden)

    Mercy Manyema

    2016-05-01

    Full Text Available Abstract Background Stroke poses a growing human and economic burden in South Africa. Excess sugar consumption, especially from sugar-sweetened beverages (SSBs, has been associated with increased obesity and stroke risk. Research shows that price increases for SSBs can influence consumption and modelling evidence suggests that taxing SSBs has the potential to reduce obesity and related diseases. This study estimates the potential impact of an SSB tax on stroke-related mortality, costs and health-adjusted life years in South Africa. Methods A proportional multi-state life table-based model was constructed in Microsoft Excel (2010. We used consumption data from the 2012 South African National Health and Nutrition Examination Survey, previously published own and cross price elasticities of SSBs and energy balance equations to estimate changes in daily energy intake and BMI arising from increased SSB prices. Stroke relative risk, and prevalent years lived with disability estimates from the Global Burden of Disease Study and modelled disease epidemiology estimates from a previous study, were used to estimate the effect of the BMI changes on the burden of stroke. Results Our model predicts that an SSB tax may avert approximately 72 000 deaths, 550 000 stroke-related health-adjusted life years and over ZAR5 billion, (USD400 million in health care costs over 20 years (USD296-576 million. Over 20 years, the number of incident stroke cases may be reduced by approximately 85 000 and prevalent cases by about 13 000. Conclusions Fiscal policy has the potential, as part of a multi-faceted approach, to mitigate the growing burden of stroke in South Africa and contribute to the achievement of the target set by the Department of Health to reduce relative premature mortality (less than 60 years from non-communicable diseases by the year 2020.

  15. Initial Northwest Power Act Power Sales Contracts : Final Environmental Impact Statement. Volume 1, Environmental Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1992-01-01

    This is volume 1 of the final environmental impact statement of the Bonneville Power Administration Information is included on the following: Purpose of and need for action; alternatives including the proposed action; affected environment; and environmental consequences.

  16. Baseline Survey for an Impact Evaluation of the Greenbelt Transformation Initiative in South Sudan

    Data.gov (United States)

    US Agency for International Development — This data set is derived from a 2013 household baseline survey in the country's Greenbelt region as part of an impact evaluation of the Food, Agribusiness, and Rural...

  17. Initial teacher training. His musical impact on children in terms of refuge

    Directory of Open Access Journals (Sweden)

    Ana Rita Castañeda-de Liendo

    2017-04-01

    Full Text Available The initial teacher training was the cultivation of teacher preparation in order to be the executors of government projects drive enacted by social groups of power in the historical development of Venezuela This article analyzes the initial teacher training in Venezuela, with the help of the logical place to unveil what characterizes the initial training of teachers historical method, specifically the working conditions of temporary shelter, and develops the axiological dynamics through musical training, which determine the current and future behavior regarding the formation of these. There is insufficient number of documents that allow raising the methodological work in the preparation of teachers of children of preschool age who are in temporary shelter provided, this work contributes to the improvement of such problems.

  18. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available The Community-based Health Planning and Services (CHPS initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  19. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Science.gov (United States)

    Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J P; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W; Falkingham, Jane; Atkinson, Peter M

    2015-01-01

    The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  20. Detection of soil moisture impact in convective initiation in the central region of Mexico

    Science.gov (United States)

    Dolores, Edgar; Caetano, Ernesto

    2017-04-01

    Soil moisture is important for understanding hydrological cycle variability in many regions. Local surface heat and moisture fluxes represent a major source of convective rainfall in Mexico during the summer, driven by positive evaporation-precipitation feedback. The effects of soil moisture are directly reflected in the limitation of evapotranspiration, affecting the development of the planetary boundary layer and, therefore, the initiation and intensity of convective precipitation. This study presents preliminary analysis of the role of soil moisture in convective initiations in central Mexico, for which a methodology for the detection of convective initiations similar to Taylor (2015) has been considered. The results show that the moisture fluxes from the surface influence the development of convection favored by mesoscale circulations at low levels. Initiations are more frequent in regions less humid than their surroundings with the very strong signal during the month of September. The knowledge of the soil predisposition to allow the development of deep convection suggests an alternative tool for the prediction of convective rains in Mexico.

  1. Investigating the Impacts of Design Heuristics on Idea Initiation and Development

    Science.gov (United States)

    Kramer, Julia; Daly, Shanna R.; Yilmaz, Seda; Seifert, Colleen M.; Gonzalez, Richard

    2015-01-01

    This paper presents an analysis of engineering students' use of Design Heuristics as part of a team project in an undergraduate engineering design course. Design Heuristics are an empirically derived set of cognitive "rules of thumb" for use in concept generation. We investigated heuristic use in the initial concept generation phase,…

  2. The impact of a technology-rich intervention on grade 7 students' skills in initial algebra

    NARCIS (Netherlands)

    Jupri, Al; Drijvers, Paul; van den Heuvel - Panhuizen, Marja

    2014-01-01

    This paper describes a classroom experiment on the use of digital technology in initial algebra. Indonesian grade seven students of 12-13 year-old took part in a four session teaching sequence on beginning algebra enriched with digital technology, and in particular applets embedded in the Digital

  3. Impact of inhomogeneity on SH-type wave propagation in an initially stressed composite structure

    Science.gov (United States)

    Saha, S.; Chattopadhyay, A.; Singh, A. K.

    2018-02-01

    The present analysis has been made on the influence of distinct form of inhomogeneity in a composite structure comprised of double superficial layers lying over a half-space, on the phase velocity of SH-type wave propagating through it. Propagation of SH-type wave in the said structure has been examined in four distinct cases of inhomogeneity viz. when inhomogeneity in double superficial layer is due to exponential variation in density only (Case I); when inhomogeneity in double superficial layers is due to exponential variation in rigidity only (Case II); when inhomogeneity in double superficial layer is due to exponential variation in rigidity, density and initial stress (Case III) and when inhomogeneity in double superficial layer is due to linear variation in rigidity, density and initial stress (Case IV). Closed-form expression of dispersion relation has been accomplished for all four aforementioned cases through extensive application of Debye asymptotic analysis. Deduced dispersion relations for all the cases are found in well-agreement to the classical Love-wave equation. Numerical computation has been carried out to graphically demonstrate the effect of inhomogeneity parameters, initial stress parameters as well as width ratio associated with double superficial layers in the composite structure for each of the four aforesaid cases on dispersion curve. Meticulous examination of distinct cases of inhomogeneity and initial stress in context of considered problem has been carried out with detailed analysis in a comparative approach.

  4. Making Inclusive Education Happen: The Impact of Initial Teacher Education in Remote Aboriginal Communities

    Science.gov (United States)

    Maher, Marguerite

    2013-01-01

    This paper discusses the "Growing Our Own" initial teacher education (ITE) pilot programme which allowed Indigenous assistant teachers in their own communities to study to become a teacher with the support of a non-Indigenous teacher. There are five sections in this paper, including: (1) the underpinning theory and philosophy of one…

  5. The impact of UV irradiation on the radical initiating capacity of dissolved dyes

    International Nuclear Information System (INIS)

    Vig, A.; Czilik, M.; Rusznak, I.

    2002-01-01

    Complete text of publication follows. Kinetics of photodecomposition of three model dyes dissolved in isopropanol-water mixture has been determined after exposure to UV radiation in the range from 360 through 400 nm and from 220 through 400 nm, respectively. It has been disclosed earlier that photodecomposition of the dissolved dyes was decelerated initially by the presence of the dissolved oxygen in the system. The presence of a radical initiator, AIBN was indispensable for arriving at the decomposition of the irradiated dye solution in the range from 360 through 400 nm. The equation of W i D = [O 2 ]/τ D was used for the calculation of radical initiating rate of the irradiated dye molecule on the isopropanol (W i D (mol/l x s)), where [O 2 ] (mol/l) is the dissolved oxygen concentration in the system and τ D (s) is duration of the induction period of the photodestruction of the dissolved dye. The equation is valid only for photodecomposition which are not chain reaction. The photodegradation of dissolved dyes was also other then chain reaction, consequently the above equation could be applied in the study too. The average radical initiating rate of the dyes applied in this study was in the order of magnitude equal to that of AIBN. The number of cycles between the first radical formation and the last regeneration of the dye molecule could be calculated in bath systems (in the presence and absence of oxygen, respectively): K = W i D /W D , where K is the number of cycles, W D (mol/l x s) is the initial rate of the decomposition of the dissolved dyed. The number of cycles in the oxygen containing systems significantly exceeded those obtained in the oxygen systems because W D was markedly higher in the latter system than in the former one

  6. Damage initiation and growth in laminated polymer compsosite plates with fluid-structure interaction under impact loading

    Directory of Open Access Journals (Sweden)

    Y Kwon

    2016-09-01

    Full Text Available Damage initiation and growth as well as dynamic response of laminated polymer composite plates were investigated with the effect of Fluid-Structure Interaction (FSI when they were subjected to impact loading. The E-glass composite plates were clamped along the boundaries and impact loading was applied from a specially designed vertical drop-impact testing machine while the plates were surrounded by either water or air. The damage and transient responses such as force- and strain-time history were measured during the progressive impact tests, and the test data collected from either impact in air or under water were compared to determine the effect of FSI. The study showed that FSI was generally detrimental to composite plates because of the hydrodynamic mass effect so that damage occurred at a lower impact force for the composite plate submerged in water. The strain measure also suggested that the FSI effect varied from location to location of the plate surface. Additionally, the FSI effect yielded a significant change in the strain response in terms of both magnitude and shape in time history for the plate in water along with progressive damage. In summary, it is essential to include the FSI effect for design and analysis of composite structures when they are in contact with water.

  7. State and local fiscal impacts associated with nuclear energy centers: some initial considerations

    International Nuclear Information System (INIS)

    Bjornstad, D.J.

    1976-04-01

    The concept of the nuclear energy center is designed to consolidate a number of electrical power reactors and/or related fuel cycle activities on a single site. Such a siting strategy would concentrate a great deal of economic activity in one area and, as a consequence, generate significant impacts on state and local governments by increasing tax bases and public service demands and by altering intergovernmental fiscal relations. This study was designed to place rough empirical measures on relevant impact variables and to highlight areas for which a need for further research was indicated.

  8. Neonatal Escherichia coli Bloodstream Infections: Clinical Outcomes and Impact of Initial Antibiotic Therapy.

    Science.gov (United States)

    Bergin, Stephen P; Thaden, Joshua T; Ericson, Jessica E; Cross, Heather; Messina, Julia; Clark, Reese H; Fowler, Vance G; Benjamin, Daniel K; Hornik, Christoph P; Smith, P Brian

    2015-09-01

    Escherichia coli is a common cause of bloodstream infections (BSIs) in infants and is associated with high mortality and morbidity among survivors. The clinical significance of antibiotic resistance and timing of appropriate antimicrobial therapy in this population is poorly understood. We identified all infants with E. coli BSIs discharged from 77 neonatal intensive care units managed by the Pediatrix Medical Group in 2012. We used multivariable logistic regression to evaluate the association between 30-day mortality and ampicillin-resistant E. coli BSI, as well as the number of active empiric antimicrobial agents administered, controlling for gestational age, small-for-gestational age status, early-onset versus late-onset BSI, oxygen requirement, ventilator support and inotropic support on the day of the first positive blood culture. We identified 258 episodes of E. coli BSI, including 123 (48%) ampicillin-resistant isolates. Unadjusted 30-day mortality did not significantly differ between infants with ampicillin-resistant versus ampicillin-susceptible E. coli BSI [11 of 123 (9%) vs. 7 of 135 (5%); P = 0.33; adjusted odds ratio = 1.37 (95% confidence interval: 0.39, 4.77)]. Among ampicillin-resistant E. coli BSIs, 30-day mortality was not significantly lower for infants treated with at least one empiric antimicrobial active against ampicillin-resistant E. coli versus infants receiving no active empiric agent [adjusted odds ratio = 1.50 (0.07, 33.6)]. In this population of infants with E. coli BSI, ampicillin resistance was not associated with significantly increased mortality. Among the subset of infants with ampicillin-resistant E. coli, appropriate empirical antibiotic therapy was not associated with lower mortality.

  9. CRISP-Psychometric Assessment of Postdivorce Stress/Adjustment in Children.

    Science.gov (United States)

    Aronson, David M.; Baum, Steven K.

    A new psychometric instrument for measuring the impact of divorce on elementary school age children was developed: the Child's Report of the Impact of Separation by Parents (CRISP). This structured projective test was specifically designed to assess children's postdivorce stress/adjustment. An initial version of the CRISP was administered to 99…

  10. Longitudinal Psychosocial Adjustment of Women to Human Papillomavirus Infection.

    Science.gov (United States)

    Hsu, Yu-Yun; Wang, Wei-Ming; Fetzer, Susan Jane; Cheng, Ya-Min; Hsu, Keng-Fu

    2018-05-29

    The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and health care information, as well as factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. A prospective longitudinal design was conducted with a convenience sample. Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed-up psychosocial adjustment. A mixed-effects model was applied to analyze the longitudinal changes in psychosocial adjustment. Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in health care orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6-12 months was significant in health care orientation. Initial emotional distress was associated with changes in psychological adjustment. Psychosocial adjustment to human papillomavirus was worse at one month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  11. What Research On Learning Transfer Can Teach About Improving The Impact of Leadership-Development Initiatives

    DEFF Research Database (Denmark)

    Sørensen, Peter

    2017-01-01

    The worldwide effort to improve organizational performance through leadership Development has been impressive, with huge sums of money being devoted to it each year. Unfortunately, the evaluation of the impact of leadership development has not kept pace, resulting in little evidence-based guidanc...

  12. Formation of Close-in Super-Earths by Giant Impacts: Effects of Initial Eccentricities and Inclinations of Protoplanets

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Yuji [Planetary Exploration Research Center, Chiba Institute of Technology, Narashino, Chiba, 275-0016 (Japan); Kokubo, Eiichiro, E-mail: ymatsumoto@cfca.nao.ac.jp [Center for Computational Astrophysics, National Astronomical Observatory of Japan, Osawa, Mitaka, Tokyo, 181-8588 (Japan)

    2017-07-01

    Recent observations have revealed the eccentricity and inclination distributions of close-in super-Earths. These distributions have the potential to constrain their formation processes. In the in situ formation scenario, the eccentricities and inclinations of planets are determined by gravitational scattering and collisions between protoplanets on the giant impact stage. We investigate the effect of the initial eccentricities and inclinations of protoplanets on the formation of close-in super-Earths. We perform N -body simulations of protoplanets in gas-free disks, changing the initial eccentricities and inclinations systematically. We find that while the eccentricities of protoplanets are well relaxed through their evolution, the inclinations are not. When the initial inclinations are small, they are not generally pumped up since scattering is less effective and collisions occur immediately after orbital crossing. On the other hand, when the initial inclinations are large, they tend to be kept large since collisional damping is less effective. Not only the resultant inclinations of planets, but also their number, eccentricities, angular momentum deficit, and orbital separations are affected by the initial inclinations of protoplanets.

  13. Multi-model assessment of the impact of soil moisture initialization on mid-latitude summer predictability

    Science.gov (United States)

    Ardilouze, Constantin; Batté, L.; Bunzel, F.; Decremer, D.; Déqué, M.; Doblas-Reyes, F. J.; Douville, H.; Fereday, D.; Guemas, V.; MacLachlan, C.; Müller, W.; Prodhomme, C.

    2017-12-01

    Land surface initial conditions have been recognized as a potential source of predictability in sub-seasonal to seasonal forecast systems, at least for near-surface air temperature prediction over the mid-latitude continents. Yet, few studies have systematically explored such an influence over a sufficient hindcast period and in a multi-model framework to produce a robust quantitative assessment. Here, a dedicated set of twin experiments has been carried out with boreal summer retrospective forecasts over the 1992-2010 period performed by five different global coupled ocean-atmosphere models. The impact of a realistic versus climatological soil moisture initialization is assessed in two regions with high potential previously identified as hotspots of land-atmosphere coupling, namely the North American Great Plains and South-Eastern Europe. Over the latter region, temperature predictions show a significant improvement, especially over the Balkans. Forecast systems better simulate the warmest summers if they follow pronounced dry initial anomalies. It is hypothesized that models manage to capture a positive feedback between high temperature and low soil moisture content prone to dominate over other processes during the warmest summers in this region. Over the Great Plains, however, improving the soil moisture initialization does not lead to any robust gain of forecast quality for near-surface temperature. It is suggested that models biases prevent the forecast systems from making the most of the improved initial conditions.

  14. Impact of initial biodegradability on sludge anaerobic digestion enhancement by thermal pretreatment.

    Science.gov (United States)

    Carrère, Hélène; Bougrier, Claire; Castets, Delphine; Delgenès, Jean Philippe

    2008-11-01

    Thermal treatments with temperature ranging from 60 to 210 degrees C were applied to 6 waste-activated sludge samples originating from high or medium load, extended aeration wastewater treatment processes that treated different wastewaters (urban, urban and industrial or slaughterhouse). COD sludge solubilisation was linearly correlated with the treatment temperature on the whole temperature range and independently of the sludge samples. Sludge batch mesophilic biodegradability increased with treatment temperature up to 190 degrees C. In this temperature range, biodegradability enhancement or methane production increase by thermal hydrolysis was shown to be a function of sludge COD solubilisation but also of sludge initial biodegradability. The lower the initial biodegradability means the higher efficiency of thermal treatment.

  15. Initial impact of integrated agricultural research for development in East and Central Africa

    OpenAIRE

    Nkonya, Ephraim; Kato, Edward; Oduol, Judith; Pali, Pamela; Farrow, Andrew

    2013-01-01

    Conventional agricultural research approaches have generated research results with limited adoption rates in sub-Saharan Africa (SSA). Recently, a new research approach – integrated agricultural research for development (IAR4D) was introduced in SSA. The IAR4D approach goes beyond the conventional research focus on agricultural production technologies, as it includes marketing and development activities. This paper analyses the impact of IAR4D in the East and Central African region using pa...

  16. Development and initial validation of the Bristol Impact of Hypermobility questionnaire.

    Science.gov (United States)

    Palmer, S; Cramp, F; Lewis, R; Gould, G; Clark, E M

    2017-06-01

    Stage 1 - to identify the impact of joint hypermobility syndrome (JHS) on adults; Stage 2 - to develop a questionnaire to assess the impact of JHS; and Stage 3 - to undertake item reduction and establish the questionnaire's concurrent validity. A mixed methods study employing qualitative focus groups and interviews (Stage 1); a working group of patients, clinicians and researchers, and 'think aloud' interviews (Stage 2); and quantitative analysis of questionnaire responses (Stage 3). Stages 1 and 2 took place in one secondary care hospital in the UK. Members of a UK-wide patient organisation were recruited in Stage 3. In total, 15, four and 615 participants took part in Stages 1, 2 and 3, respectively. Inclusion criteria were: age ≥18 years; diagnosis of JHS; no other conditions affecting physical function; able to give informed consent; and able to understand and communicate in English. None. The development of a questionnaire to assess the impact of JHS. Stage 1 identified a wide range of impairments, activity limitations and participation restrictions In Stage 2, a draft questionnaire was developed and refined following 'think aloud' analysis, leaving 94 scored items. In Stage 3, items were removed on the basis of low severity and/or high correlation with other items. The final Bristol Impact of Hypermobility (BIoH) questionnaire had 55 scored items, and correlated well with the physical component score of the Short Form 36 health questionnaire (r=-0.725). The BIoH questionnaire demonstrated good concurrent validity. Further psychometric properties need to be established. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  17. Initiating running barefoot: Effects on muscle activation and impact accelerations in habitually rearfoot shod runners.

    Science.gov (United States)

    Lucas-Cuevas, Angel Gabriel; Priego Quesada, José Ignacio; Giménez, José Vicente; Aparicio, Inma; Jimenez-Perez, Irene; Pérez-Soriano, Pedro

    2016-11-01

    Runners tend to shift from a rearfoot to a forefoot strike pattern when running barefoot. However, it is unclear how the first attempts at running barefoot affect habitually rearfoot shod runners. Due to the inconsistency of their recently adopted barefoot technique, a number of new barefoot-related running injuries are emerging among novice barefoot runners. The aim of this study was therefore to analyse the influence of three running conditions (natural barefoot [BF], barefoot with a forced rearfoot strike [BRS], and shod [SH]) on muscle activity and impact accelerations in habitually rearfoot shod runners. Twenty-two participants ran at 60% of their maximal aerobic speed while foot strike, tibial and head impact accelerations, and tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscle activity were registered. Only 68% of the runners adopted a non-rearfoot strike pattern during BF. Running BF led to a reduction of TA activity as well as to an increase of GL and GM activity compared to BRS and SH. Furthermore, BRS increased tibial peak acceleration, tibial magnitude and tibial acceleration rate compared to SH and BF. In conclusion, 32% of our runners showed a rearfoot strike pattern at the first attempts at running barefoot, which corresponds to a running style (BRS) that led to increased muscle activation and impact accelerations and thereby to a potentially higher risk of injury compared to running shod.

  18. Salmeterol/fluticasone stable-dose treatment compared with formoterol/budesonide adjustable maintenance dosing: impact on health-related quality of life

    Directory of Open Access Journals (Sweden)

    Williams Angela E

    2007-07-01

    Full Text Available Abstract Background Improving patients' health-related quality of life (HRQoL is recognized as a fundamental part of asthma management. The aims of this study were to evaluate the long-term efficacy (including symptom-free days and exacerbations and impact on HRQoL of a stable-dose regimen of salmeterol/fluticasone propionate (SAL/FP and an adjustable maintenance dosing (AMD regimen of formoterol/budesonide (FOR/BUD where treatment is adjusted based on symptoms [SAM40056]. Methods A total of 688 outpatients with asthma receiving regular low-dose inhaled corticosteroids (ICS plus a long-acting β2-agonist, or medium dose ICS alone participated in this randomized, double-blind, double-dummy, parallel-group, 1-year trial, which was conducted in 91 centers in 15 countries. Patients were randomized to receive 1 inhalation of SAL/FP 50/250 μg BID or 2 inhalations of FOR/BUD 6/200 μg BID during Weeks 1–4. For Weeks 5–52, patients meeting strict continuation criteria for stable asthma at Week 4 received AMD with FOR/BUD or stable-dose SAL/FP. Results The percentage of symptom-free days was significantly greater (58.8% vs 52.1%; p = 0.034 and the annual exacerbation rate was significantly lower (47%; p = 0.008 with stable-dose SAL/FP compared with FOR/BUD AMD. A total of 568 patients completed the Asthma Quality of Life Questionnaire (AQLQ at least once during the study. The mean change from baseline in AQLQ overall score was numerically greater with SAL/FP than FOR/BUD at week 28 and week 52, but did not reach statistical significance (p = 0.121 at Week 52. However, in a post hoc logistic regression analyses for any AQLQ improvement, significant benefits with SAL/FP were seen at both time points (p = 0.038 and p = 0.009, respectively. The minimally important difference of ≥ 0.5-point improvement in AQLQ overall score was achieved by a significantly greater number of patients receiving SAL/FP at Week 28 (68% vs 60%; p = 0.049; a trend for this

  19. The impact of age and sex adjusted body mass index (ISO-BMI) in obese versus non-obese children and adolescents with cholecystectomy.

    Science.gov (United States)

    Kiuru, Eveliina; Kokki, Hannu; Juvonen, Petri; Lintula, Hannu; Paajanen, Hannu; Gissler, Mika; Eskelinen, Matti

    2014-01-01

    The impact of the age and sex adjusted body mass index (ISO-BMI) in the obese vs. non-obese children and adolescents with cholecystectomy for cholelithias is rarely reported. The national database was searched for cholecystectomies performed in paediatric patients between 1997 and 2011, and the 59 paediatric and adolescent patients having cholecystectomy in the Kuopio University Hospital district were divided in two groups by age and sex adjusted BMI (ISO-BMI) using the cut-off point of overweight (ISO-BMI 25 kg/m(2)) based on the Finnish growth standards. Nationwide a total of 840 cholecystectomies were performed during the 15 years study period in Finland, most of which included females (77%), resulting in a mean of annual frequency of 4.8 (range: 3.9-6.1) procedures/100,000 population. In the study sample, most of the patients with the cholelithiasis were female (50/59, 85%). The gender distribution was equal among the younger patients, but among adolescents 6/52 (12%) of the patients with cholelithiasis were boys and 46/52 (88%) of the patients with cholelithiasis were girls. Obesity did not affect on operative parameters. The median operative time was 70 min (range, 30-155) and 66 min (44-130) in the high ISO-BMI-group. The recovery was similar in the two groups: the median length of hospital stay was 4 days in both groups. The patients in the low ISO-BMI-group vs. high ISO-BMI-group had a trend of higher serum bilirubin (p=0.16) and serum AFOS values (p=0.19). In the histological examination of the gallbladders 19/28 (68%) patients in the low ISO-BMI-group had inflammation vs. 26/31 (84%) patients in the high ISO-BMI-group (p=0.15). Our results between obese and non-obese children and adolescents with cholelithiasis are not statistically significant. The obese adolescents with female gender are in greater risk for cholelithiasis. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  20. Impact of previous ART and of ART initiation on outcome of HIV-associated tuberculosis.

    Science.gov (United States)

    Girardi, Enrico; Palmieri, Fabrizio; Angeletti, Claudio; Vanacore, Paola; Matteelli, Alberto; Gori, Andrea; Carbonara, Sergio; Ippolito, Giuseppe

    2012-01-01

    Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available. A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics. Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0-16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis. ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death.

  1. Impact of particle density and initial volume on mathematical compression models

    DEFF Research Database (Denmark)

    Sonnergaard, Jørn

    2000-01-01

    In the calculation of the coefficients of compression models for powders either the initial volume or the particle density is introduced as a normalising factor. The influence of these normalising factors is, however, widely different on coefficients derived from the Kawakita, Walker and Heckel...... equations. The problems are illustrated by investigations on compaction profiles of 17 materials with different molecular structures and particle densities. It is shown that the particle density of materials with covalent bonds in the Heckel model acts as a key parameter with a dominating influence...

  2. Measuring health systems strength and its impact: experiences from the African Health Initiative.

    Science.gov (United States)

    Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M; Bawah, Ayaga; Condo, Jeanine; Mutale, Wilbroad

    2017-12-21

    Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and

  3. Urban Security Initiative: Earthquake impacts on the urban ``system of systems``

    Energy Technology Data Exchange (ETDEWEB)

    Maheshwari, S.; Jones, E.; Rasmussen, S.

    1999-06-01

    This paper is a discussion of how to address the problems of disasters in a large city, a project titled Urban Security Initiative undertaken by the Los Alamos National Laboratory. The paper first discusses the need to address the problems of disasters in large cities and ten provides a framework that is suitable to address this problem. The paper then provides an overview of the module of the project that deals with assessment of earthquake damage on urban infrastructure in large cities and an internet-based approach for consensus building leading to better coordination in the post-disaster period. Finally, the paper discusses the future direction of the project.

  4. Senate Voting On the Strategic Defense Initiative: The Impact of the 1991 Gulf War

    Directory of Open Access Journals (Sweden)

    James F. Pasley

    2012-04-01

    Full Text Available This paper examines the effects of the success of the Patriot missile system in the 1991 Gulf War on Senate roll call votes for the Strategic Defense Initiative (SDI. Previous studies have shown that both Party Identification (PID and Ideology have had a significant effect on senators' votes on defense weapons systems. Using Logit regression techniques, this paper examines whether PID and Ideology, both of which are central to political identity, remained significant factors in three Senate votes on SDI; this paper is unique compare to previous studies of such matters in that it adds two additional explanatory variables to existing models: (1 the extent to which each state might benefit from SDI and (2 whether or not the senator from each state was up for re-election in 1992 It is hypothesized that the findings will suggest that external factors played a role in the SDI Senate votes in question. Specifically, it is hypothesized that the effects of the Gulf War Patriot missile successes led to greater legislative support (compared to support levels from previous years for the Strategic Defense Initiative among Democrats, those senators whose states would benefit from SDI funding, and those senators seeking re-election.

  5. Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis.

    Science.gov (United States)

    Yu, Yusheng; Zhou, Yan; Wang, Han; Zhou, Tingting; Li, Qing; Li, Taoyu; Wu, Yan; Liu, Zhihong

    2014-06-01

    We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal dialysis (PD). In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 (control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place. Peritonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy. After implementation of the CQI initiative, the peritonitis rate declined to 1 episode in 77.25 patient-months from 1 episode in 22.86 patient-months. Ultrasound parameters of cardiac structure were generally unchanged in the CQI group, but significant increases in cardiothoracic ratio and interventricular septal thickness were observed in the control group (both p improve technique survival rates: 95.6%, 92.6%, and 92.6% in the CQI group compared with 89.6%, 79.2%, and 76.8% in the control group (p improve the quality of therapy and its outcomes. Copyright © 2014 International Society for Peritoneal Dialysis.

  6. Impact of Communication on Parents' and First-Year College Students' Ratings of Student Academic, Emotional, and Social Adjustment

    Science.gov (United States)

    Yogan, Lissa; Freedle, Agata; Ringenberg, Matthew

    2017-01-01

    This study explored the effects of parents' and students' communication patterns on students' social, emotional, and academic adjustment to college. It matched 118 pairs of parents and students (n = 236) and asked them to report their frequency and mode of communication, as well as the first-year students' perceived adjustment to college. The…

  7. Environmental impact statement for initiation of transuranic waste disposal at the waste isolation pilot plant

    International Nuclear Information System (INIS)

    Johnson, H.E.; Whatley, M.E.

    1996-01-01

    WIPP's long-standing mission is to demonstrate the safe disposal of TRU waste from US defense activities. In 1980, to comply with NEPA, US DOE completed its first environmental impact statement (EIS) which compared impacts of alternatives for TRU waste disposal. Based on this 1980 analysis, DOE decided to construct WIPP in 1981. In a 1990 decision based on examination of alternatives in a 1990 Supplemental EIS, DOE decided to continue WIPP development by proceeding with a testing program to examine WIPP's suitability as a TRU waste repository. Now, as DOE's Carlsbad Area Office (CAO) attempts to complete its regulatory obligations to begin WIPP disposal operations, CAO is developing WIPP's second supplemental EIS (SEIS-II). To complete the SEIS-II, CAO will have to meet a number of challenges. This paper explores both the past and present EISs prepared to evaluate the suitability of WIPP. The challenges in completing an objective comparison of alternatives, while also finalizing other critical-path compliance documents, controlling costs, and keeping stakeholders involved during the decision-making process are addressed

  8. Measuring the difference made by conservation initiatives: protected areas and their environmental and social impacts.

    Science.gov (United States)

    Ferraro, Paul J; Pressey, Robert L

    2015-11-05

    Success in conservation depends on our ability to reduce human pressures in areas that harbour biological diversity and ecosystem services. Legally protecting some of these areas through the creation of protected areas is a key component of conservation efforts globally. To develop effective protected area networks, practitioners need credible, scientific evidence about the degree to which protected areas affect environmental and social outcomes, and how these effects vary with context. Such evidence has been lacking, but the situation is changing as conservation scientists adopt more sophisticated research designs for evaluating protected areas' past impacts and for predicting their future impacts. Complementing these scientific advances, conservation funders and practitioners are paying increasing attention to evaluating their investments with more scientifically rigorous evaluation designs. This theme issue highlights recent advances in the science of protected area evaluations and explores the challenges to developing a more credible evidence base that can help societies achieve their goals of protecting nature while enhancing human welfare. © 2015 The Author(s).

  9. Poor WOMAC scores in contralateral knee negatively impact TKA outcomes: data from the osteoarthritis initiative.

    Science.gov (United States)

    Kahn, Timothy L; Soheili, Aydin C; Schwarzkopf, Ran

    2014-08-01

    While total knee arthroplasty (TKA) has been shown to have excellent outcomes, a significant proportion of patients experience relatively poor post-operative function. In this study, we test the hypothesis that the level of osteoarthritic symptoms in the contralateral knee at the time of TKA is associated with poorer post-operative outcomes in the operated knee. Using longitudinal cohort data from the Osteoarthritis Initiative (OAI), we included 171 patients who received a unilateral TKA. We compared pre-operative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in the contralateral knee to post-operative WOMAC scores in the index knee. Pre-operative contralateral knee WOMAC scores were associated with post-operative index knee WOMAC Total scores, indicating that the health of the pre-operative contralateral knee is a significant factor in TKA outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. The impact of resolution on the adjustment and decadal variability of the Atlantic meridional overturning circulation in a coupled climate model

    Energy Technology Data Exchange (ETDEWEB)

    Hodson, Daniel L.R.; Sutton, Rowan T. [University of Reading, NCAS-Climate, Department of Meteorology, Earley Gate, PO Box 243, Reading (United Kingdom)

    2012-12-15

    Variations in the Atlantic meridional overturning circulation (MOC) exert an important influence on climate, particularly on decadal time scales. Simulation of the MOC in coupled climate models is compromised, to a degree that is unknown, by their lack of fidelity in resolving some of the key processes involved. There is an overarching need to increase the resolution and fidelity of climate models, but also to assess how increases in resolution influence the simulation of key phenomena such as the MOC. In this study we investigate the impact of significantly increasing the (ocean and atmosphere) resolution of a coupled climate model on the simulation of MOC variability by comparing high and low resolution versions of the same model. In both versions, decadal variability of the MOC is closely linked to density anomalies that propagate from the Labrador Sea southward along the deep western boundary. We demonstrate that the MOC adjustment proceeds more rapidly in the higher resolution model due the increased speed of western boundary waves. However, the response of the Atlantic sea surface temperatures to MOC variations is relatively robust - in pattern if not in magnitude - across the two resolutions. The MOC also excites a coupled ocean-atmosphere response in the tropical Atlantic in both model versions. In the higher resolution model, but not the lower resolution model, there is evidence of a significant response in the extratropical atmosphere over the North Atlantic 6 years after a maximum in the MOC. In both models there is evidence of a weak negative feedback on deep density anomalies in the Labrador Sea, and hence on the MOC (with a time scale of approximately ten years). Our results highlight the need for further work to understand the decadal variability of the MOC and its simulation in climate models. (orig.)

