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Sample records for multiple case study

  1. MULTIPLE PERSONALITY: CASE REPORT STUDY

    Directory of Open Access Journals (Sweden)

    Miloš Židanik

    2004-07-01

    Full Text Available Background. Multiple personality disorder is characterised by splited individual ego-states and splited professional community arguing whether this disorder actually exists or not.Methods. In this case report study a supportive psychodynamic psychotherapy of a patient with multiple personality disorder is presented, that lasted for 4.5 years and resulted in ego-reintegration.Conclusions. The spliting between different ego-states is powered by unneutralised aggression with the possibility of hetero- and autoaggressive behaviour. Therefore the patient in the analytically oriented psychotherapeutic process is at high risk and a safe therapeutic (e. g. in-patient setting has to be provided.

  2. Using Correspondence Analysis in Multiple Case Studies

    NARCIS (Netherlands)

    Kienstra, Natascha; van der Heijden, Peter G.M.

    2015-01-01

    In qualitative research of multiple case studies, Miles and Huberman proposed to summarize the separate cases in a so-called meta-matrix that consists of cases by variables. Yin discusses cross-case synthesis to study this matrix. We propose correspondence analysis (CA) as a useful tool to study

  3. Using correspondence analysis in multiple case studies

    NARCIS (Netherlands)

    Kienstra, N.H.H.; van der Heijden, P.G.M.

    2015-01-01

    In qualitative research of multiple case studies, Miles and Huberman proposed to summarize the separate cases in a so-called meta-matrix that consists of cases by variables. Yin discusses cross-case synthesis to study this matrix. We propose correspondence analysis (CA) as a useful tool to study

  4. Stakeholders and Apart Hotels: Multiple Case Study

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    Elizabeth Kyoko Wada

    2012-09-01

    Full Text Available Means of accommodation involve a wide range of social actors and agents, as well as different business models. Management strategies in this sector have been increasingly important for long-term sustainability and competitiveness of business organizations. This study aims to analyze the interactions between apart-hotels and their stakeholders to foster an improvement of services provided, aligning the interface of strategic management from the point of view of managers and their key stakeholders. It is an exploratory study, with qualitative chacter, along with multiple case studies of the following establishments: Travel Inn, Hotels Slaviero and Etoile george v. Brazilian enterprises, which manage lodging facilities with apart-hotel concepts, combining features that enable comparative analysis of the study. For conceptual understanding, this study was based on literature about stakeholders, taking the work of Freeman (1984 and Freeman et al (2010 as main references. The research was conducted through semi-structured interviews with managers of lodging facilities and their key stakeholders and through direct observation and documentation. We found that not all groups of influence are considered in the planning of service flats. However, the organizations surveyed indicated that the market has realized the importance of the groups that exert influence and are influenced by their goals, and are therefore increasingly alert for integration of such groups in their strategic planning.

  5. Case studies: Soil mapping using multiple methods

    Science.gov (United States)

    Petersen, Hauke; Wunderlich, Tina; Hagrey, Said A. Al; Rabbel, Wolfgang; Stümpel, Harald

    2010-05-01

    Soil is a non-renewable resource with fundamental functions like filtering (e.g. water), storing (e.g. carbon), transforming (e.g. nutrients) and buffering (e.g. contamination). Degradation of soils is meanwhile not only to scientists a well known fact, also decision makers in politics have accepted this as a serious problem for several environmental aspects. National and international authorities have already worked out preservation and restoration strategies for soil degradation, though it is still work of active research how to put these strategies into real practice. But common to all strategies the description of soil state and dynamics is required as a base step. This includes collecting information from soils with methods ranging from direct soil sampling to remote applications. In an intermediate scale mobile geophysical methods are applied with the advantage of fast working progress but disadvantage of site specific calibration and interpretation issues. In the framework of the iSOIL project we present here some case studies for soil mapping performed using multiple geophysical methods. We will present examples of combined field measurements with EMI-, GPR-, magnetic and gammaspectrometric techniques carried out with the mobile multi-sensor-system of Kiel University (GER). Depending on soil type and actual environmental conditions, different methods show a different quality of information. With application of diverse methods we want to figure out, which methods or combination of methods will give the most reliable information concerning soil state and properties. To investigate the influence of varying material we performed mapping campaigns on field sites with sandy, loamy and loessy soils. Classification of measured or derived attributes show not only the lateral variability but also gives hints to a variation in the vertical distribution of soil material. For all soils of course soil water content can be a critical factor concerning a succesful

  6. Case study: Malingering or multiple personality disorder?

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    Alba García-Cortés

    2017-03-01

    Full Text Available The dissociative identity disorder (DID can be considered a rare disorder because of its seemingly low prevalence. However, in recent years it points to the possible underdiagnosis because its complexity and confusion at the time of differential diagnosis. On the other hand, the malingering of mental psychopathology can have a major socio-economic and legal impact, particularly important in this type of disorder, given the inability it generates and its complex diagnostic. This paper refers the case of a patient admitted to the short-term hospitalization unit of Dr. Rodríguez Lafora Hospital (Madrid with depressive symptoms. Then the patient seemed to become a TID case. The evaluation consisted of a psychological history and the application of the Structured Inventory of Malingered Symptoms (SIMS and the Millon Clinical Multiaxial Inventory (MCMI-II. The results showed an altered personality profile as well as likely malingered symptoms, what prevented us from a DID diagnosis. In view of the results, possible implications of this case for the clinical setting are discussed.

  7. Team effectiveness in academic medical libraries: a multiple case study.

    Science.gov (United States)

    Martin, Elaine Russo

    2006-07-01

    The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams.

  8. Team effectiveness in academic medical libraries: a multiple case study*

    Science.gov (United States)

    Russo Martin, Elaine

    2006-01-01

    Objectives: The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. Methods: The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Findings: Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Conclusions: Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams. PMID:16888659

  9. Multiple Study of Case Involving Implementation of Lean Manufacturing

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    Delvio Venanzi

    2018-03-01

    Full Text Available This article aims to show some factors that can cause companies to succeed or fail in their attempts to use lean manufacturing, by performing a multiple case study which presents two successful cases and three conditions of failure, in a survey of five large companies, all belonging to the metal-mechanical sector, located in Campinas and Sorocaba, both in the state of São Paulo, Brazil. The data were collected using exploratory research between the periods of January 2013 and February 2015. The results show that successful cases of lean manufacturing implementation are the result of a more organized work environment, standardization of production and service areas, employee satisfaction, productivity results and quality of the final product. Unsuccessful deployments result from poor execution and faulty planning, that has no benefit and ultimately decrease the morale of its employees, creating more distrust and frustration directly influencing the results and productivity. In other words, lean manufacturing implementation requires hard and continuous work and these procedures should be aligned with the mission and goals of companies and mainly focus on the maintenance result by using tools to monitor and track the process systematically and also making investments to eliminate waste.

  10. Combined interpretation of multiple geophysical techniques: an archaeological case study

    Science.gov (United States)

    Riedl, S.; Reichmann, S.; Tronicke, J.; Lück, E.

    2009-04-01

    subsurface structures and relevant geometries. From this data set, we interpret the depth and the extent of foundation and wall remains in the southern and central part of the site indicating the extent of the old orangery. This case study clearly illustrates the benefit of using multiple geophysical methods in archaeological studies. It further illustrates the advantage of 3-D GPR surveying at sites where anthropogenic disturbances (such as metallic pipes and other utilities) might limit the applicability of commonly applied mapping techniques such as magnetic gradiometry or EM38 conductivity mapping.

  11. How Multiple Interventions Influenced Employee Turnover: A Case Study.

    Science.gov (United States)

    Hatcher, Timothy

    1999-01-01

    A 3-year study of 46 textile industry workers identified causes of employee turnover (supervision, training, organizational communication) using performance analysis. A study of multiple interventions based on the analysis resulted in changes in orientation procedures, organizational leadership, and climate, reducing turnover by 24%. (SK)

  12. Administrative support of novice science teachers: A multiple case study

    Science.gov (United States)

    Iacuone, Leann

    Novice science teachers leave the confines of colleges and universities to embark on a new adventure in education where they aim to influence young minds, make a difference in the world, and share their love for their content. They have learned their pedagogical skills with the support and assistance of fellow classmates, a supporting professor, and a cooperating teacher. These teachers enter their new place of employment and are met with many unexpected challenges, such as a lack of resources, no one to ask questions of, and a busy staff with already established relationships, causing them to feel an overall lack of support and resulting in many new teachers rethinking their career choice and leaving the field of education within 5 years of entering. This multiple-case study investigated the administrative support 4 novice science teachers received during an academic year and the novice teachers' perceptions of the support they received to answer the following research question: How do novice science teachers who have consistent interactions with administrators develop during their first year? To answer this question, semistructured interviews, reflection journals, observations, resumes, long-range plans, and student discipline referrals were collected. The findings from this study show novice science teachers who had incidents occur in the classroom requiring administrative assistance and guidance felt more confident in enforcing their classroom management policies and procedures as the year progressed to change student behavior. The novice science teachers perceived administrators who provided resources including technology, office supplies, science supplies, and the guidance of a mentor as supportive. Novice science teachers who engaged in dialogue after administrative observations, were provided the opportunity to attend professional development outside the district, and had a mentor who taught the same discipline made more changes to their instructional

  13. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    NARCIS (Netherlands)

    Slot, P.L.|info:eu-repo/dai/nl/328192694; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive

  14. Supporting Affect Regulation in Children With Multiple Disabilities During Psychotherapy: A Multiple Case Design Study of Therapeutic Attachment. [Miscellaneous Article

    NARCIS (Netherlands)

    Schuengel, C; Sterkenburg, P S; Jeczynski, P; Janssen, C G C; Jongbloed, G

    2009-01-01

    : In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase,

  15. Networks in Argentine agriculture: a multiple-case study approach

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    Sebastián Senesi

    2013-06-01

    Full Text Available Argentina is among the four largest producers of soybeans, sunflower, corn, and wheat, among other agricultural products. Institutional and policy changes during the 1990s fostered the development of Argentine agriculture and the introduction of innovative process and product technologies (no-till, agrochemicals, GMO, GPS and new investments in modern, large-scale sunflower and soybean processing plants. In addition to technological changes, a "quiet revolution" occurred in the way agricultural production was carried out and organized: from self-production or ownership agriculture to a contract-based agriculture. The objective of this paper is to explore and describe the emergence of networks in the Argentine crop production sector. The paper presents and describes four cases that currently represent about 50% of total grain and oilseed production in Argentina: "informal hybrid form", "agricultural trust fund", "investor-oriented corporate structure", and "network of networks". In all cases, hybrid forms involve a group of actors linked by common objectives, mainly to gain scale, share resources, and improve the profitability of the business. Informal contracts seem to be the most common way of organizing the agriculture process, but using short-term contracts and sequential interfirm collaboration. Networks of networks involve long-term relationships and social development, and reciprocal interfirm collaboration. Agricultural trust fund and investor-oriented corporate structures have combined interfirm collaboration and medium-term relationships. These organizational forms are highly flexible and show a great capacity to adapt to challenges; they are competitive because they enjoy aligned incentives, flexibility, and adaptability.

  16. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    OpenAIRE

    Slot, P.L.; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    2016-01-01

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive data collection on structural characteristics, process quality, implemented curricula and pedagogical approaches in four ECEC centers in each of the seven countries that were considered examples of ‘g...

  17. Dynamic capabilities and innovation: a Multiple-Case Study

    OpenAIRE

    Bravo Ibarra, Edna Rocío; Mundet Hiern, Joan; Suñé Torrents, Albert

    2009-01-01

    After a detailed survey of the scientific literature, it was found that several characteristics of dynamic capabilities were similar to those of innovation capability. Therefore, with a deeper study of the first ones, it could be possible to design a model aimed to structure innovation capability. Thus, this work presents a conceptual model, where the innovation capability is shown as result of three processes: knowledge absorption and creation capability, knowledge integration and knowledge ...

  18. Making Meaning with Multimedia in Secondary English Language Arts: A Multiple Case Study

    Science.gov (United States)

    Mahoney, Kerrigan Rose

    2016-01-01

    The purpose of this multiple case study was to learn about how secondary English language arts (ELA) teachers help students to make meaning with multimedia. The study focused on how and why teachers plan and implement meaning-making learning experiences. The cases represent the experiences and perspectives of five ELA teachers who use digital and…

  19. Collaborative learning in local partnerships for public value : a multiple case study

    NARCIS (Netherlands)

    Bos, Eltje; de Zeeuw, Anna; van Vliet, Pieter; de Kreek, Mike

    2017-01-01

    In our recently started multiple case study - funded by the Netherlands Scientific Board (NWO) - on these processes of collaboration, we focused on the dynamics in growing partnerships between citizens, community social workers and civil servants. Three cases of social neighbourhood initiatives are

  20. Multiple myeloma: 45 cases

    International Nuclear Information System (INIS)

    Yang, Hee Chul; Suh, Jin Suck; Park, Chang Yun

    1990-01-01

    We evaluated 45 cases of multiple myelomas retrospectively confirmed in Severance Hospital from the period of 1983-1989. In order to assess the radiologic features of the multiple myeloma and to assist in possible early diagnosis and treatment. The result were as follows: 1. IgG(41%) was the most common immunoglobulin type secreted followed by light chain(36%). IgA(19%) and IgD(2%). Two percent of the patients had non-secretory type. 89% of patients were in their stage III of the disease. 2. Among the 45 patients, 96% had abnormal plain radiographic findings with average number of 4.5 lesions. Common sites were the spine, rib, skull, pelvis, and humerus in descending orders. The findings were localized or diffuse osteolytic bone destruction(85%). osteoporosis(49%), pathologic fracture and endosteal scalloping(55%). Osteoporosis was more prominent in stage III than stage II. 3. Both plain X-ray and radioisotope study was available for comparison in 28 patients. Concordance between the two studies were 44%, lesions detected only on plain X-ray film were 51%, and lesions detected only on the radioisotope were 5%. The plain radiography was able to detect only 54% of bone lesions confirmed by bone marrow biopsy. With the above results, accurate evaluation of bone lesions in multiple myeloma may be difficult with radiologic studies only. But familiarity with these radiologic findings of the this disease entity is necessary for early suspicion of the disease, thus for early diagnosis and treatment

  1. Does decision documentation help junior designers rationalize their decisions? A comparative multiple-case study

    OpenAIRE

    Heesch, U. van; Avgeriou, P.; Tang, A.

    2013-01-01

    Software architecture design is challenging, especially for junior software designers. Lacking practice and experience, junior designers need process support in order to make rational architecture decisions. In this paper, we present the results of a comparative multiple-case study conducted to find out if decision viewpoints from van Heesch et al. (2012, in press) can provide such a support. The case study was conducted with four teams of software engineering students working in industrial s...

  2. State Politics and Education: An Examination of Selected Multiple-State Case Studies.

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    Burlingame, Martin; Geske, Terry G.

    1979-01-01

    Reviews the multiple-state case study literature, highlights some findings, discusses several methodological issues, and concludes with suggestions for possible research agendas. Urges students and researchers to be more actively critical of the assumptions and findings of these studies. (Author/IRT)

  3. Customer service strategy options : a multiple case study in a B2B setting

    NARCIS (Netherlands)

    Wouters, J.P.M.

    2004-01-01

    This study addresses the question whether customer service actually has order winning potential in B2B situations, which customer service strategies are deployed, and what determines customer service relevance. A literature review was followed by a multiple case study, using 12 organizations from

  4. Exploring Community College Peer Mentoring Practices within Central California: A Multiple Case Study

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    Brown, Lenis Colton

    2017-01-01

    The purpose of this qualitative, multiple case study was to illuminate the prevalence and configurations of peer mentoring programs at Central California Community Colleges with emphasis on how the programs impacted student retention. The study's sample was drawn from ten campuses and five centers that operate within five California Community…

  5. The MORPG-Based Learning System for Multiple Courses: A Case Study on Computer Science Curriculum

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    Liu, Kuo-Yu

    2015-01-01

    This study aimed at developing a Multiplayer Online Role Playing Game-based (MORPG) Learning system which enabled instructors to construct a game scenario and manage sharable and reusable learning content for multiple courses. It used the curriculum of "Introduction to Computer Science" as a study case to assess students' learning…

  6. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

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    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  7. Examining Education Leadership Communication Practices around Basic and Advanced Skill Sets: A Multiple Case Study

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    Minger, Leslie

    2017-01-01

    The purpose of this multiple case study was to explore and describe the leadership communication practices of school principals in Southern California schools with demonstrated high levels of academic performance in order to identify practices that might be replicated in other schools. Communication practices were studied in relation to two…

  8. Where Adults Go: A Multiple Case Study of Adult Serving Undergraduate Colleges and Universities

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    Dixon-Williams, Shelley B.

    2010-01-01

    This research is an exploratory multiple case study of adult serving undergraduate colleges and universities. Using the Council of Adult and Experiential Learning (CAEL) Principles of Effective Practice for Serving Adult Learners, this study examines the differences of adult serving undergraduate colleges across the three sectors of higher…

  9. Accounting for multiple births in neonatal and perinatal trials: systematic review and case study.

    Science.gov (United States)

    Hibbs, Anna Maria; Black, Dennis; Palermo, Lisa; Cnaan, Avital; Luan, Xianqun; Truog, William E; Walsh, Michele C; Ballard, Roberta A

    2010-02-01

    To determine the prevalence in the neonatal literature of statistical approaches accounting for the unique clustering patterns of multiple births and to explore the sensitivity of an actual trial to several analytic approaches to multiples. A systematic review of recent perinatal trials assessed the prevalence of studies accounting for clustering of multiples. The Nitric Oxide to Prevent Chronic Lung Disease (NO CLD) trial served as a case study of the sensitivity of the outcome to several statistical strategies. We calculated odds ratios using nonclustered (logistic regression) and clustered (generalized estimating equations, multiple outputation) analyses. In the systematic review, most studies did not describe the random assignment of twins and did not account for clustering. Of those studies that did, exclusion of multiples and generalized estimating equations were the most common strategies. The NO CLD study included 84 infants with a sibling enrolled in the study. Multiples were more likely than singletons to be white and were born to older mothers (P accounted for clustering were statistically significant; analyses assuming independence were not. The statistical approach to multiples can influence the odds ratio and width of confidence intervals, thereby affecting the interpretation of a study outcome. A minority of perinatal studies address this issue. Copyright 2010 Mosby, Inc. All rights reserved.

  10. Does decision documentation help junior designers rationalize their decisions? A comparative multiple-case study

    NARCIS (Netherlands)

    Heesch, U. van; Avgeriou, P.; Tang, A.

    Software architecture design is challenging, especially for junior software designers. Lacking practice and experience, junior designers need process support in order to make rational architecture decisions. In this paper, we present the results of a comparative multiple-case study conducted to find

  11. The Best Practices for School Transformation: A Multiple-Case Study

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    Waheed, Zarina; Hussin, Sufean; Bin Megat Daud, Megat Ahmad Kamaluddin

    2018-01-01

    Purpose: The purpose of this paper is to explore the best practices of school leaders, teachers, pupils, parents and the community in selected transformed schools in Selangor, Malaysia. Design/methodology/approach: This qualitative multiple-case study explores the best practices in two selected transformed schools through in-depth interviews,…

  12. Multiple Case Study of STEM in School-Based Agricultural Education

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    Stubbs, Eric A.; Myers, Brian E.

    2015-01-01

    This multiple case study investigated the integration of science, technology, engineering, and mathematics (STEM) in three Florida high school agriculture programs. Observations, interviews, documents, and artifacts provided qualitative data that indicated the types of STEM knowledge taught. Variables of interest included student and teacher…

  13. Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; Dijk, L. van; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  14. Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  15. An Exploration of Infant and Toddler Child Care Consultation: A Multiple Case Study

    Science.gov (United States)

    John, Christine Marie

    2015-01-01

    This qualitative, multiple case study was an exploration of the professional development (PD) experience of consultation as it occurred within infant and toddler child care settings. Consultation is dependent upon the establishment of a relationship between the consultant and the consultee and offers opportunities for professional growth and…

  16. Key aspects in managing safety when working with multiple contractors: A case study

    NARCIS (Netherlands)

    Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues

  17. Negotiating jurisdiction in the workplace : A multiple-case study of nurse prescribing in hospital settings

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P. P.; Francke, A. L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  18. Studying abroad: a multiple case study of nursing students' international experiences.

    Science.gov (United States)

    Green, Barbara F; Johansson, Inez; Rosser, Megan; Tengnah, Cassam; Segrott, Jeremy

    2008-11-01

    This paper examines the experiences of nursing students undertaking an international placement during their pre-registration education. The study took place in two schools--one in the United Kingdom, and one in Sweden. The move of nursing education into higher education enabled students to participate in international exchange programmes. Previous research demonstrates that students participating in such programmes may gain enhanced cultural awareness and experience personal and professional growth. The study comprised a multiple case study, utilising semi-structured individual and group interviews and documentary analysis. Eighteen students from the UK and 14 from Sweden participated. Participants described an increase in confidence, self-reliance and professional knowledge and skills resulting from their international placement. There was an awareness of how healthcare roles differ between countries and a change in attitudes to others from different backgrounds and cultures. The differences between the two cases were marginal. Whilst there was support from both home and host universities this varied between the international placement providers. The international placements were beneficial; however, there is a need for change in the preparation, support and monitoring of students, greater engagement with the partner institutions, and more effective mentoring of staff.

  19. Organizational Crises and Reactions from a Legitimacy Perspective - Results from Two Multiple-case Studies

    OpenAIRE

    Heiko Breitsohl

    2009-01-01

    Organizational crises can be conceptualized as interactions between organizations and stake-holders around the breach and reestablishment of common norms and social codes, i.e. per-ceptions of legitimacy. This paper contributes to the understanding of organizational crises by exploring the roles of dimensions of legitimacy in organizational crises as well as the role of different reactions in the resolution of crises. Results of two qualitative multiple-case studies based on analyses of media...

  20. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study.

    Science.gov (United States)

    Hoonakker, Peter L T; Carayon, Pascale; Cartmill, Randi S

    2017-04-01

    Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. We used a multiple case study design with multiple data collections methods (observation, interviews and survey). Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Case report 383: Multiple myeloma

    International Nuclear Information System (INIS)

    Kouwenberg, J.J.; Simons, A.J.

    1986-01-01

    A unique and obviously extremely rare example of multiple myeloma has been presented, affecting the peripheral appendicular skeleton and not the hematopoietic system of the axial skeleton, radiologically and probably pathologically. Only one other similar case has been described. The radiological features were confirmed by the pathological studies: a biopsy specimen obtained from a large osteolytic lesion in a patella showed the typical stigma of multiple myeloma; a biopsy from the iliac creast showed no abnormality. (orig./SHA)

  2. PORTFOLIO MANAGEMENT IN NEW PRODUCTS DEVELOPMENT IN THE TELECOMMUNICATION SECTOR IN BRAZIL: A MULTIPLE CASES STUDY

    Directory of Open Access Journals (Sweden)

    Roque Rabechini Jr.

    2017-06-01

    Full Text Available This study aimed to understand how the use of portfolio management practices influence the development of new products in the Brazilian telecommunications operators. The chosen alternative methodology was the multiple case study. The results showed that the processes of identification, selection and prioritization projects influence the development of new products. Specifically, we found that the optimization of resources and product launch projects in short periods of time, are indicators to reveal the possibilities of organizations to remain competitive in the market.

  3. The impact of science teachers' epistemological beliefs on authentic inquiry: A multiple-case study

    Science.gov (United States)

    Jackson, Dionne Bennett

    The purpose of this study was to examine how science teachers' epistemological beliefs impacted their use of authentic inquiry in science instruction. Participants in this multiple-case study included a total of four teachers who represented the middle, secondary and post-secondary levels. Based on the results of the pilot study conducted with a secondary science teacher, adjustments were made to the interview questions and observation protocol. Data collection for the study included semi-structured interviews, direct observations of instructional techniques, and the collection of artifacts. The cross case analysis revealed that the cases epistemological beliefs were mostly Transitional and the method of instruction used most was Discussion. Two of the cases exhibited consistent beliefs and instructional practices, whereas the other two exhibited beliefs beyond their instruction. The findings of this study support the literature on the influence of contextual factors and professional development on teacher beliefs and practice. The findings support and contradict literature relevant to the consistency of teacher beliefs with instruction. This study's findings revealed that the use of reform-based instruction, or Authentic Inquiry, does not occur when science teachers do not have the beliefs and experiences necessary to implement this form of instruction.

  4. Family Owned Business Succession and Governance: a multiple case study in Brazil

    Directory of Open Access Journals (Sweden)

    Leonardo Roth

    2017-08-01

    Full Text Available One of the main threats to the continuity of family owned business is the poor management of the succession process between generations of the family. This risk factor can be avoided when the process works properly and can also become a renewal and strengthening tool for organizations. The aim of this study is to evaluate the different factors that trigger the succession, as well as the various ways in which companies act and react to the process and the succession’s turbulence. The methodology used was a qualitative study of multiple cases in four representatives family owned organizations in south of Brazil. These families are going, either have passed or have chosen not to go through generational succession processes. The results show the process can be an opportunity to improve the company’s management. Moreover, it shows that there is no single model to follow, but good practices that can be applied to each case.

  5. Stakeholders: Organizational Strategy and Relationship a Multiple Case Study in the Hotel Sector

    Directory of Open Access Journals (Sweden)

    Rosemeire Rodrigues Junqueira

    2011-12-01

    Full Text Available Research into organizational management that focuses on relationships with stakeholders refers to the importance of the commitment of the various groups in the business development prioritizing the creation and distribution of values. For a better view and understanding of strategy-oriented management with stakeholders and the usage of this strategy in hotel chains, a qualitative approach to the methodology, focused on multiple case studies, was the most suitable for empirical investigation. Three hotel chains were selected, with features that allowed a comparative analysis of the study according to the method suggested by Yin (2010, with three sources of evidence: interviews, direct observations and documentation. Through this research, it was found that, through transparency, ethics, values and especially mutual respect clearly shown by the management, a strategy can be more collaborative and result in increasing the sustainability of organizations.

  6. Exploring Content Management Issues in Air Force On-Line Communities of Practice: A Multiple Case Study Approach

    National Research Council Canada - National Science Library

    Jaime

    2004-01-01

    .... Addressing existing or potential content management issues will help do so. This multiple-case study research observed and interviewed managers and members of eight active CoPs busted by AFMC/DRW...

  7. A Case Study in Support of Multiple Post Mortem Assessments (Invited Paper

    Directory of Open Access Journals (Sweden)

    Jill Pable

    2015-02-01

    Full Text Available Creative projects in various fields are often subjected to afterthe- fact 'post-mortem' assessments to better understand their successes and failures. Names for these include project retrospectives or post occupancy evaluations (POEs depending on their field of origin. This case study from the architecture field will show the utility of engaging in multiple rounds of post-mortem activities in order to assess the solution from multiple stakeholder perspectives and in doing so, more fully recognize its strengths and weaknesses. The design of a homeless shelter bedroom was subjected to two POE analyses: a 'demand side' focused study that analyzed user accommodation, and a 'supply side' study that addressed issues including budget and funding. The two POEs yielded both corroborative and contrasting findings that sometimes worked at cross purposes. Three evaluation tactics emerged that could be extended to other fields' post mortem assessment activities: 1 conduct two or more POEs; 2 vary the POE criteria so that one is deep and focused 'demand side' user analysis and the other is 'supply side' operational and installation issues; and 3 conduct the POEs over a broad time period.

  8. Middle school science teachers' reaction and pedagogical response to high stakes accountability: A multiple case study

    Science.gov (United States)

    Tse, Kenneth

    The purpose of this study was to understand how science teachers reacted to the high stakes accountability and standardized testing in California. In a multiple case study of middle and intermediate schools in Southern California, four research questions focused on the perceptions of secondary science teachers and how they responded to the changes in the accountability specifically geared towards science as a content area, the pedagogical skills teachers were using both outside and inside of the classroom that impact instruction, the pedagogical training received that related specifically to the content standards, the tools or impediments that existed for teachers to successfully utilize these pedagogical methods and types of support and assistance the school site administration and/or school district offered in learning about the California Science Standards and the STAR test. Interviews were conducted with multiple middle/intermediate school teachers, science department chairpersons and school site administrators to gather information about what the classroom teachers were doing pedagogically to improve student performance on the STAR tests. Moreover, the study described the issues that supported the professional development of the teacher and what schools and districts were doing to support them.

  9. Vocabulary skills are well developed in university students with dyslexia: Evidence from multiple case studies.

    Science.gov (United States)

    Cavalli, Eddy; Casalis, Séverine; El Ahmadi, Abdessadek; Zira, Mélody; Poracchia-George, Florence; Colé, Pascale

    2016-01-01

    Most studies in adults with developmental dyslexia have focused on identifying the deficits responsible for their persistent reading difficulties, but little is known on how these readers manage the intensive exposure to written language required to obtain a university degree. The main objective of this study was to identify certain skills, and specifically vocabulary skills, that French university students with dyslexia have developed and that may contribute to their literacy skills. We tested 20 university students with dyslexia and 20 normal readers (matched on chronological age, gender, nonverbal IQ, and level of education) in reading, phonological, vocabulary breadth (number of known words), and vocabulary depth (accuracy and precision) tasks. In comparing vocabulary measures, we used both Rasch model and single case study methodologies. Results on reading and phonological tasks confirmed the persistence of deficits in written word recognition and phonological skills. However, using the Rasch model we found that the two groups performed at the same level in the vocabulary breadth task, whereas dyslexics systematically outperformed their chronological age controls in the vocabulary depth task. These results are supplemented by multiple case studies. The vocabulary skills of French university students with dyslexia are well developed. Possible interpretations of these results are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. A case-control study of risk factors for multiple sclerosis in Iran.

    Science.gov (United States)

    Alonso, Alvaro; Cook, Stuart D; Maghzi, Amir-Hadi; Divani, Afshin A

    2011-05-01

    Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. A case-control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53-0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46-28.78), but not in men (OR: 0.72, 95% CI: 0.31-1.68) (p=0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

  11. Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

    Science.gov (United States)

    Montgomery, Leslie D.; Montgomery, Richard W.; Ku, Yu-Tsuan; Luna, Bernadette (Technical Monitor)

    1997-01-01

    Cognitive dysfunction is a common symptom in patients with multiple sclerosis (MS). This can have a significant impact on the quality of life of both the patient and of their primary care giver. This case study explores the possibility that liquid cooling therapy may be used to enhance the cognitive processing of MS patients in the same way that it provides temporary relief of some physical impairment. Two MS patients were presented a series of pattern discrimination tasks before and after being cooled with a liquid cooling garment for a one hour period. The subject whose ear temperature was reduced during cooling showed greater electroencephalographic (EEG) activity and scored much better on the task after cooling. The patient whose ear temperature was unaffected by cooling showed less EEG activity and degraded performance after the one hour cooling period.

  12. Resilience Processes Supporting Adolescents With Intellectual Disability: A Multiple Case Study.

    Science.gov (United States)

    Hall, Anna-Marié; Theron, Linda C

    2016-02-01

    Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.

  13. Neophyte experiences of football (soccer) match analysis: a multiple case study approach.

    Science.gov (United States)

    McKenna, Mark; Cowan, Daryl Thomas; Stevenson, David; Baker, Julien Steven

    2018-03-05

    Performance analysis is extensively used in sport, but its pedagogical application is little understood. Given its expanding role across football, this study explored the experiences of neophyte performance analysts. Experiences of six analysis interns, across three professional football clubs, were investigated as multiple cases of new match analysis. Each intern was interviewed after their first season, with archival data providing background information. Four themes emerged from qualitative analysis: (1) "building of relationships" was important, along with trust and role clarity; (2) "establishing an analysis system" was difficult due to tacit coach knowledge, but analysis was established; (3) the quality of the "feedback process" hinged on coaching styles, with balance of feedback and athlete engagement considered essential; (4) "establishing effect" was complex with no statistical effects reported; yet enhanced relationships, role clarity, and improved performances were reported. Other emic accounts are required to further understand occupational culture within performance analysis.

  14. A Case Study of Tack Tiles[R] Literacy Instruction for a Student with Multiple Disabilities Including Congenital Blindness

    Science.gov (United States)

    Klenk, Jessicia A.; Pufpaff, Lisa A.

    2011-01-01

    Research on literacy instruction for students with multiple disabilities is limited. Empirical research on braille instruction for students with multiple disabilities that include congenital blindness is virtually nonexistent. This case study offers initial insight into possible methods of early braille literacy instruction for a student with…

  15. The Relation of Shadow Systems and ERP Systems—Insights from a Multiple-Case Study

    Directory of Open Access Journals (Sweden)

    Melanie Huber

    2016-01-01

    Full Text Available ERP systems integrate a major part of all business processes and organizations include them in their IT service management. Besides these formal systems, there are additional systems that are rather stand-alone and not included in the IT management tasks. These so-called ‘shadow systems’ also support business processes but hinder a high enterprise integration. Shadow systems appear during their explicit detection or during software maintenance projects such as enhancements or release changes of enterprise systems. Organizations then have to decide if and to what extent they integrate the identified shadow systems into their ERP systems. For this decision, organizations have to compare the capabilities of each identified shadow system with their ERP systems. Based on multiple-case studies, we provide a dependency approach to enable their comparison. We derive categories for different stages of the dependency and base insights into integration possibilities on these stages. Our results show that 64% of the shadow systems in our case studies are related to ERP systems. This means that they share parts or all of their data and/or functionality with the ERP system. Our research contributes to the field of integration as well as to the discussion about shadow systems.

  16. Sympathetic skin response in multiple sclerosis: a meta-analysis of case-control studies.

    Science.gov (United States)

    Margaritella, Nicolò; Mendozzi, Laura; Garegnani, Massimo; Gilardi, Elisabetta; Nemni, Raffaello; Pugnetti, Luigi

    2018-01-01

    The usefulness of sympathetic skin responses (SSR) in multiple sclerosis (MS) has been advocated by several studies in the last 20 years; however, due to a great heterogeneity of findings, a comprehensive meta-analysis of case-control studies is in order to pinpoint consistencies and investigate the causes of discrepancies. We searched MEDLINE, EMBASE and Cochrane databases for case-control studies comparing SSR absence frequency and latency between patients with MS and healthy controls. Thirteen eligible studies including 415 MS patients and 331 healthy controls were identified. The pooled analysis showed that SSR can be always obtained in healthy controls while 34% of patients had absent SSRs in at least one limb (95% CI 22-47%; p studies (I 2  = 90.3%). Patients' age explained 22% of the overall variability and positive correlations were found with Expanded Disability Status Scale and disease duration. The pooled mean difference of SSR latency showed a significant increase in patients on both upper (193 ms; 95% CI 120-270 ms) and lower (350 ms; 95% CI 190-510 ms) extremities. We tested the discriminatory value of SSR latency thresholds defined as the 95% confidence interval (CI) upper bound of the healthy controls, and validated the results on a new dataset. The lower limb threshold of 1.964 s produces the best results in terms of sensitivity 0.86, specificity 0.67, positive predicted value 0.75 and negative predicted value 0.80. Despite a considerable heterogeneity of findings, there is evidence that SSR is a useful tool in MS.

  17. The Fashion Retail and the value creation with sustainable products: a multiple case study

    Directory of Open Access Journals (Sweden)

    Eleonora Alves Baptista

    2016-06-01

    Full Text Available This study aims to understand how the development of sustainable products in Brazilian fashion retail businesses creates value for the companies themselves, society and the environment. A qualitative approach to multiple case study method investigates practices and processes at four companies from Rio de Janeiro State. The study collected primary information from direct observation and interviews with the firms’ directors, and secondary data from industry reports and other documents. Three overall dimensions of the study - environmental management, value creation and product development in fast fashion companies - encoded into seven categories, when considered in data crosssynthesis, elucidate the following conclusions: (1 the firms do not have economic, ethical and legal fields integrated view; (2 the companies do not believe that the fashion consumer market values environmental practices and thus not motivated to invest in practices and products; (3 a fragmented supply chain makes it difficult to control activities and appears as a major constraint to the development of sustainable products; (4 access to information on best environmental practices and tax incentives are important inductors’ mechanisms to leverage the development of sustainable products in the Brazilian fashion retail; (5 the development of strategic capabilities in pollution prevention area, management products and clean technology create value for the production chain.

  18. Multiple meningiomas CASE SERIES

    African Journals Online (AJOL)

    masses in the right parietal and parasagittal region (Figs 1a and b). Case 2: A ... scan showed hyperdense parasagittal and left cerebellopontine angle meningiomas (Figs ... Meningiomas are the most common primary non-glial brain tumours.

  19. Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

    Science.gov (United States)

    Brown, Willie L., Jr.

    Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

  20. Critical operations capabilities in a high cost environment: a multiple case study

    Science.gov (United States)

    Sansone, C.; Hilletofth, P.; Eriksson, D.