  11. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Virginia M., E-mail: vweaver@jhsph.edu [Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Johns Hopkins University School of Medicine, Baltimore, MD (United States); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Vargas, Gonzalo García [Faculty of Medicine, University of Juárez of Durango State, Durango (Mexico); Secretaría de Salud del Estado de Coahuila, Coahuila, México (Mexico); Silbergeld, Ellen K. [Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Rothenberg, Stephen J. [Instituto Nacional de Salud Publica, Centro de Investigacion en Salud Poblacional, Cuernavaca, Morelos (Mexico); Fadrowski, Jeffrey J. [Johns Hopkins University School of Medicine, Baltimore, MD (United States); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Rubio-Andrade, Marisela [Faculty of Medicine, University of Juárez of Durango State, Durango (Mexico); Parsons, Patrick J. [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY (United States); Department of Environmental Health Sciences, School of Public Health, University at Albany, Albany, NY (United States); Steuerwald, Amy J. [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY (United States); and others

    2014-07-15

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m{sup 2}; 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary. - Highlights: • Positive associations between urine metals and creatinine-based eGFR are unexpected. • Optimal approach to urine concentration adjustment for urine biomarkers uncertain. • We compared urine concentration adjustment methods. • Positive associations observed only with urine creatinine adjustment. • Additional research using non-creatinine-based methods of adjustment needed.

  12. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents

    International Nuclear Information System (INIS)

    Weaver, Virginia M.; Vargas, Gonzalo García; Silbergeld, Ellen K.; Rothenberg, Stephen J.; Fadrowski, Jeffrey J.; Rubio-Andrade, Marisela; Parsons, Patrick J.; Steuerwald, Amy J.

    2014-01-01

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m 2 ; 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary. - Highlights: • Positive associations between urine metals and creatinine-based eGFR are unexpected. • Optimal approach to urine concentration adjustment for urine biomarkers uncertain. • We compared urine concentration adjustment methods. • Positive associations observed only with urine creatinine adjustment. • Additional research using non-creatinine-based methods of adjustment needed

  13. Reviewing the impact of organisational factors on nuclear power plants safety. A Spanish research initiative

    International Nuclear Information System (INIS)

    Sola, R.; Garces, M.I.; Vaquero, C.; Sendio, F.; De la Cal, C.; Villadoniga, J.I.

    2000-01-01

    This paper describes the Spanish R and D project 'Development of methods to evaluate and model the impact of organisation on nuclear power plants safety' framed in an specific agreement among UNESA (Association of Spanish Utilities), CSN (Spanish Nuclear Safety Council) and CIEMAT (Research Centre for Energy, Environment and Technology), being this last one the institution in charge of the development of the research activities. The main goal of the proposed project is to increase the knowledge related the way nuclear power plants organise and manage their activities to enhance safety. This goal will be achieved through three perspectives: the development of preventive and corrective methodologies and the development of models to incorporate the organisation and management in the probabilistic safety assessment, PSA. (author)

  14. Impact of recent Federal tax and R and D initiatives on enhanced oil recovery

    International Nuclear Information System (INIS)

    Brashear, J.P.; Biglarbigi, K.; Ray, M.R.

    1991-01-01

    The National Energy Strategy contains two major elements designed to increase oil production from known reservoirs in the contiguous United States: (1) a tax credit for specific investment and injectant costs for qualified enhanced oil recovery (EOR) projects; and (2) a highly focused, public-private cooperative R ampersand D program. Both are currently being implemented by the Department of the Treasury and the Department of Energy, respectively. The present paper estimates the potential reserve additions and impacts on public treasuries at oil prices between $22 and $34/Bbl. The new Federal tax credit, alone, could doubler current proved EOR reserves at oil prices in the $22/Bbl range and increase them by about one-third at prices in the $30/Bbl range. The effect of technology advances alone could also about double EOR reserves at these prices. The combination of technology advances and the tax incentive synergistically amplifies the effects on potential EOR reserves

  15. Residual pathological stage at radical cystectomy significantly impacts outcomes for initial T2N0 bladder cancer.

    Science.gov (United States)

    Isbarn, Hendrik; Karakiewicz, Pierre I; Shariat, Shahrokh F; Capitanio, Umberto; Palapattu, Ganesh S; Sagalowsky, Arthur I; Lotan, Yair; Schoenberg, Mark P; Amiel, Gilad E; Lerner, Seth P; Sonpavde, Guru

    2009-08-01

    We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease. We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0). None received perioperative chemotherapy. Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates. Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery. Residual pT stage at radical cystectomy was P0 in 24 (11.5%) patients, Pa in 9 (4.3%), PCIS in 22 (10.6%), P1 in 35 (16.8%) and P2 in 118 (56.7%). Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses. The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100%, 85% and 75%, respectively. The 5-year cancer specific survival rates for the same cohorts were 100%, 93% and 81%, respectively. On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02). Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality. Further validation of this finding is warranted.

  16. Impact of Rocuronium and Succinylcholine on Sedation Initiation After Rapid Sequence Intubation.

    Science.gov (United States)

    Johnson, Eric G; Meier, Alex; Shirakbari, Alicia; Weant, Kyle; Baker Justice, Stephanie

    2015-07-01

    Rapid sequence intubation (RSI) involves a rapidly acting sedative plus a neuromuscular blocking agent (NMBA) to facilitate endotracheal intubation. Rocuronium and succinylcholine are NMBAs commonly used in RSI with drastically different durations of action. Evaluate whether patients receiving RSI with a longer-acting NMBA had a greater delay in sedation or analgesia than patients that received a short-acting NMBA. This was a retrospective review of patients presenting to the emergency department requiring endotracheal intubation. Exclusions included age rocuronium or succinylcholine. Secondary endpoints included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), and impact of an emergency medicine pharmacist (EPh). A total 106 patients met inclusion criteria, 76 patients receiving rocuronium and 30 receiving succinylcholine. Mean time to sedation or analgesia was longer in the rocuronium group when compared to the succinylcholine group at 34 ± 36 min vs. 16 ± 21 min (p = 0.002). In the presence of an EPh, the mean time to sedation or analgesia was 20 ± 21 min, vs. 49 ± 45 min (p rocuronium in RSI had a significantly longer time to sedation or analgesia when compared to patients receiving succinylcholine. The presence of an EPh significantly decreased the time to administration of sedation or analgesia after RSI. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Initial assessment of intrinsic and assisted bioremediation potential for diesel fuel impacted soils at Eureka, NWT

    International Nuclear Information System (INIS)

    Wilson, J. J.; Yeske, B.; Lee, D.; Nahir, M.

    1999-01-01

    Two diesel fuel-impacted soil columns prepared to simulate in situ conditions for assessing intrinsic bioremediation were studied. The samples were from Eureka in the Northwest Territories. Two soil jars that were mixed periodically to simulate the ex situ land treatment bioremediation option, were also part of the treatability study. Results strongly suggest that bioremediation at Eureka is a viable option, although the slow rate of biodegradation and the short operating season will necessitate treatment over several years to achieve the remediation endpoint. The intrinsic bioremediation process can be accelerated using periodic addition of a water soluble nitrogen fertilizer, as shown by the nitrogen-amended soil column test. Ex situ bioremediation also appears to be possible judged by the response of the natural bacterial population to periodic mixing and oxygen uptake at 5 degrees C. The principal challenge will be to adequately mix the soil at the surface and to prevent it from drying out. The addition of organic bulking material may be required. 1 ref., 3 tabs., 4 figs

  18. Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis.

    Science.gov (United States)

    Leone, Bernardo Amadeo; Vallejo, Carlos Teodoro; Romero, Alberto Omar; Machiavelli, Mario Raúl; Pérez, Juan Eduardo; Leone, Julieta; Leone, José Pablo

    2017-02-01

    To analyze the prognostic influence of metastatic pattern (MP) compared with other biologic and clinical factors in stage IV breast cancer at initial diagnosis (BCID) and evaluate factors associated with specific sites of metastases (SSM). We evaluated women with stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results program from 2010 to 2013. MP was categorized as bone-only, visceral, bone and visceral (BV), and other. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with SSM. We included 9143 patients. Bone represented 37.5% of patients, visceral 21.9%, BV 28.8%, and other 11.9%. Median OS by MP was as follows: bone 38 months, visceral 21 months, BV 19 months, and other 33 months (P < 0.0001). Univariate analysis showed that higher number of metastatic sites had worse prognosis. In multivariate analysis, older age (hazard ratio 1.9), black race (hazard ratio 1.17), grade 3/4 tumors (hazard ratio 1.6), triple-negative (hazard ratio 2.24), BV MP (hazard ratio 2.07), and unmarried patients (hazard ratio 1.25) had significantly shorter OS. As compared with HR+/HER2- tumors, triple-negative and HR-/HER2+ had higher odds of brain, liver, lung, and other metastases. HR+/HER2+ had higher odds of liver metastases. All three subtypes had lower odds of bone metastases. There were substantial differences in OS according to MP. Tumor subtypes have a clear influence among other factors on SSM. We identified several prognostic factors that could guide therapy selection in treatment naïve patients.

  19. The impact of a workplace catering initiative on dietary intakes of salt and other nutrients: a pilot study.

    Science.gov (United States)

    Geaney, F; Harrington, J; Fitzgerald, Ap; Perry, Ij

    2011-08-01

    Owing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting. A cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes. Two public sector hospitals in Cork, Ireland. A total of 100 random participants aged 18-64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program). Reported mean intakes of total sugars (P catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices. Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet.

  20. Initial Impacts of the Mount Polley Tailings Pond Breach on Adjacent Aquatic Ecosystems

    Science.gov (United States)

    Petticrew, Ellen; Gantner, Nikolaus; Albers, Sam; Owens, Philip

    2015-04-01

    . Notably, some of these fish provide food to recipients as diverse as aboriginal communities and large commercial markets embedded within a global marketplace. Moreover, metals can be accumulated in aquatic organisms, thus it is very important to understand its long-term biomagnification and potential health effects on organisms. We present initial findings from physical and chemical limnological early response-sampling and recommendations for future monitoring in the affected watershed.

  1. Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

    Science.gov (United States)

    Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

    2017-01-01

    Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

  2. Impact of analgesics on executive function and memory in the Alzheimer's Disease Neuroimaging Initiative Database.

    Science.gov (United States)

    Doan, Lisa; Choi, Daniel; Kline, Richard

    2017-10-01

    Pain is common in older adults but may be undertreated in part due to concerns about medication toxicity. Analgesics may affect cognition. In this retrospective cohort study, we used the Alzheimer's Disease Neuroimaging Initiative (ADNI) database to examine the interaction of cognitive status and medications, especially non-steroidal anti-inflammatory drugs (NSAIDs). We hypothesized NSAID use would be associated with cognition and that this could be mediated through changes in brain structure. In this post hoc analysis of the ADNI database, subjects were selected by searching the "concurrent medications log" for analgesic medications. Subjects were included if the analgesic was listed on the medication log prior to enrollment in ADNI and throughout the study. Subjects taking analgesics, particularly NSAIDs, at each study visit were compared to control subjects taking no analgesics. Using descriptive statistics as well as univariate, multivariate and repeated measure ANOVA, we explored the relationship between NSAID use and scores for executive function and memory related cognitive activities. We further took advantage of the extensive magnetic resonance imaging (MRI) data available in ADNI to test whether cognitive change was associated with brain structure. The multitude of imaging variables was compressed into a small number of features (five eigenvectors (EV)) using principal component analysis. There were 87 NSAID users, 373 controls, and 71 taking other analgesics. NSAID use was associated with higher executive function scores for cognitively normal (NL) subjects as well as subjects with mild cognitive impairment (MCI). NSAID use was also associated with higher memory scores, but for NL females only. We analysed MRI data using principal component analysis to generate a set of five EVs. Examining NL and MCI subjects, one EV had significantly larger values in subjects taking NSAIDs versus control. This EV was one of two EVs which significantly correlated with

  3. Do fair value adjustments influence dividend policy?

    NARCIS (Netherlands)

    Goncharov, I.; van Triest, S.

    2011-01-01

    We examine the impact of positive fair value adjustments on dividend policy. If fair value adjustments are transitory in nature and managers are able to assess their implications for future earnings, fair value adjustments in net income is expected to have no distribution consequences. However,

  4. Small-scale bioenergy initiatives: brief description and preliminary lessons on livelihood impacts from case studies in Asia, Latin America and Afica. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-01-15

    Fifteen case studies from Africa, Asia, and Latin America were undertaken to assess the impacts that different types of local-level bioenergy initiatives can have on rural livelihoods. The report concludes with preliminary lessons and recommendations for further work.

  5. Economic and energy impacts from participation in the regional greenhouse gas initiative: A case study of the State of Maryland

    International Nuclear Information System (INIS)

    Ruth, Matthias; Gabriel, Steven A.; Palmer, Karen L.; Burtraw, Dallas; Paul, Anthony; Chen, Yihsu; Hobbs, Benjamin F.; Irani, Daraius; Michael, Jeffrey; Ross, Kim M.; Conklin, Russell; Miller, Julia

    2008-01-01

    Tradable emissions allowance systems to reduce carbon emissions are increasingly promoted as means to mitigate climate change. This paper briefly reviews the application of such systems at the global, regional, and corporate scales. Given the recent expansion of cap-and-trade systems at the regional level, the paper concentrates on energy and economic implications at that level, using the decision of the State of Maryland, USA, to join the Regional Greenhouse Gas Initiative as an illustration. The paper presents the results of an analysis of the implications for technology choice, generation capacity, energy reliability, and cost to ratepayers of that decision, combining a national electricity market model with a regional model that includes market power and an economic impact model. The results suggest several issues that will be key to the acceptability and effectiveness of cap-and-trade systems for regional climate change mitigation policy, including rules for distribution of allowances and subsidies for energy efficiency programs. (author)

  6. Economic and energy impacts from participation in the regional greenhouse gas initiative: A case study of the State of Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Ruth, Matthias [Center for Integrative Environmental Research, Division of Research, University of Maryland, 2101 Van Munching Hall, College Park, MD 20742 (United States); Environmental Policy Program, School of Public Policy, University of Maryland, MD (United States); Department of Civil and Environmental Engineering, A. James Clark School of Engineering, University of Maryland, MD (United States); Gabriel, Steven A. [Center for Integrative Environmental Research, Division of Research, University of Maryland, 2101 Van Munching Hall, College Park, MD 20742 (United States); Department of Civil and Environmental Engineering, A. James Clark School of Engineering, University of Maryland, MD (United States); Applied Mathematics and Scientific Computation Program, University of Maryland, College Park, Maryland, MD (United States); Palmer, Karen L.; Burtraw, Dallas; Paul, Anthony [Resources for the Future, Washington, DC (United States); Chen, Yihsu [School of Engineering, Social Sciences, Humanities and Arts, University of California, Merced, CA (United States); Hobbs, Benjamin F. [Department of Geography and Environmental Engineering, Whiting School of Engineering, The Johns Hopkins University, MD (United States); Irani, Daraius [Regional Economic Studies Institute, Towson University, Towson, Maryland, MD (United States); Michael, Jeffrey [Eberhardt School of Business, University of the Pacific, Stockton, CA (United States); Ross, Kim M. [Center for Integrative Environmental Research, Division of Research, University of Maryland, 2101 Van Munching Hall, College Park, MD 20742 (United States); Conklin, Russell; Miller, Julia [Center for Integrative Environmental Research, Division of Research, University of Maryland, 2101 Van Munching Hall, College Park, MD 20742 (United States); Environmental Policy Program, School of Public Policy, University of Maryland, MD (United States)

    2008-06-15

    Tradable emissions allowance systems to reduce carbon emissions are increasingly promoted as means to mitigate climate change. This paper briefly reviews the application of such systems at the global, regional, and corporate scales. Given the recent expansion of cap-and-trade systems at the regional level, the paper concentrates on energy and economic implications at that level, using the decision of the State of Maryland, USA, to join the Regional Greenhouse Gas Initiative as an illustration. The paper presents the results of an analysis of the implications for technology choice, generation capacity, energy reliability, and cost to ratepayers of that decision, combining a national electricity market model with a regional model that includes market power and an economic impact model. The results suggest several issues that will be key to the acceptability and effectiveness of cap-and-trade systems for regional climate change mitigation policy, including rules for distribution of allowances and subsidies for energy efficiency programs. (author)

  7. Initial Clinical Experience With the Strut-Adjusted Volume Implant (SAVI) Breast Brachytherapy Device for Accelerated Partial-Breast Irradiation (APBI): First 100 Patients With More Than 1 Year of Follow-Up

    International Nuclear Information System (INIS)

    Yashar, Catheryn M.; Scanderbeg, Daniel; Kuske, Robert; Wallace, Anne; Zannis, Victor; Blair, Sarah; Grade, Emily; Swenson, Virginia H.; Quiet, Coral

    2011-01-01

    Purpose: The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry brachytherapy device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials: One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results: The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon brachytherapy. The recurrence rate was 1%. Conclusions: The SAVI appears to safely allow an increase in eligibility for APBI over balloon brachytherapy or three-dimensional conformal radiation, highlighting the outstanding device flexibility to maximize the target dose and minimize the

  8. The impact on air quality of energy saving measures in the major cities signatories of the Covenant of Mayors initiative.

    Science.gov (United States)

    Monforti-Ferrario, Fabio; Kona, Albana; Peduzzi, Emanuela; Pernigotti, Denise; Pisoni, Enrico

    2018-06-08

    This study is a first attempt to evaluate how the major efforts made by several European cities in the frame of the Covenant of Mayors (CoM) initiative can impact the air pollution levels in the participating cities. CoM is by no mean one of the major cities initiatives aimed at mitigating climate change, supporting local authorities in the implementation of their climate action plans. Energy savings measures reported in the CoM cities' action plans have been analysed from the air quality perspective in order to find quantitative relations in the way local authorities deal with mitigation and how these practices are expected to have consequences on the air quality at urban level and finally positively impacting the citizens' health. In the paper, the air quality 2713 energy saving measures proposed by 146 cities located in 23 countries in the frame of the CoM are selected and their co-benefits for air quality and public health estimated by means of SHERPA, a fast modelling tool that mimics the behaviour of a full physically-based Chemical Transport Model. Besides evaluating the overall benefits of this subset of mitigation measures for the air quality, the study also investigates the relevance of some factors such as the implementation sector, the city size and the pollution levels in achieving the highest possible co-benefits. The results presented refer to the special field covered by the study, i.e. energy saving measures and are not automatically referable to other types of measures. Nevertheless, they clearly show how climate mitigation and air quality policies are deeply interconnected at the urban level. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Timing of Initiating Glycopeptide Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: The Impact on Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Chen-Hsiang Lee

    2013-01-01

    Full Text Available When a Staphylococcus-like organism (SLO is microscopically found in Gram staining of blood culture (BC specimen, it seems reasonable to administrate a glycopeptide (GP for empirical therapy. The paper investigates the risk factors for 14-day mortality in patients with methicillin-resistance Staphylococcus aureus bacteremia (MRSAB and clarifies the impact of the timing for initiating GP therapy. A retrospective study identifies patients with MRSAB (endocarditis was excluded between 2006 and 2009. Patients were categorized as receiving GP at the interval before a preliminary BC report indicating the growth of SLO and the onward 24 hours or receiving GP 24 h after a preliminary BC report indicating the growth of SLO. Total 339 patients were enrolled. There was no difference on the 14-day overall or infection-related mortality rates at the time to administer GP. Multivariate analysis disclosed pneumonia (OR = 4.47; of 95% CI; of 2.09–9.58; and high APACHE II score (OR, 2.81, with 95% CI, 1.19–6.65; were independent risk factors for infection-related mortality. The mortality rate did not decrease following administrating GP immediately after a preliminary BC indicating SLO growth. An additional research for the optimal timing for initiating GP treatment is warranted.

  10. Effect of initial-state target polarization on the single ionization of helium by 1-keV electron impact

    International Nuclear Information System (INIS)

    Sun Shi-Yan; Ma Xiao-Yan; Li Xia; Miao Xiang-Yang; Jia Xiang-Fu

    2012-01-01

    We report new results of triple differential cross sections for the single ionization of helium by 1-KeV electron impact at the ejection energy of 10 eV. Investigations have been made for both the perpendicular plane and the plane perpendicular to the momentum transfer geometries. The present calculation is based on the three-Coulomb wave function. Here we have also incorporated the effect of target polarization in the initial state. A comparison is made between the present calculation with the results of other theoretical methods and a recent experiment [Dürr M, Dimopoulou C, Najjari B, Dorn A, Bartschat K, Bray I, Fursa D V, Chen Z, Madison D H and Ullrich J 2008 Phys. Rev. A 77 032717]. At an impact energy of 1 KeV, the target polarization is found to induce a substantial change of the cross section for the ionization process. We observe that the effect of target polarization plays a dominant role in deciding the shape of triple differential cross sections. (atomic and molecular physics)

  11. An initial assessment of the impact of Australian aerosols on surface ultraviolet radiation and implications for human health

    International Nuclear Information System (INIS)

    Chee, C Y; Mills, F P

    2010-01-01

    Aerosols can have significant influence on surface radiation, and the intense surface ultraviolet radiation Australia experiences contributes to Australia's high incidence rates for related human diseases. Aerosol properties, such as total column aerosol optical depth, have been measured over several years for varying lengths of time at sites across Australia using sunphotometers. Statistical analysis of the average daily aerosol optical depth over sites near Alice Springs, Canberra, Darwin, and Perth provides one measure of the annual atmospheric loading of aerosols over these sites. The sunphotometers used at these sites do not make measurements in the UV-B spectral region and have only one channel in the UV-A spectral region, the regions of most interest for assessing human health impact. Consequently, model calculations using standard aerosol types have been used to make an initial estimate of the impact of the aerosols found over these four sites on surface ultraviolet radiation. The aerosol loading is at times sufficient to significantly reduce the surface ultraviolet radiation, but few such days occur each year. The annual average effect of aerosols on surface ultraviolet radiation, thus, appears to be small compared to lifestyle factors, such as clothing and use of sunscreen.

  12. The Landscape Ecological Impact of Afforestation on the British Uplands and Some Initiatives to Restore Native Woodland Cover

    Directory of Open Access Journals (Sweden)

    Bunce Robert G. H.

    2014-11-01

    Full Text Available The majority of forest cover in the British Uplands had been lost by the beginning of the Nineteenth Century, because of felling followed by overgrazing by sheep and deer. The situation remained unchanged until a government policy of afforestation, mainly by exotic conifers, after the First World War up to the present day. This paper analyses the distribution of these predominantly coniferous plantations, and shows how they occupy specific parts of upland landscapes in different zones throughout Britain Whilst some landscapes are dominated by these new forests, elsewhere the blocks of trees are more localised. Although these forests virtually eliminate native ground vegetation, except in rides and unplanted land, the major negative impacts are at the landscape level. For example, drainage systems are altered and ancient cultural landscape patterns are destroyed. These impacts are summarised and possible ways of amelioration are discussed. By contrast, in recent years, a series of projects have been set up to restore native forest cover, as opposed to the extensive plantations of exotic species. Accordingly, the paper then provides three examples of such initiatives designed to restore native forests to otherwise bare landscapes, as well as setting them into a policy context. Whilst such projects cover a limited proportion of the British Uplands they nevertheless restore forest to landscapes at a local level.

  13. Impact of generic antiretroviral therapy (ART) and free ART programs on time to initiation of ART at a tertiary HIV care center in Chennai, India.

    Science.gov (United States)

    Solomon, Sunil S; Lucas, Gregory M; Kumarasamy, Nagalingeswaran; Yepthomi, Tokugha; Balakrishnan, Pachamuthu; Ganesh, Aylur K; Anand, Santhanam; Moore, Richard D; Solomon, Suniti; Mehta, Shruti H

    2013-08-01

    Antiretroviral therapy (ART) access in the developing world has improved, but whether increased access has translated to more rapid treatment initiation among those who need it is unknown. We characterize time to ART initiation across three eras of ART availability in Chennai, India (1996-1999: pregeneric; 2000-2003: generic; 2004-2007: free rollout). Between 1996 and 2007, 11,171 patients registered for care at the YR Gaitonde Centre for AIDS Research and Education (YRGCARE), a tertiary HIV referral center in southern India. Of these, 5726 patients became eligible for ART during this period as per Indian guidelines for initiation of ART. Generalized gamma survival models were used to estimate relative times (RT) to ART initiation by calendar periods of eligibility. Time to initiation of ART among patients in Chennai, India was also compared to an HIV clinical cohort in Baltimore, USA. Median age of the YRGCARE patients was 34 years; 77% were male. The median CD4 at presentation was 140 cells/µl. After adjustment for demographics, CD4 and WHO stage, persons in the pregeneric era took 3.25 times longer (95% confidence interval [CI]: 2.53-4.17) to initiate ART versus the generic era and persons in the free rollout era initiated ART more rapidly than the generic era (RT: 0.73; 95% CI: 0.63-0.83). Adjusting for differences across centers, patients at YRGCARE took longer than patients in the Johns Hopkins Clinical Cohort (JHCC) to initiate ART in the pregeneric era (RT: 4.90; 95% CI: 3.37-7.13) but in the free rollout era, YRGCARE patients took only about a quarter of the time (RT: 0.31; 95% CI: 0.22-0.44). These data demonstrate the benefits of generic ART and government rollouts on time to initiation of ART in one developing country setting and suggests that access to ART may be comparable to developed country settings.

  14. Can parents adjust to the idea that their child is at risk for a sudden death?: Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, F. J. M.; van Tintelen, J. P.; van Langen, I. M.; Wilde, A. A. M.; van den Bout, J.; ten Kroode, H. F. J.

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  15. Can parents adjust to the idea that their child is at risk for a sudden death? : Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, FJM; van Tintelen, JP; van Langen, IM; Wilde, AAM; van den Bout, J; ten Kroode, HFJ

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  16. The impact of pain on psychological well-being in rheumatoid arthritis : the mediating effects of self-esteem and adjustment to disease

    NARCIS (Netherlands)

    Nagyova, I.; Stewart, R.E.; Macejova, Z.; van Dijk, J.P.; van den Heuvel, W.J.

    The aim of this study was to determine whether self-esteem and adjustment to disease can mediate the association between pain and psychological well-being in patients with Rheumatoid Arthritis (RA). Coefficients of correlation, multiple linear regressions and Structural Equation Model (SEM) were

  17. A Test of the Family Stress Model on Toddler-Aged Children's Adjustment among Hurricane Katrina Impacted and Nonimpacted Low-Income Families

    Science.gov (United States)

    Scaramella, Laura V.; Sohr-Preston, Sara L.; Callahan, Kristin L.; Mirabile, Scott P.

    2008-01-01

    Hurricane Katrina dramatically altered the level of social and environmental stressors for the residents of the New Orleans area. The Family Stress Model describes a process whereby felt financial strain undermines parents' mental health, the quality of family relationships, and child adjustment. Our study considered the extent to which the Family…

  18. Initiation of detonation by impact on granular explosives; Contribution a l'etude de la generation de la detonation provoquee par impact sur un explosif

    Energy Technology Data Exchange (ETDEWEB)

    Bernier, H [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1964-05-15

    A good number of experiments have shown up the particular behaviour of granular explosives when they are detonated by barrier transmitted shocks. Similar results can be obtained when the shock is induced by impact. In this case the pressure signal shape applied at the explosive is better known and both its intensity and duration can be varied. By using a mathematical model in which the law of chemical kinetics is a linear function of pressure, and different temperatures are used for solids and gases, it is possible to describe most of the behaviour of detonation initiation in solid granular explosives. (author) [French] De nombreuses etudes experimentales ont montre le comportement particulier des explosifs granulaires lors de la detonation provoquee par choc transmis a travers une barriere. Les memes resultats peuvent etre obtenus lorsque la detonation est engendree par impact. Dans ce cas, la forme du signal de pression induit dans l'explosif est mieux connue, et il est possible d'en faire varier l'intensite et la duree d'application. Un modele mathematique utilisant une loi de cinetique chimique fonction lineaire de la pression et ou les temperatures des etats solide et gazeux pendant la reaction sont differenciees, permet de retrouver la plupart des caracteres specifiques de la generation dans un explosif solide granulaire. (auteur)

  19. Stakeholder initiatives in flood risk management: exploring the role and impact of bottom-up initiatives in three ‘Room for the River’ projects in the Netherlands

    NARCIS (Netherlands)

    J. Edelenbos (Jurian); M.W. van Buuren (Arwin); D. Roth (Dik); M.H. Winnubst (Madelinde)

    2017-01-01

    textabstractIn recent years stakeholder participation has become a popular topic in flood management. Little is known about how and under which circumstances local stakeholders initiate and develop successful flood management strategies and how governmental actors respond to them. Drawing on

  20. A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

    Science.gov (United States)

    Amick, Benjamin C.; Menéndez, Cammie Chaumont; Bazzani, Lianna; Robertson, Michelle; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2016-01-01

    Objective Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions. Methods Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses. Results The CWT intervention lowered daily visual symptoms (p ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms. PMID:21963250

  1. A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization.

    Science.gov (United States)

    Amick, Benjamin C; Menéndez, Cammie Chaumont; Bazzani, Lianna; Robertson, Michelle; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2012-05-01

    Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions. Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses. The CWT intervention lowered daily visual symptoms (p office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  2. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    Science.gov (United States)

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  3. The impact of coping and emotional intelligence on the relationship between posttraumatic stress disorder from past trauma, adjustment difficulty, and psychological distress following divorce.

    Science.gov (United States)

    Slanbekova, Gulnara; Chung, Man Cheung; Abildina, Saltanat; Sabirova, Raikhan; Kapbasova, Gulzada; Karipbaev, Baizhol

    2017-08-01

    Focusing on a group of Kazakh divorcees, this study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, coping strategies, emotional intelligence, adjustment difficulties, and psychiatric symptom severity following divorce. One hundred and twenty divorcees participated in the research and completed the Emotional Intelligence Questionnaire, Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Brief COPE, and Fisher's Divorce Adjustment Scale Results: About 29% reported no trauma; 53%, 21%, and 26% met the criteria for no-PTSD, partial-PTSD, and full-PTSD respectively. Emotion-focused coping and managing emotions predicted adjustment difficulties. Controlling for gender, PTSD, problem-focused coping, and managing emotions predicted psychiatric symptom severity. Problem-focused coping mediated the direct effect of the path between PTSD and psychiatric symptom severity with its mediational effect being moderated by the effect of managing emotions. Following divorce, people can experience psychological distress which is influenced by the effects of PTSD from past trauma, and whether they used problem-focused coping and were able to manage their emotions.

  4. The Ne3LS Network, Quebec's initiative to evaluate the impact and promote a responsible and sustainable development of nanotechnology

    International Nuclear Information System (INIS)

    Endo, Charles-Anica; Emond, Claude; Battista, Renaldo; Parizeau, Marie-Helene; Beaudry, Catherine

    2011-01-01

    The spectacular progress made by nanosciences and nanotechnologies elicits as much hope and fear. Consequently, a great number of research and training initiatives on the ethical, environmental, economic, legal and social issues regarding nanotechnology development (Ne 3 LS) are emerging worldwide. In Quebec, Canada, a Task Force was mandated by NanoQuebec to conceive a Ne 3 LS research and training strategy to assess those issues. This Task Force brought together experts from universities, governments or industry working in nanosciences and nanotechnologies or in Ne 3 LS. Their resulting action plan, made public in November 2006, contained several recommendations, including the creation of a knowledge network (Ne 3 LS Network). In the following years, after consulting with numerous key players concerned with the possible impacts of nanosciences and nanotechnologies in Quebec, the Ne 3 LS Network was launched in January 2010 in partnership with the Fonds quebecois de la recherche sur la nature et les technologies, the Fonds quebecois de la recherche sur la societe et la culture and the Fonds de la recherche en sante du Quebec, NanoQuebec, the Institut de recherche Robert-Sauve en sante et en securite du travail as well as the University of Montreal. Its objectives are to 1) Foster the development of Ne 3 LS research activities (grants and fellowships); 2) Spearhead the Canadian and international Ne 3 LS network; 3) Take part in the training of researchers and experts; 4) Encourage the creation of interactive tools for the general public; 5) Facilitate collaboration between decision-makers and experts; 6) Involve the scientific community through a host of activities (symposium, conferences, thematic events); 7) Build multidisciplinary research teams to evaluate the impact of nanotechnology.

  5. An Analysis of Current Energy Policy Initiatives in New Mexico. What are the Potential Impacts to the State's Water Resources?

    Science.gov (United States)

    Klise, G. T.; Hart, W. E.; Kobos, P. H.; Malczynski, L. A.; Tidwell, V. C.

    2008-12-01

    Population in New Mexico is increasing rapidly with recent projections showing that the state will add more than 1 million people by 2035. This growth will create a demand for additional energy and water supplies that have yet to be developed. New Mexico currently exports about 50% of the energy generated within the state to neighboring states, and existing power plants predominately utilize traditional fossil fuels such as coal, oil and natural gas. Because traditional electric generation technologies utilize large quantities of water, New Mexico can also be seen as exporting water for the benefit of electricity consumed in neighboring states. As it is, both surface water and groundwater supplies are stretched thin and these internal and external stresses stemming from population growth will have a substantial impact on the state's water resources. In 2004, the Governor laid out a plan to make New Mexico a "Clean Energy State" by implementing renewable portfolio standards, developing renewable energy transmission infrastructure, creating an alternative energy innovation fund and creating state specific tax credits for renewable energy production and manufacturing. Recent work in the National Energy-Water Roadmap has pointed out that certain renewable sources of energy utilize less water than traditional power plants, and technological fixes to existing power plants will result in less water consumption. If New Mexico carries out its energy initiative, what will be the impacts to the state's water resources? Will it be possible to meet competing demands for this water? These questions and others will be analyzed in a decision-support tool that can look at the connection between both the physical and economic systems to see what the tradeoffs might be as a result of specific policy decisions. The ability to plan for future energy needs and understanding potential impacts to the state's limited water resources will be an invaluable tool for decision-makers in New

  6. Initiation, influence, and impact: adolescents and parents discuss the marketing of gambling products during Australian sporting matches

    Directory of Open Access Journals (Sweden)

    Hannah Pitt

    2016-09-01

    Full Text Available Abstract Background Harmful gambling is a significant public health issue. Alongside the rapid diversification of gambling products, are rapid increases in the marketing for specific types of gambling products, such as online wagering. While concern has been raised about the impact of gambling promotions during sporting matches on the gambling beliefs and behaviours of adolescents, very little research has explored adolescents’ and parents’ attitudes towards the marketing of gambling products within sport. Methods A qualitative study was conducted with 59 family groups comprising of at least one parent and one adolescent (14–18 years old in Victoria, Australia. Parents and adolescents were interviewed separately and asked questions relating to their gambling attitudes and behaviours. They were then brought together, and advertising reception techniques were utilised to prompt discussions about the marketing of gambling during sport. A thematic approach to analysis was used, constantly comparing similarities and differences between and across groups. Results Three main themes emerged. First, was initiation of sport as a platform for the promotion of gambling. Adolescents perceived that the use of embedded promotions (for example during the match and the use of athletes in gambling promotions were significant mechanisms for creating an alignment between gambling companies and sporting teams and codes. Second, was the influence of marketing messages in creating a perception that gambling was always accessible, and was an integral part of the sporting experience. Third was the impact of marketing messages on adolescent’s discourses about sport. Parents described that they had noticed that wagering, and ‘odds’ discussions, had become embedded in adolescents narratives about sporting matches. Discussion and conclusions Gambling marketing during sport has significantly increased. While the gambling industry states that it does not aim to

  7. Initiation, influence, and impact: adolescents and parents discuss the marketing of gambling products during Australian sporting matches.

    Science.gov (United States)

    Pitt, Hannah; Thomas, Samantha L; Bestman, Amy

    2016-09-13

    Harmful gambling is a significant public health issue. Alongside the rapid diversification of gambling products, are rapid increases in the marketing for specific types of gambling products, such as online wagering. While concern has been raised about the impact of gambling promotions during sporting matches on the gambling beliefs and behaviours of adolescents, very little research has explored adolescents' and parents' attitudes towards the marketing of gambling products within sport. A qualitative study was conducted with 59 family groups comprising of at least one parent and one adolescent (14-18 years old) in Victoria, Australia. Parents and adolescents were interviewed separately and asked questions relating to their gambling attitudes and behaviours. They were then brought together, and advertising reception techniques were utilised to prompt discussions about the marketing of gambling during sport. A thematic approach to analysis was used, constantly comparing similarities and differences between and across groups. Three main themes emerged. First, was initiation of sport as a platform for the promotion of gambling. Adolescents perceived that the use of embedded promotions (for example during the match) and the use of athletes in gambling promotions were significant mechanisms for creating an alignment between gambling companies and sporting teams and codes. Second, was the influence of marketing messages in creating a perception that gambling was always accessible, and was an integral part of the sporting experience. Third was the impact of marketing messages on adolescent's discourses about sport. Parents described that they had noticed that wagering, and 'odds' discussions, had become embedded in adolescents narratives about sporting matches. Gambling marketing during sport has significantly increased. While the gambling industry states that it does not aim to intentionally target young people, adolescents are increasingly aware of the relationship

  8. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  9. Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort.

    Science.gov (United States)

    Ahonkhai, Aimalohi A; Adeola, Juliet; Banigbe, Bolanle; Onwuatuelo, Ifeyinwa; Adegoke, Abdulkabir B; Bassett, Ingrid V; Losina, Elena; Freedberg, Kenneth A; Okonkwo, Prosper; Regan, Susan

    The authors conducted a retrospective cohort study of unplanned care interruption (UCI) among adults initiating antiretroviral therapy (ART) from 2009 to 2011 in a Nigerian clinic. The authors used repeated measures regression to model the impact of UCI on CD4 count upon return to care and rate of CD4 change on ART. Among 2496 patients, 83% had 0, 15% had 1, and 2% had ≥2 UCIs. Mean baseline CD4 for those with 0, 1, or ≥2 UCIs was 228/cells/mm 3 , 355/cells/mm 3 , and 392/cells/mm 3 ( P ART, patients with 0 UCI gained 10 cells/µL/mo (95% CI: 7-4). Those with 1 and ≥2 UCIs lost 2 and 5 cells/µL/mo (95% CI: -18 to 13 and -26 to 16). Patients with UCI did not recover from early CD4 losses associated with UCI. Preventing UCI is critical to maximize benefits of ART.

  10. H. guilliermondii impacts growth kinetics and metabolic activity of S. cerevisiae: the role of initial nitrogen concentration.

    Science.gov (United States)

    Lage, Patrícia; Barbosa, Catarina; Mateus, Beatriz; Vasconcelos, Isabel; Mendes-Faia, Arlete; Mendes-Ferreira, Ana

    2014-02-17

    Non-Saccharomyces yeasts include different species which comprise an ecologically and biochemically diverse group capable of altering fermentation dynamics and wine composition and flavour. In this study, single- and mixed-culture of Hanseniaspora guilliermondii and Saccharomyces cerevisiae were used to ferment natural grape-juice, under two nitrogen regimes. In single-culture the strain H. guilliermondii failed to complete total sugar breakdown even though the nitrogen available has not been a limiting factor of its growth or fermentative activity. In mixed-culture, that strain negatively interfered with the growth and fermentative performance of S. cerevisiae, resulting in lower fermentation rate and longer fermentation length, irrespective of the initial nitrogen concentration. The impact of co-inoculation on the volatile compounds profile was more evident in the wines obtained from DAP-supplemented musts, characterised by increased levels of ethyl and acetate esters, associated with fruity and floral character of wines. Moreover, the levels of fatty acids and sulphur compounds which are responsible for unpleasant odours that depreciate wine sensory quality were significantly lower. Accordingly, data obtained suggests that the strain H. guilliermondii has potential to be used as adjunct of S. cerevisiae in wine industry, although possible interactions with S. cerevisiae still need to be elucidated. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Determinants of perceived risk and initial trust on a team leader. Impact of working environment and leader traits

    Directory of Open Access Journals (Sweden)

    Miguel Guinalíu Blasco

    2014-02-01

    Full Text Available Aspects such as the growing importance of teamwork and the emergence of new organizational schemes based on information and communication technologies highlight the need for understanding the mechanisms that promote effective leadership. In this sense, this paper analyzes the determinants of perceived risk and trust on a team leader. The research consists of two experiments. The first analyzes the influence of working environment—virtual or traditional—on the two dependent variables considered. The second experiment focuses on the virtual environment and analyzes the importance of the inclusion of a photo on the electronic leader’s profile in order to generate trust. Moreover, it analyzes the impact of perceived leader traits (attractive or expert on the ability to build trust and the perception of risk. It shouldbe noted that these analyzes are contextualized in the initial stage of team development, poorly studied in the literature. Among others, the results reveal the greater difficulty of building trust in virtual environments, as well as the relevance of including graphical information on the profile and that the leader with expert traits has the greatest potential to buildtrust. These results have interesting managerial implications, which are discussed along with the main future research lines and limitations.

  12. Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative.

    Science.gov (United States)

    Fonseca, Jacqueline Evangelista; Carneiro, Mariângela; Pena, João Luiz; Colosimo, Enrico A; da Silva, Nívea Bispo; da Costa, André Gabriel F C; Moreira, Luciano E; Cairncross, Sandy; Heller, Léo

    2014-06-01

    In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program "One Million Cisterns" (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water source. The aim of this study was to evaluate whether access to rainwater harvesting cisterns is associated with the decrease in the occurrence of Giardia duodenalis infections in children, compared to other children living in households supplied by other water sources. A quasi-experimental study with two concurrent cohorts was developed in two rural municipalities of the semiarid region of Brazil. A sample of 664 children, aged between 4 months and 5 years old, was followed up, of which 332 had access to rainwater cisterns (cistern group) and 332 did not, having water supplied from alternative sources (comparison group). In a period of approximately one year (2010) intestinal parasites were investigated in feces three times. The prevalence of G. duodenalis in children from the cistern group ranged from 4.8 to 10.5%, while the prevalence in the comparison group ranged from 7.6 to 16.7%. Multivariate analysis (GEE) showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns, when compared to children who did (OR 1.72; 95% CI 1.14-2.59). The other variables associated with G. duodenalis infection were: number of rooms per house (OR 0.89; 95% CI 0.80-0.99); family income (OR0.48; 95% CI 0.26-0.88); birth order (OR 1.72; 95% CI 1.17-2.51); preterm children (OR 1.70; 95% CI 1.19-2.43); and improper hand hygiene prior to food preparation (OR 4.78; 95% CI 1.95-11.76). Ownership of a rainwater cistern is associated with a lower prevalence of G. duodenalis infection in children after adjustment for environmental and family-related factors. Nevertheless, the study suggests the necessity

  13. Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative.

    Directory of Open Access Journals (Sweden)

    Jacqueline Evangelista Fonseca

    2014-06-01

    Full Text Available BACKGROUND: In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program "One Million Cisterns" (P1MC. Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water source. The aim of this study was to evaluate whether access to rainwater harvesting cisterns is associated with the decrease in the occurrence of Giardia duodenalis infections in children, compared to other children living in households supplied by other water sources. METHODOLOGY/PRINCIPAL FINDINGS: A quasi-experimental study with two concurrent cohorts was developed in two rural municipalities of the semiarid region of Brazil. A sample of 664 children, aged between 4 months and 5 years old, was followed up, of which 332 had access to rainwater cisterns (cistern group and 332 did not, having water supplied from alternative sources (comparison group. In a period of approximately one year (2010 intestinal parasites were investigated in feces three times. The prevalence of G. duodenalis in children from the cistern group ranged from 4.8 to 10.5%, while the prevalence in the comparison group ranged from 7.6 to 16.7%. Multivariate analysis (GEE showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns, when compared to children who did (OR 1.72; 95% CI 1.14-2.59. The other variables associated with G. duodenalis infection were: number of rooms per house (OR 0.89; 95% CI 0.80-0.99; family income (OR0.48; 95% CI 0.26-0.88; birth order (OR 1.72; 95% CI 1.17-2.51; preterm children (OR 1.70; 95% CI 1.19-2.43; and improper hand hygiene prior to food preparation (OR 4.78; 95% CI 1.95-11.76. CONCLUSIONS/SIGNIFICANCE: Ownership of a rainwater cistern is associated with a lower prevalence of G. duodenalis infection in children after adjustment for

  14. NET SALARY ADJUSTMENT

    CERN Multimedia

    Finance Division

    2001-01-01

    On 15 June 2001 the Council approved the correction of the discrepancy identified in the net salary adjustment implemented on 1st January 2001 by retroactively increasing the scale of basic salaries to achieve the 2.8% average net salary adjustment approved in December 2000. We should like to inform you that the corresponding adjustment will be made to your July salary. Full details of the retroactive adjustments will consequently be shown on your pay slip.

  15. Theories on coping with loss: the impact of social support and self-esteem on adjustment to emotional and social loneliness following a partner's death in later life.

    Science.gov (United States)

    van Baarsen, Berna

    2002-01-01

    This longitudinal study focused on the role of self-esteem and social support in adjustment to loneliness experienced by bereaved elderly persons. This study also examined the contributions of a general and a specific coping theory toward explaining loneliness. A distinction has been made between emotional loneliness and social loneliness/perceived support. The theory of mental incongruity predicts that the presence of more favorable conditions, such as higher self-esteem or more social support, results in less loneliness (i.e., less incongruity). According to the theory of relational loneliness, the partner's death leads to a loss of identity, thus increasing emotional loneliness, and social support does not mitigate emotional loneliness following a loss. In total, 101 participants, aged 55-89 years, were interviewed before and after their partners' deaths. Findings were ambiguous with regard to both theories. As hypothesized, partner loss lowered self-esteem, resulting in higher emotional loneliness and social loneliness, that is, perception of less support. Supportive personal relations reduced emotional loneliness. The presence of close friends, however, seemed to increase emotional and social loneliness (i.e., decrease perceived support) in the long term, particularly among bereaved participants with lower self-esteem. The findings highlight the need to integrate theoretical concepts. In explaining adjustment to a partner's death, attention should be paid to underlying mechanisms relevant to the restoration process (e.g., identity change) and the ways in which the adjustment process can be improved (e.g., intimate relationships) or impeded (e.g., dependency-sustaining relationships).

  16. A multigene prognostic assay for selection of adjuvant chemotherapy in patients with T3, stage II colon cancer: impact on quality-adjusted life expectancy and costs.

    Science.gov (United States)

    Hornberger, John; Lyman, Gary H; Chien, Rebecca; Meropol, Neal J

    2012-12-01

    Uncertainty exists regarding appropriate and affordable use of adjuvant chemotherapy in stage II colon cancer (T3, proficient DNA mismatch repair). This study aimed to estimate the effectiveness and costs from a US societal perspective of a multigene recurrence score (RS) assay for patients recently diagnosed with stage II colon cancer (T3, proficient DNA mismatch repair) eligible for adjuvant chemotherapy. RS was compared with guideline-recommended clinicopathological factors (tumor stage, lymph nodes examined, tumor grade, and lymphovascular invasion) by using a state-transition (Markov) lifetime model. Data were obtained from published literature, a randomized controlled trial (QUick And Simple And Reliable) of adjuvant chemotherapy, and rates of chemotherapy use from the National Cooperative Cancer Network Colon/Rectum Cancer Outcomes study. Life-years, quality-adjusted life expectancy, and lifetime costs were examined. The RS is projected to reduce adjuvant chemotherapy use by 17% compared with current treatment patterns and to increase quality-adjusted life expectancy by an average of 0.035 years. Direct medical costs are expected to decrease by an average of $2971 per patient. The assay was cost saving for all subgroups of patients stratified by clinicopathologic factors. The most influential variables affecting treatment decisions were projected years of life remaining, recurrence score, and patients' disutilities associated with adjuvant chemotherapy. Use of the multigene RS to assess recurrence risk after surgery in stage II colon cancer (T3, proficient DNA mismatch repair) may reduce the use of adjuvant chemotherapy without decreasing quality-adjusted life expectancy and be cost saving from a societal perspective. These findings need to be validated in additional cohorts, including studies of clinical practice as assay use diffuses into nonacademic settings. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR

  17. 10 CFR 905.34 - Adjustment provisions.

    Science.gov (United States)

    2010-01-01

    ... continue to take place based on existing contract/marketing criteria principles. ... 10 Energy 4 2010-01-01 2010-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment...

  18. Self-initiated expatriates

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2014-01-01

    Purpose – As it has been suggested that adult third-culture kids may be more culturally adaptable than others, they have been labelled “the ideal” expatriates. In this article, we explore the adjustment of self-initiated expatriate academics in Hong Kong, comparing adult third-culture kids...... with adult mono-culture kids. Design/methodology/approach – We use survey results from 267 self-initiated expatriate academics in Hong Kong. Findings – Exploratory results show that adult third-culture kids had a higher extent of general adjustment. No significant results were found in relation...... to interaction adjustment and job adjustment. We also found that recent expatriate experiences generally had a positive association with the adjustment of adult mono-culture kids, but this association only existed in terms of general adjustment for adult third-culture kids. Originality/value – Once corroborated...

  19. The Impact of Marital Separation/Divorce on Children: III. Parent-Child Communication and Child Adjustment, and Regression Analysis of Findings from Overall Study.

    Science.gov (United States)

    Jacobson, Doris S.

    1978-01-01

    This is the third of a series of reports on the findings from a study directed at further understanding the impact of marital separation/divorce on children during the 12-month period following the parental separation. This paper reports on parent-child communication regarding cognitive preparation of children for the parental separation. (Author)

  20. World Bank Development Sector Adjustment Operation Life Line to Nigerian Universities: Impact on Information Demand and Supply in the University of Agriculture, Makurdi Library.

    Science.gov (United States)

    Ozowa, Vincent Nnamdi

    1995-01-01

    Provides an overview of the rationale behind the World Bank credit line to Nigerian universities and examines the impact of the credit facility on the information demand and supply in the University of Agriculture, Makurdi Library (Nigeria). Discusses problems, such as poor quantity and quality of books and journals, lack of equipment, and lack of…

  1. Equity Mispricing and Leverage Adjustment Costs

    NARCIS (Netherlands)

    Warr, R.S.; Elliott, W.B.; Koeter-Kant, J.; Oztekin, O.

    2012-01-01

    We find that equity mispricing impacts the speed at which firms adjust to their target leverage (TL) and does so in predictable ways depending on whether the firm is over- or underlevered. For example, firms that are above their TL and should therefore issue equity (or retire debt) adjust more

  2. Long-term impact of changing childhood malnutrition on rotavirus diarrhoea: Two decades of adjusted association with climate and socio-demographic factors from urban Bangladesh.

    Directory of Open Access Journals (Sweden)

    Sumon Kumar Das

    Full Text Available There is strong association between childhood rotavirus, diarrhoea, climate factors and malnutrition. Conversely, a significant nutritional transition (reduced under-nutrition with a concurrent increasing trend of rotavirus infection in last decade was also observed among under 5 children, especially in developing countries including Bangladesh. Considering the pathophysiology of rotavirus, there might be an interaction of this nutrition transition which plays a pivotal role in increasing rotavirus infection in addition to climate and other man-made factors in urban areas such as Dhaka, Bangladesh.Relevant monthly data from 1993-2012 were extracted from the archive of the Diarrhoeal Disease Surveillance System of icddr, b and linked with data collected from the Dhaka station of the Bangladesh Meteorological Department (mean temperature, rainfall, sea level pressure and humidity. Seasonal autoregressive integrated moving average time series models were deployed to determine the association between the monthly proportion of rotavirus infection and underweight, stunting and wasting adjusting for climate, socio-demographic and sanitation factors.The proportion of rotavirus cases among all causes diarrhoea increased from 20% in 1993 to 43% in 2012 (Chi squared for trend p = 0.010. In contrast, underweight, stunting and wasting decreased from 59%-29% (p<0.001; 53%-21% (p<0.001 and 32%-22% (p<0.001 respectively over the same period. Mean ambient temperature increased from 25.76°C-26.62°C (p = 0.07; mean rainfall, sea level pressure and mean humidity decreased from 234.92-111.75 mm (p = 0.5, 1008.30-1006.61 mm of hg (p = 0.02 and 76.63%-70.26% (p<0.001, respectively. In the adjusted model, a decrease in monthly proportion of underweight [coef.: -0.189 (95% CI:-0.376, -0.003] and wasting [-0.265 (-0.455, -0.075] were significantly and inversely associated with rotavirus infection. However, an inverse but insignificant association was observed for

  3. Time to ART Initiation among Patients Treated for Rifampicin-Resistant Tuberculosis in Khayelitsha, South Africa: Impact on Mortality and Treatment Success.

    Science.gov (United States)

    Daniels, Johnny Flippie; Khogali, Mohammed; Mohr, Erika; Cox, Vivian; Moyo, Sizulu; Edginton, Mary; Hinderaker, Sven Gudmund; Meintjes, Graeme; Hughes, Jennifer; De Azevedo, Virginia; van Cutsem, Gilles; Cox, Helen Suzanne

    2015-01-01

    Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation. Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4). Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.

  4. Repatriation Adjustment: Literature Review

    Directory of Open Access Journals (Sweden)

    Gamze Arman

    2009-12-01

    Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

  5. Long-term impact of changing childhood malnutrition on rotavirus diarrhoea: Two decades of adjusted association with climate and socio-demographic factors from urban Bangladesh.

    Science.gov (United States)

    Das, Sumon Kumar; Chisti, Mohammod Jobayer; Sarker, Mohammad Habibur Rahman; Das, Jui; Ahmed, Shawnawaz; Shahunja, K M; Nahar, Shamsun; Gibbons, Nora; Ahmed, Tahmeed; Faruque, Abu Syed Golam; Rahman, Mustafizur; J Fuchs, George; Al Mamun, Abdullah; John Baker, Peter

    2017-01-01

    There is strong association between childhood rotavirus, diarrhoea, climate factors and malnutrition. Conversely, a significant nutritional transition (reduced under-nutrition) with a concurrent increasing trend of rotavirus infection in last decade was also observed among under 5 children, especially in developing countries including Bangladesh. Considering the pathophysiology of rotavirus, there might be an interaction of this nutrition transition which plays a pivotal role in increasing rotavirus infection in addition to climate and other man-made factors in urban areas such as Dhaka, Bangladesh. Relevant monthly data from 1993-2012 were extracted from the archive of the Diarrhoeal Disease Surveillance System of icddr, b and linked with data collected from the Dhaka station of the Bangladesh Meteorological Department (mean temperature, rainfall, sea level pressure and humidity). Seasonal autoregressive integrated moving average time series models were deployed to determine the association between the monthly proportion of rotavirus infection and underweight, stunting and wasting adjusting for climate, socio-demographic and sanitation factors. The proportion of rotavirus cases among all causes diarrhoea increased from 20% in 1993 to 43% in 2012 (Chi squared for trend p = 0.010). In contrast, underweight, stunting and wasting decreased from 59%-29% (pchildhood malnutrition is significantly associated with increasing rotavirus diarrhoea among under-5 children. Thus mass vaccination in addition to interventions directed at man-made modifiable predictors for prevention and control is warranted.

  6. Adjustment to Acute Leukemia: The Impact of Social Support and Marital Satisfaction on Distress and Quality of Life Among Newly Diagnosed Patients and Their Caregivers.

    Science.gov (United States)

    Pailler, Megan E; Johnson, Teresa M; Kuszczak, Sarah; Attwood, Kristopher M; Zevon, Michael A; Griffiths, Elizabeth; Thompson, James; Wang, Eunice S; Wetzler, Meir

    2016-09-01

    Little is known about the specific patterns of adjustment among newly diagnosed acute leukemia patients and their caregivers. This study examined the trajectories of patient and caregiver distress over time as well as the extent to which marital satisfaction and social support moderated these trajectories among those with significant-other caregivers. Forty six patient-caregiver dyads provided ratings at four time points: within 1 week of diagnosis (T1), 2 week follow-up (T2), 6 week follow-up (T3) and 12 week follow-up (T4). As anticipated, patients and caregivers reported higher levels of distress around the time of diagnosis than they did during subsequent time points. Marital satisfaction was a significant predictor of distress among patients, whereas among caregivers, social support predicted distress and quality of life. Results support the inclusion of relational variables such as social support and relationship satisfaction in the assessment of newly diagnosed patients and families in order to best identify those at risk for distress over time.

  7. Adjusting for unrecorded consumption in survey and per capita sales data: quantification of impact on gender- and age-specific alcohol-attributable fractions for oral and pharyngeal cancers in Great Britain.

    Science.gov (United States)

    Meier, Petra Sylvia; Meng, Yang; Holmes, John; Baumberg, Ben; Purshouse, Robin; Hill-McManus, Daniel; Brennan, Alan

    2013-01-01

    Large discrepancies are typically found between per capita alcohol consumption estimated via survey data compared with sales, excise or production figures. This may lead to significant inaccuracies when calculating levels of alcohol-attributable harms. Using British data, we demonstrate an approach to adjusting survey data to give more accurate estimates of per capita alcohol consumption. First, sales and survey data are adjusted to account for potential biases (e.g. self-pouring, under-sampled populations) using evidence from external data sources. Secondly, survey and sales data are aligned using different implementations of Rehm et al.'s method [in (2010) Statistical modeling of volume of alcohol exposure for epidemiological studies of population health: the US example. Pop Health Metrics 8, 1-12]. Thirdly, the impact of our approaches is tested by using our revised survey dataset to calculate alcohol-attributable fractions (AAFs) for oral and pharyngeal cancers. British sales data under-estimate per capita consumption by 8%, primarily due to illicit alcohol. Adjustments to survey data increase per capita consumption estimates by 35%, primarily due to under-sampling of dependent drinkers and under-estimation of home-poured spirits volumes. Before aligning sales and survey data, the revised survey estimate remains 22% lower than the revised sales estimate. Revised AAFs for oral and pharyngeal cancers are substantially larger with our preferred method for aligning data sources, yielding increases in an AAF from the original survey dataset of 0.47-0.60 (males) and 0.28-0.35 (females). It is possible to use external data sources to adjust survey data to reduce the under-estimation of alcohol consumption and then account for residual under-estimation using a statistical calibration technique. These revisions lead to markedly higher estimated levels of alcohol-attributable harm.

  8. Impact of a hospital improvement initiative in Bangladesh on patient experiences and satisfaction with services: two cross-sectional studies

    Directory of Open Access Journals (Sweden)

    Omer Khalid

    2011-12-01

    Full Text Available Abstract Background The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals. Methods In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community. Results Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements

  9. Investigation of Rheological Impacts on the Defense Waste Processing Facility's Sludge Slurry Feed as Insoluble Solids and Wash Endpoints are Adjusted

    International Nuclear Information System (INIS)

    Fellinger, T. L.; Howard, S.J.; Lee, M.C.; Galloway, R.H.

    2006-01-01

    The Savannah River Site (SRS) is currently pursuing an aggressive program to empty its High Level Waste (HLW) tanks and immobilize its radioactive waste into a durable borosilicate glass in the Defense Waste Processing Facility (DWPF). To create a batch of feed for the DWPF, several tanks of radioactive sludge slurry are combined into one of the million gallon (i.e. 3.79 E06 liters) feed tanks for DWPF. Once these sludge slurries are combined, the soluble sodium and weight percent total solids are adjusted by a 'washing' process. The 'washing' process involves diluting the soluble sodium of the sludge slurry with inhibited water (0.015 M NaOH and 0.015 M NaNO 2 ) and allowing the sludge slurry to settle into two layers. The two layers in the tank consist of a clear supernate on top and a layer of settled sludge solids on the bottom. The clear supernate layer is then decanted to another hold tank. This 'washing' process is repeated until the desired wash endpoint (i.e. sodium concentration in the supernate) and weight percent total solids are achieved. A final washed batch of feed consists of approximately 500,000 gallons (i.e. 1.89 E06 liters). DWPF has already processed three batches of feed and is currently processing a fourth. Prior to processing a batch of feed in the DWPF, it must be well characterized. Samples of the prepared feed batch are sent to the Savannah River National Laboratory (SRNL) for this characterization. As a part of the SRNL characterization for the fourth batch, rheology measurements were performed. Measurements were performed at different weight percent insoluble solids loadings to mimic potential facility processing scenarios (i.e. mixing/pumping of concentrated sludge slurry). In order to determine the influence of the soluble Na on the rheological properties of the sample, the supernate of the 'as received' sample was adjusted from 1 M soluble Na to 0.5 M soluble Na by using a lab scale version of the 'washing' process. Rheology

  10. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

  11. Impact of spatio-temporal scale of adjustment on variational assimilation of hydrologic and hydrometeorological data in operational distributed hydrologic models

    Science.gov (United States)

    Lee, H.; Seo, D.; McKee, P.; Corby, R.

    2009-12-01

    One of the large challenges in data assimilation (DA) into distributed hydrologic models is to reduce the large degrees of freedom involved in the inverse problem to avoid overfitting. To assess the sensitivity of the performance of DA to the dimensionality of the inverse problem, we design and carry out real-world experiments in which the control vector in variational DA (VAR) is solved at different scales in space and time, e.g., lumped, semi-distributed, and fully-distributed in space, and hourly, 6 hourly, etc., in time. The size of the control vector is related to the degrees of freedom in the inverse problem. For the assessment, we use the prototype 4-dimenational variational data assimilator (4DVAR) that assimilates streamflow, precipitation and potential evaporation data into the NWS Hydrology Laboratory’s Research Distributed Hydrologic Model (HL-RDHM). In this talk, we present the initial results for a number of basins in Oklahoma and Texas.

  12. Parental Divorce during Adolescence and Adjustment in Early Adulthood.

    Science.gov (United States)

    Richardson, Stacey; McCabe, Marita P.

    2001-01-01

    Examined the impact of parental divorce during adolescence, interparental conflict, and intimacy with parents on young adult adjustment. High levels of interparental conflict were found to be negatively associated with adjustment and current intimacy of parents. (Author)

  13. The static and dynamic behavior of MEMS arch resonators near veering and the impact of initial shapes

    KAUST Repository

    Hajjaj, Amal Z.; Alcheikh, Nouha; Younis, Mohammad I.

    2017-01-01

    We investigate experimentally and analytically the effect of initial shapes, arc and cosine wave, on the static and dynamic behavior of microelectromechanical systems (MEMS) arch resonators. We show that by carefully choosing the geometrical

  14. The Classification of Race, Ethnicity, Color, or National Origin (CRECNO) Initiative:A Guide to the Projected Impacts on Californians

    OpenAIRE

    Michaelson, Richard; Probert, Michelle; Swearingen, Van; Wolf, Marc

    2003-01-01

    Californians are scheduled to vote on the Classification of Race, Ethnicity, Color, or National Origin (CRECNO) Initiative in a special recall election on October 7, 2003. If passed by voters, the initiative will amend Article I of the California Constitution effective January 1, 2005, banning the state from classifying any individual by race, ethnicity, color, or national origin, except for certain purposes or under specified circumstances. CRECNO defines "classifying" as "separating, sorti...

  15. The impact of compaction, moisture content, particle size and type of bulking agent on initial physical properties of sludge-bulking agent mixtures before composting.

    Science.gov (United States)

    Huet, J; Druilhe, C; Trémier, A; Benoist, J C; Debenest, G

    2012-06-01

    This study aimed to experimentally acquire evolution profiles between depth, bulk density, Free Air Space (FAS), air permeability and thermal conductivity in initial composting materials. The impact of two different moisture content, two particle size and two types of bulking agent on these four parameters was also evaluated. Bulk density and thermal conductivity both increased with depth while FAS and air permeability both decreased with it. Moreover, depth and moisture content had a significant impact on almost all the four physical parameters contrary to particle size and the type of bulking agent. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Investigation and microstructural analyses of massive LSP impacts with coverage area on crack initiation location and tensile properties of AM50 magnesium alloy

    Energy Technology Data Exchange (ETDEWEB)

    Luo, K.Y.; Wang, C.Y. [School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013 (China); Sun, G.F. [School of Mechanical Engineering, Southeast University, Nanjing 211189 (China); Cui, C.Y.; Sheng, J. [School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013 (China); Lu, J.Z., E-mail: blueesky2005@163.com [School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013 (China)

    2016-01-05

    The influence of massive laser shock peening (LSP) impacts with coverage area on tensile properties of AM50 magnesium alloy was investigated using MTS880-10 servo-hydraulic material testing machine system. Microstructure in the surface layer and fracture morphologies of as-machined and LSPed tensile specimens were also characterized and analyzed by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and cross-sectional optical microscopy (OM). Special attention is paid to the crack initiation location as a function of LSPed coverage area in the gauge part of tensile specimen. Experimental results and analysis indicate that coverage area significantly influenced tensile properties of the tensile specimen. In addition, the grain refinement process in the top surface layer of AM50 magnesium alloy caused by massive LSP impacts is presented. Furthermore, the underlying influence mechanism of LSPed coverage area on tensile properties and crack initiation location of tensile specimen was clearly revealed.

  17. Investigation and microstructural analyses of massive LSP impacts with coverage area on crack initiation location and tensile properties of AM50 magnesium alloy

    International Nuclear Information System (INIS)

    Luo, K.Y.; Wang, C.Y.; Sun, G.F.; Cui, C.Y.; Sheng, J.; Lu, J.Z.