    2018-04-01

    Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

  1. Environmental risk factors in the aetiology of multiple sclerosis in Kayseri: a case control study

    Directory of Open Access Journals (Sweden)

    Servin Yeşil Günal

    2013-06-01

    Full Text Available Background: our purpose is to evaluate the possible relationship between multiple sclerosis (MS and environmental factors in Kayseri.Methods: this case control study was conducted on 100 patients with MS and 100 sex-aged and residential area matched control. Data was collected by using face to face interviews. Questionnaire consisted of two parts. The first part was comprised of items related with the participants’ sociodemographic features. The second part was related with factors thought to be involved in the occurrence or aggravation of the disease. The Chi-square test and logistic regression were used for analysis.Results: logistic regression analysis revealed the following as possible risk factors in MS cases: economic status (Odds Ratio (OR: 0.14 adjusted 7.19; Confidence Interval 95% (CI: 0.05-0.43, having a sensitive personality (OR:4.51; 95% CI: 1.10-18.45, familial history of MS (OR:3.28; 95% CI: 1.3-8.27, history of cranial and spinal injury (OR: 2.99; 95% CI: 1.11-8.08, cooking oil consumption (OR:0.07 adjusted 13.5; 95% CI: 0.03-0.20, consumption of legumes and grains (OR: 0.11 adjusted 8.9; 95% CI: 0.03-0.41, and living in dwellings within a distance of 500 meters from transformer basestations (OR: 6.5; 95% CI: 1.54-28.21.Conclusions: we believe that it is necessary to inform the individuals about the risk of MS and their relatives of the results of large-scale joint studies and to offer suggestions based on the data obtained.

  2. Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru.

    Science.gov (United States)

    Goicolea, Isabel; Coe, Anna-Britt; San Sebastián, Miguel; Hurtig, Anna-Karin

    2017-08-01

    Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries - Peru and Ecuador - introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities' transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.

  3. The multiple imputation method: a case study involving secondary data analysis.

    Science.gov (United States)

    Walani, Salimah R; Cleland, Charles M

    2015-05-01

    To illustrate with the example of a secondary data analysis study the use of the multiple imputation method to replace missing data. Most large public datasets have missing data, which need to be handled by researchers conducting secondary data analysis studies. Multiple imputation is a technique widely used to replace missing values while preserving the sample size and sampling variability of the data. The 2004 National Sample Survey of Registered Nurses. The authors created a model to impute missing values using the chained equation method. They used imputation diagnostics procedures and conducted regression analysis of imputed data to determine the differences between the log hourly wages of internationally educated and US-educated registered nurses. The authors used multiple imputation procedures to replace missing values in a large dataset with 29,059 observations. Five multiple imputed datasets were created. Imputation diagnostics using time series and density plots showed that imputation was successful. The authors also present an example of the use of multiple imputed datasets to conduct regression analysis to answer a substantive research question. Multiple imputation is a powerful technique for imputing missing values in large datasets while preserving the sample size and variance of the data. Even though the chained equation method involves complex statistical computations, recent innovations in software and computation have made it possible for researchers to conduct this technique on large datasets. The authors recommend nurse researchers use multiple imputation methods for handling missing data to improve the statistical power and external validity of their studies.

  4. Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia

    Directory of Open Access Journals (Sweden)

    Tatjana D. Pekmezovic

    2009-03-01

    Full Text Available

    Background: The aetiology of multiple sclerosis (MS is unclear, but numerous studies suggest that different exogenous factors can lead to the development of the disease in genetically susceptible individuals. The objective of this case-control study was to determine the role of food and dietary patterns in patients with MS in the population of Belgrade (Serbia.

    Methods: In this matched case-control study, we included 110 cases with definite MS according to McDonald’s criteria, in whom the onset symptoms occurred up to 2 years prior to the interview, who were followed-up at the Institute of Neurology, Clinical Centre of Serbia, Belgrade. The identical number of controls from the same institution, individually matched by sex, age and area of residence, was recruited from patients with various non-autoimmune neurological disorders. Dietary information was obtained by using a frequency history approach.

    Results: According to univariate conditional logistic regression analysis the following factors were significantly related to MS: body mass index (BMI less than 25 (OR=2.2, p=0.009, frequent consumption of beef (OR=1.7, p=0.043, chicken (OR=2.0, p=0.045, meat of the lamb (OR=2.1, p=0.013, butter (OR=1.7, p=0.056 and ice-cream (OR=1.8, p=0.031, with dose-response relationship. Consumption of majority of various fruit was more frequently reported by controls. According to multivariate conditional logistic regression analysis, BMI less than 25 (OR=2.3, p=0.008, consumption (weekly of beef (OR=2.0, p=0.017 and butter (OR=1.9, p=0.027 was significantly related to MS, while regular consumption of cherry (OR=0.4, p=0.024 had protective role.

    Conclusions: This study might assist in potential defining of the dietary factors that could contribute to the risk of developing MS.

  5. Exploring the use of storytelling in quantitative research fields using a multiple case study method

    Science.gov (United States)

    Matthews, Lori N. Hamlet

    The purpose of this study was to explore the emerging use of storytelling in quantitative research fields. The focus was not on examining storytelling in research, but rather how stories are used in various ways within the social context of quantitative research environments. In-depth interviews were conducted with seven professionals who had experience using storytelling in their work and my personal experience with the subject matter was also used as a source of data according to the notion of researcher-as-instrument. This study is qualitative in nature and is guided by two supporting theoretical frameworks, the sociological perspective and narrative inquiry. A multiple case study methodology was used to gain insight about why participants decided to use stories or storytelling in a quantitative research environment that may not be traditionally open to such methods. This study also attempted to identify how storytelling can strengthen or supplement existing research, as well as what value stories can provide to the practice of research in general. Five thematic findings emerged from the data and were grouped under two headings, "Experiencing Research" and "Story Work." The themes were found to be consistent with four main theoretical functions of storytelling identified in existing scholarly literature: (a) sense-making; (b) meaning-making; (c) culture; and (d) communal function. The five thematic themes that emerged from this study and were consistent with the existing literature include: (a) social context; (b) quantitative versus qualitative; (c) we think and learn in terms of stories; (d) stories tie experiences together; and (e) making sense and meaning. Recommendations are offered in the form of implications for various social contexts and topics for further research are presented as well.

  6. Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study

    Directory of Open Access Journals (Sweden)

    Patrícia Fernanda Ferreira PIRES

    Full Text Available ABSTRACT Objective: To assess dietician’s numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian’s private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.

  7. System-wide lean implementation in health care: A multiple case study.

    Science.gov (United States)

    Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

    2018-05-01

    Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

  8. Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study.

    Science.gov (United States)

    Yalcin, Serenat Eris; Yalcin, Yakup; Yavuz, And; Akkurt, Mehmet Ozgur; Sezik, Mekin

    2017-05-24

    To assess whether maternal multiple sclerosis (MS) is associated with adverse pregnancy outcomes by determining the clinical course of disease during pregnancy and postpartum throughout a 10-year-period in a single tertiary center. We conducted a case-control study that included pregnancies with a definitive diagnosis of MS (n=43), matched with 100 healthy pregnant women with similar characteristics. Maternal and perinatal data were retrieved from hospital files. Groups were compared with the Mann-Whitney and χ2 tests. Logistic regression models were constructed to determine independent effects. Maternal demographic and baseline laboratory data were similar across the groups. Rates of preterm delivery, fetal growth restriction, preeclampsia, gestational diabetes, stillbirth, cesarean delivery, congenital malformation, and 5-min Apgar score were comparable (P>0.05 for all). General anesthesia during cesarean delivery (96% vs. 39%, P=0.002), urinary tract infection (UTI) (12% vs. 3%, P=0.04), low 1-min Apgar score (21% vs. 9%, P=0.04), and nonbreastfeeding (33% vs. 2%, P=0.001) were more frequent in women with MS. The low 1-min Apgar score and breastfeeding rates were independent of general anesthesia and UTI in regression models. MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

  9. Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

    Directory of Open Access Journals (Sweden)

    Jan Krüger

    Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

  10. Methodology for Selecting Best Management Practices Integrating Multiple Stakeholders and Criteria. Part 2: Case Study

    Directory of Open Access Journals (Sweden)

    Mauricio Carvallo Aceves

    2016-02-01

    Full Text Available The selection of stormwater Best Management Practices (BMPs for mitigating the effects of urbanization on the hydrological cycle could be a complex process due to conflicting stakeholder views, and varying levels of performance of BMPs across a range of criteria (runoff reduction, erosion control, etc.. Part 1 of this article proposed a methodology based on the application of multi-criteria decision aid (MCDA methods, which was tested here on a residential stormwater network in the Montreal area. The case study considered green roofs, rain gardens, rain barrels and pervious pavement over a range of economic, social, and water quality and quantity criteria by applying 4 MCDA methods under three different stakeholder views. The results indicated Elimination et Choix Traduisant la Réalité (ELECTRE III to be the most appropriate method for the methodology, presenting flexibility concerning threshold values, criteria weights, and showing shared top choices across stakeholders (rain gardens, and rain gardens in combination with pervious pavement. The methodology shows potential for more formal applications and research opportunities. Future work may lie in the inclusion of multiple objective optimization, better stakeholder engagement, estimation of economic benefits, water quality modeling, long-term hydrological simulations, and estimating real BMP pollutant removal rates.

  11. A retrospective likelihood approach for efficient integration of multiple omics factors in case-control association studies.

    Science.gov (United States)

    Balliu, Brunilda; Tsonaka, Roula; Boehringer, Stefan; Houwing-Duistermaat, Jeanine

    2015-03-01

    Integrative omics, the joint analysis of outcome and multiple types of omics data, such as genomics, epigenomics, and transcriptomics data, constitute a promising approach for powerful and biologically relevant association studies. These studies often employ a case-control design, and often include nonomics covariates, such as age and gender, that may modify the underlying omics risk factors. An open question is how to best integrate multiple omics and nonomics information to maximize statistical power in case-control studies that ascertain individuals based on the phenotype. Recent work on integrative omics have used prospective approaches, modeling case-control status conditional on omics, and nonomics risk factors. Compared to univariate approaches, jointly analyzing multiple risk factors with a prospective approach increases power in nonascertained cohorts. However, these prospective approaches often lose power in case-control studies. In this article, we propose a novel statistical method for integrating multiple omics and nonomics factors in case-control association studies. Our method is based on a retrospective likelihood function that models the joint distribution of omics and nonomics factors conditional on case-control status. The new method provides accurate control of Type I error rate and has increased efficiency over prospective approaches in both simulated and real data. © 2015 Wiley Periodicals, Inc.

  12. The integration of occupational therapy into primary care: a multiple case study design

    Science.gov (United States)

    2013-01-01

    Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

  13. Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

    Directory of Open Access Journals (Sweden)

    Pasquale Marchione

    Full Text Available OBJECTIVE: Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS, controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR, Primary Progressive (PP Multiple Sclerosis and age and sex-matched controls subjects. MATERIAL AND METHODS: All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV of middle cerebral arteries (MCA, differences between cerebral venous outflow (CVF in clinostatism and in the seated position (ΔCVF and non-invasive cerebral perfusion pressure (CPP were evaluated. RESULTS: 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9% RR-MS, 63/83 (75.9% PP-MS (p = 0.01 and 11/82 (13.4% controls (p<0.001, while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01. No significant differences in CPP were observed within and between groups. CONCLUSIONS: The quantitative evaluation of cerebral blood flow (CBF and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an

  14. Study on the clinical usefulness of magnetic resonance imaging in cases of multiple cerebral infarction

    International Nuclear Information System (INIS)

    Miyashita, Kotaro

    1991-01-01

    The clinical significance of MRI in thrombotic multiple cerebral infarction was examined in 9 patients having recent lacunar stroke. Recent infarct was identified on Gd-enhanced MRI in 4 patients. For patients multiple small infarction, Gd-enhanced MRI made it possible to differentiate recent from other lesions. To clarify the significance of periventricular high intensity lesion (PVH) on T2-weighted MRI, hemodynamic and neuropsychologic examinations were carried out in 41 patients with multiple cerebral infarction. All the patients had PVH, which was classified into three grades as follows: grade I (n=16) showing only a thin high intensity band along the body of lateral ventricles; grade 2 (n=15) showing a definite high intensity area around the lateral ventricles; grade 3 (n=10) showing diffuse thick and irregular foci around the whole ventricle. In these patients, rCBF was measured by 133 Xe inhalation methods. Initial slope index was significantly higher in patients with grade 3 than those with grade I. Mini-mental state test score was significantly higher in patients with grade l than those with grade 2 and 3. Progression of PVH may be related with the reduction of the cerebral circulation and mental function in cases of multiple cerebral infarction. Ischemic and hemorrhagic lesions can be distinguished by MRI, because old intracerebral hemorrhage appear as hypointensity areas with or without hyperintensity area on T2w images. In 92 patients with multiple infarction, MRI was used to evaluate the incidence and distribution of coexisting old intracerebral hemorrhage. Old hemorrhage were found in 15 patients (16.3%). locating the site where hypertensive hemorrhage commonly occurred. High-field MRI is useful for assessing the coexistence of hemorrhage in hypertensive patients with multiple cerebral infarction. (N.K.)

  15. VGC analyzer: a software for statistical analysis of fully crossed multiple-reader multiple-case visual grading characteristics studies

    International Nuclear Information System (INIS)

    Baath, Magnus; Hansson, Jonny

    2016-01-01

    Visual grading characteristics (VGC) analysis is a non-parametric rank-invariant method for analysis of visual grading data. In VGC analysis, image quality ratings for two different conditions are compared by producing a VGC curve, similar to how the ratings for normal and abnormal cases in receiver operating characteristic (ROC) analysis are used to create an ROC curve. The use of established ROC software for the analysis of VGC data has therefore previously been proposed. However, the ROC analysis is based on the assumption of independence between normal and abnormal cases. In VGC analysis, this independence cannot always be assumed, e.g. if the ratings are based on the same patients imaged under both conditions. A dedicated software intended for analysis of VGC studies, which takes possible dependencies between ratings into account in the statistical analysis of a VGC study, has therefore been developed. The software-VGC Analyzer-determines the area under the VGC curve and its uncertainty using non-parametric re-sampling techniques. This article gives an introduction to VGC Analyzer, describes the types of analyses that can be performed and instructs the user about the input and output data. (authors)

  16. [The life as a caregiver of a person affected by Chorea Huntington: multiple case study].

    Science.gov (United States)

    Winkler, Evi; Ausserhofer, Dietmar; Mantovan, Franco

    2012-10-01

    Chorea Huntington is an autosomal dominantly inherited, neurodegenerative brain disorder that leads to involuntary hyperkinesia, psychotic symptoms and dementia. The illness not only changes the life of the person itself but also the world of the caregivers. The challenges in the care of a person which is affected by Chorea Huntington have an effect on the daily living as an assemblage of natural and social conditions. a multiple case study was conducted. It included semi-structured interviews with three caregivers of people with Chorea Huntington in South Tyrol. The qualitative data was analyzed using the qualitative structured analysis of Mayring (2007). The objective of this study was to describe the phenomenon of change of life from family members that care people affected by Chorea Huntington in a specific cultural setting (South Tyrol, Italy). The caregivers reported that the diagnosis of Chorea Huntington leads to negative changes in "relationship and family". Particularly, frustration, aggression, impatience and apathy were perceived as stressful. At the same time they highlight the positive changes through home care. They report that the relationship became more intimate and integral and it was characterized by more cohesion. Family caregivers get valuable support from the home care service, however, they complain that there is no facility in South Tyrol, which is specialized to care people with Chorea Huntington. Therefore, the caregivers have to "give up a lot" and don't have any personal desires, dreams and expectations for the future. The caregivers have learned independently to deal with their changed life step by step, and to see also the positive effects of the caring role. The life of family caregivers of a person which is affected by Chorea Huntington is characterized by abandonment. A continuous and professional care would be important for the affected and his caregiver. A continuous and professional care is important for both, addressing the

  17. Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

    Science.gov (United States)

    Phasha, T. N.; Nyokangi, D.

    2012-01-01

    This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

  18. Citation searching: a systematic review case study of multiple risk behaviour interventions.

    Science.gov (United States)

    Wright, Kath; Golder, Su; Rodriguez-Lopez, Rocio

    2014-06-03

    The value of citation searches as part of the systematic review process is currently unknown. While the major guides to conducting systematic reviews state that citation searching should be carried out in addition to searching bibliographic databases there are still few studies in the literature that support this view. Rather than using a predefined search strategy to retrieve studies, citation searching uses known relevant papers to identify further papers. We describe a case study about the effectiveness of using the citation sources Google Scholar, Scopus, Web of Science and OVIDSP MEDLINE to identify records for inclusion in a systematic review.We used the 40 included studies identified by traditional database searches from one systematic review of interventions for multiple risk behaviours. We searched for each of the included studies in the four citation sources to retrieve the details of all papers that have cited these studies.We carried out two analyses; the first was to examine the overlap between the four citation sources to identify which citation tool was the most useful; the second was to investigate whether the citation searches identified any relevant records in addition to those retrieved by the original database searches. The highest number of citations was retrieved from Google Scholar (1680), followed by Scopus (1173), then Web of Science (1095) and lastly OVIDSP (213). To retrieve all the records identified by the citation tracking searching all four resources was required. Google Scholar identified the highest number of unique citations.The citation tracking identified 9 studies that met the review's inclusion criteria. Eight of these had already been identified by the traditional databases searches and identified in the screening process while the ninth was not available in any of the databases when the original searches were carried out. It would, however, have been identified by two of the database search strategies if searches had been

  19. Tolerance to multiple climate stressors: a case study of Douglas-fir drought and cold hardiness

    Science.gov (United States)

    Sheel Bansal; Connie Harrington; Brad St. Clair

    2016-01-01

    1. Drought and freeze events are two of the most common forms of climate extremes which result in tree damage or death, and the frequency and intensity of both stressors may increase with climate change. Few studies have examined natural covariation in stress tolerance traits to cope with multiple stressors among wild plant populations. 2. We assessed the...

  20. Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

    Directory of Open Access Journals (Sweden)

    Orianne Costini

    2017-07-01

    Full Text Available Aim: Praxis assessment in children with developmental coordination disorder (DCD is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach.Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures, representational (transitive, intransitive, and non-representational gestures (imitation of meaningless postures. We realized an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions. Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old.Results: Among the 27 DCD patients, we first classified profiles that are characterized by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8. Patients with a weakness in executive functions (n = 6 were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4. Among the nine remaining patients, six could be classified as having a visual

  1. A Qualitative Exploration of Multiple Case Studies of the Perception of School Social Workers Concerning Their Roles in Public Schools

    Science.gov (United States)

    Morrison, Alesha Nicole

    2016-01-01

    This qualitative exploration in the form of multiple case studies interviewed a group of seven social workers from the St. Louis Metropolitan area to gain their perception as school social workers concerning their roles in public schools. The literature on school social workers indicated that school social workers brought unique knowledge and…

  2. Multiple case study analysis of young women's experiences in high school engineering

    Science.gov (United States)

    Pollock, Meagan C.

    richly describe the diversity of experiences. A multiple case study analysis, this study answers the question: How do gender, class, race, and other components of intersectionality, influence high school females' experiences in engineering? Nine young women taking a high school engineering course in a suburban high school in Central Texas during the school year 2011-2012 volunteered to participate. The students were observed in their engineering classes for half of the spring 2012 semester, with bi-weekly interviews with the students, monthly interviews with the teacher, and a single interview with a parent of each volunteer. The nine rich case studies provide us with new stories that help prevent us from narrowing the experiences of women to a single incomplete stereotype, because these young women vary across race, socioeconomic backgrounds, and sexual orientation. Although each story is unique, there are commonalities among their experiences, including family, influence, classroom environment, biases, and beliefs. By drawing from their collective experiences in high school engineering, the findings direct us toward recommendations for educators, parents, engineering curriculum developers, designers of teacher professional development, and future research to improve equity and access for every student in engineering.

  3. Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

    Science.gov (United States)

    Montgomery, Leslie D.; Ku, Yu-Tsuan E.; Montgomery, Richard W.; Kliss, Mark (Technical Monitor)

    1997-01-01

    Recent neuropsychological studies demonstrate that cognitive dysfunction is a common symptom in patients with multiple sclerosis. In many cases the presence of cognitive impairment affects the patient's daily activities to a greater extent than would be found due to their physical disability alone. Cognitive dysfunction can have a significant impact on the quality of life of both the patient and that of their primary caregiver. Two cognitively impaired male MS patients were given a visual discrimination task before and after a one hour cooling period. The subjects were presented a series of either red or blue circles or triangles. One of these combinations, or one fourth of the stimuli, was designated as the "target" presentation. EEG was recorded from 20 scalp electrodes using a Tracor Northern 7500 EEG/ERP system. Oral and ear temperatures were obtained and recorded manually every five minutes during the one hour cooling period. The EEG ERP signatures from each series of stimuli were analyzed in the energy density domain to determine the locus of neural activity at each EEG sampling time. The first subject's ear temperature did not decrease during the cooling period. It was actually elevated approximately 0.05 C by the end of the cooling period compared to his mean of control period value. In turn, Subject One's discrimination performance and cortical energy remained essentially the same after body cooling. In contrast, Subject Two's ear temperature decreased approx. 0.8 C during his cooling period. Subject Two's ERROR score decreased from 12 during the precooling control period to 2 after cooling. His ENERGY value increased approximately 300%, from a precooling value of approximately 200 to a postcooling value of nearly 600. These findings might be interpreted by the following three-part hypothesis: (1) the general cognitive impairment of MS patients may be a result of low or unfocused metabolic energy conversion in the cortex; (2) such differences show up most

  4. Satellite observed impacts of wildfires on regional atmosphere composition and shortwave radiative forcing: multiple cases study

    Science.gov (United States)

    Fu, Y.; Li, R.; Huang, J.; Bergeron, Y.; Fu, Y.

    2017-12-01

    Emissions of aerosols and trace gases from wildfires and the direct shortwave radiative forcing were studied using multi-satellite/sensor observations from Aqua Moderate-Resolution Imaging Spectroradiometer (MODIS), Aqua Atmospheric Infrared Sounder (AIRS), Aura Ozone Monitoring Instrument (OMI), and Aqua Cloud's and the Earth's Radiant Energy System (CERES). The selected cases occurred in Northeast of China (NEC), Siberia of Russia, California of America have dominant fuel types of cropland, mixed forest and needleleaf forest, respectively. The Fire radiative power (FRP) based emission coefficients (Ce) of aerosol, NOx (NO2+NO), formaldehyde (HCHO), and carbon monoxide (CO) showed significant differences from case to case. 1) the FRP of the cropland case in NEC is strongest, however, the Ce of aerosol is the lowest (20.51 ± 2.55 g MJ-1). The highest Ce of aerosol is 71.34 ± 13.24 g MJ-1 in the needleleaf fire case in California. 2) For NOx, the highest Ce existed in the cropland case in NEC (2.76 ± 0.25 g MJ-1), which is more than three times of those in the forest fires in Siberia and California. 3) The Ce of CO is 70.21±10.97 and 88.38±46.16 g MJ-1 in the forest fires in Western Siberia and California, which are about four times of that in cropland fire. 4) The variation of Ce of HCHO are relatively small among cases. Strong spatial correlations are found among aerosol optical depth (AOD), NOx, HCHO, and CO. The ratios of NOx to AOD, HCHO, and CO in the cropland case in NEC show much higher values than those in other cases. Although huge differences of emissions and composition ratios exist among cases, the direct shortwave (SW) radiative forcing efficiency (SWARFE) of smoke at the top of the atmosphere (TOA) are in good agreement, with the shortwave radiative forcing efficiencies values of 20.09 to 22.93 per unit AOD. Results in this study reveal noteworthy variations of the FRP-based emissions coefficient and relative chemical composition in the smoke

  5. Understanding Information Technology Investment Decision-Making in the Context of Hotel Global Distribution Systems: a Multiple-Case Study

    OpenAIRE

    Connolly, Daniel J.

    1999-01-01

    UNDERSTANDING INFORMATION TECHNOLOGY INVESTMENT DECISION-MAKING IN THE CONTEXT OF HOTEL GLOBAL DISTRIBUTION SYSTEMS: A MULTIPLE-CASE STUDY by Daniel J. Connolly Dr. Michael D. Olsen, Chair Department of Hospitality and Tourism Management ABSTRACT This study investigates what three large, multinational hospitality companies do in practice when evaluating and making IT investment decisions. This study was launched in an attempt to 1) learn more about ...

  6. Peer Support in Full-Service Partnerships: A Multiple Case Study Analysis.

    Science.gov (United States)

    Siantz, Elizabeth; Henwood, Benjamin; Gilmer, Todd

    2017-07-01

    Peer providers are integral to Full Service Partnerships (FSPs), which are team-based mental health service models. Peer providers use principles of recovery to engage clients, but FSPs can vary in their recovery orientation. Whether and how peer recovery orientation reflects the organizational environments of FSPs is unclear. This qualitative study explored peer provider attitudes towards recovery within the organizational contexts of FSPs where they are employed. Case study analysis was conducted on eight purposively sampled FSPs using qualitative interviews with peer providers and program directors. In two cases, peer recovery attitudes diverged from those of their organizational context. In these cases, peer providers were champions for recovery, and used practice-based strategies to promote client autonomy despite working in settings with lower recovery orientation. Peer providers could be uniquely positioned to promote client autonomy in settings where organizational factors limit consumer choice.

  7. GAINING SUSTAINABLE COMPETITIVE IT ADVANTAGES: MULTIPLE CASE STUDIES IN INTERNATIONALIZED BUSINESSES

    Directory of Open Access Journals (Sweden)

    Eduardo Armando

    2010-07-01

    Full Text Available This research studies how the studied firms gain sustainable competitive advantages (SCAs. The issue has been studied in the literature on business strategy: the challenge for managers is to identify, develop, protect and use resources and skills that provide the firm with SCAs. Eight cases were studied. All concerned Information Technology firms that sell to other companies. The variables used were qualitative. Data was collected from primary and secondary sources of information. The primary sources consisted of the studied firms, where interviews with management were held. The main results are: (1 One firm develops products abroad and this aspect is a competitive advantage. (2 There are cases that resort to a model that provides them with great operating flexibility. (3 One firm obtained SCAs by developing a strategy whereby it implemented a franchise model for development and distribution. The franchise system encourages entrepreneurial behavior among the franchisees. (4 One case gained a competitive advantage through the complexity and sophistication of its products. (5 Some of the cases searched for market niches that were less exposed to competition.Key-words: Strategic management. Strategic planning. Advanced Technology firms. Management of multinationals. 

  8. The nature of embedded purchasing activities in SMEs : results from a Dutch multiple case study

    NARCIS (Netherlands)

    Hagelaar, Geoffrey; Staal, Anne; Holman, Richard; Walhof, Gert

    2015-01-01

    Aims: identify and explain purchasing-oriented patterns in Small and Medium Sized Enterprises (SMEs) via case study research. Scope: Using a conceptual framework and empirical research this article proposes a series of purchasing-oriented patterns in SMEs. These patterns align activities to achieve

  9. Effects of Business Model Development Projects on Organizational Culture: A Multiple Case Study of SMEs

    OpenAIRE

    Ulla Santti; Tuomo Eskelinen; Mervi Rajahonka; Kaija Villman; Ari Happonen

    2017-01-01

    Previous research has shown that links between organizational culture and innovativeness/performance may act as a “social glue” that helps a company develop organizational culture as a competitive advantage. In this study of three case companies, the organizational culture change due business model development projects is studied using the Competing Values Framework (CVF) tool and interviews with respondents about discovered changes. To reveal intervention and implied effects between business...

  10. Effects of Business Model Development Projects on Organizational Culture: A Multiple Case Study of SMEs

    Directory of Open Access Journals (Sweden)

    Ulla Santti

    2017-08-01

    Full Text Available Previous research has shown that links between organizational culture and innovativeness/performance may act as a “social glue” that helps a company develop organizational culture as a competitive advantage. In this study of three case companies, the organizational culture change due business model development projects is studied using the Competing Values Framework (CVF tool and interviews with respondents about discovered changes. To reveal intervention and implied effects between business model development project and organizational culture changes, we used CIMO logic (context, intervention, mechanism, and outcome to bridge practice and theory by explanatory, backward-looking research. Our case studies of companies in relatively short-duration business model development projects indicate that organizational culture may have some dynamic characteristics, for example, an increase of the adhocracy organizational type in all case companies or an increase in the hierarchical leadership type in one case company. Thus, the development of an organizational culture type can be partly controlled. Our results also indicated business model development projects do have a minor effect on organizational culture, even when development activities have not been put fully into practice. However, the more comprehensively business model development project activities have been put into practice, the larger the effect on organizational culture.

  11. The Interplay of Virtual Communities: A Multiple Case Study of E-Retailers in Yahoo E-Auctions

    Directory of Open Access Journals (Sweden)

    Julia Zhi-Xian Zhao

    2012-06-01

    Full Text Available This study investigated how businesses operate e-shops in a transaction-oriented virtual community. This research employed a multiple case study approach by observing three cases of e-retailers, as being new e-commerce initiates, operating their businesses on the Yahoo! e-auction website. The results showed that e-shops displaying amusing stories can attract site visitors and “spick and span” e-shop design format can be helpful for converting visitors into buyers.

  12. Case-Based Instructional Practices: A Multiple-Case Study from Torts, Marketing, and Online Instructional Design Classes

    Science.gov (United States)

    Jung, Ji yoon

    2017-01-01

    The purpose of this study is to provide a comprehensive account on case-based instructional practices. Semester-long participant observation records in torts, marketing, and online instructional design classes, instructor interviews, course syllabi and teaching materials were used to describe the within-class complexity of the practices in terms…

  13. Tolerance to multiple climate stressors: A case study of Douglas-fir drought and cold hardiness

    Science.gov (United States)

    Bansal, Sheel; Harrington, Constance A; St. Clair, John Bradley

    2016-01-01

    Summary: 1. Drought and freeze events are two of the most common forms of climate extremes which result in tree damage or death, and the frequency and intensity of both stressors may increase with climate change. Few studies have examined natural covariation in stress tolerance traits to cope with multiple stressors among wild plant populations. 2. We assessed the capacity of coastal Douglas-fir (Pseudotsuga menziesii var. menziesii), an ecologically and economically important species in the northwestern USA, to tolerate both drought and cold stress on 35 populations grown in common gardens. We used principal components analysis to combine drought and cold hardiness trait data into generalized stress hardiness traits to model geographic variation in hardiness as a function of climate across the Douglas-fir range. 3. Drought and cold hardiness converged among populations along winter temperature gradients and diverged along summer precipitation gradients. Populations originating in regions with cold winters had relatively high tolerance to both drought and cold stress, which is likely due to overlapping adaptations for coping with winter desiccation. Populations from regions with dry summers had increased drought hardiness but reduced cold hardiness, suggesting a trade-off in tolerance mechanisms. 4. Our findings highlight the necessity to look beyond bivariate trait–climate relationships and instead consider multiple traits and climate variables to effectively model and manage for the impacts of climate change on widespread species.

  14. Configuration of supply chains in emerging industries: a multiple-case study in the wave-and-tidal energy industry

    OpenAIRE

    Bjørgum, Øyvind; Netland, Torbjørn H.

    2017-01-01

    Companies in emerging industries face particular challenges in configuring effective supply chains. In this paper, we build on transaction cost economics to explore how supply chains can be configured in emerging industries. We focus on two key aspects of supply chain configuration: the make-or-buy decision and the strength of the ties between a focal firm and its suppliers. We utilise a multiple-case study methodology, including seven start-up companies in the emerging wave-and-tidal energy ...

  15. The organisational and human resource challenges facing primary care trusts: protocol of a multiple case study

    Directory of Open Access Journals (Sweden)

    Tim Scott J

    2001-11-01

    Full Text Available Abstract Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs. Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development.

  16. Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea

    2014-08-01

    Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

  17. Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

    Science.gov (United States)

    Zhao, Fang; Hämäläinen, Juha; Chen, Yu-Ting

    2017-01-01

    With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

  18. Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders' Perspectives

    Directory of Open Access Journals (Sweden)

    Shara Elrod

    2012-01-01

    Full Text Available Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4, support staff (n=2, collaborating providers (n=4, patients (n=3, and a payer (n=1. Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice.   Type: Case Study

  19. Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

    International Nuclear Information System (INIS)

    Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko; Konagaya, Yoko

    1998-01-01

    Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7±8.0 (M±SD) years, duration of illness at the first MRI study 3.2±1.1 years, duration of illness at the last study 8.1±2.2 years, and the following up duration 4.9±2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

  20. Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

    Energy Technology Data Exchange (ETDEWEB)

    Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko [Suzuka National Hospital, Mie (Japan); Konagaya, Yoko

    1998-12-01

    Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7{+-}8.0 (M{+-}SD) years, duration of illness at the first MRI study 3.2{+-}1.1 years, duration of illness at the last study 8.1{+-}2.2 years, and the following up duration 4.9{+-}2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

  1. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

    Science.gov (United States)

    Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

    2015-06-18

    Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

  2. Relevance of multiple spatial scales in habitat models: A case study with amphibians and grasshoppers

    Science.gov (United States)

    Altmoos, Michael; Henle, Klaus

    2010-11-01

    Habitat models for animal species are important tools in conservation planning. We assessed the need to consider several scales in a case study for three amphibian and two grasshopper species in the post-mining landscapes near Leipzig (Germany). The two species groups were selected because habitat analyses for grasshoppers are usually conducted on one scale only whereas amphibians are thought to depend on more than one spatial scale. First, we analysed how the preference to single habitat variables changed across nested scales. Most environmental variables were only significant for a habitat model on one or two scales, with the smallest scale being particularly important. On larger scales, other variables became significant, which cannot be recognized on lower scales. Similar preferences across scales occurred in only 13 out of 79 cases and in 3 out of 79 cases the preference and avoidance for the same variable were even reversed among scales. Second, we developed habitat models by using a logistic regression on every scale and for all combinations of scales and analysed how the quality of habitat models changed with the scales considered. To achieve a sufficient accuracy of the habitat models with a minimum number of variables, at least two scales were required for all species except for Bufo viridis, for which a single scale, the microscale, was sufficient. Only for the European tree frog ( Hyla arborea), at least three scales were required. The results indicate that the quality of habitat models increases with the number of surveyed variables and with the number of scales, but costs increase too. Searching for simplifications in multi-scaled habitat models, we suggest that 2 or 3 scales should be a suitable trade-off, when attempting to define a suitable microscale.

  3. An overview of the circular economy among SMEs in the Basque country: A multiple case study

    Energy Technology Data Exchange (ETDEWEB)

    Ormazabal, M.; Prieto-Sandoval, V.; Jaca, C.; Santos, J.

    2016-07-01

    Purpose: This research analyzes the maturity of environmental management as well as the degree of to which the Circular Economy has been implemented in Basque SMEs. Design/methodology/approach: A total of 17 case studies were carried out in industrial SMEs companies in the Basque Country. Findings: The main results show that companies are limited to complying with the law and in many cases are worried about the image of the company, although they are not committed to environmental issues. There is still a lot to do in SMEs, as they are the companies that face the biggest challenges due to a lack of resources. Originality/value: Circular Economy aims to change a linear economy into promoting sustainability of the economy while also engaging in sustainable environmental protection. This research has focused on small and medium enterprises as they represent a 99% of companies in Europe and they are the ones that have the most difficulty reaching a stage of environmental excellence due to their limited resources.

  4. An overview of the circular economy among SMEs in the Basque country: A multiple case study

    International Nuclear Information System (INIS)

    Ormazabal, M.; Prieto-Sandoval, V.; Jaca, C.; Santos, J.

    2016-01-01

    Purpose: This research analyzes the maturity of environmental management as well as the degree of to which the Circular Economy has been implemented in Basque SMEs. Design/methodology/approach: A total of 17 case studies were carried out in industrial SMEs companies in the Basque Country. Findings: The main results show that companies are limited to complying with the law and in many cases are worried about the image of the company, although they are not committed to environmental issues. There is still a lot to do in SMEs, as they are the companies that face the biggest challenges due to a lack of resources. Originality/value: Circular Economy aims to change a linear economy into promoting sustainability of the economy while also engaging in sustainable environmental protection. This research has focused on small and medium enterprises as they represent a 99% of companies in Europe and they are the ones that have the most difficulty reaching a stage of environmental excellence due to their limited resources.

  5. An overview of the circular economy among SMEs in the Basque country: A multiple case study

    Directory of Open Access Journals (Sweden)

    Marta Ormazabal

    2016-12-01

    Full Text Available Purpose: This research analyzes the maturity of environmental management as well as the degree of to which the Circular Economy has been implemented in Basque SMEs. Design/methodology/approach: A total of 17 case studies were carried out in industrial SMEs companies in the Basque Country. Findings: The main results show that companies are limited to complying with the law and in many cases are worried about the image of the company, although they are not committed to environmental issues. There is still a lot to do in SMEs, as they are the companies that face the biggest challenges due to a lack of resources. Originality/value: Circular Economy aims to change a linear economy into promoting sustainability of the economy while also engaging in sustainable environmental protection. This research has focused on small and medium enterprises as they represent a 99% of companies in Europe and they are the ones that have the most difficulty reaching a stage of environmental excellence due to their limited resources.

  6. Sexual habits before multiple sclerosis: a national case-control study

    DEFF Research Database (Denmark)

    Lidegaard, O.; Svendsen, Anne Louise; Lidegaard, Øjvind

    2008-01-01

    The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease.......The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease....

  7. Using Multiple Big Datasets and Machine Learning to Produce a New Global Particulate Dataset: A Technology Challenge Case Study

    Science.gov (United States)

    Lary, D. J.