    2016-01-01

    The influence of massive laser shock peening (LSP) impacts with coverage area on tensile properties of AM50 magnesium alloy was investigated using MTS880-10 servo-hydraulic material testing machine system. Microstructure in the surface layer and fracture morphologies of as-machined and LSPed tensile specimens were also characterized and analyzed by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and cross-sectional optical microscopy (OM). Special attention is paid to the crack initiation location as a function of LSPed coverage area in the gauge part of tensile specimen. Experimental results and analysis indicate that coverage area significantly influenced tensile properties of the tensile specimen. In addition, the grain refinement process in the top surface layer of AM50 magnesium alloy caused by massive LSP impacts is presented. Furthermore, the underlying influence mechanism of LSPed coverage area on tensile properties and crack initiation location of tensile specimen was clearly revealed.

  18. Initial Northwest Power Act Power Sales Contracts : Final Environmental Impact Statement. Volume 2, Appendices A--L.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1992-01-01

    This report consists of appendices A-L of the final environmental impact statement for the Bonneville Power Administration. The appendices provide information on the following: Ninth circuit Court opinion in Forelaws on Board v. Johnson; guide to Northwest Power act contracts; guide to hydro operations; glossary; affected environment supporting documentation; environmental impacts of generic resource types; information on models used; technical information on analysis; public involvement activities; bibliography; Pacific Northwest Electric Power Planning and Conservation Act; and biological assessment. (CBS)

  19. Quantification of the impact of multifaceted initiatives intended to improve operational efficiency and the safety culture: a case study from an academic medical center radiation oncology department.

    Science.gov (United States)

    Chera, Bhishamjit S; Mazur, Lukasz; Jackson, Marianne; Taylor, Kinely; Mosaly, Prithima; Chang, Sha; Deschesne, Kathy; LaChapelle, Dana; Hoyle, Lesley; Saponaro, Patricia; Rockwell, John; Adams, Robert; Marks, Lawrence B

    2014-01-01

    We have systematically been incorporating several operational efficiency and safety initiatives into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful, metrics. The data from 5 quality improvement initiatives, each focused on a specific safety/process concern in our clinic, are presented. Data was collected prospectively: operational metrics recorded before and after implementation of the initiative were compared using statistical analysis. Results from the Agency for Health Care Research and Quality (AHRQ) patient safety culture surveys administered during and after many of these initiatives were similarly compared. (1) Workload levels for nurses assisting with brachytherapy were high (National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores >55-60, suggesting, "overwork"). Changes in work flow and procedure room layout reduced workload to more acceptable levels (NASA-TLX 50% to <10%; P < .01). To assess the overall changes in "patient safety culture," we conducted a pre- and postanalysis using the AHRQ survey. Improvements in all measured dimensions were noted. Quality improvement initiatives can be successfully implemented in an academic radiation oncology department to yield measurable improvements in operations resulting in improvement in patient safety culture. Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  20. Do transition towns have the potential to promote health and well-being? A health impact assessment of a transition town initiative.

    Science.gov (United States)

    Richardson, J; Nichols, A; Henry, T

    2012-11-01

    Climate change and energy vulnerability present significant challenges for the development and sustainability of our communities. The adverse effects will most likely impact on those already experiencing poverty, as energy and food costs will rise, thus increasing inequalities in health. Transition town initiatives seek to build cohesive sustainable communities to prepare for a future with limited oil and a changing climate. Increasingly, public health practitioners are interested in the role of transition towns as a community development initiative, and their potential to support the wider public health agenda. Health impact assessment (HIA) is an evidence-based process that aims to predict the positive and negative impacts of a strategy, proposal or development. The HIA process provides an opportunity to promote sustainable communities by ensuring that new strategies and developments are considered in the context of their contribution to the health and well-being of local populations. The aim of this study was to use an HIA to examine the potential health and well-being benefits of two related transition town initiatives. A rapid HIA to consider the potential lifestyle changes and health and well-being impacts of Transition Together/Transition Streets (TT/TS) projects. An HIA template was used to assess key documents related to the TT/TS initiatives and those related to the characteristics of the community. Additionally, meetings with 12 key informants (four involved in TT/TS and eight purposively selected for their local knowledge) were held using the HIA template to focus the discussion. The findings highlight the associated lifestyle changes such as increased physical activity and healthy eating, and possible social and well-being benefits of engagement in such an initiative. Engagement may be limited to those already concerned about environmental issues. This paper illustrates the important links between transition towns and the wider public health agenda

  1. Adjusting estimative prediction limits

    OpenAIRE

    Masao Ueki; Kaoru Fueda

    2007-01-01

    This note presents a direct adjustment of the estimative prediction limit to reduce the coverage error from a target value to third-order accuracy. The adjustment is asymptotically equivalent to those of Barndorff-Nielsen & Cox (1994, 1996) and Vidoni (1998). It has a simpler form with a plug-in estimator of the coverage probability of the estimative limit at the target value. Copyright 2007, Oxford University Press.

  2. Adjustable Pitot Probe

    Science.gov (United States)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  3. Cargo Security Initiatives in the EU and the USA, their Impact on Business Operations and Mutual Recognition with Focus on AEO and C-TPAT

    OpenAIRE

    Szelp, Attila

    2010-01-01

    The terrorist attacks of September 11, 2001 had a tremendous impact on international trade policy. The USA was the first country to introduce cargo security and facilitation measures as a counteraction. The EU and international organizations also established new security programs in order to better secure cargo movements across borders. This thesis gives an overview of security initiatives introduced by international organizations, the EU and the USA, with an emphasis on the tr...

  4. The impact of initialization procedures on unsupervised unmixing of hyperspectral imagery using the constrained positive matrix factorization

    Science.gov (United States)

    Masalmah, Yahya M.; Vélez-Reyes, Miguel

    2007-04-01

    The authors proposed in previous papers the use of the constrained Positive Matrix Factorization (cPMF) to perform unsupervised unmixing of hyperspectral imagery. Two iterative algorithms were proposed to compute the cPMF based on the Gauss-Seidel and penalty approaches to solve optimization problems. Results presented in previous papers have shown the potential of the proposed method to perform unsupervised unmixing in HYPERION and AVIRIS imagery. The performance of iterative methods is highly dependent on the initialization scheme. Good initialization schemes can improve convergence speed, whether or not a global minimum is found, and whether or not spectra with physical relevance are retrieved as endmembers. In this paper, different initializations using random selection, longest norm pixels, and standard endmembers selection routines are studied and compared using simulated and real data.

  5. Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM

    DEFF Research Database (Denmark)

    Phillips, Andrew N; Cambiano, Valentina; Miners, Alec

    2015-01-01

    count 350/μl. We investigated what would be required to reduce HIV incidence in MSM to below 1 per 1000 person-years (i.e. cost-effective. METHODS: A dynamic, individual-based simulation model was calibrated to multiple data sources...... with viral suppression to 80%, and it would be 90%, if ART is initiated at diagnosis. The scenarios required for such a policy to be cost-effective are presented. CONCLUSION: This analysis provides targets for the proportion of all HIV-positive MSM with viral suppression required to achieve substantial......BACKGROUND: Increased rates of testing, with early antiretroviral therapy (ART) initiation, represent a key potential HIV-prevention approach. Currently, in MSM in the United Kingdom, it is estimated that 36% are diagnosed by 1 year from infection, and the ART initiation threshold is at CD4 cell...

  6. 18F-FDG PET/CT for initial staging in breast cancer patients. Is there a relevant impact on treatment planning compared to conventional staging modalities?

    International Nuclear Information System (INIS)

    Krammer, J.; Schnitzer, A.; Kaiser, C.G.; Buesing, K.A.; Schoenberg, S.O.; Wasser, K.; Sperk, E.; Brade, J.; Wasgindt, S.; Suetterlin, M.; Sutton, E.J.

    2015-01-01

    To evaluate the impact of whole-body 18 F-FDG PET/CT on initial staging of breast cancer in comparison to conventional staging modalities. This study included 102 breast cancer patients, 101 patients were eligible for evaluation. Preoperative whole-body staging with PET/CT was performed in patients with clinical stage ≥ T2 tumours or positive local lymph nodes (n = 91). Postoperative PET/CT was performed in patients without these criteria but positive sentinel lymph node biopsy (n = 10). All patients underwent PET/CT and a conventional staging algorithm, which included bone scan, chest X-ray and abdominal ultrasound. PET/CT findings were compared to conventional staging and the impact on therapeutic management was evaluated. PET/CT led to an upgrade of the N or M stage in overall 19 patients (19 %) and newly identified manifestation of breast cancer in two patients (2 %). PET/CT findings caused a change in treatment of 11 patients (11 %). This is within the range of recent studies, all applying conventional inclusion criteria based on the initial T and N status. PET/CT has a relevant impact on initial staging and treatment of breast cancer when compared to conventional modalities. Further studies should assess inclusion criteria beyond the conventional T and N status, e.g. tumour grading and receptor status. (orig.)

  7. Impact of initial spacing on yield per acre and wood quality of unthinned loblolly pine at age 21

    Science.gov (United States)

    Alexander, III Clark; Richard F. Daniels; Lewis Jordan; Laurie Schimleck

    2010-01-01

    The market for southern pine first thinnings is soft. Thus, forest managers are planting at wider spacings, and using weed control and fertilization to grow chipping-saw and sawtimber trees in shorter rotations. A 21-year-old unthinned spacing study was sampled to determine the effect of initial spacing on wood quality and yield per acre of planted loblolly pine (

  8. Investigating the Impact of the Cisco 21st Century Schools Initiative on Harrison County School District. Summative Report

    Science.gov (United States)

    Ba, Harouna; Meade, Terri; Pierson, Elizabeth; Ferguson, Camille; Roy, Amanda; Williams, Hakim

    2009-01-01

    There are 21 schools in the Harrison County School District (HCSD), located in southern Mississippi, in the Gulfport/Biloxi metropolitan area. Of those, only Harrison Central 9th Grade (HC9) and Harrison County High School (HCHS) participated in the Cisco 21S Initiative--therefore, this summary will focus on only administrators, teachers,…

  9. Investigating the Impact of the Cisco 21st Century Schools Initiative on Forrest County Agricultural High School. Summative Report

    Science.gov (United States)

    Ba, Harouna; Meade, Terri; Pierson, Elizabeth; Ferguson, Camille; Roy, Amanda; Williams, Hakim

    2009-01-01

    Forrest County Agricultural High School (FCAHS) is located in Brooklyn, a small rural town in southern Mississippi and part of the Hattiesburg Metropolitan Statistical Area. Unlike the other schools that participated in the Cisco 21S initiative, FCAHS is not part of a larger school district. Therefore, the unit of analysis throughout this summary…

  10. Investigating the Impact of the Cisco 21st Century Schools Initiative on Forrest County School District. Summative Report

    Science.gov (United States)

    Ba, Harouna; Meade, Terri; Pierson, Elizabeth; Ferguson, Camille; Roy, Amanda; Williams, Hakim

    2009-01-01

    Located in southern Mississippi, the Forrest County School District (FCSD) consists of six schools: three K-6 elementary schools, two K-8 elementary-middle schools, and one high school (grades 9-12), all of which have been involved in the Cisco Initiative since its inception. The district employed 16 administrators, 7 technology staff members, and…

  11. Ozone's impact on public health: Contributions from indoor exposures to ozone and products of ozone-initiated chemistry

    DEFF Research Database (Denmark)

    Weschler, Charles J.

    2006-01-01

    OBJECTIVES: The associations between ozone concentrations measured outdoors and both morbidity and mortality may be partially due to indoor exposures to ozone and ozone-initiated oxidation products. In this article I examine the contributions of such indoor exposures to overall ozone-related heal...

  12. Impact of human presence on secondary organic aerosols derived from ozone-initiated chemistry in a simulated office environment

    DEFF Research Database (Denmark)

    Fadeyi, Moshood O.; Weschler, Charles J.; Tham, Kwok W.

    2013-01-01

    's reactions with various indoor pollutants. The present study examines this possibility for secondary organic aerosols (SOA) derived from ozone-initiated chemistry with limonene, a commonly occurring indoor terpene. The experiments were conducted at realistic ozone and limonene concentrations in a 240 m3...

  13. The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia.

    Science.gov (United States)

    Eliseev, Platon; Balantcev, Grigory; Nikishova, Elena; Gaida, Anastasia; Bogdanova, Elena; Enarson, Donald; Ornstein, Tara; Detjen, Anne; Dacombe, Russell; Gospodarevskaya, Elena; Phillips, Patrick P J; Mann, Gillian; Squire, Stephen Bertel; Mariandyshev, Andrei

    2016-01-01

    In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, ptime to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, ptime to MDR diagnosis and earlier treatment initiation as well as better treatment outcomes for patients with MDR-TB. These findings also highlight the need for further improvements within the health system to reduce both patient and diagnostic delays to truly optimize the impact of new, rapid diagnostics.

  14. Final Report on the Study of the Impact of the Statewide Systemic Initiatives. Lessons Learned about Designing, Implementing, and Evaluating Statewide Systemic Reform. WCER Working Paper No. 2003-12

    Science.gov (United States)

    Heck, Daniel J.; Weiss, Iris R.; Boyd, Sally E.; Howard, Michael N.; Supovitz, Jonathan A.

    2003-01-01

    This document represents the first of two volumes presented in "Study of the Impact of the Statewide Systemic Initiatives Program" (Norman L. Webb and Iris R. Weiss). In an effort to evaluate the impact of the Statewide Systemic Initiatives (SSIs) on student achievement and the lessons that could be learned from the National Science…

  15. Longitudinal Impacts of the Children's Literacy Initiative Professional Development, Coaching, and Model Classroom Intervention on Early Literacy Achievement

    Science.gov (United States)

    Parkinson, Julia; Meakin, John; Salinger, Terry

    2015-01-01

    Student achievement in literacy has been a focal concern in the United States for many years. Improving teachers' knowledge and skill that leads to improved student achievement, particularly in the early grades, can place children on an improved trajectory that can have long-term impacts on life outcomes. Over the past decade, a large body of…

  16. Development and initial psychometric evaluation of patient-reported outcome questionnaires to evaluate the symptoms and impact of hidradenitis suppurativa.

    Science.gov (United States)

    Kimball, Alexa B; Sundaram, Murali; Banderas, Benjamin; Foley, Catherine; Shields, Alan L

    2018-03-01

    Two patient-reported outcome (PRO) questionnaires, the Hidradenitis Suppurativa Symptom Assessment (HSSA) and Hidradenitis Suppurativa Impact Assessment (HSIA), were developed to measure signs, symptoms and impacts of HS in treatment efficacy studies. In accordance with FDA guidelines and published best practices, four stages of research were conducted to create the questionnaires: concept elicitation, questionnaire construction, content evaluation and psychometric evaluation. Subjects (N = 20) who participated in the concept elicitation stage reported 15 unique HS-related signs and symptoms and 51 impacts. Following this, eight sign and symptom concepts and 21 impacts were selected for construction of the HSSA and HSIA, respectively. During content evaluation, cognitive debriefing interviews with HS subjects (N = 20) confirmed subjects could read, comprehend and meaningfully respond to both questionnaires. Modifications made after this stage of work resulted in a nine-item HSSA and a 17-item HSIA. The HSSA and HSIA were subsequently entered into a US-based observational study (N = 40), and the scores produced by each were found to be reliable, construct valid, and able to distinguish among clinically distinct groups. The HSSA and HSIA are content-valid, HS-specific, PRO questionnaires with demonstrated ability to generate reliable, valid scores when administered to patients with HS in a research setting.

  17. 77 FR 42329 - Notice of Intent To Initiate Public Scoping and Prepare an Environmental Impact Statement for the...

    Science.gov (United States)

    2012-07-18

    ... analyze impacts for the BHP Navajo Coal Company (BNCC) Proposed Pinabete Permit and for the Navajo Mine... Nation and Hopi Tribe through lease and right-of-way revenues, royalties, tribal taxes and jobs. The EIS... Navajo Reservation, is a coal-fired electric generating station, which currently includes five units...

  18. Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches.

    Science.gov (United States)

    Champagne, François; Lemieux-Charles, Louise; Duranceau, Marie-France; MacKean, Gail; Reay, Trish

    2014-05-02

    The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. We conducted a theory-driven evaluation of the organizational impact of healthcare leaders' participation in two training programs using a logic model based on Nonaka's theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. We found that the impact of training could primarily be felt in trainees' immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence--both positive and negative--of specific organizational factors on extending the impact of training programs.

  19. Effects of Mothers against Drunk Driving's (MADD's) Victim Impact Panels on First-Time DWI Offenders: Some Initial Results.

    Science.gov (United States)

    Rao, Nagesh; And Others

    A study assessed the effects of victim impact panels (VIP) on first-time DWI (Driving While Intoxicated) offenders in Albuquerque, New Mexico. The VIP is an emotional presentation by the victim or their parents about how they were injured or their child was killed by a drunk driver. Subjects, 350 first-time offenders participated in a Mothers…

  20. Adjusting water resources management to climate change

    Energy Technology Data Exchange (ETDEWEB)

    Riebsame, W E

    1988-01-01

    The nature of climate impacts and adjustment in water supply and flood management is discussed, and a case study of water manager response to climate fluctuation in California's Sacramento Basin is presented. The case illuminates the effect on climate impact and response of traditional management approaches, the dynamic qualities of maturing water systems, socially imposed constraints, and climate extremes. A dual pattern of crisis-response and gradual adjustment emerges, and specific mechanisms for effecting adjustment of water management systems are identified. The case study, and broader trends in US water development, suggest that oversized structural capacity, the traditional adjustment to climate variability in water resources, may prove less feasible in the future as projects become smaller and new facilities are delayed by economic and environmental concerns.

  1. Initial review and analysis of the direct environmental impacts of CSP in the northern Cape, South Africa

    Science.gov (United States)

    Rudman, Justine; Gauché, Paul; Esler, Karen J.

    2016-05-01

    The Integrated Resource Plan (IRP) of 2010 and the IRP Update provide the most recent guidance to the electricity generation future of South Africa (SA) and both plans include an increased proportion of renewable energy generation capacity. Given that SA has abundant renewable energy resource potential, this inclusion is welcome. Only 600 MW of the capacity allocated to concentrating solar power (CSP) has been committed to projects in the Northern Cape and represents roughly a fifth of the capacity that has been included in the IRP. Although CSP is particularly new in the electricity generation system of the country, the abundant solar resources of the region with annual DNI values of above 2900 kWh/m2 across the arid Savannah and Nama-Karoo biomes offer a promising future for the development of CSP in South Africa. These areas have largely been left untouched by technological development activities and thus renewable energy projects present a variety of possible direct and indirect environmental, social and economic impacts. Environmental Impact Assessments do focus on local impacts, but given that ecological processes often extend to regional- and landscape scales, understanding this scaled context is important to the alignment of development- and conservation priorities. Given the capacities allocated to CSP for the future of SA's electricity generation system, impacts on land, air, water and biodiversity which are associated with CSP are expected to increase in distribution and the understanding thereof deems valuable already from this early point in CSP's future in SA. We provide a review of direct impacts of CSP on the natural environment and an overview of the anticipated specific significance thereof in the Northern Cape.

  2. Cultural Distance Asymmetry in Expatriate Adjustment

    DEFF Research Database (Denmark)

    Selmer, Jan; Chiu, Randy K.; Shenkar, Oded

    2007-01-01

    of the assignment. Design/methodology/approach - Using a two-flow sample of US expatriates in Germany and German expatriates in the USA, we examine and compare the psychological and socio-cultural adjustment of each group of executives. Findings - Controlling for the length of assignment, we find that German...... expatriates in the USA were better adjusted, both socio-culturally and psychologically, than American expatriates in Germany. These results support the asymmetry hypothesis and call into question previous findings attesting to the relationship between CD and expatriate adjustment. Originality......Purpose - The current literature implicitly assumes a symmetric impact of cultural distance (CD) on expatriate adjustment. By using distance as a predictor of adjustment, the literature has rendered the direction of the flow irrelevant: a US expatriate in Germany is presumed to face the same hurdle...

  3. Impact of soil moisture initialization on boreal summer subseasonal forecasts: mid-latitude surface air temperature and heat wave events

    Science.gov (United States)

    Seo, Eunkyo; Lee, Myong-In; Jeong, Jee-Hoon; Koster, Randal D.; Schubert, Siegfried D.; Kim, Hye-Mi; Kim, Daehyun; Kang, Hyun-Suk; Kim, Hyun-Kyung; MacLachlan, Craig; Scaife, Adam A.

    2018-05-01

    This study uses a global land-atmosphere coupled model, the land-atmosphere component of the Global Seasonal Forecast System version 5, to quantify the degree to which soil moisture initialization could potentially enhance boreal summer surface air temperature forecast skill. Two sets of hindcast experiments are performed by prescribing the observed sea surface temperature as the boundary condition for a 15-year period (1996-2010). In one set of the hindcast experiments (noINIT), the initial soil moisture conditions are randomly taken from a long-term simulation. In the other set (INIT), the initial soil moisture conditions are taken from an observation-driven offline Land Surface Model (LSM) simulation. The soil moisture conditions from the offline LSM simulation are calibrated using the forecast model statistics to minimize the inconsistency between the LSM and the land-atmosphere coupled model in their mean and variability. Results show a higher boreal summer surface air temperature prediction skill in INIT than in noINIT, demonstrating the potential benefit from an accurate soil moisture initialization. The forecast skill enhancement appears especially in the areas in which the evaporative fraction—the ratio of surface latent heat flux to net surface incoming radiation—is sensitive to soil moisture amount. These areas lie in the transitional regime between humid and arid climates. Examination of the extreme 2003 European and 2010 Russian heat wave events reveal that the regionally anomalous soil moisture conditions during the events played an important role in maintaining the stationary circulation anomalies, especially those near the surface.

  4. The static and dynamic behavior of MEMS arch resonators near veering and the impact of initial shapes

    KAUST Repository

    Hajjaj, Amal Z.

    2017-07-19

    We investigate experimentally and analytically the effect of initial shapes, arc and cosine wave, on the static and dynamic behavior of microelectromechanical systems (MEMS) arch resonators. We show that by carefully choosing the geometrical parameters and the initial shape of the arch, the veering phenomenon (avoided-crossing) among the first two symmetric modes can be strongly activated. To demonstrate this, we study electrothermally tuned and electrostatically driven initially curved MEMS resonators. Upon changing the electrothermal voltage, we demonstrate high frequency tunability of arc resonators compared to the cosine-configuration resonators for the first and third resonance frequencies. For arc beams, we show that the first resonance frequency increases up to twice its fundamental value and the third resonance frequency decreases until getting very close to the first resonance frequency triggering the veering phenomenon. Around the veering regime, we study experimentally and analytically the dynamic behavior of the arc beam for different electrostatic loads. The analytical study is based on a reduced order model of a nonlinear Euler–Bernoulli shallow arch beam model. The veering phenomenon is also confirmed through a finite-element multi-physics and nonlinear model.

  5. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  6. Estimating the Impact of Earlier ART Initiation and Increased Testing Coverage on HIV Transmission among Men Who Have Sex with Men in Mexico using a Mathematical Model.

    Science.gov (United States)

    Caro-Vega, Yanink; del Rio, Carlos; Lima, Viviane Dias; Lopez-Cervantes, Malaquias; Crabtree-Ramirez, Brenda; Bautista-Arredondo, Sergio; Colchero, M Arantxa; Sierra-Madero, Juan

    2015-01-01

    To estimate the impact of late ART initiation on HIV transmission among men who have sex with men (MSM) in Mexico. An HIV transmission model was built to estimate the number of infections transmitted by HIV-infected men who have sex with men (MSM-HIV+) MSM-HIV+ in the short and long term. Sexual risk behavior data were estimated from a nationwide study of MSM. CD4+ counts at ART initiation from a representative national cohort were used to estimate time since infection. Number of MSM-HIV+ on treatment and suppressed were estimated from surveillance and government reports. Status quo scenario (SQ), and scenarios of early ART initiation and increased HIV testing were modeled. We estimated 14239 new HIV infections per year from MSM-HIV+ in Mexico. In SQ, MSM take an average 7.4 years since infection to initiate treatment with a median CD4+ count of 148 cells/mm3(25th-75th percentiles 52-266). In SQ, 68% of MSM-HIV+ are not aware of their HIV status and transmit 78% of new infections. Increasing the CD4+ count at ART initiation to 350 cells/mm3 shortened the time since infection to 2.8 years. Increasing HIV testing to cover 80% of undiagnosed MSM resulted in a reduction of 70% in new infections in 20 years. Initiating ART at 500 cells/mm3 and increasing HIV testing the reduction would be of 75% in 20 years. A substantial number of new HIV infections in Mexico are transmitted by undiagnosed and untreated MSM-HIV+. An aggressive increase in HIV testing coverage and initiating ART at a CD4 count of 500 cells/mm3 in this population would significantly benefit individuals and decrease the number of new HIV infections in Mexico.

  7. Impacts of disturbance initiated by road construction in a subtropical cloud forest in the Luquillo Experimental Forest, Puerto Rico

    Science.gov (United States)

    Lydia P. Olander; F.N Scatena; Whendee L. Silver

    1998-01-01

    The impacts of road construction and the spread of exotic vegetation, which are common threats to upper elevation tropical forests, were evaluated in the subtropical cloud forests of Puerto Rico. The vegetation, soil and microclimate of 6-month-old road®lls, 35-year-old road®lls and mature forest with and without grass understories were compared. Recent road®lls had...

  8. Initial Northwest Power Act Power Sales Contracts : Final Environmental Impact Statement. Volume 3, Appendix M, Contract Copies.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1992-01-01

    This report, is part of the final environmental impact statement of the Bonneville Power Administration, consists of an appendix of contract copies related to the following: Detailed Index to Generic Utility Power Sales Contracts, Text of Generic Utility Contract, Detailed Index to Generic DSI Power Sales Contracts, Text of Generic DSI Contract, Text of Residential Purchase and Sale Agreement (Residential Exchange), and Detailed Index to General Contract Provisions -- GCP Form PSC-2 (Incorporated into all three types of contracts as an Exhibit).

  9. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

  10. Impact of an electronic sepsis initiative on antibiotic use and health care facility-onset Clostridium difficile infection rates.

    Science.gov (United States)

    Hiensch, Robert; Poeran, Jashvant; Saunders-Hao, Patricia; Adams, Victoria; Powell, Charles A; Glasser, Allison; Mazumdar, Madhu; Patel, Gopi

    2017-10-01

    Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P antibiotic use were not those included in the sepsis order set. The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Remotely adjustable fishing jar and method for using same

    International Nuclear Information System (INIS)

    Wyatt, W.B.

    1992-01-01

    This patent describes a method for providing a jarring force to dislodge objects stuck in well bores, the method it comprises: connecting a jarring tool between an operating string and an object in a well bore; selecting a jarring force to be applied to the object; setting the selected reference jarring force into a mechanical memory mechanism by progressively engaging a first latch body and a second latch body; retaining the reference jarring force in the mechanical memory mechanism during diminution of tensional force applied by the operating string; and initiating an upwardly directed impact force within the jarring tool by increasing tensional force on the operating string to a value greater than the tensional force corresponding with the selected jarring force. This patent also describes a remotely adjustable downhole fishing jar apparatus comprising: an operating mandrel; an impact release spring; a mechanical memory mechanism; and releasable latching means

  12. A micro focus with macro impact: Exploration of initial abstraction coefficient ratio (λ) in Soil Conservation Curve Number (CN) methodology

    International Nuclear Information System (INIS)

    Ling, L; Yusop, Z

    2014-01-01

    Researchers started to cross examine United States Department of Agriculture (USDA) Soil Conservation Services (SCS) Curve Number (CN) methodology after the technique produced inconsistent results throughout the world. More field data from recent decades were leaning against the assumption of the initial abstraction coefficient ratio value proposed by SCS in 1954. Physiographic conditions were identified as vital influencing factors to be considered under this methodology while practitioners of this method are encouraged to validate and derive regional specific relationship and employ the method with caution

  13. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This direc...

  14. Exciplexes versus Loose Ion Pairs: How Does the Driving Force Impact the Initial Product Ratio of Photoinduced Charge Separation Reactions?

    Science.gov (United States)

    2014-01-01

    Many donor–acceptor systems can undergo a photoinduced charge separation reaction, yielding loose ion pairs (LIPs). LIPs can be formed either directly via (distant) electron transfer (ET) or indirectly via the dissociation of an initially formed exciplex or tight ion pair. Establishing the prevalence of one of the reaction pathways is challenging because differentiating initially formed exciplexes from LIPs is difficult due to similar spectroscopic footprints. Hence, no comprehensive reaction model has been established for moderately polar solvents. Here, we employ an approach based on the time-resolved magnetic field effect (MFE) of the delayed exciplex luminescence to distinguish the two reaction channels. We focus on the effects of the driving force of ET and the solvent permittivity. We show that, surprisingly, the exciplex channel is significant even for an exergonic ET system with a free energy of ET of −0.58 eV and for the most polar solutions studied (butyronitrile). Our findings demonstrate that exciplexes play a crucial role even in polar solvents and at moderate driving forces, contrary to what is usually assumed. PMID:25243054

  15. High-Resolution Mesoscale Simulations of the 6-7 May 2000 Missouri Flash Flood: Impact of Model Initialization and Land Surface Treatment

    Science.gov (United States)

    Baker, R. David; Wang, Yansen; Tao, Wei-Kuo; Wetzel, Peter; Belcher, Larry R.

    2004-01-01

    High-resolution mesoscale model simulations of the 6-7 May 2000 Missouri flash flood event were performed to test the impact of model initialization and land surface treatment on timing, intensity, and location of extreme precipitation. In this flash flood event, a mesoscale convective system (MCS) produced over 340 mm of rain in roughly 9 hours in some locations. Two different types of model initialization were employed: 1) NCEP global reanalysis with 2.5-degree grid spacing and 12-hour temporal resolution, and 2) Eta reanalysis with 40- km grid spacing and $hour temporal resolution. In addition, two different land surface treatments were considered. A simple land scheme. (SLAB) keeps soil moisture fixed at initial values throughout the simulation, while a more sophisticated land model (PLACE) allows for r interactive feedback. Simulations with high-resolution Eta model initialization show considerable improvement in the intensity of precipitation due to the presence in the initialization of a residual mesoscale convective vortex (hlCV) from a previous MCS. Simulations with the PLACE land model show improved location of heavy precipitation. Since soil moisture can vary over time in the PLACE model, surface energy fluxes exhibit strong spatial gradients. These surface energy flux gradients help produce a strong low-level jet (LLJ) in the correct location. The LLJ then interacts with the cold outflow boundary of the MCS to produce new convective cells. The simulation with both high-resolution model initialization and time-varying soil moisture test reproduces the intensity and location of observed rainfall.

  16. Impact of rapid molecular diagnostic tests on time to treatment initiation and outcomes in patients with multidrug-resistant tuberculosis, Tamil Nadu, India.

    Science.gov (United States)

    Nair, Dina; Navneethapandian, Pooranaganga D; Tripathy, Jaya Prasad; Harries, Anthony D; Klinton, Joel S; Watson, Basilea; Sivaramakrishnan, Gomathi N; Reddy, Devarajulu S; Murali, Lakshmi; Natrajan, Mohan; Swaminathan, Soumya

    2016-09-01

    India is replacing culture and drug sensitivity testing (CDST) with rapid molecular tests for diagnosing MDR-TB. We assessed the impact of rapid tests on time to initiation of treatment and outcomes in patients with MDR-TB compared with CDST. A retrospective cohort study involving MDR-TB patients from six districts in Tamil Nadu state, who underwent CDST (2010-2011) and rapid tests (2012-2013). There were 135 patients in the CDST group and 389 in the rapid diagnostic test group. Median time from sputum receipt at the laboratory to initiation of MDR-TB treatment was 130 days (IQR 75-213) in the CDST group and 22 days (IQR 14-38) in the rapid diagnostic test group (p30% in both groups and missing data were higher in CDST (13%) compared with rapid tests (3%). There were significantly higher risks of unfavourable treatment outcomes in males (aRR 1.3, 95% CI 1.1-1.5) and those with treatment initiation delays >30 days (aRR 1.3, 95% CI 1.0-1.6). Rapid molecular diagnostic tests shortened the time to initiate treatment which was associated with reduced unfavourable outcomes in MDR-TB patients. This supports the policy to scale up these tests in India. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Assessing the initial adaptability and impact of a mobile dictation and reporting system in the radiology department of an academic hospital

    Science.gov (United States)

    Gali, Raja L.; Dave, Jaydev K.