    2013-12-01

    A BigData case study is described where multiple datasets from several satellites, high-resolution global meteorological data, social media and in-situ observations are combined using machine learning on a distributed cluster using an automated workflow. The global particulate dataset is relevant to global public health studies and would not be possible to produce without the use of the multiple big datasets, in-situ data and machine learning.To greatly reduce the development time and enhance the functionality a high level language capable of parallel processing has been used (Matlab). A key consideration for the system is high speed access due to the large data volume, persistence of the large data volumes and a precise process time scheduling capability.

  8. Multiple hereditary exostoses and ischiofemoral impingement: a case-control study

    International Nuclear Information System (INIS)

    Yoong, Philip; Mansour, Ramy; Teh, James L.

    2014-01-01

    To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55 % were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change. (orig.)

  9. Multiple hereditary exostoses and ischiofemoral impingement: a case-control study

    Energy Technology Data Exchange (ETDEWEB)

    Yoong, Philip; Mansour, Ramy; Teh, James L. [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom)

    2014-09-15

    To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55 % were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change. (orig.)

  10. Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study.

    Science.gov (United States)

    Derancourt, C; Bourdon-Lanoy, E; Grob, J-J; Guillaume, J-C; Bernard, P; Bastuji-Garin, S

    2007-01-01

    Multiple solar lentigos commonly seen on the upper back and shoulders of adults are classically considered as a sign of photodamage, although epidemiological studies are scarce. To assess whether these lesions are clinical markers of past severe sunburn. A case-control study in two outpatient dermatology clinics in French university hospitals. Past episodes of moderate and severe sunburn were compared between 145 adult patients with multiple solar lentigos on the upper back and 145 matched controls. In multivariate analysis adjusted for potential confounders, recalled episodes of sunburn during childhood, adolescence and adulthood were independently associated with the presence of multiple solar lentigos (adjusted odds ratios, 95% confidence intervals: 2.3 (1.1-5.2) and 28.1 (10.4-75.6) for moderate and severe sunburn, respectively). Multiple solar lentigos on the upper back and shoulders of adults are potential clinical markers of past severe sunburn which may thus be used to identify a population at higher risk of developing cutaneous malignant melanoma.

  11. A Case Study of Resources Management Planning with Multiple Objectives and Projects

    Science.gov (United States)

    David L. Peterson; David G. Silsbee; Daniel L. Schmoldt

    1995-01-01

    Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decisionmaking tools. We have previously described a multiple objective planning...

  12. Creating Multiple Pathways in the Arts: A New York City Case Study

    Science.gov (United States)

    Maguire, Cindy; Mishook, Jacob; Garcia, Ivonne; de Gaillande, Genevieve

    2013-01-01

    Increasingly, education policy makers understand the importance of students and families having access to a range of high quality educational opportunities inside and outside of school, 365 days a year. This paper explores the concept of multiple pathways in arts education to further conceptualize and build upon such opportunities, inside and…

  13. Therapeutic Riding for a Student with Multiple Disabilities and Visual Impairment: A Case Study.

    Science.gov (United States)

    Lehrman, Jennifer; Ross, David B.

    2001-01-01

    A 9-year-old with multiple disabilities and visual impairments was the focus of a 10-week developmental therapeutic riding program incorporating hippotherapy. The program has led to increased mobility, an increase in visual attention span and fixation time, signs of greater verbal communication, and the acquisition of new functional signs.…

  14. Modeling transport pricing with multiple stakeholders. Working paper : Methodology and a case study

    NARCIS (Netherlands)

    Smits, E.

    2012-01-01

    Pricing measures (e.g., a kilometre charge or cordon toll) are used to improve the external effects of transportation (e.g., congestion or emissions). This working paper presents a planning model for pricing while taking the preferences and interactions of multiple stakeholders (e.g., governments or

  15. Multiple Site Action Research Case Studies: Practical and Theoretical Benefits and Challenges

    Science.gov (United States)

    Pereira, Mary Delfin; Vallance, Roger

    2006-01-01

    A curriculum initiative project was implemented in four schools in Singapore over a span of five to six weeks during 2004. The project employed a number of different schools: girls only, boys only and co-educational schools; different levels of performance in a graded situation; multiple teachers and classes within each site; and control and…

  16. The Use of Management and Marketing Textbook Multiple-Choice Questions: A Case Study.

    Science.gov (United States)

    Hampton, David R.; And Others

    1993-01-01

    Four management and four marketing professors classified multiple-choice questions in four widely adopted introductory textbooks according to the two levels of Bloom's taxonomy of educational objectives: knowledge and intellectual ability and skill. Inaccuracies may cause instructors to select questions that require less thinking than they intend.…

  17. ePRISM: A case study in multiple proxy and mixed temporal resolution integration

    Science.gov (United States)

    Robinson, Marci M.; Dowsett, Harry J.

    2010-01-01

    As part of the Pliocene Research, Interpretation and Synoptic Mapping (PRISM) Project, we present the ePRISM experiment designed I) to provide climate modelers with a reconstruction of an early Pliocene warm period that was warmer than the PRISM interval (similar to 3.3 to 3.0 Ma), yet still similar in many ways to modern conditions and 2) to provide an example of how best to integrate multiple-proxy sea surface temperature (SST) data from time series with varying degrees of temporal resolution and age control as we begin to build the next generation of PRISM, the PRISM4 reconstruction, spanning a constricted time interval. While it is possible to tie individual SST estimates to a single light (warm) oxygen isotope event, we find that the warm peak average of SST estimates over a narrowed time interval is preferential for paleoclimate reconstruction as it allows for the inclusion of more records of multiple paleotemperature proxies.

  18. Examining small "c" creativity in the science classroom: Multiple case studies of five high school teachers

    Science.gov (United States)

    Lasky, Dorothea Shawn

    As the US continues to strive toward building capacity for a workforce in STEM fields (NSF, 2006), educational organizations and researchers have constructed frameworks that focus on increasing competencies in creativity in order to achieve this goal (ISTE, 2007; Karoly & Panis, 2004; Partnership for 21st Century Skills, 2007). Despite these recommendations, many teachers either do not believe in the relevance of nurturing creativity in their students (Kaufman & Sternberg, 2007) or accept the importance of it, but do not know how best to foster it in their classrooms (Kampylis et al., 2009). Researchers conclude that teachers need to revise their ideas about the kind of creativity they can expect from their students to reflect the idea of small 'c' versus large 'C' creativity. There is a dearth of literature that looks closely at teacher practice surrounding creativity in the US and gives teachers a set of practical suggestions they can follow easily. I examined five case studies of teachers as they participated in and implemented a large-scale, NSF-funded project premised on the idea that training teachers in 21 st century pedagogies, (for example, problem-based learning), helps teachers create classrooms that increase science competencies in students. I investigated how teachers' curricular choices affect the amount of student creativity produced in their classrooms. Analysis included determining CAT scores for student products and continua scores along the Small 'c' Creativity Framework. In the study, I present an understanding of how teachers' beliefs influence practice and how creativity is fostered in students through various styles of teacher practice. The data showed a relationship between teachers' CAT scores, framework scores, and school context. Thus, alongside CAT, the framework was determined to be a successful tool for understanding the degree to which teachers foster small 'c' creativity. Other themes emerged, which included teachers' allotment of

  19. Development of Integrative STEM Curriculum: A Multiple Case Study of Multi-Disciplinary Teams in Two Pennsylvania High Schools

    Science.gov (United States)

    Rider-Bertrand, Joey H.

    At the start of the 21st century, STEM education was a new priority in many schools as the focus shifted from separate disciplines to integrative STEM education. Unfortunately, there was limited research to offer guidance to practitioners (Brown, 2012; Honey, Pearson & Schweingruber, 2014). This qualitative, multiple case study explored the experiences of two multi-disciplinary teams of secondary teachers from Pennsylvania who developed and implemented integrative STEM curriculum. Four teachers from a rural high school and four teachers from a suburban high school participated in the study. A document review of integrative STEM curriculum and semi-structured interviews were conducted to learn about the curriculum development process and teachers' perceptions regarding conditions that support or hinder success. Individual and cross-case analyses were performed to establish findings and themes. Although the individual case themes varied slightly, the cross-case themes and assertions that emerged provided highly sought after guidance to practitioners and added to the limited body of research on integrative STEM education. This study found that current curriculum models do not fit integrative STEM curriculum, the development process is fluid, and substantial administrative support and resources are necessary to develop, implement, and sustain integrative STEM education programs. The results offered implications for all educators, as well as two examples of how teachers navigated the terrain of integrative STEM curriculum.

  20. UV imaging of Multiple Unit Pellet System (MUPS) tablets: A case study of acetylsalicylic acid stability

    DEFF Research Database (Denmark)

    Novikova, Anna; Carstensen, Jens Michael; Rades, Thomas

    2017-01-01

    for estimation of the salicylic acid (SA) concentration as degradation product of ASA in the tablets were compared to the SA concentration measured by high performance liquid chromatography with a partial least squares regression resulting in an RMSEP of 4.86% and an R2 of 0.9812. The estimation of the SA......The applicability of multispectral ultraviolet (UV) imaging in combination with multivariate image analysis was investigated to monitor API degradation within multiple unit pellet system (MUPS) tablets during storage. For this purpose, acetylsalicylic acid (ASA) layered pellets were coated...

  1. Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

    Directory of Open Access Journals (Sweden)

    van de Glind Irene M

    2012-10-01

    Full Text Available Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer

  2. College Student Perceptions and Learning Points from the Formal University Judicial Process: A Multiple Case Study

    Science.gov (United States)

    Lucas, Christopher M.

    2009-01-01

    For educators in the field of higher education and judicial affairs, issues are growing. Campus adjudicators must somehow maximize every opportunity for student education and development in the context of declining resources and increasing expectations of public accountability. Numbers of student misconduct cases, including matters of violence and…

  3. Perceptions of Cyberbullying Management within Southern California Independent Middle Schools: A Multiple Case Study

    Science.gov (United States)

    Lyons, Suzanne Shaw

    2013-01-01

    Cyberbullying among students has become a serious issue for school communities, partly due to ubiquitous Internet access, instant messaging, and a myriad of social media websites that provide infinite ways to abuse, threaten, and insult others. In some cases, students have been cyberbullied so brutally that adolescent victims even contemplate or…

  4. International technology transfer: building theory from a multiple case-study in the aircraft industry

    NARCIS (Netherlands)

    Steenhuis, H.J.; de Bruijn, E.J.

    2005-01-01

    International technology transfer occurs frequently in international operations, for example in cases of foreign direct investment where companies set-up existing manufacturing lines in new locations. It also occurs in situations of international outsourcing where a new supplier receives product

  5. Farmer responses to multiple stresses in the face of global change: Assessing five case studies to enhance adaptation

    Science.gov (United States)

    Nicholas, K. A.; Feola, G.; Lerner, A. M.; Jain, M.; Montefrio, M.

    2013-12-01

    The global challenge of sustaining agricultural livelihoods and yields in the face of growing populations and increasing climate change is the topic of intense research. The role of on-the-ground decision-making by individual farmers actually producing food, fuel, and fiber is often studied in individual cases to determine its environmental, economic, and social effects. However, there are few efforts to link across studies in a way that provides opportunities to better understand empirical farmer behavior, design effective policies, and be able to aggregate from case studies to a broader scale. Here we synthesize existing literature to identify four general factors affecting farmer decision-making: local technical and socio-cultural contexts; actors and institutions involved in decision-making; multiple stressors at broader scales; and the temporal gradient of decision-making. We use these factors to compare five cases that illustrate agricultural decision-making and its impacts: cotton and castor farming in Gujarat, India; swidden cultivation of upland rice in the Philippines; potato cultivation in Andean Colombia; winegrowing in Northern California; and maize production in peri-urban central Mexico. These cases span a geographic and economic range of production systems, but we find that we are able to make valid comparisons and draw lessons common across all cases by using the four factors as an organizing principle. We also find that our understanding of why farmers make the decisions they do changes if we neglect to examine even one of the four general factors guiding decision-making. This suggests that these four factors are important to understanding farmer decision-making, and can be used to guide the design and interpretation of future studies, as well as be the subject of further research in and of themselves to promote an agricultural system that is resilient to climate and other global environmental changes.

  6. What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

    Science.gov (United States)

    Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

    2017-01-01

    Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

  7. Debating the legitimacy of a contested environmental illness: a case study of multiple chemical sensitivities (MCS).

    Science.gov (United States)

    Phillips, Tarryn

    2010-11-01

    More than 20years after it was first identified, the anomalous condition, multiple chemical sensitivities (MCS), remains immersed in controversy, with a continuing debate over its causation being played out in the medico-scientific community and in the courts. This article examines why sceptical and supportive experts disagree over the condition's legitimacy as an organic condition. Drawing on ethnographic research conducted in Perth, Western Australia, the author scrutinises the decision-making practices of 16 experts (eight sceptical and eight supportive of a chemical explanation). Both groups were found to use evidence-based, inductive reasoning. However, sceptical experts tended to use a different set of evidence requirements, exhibited more faith in the efficiency of the current biomedical paradigm regarding toxicity and were less likely to acknowledge uncertainty in their field. All the experts recognised a spectrum of beliefs about the causal mechanisms of MCS. However, when they were engaged in litigation as expert witnesses due to their supportive or sceptical tendency, the oppositional legal system polarised their opinions and exacerbated the perceived divide between them. Ultimately, the adversarial medico-legal process inhibits genuine dialogue between some of the key players in the MCS debate, thus impeding understanding and consensus about the condition. © 2010 The Author. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  8. A case study of resources management planning with multiple objectives and projects

    Science.gov (United States)

    Peterson, David L.; Silsbee, David G.; Schmoldt, Daniel L.

    1994-09-01

    Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decision-making tools. We have previously described a multiple objective planning process for inventory and monitoring programs (Schmoldt and others 1994). To test the applicability of that process for the more general needs of resources management planning, we conducted an exercise on the Olympic National Park (NP) in Washington State, USA. Eight projects were selected as typical of those considered in RMPs and five members of the Olympic NP staff used the analytic hierarchy process (AHP) to prioritize the eight projects with respect to their implicit management objectives. By altering management priorities for the park, three scenarios were generated. All three contained some similarities in rankings for the eight projects, as well as some differences. Mathematical allocations of money and people differed among these scenarios and differed substantially from what the actual 1990 Olympic NP RMP contains. Combining subjective priority measures with budget dollars and personnel time into an objective function creates a subjective economic metric for comparing different RMP’s. By applying this planning procedure, actual expenditures of budget and personnel in Olympic NP can agree more closely with the staff’s management objectives for the park.

  9. Multiple Kernel Learning for Heterogeneous Anomaly Detection: Algorithm and Aviation Safety Case Study

    Science.gov (United States)

    Das, Santanu; Srivastava, Ashok N.; Matthews, Bryan L.; Oza, Nikunj C.

    2010-01-01

    The world-wide aviation system is one of the most complex dynamical systems ever developed and is generating data at an extremely rapid rate. Most modern commercial aircraft record several hundred flight parameters including information from the guidance, navigation, and control systems, the avionics and propulsion systems, and the pilot inputs into the aircraft. These parameters may be continuous measurements or binary or categorical measurements recorded in one second intervals for the duration of the flight. Currently, most approaches to aviation safety are reactive, meaning that they are designed to react to an aviation safety incident or accident. In this paper, we discuss a novel approach based on the theory of multiple kernel learning to detect potential safety anomalies in very large data bases of discrete and continuous data from world-wide operations of commercial fleets. We pose a general anomaly detection problem which includes both discrete and continuous data streams, where we assume that the discrete streams have a causal influence on the continuous streams. We also assume that atypical sequence of events in the discrete streams can lead to off-nominal system performance. We discuss the application domain, novel algorithms, and also discuss results on real-world data sets. Our algorithm uncovers operationally significant events in high dimensional data streams in the aviation industry which are not detectable using state of the art methods

  10. Student ownership of projects in an upper-division optics laboratory course: A multiple case study of successful experiences

    Directory of Open Access Journals (Sweden)

    Dimitri R. Dounas-Frazer

    2017-12-01

    Full Text Available We investigate students’ sense of ownership of multiweek final projects in an upper-division optics lab course. Using a multiple case study approach, we describe three student projects in detail. Within-case analyses focused on identifying key issues in each project, and constructing chronological descriptions of those events. Cross-case analysis focused on identifying emergent themes with respect to five dimensions of project ownership: student agency, instructor mentorship, peer collaboration, interest and value, and affective responses. Our within- and cross-case analyses yielded three major findings. First, coupling division of labor with collective brainstorming can help balance student agency, instructor mentorship, and peer collaboration. Second, students’ interest in the project and perceptions of its value can increase over time; initial student interest in the project topic is not a necessary condition for student ownership of the project. Third, student ownership is characterized by a wide range of emotions that fluctuate as students alternate between extended periods of struggle and moments of success while working on their projects. These findings not only extend the literature on student ownership into a new educational domain—namely, upper-division physics labs—they also have concrete implications for the design of experimental physics projects in courses for which student ownership is a desired learning outcome. We describe the course and projects in sufficient detail that others can adapt our results to their particular contexts.

  11. Student ownership of projects in an upper-division optics laboratory course: A multiple case study of successful experiences

    Science.gov (United States)

    Dounas-Frazer, Dimitri R.; Stanley, Jacob T.; Lewandowski, H. J.

    2017-12-01

    We investigate students' sense of ownership of multiweek final projects in an upper-division optics lab course. Using a multiple case study approach, we describe three student projects in detail. Within-case analyses focused on identifying key issues in each project, and constructing chronological descriptions of those events. Cross-case analysis focused on identifying emergent themes with respect to five dimensions of project ownership: student agency, instructor mentorship, peer collaboration, interest and value, and affective responses. Our within- and cross-case analyses yielded three major findings. First, coupling division of labor with collective brainstorming can help balance student agency, instructor mentorship, and peer collaboration. Second, students' interest in the project and perceptions of its value can increase over time; initial student interest in the project topic is not a necessary condition for student ownership of the project. Third, student ownership is characterized by a wide range of emotions that fluctuate as students alternate between extended periods of struggle and moments of success while working on their projects. These findings not only extend the literature on student ownership into a new educational domain—namely, upper-division physics labs—they also have concrete implications for the design of experimental physics projects in courses for which student ownership is a desired learning outcome. We describe the course and projects in sufficient detail that others can adapt our results to their particular contexts.

  12. Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study.

    Science.gov (United States)

    Goicolea, Isabel; Marchal, Bruno; Hurtig, Anna-Karin; Vives-Cases, Carmen; Briones-Vozmediano, Erica; San Sebastián, Miguel

    2017-12-09

    To analyse how team level conditions influenced health care professionals' responses to intimate partner violence. We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations. The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach. Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. A case study of lightning attachment to flat ground showing multiple unconnected upward leaders

    Science.gov (United States)

    Cummins, Kenneth L.; Krider, E. Philip; Olbinski, Mike; Holle, Ronald L.

    2018-04-01

    On 10 July 2015, a cloud-to-ground (CG) lightning flash that produced two ground terminations was photographed from inside the safety of a truck in southern New Mexico. An analysis of archived NLDN data verified that this was a two-stroke flash, and a close-up view of the first stroke shows that it also initiated at least 12 unconnected, upward leaders (or "streamers") near the ground termination. No unconnected upward leaders were seen near the second ground attachment. After combining an analysis of the photograph with information provided by the NLDN, we infer that the first stroke was of negative (normal) polarity, had modest peak current, and struck about 460 m (± 24%) from the camera. Attachment occurred when an upward-propagating positive leader reached an inferred height of about 21 m above local ground. The second stroke struck ground about 740 m from the camera, and the height of its attachment leader is estimated to be 15 m. The estimated lengths of the unconnected upward leaders in the two-dimensional (2-D) plane of the first stroke range from 2 to 8 m, and all appear to be located within 15 m (2-D) of the main ground termination, with 24% uncertainty. Many of the unconnected upward leaders (inferred to be positive) exhibit multiple upward branches, and most of those branches have upward-directed forks or splits at their ends. This is the first report showing such extensive branching for positive upward leaders in natural lightning strikes to ground. None of the upward leaders can be seen to emanate from the tops of tall, isolated, or pointed objects on the ground, but they likely begin on small plants and rocks, or flat ground. In terms of lightning safety, this photo demonstrates that numerous upward leaders can be produced near a lightning strike point and have the potential to damage or cause injury at more than one specific point on the ground.

  14. Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors

    NARCIS (Netherlands)

    Josien Bensing; prof Berno van Meijel; Jessika Ouwerkerk; Miel Ribbe; Renate Verkaik; Anneke Francke

    2011-01-01

    Successfully introducing care innovations depends on the type of care setting, the intervention and specific circumstances. In this study the factors influencing the introduction of an evidence based nursing guideline on depression in psychogeriatric nursing home residents were studied.

  15. Introducing a nursing guideline on depression in dementia: a multiple case study on influencing factors.

    NARCIS (Netherlands)

    Verkaik, R.; Francke, A.L.; Meijel, B. van; Ouwerkerk, J.; Ribbe, M.W.; Bensing, J.M.

    2011-01-01

    Background: Successfully introducing care innovations depends on the type of care setting, the intervention and specific circumstances. In this study the factors influencing the introduction of an evidence based nursing guideline on depression in psychogeriatric nursing home residents were studied.

  16. APPLICATION OF FAILURE MODE & EFFECT ANALYSIS (FMEA FOR CONTINUOUS QUALITY IMPROVEMENT - MULTIPLE CASE STUDIES IN AUTOMOBILE SMES

    Directory of Open Access Journals (Sweden)

    Jigar Doshi

    2017-06-01

    Full Text Available Failure Mode and Effects Analysis (FMEA is a quality tool used to identify potential failures and related effects on processes and products, so continuous improvement in quality can be achieved by reducing them. The purpose of this research paper is to showcase the contribution of FMEA to achieve Continuous Quality Improvement (CQI by multiple case study research. The outcome research conducted by implementing FMEA; one of the Auto Core Tools (ACTs, in the automobile Small and Medium Enterprises (SMEs in Gujarat, India is presented in this paper which depict various means of Continuous Quality Improvements. The case study based research was carried out in four automobile SMEs; all of them are supplied to automotive Original Equipment Manufacturer (OEM. The FMEA was implemented with the help of Cross Functional Team (CFT to identify the potential failure modes and effects, in overall effect on Continuous Quality Improvement. The outcome of FMEA at four companies' reveals the scope of improvement exists in the manufacturing process. Implementation of those improvement points shows the definite signs of continuous improvement of the quality of process and product as well. The FMEA and subsequent implementations had reduced the quality rejections around 3% to 4% in case companies.

  17. Strategies for Promoting Autonomous Reading Motivation: A Multiple Case Study Research in Primary Education

    Science.gov (United States)

    De Naeghel, Jessie; Van Keer, Hilde; Vanderlinde, Ruben

    2014-01-01

    It is important to reveal strategies which foster students' reading motivation in order to break through the declining trend in reading motivation throughout children's educational careers. Consequently, the present study advances an underexposed field in reading motivation research by studying and identifying the strategies of teachers excellent…

  18. Managing Supplier Involvement in New Product Development: A Multiple-Case Study

    NARCIS (Netherlands)

    F.E.A. van Echtelt (Ferrie); J.Y.F. Wynstra (Finn); A.J. van Weele (Arjan); G.M. Duysters (Geert)

    2006-01-01

    textabstractExisting studies of supplier involvement in new product development have mainly focused on project-related short-term processes and success-factors. This study validates and extends an existing exploratory framework, which comprises both long-term strategic processes and short-term

  19. Managing supplier involvement in new product development : a multiple-case study

    NARCIS (Netherlands)

    Echtelt, van F.E.A.; Wynstra, J.Y.F.; Weele, van A.J.; Duysters, G.M.

    2008-01-01

    Existing studies of supplier involvement in new product development have mainly focused on project-related short-term processes and success factors. This study validates and extends an existing exploratory framework, which comprises both long-term strategic processes and short-term operational

  20. Empowerment of African American Women Leaders in Higher Education: A Multiple Case Study

    Science.gov (United States)

    McDaniel, Sharon L.

    2016-01-01

    The purpose of this study was to gain an understanding of the perspectives on empowerment held by African American women who work in executive positions within higher educational settings. This study also seeks to provide other women with a deeper level of awareness regarding the journey towards executive leadership. Current literature explores…

  1. Musikkterapi og Meistring - ein multiple case studie om korleis brukarar i rusbehandling opplev meistring

    OpenAIRE

    Myklebust, Kristin Mjånes

    2017-01-01

    This study aims to capture the importance of mastery and coping in addiction treatment and combine it with the user perspective and music therapy. The study explores music therapy in addiction treatment at a detoxification unit for women. The data material consists of interviews with three women in a detoxification unit and a research log from the music therapy group sessions that helps my understanding of the data. The music therapy group was created by myself and a fellow student. The focus...

  2. How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.

    Science.gov (United States)

    Gort, Marjan; Broekhuis, Manda; Regts, Gerdien

    2013-11-01

    A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results. Copyright © 2013. Published by Elsevier Ltd.

  3. Glogsters and Other Motivating Technology: A Multiple Case Study of English Learners

    Science.gov (United States)

    Martinez-Alba, Gilda; Cruzado-Guerrero, Judith; Pitcher, Sharon

    2014-01-01

    The purpose of this study was to investigate how undergraduate Latino English learner (EL) students were motivated to read using technology by their teachers throughout their education. To examine this, they were interviewed, asked to perform a task that involved reading online, required to make a Glogster (an online interactive poster) about…

  4. Recruitment and retention of health professionals across Europe : A literature review and multiple case study research

    NARCIS (Netherlands)

    Kroezen, Marieke; Dussault, Gilles; Craveiro, Isabel; Dieleman, Marjolein; Jansen, Christel; Buchan, James; Barriball, Louise; Rafferty, Anne Marie; Bremner, Jeni; Sermeus, Walter

    2015-01-01

    Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals

  5. Modularity in supply chains: a multiple case study in the construction industry

    NARCIS (Netherlands)

    Voordijk, Johannes T.; Meijboom, Bert; de Haan, Job

    2006-01-01

    Purpose – The objective of this study is to assess the applicability of Fine's three-dimensional modularity concept as a tool to describe and to analyze the alignment of product, process, and supply chain architectures. Fine claims that the degree of modularity in the final output product has a

  6. Multiple Case Studies of Public Library Systems in New York State: Service Decision-Making Processes

    Science.gov (United States)

    Ren, Xiaoai

    2012-01-01

    This research examined the functions and roles of public library systems in New York State and the services they provide for individual libraries and the public. The dissertation further studied the service decision-making processes at three selected New York State cooperative public library systems. Public library systems have played an important…

  7. A multiple case study approach to work stress prevention in Europe

    NARCIS (Netherlands)

    Kompier, M.A.J.; Cooper, C.L.; Geurts, S.A.E.

    2000-01-01

    Work stress has become a major issue among European employees. The current practice of its prevention seems disappointing, as work stress prevention programmes are predominantly reactive and biased to the individual. The lack of organization-level intervention studies is a barrier to progress in

  8. Failure mode and effect analysis in asset maintenance : a multiple case study in the process industry

    NARCIS (Netherlands)

    Braaksma, Jan; Klingenberg, W.; Veldman, J.

    2013-01-01

    Failure mode and effect analysis (FMEA) is an important method for designing and prioritising preventive maintenance activities and is often used as the basis for preventive maintenance planning. Although FMEA was studied extensively, most of the published work so far covers FMEA concept design.

  9. Failure mode and effect analysis in asset maintenance: a multiple case study in the process industry

    NARCIS (Netherlands)

    Braaksma, Anne Johannes Jan; Klingenberg, W.; Veldman, Jasper

    2013-01-01

    Failure mode and effect analysis (FMEA) is an important method for designing and prioritising preventive maintenance activities and is often used as the basis for preventive maintenance planning. Although FMEA was studied extensively, most of the published work so far covers FMEA concept design.

  10. A multiple case study on the effects of temperamental traits in Chinese preschoolers learning English

    NARCIS (Netherlands)

    Sun, He; de Bot, Kees; Steinkrauss, Rasmus

    2015-01-01

    Aims The current study tests Clarke’s (1999) findings on phases and variations of the English development of young second language learners in a Chinese EFL setting and explores the cause of these variations under the following questions: 1. What verbal and nonverbal behavior can be observed in

  11. A multiple case study approach to work stress prevention in Europe

    NARCIS (Netherlands)

    Kompier, M.A.J.; Cooper, C.L.; Geurts, S.A.E.; Cooper, C.L.

    2013-01-01

    Work stress has become a major issue among European employees. The current practice of its prevention seems disappointing, as work stress prevention programmes are predominantly reactive and biased to the individual. The lack of organization-level intervention studies is a barrier to progress in

  12. The Fluctuating Development of Cross-Linguistic Semantic Awareness: A Longitudinal Multiple-Case Study

    Science.gov (United States)

    Zheng, Yongyan

    2014-01-01

    Second language (L2) learners' awareness of first language-second language (L1-L2) semantic differences plays a critical role in L2 vocabulary learning. This study investigates the long-term development of eight university-level Chinese English as a foreign language learners' cross-linguistic semantic awareness over the course of 10 months. A…

  13. Economic and Demographic Trends in Jesuit Higher Education: A Qualitative Multiple Case Study

    Science.gov (United States)

    Hansen, Damien J.

    2017-01-01

    This study addressed the current paucity of research dedicated to the perceptions of strategic planners in Jesuit colleges and universities pertaining to how current market trends are impacting their institutions. The collective success of member institutions is paramount as these institutions are purveyors of Ignatian principals such as social…

  14. ePortfolios in the Workplace for Human Capital Management: A Multiple Case Study

    Science.gov (United States)

    Lievens, Ronald

    2015-01-01

    This study researches whether the ePortfolio is a suitable instrument for human capital management in the business environment. The implementation of ePortfolio systems in five different organizations is analyzed. It considers whether ePortfolio implementations were successful, and relevant critical success factors were identified. For the latter…

  15. Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

    Science.gov (United States)

    Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

    2018-01-01

    To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  16. Pre-purchase customer experience : multiple case study of leading service providers in Norway

    OpenAIRE

    Kujala, Lisanna Carolina; Citic, Marija

    2015-01-01

    The theory of experience economy presents customer experience as a form of new economic offering and stresses the importance of customer experience for companies that are trying to differentiate from the competitors. Many service providers are increasing their focus on customer experience by putting the customer in the center of their business. This study investigates how experience centricity and customer centricity can be enhanced at prepurchase level. Nowadays, customer a...

  17. INVESTIGATING TEACHING PRACTICES FOR ALGEBRAIC EXPRESSIONS WITHIN A MULTIPLE CASE STUDY

    OpenAIRE

    Girit, Dilek; Akyuz, Didem

    2017-01-01

    Aseffective teaching practices support students’ learning; it is essential toinvestigate teachers’ teaching practices. It can also shed light on the causes of students’difficulties.In this regard, proposing teaching practices might be important as thepractices can give insight about what is going on in teaching process. Thus,the aim of this study is to extract the practices by focusing on the teachers’actions during the teaching of operations with algebraic expressions.Mathematical Knowledge ...

  18. Outsourcing from the perspectives of TCE and RBV: a multiple case study

    Directory of Open Access Journals (Sweden)

    Lincoln Wolf de Almeida Neves

    2014-09-01

    Full Text Available The theories of transaction cost economics (TCE and the resource-based view (RBV have been applied in studies of outsourcing. The research presented in this study was conducted to gain an understanding of why firms outsource their value chain activities, using a combined TCE and RBV perspective. The research assesses how six instant coffee firms in Brazil perceive the rationale for their outsourcing processes. The authors conclude that the two theories should be used together to determine a firm's frontiers, and they offer a mechanism for combining them. The results, relevant to both academics and practitioners, reveal that outsourcing should be defined at two stages: an initial strategic stage in which the activities that should be performed internally are identified, based on RBV, and a second stage in which the activities that can be performed externally are examined and those that should be outsourced are identified on the basis of both TCE and RBV. Insights relevant to practitioners include the importance of the executive leadership role in defining a firm's outsourcing strategy and the need for constant vigilance to prevent opportunism in relationships with trading partners.

  19. Categorization skills and recall in brain damaged children: a multiple case study.

    Science.gov (United States)

    Mello, Claudia Berlim de; Muszkat, Mauro; Xavier, Gilberto Fernando; Bueno, Orlando Francisco Amodeo

    2009-09-01

    During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.

  20. Complexity Management - A multiple case study analysis on control and reduction of complexity costs

    DEFF Research Database (Denmark)

    Myrodia, Anna

    of products, with features more custom-made to cover individual needs, both regarding characteristics of products and support services. This necessity leads to a considerable increase of the complexity in the company, which affects the product portfolio, production and supply chain, market segments......, IT systems, and business processes. In order to identify and eliminate complexity, several approaches are used, both by researchers and practitioners. The purpose of this thesis is to contribute to the existing knowledge of complexity management theory. This research focuses on the relationship between......Complexity tends to be arguably the biggest challenge of manufacturing companies. The motivation of further studying complexity is a combination between the existing literature and the practical experiences from the industry. Based on the latest trend companies are trying to supply a growing mix...

  1. From struggles to resource gains in interprofessional service networks: Key findings from a multiple case study.

    Science.gov (United States)

    Toiviainen, Hanna; Kira, Mari

    2017-07-01

    In interprofessional service networks, employees cross professional boundaries to collaborate with colleagues and clients with expertise and values different from their own. It can be a struggle to adopt shared work practices and deal with "multivoicedness." At the same time, networks allow members to engage in meaningful service provision, gain a broader understanding of the service provided, and obtain social support. Intertwined network struggles and resource gains have received limited attention in the interprofessional care literature to date. The aim of the study was to investigate the learning potential of the co-existing struggles and resource gains. This article reports findings from two interprofessional networks. Interviews were conducted with 19 employees and thematically analysed. Three types of struggles and six types of resource gains of networking were identified. The struggles relate, first, to the assumptions of networking following similar practices to those in a home organisation; second, to the challenges of dealing with the multivoicedness of networking; and, third, to the experienced gap between the networking ideals and the reality of cooperation. At the same time, the network members experience gains in emotional resources (e.g., stronger sense of meaningfulness at work), cognitive resources (e.g., understanding the customer needs from alternative perspectives), and social resources (e.g., being able to rely on other professionals' competence). Learning potential emerged from the dynamics between coexisting struggles and resource gains.

  2. Building new business model from multiple case study research in the Internet of Me

    Directory of Open Access Journals (Sweden)

    Ruggieri Roberto

    2017-07-01

    Full Text Available The digital revolution has greatly changed the approach to culture, work, leisure time, the way we interact and communicate with people: the digitization of information has taken root and has become essential in all areas of social life as a phenomenon that guides and monitors the transformation of society in all its various forms, bringing great changes in almost all areas and especially in the world of work and industry. One of the core elements of the fourth industrial revolution is the systematic application of IoT technologies (Internet of Things and IoM (Internet of Me to production processes on a global scale. This study seeks to identify the main decision in the IoT/IoM pattern innovation, more specifically, the purpose of the paper is primarily an analysis of what are the possible future benefits of IoT and IoM, trying to understand the effort and their opportunities for a consumer oriented business. Then to analyze the competitive advantage that companies are pursuing when they implement a business which is IoT/IoM oriented. Our research aims to address the following two research questions: 1Does exist a well-structured business model for the companies IoT/IoM service oriented? and 2Is it possible to standardize behavioral pattern and to draw guidelines for companies who want to start similar strategic management? The research presents two phases methodologically joined between them: from a theoretical point of view it is defined the change from the business model towards the “ecosystem” of business model in the strategy IoT/IoM oriented, and from a empirical point of view the business development of an Italian start-up first mover group in the sectors involved in IoT and IoM revolution, through the direct interview qualitative tool.

  3. Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

    2013-07-01

    These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

    Directory of Open Access Journals (Sweden)

    Isabelle Brault

    2014-01-01

    Full Text Available Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP. To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

  5. Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study.

    Science.gov (United States)

    Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique

    2014-01-01

    Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

  6. The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

    Directory of Open Access Journals (Sweden)

    Doreen K.M. M'Rithaa

    2015-12-01

    Full Text Available Background: Daily activities within a health care organisation are mediated by information communication processes (ICP involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods: Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results: The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held threee merging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion: This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines.

  7. Multiple Sclerosis and Several Demographic Characteristics, Family History of MS, and Month of Birth: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Bagheri

    2015-09-01

    Full Text Available Background Several factors have been reported as risk factors for multiple sclerosis (MS; however, the main causes of the disease are still unknown. A geographical area with a low MS incidence is Ahvaz, Iran. Objectives The objective of this study was to evaluate the association of several demographic characteristics, family history, and birth month with MS in Ahvaz. Patients and Methods This was a case-control study including 155 MS cases and 155 controls matched for age, sex, and residential status. The participants were selected randomly, using a systematic method, from the MS patients referred to the MS Society of Khuzestan (Iran. The data collection tool was a standardized questionnaire designed by the authors to assess demographic characteristics. Data were analyzed using descriptive statistics including mean, frequency, and standard deviation and inferential statistical tests including χ2, Fisher’s exact test, and logistic regression using SPSS version 19. Results In both cases and controls, no significant associations were found between Arab ethnicity and incidence of MS, marital status and risk of MS in Ahvaz, or more than 15-year residency in Ahvaz, birth in Khuzestan, and month of birth and the risk of MS (P > 0.05. However, there was a marginally significant association between living from birth to age 15 years in Ahvaz and MS (P = 0.05. Furthermore, there was an association between a family history of MS and the risk of MS in Ahvaz (P = 0.02, which was significant in univariate logistic regression (P = 0.006. Conclusions The findings suggested that according to the ecological conditions of Ahvaz, a family history of MS may increase the risk of developing MS.