    2017-03-01

    Mobile Radiologist 360, rolled out as part of the voice dictation system upgrade from Nuance Powerscribe 5.0 to PS360 allows an attending radiologist to edit and sign-off a report assigned by a trainee or that has been started by the radiologist on a workstation. The purpose of this study was to evaluate the adoptability and impact of this application. Report turnaround time data was extracted from the RIS (GE-Centricity RIS-IC) for 60 days before- (period-1) and 60 days after- (period-2) the application implementation and then, for 60 days after end of period-2 (period-3). Adoptability of the application was evaluated using two metrics; first, the number of attending radiologists who signed-off reports using the application in periods 2 and 3, and second, the proportion of reports signed-off by the top five users of the mobile application using the application. Impact of the application was evaluated by comparing the time from initial dictation to final sign-off (time_PF) for the top five users of the mobile application to the time_PF by other five radiologists who did not use the application. 41% radiologists used the mobile application at least once during the study period; the proportion of cases signed-off using the mobile application ranged from 1% to 20%. ANOVA revealed no statistically significant effect of the mobile application system on time_PF (p=0.842). In conclusion, there was low initial adoptability and no impact of the mobile dictation and reporting system in reducing the time from initial dictation to final sign-off on a radiology report.

  18. Initial data release of regular blood drip stain created by varying fall height, angle of impact and source dimension

    Directory of Open Access Journals (Sweden)

    Nabanita Basu

    2016-09-01

    Full Text Available The dataset developed consists of 108 blood drip stains developed with fresh porcine blood, blood admixed with different dosage of Warfarin and Heparin, respectively. For each particular blood type (i.e. fresh blood, blood admixed with Warfarin at different dosage and blood admixed with Heparin at varied dosage stain patterns were created by passive dripping of blood from a 2.5 cm3 subcutaneous syringe with needle filled to capacity, at 30°, 60° and 90° angle of impact with corresponding fall height of 20, 40 and 60 cm respectively. In the other dataset of 162 datapoints, 81 regular drip stains were formed from blood that had dripped passively from a subcutaneous syringe without needle at the aforementioned angle of impact and fall height, while the other stains were formed as a result of dripping of blood from a subcutaneous syringe with needle. In order to compare stains formed, all stains were recorded on the same representative, non-porous, smooth target surface under similar physical conditions. The interpretations relevant to the dataset are available in the article titled ‘2D Source Area prediction based on physical characteristics of a regular, passive blood drip stain’ (Basu and Bandyopadhyay, 2016 [7]. An image pre-processing algorithm for extracting ROI has also been incorporated in this article. Keywords: Drip stain, Bloodstain Pattern Analysis, Source Dimension prediction

  19. Indoor transient SOA formation from ozone + α-pinene reactions: Impacts of air exchange and initial product concentrations, and comparison to limonene ozonolysis

    Science.gov (United States)

    Youssefi, Somayeh; Waring, Michael S.

    2015-07-01

    The ozonolysis of reactive organic gases (ROG), e.g. terpenes, generates secondary organic aerosol (SOA) indoors. The SOA formation strength of such reactions is parameterized by the aerosol mass fraction (AMF), a.k.a. SOA yield, which is the mass ratio of generated SOA to oxidized ROG. AMFs vary in magnitude both among and for individual ROGs. Here, we quantified dynamic SOA formation from the ozonolysis of α-pinene with 'transient AMFs,' which describe SOA formation due to pulse emission of a ROG in an indoor space with air exchange, as is common when consumer products are intermittently used in ventilated buildings. We performed 19 experiments at low, moderate, and high (0.30, 0.52, and 0.94 h-1, respectively) air exchange rates (AER) at varying concentrations of initial reactants. Transient AMFs as a function of peak SOA concentrations ranged from 0.071 to 0.25, and they tended to increase as the AER and product of the initial reactant concentrations increased. Compared to our similar research on limonene ozonolysis (Youssefi and Waring, 2014), for which formation strength was driven by secondary ozone reactions, the AER impact for α-pinene was opposite in direction and weaker, while the initial reactant product impact was in the same direction but stronger for α-pinene than for limonene. Linear fits of AMFs for α-pinene ozonolysis as a function of the AER and initial reactant concentrations are provided so that future indoor models can predict SOA formation strength.

  20. Initial porosity impact on equal channel angular pressing (ECAP of Ti–6Al–4V powder material

    Directory of Open Access Journals (Sweden)

    V. A. Andreyachshenko

    2016-10-01

    Full Text Available There is studied the technology of processing Ti-6Al-4V powder material with various initial densities using the method of equal channel angular pressing. The device with the 90, 120 and 135 degree angled joint channels was used for the study. The deformation was carried out at the room temperature. It was found that the most favorable stressed-and-strained state was formed in the instrument where the angle of channel joints was equal to 135 degrees. The maximum compression in the instrument is reached at 90 degree angle of the channel joints, but it needs a larger deformation force. To obtain pressed material it is recommended to use a high ECAP cycle for any configuration.

  1. Atmospheric Motion Vectors from INSAT-3D: Initial quality assessment and its impact on track forecast of cyclonic storm NANAUK

    Science.gov (United States)

    Deb, S. K.; Kishtawal, C. M.; Kumar, Prashant; Kiran Kumar, A. S.; Pal, P. K.; Kaushik, Nitesh; Sangar, Ghansham

    2016-03-01

    The advanced Indian meteorological geostationary satellite INSAT-3D was launched on 26 July 2013 with an improved imager and an infrared sounder and is placed at 82°E over the Indian Ocean region. With the advancement in retrieval techniques of different atmospheric parameters and with improved imager data have enhanced the scope for better understanding of the different tropical atmospheric processes over this region. The retrieval techniques and accuracy of one such parameter, Atmospheric Motion Vectors (AMV) has improved significantly with the availability of improved spatial resolution data along with more options of spectral channels in the INSAT-3D imager. The present work is mainly focused on providing brief descriptions of INSAT-3D data and AMV derivation processes using these data. It also discussed the initial quality assessment of INSAT-3D AMVs for a period of six months starting from 01 February 2014 to 31 July 2014 with other independent observations: i) Meteosat-7 AMVs available over this region, ii) in-situ radiosonde wind measurements, iii) cloud tracked winds from Multi-angle Imaging Spectro-Radiometer (MISR) and iv) numerical model analysis. It is observed from this study that the qualities of newly derived INSAT-3D AMVs are comparable with existing two versions of Meteosat-7 AMVs over this region. To demonstrate its initial application, INSAT-3D AMVs are assimilated in the Weather Research and Forecasting (WRF) model and it is found that the assimilation of newly derived AMVs has helped in reduction of track forecast errors of the recent cyclonic storm NANAUK over the Arabian Sea. Though, the present study is limited to its application to one case study, however, it will provide some guidance to the operational agencies for implementation of this new AMV dataset for future applications in the Numerical Weather Prediction (NWP) over the south Asia region.

  2. The impact of cow's milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer

    Directory of Open Access Journals (Sweden)

    Melnik Bodo C

    2012-08-01

    Full Text Available Abstract Prostate cancer (PCa is dependent on androgen receptor signaling and aberrations of the PI3K-Akt-mTORC1 pathway mediating excessive and sustained growth signaling. The nutrient-sensitive kinase mTORC1 is upregulated in nearly 100% of advanced human PCas. Oncogenic mTORC1 signaling activates key subsets of mRNAs that cooperate in distinct steps of PCa initiation and progression. Epidemiological evidence points to increased dairy protein consumption as a major dietary risk factor for the development of PCa. mTORC1 is a master regulator of protein synthesis, lipid synthesis and autophagy pathways that couple nutrient sensing to cell growth and cancer. This review provides evidence that PCa initiation and progression are promoted by cow´s milk, but not human milk, stimulation of mTORC1 signaling. Mammalian milk is presented as an endocrine signaling system, which activates mTORC1, promotes cell growth and proliferation and suppresses autophagy. Naturally, milk-mediated mTORC1 signaling is restricted only to the postnatal growth phase of mammals. However, persistent consumption of cow´s milk proteins in humans provide highly insulinotropic branched-chain amino acids (BCAAs provided by milk´s fast hydrolysable whey proteins, which elevate postprandial plasma insulin levels, and increase hepatic IGF-1 plasma concentrations by casein-derived amino acids. BCAAs, insulin and IGF-1 are pivotal activating signals of mTORC1. Increased cow´s milk protein-mediated mTORC1 signaling along with constant exposure to commercial cow´s milk estrogens derived from pregnant cows may explain the observed association between high dairy consumption and increased risk of PCa in Westernized societies. As well-balanced mTORC1-signaling plays an important role in appropriate prostate morphogenesis and differentiation, exaggerated mTORC1-signaling by high cow´s milk consumption predominantly during critical growth phases of prostate development and

  3. The impact of cow's milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer

    Science.gov (United States)

    2012-01-01

    Prostate cancer (PCa) is dependent on androgen receptor signaling and aberrations of the PI3K-Akt-mTORC1 pathway mediating excessive and sustained growth signaling. The nutrient-sensitive kinase mTORC1 is upregulated in nearly 100% of advanced human PCas. Oncogenic mTORC1 signaling activates key subsets of mRNAs that cooperate in distinct steps of PCa initiation and progression. Epidemiological evidence points to increased dairy protein consumption as a major dietary risk factor for the development of PCa. mTORC1 is a master regulator of protein synthesis, lipid synthesis and autophagy pathways that couple nutrient sensing to cell growth and cancer. This review provides evidence that PCa initiation and progression are promoted by cow´s milk, but not human milk, stimulation of mTORC1 signaling. Mammalian milk is presented as an endocrine signaling system, which activates mTORC1, promotes cell growth and proliferation and suppresses autophagy. Naturally, milk-mediated mTORC1 signaling is restricted only to the postnatal growth phase of mammals. However, persistent consumption of cow´s milk proteins in humans provide highly insulinotropic branched-chain amino acids (BCAAs) provided by milk´s fast hydrolysable whey proteins, which elevate postprandial plasma insulin levels, and increase hepatic IGF-1 plasma concentrations by casein-derived amino acids. BCAAs, insulin and IGF-1 are pivotal activating signals of mTORC1. Increased cow´s milk protein-mediated mTORC1 signaling along with constant exposure to commercial cow´s milk estrogens derived from pregnant cows may explain the observed association between high dairy consumption and increased risk of PCa in Westernized societies. As well-balanced mTORC1-signaling plays an important role in appropriate prostate morphogenesis and differentiation, exaggerated mTORC1-signaling by high cow´s milk consumption predominantly during critical growth phases of prostate development and differentiation may exert long

  4. Zn(II, Mn(II and Sr(II Behavior in a Natural Carbonate Reservoir System. Part I: Impact of Salinity, Initial pH and Initial Zn(II Concentration in Atmospheric Conditions

    Directory of Open Access Journals (Sweden)

    Auffray B.

    2016-07-01

    Full Text Available The sorption of inorganic elements on carbonate minerals is well known in strictly controlled conditions which limit the impact of other phenomena such as dissolution and/or precipitation. In this study, we evidence the behavior of Zn(II (initially in solution and two trace elements, Mn(II and Sr(II (released by carbonate dissolution in the context of a leakage from a CO2 storage site. The initial pH chosen are either equal to the pH of the water-CO2 equilibrium (~ 2.98 or equal to the pH of the water-CO2-calcite system (~ 4.8 in CO2 storage conditions. From this initial influx of liquid, saturated or not with respect to calcite, the batch experiments evolve freely to their equilibrium, as it would occur in a natural context after a perturbation. The batch experiments are carried out on two natural carbonates (from Lavoux and St-Emilion with PCO2 = 10−3.5 bar, with different initial conditions ([Zn(II]i from 10−4 to 10−6 M, either with pure water or 100 g/L NaCl brine. The equilibrium regarding calcite dissolution is confirmed in all experiments, while the zinc sorption evidenced does not always correspond to the two-step mechanism described in the literature. A preferential sorption of about 10% of the concentration is evidenced for Mn(II in aqueous experiments, while Sr(II is more sorbed in saline conditions. This study also shows that this preferential sorption, depending on the salinity, is independent of the natural carbonate considered. Then, the simulations carried out with PHREEQC show that experiments and simulations match well concerning the equilibrium of dissolution and the sole zinc sorption, with log KZn(II ~ 2 in pure water and close to 4 in high salinity conditions. When the simulations were possible, the log K values for Mn(II and Sr(II were much different from those in the literature obtained by sorption in controlled conditions. It is shown that a new conceptual model regarding multiple Trace Elements (TE sorption is

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

    Science.gov (United States)

    Nakanishi, Miharu; Yamauchi, Takashi; Takeshima, Tadashi

    2015-01-01

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

  6. Environmental Impacts of Petroleum Production: Initial Results from the Osage-Skiatook Petroleum Environmental Research Sites, Osage County, Oklahoma

    Science.gov (United States)

    Kharaka, Yousif K.; Otton, James K.

    2003-01-01

    Exploration for and production of petroleum have caused major detrimental impacts to soils, surface and ground waters, and the local ecosystems in the United States. These impacts arise primarily from the improper disposal of large volumes of saline water produced with oil and gas, from accidental hydrocarbon and produced water releases, and from abandoned oil wells that were not correctly sealed. It is important to understand the long-term and short-term effects of produced water and hydrocarbon releases from these sites in order to develop risk-based remediation plans. Remediation is particularly needed in aging and depleted fields where land use is changing from petroleum production to residential, agricultural or recreational uses. About 20 scientists from the USGS and other governmental agencies and academia are involved in a multidisciplinary investigation to study the transport, fate, and natural attenuation of inorganic salts, trace metals, organic compounds and radionuclides present in produced water, and their impacts at the Osage-Skiatook Petroleum Environmental Research (OSPER) 'A' and 'B' sites, located on the Osage Reservation in Osage County, Oklahoma. Stakeholders in the project include the Osage Nation, which holds the mineral rights, the Bureau of Indian Affairs with trust responsibility, and the Army Corps of Engineers, which owns the surface rights at these sites and manages adjacent Skiatook Lake. The 4250-hectare Skiatook Lake provides drinking water to local Tulsa suburban communities and a rural water district, and offers recreational fishing and boating opportunities to tens of thousands of visitors each year. Approximately 1.5 and 1.0 hectare of land at the OSPER 'A' (depleted Lester lease) and 'B' (active Branstetter lease) sites, respectively, are affected by salt scarring, tree kills, soil salinization and brine and petroleum contamination due to the leakage of produced water and associated hydrocarbons from brine pits and accidental

  7. Accelerating Research Impact in a Learning Health Care System: VA's Quality Enhancement Research Initiative in the Choice Act Era.

    Science.gov (United States)

    Kilbourne, Amy M; Elwy, A Rani; Sales, Anne E; Atkins, David

    2017-07-01

    Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. QUERI's national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law's further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health.

  8. Evaluation of the impact of initial red wine composition on changes in color and anthocyanin content during bottle storage.

    Science.gov (United States)

    Avizcuri, José-Miguel; Sáenz-Navajas, María-Pilar; Echávarri, José-Federico; Ferreira, Vicente; Fernández-Zurbano, Purificación

    2016-12-15

    Sixteen commercial red wines, selected to cover a different range of color and total polyphenols index (TPI), were stored at 25°C during 6months under controlled and different oxygen additions (0, 1.1, 3.1, 10.6 and 30.4mgL(-1)) during the bottling process. Changes in color and the anthocyanic composition were evaluated using transmittance spectra and UPLC-MS-UV/Vis respectively. Results reveal a general pattern in the evolution of wines. However, different patterns of evolution related to initial wine composition, especially to TPI, were observed. Wines with higher TPI had a lower evolution, whereas wines with lower TPI showed a higher evolution and greater variability in behavior. In general, oxygen seemed to accelerate all changes observed during aging although the oxygen effect was more limited than the effect of the storage time. These results are relevant for wine experts and help explain the evolution of wine at the bottling stage. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Parental Perceptions of Family Adjustment in Childhood Developmental Disabilities

    Science.gov (United States)

    Thompson, Sandra; Hiebert-Murphy, Diane; Trute, Barry

    2013-01-01

    Based on the adjustment phase of the double ABC-X model of family stress (McCubbin and Patterson, 1983) this study examined the impact of parenting stress, positive appraisal of the impact of child disability on the family, and parental self-esteem on parental perceptions of family adjustment in families of children with disabilities. For mothers,…

  10. An Initial Assessment of the Impact of CYGNSS Ocean Surface Wind Assimilation on Navy Global and Mesoscale Numerical Weather Prediction

    Science.gov (United States)

    Baker, N. L.; Tsu, J.; Swadley, S. D.

    2017-12-01

    We assess the impact of assimilation of CYclone Global Navigation Satellite System (CYGNSS) ocean surface winds observations into the NAVGEM[i] global and COAMPS®[ii] mesoscale numerical weather prediction (NWP) systems. Both NAVGEM and COAMPS® used the NRL 4DVar assimilation system NAVDAS-AR[iii]. Long term monitoring of the NAVGEM Forecast Sensitivity Observation Impact (FSOI) indicates that the forecast error reduction for ocean surface wind vectors (ASCAT and WindSat) are significantly larger than for SSMIS wind speed observations. These differences are larger than can be explained by simply two pieces of information (for wind vectors) versus one (wind speed). To help understand these results, we conducted a series of Observing System Experiments (OSEs) to compare the assimilation of ASCAT wind vectors with the equivalent (computed) ASCAT wind speed observations. We found that wind vector assimilation was typically 3 times more effective at reducing the NAVGEM forecast error, with a higher percentage of beneficial observations. These results suggested that 4DVar, in the absence of an additional nonlinear outer loop, has limited ability to modify the analysis wind direction. We examined several strategies for assimilating CYGNSS ocean surface wind speed observations. In the first approach, we assimilated CYGNSS as wind speed observations, following the same methodology used for SSMIS winds. The next two approaches converted CYGNSS wind speed to wind vectors, using NAVGEM sea level pressure fields (following Holton, 1979), and using NAVGEM 10-m wind fields with the AER Variational Analysis Method. Finally, we compared these methods to CYGNSS wind speed assimilation using multiple outer loops with NAVGEM Hybrid 4DVar. Results support the earlier studies suggesting that NAVDAS-AR wind speed assimilation is sub-optimal. We present detailed results from multi-month NAVGEM assimilation runs along with case studies using COAMPS®. Comparisons include the fit of

  11. Increasing medical student exposure to musculoskeletal medicine: the initial impact of the Orthopaedic Surgery and Sports Medicine Interest Group

    Directory of Open Access Journals (Sweden)

    Mickelson DT

    2017-07-01

    Full Text Available Dayne T Mickelson,1 Philip K Louie,2 Kenneth R Gundle,3 Alex W Farnand,4 Douglas P Hanel5 1Department of Orthopedic Surgery and Sports Medicine, Duke University, Durham, NC, USA; 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; 3Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA; 4Department of General Surgery, Presence Saint Joseph Hospital – Chicago, Chicago, IL, USA; 5Department of Orthopedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA Purpose: To investigate the impact of the Orthopaedic Surgery and Sports Medicine Interest Group (OSSMIG on medical student interest and confidence in core musculoskeletal (MSK concepts through supplemental education and experiences at a single tertiary, academic institution.Methods: Medical student OSSMIG members at various levels of training were anonymously surveyed at the beginning and end of the 2014–2015 academic year.Results: Eighteen (N=18 medical student interest group members completed the survey. Significant improvement in their level of training was observed with regard to respondents’ self-assessed competence and confidence in MSK medicine (p<0.05. Additionally, respondents’ attitudes toward exposure and support from the interest group were significantly higher than those provided by the institution (p<0.05. Members believed OSSMIG increased interest in MSK medicine, improved confidence in their ability to perform orthopedics-related physical exams, strengthened mentorship with residents and attendings, and developed a connection with the Department of Orthopedic Surgery and its residents (median “Strongly Agree”, interquartile range one and two scale items.Conclusion: Since its inception 8 years ago, OSSMIG has been well received and has positively impacted University of Washington School of Medicine students through various interventions

  12. Learning about Occlusion: Initial Assumptions and Rapid Adjustments

    Science.gov (United States)

    Kochukhova, Olga; Gredeback, Gustaf

    2007-01-01

    We examined 6-month-olds' abilities to represent occluded objects, using a corneal-reflection eye-tracking technique. Experiment 1 compared infants' ability to extrapolate the current pre-occlusion trajectory with their ability to base predictions on recent experiences of novel object motions. In the first condition infants performed at asymptote…

  13. Evaluating the Impact of the Medical Education Partnership Initiative at the University of Zimbabwe College of Health Sciences Using the Most Significant Change Technique.

    Science.gov (United States)

    Connors, Susan C; Nyaude, Shemiah; Challender, Amelia; Aagaard, Eva; Velez, Christine; Hakim, James

    2017-09-01

    In medical education, evaluating outcomes from programs intended to transform attitudes or influence career trajectories using conventional methods of monitoring is often difficult. To address this problem, the authors adapted the most significant change (MSC) technique to gain a more comprehensive understanding of the impact of the Medical Education Partnership Initiative (MEPI) program at the University of Zimbabwe College of Health Sciences. In 2014-2015, the authors applied the MSC to systematically examine the personal significance and level of positive transformation that individuals attributed to their MEPI participation. Interviews were conducted with 28 participants nominated by program leaders. The authors coded results inductively for prevalent themes in participants' stories and prepared profiles with representative quotes to place the stories in context. Stakeholders selected 9 themes and 18 stories to illustrate the most significant changes. Six themes (or outcomes) were expected, as they aligned with MEPI goals-becoming a better teacher, becoming a better clinician, increased interest in teaching, increased interest in research, new career pathways (including commitment to practice in Zimbabwe), and improved research skills. Three themes were unexpected-increased confidence, expanded interprofessional networks, and improved interpersonal interactions. The authors found the MSC to be a useful and systematic evaluation approach for large, complex, and transformative initiatives like MEPI. The MSC seemed to encourage participant reflection, support values inquiry by program leaders, and provide insights into the personal and cultural impacts of MEPI. Additional trial applications of the MSC technique in academic medicine are warranted.

  14. Impact of a Diagnostic Pressure Equation Constraint on Tornadic Supercell Thunderstorm Forecasts Initialized Using 3DVAR Radar Data Assimilation

    Directory of Open Access Journals (Sweden)

    Guoqing Ge

    2013-01-01

    Full Text Available A diagnostic pressure equation constraint has been incorporated into a storm-scale three-dimensional variational (3DVAR data assimilation system. This diagnostic pressure equation constraint (DPEC is aimed to improve dynamic consistency among different model variables so as to produce better data assimilation results and improve the subsequent forecasts. Ge et al. (2012 described the development of DPEC and testing of it with idealized experiments. DPEC was also applied to a real supercell case, but only radial velocity was assimilated. In this paper, DPEC is further applied to two real tornadic supercell thunderstorm cases, where both radial velocity and radar reflectivity data are assimilated. The impact of DPEC on radar data assimilation is examined mainly based on the storm forecasts. It is found that the experiments using DPEC generally predict higher low-level vertical vorticity than the experiments not using DPEC near the time of observed tornadoes. Therefore, it is concluded that the use of DPEC improves the forecast of mesocyclone rotation within supercell thunderstorms. The experiments using different weighting coefficients generate similar results. This suggests that DPEC is not very sensitive to the weighting coefficients.

  15. The impact of initiatives to limit the advertising of food and beverage products to children: a systematic review.

    Science.gov (United States)

    Galbraith-Emami, S; Lobstein, T

    2013-12-01

    In response to increasing evidence that advertising of foods and beverages affects children's food choices and food intake, several national governments and many of the world's larger food and beverage manufacturers have acted to restrict the marketing of their products to children or to advertise only 'better for you' products or 'healthier dietary choices' to children. Independent assessment of the impact of these pledges has been difficult due to the different criteria being used in regulatory and self-regulatory regimes. In this paper, we undertook a systematic review to examine the data available on levels of exposure of children to the advertising of less healthy foods since the introduction of the statutory and voluntary codes. The results indicate a sharp division in the evidence, with scientific, peer-reviewed papers showing that high levels of such advertising of less healthy foods continue to be found in several different countries worldwide. In contrast, the evidence provided in industry-sponsored reports indicates a remarkably high adherence to voluntary codes. We conclude that adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children's exposure to this advertising. © 2013 The Authors. obesity reviews © 2013 International Association for the Study of Obesity.

  16. Short and intermediate economic impacts of a terrorist-initiated loss of electric power: Case study of New Jersey

    International Nuclear Information System (INIS)

    Greenberg, Michael; Mantell, Nancy; Lahr, Michael; Felder, Frank; Zimmerman, Rae

    2007-01-01

    The economic impacts of potential terrorist attacks on the New Jersey electric power system are examined using a regional econometric model. The magnitude and duration of the effects vary by type of business and income measure. We assume damage is done during in the summer 2005 quarter, a peak period for energy use. The state economy recovers within a year, if we assume that economic activity is restored in the next time period. However, if the attacks prompt an absolute of loss of activity due to firm relocation, closing, and geographical changes in expansion plans, then the economy does not fully recover by the year 2010. Hence, the electrical power system's resiliency to damage is the key to the extent and duration of any economic consequences of a terrorist attack, at least in New Jersey. The policy implication is that the costs and benefits of making the electric power system more resilient to plausible attacks should be weighed and that the restorative capacity of the system should be strengthened

  17. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    Science.gov (United States)

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Short and intermediate economic impacts of a terrorist-initiated loss of electric power: case study of New Jersey

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, M.; Mantell, N.; Lahr, M.; Felder, F. [Rutgers University, New Brunswick, NJ (United States). Edward J. Bloustein School; Zimmerman, R. [New York University (United States). Robert F. Wagner School of Public Service

    2007-01-15

    The economic impacts of potential terrorist attacks on the New Jersey electric power system are examined using a regional econometric model. The magnitude and duration of the effects vary by type of business and income measure. We assume damage is done during in the summer 2005 quarter, a peak period for energy use. The state economy recovers within a year, if we assume that economic activity is restored in the next time period. However, if the attacks prompt an absolute of loss of activity due to firm relocation, closing, and geographical changes in expansion plans, then the economy does not fully recover by the year 2010. Hence, the electrical power system's resiliency to damage is the key to the extent and duration of any economic consequences of a terrorist attack, at least in New Jersey. The policy implication is that the costs and benefits of making the electric power system more resilient to plausible attacks should be weighed and that the restorative capacity of the system should be strengthened. (author)

  19. The impact of a community mental health initiative on outcomes for offenders with a serious mental disorder.

    Science.gov (United States)

    Stewart, Lynn A; Farrell-MacDonald, Shanna; Feeley, Stacey

    2017-10-01

    The Community Mental Health Initiative (CMHI) is mandated to assist offenders with serious mental disorders in their transition from institutions to the community, but this incorporates different styles of service. An important unanswered question is whether these are equivalent. Our aim was to compare outcomes for different intervention styles within the CMHI, a programme for serious offenders in prison who also have at least one major mental disorder. Our specific research questions were as follows: do outcomes differ according to whether offenders with mental health difficulties receive (1) clinical discharge planning only; (2) community mental health services only; (3) the combined services or (4) none, although meeting criteria for any CMHI service? Survival analyses, controlling for variables with a significant effect on recidivism or return to prison, were used to test for differences in recidivism or return to prison rates between the intervention and no-intervention groups during a fixed follow-up period. Men receiving only community mental health services had a significantly lower risk of returning to custody and of recidivism than men receiving discharge planning alone or no community mental health service at all, even after controlling for potential confounders including age, number of previous imprisonments and number of previous community failures. The advantages were apparent within 3-6 months and sustained for up to 4 years. Provision of specialised community mental health services for higher-risk male offenders with a mental disorder may reduce recidivism in the short and longer term - within 3 months and up to 4 years respectively. Statistical modelling also pointed to the need to include treatment for substance abuse and assistance in identifying stable accommodation and brokerage of community services among the interventions and services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  20. Initial observations of electronic medical record usage during CT and MRI interpretation: Frequency of use and impact on workflow.

    Science.gov (United States)

    Lin, Abraham; Harris, Mitchell; Zalis, Michael

    2010-07-01

    Electronic medical record (EMR) systems permit integration of contextual nonimaging EMR data into examination interpretation; however, the extra effort required to search and review these nonradiologic data are not well characterized. We assessed the gross frequency and pattern of EMR usage in the interpretation of diagnostic CT and MRI examinations. We defined nonradiologic EMR data as laboratory data, nonimaging specialty report, clinical note, and administrative data not available on PACS. For abdominal, neuroradiologic, and musculoskeletal CT and MRI, we prospectively recorded the time required for image analysis (including prior imaging studies and their reports), nonradiologic EMR use, and initial report drafting by fellows and staff in randomized sessions. We assessed EMR use as a fraction of work activity and according to technique, subspecialty, inpatient status, and radiologist experience. We observed 372 CT and MRI interpretations by 33 radiologists. For CT, radiologists used the EMR in 34% of abdominal, 57% of neuroradiologic, and 38% of musculoskeletal interpretations. For MRI, EMR was used in 73% of abdominal, 56% of neuroradiologic, and 33% of musculoskeletal interpretations. For CT, EMR usage comprised 18%, 14%, and 18% of diagnostic effort (image analysis plus EMR use) for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively; for MRI, EMR usage comprised 21%, 16%, and 15% of diagnostic effort for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively. Frequency of EMR use was significantly greater for neuroradiology CT and abdominal MRI (p < 0.05, Fisher's test). EMR usage was not consistently related to inpatient status for CT or radiologist experience. For CT and MRI interpretation, EMR usage is frequent and comprises a significant fraction of diagnostic effort.

  1. Impact of pain reported during isometric quadriceps muscle strength testing in people with knee pain: data from the osteoarthritis initiative.

    Science.gov (United States)

    Riddle, Daniel L; Stratford, Paul W

    2011-10-01

    Muscle force testing is one of the more common categories of diagnostic tests used in clinical practice. Clinicians have little evidence to guide interpretations of muscle force tests when pain is elicited during testing. The purpose of this study was to examine the construct validity of isometric quadriceps muscle strength tests by determining whether the relationship between maximal isometric quadriceps muscle strength and functional status was influenced by pain during isometric testing. A cross-sectional design was used. Data from the Osteoarthritis Initiative were used to identify 1,344 people with unilateral knee pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores of 1 or higher on the involved side. Measurements of maximal isometric quadriceps strength and ratings of pain during isometric testing were collected. Outcome variables were WOMAC physical function subscale, 20-m walk test, 400-m walk test, and a repeated chair stand test. Multiple regression models were used to determine whether pain during testing modified or confounded the relationship between strength and functional status. Pearson r correlations among the isometric quadriceps strength measures and the 4 outcome measures ranged from -.36 (95% confidence interval=-.41, -.31) for repeated chair stands to .36 (95% confidence interval=.31, .41) for the 20-m walk test. In the final analyses, neither effect modification nor confounding was found for the repeated chair stand test, the 20-m walk test, the 400-m walk test, or the WOMAC physical function subscale. Moderate or severe pain during testing was weakly associated with reduced strength, but mild pain was not. The disease spectrum was skewed toward mild or moderate symptoms, and the pain measurement scale used during muscle force testing was not ideal. Given that the spectrum of the sample was skewed toward mild or moderate symptoms and disease, the data suggest that isometric quadriceps muscle

  2. Variations of the stellar initial mass function in semi-analytical models - II. The impact of cosmic ray regulation

    Science.gov (United States)

    Fontanot, Fabio; De Lucia, Gabriella; Xie, Lizhi; Hirschmann, Michaela; Bruzual, Gustavo; Charlot, Stéphane

    2018-04-01

    Recent studies proposed that cosmic rays (CRs) are a key ingredient in setting the conditions for star formation, thanks to their ability to alter the thermal and chemical state of dense gas in the ultraviolet-shielded cores of molecular clouds. In this paper, we explore their role as regulators of the stellar initial mass function (IMF) variations, using the semi-analytic model for GAlaxy Evolution and Assembly (GAEA). The new model confirms our previous results obtained using the integrated galaxy-wide IMF (IGIMF) theory. Both variable IMF models reproduce the observed increase of α-enhancement as a function of stellar mass and the measured z = 0 excess of dynamical mass-to-light ratios with respect to photometric estimates assuming a universal IMF. We focus here on the mismatch between the photometrically derived (M^app_{\\star }) and intrinsic (M⋆) stellar masses, by analysing in detail the evolution of model galaxies with different values of M_{\\star }/M^app_{\\star }. We find that galaxies with small deviations (i.e. formally consistent with a universal IMF hypothesis) are characterized by more extended star formation histories and live in less massive haloes with respect to the bulk of the galaxy population. In particular, the IGIMF theory does not change significantly the mean evolution of model galaxies with respect to the reference model, a CR-regulated IMF instead implies shorter star formation histories and higher peaks of star formation for objects more massive than 1010.5 M⊙. However, we also show that it is difficult to unveil this behaviour from observations, as the key physical quantities are typically derived assuming a universal IMF.

  3. Impact of the Global Food Safety Initiative on Food Safety Worldwide: Statistical Analysis of a Survey of International Food Processors.