  8. Cost comparison between private and public collection of residual household waste: multiple case studies in the Flemish region of Belgium.

    Science.gov (United States)

    Jacobsen, R; Buysse, J; Gellynck, X

    2013-01-01

    The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Connections Between Future Time Perspectives and Self-Regulated Learning for Mid-Year Engineering Students: A Multiple Case Study

    Science.gov (United States)

    Chasmar, Justine

    This dissertation presents multiple studies with the purpose of understanding the connections between undergraduate engineering students' motivations, specifically students' Future Time Perspectives (FTPs) and Self-Regulated Learning (SRL). FTP refers to the views students hold about the future and how their perceptions of current tasks are affected by these views. SRL connects the behaviors, metacognition, and motivation of students in their learning. The goals of this research project were to 1) qualitatively describe and document engineering students' SRL strategies, 2) examine interactions between engineering students' FTPs and SRL strategy use, and 3) explore goal-setting as a bridge between FTP and SRL. In an exploratory qualitative study with mid-year industrial engineering students to examine the SRL strategies used before and after an SRL intervention, results showed that students intended to use more SRL strategies than they attempted. However, students self-reported using new SRL strategies from the intervention. Students in this population also completed a survey and a single interview about FTP and SRL. Results showed perceptions of instrumentality of coursework and skills as motivation for using SRL strategies, and a varied use of SRL strategies for students with different FTPs. Overall, three types of student FTP were seen: students with a single realistic view of the future, conflicting ideal and realistic future views, or open views of the future. A sequential explanatory mixed methods study was conducted with mid-year students from multiple engineering majors. First a cluster analysis of survey results of FTP items compared to FTP interview responses was used for participant selection. Then a multiple case study was conducted with data collected through surveys, journal entries, course performance, and two interviews. Results showed that students with a well-defined FTP self-regulated in the present based on their varied perceptions of

  10. Finding the Little 'c' in Physics: A Multiple Case Study Examining the Development of Creative Activities in the Physics Classroom

    Science.gov (United States)

    Wheeler, Christopher

    This study focused on how physics teachers develop and implement activities that promote creative thinking strategies in the standards based physics classroom. A particular focus was placed on every day or little "c", creativity, which can be taught in the high school classroom. The study utilized a multiple case study design, which allows for in-depth study in a variety of settings. Four participants from various high schools were identified utilizing administrator recommendations. Data were then collected via interviews, observations, and documents. The data were coded and analyzed for emerging themes. The themes were then merged to determine findings to the stated research questions. The research demonstrated the importance of modifying activities for student interest and understanding through effective use of scientific inquiry. The past experiences and professional development of the participants served as a vital piece to the development of their educational pedagogy especially concerning inquiry and questioning strategies. It was also established that an unstructured, positive classroom environment is a vital aspect of teaching while supporting creative thinking skills.

  11. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  12. Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

    International Nuclear Information System (INIS)

    Jacobsen, R.; Buysse, J.; Gellynck, X.

    2013-01-01

    Highlights: ► The goal is to compare collection costs for residual household waste. ► We have clustered all municipalities in order to find mutual comparable pairs. ► Each pair consists of one private and one public operating waste collection program. ► All cases show that private service has lower costs than public service. ► Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

  13. Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

    Energy Technology Data Exchange (ETDEWEB)

    Jacobsen, R., E-mail: ray.jacobsen@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Buysse, J., E-mail: j.buysse@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Gellynck, X., E-mail: xavier.gellynck@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer The goal is to compare collection costs for residual household waste. Black-Right-Pointing-Pointer We have clustered all municipalities in order to find mutual comparable pairs. Black-Right-Pointing-Pointer Each pair consists of one private and one public operating waste collection program. Black-Right-Pointing-Pointer All cases show that private service has lower costs than public service. Black-Right-Pointing-Pointer Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

  14. Beyond the City Lights: A Multiple-Case Study of Successful, Experienced Secondary Science Teachers in Rural Schools

    Science.gov (United States)

    DeVore-Wedding, Beverly R.

    Recruitment and retention concerns for teachers, particularly in rural school districts and in science, fill the daily news and research literature. The shortage of STEM workers is also another concern as well. Then why do nationally recognized secondary science teachers remain in rural schools with lower salaries, increased responsibilities beyond teaching content, and multi-preparations, stay in those schools? How do they overcome challenges in their schools? This multiple case study focuses on Presidential Award for Excellence in Mathematics and Science Teaching (PAEMST) awardees who have taught secondary science in rural school districts 10 years or more. Eight rural PAEMST high school science teachers were identified in Nebraska and the six contiguous states; four consented to participate in this study. Interviews of these teachers and a colleague, principal, and or students were conducted to answer the research questions. Using a lens of resiliency, similarities were identified that show how these teachers overcome adversity and thrived in their rural school and communities. Resilient themes that emerged from this study are adaptability, autonomy, collaborative, competency, connectedness, problem-solvers, and resourcefulness. Common themes of success for teaching in rural schools for the four teachers were autonomy and relationships. Common themes of challenges for teaching in rural schools were diversity, funding, professional isolation, and teaching assignments. These characteristics and strategies may help schools with their recruitment and retention of teachers as well as teachers themselves benefiting from hearing other teachers' stories of success and longevity.

  15. Barriers to the adoption of low carbon production: A multiple-case study of Chinese industrial firms

    International Nuclear Information System (INIS)

    Liu, Yong

    2014-01-01

    This study employs a multiple-case study method, identifies barriers to the adoption of low carbon production, and categorizes these barriers into four domains: structural, regulatory, cultural, and contextual. The two most frequently mentioned barriers were “lack of financial incentives to stimulate low carbon innovation” and “lack of a common definition of low carbon production”. The two least frequently mentioned barriers were “silos exist between planning and production” and “operational staff are often physically separated from planning staff, which isolates them from planning decisions”. Furthermore, contextual barriers were significantly related to structural and regulatory barriers, while regulatory barriers were significantly related to structural barriers. Larger firms tend to have a more structured organization and lower perceptions of the employment term barrier. However, larger structured organizations have been affected by a long history of a planning-oriented economy and hence tend to have inflexible hierarchical systems. In contrast, small firms have hierarchical systems with less effect on low carbon production than those of large enterprises. Another interesting trend is the direct size effect on cultural barriers, which is evident in a culture of risk aversion, as well as the lack of low carbon technology and the existence of silos between planning and production. - Highlights: • Barriers were categorized as structural, regulatory, cultural and contextual. • Contextual barriers were significantly related to structural and regulatory barriers. • Regulatory barriers were significantly related to structural barriers. • Firm size directly affected firm hierarchical systems and cultural barriers

  16. Sociocultural and Demographic Risk Factors for the Development of Multiple Sclerosis in Kuwait: A Case - Control Study.

    Directory of Open Access Journals (Sweden)

    Suhail N Al-Shammri

    Full Text Available Immunological, genetic and environmental factors are believed to play important roles in the pathogenesis of Multiple Sclerosis (MS. There have been many studies on risk factors for MS but these have been mainly in Caucasian populations; robust studies in Arab populations remain relatively uncommon. This study therefore aimed to identify behavioral, socio-cultural, and demographic factors associated with development of MS in Kuwait, a high income Arab country, currently undergoing a demographic transition.In this case- control study, 195 Kuwaiti MS patients and 146 healthy age and sex-matched controls were recruited. Both groups of subjects were interviewed using a structured questionnaire, in relation to anthropometric, socio-cultural and demographic data, residence during the 1990/91 Gulf War and current and past medical history, including medications. We also clinically evaluated, and retrospectively reviewed medical records of patients to derive appropriate clinical information, including associated chronic medical illness requiring long-term treatment.On multiple logistic regression analysis after adjustment for potential confounders including age, gender and BMI, in all the subjects, a positive associations prevail with presence of MS and some sociocultural and demographic factors, which included non-Bedouin ethnicity (AOR 2, 95% CI 1.0-3.9, p 0.049, positive family history of MS (AOR 10.6, 95% CI 3.0-36.9, p < 0.001, and low daily sunlight exposure of < 15min/day (AOR 5.3, 95% CI 2.7-10.5 p < 0.001. In addition, while 41.8% of MS patients indicated at least one comorbidity, only 26.8% of the controls reported any associated physical illness, with the suggestion that presence of certain comorbidities might increase MS risk (AOR 2.4, 95% CI 1.3-4.7, p < 0.001. Other risk variables such as smoking status and mode of routine outdoor dressing were not significant in all the MS subjects taken as a whole, but demonstrated variably positive

  17. Use of multiple sensor technologies for quality control of in situ biogeochemical measurements: A SeaCycler case study

    Science.gov (United States)

    Atamanchuk, Dariia; Koelling, Jannes; Lai, Jeremy; Send, Uwe; Wallace, Douglas

    2017-04-01

    Over the last two decades observing capacity for the global ocean has increased dramatically. Emerging sensor technologies for dissolved gases, nutrients and bio-optical properties in seawater are allowing extension of in situ observations beyond the traditionally measured salinity, temperature and pressure (CTD). However the effort to extend observations using autonomous instruments and platforms carries the risk of losing the level of data quality achievable through conventional water sampling techniques. We will present results from a case study with the SeaCycler profiling winch focusing on quality control of the in-situ measurements. A total of 13 sensors were deployed from May 2016 to early 2017 on SeaCycler's profiling sensor float, including CTD, dissolved oxygen (O2, 3 sensors), carbon dioxide (pCO2, 2 sensors), nutrients, velocity sensors, fluorometer, transmissometer, single channel PAR sensor, and others. We will highlight how multiple measurement technologies (e.g. for O2 and CO2) complement each other and result in a high quality data product. We will also present an initial assessment of the bio-optical data, their implications for seasonal phytoplankton dynamics and comparisons to climatologies and ocean-color data products obtained from the MODIS satellite.

  18. Cooperation and organization in decision making : a more decisive road safety policy ? : results from a multiple case study in the Netherlands.

    NARCIS (Netherlands)

    Bax, C.

    2005-01-01

    This study examines the administrative processes that led to the implementation of road safety measures in Dutch Regional Traffic and Transport Plans. The design of the study is a multiple case study in six regions in the Netherlands. The road safety policy is evaluated by looking at the

  19. A Multiple Case Study Discovering Part-Time Faculties' Perceptions of Their Professional Needs, Working Conditions, Social Network, and Job Satisfaction at Three Community Colleges

    Science.gov (United States)

    Millner-Harlee, Tanya

    2010-01-01

    This study employed a multiple case study design to evaluate the perspectives of part-time faculties at three community colleges in the Northeast. The purpose of this study was to discover how needs, working conditions, and social networks influence the part-time faculties' job satisfaction. Maslow (1954), Bourdieu (1986), and Herzberg, Mausner,…

  20. Classifying Multiple Types of Hand Motions Using Electrocorticography During Intraoperative Awake Craniotomy & Seizure Monitoring Processes - Case Studies

    Directory of Open Access Journals (Sweden)

    Tao eXie

    2015-10-01

    Full Text Available In this work, some case studies were conducted toclassify several kinds of hand motions from electrocorticography(ECoG signals during intraoperative awake craniotomy &extraoperative seizure monitoring processes. Four subjects (P1,P2 with intractable epilepsy during seizure monitoring and P3,P4 with brain tumor during awake craniotomy participatedin the experiments. Subjects performed three types of handmotions (Grasp, Thumb-finger motion and Index-finger motioncontralateral to the motor cortex covered with ECoG electrodes.Two methods were used for signal processing. Method I:autoregressive (AR model with burg method was applied toextract features, and additional waveform length (WL featurehas been considered, finally the linear discriminative analysis(LDA was used as the classifier. Method II: stationary subspaceanalysis (SSA was applied for data preprocessing, and thecommon spatial pattern (CSP was used for feature extractionbefore LDA decoding process. Applying method I, the threeclassaccuracy of P1□P4 were 90.17%, 96.00%, 91.77% and92.95% respectively. For method II, the three-class accuracy ofP1□P4 were 72.00%, 93.17%, 95.22% and 90.36% respectively.This study verified the possibility of decoding multiple handmotion types during an awake craniotomy, which is the firststep towards dexterous neuroprosthetic control during surgicalimplantation, in order to verify the optimal placement of electrodes.The accuracy during awake craniotomy was comparableto results during seizure monitoring. This study also indicatedthat ECoG was a promising approach for precise identificationof eloquent cortex during awake craniotomy, and might forma promising BCI system that could benefit both patients andneurosurgeons.

  1. Classifying multiple types of hand motions using electrocorticography during intraoperative awake craniotomy and seizure monitoring processes—case studies

    Science.gov (United States)

    Xie, Tao; Zhang, Dingguo; Wu, Zehan; Chen, Liang; Zhu, Xiangyang

    2015-01-01

    In this work, some case studies were conducted to classify several kinds of hand motions from electrocorticography (ECoG) signals during intraoperative awake craniotomy & extraoperative seizure monitoring processes. Four subjects (P1, P2 with intractable epilepsy during seizure monitoring and P3, P4 with brain tumor during awake craniotomy) participated in the experiments. Subjects performed three types of hand motions (Grasp, Thumb-finger motion and Index-finger motion) contralateral to the motor cortex covered with ECoG electrodes. Two methods were used for signal processing. Method I: autoregressive (AR) model with burg method was applied to extract features, and additional waveform length (WL) feature has been considered, finally the linear discriminative analysis (LDA) was used as the classifier. Method II: stationary subspace analysis (SSA) was applied for data preprocessing, and the common spatial pattern (CSP) was used for feature extraction before LDA decoding process. Applying method I, the three-class accuracy of P1~P4 were 90.17, 96.00, 91.77, and 92.95% respectively. For method II, the three-class accuracy of P1~P4 were 72.00, 93.17, 95.22, and 90.36% respectively. This study verified the possibility of decoding multiple hand motion types during an awake craniotomy, which is the first step toward dexterous neuroprosthetic control during surgical implantation, in order to verify the optimal placement of electrodes. The accuracy during awake craniotomy was comparable to results during seizure monitoring. This study also indicated that ECoG was a promising approach for precise identification of eloquent cortex during awake craniotomy, and might form a promising BCI system that could benefit both patients and neurosurgeons. PMID:26483627

  2. Coupling the effect of mental practice and Pilates on ambulation of individuals with multiple sclerosis: Five case studies

    Directory of Open Access Journals (Sweden)

    Darshpreet Kaur

    2016-01-01

    Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.

  3. A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

    Science.gov (United States)

    Barker, Trevor; Russo, Stephen A; Barker, Gaytri; Rice, Mark A; Jeffrey, Mary G; Broderick, Gordon; Craddock, Travis J A

    2017-04-28

    Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η 2  = .035), fogginess (p = .038, η 2  = .032), memory problems (p = .003, η 2  = .055), and concentration problems (p = .009, η 2  = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to

  4. Applicability of bioanalysis of multiple analytes in drug discovery and development: review of select case studies including assay development considerations.

    Science.gov (United States)

    Srinivas, Nuggehally R

    2006-05-01

    The development of sound bioanalytical method(s) is of paramount importance during the process of drug discovery and development culminating in a marketing approval. Although the bioanalytical procedure(s) originally developed during the discovery stage may not necessarily be fit to support the drug development scenario, they may be suitably modified and validated, as deemed necessary. Several reviews have appeared over the years describing analytical approaches including various techniques, detection systems, automation tools that are available for an effective separation, enhanced selectivity and sensitivity for quantitation of many analytes. The intention of this review is to cover various key areas where analytical method development becomes necessary during different stages of drug discovery research and development process. The key areas covered in this article with relevant case studies include: (a) simultaneous assay for parent compound and metabolites that are purported to display pharmacological activity; (b) bioanalytical procedures for determination of multiple drugs in combating a disease; (c) analytical measurement of chirality aspects in the pharmacokinetics, metabolism and biotransformation investigations; (d) drug monitoring for therapeutic benefits and/or occupational hazard; (e) analysis of drugs from complex and/or less frequently used matrices; (f) analytical determination during in vitro experiments (metabolism and permeability related) and in situ intestinal perfusion experiments; (g) determination of a major metabolite as a surrogate for the parent molecule; (h) analytical approaches for universal determination of CYP450 probe substrates and metabolites; (i) analytical applicability to prodrug evaluations-simultaneous determination of prodrug, parent and metabolites; (j) quantitative determination of parent compound and/or phase II metabolite(s) via direct or indirect approaches; (k) applicability in analysis of multiple compounds in select

  5. [Special cases of multiple sclerosis].