    Science.gov (United States)

    Crandall, Philip G; Mauromoustakos, Andy; O'Bryan, Corliss A; Thompson, Kevin C; Yiannas, Frank; Bridges, Kerry; Francois, Catherine

    2017-10-01

    In 2000, the Consumer Goods Forum established the Global Food Safety Initiative (GFSI) to increase the safety of the world's food supply and to harmonize food safety regulations worldwide. In 2013, a university research team in conjunction with Diversey Consulting (Sealed Air), the Consumer Goods Forum, and officers of GFSI solicited input from more than 15,000 GFSI-certified food producers worldwide to determine whether GFSI certification had lived up to these expectations. A total of 828 usable questionnaires were analyzed, representing about 2,300 food manufacturing facilities and food suppliers in 21 countries, mainly across Western Europe, Australia, New Zealand, and North America. Nearly 90% of these certified suppliers perceived GFSI as being beneficial for addressing their food safety concerns, and respondents were eight times more likely to repeat the certification process knowing what it entailed. Nearly three-quarters (74%) of these food manufacturers would choose to go through the certification process again even if certification were not required by one of their current retail customers. Important drivers for becoming GFSI certified included continuing to do business with an existing customer, starting to do business with new customer, reducing the number of third-party food safety audits, and continuing improvement of their food safety program. Although 50% or fewer respondents stated that they saw actual increases in sales, customers, suppliers, or employees, significantly more companies agreed than disagreed that there was an increase in these key performance indicators in the year following GFSI certification. A majority of respondents (81%) agreed that there was a substantial investment in staff time since certification, and 50% agreed there was a significant capital investment. This survey is the largest and most representative of global food manufacturers conducted to date.

  4. Economic impact of an ultrasonographic contrast agent on the diagnosis and initial management of patients with suspected renal artery stenosis

    International Nuclear Information System (INIS)

    Levesque, J.; Lacourciere, Y.; Onrot, J.M.

    2002-01-01

    To determine resource use in the diagnosis and management of Canadian hypertensive patients with suspected renal artery stenosis and to estimate the impact of diagnosis with contrast-enhanced duplex Doppler ultrasonography (US) on resource use. Seventy-eight patients with suspected renal artery stenosis underwent usual diagnostic tests (captopril-enhanced renal scintigraphy or duplex Doppler US) and contrast-enhanced US. A management pathway ('planned') describing the medical resources required for further patient care was outlined on the basis of results from each test (separately), and a modified management pathway ('recommended'), which considered data from both diagnostic methods, was also outlined. Medical resources and productivity losses were assessed prospectively for a 3-month period after patients underwent both tests ('actual' management pathway). With usual diagnostic methods, 14 (18%) of the tests were inconclusive, whereas only 1 (1%) of the enhanced US examinations was inconclusive; the cost-efficacy ratio was $422 and $343 per successful diagnosis, respectively. Further management costs for patients with an inconclusive diagnosis were estimated at $6370 after the usual diagnostic tests, but only $1278 with enhanced US. Although the costs of the planned and recommended management pathways were similar ($227 and $294 per patient respectively), the proportion of patients requiring further resources was lower with enhanced US (56% v. 46%). Three-month actual management costs ranged from $121 to $1605 per patient (mean $360). Diagnostic tests and surgical procedures were the major cost drivers in all pathways, and costs wore highest for patients in whom stenosis was diagnosed. For patients with suspected renal artery stenosis, contrast-enhanced US had a higher diagnostic success rate than usual diagnostic methods and afforded savings through lower administrative costs and lower medical resource consumption for patients whose diagnosis was unclear after

  5. Impact of the Urban Reproductive Health Initiative on family planning uptake at facilities in Kenya, Nigeria, and Senegal.

    Science.gov (United States)

    Winston, Jennifer; Calhoun, Lisa M; Corroon, Meghan; Guilkey, David; Speizer, Ilene

    2018-01-05

    The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The Urban Reproductive Health Initiative (URHI) was a Bill & Melinda Gates Foundation funded program designed to help contribute to these goals in urban areas in India, Kenya, Nigeria, and Senegal. URHI implemented a range of country-specific demand and supply side interventions, with supply interventions generally focused on improved service quality, provider training, outreach to patients, and commodity stock management. This study uses data collected by the Measurement, Learning & Evaluation (MLE) Project to examine the effectiveness of these supply-side interventions by considering URHI's influence on the number of family planning clients at health facilities over a four-year period in Kenya, Nigeria, and Senegal. The analysis used facility audits and provider surveys. Principal-components analysis was used to create country-specific program exposure variables for health facilities. Fixed-effects regression was used to determine whether family planning uptake increased at facilities with higher exposure. Outcomes of interest were the number of new family planning acceptors and the total number of family planning clients per reproductive health care provider in the last year. Higher program component scores were associated with an increase in new family planning acceptors per provider in Kenya (β = 18, 95% CI = 7-29), Nigeria (β = 14, 95% CI = 8-20), and Senegal (β = 7, 95% CI = 3-12). Higher scores were also associated with more family planning clients per provider in Kenya (β = 31, 95% CI = 7-56) and Nigeria (β = 26, 95% CI = 15-38), but not in Senegal. Supply-side interventions have increased the number of new family planning acceptors at facilities in urban Nigeria, Kenya, and Senegal and the overall number of clients in urban Nigeria and Kenya. While tailoring

  6. The impact of area-based initiatives on physical activity trends in deprived areas; a quasi-experimental evaluation of the Dutch District Approach.

    Science.gov (United States)

    Kramer, Daniëlle; Droomers, Mariël; Jongeneel-Grimen, Birthe; Wingen, Marleen; Stronks, Karien; Kunst, Anton E

    2014-03-11

    Numerous area-based initiatives (ABIs) have been implemented in deprived neighbourhoods across Europe. These large-scale initiatives aim to tackle the socio-economic and environmental problems in these areas that might influence physical activity (PA). There is little robust evidence of their impact on PA. This study aimed to assess the impact of a Dutch ABI called the District Approach on trends in leisure-time PA in deprived districts. Repeated cross-sectional data on 48401 adults across the Netherlands were obtained from the Integrated Survey on Household Living Conditions (POLS) 2004-2011. 1517 of these adults resided in deprived target districts and 46884 adults resided elsewhere in the Netherlands. In a quasi-experimental interrupted time-series design, multilevel logistic regression analyses were performed to assess trends in leisure-time walking, cycling, and sports before and during the intervention. Trends in deprived target districts were compared with trends in various control groups. The role of the intensity of environmental interventions was also assessed. Deprived target districts showed a significantly positive change in walking trend between the pre-intervention and intervention period. The trend change in the deprived target districts was significantly larger compared to the rest of the Netherlands, but not compared to other deprived districts. For cycling and sports, neither deprived districts nor control districts showed a significant trend change. For all leisure-time PA outcomes, trend changes were not related to the intensity of environmental interventions in the deprived target districts. Some evidence was found to suggest that ABIs like the District Approach have a positive impact on leisure-time PA in deprived districts, regardless of the intensity of environmental interventions.

  7. Downhole adjustable bent assemblies

    International Nuclear Information System (INIS)

    Askew, W.E.

    1992-01-01

    This patent describes downhole adjustable apparatus for creating a bend angle in order to affect the inclination of a drilled borehole. It comprises an upper tubular member having an upper portion and a lower portion; lower tubular member having an upper portion and a lower portion; one of the portions being received within the other for relative rotational movement about an axis that is inclined with respect to the the longitudinal axes of the members, whereby in a first rotational position the longitudinal axes have one geometrical relationship, and in a second rotational position the longitudinal axes have a second, different geometrical relationship

  8. Nausea still the poor relation in antiemetic therapy? The impact on cancer patients' quality of life and psychological adjustment of nausea, vomiting and appetite loss, individually and concurrently as part of a symptom cluster.

    Science.gov (United States)

    Pirri, Carlo; Bayliss, Evan; Trotter, James; Olver, Ian N; Katris, Paul; Drummond, Peter; Bennett, Robert

    2013-03-01

    Despite significant antiemetic advances, almost 50% of treated cancer patients still experience nausea and vomiting (N&V). The goal of antiemetic therapy--complete prevention of treatment-induced nausea and/or vomiting (TIN+/-V)--remains elusive for several reasons. Potentially, N&V may be part of a symptom cluster where co-occurring symptoms negatively affect antiemetic management. Consequently, we examined TIN+/-V incidence and the impact of nausea, vomiting and symptom cluster(s) containing them, respectively, on patients' quality of life (QoL) and psychological adjustment across treatment. A longitudinal secondary analysis was performed on data from a prospective, observational QoL study involving 200 newly diagnosed cancer patients who underwent combined modality treatment. QoL, psychological adjustment and patient/clinical characteristics were examined at pretreatment, on-treatment (8 weeks) and post-treatment. Overall, 62% of patients experienced TIN+/-V, with TIN (60%) doubling TIV incidence (27 %). Exploratory factor analyses of QoL scores at each treatment time point identified a recurrent gastrointestinal symptom cluster comprising nausea, vomiting and appetite loss. Approximately two thirds of patients reported co-occurrence of all three symptoms, which exerted synergistic effects of multiplicative proportions on overall QoL. Patients who reported co-occurrence of these symptoms during treatment experienced significantly greater QoL impairment (physical, role and social functioning, fatigue, N&V, appetite loss, overall physical health, overall QOL) and psychological distress (cancer distress, premorbid neuroticism) than those unaffected (0.001 > p ≤ 0.05). Moreover, nausea was more pervasive than vomiting or appetite loss across treatment and had a greater impact on overall QoL. While antiemetic therapy was effective for vomiting and helped prevent/relieve associated appetite loss, the benefits for appetite loss were seemingly constrained by its

  9. Global change impact on oxidative potential and toxicity of atmospheric particles from the East Mediterranean basin: the ARCHIMEDES initiative

    Science.gov (United States)

    Alleman, Laurent; Anthérieu, Sébastien; Baeza-Squiban, Armelle; Garçon, Guillaume; Lo Guidice, Jean-Marc; Hamonou, Eric; Öztürk, Fatma; Perdrix, Esperanza; Rudich, Yinon; Sciare, Jean; Sauvage, Stéphane

    2017-04-01

    , several projects under the ARCHIMEDES (Envi-MED funded) initiative including various research groups from Eastern Mediterranean countries have been submitted to French research calls. Their objectives are to develop an integrated testing strategy (ITS) through a combination of high throughput screening (HTS) methods based on acellular and lung cellular systems evaluating the respective OP (DTT, ascorbic acid and GSH depletion, DCFH oxidation) of various PM samples according to their origins in terms of sources and CC forecast. In order to ensure significant variability in ageing of the size segregated PM (fine, coarse) tested, samples from both northern (France) and southern countries (Cyprus, Israel, Turkey) should be collected at different seasons and site typologies, searching for various compositions and mixing states in SOA (biogenic, anthropogenic), metals and PAHs. These projects will combine relevant chemical, microbiological (DNA extract) and toxicological experiments (transcriptome, epigenome and secretome). A joint toxicological analysis related to their harmful effects on relevant oxidative (ATP, TAS, GSH/GSSG, gammaH2AX), inflammatory, genetic, and epigenetic endpoints within novel tissue-engineering tools will help in recapturing the native lung environment ex vivo. In the CC context, such projects will help to (1) better understand the cellular and molecular mechanisms of PM toxicity, (2) detect and predict their respiratory effects, (3) better comprehend the relationship between the physicochemical characteristics and the toxicological effects of PM, (4) provide innovative biomarkers that could be subsequently validated in humans and thereby contribute to the predictive toxicology.

  10. Adjustment disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Zelviene P

    2018-01-01

    Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

  11. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  12. Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

    Directory of Open Access Journals (Sweden)

    SONG Yingchun

    2015-02-01

    Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

  13. One carbon cycle: Impacts of model integration, ecosystem process detail, model resolution, and initialization data, on projections of future climate mitigation strategies

    Science.gov (United States)

    Fisk, J.; Hurtt, G. C.; le page, Y.; Patel, P. L.; Chini, L. P.; Sahajpal, R.; Dubayah, R.; Thomson, A. M.; Edmonds, J.; Janetos, A. C.

    2013-12-01

    Integrated assessment models (IAMs) simulate the interactions between human and natural systems at a global scale, representing a broad suite of phenomena across the global economy, energy system, land-use, and carbon cycling. Most proposed climate mitigation strategies rely on maintaining or enhancing the terrestrial carbon sink as a substantial contribution to restrain the concentration of greenhouse gases in the atmosphere, however most IAMs rely on simplified regional representations of terrestrial carbon dynamics. Our research aims to reduce uncertainties associated with forest modeling within integrated assessments, and to quantify the impacts of climate change on forest growth and productivity for integrated assessments of terrestrial carbon management. We developed the new Integrated Ecosystem Demography (iED) to increase terrestrial ecosystem process detail, resolution, and the utilization of remote sensing in integrated assessments. iED brings together state-of-the-art models of human society (GCAM), spatial land-use patterns (GLM) and terrestrial ecosystems (ED) in a fully coupled framework. The major innovative feature of iED is a consistent, process-based representation of ecosystem dynamics and carbon cycle throughout the human, terrestrial, land-use, and atmospheric components. One of the most challenging aspects of ecosystem modeling is to provide accurate initialization of land surface conditions to reflect non-equilibrium conditions, i.e., the actual successional state of the forest. As all plants in ED have an explicit height, it is one of the few ecosystem models that can be initialized directly with vegetation height data. Previous work has demonstrated that ecosystem model resolution and initialization data quality have a large effect on flux predictions at continental scales. Here we use a factorial modeling experiment to quantify the impacts of model integration, process detail, model resolution, and initialization data on projections of

  14. Adjustable continence balloons

    DEFF Research Database (Denmark)

    Kjær, Line; Fode, Mikkel; Nørgaard, Nis

    2012-01-01

    Abstract Objective. This study aimed to evaluate the results of the Danish experience with the ProACT urinary continence device inserted in men with stress urinary incontinence. Material and methods. The ProACT was inserted in 114 patients. Data were registered prospectively. The main endpoints...... in urinary leakage > 50% was seen in 72 patients (80%). Complications were seen in 23 patients. All of these were treated successfully by removal of the device in the outpatient setting followed by replacement of the device. Another eight patients had a third balloon inserted to improve continence further....... Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Conclusions. Adjustable continence balloons seem...

  15. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    ) that vanishes for observables commuting with the state. We show that the skew information is a convex function on the manifold of states. It also satisfies other requirements, proposed by Wigner and Yanase, for an effective measure-of-information content of a state relative to a conserved observable. We...... establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state...

  16. A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE principles into daily living and how these factors change over time

    Directory of Open Access Journals (Sweden)

    White Florence

    2011-08-01

    Full Text Available Abstract Background The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE DAFNE principles into their daily lives and how these factors change over time. Methods This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time Results Four themes that influenced participants' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation. Conclusions Understanding the factors that influence people's ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation. Trial registration ISRCTN79759174

  17. A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment For Normal Eating (DAFNE) principles into daily living and how these factors change over time

    LENUS (Irish Health Repository)

    Casey, Dympna

    2011-08-30

    Abstract Background The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE) DAFNE principles into their daily lives and how these factors change over time. Methods This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time Results Four themes that influenced participants\\' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation. Conclusions Understanding the factors that influence people\\'s ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation. Trial registration ISRCTN79759174

  18. Impact of initiation of asenapine on patterns of utilization and cost of healthcare resources associated with the treatment of bipolar I disorder.

    Science.gov (United States)

    Chitnis, Abhishek; Wang, Rosa; Sun, Shawn X; Dixit, Shailja; Tawah, Alie; Boulanger, Luke

    2015-01-01

    To assess the impact of initiation of asenapine on "real-world" levels of utilization and cost of healthcare services for the treatment of bipolar I disorder (BPD) in the US. Using two large US healthcare claims databases that collectively included commercially insured patients aged a BPD diagnosis, plus psychiatric medications and the costs thereof (2012 dollars) were deemed 'BPD-related'. Differences in BPD-related utilization and cost of healthcare services were compared between the pre- and post-index periods. A total of 1403 patients met all selection criteria; the mean age was 42.8 years and 70.6% were women. Relative to pre-index, significant decreases were noted in post-index use of BPD-related healthcare services, most notably admissions (from 24.0% to 12.3% during the post-index period) and emergency department visits (from 4.6% to 2.6%) (both p levels of utilization of BPD-related healthcare services and costs decreased during the 6-month period immediately following initiation of asenapine therapy.

  19. The impact of intermittent or sustained carbon dioxide on intermittent hypoxia initiated respiratory plasticity. What is the effect of these combined stimuli on apnea severity?

    Science.gov (United States)

    Mateika, Jason H; Panza, Gino; Alex, Raichel; El-Chami, Mohamad

    2017-10-31

    The following review explores the effect that intermittent or sustained hypercapnia coupled to intermittent hypoxia has on respiratory plasticity. The review explores published work which suggests that intermittent hypercapnia leads to long-term depression of respiration when administered in isolation and prevents the initiation of long-term facilitation when administered in combination with intermittent hypoxia. The review also explores the impact that sustained hypercapnia alone and in combination with intermittent hypoxia has on the magnitude of long-term facilitation. After exploring the outcomes linked to intermittent hypoxia/hypercapnia and intermittent hypoxia/sustained hypercapnia the translational relevance of the outcomes as it relates to breathing stability during sleep is addressed. The likelihood that naturally induced cycles of intermittent hypoxia, coupled to oscillations in carbon dioxide that range between hypocapnia and hypercapnia, do not initiate long-term facilitation is addressed. Moreover, the conditions under which intermittent hypoxia/sustained hypercapnia could serve to improve breathing stability and mitigate co-morbidities associated with sleep apnea are considered. Published by Elsevier B.V.

  20. The Use of Indirect Estimates of Soil Moisture to Initialize Coupled Models and its Impact on Short-Term and Seasonal Simulations

    Science.gov (United States)

    Lapenta, William M.; Crosson, William; Dembek, Scott; Lakhtakia, Mercedes

    1998-01-01

    It is well known that soil moisture is a characteristic of the land surface that strongly affects the partitioning of outgoing radiation into sensible and latent heat which significantly impacts both weather and climate. Detailed land surface schemes are now being coupled to mesoscale atmospheric models in order to represent the effect of soil moisture upon atmospheric simulations. However, there is little direct soil moisture data available to initialize these models on regional to continental scales. As a result, a Soil Hydrology Model (SHM) is currently being used to generate an indirect estimate of the soil moisture conditions over the continental United States at a grid resolution of 36 Km on a daily basis since 8 May 1995. The SHM is forced by analyses of atmospheric observations including precipitation and contains detailed information on slope soil and landcover characteristics.The purpose of this paper is to evaluate the utility of initializing a detailed coupled model with the soil moisture data produced by SHM.

  1. Impact of initial FDG-PET/CT and serum-free light chain on transformation of conventionally defined solitary plasmacytoma to multiple myeloma.

    Science.gov (United States)

    Fouquet, Guillemette; Guidez, Stéphanie; Herbaux, Charles; Van de Wyngaert, Zoé; Bonnet, Sarah; Beauvais, David; Demarquette, Hélène; Adib, Salim; Hivert, Bénédicte; Wemeau, Mathieu; Berthon, Céline; Terriou, Louis; Coiteux, Valérie; Macro, Margaret; Decaux, Olivier; Facon, Thierry; Huglo, Damien; Leleu, Xavier

    2014-06-15

    Solitary plasmacytoma (SP) is a localized proliferation of monoclonal plasma cells in either bone or soft tissue, without evidence of multiple myeloma (MM), and whose prognosis is marked by a high risk of transformation to MM. We studied the impact of FDG-PET/CT (2[18F]fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography) on the risk of transformation of SP to overt MM among other markers in a series of 43 patients diagnosed with SP. Median age was 57.5 years; 48% of patients had an abnormal involved serum-free light chain (sFLC) value, and 64% had an abnormal sFLC ratio at diagnosis. Thirty-three percent had two or more hypermetabolic lesions on initial PET/CT, and 20% had two or more focal lesions on initial MRI. With a median follow-up of 50 months, 14 patients transformed to MM with a median time (TTMM) of 71 months. The risk factors that significantly shortened TTMM at diagnosis were two or more hypermetabolic lesions on PET/CT, abnormal sFLC ratio and involved sFLC, and to a lesser extent at completion of treatment, absence of normalized involved sFLC and PET/CT or MRI. In a multivariate analysis, abnormal initial involved sFLC [OR = 10; 95% confidence interval (CI), 1-87; P = 0.008] and PET/CT (OR = 5; 95% CI, 0-9; P = 0.032) independently shortened TTMM. An abnormal involved sFLC value and the presence of at least two hypermetabolic lesions on PET/CT at diagnosis of SP were the two predictors of early evolution to myeloma in our series. This data analysis will need confirmation in a larger study, and the study of these two risk factors may lead to a different management of patients with SP in the future. . ©2014 American Association for Cancer Research.

  2. Adolescent Mothers' Adjustment to Parenting.

    Science.gov (United States)

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  3. HPGe detector shielding adjustment

    International Nuclear Information System (INIS)

    Trnkova, L.; Rulik, P.

    2008-01-01

    Low-level background shielding of HPGe detectors is used mainly for environmental samples with very low content of radionuclides. National Radiation Protection Institute (SURO) in Prague is equipped with 14 HPGe detectors with relative efficiency up to 150%. The detectors are placed in a room built from materials with low content of natural radionuclides and equipped with a double isolation of the floor against radon. Detectors themselves are placed in lead or steel shielding. Steel shielding with one of these detectors with relative efficiency of 100% was chosen to be rebuilt to achieve lower minimum detectable activity (MDA). Additional lead and copper shielding was built up inside the original steel shielding to reduce the volume of the inner space and filled with nitrogen by means of evaporating liquid nitrogen. The additional lead and copper shielding, consequent reduction of the inner volume and supply of evaporated nitrogen, caused a decrease of the background count and accordingly MDA values as well. The effect of nitrogen evaporation on the net areas of peaks belonging to radon daughters is significant. The enhanced shielding adjustment has the biggest influence in low energy range, what can be seen in collected data. MDA values in energy range from 30 keV to 400 keV decreased to 0.65-0.85 of original value, in energy range from 400 keV to 2 MeV they fell to 0.70-0.97 of original value. (authors)

  4. 7 CFR 4287.112 - Interest rate adjustments.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Interest rate adjustments. 4287.112 Section 4287.112... Loans § 4287.112 Interest rate adjustments. (a) Reductions. The borrower, lender, and holder (if any) may collectively initiate a permanent or temporary reduction in the interest rate of the guaranteed...

  5. Linearly Adjustable International Portfolios

    Science.gov (United States)

    Fonseca, R. J.; Kuhn, D.; Rustem, B.

    2010-09-01

    We present an approach to multi-stage international portfolio optimization based on the imposition of a linear structure on the recourse decisions. Multiperiod decision problems are traditionally formulated as stochastic programs. Scenario tree based solutions however can become intractable as the number of stages increases. By restricting the space of decision policies to linear rules, we obtain a conservative tractable approximation to the original problem. Local asset prices and foreign exchange rates are modelled separately, which allows for a direct measure of their impact on the final portfolio value.

  6. Linearly Adjustable International Portfolios

    International Nuclear Information System (INIS)

    Fonseca, R. J.; Kuhn, D.; Rustem, B.

    2010-01-01

    We present an approach to multi-stage international portfolio optimization based on the imposition of a linear structure on the recourse decisions. Multiperiod decision problems are traditionally formulated as stochastic programs. Scenario tree based solutions however can become intractable as the number of stages increases. By restricting the space of decision policies to linear rules, we obtain a conservative tractable approximation to the original problem. Local asset prices and foreign exchange rates are modelled separately, which allows for a direct measure of their impact on the final portfolio value.

  7. Impact of OH Radical-Initiated H2CO3 Degradation in the Earth's Atmosphere via Proton-Coupled Electron Transfer Mechanism.

    Science.gov (United States)

    Ghoshal, Sourav; Hazra, Montu K

    2016-02-04

    The decomposition of isolated carbonic acid (H2CO3) molecule into CO2 and H2O (H2CO3 → CO2 + H2O) is prevented by a large activation barrier (>35 kcal/mol). Nevertheless, it is surprising that the detection of the H2CO3 molecule has not been possible yet, and the hunt for the free H2CO3 molecule has become challenging not only in the Earth's atmosphere but also on Mars. In view of this fact, we report here the high levels of quantum chemistry calculations investigating both the energetics and kinetics of the OH radical-initiated H2CO3 degradation reaction to interpret the loss of the H2CO3 molecule in the Earth's atmosphere. It is seen from our study that proton-coupled electron transfer (PCET) and hydrogen atom transfer (HAT) are the two mechanisms by which the OH radical initiates the degradation of the H2CO3 molecule. Moreover, the PCET mechanism is potentially the important one, as the effective barrier, defined as the difference between the zero point vibrational energy (ZPE) corrected energy of the transition state and the total energy of the isolated starting reactants in terms of bimolecular encounters, for the PCET mechanism at the CCSD(T)/6-311++G(3df,3pd) level of theory is ∼3 to 4 kcal/mol lower than the effective barrier height associated with the HAT mechanism. The CCSD(T)/6-311++G(3df,3pd) level predicted effective barrier heights for the degradations of the two most stable conformers of H2CO3 molecule via the PCET mechanism are only ∼2.7 and 4.3 kcal/mol. A comparative reaction rate analysis at the CCSD(T)/6-311++G(3df,3pd) level of theory has also been carried out to explore the potential impact of the OH radical-initiated H2CO3 degradation relative to that from water (H2O), formic acid (FA), acetic acid (AA) and sulfuric acid (SA) assisted H2CO3 → CO2 + H2O decomposition reactions in both the Earth's troposphere and stratosphere. The comparison of the reaction rates reveals that, although the atmospheric concentration of the OH radical is

  8. The impact of nudging coefficient for the initialization on the atmospheric flow field and the photochemical ozone concentration of Seoul, Korea

    Science.gov (United States)

    Choi, Hyun-Jung; Lee, Hwa Woon; Sung, Kyoung-Hee; Kim, Min-Jung; Kim, Yoo-Keun; Jung, Woo-Sik

    In order to incorporate correctly the large or local scale circulation in the model, a nudging term is introduced into the equation of motion. Nudging effects should be included properly in the model to reduce the uncertainties and improve the air flow field. To improve the meteorological components, the nudging coefficient should perform the adequate influence on complex area for the model initialization technique which related to data reliability and error suppression. Several numerical experiments have been undertaken in order to evaluate the effects on air quality modeling by comparing the performance of the meteorological result with variable nudging coefficient experiment. All experiments are calculated by the upper wind conditions (synoptic or asynoptic condition), respectively. Consequently, it is important to examine the model response to nudging effect of wind and mass information. The MM5-CMAQ model was used to assess the ozone differences in each case, during the episode day in Seoul, Korea and we revealed that there were large differences in the ozone concentration for each run. These results suggest that for the appropriate simulation of large or small-scale circulations, nudging considering the synoptic and asynoptic nudging coefficient does have a clear advantage over dynamic initialization, so appropriate limitation of these nudging coefficient values on its upper wind conditions is necessary before making an assessment. The statistical verifications showed that adequate nudging coefficient for both wind and temperature data throughout the model had a consistently positive impact on the atmospheric and air quality field. On the case dominated by large-scale circulation, a large nudging coefficient shows a minor improvement in the atmospheric and air quality field. However, when small-scale convection is present, the large nudging coefficient produces consistent improvement in the atmospheric and air quality field.

  9. Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida.

    Science.gov (United States)

    Kinsell, Heidi S; Hall, Allyson G; Harman, Jeffrey S; Tewary, Sweta; Brickman, Andrew

    2017-10-01

    Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups.

  10. The assessment of ionising radiation impact on the cooling pond freshwater ecosystem non-human biota from the Ignalina NPP operation beginning to shut down and initial decommissioning.

    Science.gov (United States)

    Mazeika, J; Marciulioniene, D; Nedveckaite, T; Jefanova, O

    2016-01-01

    The radiological doses to non-human biota of freshwater ecosystem in the Ignalina NPP cooling pond - Lake Druksiai were evaluated for several cases including the plant's operation period and initial decommissioning activities, using the ERICA 1.2 code with IAEA SRS-19 models integrated approach and tool. Among the Lake Druksiai freshwater ecosystem reference organisms investigated the highest exposure dose rate was determined for bottom fauna - benthic organisms (mollusc-bivalves, crustaceans, mollusc-gastropods, insect larvae), and among the other reference organisms - for vascular plants. The mean and maximum total dose rate values due to anthropogenic radionuclide ionising radiation impact in all investigated cases were lower than the ERICA screening dose rate value of 10 μGy/h. The main exposure of reference organisms as a result of Ignalina NPP former effluent to Lake Druksiai is due to ionizing radiation of radionuclides (60)Co and (137)Cs, of predicted releases to Lake Druksiai during initial decommissioning period - due to radionuclides (60)Co, (134)Cs and (137)Cs, and as a result of predicted releases to Lake Druksiai from low- and intermediate-level short-lived radioactive waste disposal site in 30-100 year period - due to radionuclides (99)Tc and (3)H. The risk quotient expected values in all investigated cases were <1, and therefore the risk to non-human biota can be considered negligible with the exception of a conservative risk quotient for insect larvae. Radiological protection of non-human biota in Lake Druksiai, the Ignalina NPP cooling pond, is both feasible and acceptable. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Impact of the initial classic section during a simulated cross-country skiing skiathlon on the cardiopulmonary responses during the subsequent period of skate skiing.

    Science.gov (United States)

    Mourot, Laurent; Fabre, Nicolas; Andersson, Erik; Willis, Sarah J; Hébert-Losier, Kim; Holmberg, Hans-Christer

    2014-08-01

    The aim of this study was to assess potential changes in the performance and cardiorespiratory responses of elite cross-country skiers following transition from the classic (CL) to the skating (SK) technique during a simulated skiathlon. Eight elite male skiers performed two 6 km (2 × 3 km) roller-skiing time trials on a treadmill at racing speed: one starting with the classic and switching to the skating technique (CL1-SK2) and another employing the skating technique throughout (SK1-SK2), with continuous monitoring of gas exchanges, heart rates, and kinematics (video). The overall performance times in the CL1-SK2 (21:12 ± 1:24) and SK1-SK2 (20:48 ± 2:00) trials were similar, and during the second section of each performance times and overall cardiopulmonary responses were also comparable. However, in comparison with SK1-SK2, the CL1-SK2 trial involved significantly higher increases in minute ventilation (V̇E, 89.8 ± 26.8 vs. 106.8 ± 17.6 L·min(-1)) and oxygen uptake (V̇O2; 3.1 ± 0.8 vs 3.5 ± 0.5 L·min(-1)) 2 min after the transition as well as longer time constants for V̇E, V̇O2, and heart rate during the first 3 min after the transition. This higher cardiopulmonary exertion was associated with ∼3% faster cycle rates. In conclusion, overall performance during the 2 time trials did not differ. The similar performance times during the second sections were achieved with comparable mean cardiopulmonary responses. However, the observation that during the initial 3-min post-transition following classic skiing cardiopulmonary responses and cycle rates were slightly higher supports the conclusion that an initial section of classic skiing exerts an impact on performance during a subsequent section of skate skiing.

  12. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia

    Directory of Open Access Journals (Sweden)

    Hanefeld Johanna

    2009-02-01

    Full Text Available Abstract Background Since the beginning of the 21st century, development assistance for HIV/AIDS has increasingly been provided through Global Health Initiatives, specifically the United States Presidential Emergency Plan for AIDS Relief, the Global Fund to Fight HIV, TB and Malaria and the World Bank Multi-country AIDS Programme. Zambia, like many of the countries heavily affected by HIV/AIDS in southern Africa, also faces a shortage of human resources for health. The country receives significant amounts of funding from GHIs for the large-scale provision of antiretroviral treatment through the public and private sector. This paper examines the impact of GHIs on human resources for ART roll-out in Zambia, at national level, in one province and two districts. Methods It is a qualitative policy analysis relying on in-depth interviews with more than 90 policy-makers and implementers at all levels. Results Findings show that while GHIs do not provide significant funding for additional human resources, their interventions have significant impact on human resources for health at all levels. While GHIs successfully retrain a large number of health workers, evidence suggests that GHIs actively deplete the pool of skilled human resources for health by recruiting public sector staff to work for GHI-funded nongovernmental implementing agencies. The secondment of GHI staff into public sector facilities may help alleviate immediate staff shortages, but this practice risks undermining sustainability of programmes. GHI-supported programmes and initiatives add significantly to the workload of existing public sector staff at all levels, while incentives including salary top-ups and overtime payments mean that ART programmes are more popular among staff than services for non-focal diseases. Conclusion Research findings suggest that GHIs need to actively mediate against the potentially negative consequences of their funding on human resources for health. Evidence

  13. Numerical simulations of contrail-to-cirrus transition – Part 2: Impact of initial ice crystal number, radiation, stratification, secondary nucleation and layer depth

    Directory of Open Access Journals (Sweden)

    S. Unterstrasser

    2010-02-01

    Full Text Available Simulations of contrail-to-cirrus transition were performed with an LES model. In Part 1 the impact of relative humidity, temperature and vertical wind shear was explored in a detailed parametric study. Here, we study atmospheric parameters like stratification and depth of the supersaturated layer and processes which may affect the contrail evolution. We consider contrails in various radiation scenarios herein defined by the season, time of day and the presence of lower-level cloudiness which controls the radiance incident on the contrail layer. Under suitable conditions, controlled by the radiation scenario and stratification, radiative heating lifts the contrail-cirrus and prolongs its lifetime. The potential of contrail-driven secondary nucleation is investigated. We consider homogeneous nucleation and heterogeneous nucleation of preactivated soot cores released from sublimated contrail ice crystals. In our model the contrail dynamics triggered by radiative heating does not suffice to force homogeneous freezing of ambient liquid aerosol particles. Furthermore, our model results suggest that heterogeneous nucleation of preactivated soot cores is unimportant. Contrail evolution is not controlled by the depth of the supersaturated layer as long as it exceeds roughly 500 m. Deep fallstreaks however need thicker layers. A variation of the initial ice crystal number is effective during the whole evolution of a contrail. A cut of the soot particle emission by two orders of magnitude can reduce the contrail timescale by one hour and the optical thickness by a factor of 5. Hence future engines with lower soot particle emissions could potentially lead to a reduction of the climate impact of aviation.

  14. The Ne3LS Network, Québec's initiative to evaluate the impact and promote a responsible and sustainable development of nanotechnology

    Science.gov (United States)

    Endo, Charles-Anica; Emond, Claude; Battista, Renaldo; Parizeau, Marie-Hélène; Beaudry, Catherine

    2011-07-01

    The spectacular progress made by nanosciences and nanotechnologies elicits as much hope and fear. Consequently, a great number of research and training initiatives on the ethical, environmental, economic, legal and social issues regarding nanotechnology development (Ne3LS) are emerging worldwide. In Québec, Canada, a Task Force was mandated by NanoQuébec to conceive a Ne3LS research and training strategy to assess those issues. This Task Force brought together experts from universities, governments or industry working in nanosciences and nanotechnologies or in Ne3LS. Their resulting action plan, made public in November 2006, contained several recommendations, including the creation of a knowledge network (Ne3LS Network). In the following years, after consulting with numerous key players concerned with the possible impacts of nanosciences and nanotechnologies in Québec, the Ne3LS Network was launched in January 2010 in partnership with the Fonds québécois de la recherche sur la nature et les technologies, the Fonds québécois de la recherche sur la société et la culture and the Fonds de la recherche en santé du Québec, NanoQuébec, the Institut de recherche Robert-Sauvé en santé et en sécurité du travail as well as the University of Montreal. Its objectives are to 1) Foster the development of Ne3LS research activities (grants and fellowships); 2) Spearhead the Canadian and international Ne3LS network; 3) Take part in the training of researchers and experts; 4) Encourage the creation of interactive tools for the general public; 5) Facilitate collaboration between decision-makers and experts; 6) Involve the scientific community through a host of activities (symposium, conferences, thematic events); 7) Build multidisciplinary research teams to evaluate the impact of nanotechnology.

  15. Nursing Facility Initiative Annual Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — This annual report summarizes impacts from the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents in 2014. This initiative is designed...

  16. Overcoming the initial investment hurdle for advanced biofuels. An analysis of biofuel-related risks and their impact on project financing. Report of ELOBIO subtask 7

    International Nuclear Information System (INIS)

    Bole, T.; Londo, M.; Van Stralen, J.; Uslu, A.

    2010-04-01

    The ELOBIO research project aims to develop policies that will help achieve a higher share of biofuels in total transport fuel in a low-disturbing and sustainable way. Workpackage 7 of the ELOBIO project aims at addressing the objective of providing a reliable estimate of the potential and costs of biofuels, given the application of low-disturbing policy measures. More specifically, we seek to evaluate the impact of these biofuel policy measures on the investment climate for second-generation technologies. To this end, we try to answer several sub-questions in a following logical sequence: (1) What are the different factors that contribute to investment risk in biofuels and what are their relative contributions to overall biofuel project risk as perceived by finance providers?; (2) How do these risks translate into cost of capital for different biofuel technologies?; (3) How does cost of capital influence market penetration rates for the different technologies?; and (4) What is the best policy (or policy mix) to overcome the initial investment hurdle for advanced biofuels, thus lowering their cost of capital and achieve wider market deployment?.

  17. Adopting Basic Principles of the United Nations Academic Impact Initiative (UNAI: Can Cultural Differences Be Predicted from Value Orientations and Globalization?

    Directory of Open Access Journals (Sweden)

    Andrea Nechtelberger

    2017-11-01

    Full Text Available The United Nations Academic Impact (UNAI Initiative has set forth 10 Basic Principles for higher education. In the present study, a 10 item self-report questionnaire measuring personal endorsement of these principles has been tested by self-report questionnaires with university and post-graduate students from Austria, China, Cyprus, India, Nigeria, and Slovakia (total N = 976, N = 627 female, mean age 24.7 years, s = 5.7. Starting from the assumptions of Moral Foundations Theory (MFT, we expected that personal attitudes toward the UNAI Basic Principles would be predicted by endorsement of various moral foundations as suggested by MFT and by the individual's degree of globalization. Whereas for the Austrian, Cypriot, and Nigerian sub- samples this assumption was largely confirmed, for the Chinese, Indian, and Slovak sub- samples only small amounts of the variance could be explained by regression models. All six sub-samples differed substantially with regard to their overall questionnaire responses: by five discriminant functions 83.6% of participants were classified correctly. We conclude that implementation of UNAI principles should adhere closely to the cultural requirements of the respective society and, where necessary should be accompanied by thorough informational campaigns about UN educational goals.

  18. Adopting Basic Principles of the United Nations Academic Impact Initiative (UNAI): Can Cultural Differences Be Predicted from Value Orientations and Globalization?

    Science.gov (United States)

    Nechtelberger, Andrea; Renner, Walter; Nechtelberger, Martin; Supeková, Soňa Chovanová; Hadjimarkou, Maria; Offurum, Chino; Ramalingam, Panchalan; Senft, Birgit; Redfern, Kylie

    2017-01-01

    The United Nations Academic Impact (UNAI) Initiative has set forth 10 Basic Principles for higher education. In the present study, a 10 item self-report questionnaire measuring personal endorsement of these principles has been tested by self-report questionnaires with university and post-graduate students from Austria, China, Cyprus, India, Nigeria, and Slovakia (total N = 976, N = 627 female, mean age 24.7 years, s = 5.7). Starting from the assumptions of Moral Foundations Theory (MFT), we expected that personal attitudes toward the UNAI Basic Principles would be predicted by endorsement of various moral foundations as suggested by MFT and by the individual's degree of globalization. Whereas for the Austrian, Cypriot, and Nigerian sub- samples this assumption was largely confirmed, for the Chinese, Indian, and Slovak sub- samples only small amounts of the variance could be explained by regression models. All six sub-samples differed substantially with regard to their overall questionnaire responses: by five discriminant functions 83.6% of participants were classified correctly. We conclude that implementation of UNAI principles should adhere closely to the cultural requirements of the respective society and, where necessary should be accompanied by thorough informational campaigns about UN educational goals.

  19. Adopting Basic Principles of the United Nations Academic Impact Initiative (UNAI): Can Cultural Differences Be Predicted from Value Orientations and Globalization?

    Science.gov (United States)

    Nechtelberger, Andrea; Renner, Walter; Nechtelberger, Martin; Supeková, Soňa Chovanová; Hadjimarkou, Maria; Offurum, Chino; Ramalingam, Panchalan; Senft, Birgit; Redfern, Kylie

    2017-01-01

    The United Nations Academic Impact (UNAI) Initiative has set forth 10 Basic Principles for higher education. In the present study, a 10 item self-report questionnaire measuring personal endorsement of these principles has been tested by self-report questionnaires with university and post-graduate students from Austria, China, Cyprus, India, Nigeria, and Slovakia (total N = 976, N = 627 female, mean age 24.7 years, s = 5.7). Starting from the assumptions of Moral Foundations Theory (MFT), we expected that personal attitudes toward the UNAI Basic Principles would be predicted by endorsement of various moral foundations as suggested by MFT and by the individual's degree of globalization. Whereas for the Austrian, Cypriot, and Nigerian sub- samples this assumption was largely confirmed, for the Chinese, Indian, and Slovak sub- samples only small amounts of the variance could be explained by regression models. All six sub-samples differed substantially with regard to their overall questionnaire responses: by five discriminant functions 83.6% of participants were classified correctly. We conclude that implementation of UNAI principles should adhere closely to the cultural requirements of the respective society and, where necessary should be accompanied by thorough informational campaigns about UN educational goals. PMID:29180977

  20. The Collective Impact Model and Its Potential for Health Promotion: Overview and Case Study of a Healthy Retail Initiative in San Francisco.

    Science.gov (United States)

    Flood, Johnna; Minkler, Meredith; Hennessey Lavery, Susana; Estrada, Jessica; Falbe, Jennifer

    2015-10-01

    As resources for health promotion become more constricted, it is increasingly important to collaborate across sectors, including the private sector. Although many excellent models for cross-sector collaboration have shown promise in the health field, collective impact (CI), an emerging model for creating larger scale change, has yet to receive much study. Complementing earlier collaboration approaches, CI has five core tenets: a shared agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and a central infrastructure. In this article, we describe the CI model and its key dimensions and constructs. We briefly compare CI to community coalition action theory and discuss our use of the latter to provide needed detail as we apply CI in a critical case study analysis of the Tenderloin Healthy Corner Store Coalition in San Francisco, California. Using Yin's multimethod approach, we illustrate how CI strategies, augmented by the community coalition action theory, are being used, and with what successes or challenges, to help affect community- and policy-level change to reduce tobacco and alcohol advertising and sales, while improving healthy, affordable, and sustainable food access. We discuss the strengths and weaknesses of CI as a framework for health promotion, as well as the benefits, challenges, and initial outcomes of the healthy retail project and its opportunities for scale-up. Implications for health promotion practice and research also are discussed. © 2015 Society for Public Health Education.

  1. Metric-adjusted skew information

    DEFF Research Database (Denmark)

    Liang, Cai; Hansen, Frank

    2010-01-01

    on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 ...We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... of (unbounded) metric-adjusted skew information....

  2. The impact of the uncertainty in the initial soil moisture condition of irrigated areas on the spatiotemporal characteristics of convective activity in Central Greece

    Science.gov (United States)

    Kotsopoulos, Stylianos; Ioannis, Tegoulias; Ioannis, Pytharoulis; Stergios, Kartsios; Dimitrios, Bampzelis; Theodore, Karacostas

    2015-04-01

    The region of Thessaly is the second largest plain in Greece and has a vital role in the financial life of the country, because of its significant agricultural production. The intensive and extensive cultivation of irrigated crops, in combination with the population increase and the alteration of precipitation patterns due to climate change, often leading the region to experience severe drought conditions, especially during the warm period of the year. The aim of the DAPHNE project is to tackle the problem of drought in this area by means of Weather Modification.In the framework of the project DAPHNE, the numerical weather prediction model WRF-ARW 3.5.1 is used to provide operational forecasts and hindcasts for the region of Thessaly. The goal of this study is to investigate the impact of the uncertainty in the initial soil moisture condition of irrigated areas, on the spatiotemporal characteristics of convective activity in the region of interest. To this end, six cases under the six most frequent synoptic conditions, which are associated with convective activity in the region of interest, are utilized, considering six different soil moisture initialization scenarios. In the first scenario (Control Run), the model is initialized with the surface soil moisture of the ECMWF analysis data, that usually does not take into account the modification of soil moisture due to agricultural activity in the area of interest. In the other five scenarios (Experiment 1,2,3,4,5) the soil moisture in the upper soil layers of the study area are modified from -50% to 50% of field capacity (-50%FC, -25%FC, FC, 25%FC, 50%FC),for the irrigated cropland.Three model domains, covering Europe, the Mediterranean Sea and northern Africa (d01), the wider area of Greece (d02) and central Greece - Thessaly region (d03) are used at horizontal grid-spacings of 15km, 5km and 1km respectively. ECMWF operational analyses at 6-hourly intervals (0.25ox0.25o lat.-long.) are imported as initial and

  3. Methodological aspects of journaling a dynamic adjusting entry model

    Directory of Open Access Journals (Sweden)

    Vlasta Kašparovská

    2011-01-01

    Full Text Available This paper expands the discussion of the importance and function of adjusting entries for loan receivables. Discussion of the cyclical development of adjusting entries, their negative impact on the business cycle and potential solutions has intensified during the financial crisis. These discussions are still ongoing and continue to be relevant to members of the professional public, banking regulators and representatives of international accounting institutions. The objective of this paper is to evaluate a method of journaling dynamic adjusting entries under current accounting law. It also expresses the authors’ opinions on the potential for consistently implementing basic accounting principles in journaling adjusting entries for loan receivables under a dynamic model.

  4. “It must be me” or “It could be them?” : The impact of the social network position of bullies and victims on victims' adjustment

    NARCIS (Netherlands)

    Huitsing, Gijs; Veenstra, René; Sainio, Miia; Salmivalli, Christina

    2012-01-01

    It was examined in this study whether the association between victimization and psychological adjustment (depression and self-esteem) is moderated by the classroom network position of bullies and victims. Multivariate multilevel regression analysis was used on a large sample representative of grades

  5. A complete generalized adjustment criterion

    NARCIS (Netherlands)

    Perković, Emilija; Textor, Johannes; Kalisch, Markus; Maathuis, Marloes H.

    2015-01-01

    Covariate adjustment is a widely used approach to estimate total causal effects from observational data. Several graphical criteria have been developed in recent years to identify valid covariates for adjustment from graphical causal models. These criteria can handle multiple causes, latent

  6. Impact of the initial streamwise inclination of a double jet emitted within a cool crossflow on its temperature field and pollutants dispersion

    Energy Technology Data Exchange (ETDEWEB)

    Radhouane, A.; Mahjoub Said, Nejla; Mhiri, H. [Ecole Nationale d' Ingenieurs de Monastir, Unite de Thermique et Thermodynamique des Procedes Industriels, Monastir (Tunisia); Palec, G. le; Bournot, P. [IUSTI, UMR 6595, Technopole de Chateau-Gombert, Marseille (France)

    2009-04-15

    An experimental study and a numerical modeling are carried out simultaneously on a twin inclined jets' configuration issuing into a cooler crossflow. The main purpose of this study is to track the overall evolution of the jets among the surrounding flow and then determine the thermal and mass transfer features that characterize the resulting flowfield. The experimental data are depicted by means of a particle image velocimetry technique; whereas the numerical three-dimensional model is simulated through the resolution of the different governing Navier-Stokes' equations by means of the finite volume method. Two different closure models were tested: the standard k-{epsilon} model and the Reynolds stress model (RSM) second order model. The introduction of the latter in such a configuration brings some valuable improvement since it allows the detection of the slightest variations within the domain and then describes the least occurring mechanisms. The confrontation of the differently processed numerical results with the experimentally tracked data comforted our opinion since it proved the better efficiency of the RSM model for the description of the handled flow; that's why we adopted it for the rest of the paper. Once the validation obtained, we proceeded to the evaluation of the influence of the initial streamwise inclination of the emitted jets on the engendered thermal field and on the pollutants' dispersion. For the matter, we tested the following angles: 30 , 45 , 60 and 90 . After that, we represented the temperature variation along different directions in order to detail its behavior in all of them and at different levels. This characterization is highly recommended since it may promote the efficiency of several applications (mainly the cooling applications). We also evaluated the influence of this same parameter; the initial inclination; on the pollutants' dispersion due to the high and alarming importance of the problem on the

  7. Manufacturing Initiative

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Manufacturing Technologies (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of...

  8. Parental Divorce and Children's Adjustment.

    Science.gov (United States)

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

  9. Concurrently adjusting interrelated control parameters to achieve optimal engine performance

    Science.gov (United States)

    Jiang, Li; Lee, Donghoon; Yilmaz, Hakan; Stefanopoulou, Anna

    2015-12-01

    Methods and systems for real-time engine control optimization are provided. A value of an engine performance variable is determined, a value of a first operating condition and a value of a second operating condition of a vehicle engine are detected, and initial values for a first engine control parameter and a second engine control parameter are determined based on the detected first operating condition and the detected second operating condition. The initial values for the first engine control parameter and the second engine control parameter are adjusted based on the determined value of the engine performance variable to cause the engine performance variable to approach a target engine performance variable. In order to cause the engine performance variable to approach the target engine performance variable, adjusting the initial value for the first engine control parameter necessitates a corresponding adjustment of the initial value for the second engine control parameter.

  10. Initial Results of the Master's Degree Programme in "Leadership in Medicine" – Impact on hospital-based follow-on training of doctors

    Directory of Open Access Journals (Sweden)

    Wulfert, Chris-Henrik

    2017-11-01

    Full Text Available Objective: This pilot project, which was jointly conducted by a hospital and a university, describes the development of the Master's Degree Programme in Leadership in Medicine, a course designed to supplement medical specialty training. The aim of the pilot project is to demonstrate how hospital-based projects on personnel and organisational development undertaken under academic supervision can be used to increase leadership responsibility among doctors whose duties include providing initial and follow-on training and to professionalise medical specialty training as a leadership task. This need arose from the nationwide requirements and an internal audit regarding follow-on training. The version of the degree programme described below aims to further the personnel development of the participants in the field of didactics. Method: Each of the nine modules is made up of two classroom-based phases and one distance learning phase. The distance learning phase involves undertaking hospital-based projects on personnel and organisational development under academic supervision. The pilot phase participants were hospital doctors who, as part of their duties, hold leadership responsibility or are involved in the follow-on training of doctors.Results: The 17 participants successfully implemented more than 30 hospital-based projects during the distance learning phases of the nine modules. These projects included the development of medical specialty curricula, relevant didactic methods and evaluation design and were subsequently presented and subjected to reflection in interdisciplinary groups. The project presentation together with the project report were regarded as proof of competency. Conclusion: In addition to enhancing participant competency, the degree model described, which interlinks theory and practice, promotes organisational development through the implementation of projects undertaken under academic supervision. This has a double impact on the

  11. Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

    Science.gov (United States)

    Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

    2013-01-01

    Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

  12. How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

    Medline Plus

    Full Text Available ... Gary Karp Resources The emotional impact of paralysis Learning that you are paralyzed is devastating and overwhelming ... adjustment and depression Adjustment to paralysis is a process of changing one's thoughts and feelings and is ...

  13. Normal Stress or Adjustment Disorder?

    Science.gov (United States)

    ... disorder is a type of stress-related mental illness that can affect your feelings, thoughts and behaviors. Signs and symptoms of an adjustment disorder can include: Anxiety Poor school or work performance Relationship problems Sadness ...

  14. Time-adjusted variable resistor

    Science.gov (United States)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  15. Unilateral initiatives

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

  16. Ports Initiative

    Science.gov (United States)

    EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.

  17. Adjustable chain trees for proteins

    DEFF Research Database (Denmark)

    Winter, Pawel; Fonseca, Rasmus

    2012-01-01

    A chain tree is a data structure for changing protein conformations. It enables very fast detection of clashes and free energy potential calculations. A modified version of chain trees that adjust themselves to the changing conformations of folding proteins is introduced. This results in much...... tighter bounding volume hierarchies and therefore fewer intersection checks. Computational results indicate that the efficiency of the adjustable chain trees is significantly improved compared to the traditional chain trees....

  18. Electronic gaming and psychosocial adjustment.

    Science.gov (United States)

    Przybylski, Andrew K

    2014-09-01

    The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

  19. Hawaii Clean Energy Initiative (HCEI) Scenario Analysis: Quantitative Estimates Used to Facilitate Working Group Discussions (2008-2010)

    Energy Technology Data Exchange (ETDEWEB)

    Braccio, R.; Finch, P.; Frazier, R.

    2012-03-01

    This report provides details on the Hawaii Clean Energy Initiative (HCEI) Scenario Analysis to identify potential policy options and evaluate their impact on reaching the 70% HECI goal, present possible pathways to attain the goal based on currently available technology, with an eye to initiatives under way in Hawaii, and provide an 'order-of-magnitude' cost estimate and a jump-start to action that would be adjusted with a better understanding of the technologies and market.

  20. Impacts

    NARCIS (Netherlands)

    Hellmuth, M.; Kabat, P.

    2003-01-01

    Even without the impacts of climate change, water managers face prodigious challenges in meeting sustainable development goals. Growing populations need affordable food, water and energy. Industrial development demands a growing share of water resources and contaminates those same resources with its

  1. Ajustes nos movimentos de alcançar e apreender objetos: impacto da Síndrome de Down Adjustments in the movements of reaching for and grasping objects: the impact of Down Syndrome

    Directory of Open Access Journals (Sweden)

    Mariana Martins dos Santos

    2012-06-01

    Full Text Available OBJETIVOS: verificar a influência das propriedades dos objetos nos ajustes realizados por lactentes típicos e com Síndrome de Down (SD dos quatro aos oito meses de idade ao alcançar e apreender objetos. MÉTODOS: 16 lactentes, avaliados uma vez ao mês dos 4 aos 8 meses, sendo oito típicos e oito com SD. Quatro objetos esféricos (maleável grande, maleável pequeno, rígido grande e rígido pequeno foram apresentados, e os cinco primeiros movimentos válidos foram registrados para análise das variáveis: ajuste proximal (uni e bimanual, ajuste distal (orientação da palma, abertura da mão e apreensão do objeto. RESULTADOS: os lactentes típicos apresentaram mais ajuste bimanual para objetos grandes aos seis e oito meses e os com SD aos sete meses. Quanto aos ajustes distais, os lactentes típicos variaram seu comportamento enquanto os com SD apresentaram uso predominante da posição oblíqua. Em geral, o grupo típico apresentou maior sucesso na apreensão dos objetos rígidos e maleável pequeno quando comparados aos lactentes com SD. CONCLUSÕES: Os lactentes com SD apresentaram menor variedade de ajustes o que levou a um menor sucesso na apreensão, possivelmente devido a restrições intrínsecas da SD.OBJECTIVES: to verify the influence that properties of objects have on the reaching and grasping adjustments made by infants with and without Down syndrome (DS between four to eight months of age. METHODS: 16 infants, eight typical and eight with DS, were evaluated once a month from months 4 to 8. Four spherical objects (large soft, small soft, large hard and small hard were offered and the first five valid movements were recorded for analysis of the variables: proximal adjustment (uni- and bimanual, distal adjustments (palm orientation, hand opening and grasping of the object. RESULTS: the typical infants displayed greater bimanual adjustment for large objects at six and eight months and those with DS at seven months. As for distal

  2. Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.

    Science.gov (United States)

    Keller, T S; Colloca, C J; Fuhr, A W

    1999-02-01

    To determine the dynamic force-time and force-frequency characteristics of the Activator Adjusting Instrument and to validate its effectiveness as a mechanical impedance measurement device; in addition, to refine or optimize the force-frequency characteristics of the Activator Adjusting Instrument to provide enhanced dynamic structural measurement reliability and accuracy. An idealized test structure consisting of a rectangular steel beam with a static stiffness similar to that of the human thoracolumbar spine was used for validation of a method to determine the dynamic mechanical response of the spine. The Activator Adjusting Instrument equipped with a load cell and accelerometer was used to measure forces and accelerations during mechanical excitation of the steel beam. Driving point and transfer mechanical impedance and resonant frequency of the beam were determined by use of a frequency spectrum analysis for different force settings, stylus masses, and stylus tips. Results were compared with beam theory and transfer impedance measurements obtained by use of a commercial electronic PCB impact hammer. The Activator Adjusting Instrument imparted a very complex dynamic impact comprising an initial high force (116 to 140 N), short duration pulse (analysis of the Activator Adjusting Instrument impulse indicated that the Activator Adjusting Instrument has a variable force spectrum and delivers its peak energy at a frequency of 20 Hz. Added masses and different durometer stylus tips had very little influence on the Activator Adjusting Instrument force spectrum. The resonant frequency of the beam was accurately predicted by both the Activator Adjusting Instrument and electronic PCB impact hammer, but variations in the magnitude of the driving point impedance at the resonant frequency were high (67%) compared with the transfer impedance measurements obtained with the electronic PCB impact hammer, which had a more uniform force spectrum and was more repeatable (frequency

  3. IMPACTS !

    CERN Multimedia

    2008-01-01

    (Photo courtesy of Don Davis / NASA)The University of Geneva (UNIGE) and the Ecole Polytechnique Fédérale of Lausanne (EPFL) are organising the 4th series of public lectures on astronomy, on the theme of "Impacts". The schedule is as follows: Il y a 100 ans : une explosion dans la Tunguska – Dr. Frédéric COURBIN, EPFL Les impacts sur Terre – Prof. Didier Queloz, UNIGE La fin des dinosaures – Dr. Stéphane Paltani, UNIGE Wednesday 7 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire CO1, EPFL, Ecublens Thursday 08 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire Rouiller, Uni-Dufour, Genève All 3 lectures will be givent each evening! Admission free Information: 022 379 22 00

  4. The Quest for Deeper Learning: An Investigation into the Impact of a Knowledge-Pooling WebQuest in Primary Initial Teacher Training

    Science.gov (United States)

    Allan, Jo; Street, Mark

    2007-01-01

    This paper explores the impact on learning in higher education of the integration of a knowledge-pooling stage into a WebQuest. We explain the concept of WebQuests, consider recent literature regarding the effects and difficulties of this approach to learning, and examine students' perceptions of the impact of this tool on high-order learning. The…

  5. Fiscal Adjustment in IMF-Supported Adjustment Programmes: The ...

    African Journals Online (AJOL)

    Fiscal adjustment is an essential element of macro-economic stability and economic growth. Given that economic growth is the most powerful weapon in the fight for higher living standards, poor growth performance in African countries, has been a challenge to economists, policy makers and international development ...

  6. Acculturation, personality, and psychological adjustment.

    Science.gov (United States)

    Ahadi, Stephan A; Puente-Díaz, Rogelio

    2011-12-01

    Two studies investigated relationships between traditional indicators of acculturation, cultural distance, acculturation strategies, and basic dimensions of personality as they pertain to psychological adjustment among Hispanic students. Although personality characteristics have been shown to be important determinants of psychological well-being, acculturation research has put less emphasis on the role of personality in the well-being of immigrants. Hierarchical regression analysis showed that basic dimensions of personality such as extraversion and neuroticism were strongly related to psychological adjustment. Acculturation strategies did not mediate the effect of personality variables, but cultural resistance made a small, independent contribution to the explanation of some aspects of negative psychological adjustment. The implications of the results were discussed.

  7. GPU Parallel Bundle Block Adjustment

    Directory of Open Access Journals (Sweden)

    ZHENG Maoteng

    2017-09-01

    Full Text Available To deal with massive data in photogrammetry, we introduce the GPU parallel computing technology. The preconditioned conjugate gradient and inexact Newton method are also applied to decrease the iteration times while solving the normal equation. A brand new workflow of bundle adjustment is developed to utilize GPU parallel computing technology. Our method can avoid the storage and inversion of the big normal matrix, and compute the normal matrix in real time. The proposed method can not only largely decrease the memory requirement of normal matrix, but also largely improve the efficiency of bundle adjustment. It also achieves the same accuracy as the conventional method. Preliminary experiment results show that the bundle adjustment of a dataset with about 4500 images and 9 million image points can be done in only 1.5 minutes while achieving sub-pixel accuracy.

  8. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  9. Applications of sensitivity function to dosimetric data adjustments

    International Nuclear Information System (INIS)

    Nakazawa, Masaharu

    1984-01-01

    Sensitivity functions are applied to the dosimetric field in the spectrum unfolding technique, also called as the data adjustment technique which are statistical estimation procedures of the neutron spectrum or relating dosimetric quantities basing on the reaction-rate data measurements. Using the practical formulae and numerical examples of the sensitivity functions in the dosimetric data adjustments, two comments are made that (1) present sensitivity values are highly depending on the initial spectrum inputs and (2) more attention should be paid to the dependency of the sensitivity on the very uncertain covariance data inputs of the initial neutron spectrum. (author)

  10. Interharmonic analysis and mitigation in adjustable speed drives

    DEFF Research Database (Denmark)

    Soltani, Hamid; Loh, Poh Chiang; Blaabjerg, Frede

    2014-01-01

    This paper presents the theoretical background and studies on the supply side current interharmonics in a double-stage Adjustable Speed Drive (ASD), when they are initiated by motor current imbalance. Some useful approaches are then proposed to compensate for these interharmonic currents in parti......This paper presents the theoretical background and studies on the supply side current interharmonics in a double-stage Adjustable Speed Drive (ASD), when they are initiated by motor current imbalance. Some useful approaches are then proposed to compensate for these interharmonic currents...... in partially and/or fully controlled ASD, resulting in undistorted grid currents. The simulation studies verify the effectiveness of the proposed schemes....

  11. Religiosity influences on bereavement adjustments of older widows in Taiwan.

    Science.gov (United States)

    Shih, Shaw-Nin; Turale, Sue; Shih, Fu-Jin; Tsai, Jen-Chen

    2010-03-01

    To describe difficulties encountered by older widows in Taiwan and the impact of intrinsic or extrinsic religiosity on their coping strategies during early widowhood. There is very limited information about how Taiwan's widows cope with their bereavement and no studies reporting the relationship between religious beliefs and healthy adjustment during this distressing period. Between-method qualitative and quantitative triangulation was used. Semi-structured interviews were conducted and transcribed data were analysed by critical thematic analysis. Twenty women in Taiwan, >65 years old, (mean = 72.95) were interviewed within three years of being widowed. There were two informant groups: those with intrinsic religious beliefs and those with extrinsic religious beliefs. They all reported intrapersonal and interpersonal problems. Several major coping strategies arose: 'practising positive or negative attitudes for adaptation'; 'using person-focused actions'; and 'taking the initiative or passively seeking help from others or helping others'. Informants with intrinsic religious beliefs reported fewer coping problems by holding positive attitudes and taking multiple actions for adaptation. The extrinsic religious group had more negative adaptation attitudes, such as withdrawal and low self-esteem and practised less faith religious activities in worshipping ancestors, experiencing fatalism and using divination. They reported more coping problems than the intrinsic religious group. Widows in Taiwan have different coping problems and strategies in postbereavement adjustment, affected by their different religious beliefs systems. More research is required to establish the generalisabilty of these findings. Widows in Taiwan need to be assessed for their religious belief systems and how this affects their ability to cope during bereavement. Clinicians should actively provide grief support and encourage new methods of social adaptation, especially with widows with extrinsic

  12. An Annotated Bibliography of the Literature Dealing with the Impact of Divorce upon the Academic Performance, Emotional Adjustment, Self-Concept, and Behavioral Changes of Children of Divorce and the Diagnosis of and Strategies for Alleviating Negative Symptoms of Divorce.

    Science.gov (United States)

    Barrington, Diane M.

    Annotated citations in this bibliography are divided into two sections: (1) statistical studies concerning the impact of divorce on students, and (2) diagnostic studies and suggested strategies for dealing with the issue of marital separation and divorce and their effects in the classroom. A glossary of terms, a summary of findings, conclusions,…

  13. The Impact of Personal Gender-Typicality and Partner Gender-Traditionality on Taking Sexual Initiative: Investigating a Social Tuning Hypothesis.

    Science.gov (United States)

    Emmerink, Peggy M J; Van Den Eijnden, Regina J J M; Ter Bogt, Tom F M; Vanwesenbeeck, Ine

    2017-01-01

    Sexual assertiveness is an issue of interest in the context of gender equality and sexual health. This study investigated the social tuning hypothesis that encountering a gender-traditional partner would lead to stronger gender-typical behavior, i.e., respectively, higher and lower levels of taking sexual initiative among men and women. Participants ( N = 271) read a vignette describing a romantic partner, who was either presented as gender-traditional or not, followed by a sexual scenario. Subsequently, participants were asked about their expectations toward their own sexual initiative taking. Results showed a significant 'target gender-traditionality × participant gender × participant gender-typicality (masculinity/femininity)' interaction meaning that less gender-typical men were more likely to initiate sexual contact in the experimental, compared to the control condition. Men low in masculine characteristics showed higher initiative taking in response to a gender-traditional target female. We conclude that less gender-typical men seem to employ more social tuning toward their sexual partner, whereas more gender-typical men seem to adhere to their gender-typical behavior regardless of perceived partner characteristics. These results were not seen among the women in the sample. These findings are a starting point for the further development of experimental investigations regarding the gendered nature of both sexual initiative taking and sexual assertiveness in general.

  14. The Impact of Personal Gender-Typicality and Partner Gender-Traditionality on Taking Sexual Initiative: Investigating a Social Tuning Hypothesis

    Science.gov (United States)

    Emmerink, Peggy M. J.; Van Den Eijnden, Regina J. J. M.; Ter Bogt, Tom F. M.; Vanwesenbeeck, Ine

    2017-01-01

    Sexual assertiveness is an issue of interest in the context of gender equality and sexual health. This study investigated the social tuning hypothesis that encountering a gender-traditional partner would lead to stronger gender-typical behavior, i.e., respectively, higher and lower levels of taking sexual initiative among men and women. Participants (N = 271) read a vignette describing a romantic partner, who was either presented as gender-traditional or not, followed by a sexual scenario. Subsequently, participants were asked about their expectations toward their own sexual initiative taking. Results showed a significant ‘target gender-traditionality × participant gender × participant gender-typicality (masculinity/femininity)’ interaction meaning that less gender-typical men were more likely to initiate sexual contact in the experimental, compared to the control condition. Men low in masculine characteristics showed higher initiative taking in response to a gender-traditional target female. We conclude that less gender-typical men seem to employ more social tuning toward their sexual partner, whereas more gender-typical men seem to adhere to their gender-typical behavior regardless of perceived partner characteristics. These results were not seen among the women in the sample. These findings are a starting point for the further development of experimental investigations regarding the gendered nature of both sexual initiative taking and sexual assertiveness in general. PMID:28203216

  15. Kinematic adjustments to seismic recordings

    Energy Technology Data Exchange (ETDEWEB)

    Telegin, A.N.; Levii, N.V.; Volovik, U.M.

    1981-01-01

    The introduction of kinematic adjustments by adding the displaced blocks is studied theoretically and in test seismograms. The advantage to this method resulting from the weight variation in the trace is demonstrated together with its kinematic drawback. A variation on the displaced block addition method that does not involve realignment of the travel time curves and that has improved amplitude characteristics is proposed.

  16. Birth-Order Complementarity and Marital Adjustment.

    Science.gov (United States)

    Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

    1985-01-01

    Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

  17. State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

    Science.gov (United States)

    Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

    2009-05-01

    To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are

  18. Impact of Vestibular Lesions on Allocentric Navigation and Interval Timing: The Role of Self-Initiated Motion in Spatial-Temporal Integration

    Czech Academy of Sciences Publication Activity Database

    Dallal, N. L.; Yin, B.; Nekovářová, Tereza; Stuchlík, Aleš; Meck, W. H.

    2015-01-01

    Roč. 3, 3-4 (2015), s. 269-305 ISSN 2213-445X R&D Projects: GA MŠk(CZ) LH14053 Institutional support: RVO:67985823 Keywords : peak-interval procedure * interval timing * radial-arm maze * magnitude representation * dorsolateral striatum * self-initiated movement * hippocampus * cerebellum * time perception * allocentric navigation Subject RIV: FH - Neurology

  19. A Legal Analysis of the Equal Protection Clause of the Fourteenth Amendment and Its Impact on Ballot Initiatives and Affirmative Action Programs in Higher Education

    Science.gov (United States)

    Waters, Harold Davon

    2012-01-01

    This dissertation explores the controversial issues surrounding affirmative action in higher education. Are anti-affirmative action ballot initiatives in violation of the Equal Protection Clause of the Fourteenth Amendment by restructuring the political process of minorities in such a way that places special burden on their ability to secure…

  20. Remote Sensing-based Methodologies for Snow Model Adjustments in Operational Streamflow Prediction

    Science.gov (United States)

    Bender, S.; Miller, W. P.; Bernard, B.; Stokes, M.; Oaida, C. M.; Painter, T. H.

    2015-12-01

    Water management agencies rely on hydrologic forecasts issued by operational agencies such as NOAA's Colorado Basin River Forecast Center (CBRFC). The CBRFC has partnered with the Jet Propulsion Laboratory (JPL) under funding from NASA to incorporate research-oriented, remotely-sensed snow data into CBRFC operations and to improve the accuracy of CBRFC forecasts. The partnership has yielded valuable analysis of snow surface albedo as represented in JPL's MODIS Dust Radiative Forcing in Snow (MODDRFS) data, across the CBRFC's area of responsibility. When dust layers within a snowpack emerge, reducing the snow surface albedo, the snowmelt rate may accelerate. The CBRFC operational snow model (SNOW17) is a temperature-index model that lacks explicit representation of snowpack surface albedo. CBRFC forecasters monitor MODDRFS data for emerging dust layers and may manually adjust SNOW17 melt rates. A technique was needed for efficient and objective incorporation of the MODDRFS data into SNOW17. Initial development focused in Colorado, where dust-on-snow events frequently occur. CBRFC forecasters used retrospective JPL-CBRFC analysis and developed a quantitative relationship between MODDRFS data and mean areal temperature (MAT) data. The relationship was used to generate adjusted, MODDRFS-informed input for SNOW17. Impacts of the MODDRFS-SNOW17 MAT adjustment method on snowmelt-driven streamflow prediction varied spatially and with characteristics of the dust deposition events. The largest improvements occurred in southwestern Colorado, in years with intense dust deposition events. Application of the method in other regions of Colorado and in "low dust" years resulted in minimal impact. The MODDRFS-SNOW17 MAT technique will be implemented in CBRFC operations in late 2015, prior to spring 2016 runoff. Collaborative investigation of remote sensing-based adjustment methods for the CBRFC operational hydrologic forecasting environment will continue over the next several years.

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

    Science.gov (United States)

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

    2017-12-01

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

  2. On the Output-Inflation Relationship When Price and Quantity Adjustments are Costly

    DEFF Research Database (Denmark)

    Danziger, Leif; Kreiner, Claus Thustrup

    A vast literature analyzes the real effects of price-adjustment costs assuming that quantity adjustments are costless. In this paper, we analyze whether the presence of quantity-adjustments costs, which presumably are significant, change the traditional results on the impact of inflation....... In particular, recent findings suggest that quantity-adjustment costs may remove the linkage between output and inflation. We show that this is not the case when inflation is anticipated. On the contrary, quantity-adjustment costs may significantly amplify the consequences of price-adjustment costs...

  3. Parenting Perfectionism and Parental Adjustment

    OpenAIRE

    Lee, Meghan A.; Schoppe-Sullivan, Sarah J.; Kamp Dush, Claire M.

    2012-01-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers’ and fathers’ parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perf...

  4. Impact of a universal intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years

    NARCIS (Netherlands)

    van Lier, P.A.C.; Huizink, A.C.; Crijnen, A.A.M.

    2008-01-01

    The distal impact of a school based universal preventive intervention targeting disruptive behavior problems on tobacco and alcohol use from age 10 to 13 years was explored. Second grade classrooms (children aged 7 years) were randomly assigned to the intervention or a control condition. Tobacco and

  5. Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years

    NARCIS (Netherlands)

    van Lier, P.A.C.; Huizink, A.; Crijnen, A.A.

    2009-01-01

    The distal impact of a school based universal preventive intervention targeting disruptive behavior problems on tobacco and alcohol use from age 10 to 13 years was explored. Second grade classrooms (children aged 7 years) were randomly assigned to the intervention or a control condition. Tobacco and

  6. "Short Courses Shouldn't Be Short-Lived!" Enhancing Longer-Term Impact of Short English as a Foreign Language INSET Initiatives in China

    Science.gov (United States)

    Yan, Chunmei; He, Chuanjun

    2015-01-01

    Short in-service teacher development (INSET) programmes have been globally used as a form of teacher development, but their impact has been under question. This study sought to examine teacher participants' perceptions of short INSET programmes to come up with better solutions to enhancing their effect on teachers' professional learning. A…

  7. The Impact on Anxiety and Depression of a Whole School Approach to Health Promotion: Evidence from a Canadian Comprehensive School Health (CSH) Initiative

    Science.gov (United States)

    Dassanayake, Wijaya; Springett, Jane; Shewring, Tania

    2017-01-01

    In this paper, we examine the impact of adopting a comprehensive school health (CSH) approach on reducing anxiety and depression of school-age children. We use the data from 245 schools that received government funding support to adopt a CSH approach in order to build health promoting school environments in Alberta. Using a linear multi-level…

  8. Impact velocities of the teeth after a sudden unloading at various initial bite forces, degrees of mouth opening, and distances of travel

    NARCIS (Netherlands)

    Nagashima, T; Slager, GEC; Broekhuijsen, ML; vanWilligen, JD

    A potentially dangerous situation arises when an individual bites on hard and brittle food which suddenly breaks, since the impact velocity of the lower teeth onto the upper teeth after the food is broken can be high and may cause dental damage. The present experiments were designed to study the

  9. The Male Initiative on Leadership and Excellence (MILE) and Its Impact on Retention and Persistence of Black Men at Historically Black Colleges and Universities (HBCUs)

    Science.gov (United States)

    Palmer, Robert T.; Maramba, Dina C.; Dancy, T. Elon

    2013-01-01

    A strong body of research has documented the supportive environments of historically Black colleges and universities (HBCUs) and their impact on facilitating student success. Notwithstanding the consistency of these findings, recent reports and empirical research have highlighted the problems that HBCUs are experiencing with Black male enrollment,…

  10. Targeted Prostate Cancer Screening in BRCA1 and BRCA2 Mutation Carriers: Results from the Initial Screening Round of the IMPACT Study

    NARCIS (Netherlands)

    Bancroft, Elizabeth K.; Page, Elizabeth C.; Castro, Elena; Lilja, Hans; Vickers, Andrew; Sjoberg, Daniel; Assel, Melissa; Foster, Christopher S.; Mitchell, Gillian; Drew, Kate; Mæhle, Lovise; Axcrona, Karol; Evans, D. Gareth; Bulman, Barbara; Eccles, Diana; McBride, Donna; van Asperen, Christi; Vasen, Hans; Kiemeney, Lambertus A.; Ringelberg, Janneke; Cybulski, Cezary; Wokolorczyk, Dominika; Selkirk, Christina; Hulick, Peter J.; Bojesen, Anders; Skytte, Anne-Bine; Lam, Jimmy; Taylor, Louise; Oldenburg, Rogier; Cremers, Ruben; Verhaegh, Gerald; van Zelst-Stams, Wendy A.; Oosterwijk, Jan C.; Blanco, Ignacio; Salinas, Monica; Cook, Jackie; Rosario, Derek J.; Buys, Saundra; Conner, Tom; Ausems, Margreet G.; Ong, Kai-Ren; Hoffman, Jonathan; Domchek, Susan; Powers, Jacquelyn; Teixeira, Manuel R.; Maia, Sofia; Foulkes, William D.; Taherian, Nassim; Ruijs, Marielle; van Os, Theo

    2014-01-01

    Background: Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in

  11. Targeted Prostate Cancer Screening in BRCA1 and BRCA2 Mutation Carriers : Results from the Initial Screening Round of the IMPACT Study

    NARCIS (Netherlands)

    Bancroft, Elizabeth K.; Page, Elizabeth C.; Castro, Elena; Lilja, Hans; Vickers, Andrew; Sjoberg, Daniel; Assel, Melissa; Foster, Christopher S.; Mitchell, Gillian; Drew, Kate; Maehle, Lovise; Axcrona, Karol; Evans, D. Gareth; Bulman, Barbara; Eccles, Diana; McBride, Donna; van Asperen, Christi; Vasen, Hans; Kiemeney, Lambertus A.; Ringelberg, Janneke; Cybulski, Cezary; Wokolorczyk, Dominika; Selkirk, Christina; Hulick, Peter J.; Bojesen, Anders; Skytte, Anne-Bine; Lam, Jimmy; Taylor, Louise; Oldenburg, Rogier; Cremers, Ruben; Verhaegh, Gerald; van Zelst-Stams, Wendy A.; Oosterwijk, Jan C.; Blanco, Ignacio; Salinas, Monica; Cook, Jackie; Rosario, Derek J.; Buys, Saundra; Conner, Tom; Ausems, Margreet G.; Ong, Kai-ren; Hoffman, Jonathan; Domchek, Susan; Powers, Jacquelyn; Teixeira, Manuel R.; Maia, Sofia; Foulkes, William D.; Taherian, Nassim; Ruijs, Marielle; Helderman-van den Enden, Apollonia T.

    Background: Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in

  12. The impact of the organizational transfer climate on the use of teacher leadership competences developed in a post-initial Master’s program

    NARCIS (Netherlands)

    Snoek, Marco; Volman, Monique

    2014-01-01

    In dit artikel in Teaching and Teacher Education beschrijven HvA-lector Marco Snoek en Monique Volman de uitkomsten van een onderzoek naar een masteropleiding die gericht is op het ontwikkelen van leiderschap van leraren en op de impact van dat leiderschap op scholen. ‘The transfer of learning

  13. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013

    Science.gov (United States)

    Cassini, Alessandro; Colzani, Edoardo; Pini, Alessandro; Mangen, Marie-Josee J; Plass, Dietrich; McDonald, Scott A; Maringhini, Guido; van Lier, Alies; Haagsma, Juanita A; Havelaar, Arie H; Kramarz, Piotr; Kretzschmar, Mirjam E

    2018-01-01

    Background and aims The Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25–1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control. PMID:29692315

  14. Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome.

    Science.gov (United States)

    Van der Linden, Lorenz; Decoutere, Liesbeth; Walgraeve, Karolien; Milisen, Koen; Flamaing, Johan; Spriet, Isabel; Tournoy, Jos

    2017-02-01

    Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients. A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge. On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs.intervention:median (interquartile range [IQR]) 3 (2-5) vs. 5 (3-7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs.intervention:median (IQR) 2 (1-3) vs. 0.5 (0-1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed. The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits. ClinicalTrials.gov Identifier: NCT01513265.

  15. Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

    OpenAIRE

    Yoshimura, Jumpei; Kinoshita, Takahiro; Yamakawa, Kazuma; Matsushima, Asako; Nakamoto, Naoki; Hamasaki, Toshimitsu; Fujimi, Satoshi

    2017-01-01

    Background Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicr...

  16. Breastfeeding Initiation and Duration in First-Time Mothers: Exploring the Impact of Father Involvement in the Early Post-Partum Period

    Directory of Open Access Journals (Sweden)

    Theresa Hunter

    2014-12-01

    Full Text Available Background: The early post-partum period is a crucial time for breastfeeding support. Mothers who have physical and emotional support during this period are more likely to be successful in breastfeeding. This study examined the relationship between father involvement and support for breast feeding initiation and duration in first-time mothers. Methods: Overall, 146 women who attended a childbirth education class or breastfeeding course at BABS were asked to fill out the Childbirth Experiences Survey, which explored key topics such as (1 breastfeeding initiation, (2 early post-partum breastfeeding, (3 breastfeeding plan, (4 post-partum breastfeeding support and (5 breast feeding duration. This was a voluntary self-reported questionnaire. The surveys were completed by the mothers during the post-partum period. Results: 45.9% (n=67 of mothers received helped from their husband or partner with breastfeeding while in the hospital, while 54.1% (n=79 of mothers did not receive support from their partners. Mothers who received early post-partum breastfeeding support were more likely to continue breastfeeding after leaving the hospital. Conclusion: First-time mothers who identified as having breastfeeding support from their partners, the infant’s father, during the early post-partum period were more likely to initiate breastfeeding and had longer breastfeeding durations.

  17. Impact of Initial pH and Pyrolysis Temperature on the Adsorption of Cr(Ⅵ from Aqueous Solutions on Corn Straw-based Materials

    Directory of Open Access Journals (Sweden)

    WANG Shuai

    2016-09-01

    Full Text Available Batch experiments were performed on Cr(Ⅵ adsorption using four straw-based materials including corn straw and three kinds of biochar pyrolysed at 300 ℃, 450 ℃ and 600 ℃, respectively. The results showed that the Cr(Ⅵ adsorption were significantly affected by initial pH and pyrolysis temperature. The data were described by kinetic and isotherm models, and showed that the adsorption of Cr(Ⅵ was increased with the decrease of initial pH. The removal rates of Cr(Ⅵ were decreased with the increase of the pyrolysis temperature at pH=3 or pH=5. The biochar pyrolysed at 300 ℃ had the best capability of removing Cr(Ⅵ from aqueous solution at pH=1, and the maxi-mum adsorption quantity was 141.24 mg·g-1 approximately. It observed that both the lower initial pH and the lower pyrolysis temperature had positive effects on the removal of Cr(Ⅵ from aqueous solution.

  18. Initial evaluations of the use of microbial measures to quantify impact of acid rock drainage on the Finniss River (east branch)

    International Nuclear Information System (INIS)

    Holden, P.J.; Wilde, K.L.; Stone, D.J.; Ben-David, E.A.; Foster, L.J.

    2002-01-01

    Biological measures assessing the impact of pollution on aquatic ecosystems have been increasingly used over the last ten years to examine ecosystem health. The focus, however, has been on diversity and abundance of higher organisms, such as fish, frogs and macroinvertebrates, and it is desirable that such measures be made across all trophic levels of the ecosystem. In this study, phospholipid-fatty acid analysis and microbial carbon substrate utilisation assays (BIOLOG) of sediment and water samples were conducted to evaluate their usefulness as a measure of the effect of acid rock drainage (ARD) on the East Branch of the Finniss River. Both PLFA, and BIOLOG assays, generate data well suited to multivariate analysis and previous studies of the impact of ARD from the Brukunga mine (South Australia) have demonstrated the ability to distinguish between the effect of ARD, nutrients and dry-land salinity on microbial populations

  19. The Oceans 2015 Initiative, Part II - An updated understanding of the observed and projected impacts of ocean warming and acidification on marine and coastal socioeconomic activities/sectors

    International Nuclear Information System (INIS)

    Weatherdon, Lauren; Sumaila, Rashid; Cheung, William W.L.; Rogers, Alex; Magnan, Alexandre

    2015-01-01

    Between 1971 and 2010, the oceans have absorbed approximately 93% of the excess heat caused by global warming, leading to several major changes such as the increase in stratification, limitation in the circulation of nutrients from deep waters to the surface, and sea level rise. In addition, the oceans absorbed 26% of anthropogenic CO 2 emitted since the start of the Industrial Revolution, which resulted in ocean acidification. Together, these processes strongly affect marine and coastal species' geographic distribution, abundance, migration patterns and phenology. As a consequence of these complex environmental changes, marine and coastal human sectors (i.e., fisheries, aquaculture, coastal tourism and health) are in turn at risk. This report provides an updated synthesis of what the science tells us about such a risk, based upon IPCC AR5 (2013- 2014) and published scientific articles and grey literature that have been published between July 2013 and April 2015. Although uncertainty remains strong, there is growing scientific evidence that ocean warming and acidification will affect key resources for societies through ecosystems services. For example, while AR5 indicated that coral reefs had little scope for adaptation, recent research has suggested that there may be some capacity for some coral species to recover from climatic hocks and bleaching events, and to acquire heat resistance through acclimatization. This will have huge implications on many coastal economies in the developing and developed countries. More generally, key sectors will be affected. For example, while the fish catch potential is expected to decrease at the global scale, it will show diversified trends at the regional scale as fish stocks have started shifting in latitudes or by depth. This will impact regional to local fisheries systems. Also, climate and acidification-related impacts to existing aquaculture are expected to be generally negative, with impacts varying by location

  20. 12 CFR 19.240 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

  1. Structural adjustment and drought in Zambia.

    Science.gov (United States)

    Mulwanda, M

    1995-06-01

    While drought is not uncommon in Zambia, the country is now facing the worst drought in history. The monetary and social costs will be enormous. Although it is too early to measure the economic and social costs of the drought on Zambia, it is obvious that the impact is catastrophic on a country whose economy is under pressure. The drought will affect the structural adjustment programme (SAP) unveiled by the new government which has embraced the market economy. The country has imported, and will continue to import, large quantities of maize and other foodstuffs, a situation likely to strain the balance of payments. Earlier targets with regard to export earnings, reductions in the budget deficit, and GDP growth as contained in the Policy Framework Paper (PFP) are no longer attainable due to the effects of the drought.

  2. Impact of time of initiation of once-monthly paliperidone palmitate in hospitalized Asian patients with acute exacerbation of schizophrenia: a post hoc analysis from the PREVAIL study.

    Science.gov (United States)

    Li, Huafang; Li, Yan; Feng, Yu; Zhuo, Jianmin; Turkoz, Ibrahim; Mathews, Maju; Tan, Wilson

    2018-01-01

    To evaluate the differences in efficacy and safety outcomes in acute exacerbating schizophrenia patients between 2 subgroups (≤1 week and >1 week), differing in time interval from hospitalization to time of initiation of once-monthly paliperidone palmitate. PREVAIL was a multicenter, single-arm, open-label, prospective Phase IV study in hospitalized Asian patients (either sex, aged 18-65 years) diagnosed with schizophrenia ( Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition). Change from baseline to week 13 in primary (Positive and Negative Syndrome Scale [PANSS] total score), secondary endpoints (PANSS responder rate, PANSS subscale, PANSS Marder factor, Clinical Global Impression-Severity, and Personal and Social Performance scale scores, readiness for hospital discharge questionnaire) and safety were assessed in this post hoc analysis. Significant mean reduction from baseline to week 13 in the PANSS total score, 30% PANSS responder rates ( P ≤0.01), PANSS subscales (positive and general psychopathology; all P ≤0.01), PANSS Marder factor (positive symptoms, uncontrolled hostility, and excitement and anxiety/depression; all P ≤0.01), Personal and Social Performance scale scores ( P ≤0.05) and Clinical Global Impression-Severity categorical summary ( P ≤0.05) were significantly greater in the ≤1 week subgroup versus >1 week subgroup ( P ≤0.05). The readiness for hospital discharge questionnaire improved over time for the overall study population, but remained similar between subgroups at all-time points. Treatment-emergent adverse events were similar between the subgroups. Early initiation of once-monthly paliperidone palmitate in hospitalized patients with acute exacerbation of schizophrenia led to greater improvements in psychotic symptoms with comparable safety than treatment initiation following 1 week of hospitalization.

  3. Impact on ART initiation of point-of-care CD4 testing at HIV diagnosis among HIV-positive youth in Khayelitsha, South Africa.

    Science.gov (United States)

    Patten, Gabriela E M; Wilkinson, Lynne; Conradie, Karien; Isaakidis, Petros; Harries, Anthony D; Edginton, Mary E; De Azevedo, Virginia; van Cutsem, Gilles

    2013-07-04

    Despite the rapid expansion of antiretroviral therapy (ART) programmes in developing countries, pre-treatment losses from care remain a challenge to improving access to treatment. Youth and adolescents have been identified as a particularly vulnerable group, at greater risk of loss from both pre-ART and ART care. Point-of-care (POC) CD4 testing has shown promising results in improving linkage to ART care. In Khayelitsha township, South Africa, POC CD4 testing was implemented at a clinic designated for youth aged 12-25 years. We assessed whether there was an associated reduction in attrition between HIV testing, assessment for eligibility and ART initiation. A before-and-after observational study was conducted using routinely collected data. These were collected on patients from May 2010 to April 2011 (Group A) when baseline CD4 count testing was performed in a laboratory and results were returned to the clinic within two weeks. Same-day POC CD4 testing was implemented in June 2011, and data were collected on patients from August 2011 to July 2012 (Group B). A total of 272 and 304 youth tested HIV-positive in Group A and Group B, respectively. Group B patients were twice as likely to have their ART eligibility assessed compared to Group A patients: 275 (90%) vs. 183 (67%) [relative risk (RR)=2.4, 95% CI: 1.8-3.4, pART was 50% and 44% (p=0.6) in Groups B and A, respectively; and 50% and 43% (p=0.5) when restricted to patients with baseline CD4 count≤250 cells/µL. Time between HIV-testing and ART initiation was reduced from 36 to 28 days (p=0.6). POC CD4 testing significantly improved assessment for ART eligibility. The improvement in the proportion initiating ART and the reduction in time to initiation was not significant due to sample size limitations. POC CD4 testing reduced attrition between HIV-testing and assessment of ART eligibility. Strategies to improve uptake of ART are needed, possibly by improving patient support for HIV-positive youth immediately

  4. Impact of time of initiation of once-monthly paliperidone palmitate in hospitalized Asian patients with acute exacerbation of schizophrenia: a post hoc analysis from the PREVAIL study

    Directory of Open Access Journals (Sweden)

    Li H

    2018-04-01

    Full Text Available Huafang Li,1,2 Yan Li,1,2 Yu Feng,3 Jianmin Zhuo,4 Ibrahim Turkoz,5 Maju Mathews,5 Wilson Tan3 1Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; 3Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore; 4Janssen China Research and Development, Shanghai, China; 5Janssen Research & Development LLC, Titusville, NJ, USA Purpose: To evaluate the differences in efficacy and safety outcomes in acute exacerbating schizophrenia patients between 2 subgroups (≤1 week and >1 week, differing in time interval from hospitalization to time of initiation of once-monthly paliperidone palmitate. Patients and methods: PREVAIL was a multicenter, single-arm, open-label, prospective Phase IV study in hospitalized Asian patients (either sex, aged 18–65 years diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Change from baseline to week 13 in primary (Positive and Negative Syndrome Scale [PANSS] total score, secondary endpoints (PANSS responder rate, PANSS subscale, PANSS Marder factor, Clinical Global Impression-Severity, and Personal and Social Performance scale scores, readiness for hospital discharge questionnaire and safety were assessed in this post hoc analysis. Results: Significant mean reduction from baseline to week 13 in the PANSS total score, 30% PANSS responder rates (P≤0.01, PANSS subscales (positive and general psychopathology; all P≤0.01, PANSS Marder factor (positive symptoms, uncontrolled hostility, and excitement and anxiety/depression; all P≤0.01, Personal and Social Performance scale scores (P≤0.05 and Clinical Global Impression-Severity categorical summary (P≤0.05 were significantly greater in the ≤1 week subgroup versus >1 week subgroup (P≤0.05. The readiness for hospital discharge questionnaire improved over time for the overall study population, but

  5. Differential Impact of Interferon Regulatory Factor 7 in Initiation of the Type I Interferon Response in the Lymphocytic Choriomeningitis Virus-Infected Central Nervous System versus the Periphery

    DEFF Research Database (Denmark)

    Christensen, Jeanette Erbo; Fenger, Christina; Issazadeh-Navikas, Shohreh

    2012-01-01

    in the LCMV-infected CNS, whereas concurrent elimination of both factors markedly reduces the virus-induced host response. This is unlike the situation in the periphery, where deficiency of IRF7 almost eliminates the LCMV-induced production of the type I IFNs. This difference is seemingly related to the local...... environment, as peripheral production of type I IFNs is severely reduced in intracerebrally (i.c.) infected IRF7-deficient mice, which undergo a combined infection of the CNS and peripheral organs, such as spleen and lymph nodes. Interestingly, despite the redundancy of IRF7 in initiating the type I IFN...

  6. Openness initiative

    International Nuclear Information System (INIS)

    Duncan, S.S.

    1995-01-01

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: open-quotes Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?close quotes To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts

  7. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  8. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  9. Adjustable Tooling for Bending Brake

    Science.gov (United States)

    Ellis, J. M.

    1986-01-01

    Deep metal boxes and other parts easily fabricated. Adjustable tooling jig for bending brake accommodates spacing blocks and either standard male press-brake die or bar die. Holds spacer blocks, press-brake die, bar window die, or combination of three. Typical bending operations include bending of cut metal sheet into box and bending of metal strip into bracket with multiple inward 90 degree bends. By increasing free space available for bending sheet-metal parts jig makes it easier to fabricate such items as deep metal boxes or brackets with right-angle bends.

  10. Can structural adjustment work for women farmers.

    Science.gov (United States)

    Mehra, R

    1991-12-01

    This article discusses the impact of structural adjustment programs (SAPs) on women farmers in developing countries. SAPs aim to improve economic efficiency and promote more rapid economic growth. SAPs are introduced in two phases. The first phase involves short-term loans with the condition that the country adopt monetary restraints and currency devaluation measures. In the second phase, long-term loans are given with the provision that the country deregulate their economy and open up markets. The agricultural sector is affected by SAPs because of their importance in employment, income generation, and export earnings. SAPs result in lower farm commodity prices due to currency devaluations and in removal of subsidies, which results in market-sensitive pricing or higher food prices. The impact of SAPs on agriculture vary between countries. In Morocco and Algeria, agriculture expanded under SAPs. In Indonesia, Bolivia, Costa Rica, and Mexico, the agriculture stagnated or declined. Agricultural growth was slowest in Africa. SAPs were somewhat successful in increasing agricultural exports. Food production grew slowly in many adjusting countries. Blame for failures of SAPs has been placed on government failure to implement reforms properly and overly optimistic assumptions about the timing of productive gains. Little attention has focused on the constraints facing women farmers, who are a large proportion of farmers, particularly in sub-Saharan Africa. This article focuses on the issues of limited access to resources, credit, agricultural extension and information, land ownership, education, and time as constraints to women farmers. Women also must ensure household food security. For SAPs to work effectively, complementary policies must be implemented that reallocate available productive resources and new technologies to women and that deal with women's constraints.

  11. Interpersonal ambivalence, perceived relationship adjustment, and conjugal loss.

    Science.gov (United States)

    Bonanno, G A; Notarius, C I; Gunzerath, L; Keltner, D; Horowitz, M J

    1998-12-01

    Ambivalence is widely assumed to prolong grief. To examine this hypothesis, the authors developed a measure of ambivalence based on an algorithmic combination of separate positive and negative evaluations of one's spouse. Preliminary construct validity was evidenced in relation to emotional difficulties and to facial expressions of emotion. Bereaved participants, relative to a nonbereaved comparison sample, recollected their relationships as better adjusted but were more ambivalent. Ambivalence about spouses was generally associated with increased distress and poorer perceived health but did not predict long-term grief outcome once initial outcome was controlled. In contrast, initial grief and distress predicted increased ambivalence and decreased Dyadic Adjustment Scale scores at 14 months postloss, regardless of initial scores on these measures. Limitations and implications of the findings are discussed.

  12. Adjustment costs in a two-capital growth model

    Czech Academy of Sciences Publication Activity Database

    Duczynski, Petr

    2002-01-01

    Roč. 26, č. 5 (2002), s. 837-850 ISSN 0165-1889 R&D Projects: GA AV ČR KSK9058117 Institutional research plan: CEZ:AV0Z7085904 Keywords : adjustment costs * capital mobility * convergence * human capital Subject RIV: AH - Economics Impact factor: 0.738, year: 2002

  13. Adjusting Wages to Living Costs: A Historical Note

    Science.gov (United States)

    Lowenstern, Henry

    1974-01-01

    The significant historical developments of the cost of living wage adjustments are summarized. Since the concept of cost of living took effect in 1919, developments that are noted are: World War II, the GM contract 1948, the GM Contract 1950, and the impact of the agreements. (DS)

  14. Storm Water Management Model Climate Adjustment Tool (SWMM-CAT)

    Science.gov (United States)

    The US EPA’s newest tool, the Stormwater Management Model (SWMM) – Climate Adjustment Tool (CAT) is meant to help municipal stormwater utilities better address potential climate change impacts affecting their operations. SWMM, first released in 1971, models hydrology and hydrauli...

  15. Initiative hard coal; Initiative Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, J.

    2007-08-02

    In order to decrease the import dependence of hard coal in the European Union, the author has submitted suggestions to the director of conventional sources of energy (directorate general for energy and transport) of the European community, which found a positive resonance. These suggestions are summarized in an elaboration 'Initiative Hard Coal'. After clarifying the starting situation and defining the target the presupposition for a better use of hard coal deposits as raw material in the European Union are pointed out. On that basis concrete suggestions for measures are made. Apart from the conditions of the deposits it concerns thereby also new mining techniques and mining-economical developments, connected with tasks for the mining-machine industry. (orig.)

  16. In vivo expansion of co-transplanted T cells impacts on tumor re-initiating activity of human acute myeloid leukemia in NSG mice.

    Directory of Open Access Journals (Sweden)

    Malte von Bonin

    Full Text Available Human cells from acute myeloid leukemia (AML patients are frequently transplanted into immune-compromised mouse strains to provide an in vivo environment for studies on the biology of the disease. Since frequencies of leukemia re-initiating cells are low and a unique cell surface phenotype that includes all tumor re-initiating activity remains unknown, the underlying mechanisms leading to limitations in the xenotransplantation assay need to be understood and overcome to obtain robust engraftment of AML-containing samples. We report here that in the NSG xenotransplantation assay, the large majority of mononucleated cells from patients with AML fail to establish a reproducible myeloid engraftment despite high donor chimerism. Instead, donor-derived cells mainly consist of polyclonal disease-unrelated expanded co-transplanted human T lymphocytes that induce xenogeneic graft versus host disease and mask the engraftment of human AML in mice. Engraftment of mainly myeloid cell types can be enforced by the prevention of T cell expansion through the depletion of lymphocytes from the graft prior transplantation.

  17. Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates

    Energy Technology Data Exchange (ETDEWEB)

    Bluekens, Adriana M.J. [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Karssemeijer, Nico [Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen (Netherlands); Beijerinck, David; Deurenberg, Jan J.M. [Preventicon Screening Centre/Mid-West, Utrecht (Netherlands); Engen, Ruben E. van [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Broeders, Mireille J.M. [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Radboud University Nijmegen Medical Centre, Department of Epidemiology, Biostatistics and HTA, Nijmegen (Netherlands); Heeten, Gerard J. den [National Expert and Training Centre for Breast Cancer Screening, Nijmegen (Netherlands); Academic Medical Centre (AMC), Department of Radiology, Amsterdam (Netherlands)

    2010-09-15

    To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p <.001), with a significant increase in cancer detection (p =.010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection. (orig.)

  18. Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

    Science.gov (United States)

    Bluekens, Adriana M J; Karssemeijer, Nico; Beijerinck, David; Deurenberg, Jan J M; van Engen, Ruben E; Broeders, Mireille J M; den Heeten, Gerard J

    2010-09-01

    To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

  19. Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates

    International Nuclear Information System (INIS)

    Bluekens, Adriana M.J.; Karssemeijer, Nico; Beijerinck, David; Deurenberg, Jan J.M.; Engen, Ruben E. van; Broeders, Mireille J.M.; Heeten, Gerard J. den

    2010-01-01

    To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme. Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed. A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p <.001), with a significant increase in cancer detection (p =.010). As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection. (orig.)

  20. Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

    Science.gov (United States)

    Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

    2013-01-01

    There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.