    Science.gov (United States)

    Mendibe Bilbao, Mar

    2014-12-01

    Multiple sclerosis is a chronic disease that usually occurs in young people and affects them for the rest of their lives. Patients and their families usually have a series of doubts and questions on everyday matters and all types of situations that occur during the distinct stages of life and which can influence the course of the disease. The aim of this review is to provide specific answers to these questions. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. E-SCM AND INVENTORY MANAGEMENT: A STUDY OF MULTIPLE CASES IN A SEGMENT OF THE DEPARTMENT STORE CHAIN

    Directory of Open Access Journals (Sweden)

    Juliana Chiaretti Novi

    2011-08-01

    Full Text Available Inventory management through the supply chains is a theme that has always enticed managers throughout the world. Due to the increase in market competitiveness and complexity, the traditional statistical models of forecasting demand, based on time series, no longer met the needs imposed on businesses to maintain adequate levels of their inventory and supply interruptions. With the intent to meet these market demands, ERP systems appeared in the 1990’s. Nevertheless, even if allowing for a more adequate level of inventory and supply interruptions achieved mainly by the optimization of internal processes and the reduction in lead time, ERP systems did not contribute to reach the SCM’s desired levels of inventory that were aimed at by the more competitive businesses. This is because ERP limits itself to an internal analysis of the business. By contrast, inventory management depends on the consumption information (which is external to the business. Aiming to improve even further the level of services delivered to the end consumer, new solutions have been developed, among them the e- SCM, which, since it makes consumption information available in real time, ends up being more dynamic and efficient than the traditional demand forecasting models, Therefore, the present study aims to analyze how the e-SCM can collaborate in maintaining adequate levels of inventory and interruptions in the supply chains. The hypothesis made is that the traditional statistical forecasting models, based on time series and isolatedly, are no longer adequate to adjust the demand, as the tools based on these models do not update the demand in real time and this is fundamental in the current business dynamics. The research method used was the study of multiple cases in a segment of a chain involving a large retailer, its Distribution Center and a supplier of home appliances. For the analysis of the data, the content analysis technique was used. As main results, it was

  7. User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives.

    Science.gov (United States)

    Nyborg, Ingrid; Danbolt, Lars J; Kirkevold, Marit

    2017-12-01

    The purpose of this multiple case study was to compare and contrast older people's and their relatives' experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital. Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation. This study used a qualitative design with a comparative multicase approach. Participants were recruited from two hospitals in Norway using a purposive sampling strategy. Semi-structured interviews were conducted with five patients and with six of their relatives. Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation. User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge. The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  8. Hydrological Process Simulation of Inland River Watershed: A Case Study of the Heihe River Basin with Multiple Hydrological Models

    Directory of Open Access Journals (Sweden)

    Lili Wang

    2018-04-01

    Full Text Available Simulating the hydrological processes of an inland river basin can help provide the scientific guidance to the policies of water allocation among different subbasins and water resource management groups within the subbasins. However, it is difficult to simulate the hydrological processes of an inland river basin with hydrological models due to the non-consistent hydrological characteristics of the entire basin. This study presents a solution to this problem with a case study about the hydrological process simulation in an inland river basin in China, Heihe River basin. It is divided into the upper, middle, and lower reaches based on the distinctive hydrological characteristics in the Heihe River basin, and three hydrological models are selected, applied, and tested to simulate the hydrological cycling processes for each reach. The upper reach is the contributing area with the complex runoff generation processes, therefore, the hydrological informatic modeling system (HIMS is utilized due to its combined runoff generation mechanisms. The middle reach has strong impacts of intensive human activities on the interactions of surface and subsurface flows, so a conceptual water balance model is applied to simulate the water balance process. For the lower reach, as the dissipative area with groundwater dominating the hydrological process, a groundwater modeling system with the embedment of MODFLOW model is applied to simulate the groundwater dynamics. Statistical parameters and water balance analysis prove that the three models have excellent performances in simulating the hydrological process of the three reaches. Therefore, it is an effective way to simulate the hydrological process of inland river basin with multiple hydrological models according to the characteristics of each subbasin.

  9. Lessons for Co-Innovation in Agricultural Innovation Systems: A Multiple Case Study Analysis and a Conceptual Model

    Science.gov (United States)

    Fielke, Simon J.; Botha, Neels; Reid, Janet; Gray, David; Blackett, Paula; Park, Nicola; Williams, Tracy

    2018-01-01

    Purpose: This paper highlights important lessons for co-innovation drawn from three ex-post case study innovation projects implemented within three sub-sectors of the primary industry sector in New Zealand. Design/methodology/approach: The characteristics that fostered co-innovation in each innovation project case study were identified from…

  10. Is it about money or marketing? : international marketing strategies in the luxury cosmetic industry : exploratory multiple case study of Chanel, Guerlain and La Mer

    OpenAIRE

    Ivančová, Andrea

    2014-01-01

    The aim of this study is to investigate how do the luxury cosmetic companies shape their global strategies. The Global Marketing Strategy model used in this paper helps to investigate challenges companies face among their international markets and how do they endure their international prestige and exclusivity. The multiple-case study is used to explore between cases and draw relevant conclusions. First part includes literature review and provides reader relevant background ...

  11. Building Adaptive Capacity of Pathways in Technology Early College High School Stakeholders: A Multiple-Case Study on the Influence of Performance, Leadership, and Organizational Learning

    Science.gov (United States)

    Michaud-Wells, Amy

    2016-01-01

    The purpose of this qualitative study was to explore the perceptions and beliefs of Pathways in Technology Early College High School (P-TECH) leaders and stakeholders regarding the personal and professional experiences that contributed to the development of adaptive capacity. This embedded multiple-case study was anchored by the interrelated…

  12. How School Leaders Prioritize and Allocate Resources to Improve Teacher Quality through Teacher Professional Development: A Multiple Case Study in Suburban North Carolina

    Science.gov (United States)

    Tyson, Deonte Rashawn

    2017-01-01

    This multiple case study examined the methods by which school leaders determined and planned teacher professional development, as well as what teachers perceived as their professional development needs and how they believe school leaders take those needs into account. The study took place at two suburban elementary schools (1 traditional public, 1…

  13. Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

    Directory of Open Access Journals (Sweden)

    Olstad Dana

    2012-05-01

    Full Text Available Abstract Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter

  14. Multiple orthokeratinized odontogenic cysts: a case report.

    Science.gov (United States)

    Cheng, Yi-Shing Lisa; Liang, Hui; Wright, John; Teenier, Tom

    2015-03-01

    The purpose of this report is to document the clinical, radiographic, pathological and molecular findings of the first case of multiple orthokeratinized odontogenic cysts (OOCs). Multiple odontogenic keratocysts are one of the major features of nevoid basal cell carcinoma syndrome (NBCCS), and loss of heterozygosity in the PTCH gene, the culprit gene for NBCCS, has recently been found in sporadic OOC cases. Therefore, in this presenting case, we also investigated the possibility that this patient might also have NBCCS, by comparing the available clinical information and the molecular findings of this case to the diagnostic criteria for NBCCS (as proposed by the First International Colloquium on NBCCS in 2011). However, this patient with multiple OOCs showed no evidence of having NBCCS. This conclusion supports the findings from previous case series based on sporadic cases that OOC does not appear to be associated with NBCCS.

  15. Reduce manual curation by combining gene predictions from multiple annotation engines, a case study of start codon prediction.

    Directory of Open Access Journals (Sweden)

    Thomas H A Ederveen

    Full Text Available Nowadays, prokaryotic genomes are sequenced faster than the capacity to manually curate gene annotations. Automated genome annotation engines provide users a straight-forward and complete solution for predicting ORF coordinates and function. For many labs, the use of AGEs is therefore essential to decrease the time necessary for annotating a given prokaryotic genome. However, it is not uncommon for AGEs to provide different and sometimes conflicting predictions. Combining multiple AGEs might allow for more accurate predictions. Here we analyzed the ab initio open reading frame (ORF calling performance of different AGEs based on curated genome annotations of eight strains from different bacterial species with GC% ranging from 35-52%. We present a case study which demonstrates a novel way of comparative genome annotation, using combinations of AGEs in a pre-defined order (or path to predict ORF start codons. The order of AGE combinations is from high to low specificity, where the specificity is based on the eight genome annotations. For each AGE combination we are able to derive a so-called projected confidence value, which is the average specificity of ORF start codon prediction based on the eight genomes. The projected confidence enables estimating likeliness of a correct prediction for a particular ORF start codon by a particular AGE combination, pinpointing ORFs notoriously difficult to predict start codons. We correctly predict start codons for 90.5±4.8% of the genes in a genome (based on the eight genomes with an accuracy of 81.1±7.6%. Our consensus-path methodology allows a marked improvement over majority voting (9.7±4.4% and with an optimal path ORF start prediction sensitivity is gained while maintaining a high specificity.

  16. Multiple cranial nerve palsies complicating tympanomastoiditis: case ...

    African Journals Online (AJOL)

    Otitis media either acute or chronic, is not uncommon in childhood. Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual. A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is ...

  17. Reliability of assessing the sensory perception of children with profound intellectual and multiple disabilities : a case study

    NARCIS (Netherlands)

    Vlaskamp, C.; Cuppen-Fonteine, H.

    Background This study describes preliminary stages of developing a checklist to enable practitioners to determine the behavioural responses of children with profound intellectual and multiple disabilities to sensory stimuli. Reliability of currently used checklists is low, with a focus on the

  18. Connections between Future Time Perspectives and Self-Regulated Learning for Mid-Year Engineering Students: A Multiple Case Study

    Science.gov (United States)

    Chasmar, Justine

    2017-01-01

    This dissertation presents multiple studies with the purpose of understanding the connections between undergraduate engineering students' motivations, specifically students' Future Time Perspectives (FTPs) and Self-Regulated Learning (SRL). FTP refers to the views students hold about the future and how their perceptions of current tasks are…

  19. Social and Emotional Dynamics of College Students with Musical Intelligence and Musical Training: A Multiple Case Study

    Science.gov (United States)

    Pelayo, Jose Maria G., III; Galang, Edgar

    2013-01-01

    Music has been in its formal existence for so many years now and it has also been utilized to enhance, relax and help man's meditation. This study focused on how music can or may influence an individual. The researchers investigated and described the influence of Howard Gardner's theory on Multiple Intelligence (specifically, musical…

  20. Topological characteristics of brainstem lesions in clinically definite and clinically probable cases of multiple sclerosis: An MRI-study

    International Nuclear Information System (INIS)

    Brainin, M.; Omasits, M.; Reisner, T.; Neuhold, A.; Wicke, L.

    1987-01-01

    Disseminated lesions in the white matter of the cerebral hemispheres and confluent lesions at the borders of the lateral ventricles as seen on MRI are both considered acceptable paraclinical evidence for the diagnosis of multiple sclerosis. Similar changes are, however, also found in vascular diseases of the brain. We therefore aimed at identifying those additional traits in the infratentorial region, which in our experience are not frequently found in cerebrovascular pathology. We evaluated MR brain scans of 68 patients and found pontine lesions in 71% of cases with a clinically definite diagnosis (17 out of 24) and in 33% of cases with a probable diagnosis (14 out of 43). Lesions in the medulla oblongata were present in 50% and 16%, respectively, and in the midbrain in 25% and 7%, respectively. With rare exceptions all brainstem lesions were contiguous with the cisternal or ventricular cerebrospinal fluid spaces. In keeping with post-mortem reports the morphological spectrum ranged from large confluent patches to solitary, well delineated paramedian lesions or discrete linings of the cerebrospinal fluid border zones and were most clearly depicted from horizontal and sagittal T2 weighted SE-sequences. If there is a predilection for the outer or inner surfaces of the brainstem, such lesions can be considered an additional typical feature of multiple sclerosis and can be more reliably weighted as paraclinical evidence for a definite diagnosis. (orig.)

  1. Comorbidity of Bipolar Disorder and Multiple Sclerosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Necla Keskin

    2013-08-01

    Full Text Available Multiple sclerosis is a chronic demyelinating disease of a central nervous system. Neuropsychiatric symptoms are common in multiple sclerosis and bipolar disorder is one of the most common psychiatric disorders that coexist with multiple sclerosis. Manic episodes may be the first presenting symptom of multiple sclerosis as comorbid pathology or as an adverse effect of pharmacotherapies used in multiple sclerosis. The comorbidity of bipolar disorder and multiple sclerosis is well-proven but its etiology is not known and investigated accurately. Recent studies support a common genetic susceptibility. Management of bipolar disorder in multiple sclerosis is based on evidence provided by case reports and treatment should be individualized. In this report, the association between bipolar disorder and multiple sclerosis, epidemiology, ethiology and treatment is discussed through a case had diagnosed as multiple sclerosis and had a manic episode with psychotic features. [Cukurova Med J 2013; 38(4.000: 832-836

  2. Collaborative Care for patients with severe borderline and NOS personality disorders: A comparative multiple case study on processes and outcomes

    Directory of Open Access Journals (Sweden)

    Koekkoek Bauke

    2011-06-01

    Full Text Available Abstract Background Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer access to psychotherapy a Collaborative Care Program (CCP is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen

  3. Appropriating Scientific Vocabulary in Chemistry Laboratories: A Multiple Case Study of Four Community College Students with Diverse Ethno-Linguistic Backgrounds

    Science.gov (United States)

    Cink, Ruth B.; Song, Youngjin

    2016-01-01

    This multiple case study investigated how college students with diverse ethno-linguistic backgrounds used chemistry vocabulary as a way to look at their discursive identities and cultural border crossings during first semester general chemistry laboratories. The data were collected in two major forms: video-taped laboratory observations and…

  4. Older Sibling Support of Younger Siblings' Socio-Emotional Development: A Multiple-Case Study of Second-Generation Mexican and Honduran Children's Initiative and Co-Construction

    Science.gov (United States)

    Palacios, Natalia; Kibler, Amanda K.; Yoder, Michelle; Baird, Ashley Simpson; Bergey, Rebecca

    2016-01-01

    Siblings play a critical role in the socialization experiences of their younger siblings. Societal values, standards, and customs are transmitted and created through the process of modeling and the construction of shared meaning. It follows, therefore, that the process of socialization may be culturally dependent. Using multiple case studies of…

  5. Evaluation of Hemodynamic Properties of Cerebral Venous Drainage in Patients with Multiple Sclerosis: A Case-Control Study

    International Nuclear Information System (INIS)

    Jandaghi, Ali Babaei; Amanian, Dayan; Roudbari, Seyed Ali; Kanafi, Alireza Rajabzadeh; Pourghorban, Ramin

    2014-01-01

    The purpose of this study was to compare patients with multiple sclerosis and healthy control subjects as regards hemodynamics of cerebral venous drainage. Between December 2012 and May 2013, 44 consecutive patients with multiple sclerosis and 44 age- and sex-matched healthy subjects underwent the B-mode, color Doppler, and duplex Doppler evaluations of the internal jugular vein (IJV) and vertebral vein. The following four parameters were investigated: IJV stenosis, reversal of postural control of the cerebral venous outflow pathways, absence of detectable blood flow in the IJVs and/or vertebral veins, and reflux in the IJVs and/or vertebral veins in the sitting or supine position. In the study group, IJV stenosis, postural control reversal of the cerebral venous outflow pathways, and absence of flow in the IJVs and/or vertebral veins were found in 3 (6.8%), 2 (4.5%), and 3 (6.8%) patients, respectively. In the control group, IJV stenosis (P=0.12), postural control reversal of the cerebral venous outflow pathways (P=0.50), and absence of flow (P=0.12) were not detected. Abnormal reflux was found neither in multiple sclerosis patients nor in healthy subjects. No significant difference in the cerebral venous drainage through the IJV or vertebral vein was found between patients with multiple sclerosis and healthy subjects within any of the investigated ultrasonographic parameters

  6. System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study.

    Science.gov (United States)

    Haddad, Slim; Bicaba, Abel; Feletto, Marta; Taminy, Elie; Kabore, Moussa; Ouédraogo, Boubacar; Contreras, Gisèle; Larocque, Renée; Fournier, Pierre

    2009-10-14

    Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso. A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team. The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks). The discourse on factors that determine the performance or

  7. Multiple Personality Disorder: Concepts and Cases.

    Science.gov (United States)

    Lindsley, Hope L.

    1992-01-01

    Presents two case examples illustrating nature and etiology of multiple personality disorder in two clients and describing their entry into counseling and progress through treatment. Compares and contrasts cases in areas of diagnosis, symptoms, history, and treatment. Suggests that mental health counselors combine firmness with flexibility in…

  8. Season of infectious mononucleosis as a risk factor for multiple sclerosis: A UK primary care case-control study.

    Science.gov (United States)

    Downham, Christina; Visser, Elizabeth; Vickers, Mark; Counsell, Carl

    2017-10-01

    Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. We identified all patients with MS diagnosed aged 16-60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Based on 9247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). We found no evidence that the season of IM influences the risk of subsequent MS. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. A female sex offender with multiple paraphilias: a psychologic, physiologic (laboratory sexual arousal) and endocrine case study.

    Science.gov (United States)

    Cooper, A J; Swaminath, S; Baxter, D; Poulin, C

    1990-05-01

    A 20 year old female pedophile exhibiting multiple paraphilias and who had been both a victim of incest and an active participant, undertook extensive clinical, psychometric, endocrine and laboratory sexual arousal studies. Her psychiatric, psychometric and physiologic arousal profiles showed similarities to those of a sizable proportion of male child molesters, especially incestors. It is suggested that laboratory arousal tests (using the vaginal photoplethysmograph) may have a role in the assessment of some female sex offenders.

  10. Risks in major innovation projects, a multiple case study within a world's leading company in the fast moving consumer goods

    NARCIS (Netherlands)

    Keizer, J.A.; Halman, J.I.M.

    2009-01-01

    This paper investigates which risks characterise radical innovation projects. In-dept case studies were carried out via interviews and a questionnaire. The risk concept applied in this study includes three dimensions: certainty, controllability and impact. Three structural or unambiguous risks were

  11. Epidemiologic study of neural tube defects in Los Angeles County. I. Prevalence at birth based on multiple sources of case ascertainment

    Energy Technology Data Exchange (ETDEWEB)

    Sever, L.E. (Pacific Northwest Lab., Richland, WA); Sanders, M.; Monsen, R.

    1982-01-01

    Epidemiologic studies of the neural tube defects (NTDs), anencephalus and spina bifida, have for the most part been based on single sources of case ascertainment in past studies. The present investigation attempts total ascertainment of NTD cases in the newborn population of Los Angeles County residents for the period 1966 to 1972. Design of the study, sources of data, and estimates of prevalence rates based on single and multiple sources of case ascertainment are here discussed. Anencephalus cases totaled 448, spina bifida 442, and encephalocele 72, giving prevalence rates of 0.52, 0.51, and 0.08 per 1000 total births, respectively, for these neural tube defects - rates considered to be low. The Los Angeles County prevalence rates are compared with those of other recent North American studies and support is provided for earlier suggestions of low rates on the West Coast.

  12. Hydrological Process Simulation of Inland River Watershed: A Case Study of the Heihe River Basin with Multiple Hydrological Models

    OpenAIRE

    Lili Wang; Zhonggen Wang; Jingjie Yu; Yichi Zhang; Suzhen Dang

    2018-01-01

    Simulating the hydrological processes of an inland river basin can help provide the scientific guidance to the policies of water allocation among different subbasins and water resource management groups within the subbasins. However, it is difficult to simulate the hydrological processes of an inland river basin with hydrological models due to the non-consistent hydrological characteristics of the entire basin. This study presents a solution to this problem with a case study about the hydrolo...

  13. Challenging conventional risk assessment with respect to human exposure to multiple food contaminants in food: A case study using maize.

    Science.gov (United States)

    Clarke, R; Connolly, L; Frizzell, C; Elliott, C T

    2015-10-01

    Mycotoxins and heavy metals are ubiquitous in the environment and contaminate many foods. The widespread use of pesticides in crop production to control disease contributes further to the chemical contamination of foods. Thus multiple chemical contaminants threaten the safety of many food commodities; hence the present study used maize as a model crop to identify the severity in terms of human exposure when multiple contaminants are present. High Content Analysis (HCA) measuring multiple endpoints was used to determine cytotoxicity of complex mixtures of mycotoxins, heavy metals and pesticides. Endpoints included nuclear intensity (NI), nuclear area (NA), plasma membrane permeability (PMP), mitochondrial membrane potential (MMP) and mitochondrial mass (MM). At concentrations representing legal limits of each individual contaminant in maize (3ng/ml ochratoxin A (OTA), 1μg/ml fumonisin B1 (FB1), 2ng/ml aflatoxin B1 (AFB1), 100ng/ml cadmium (Cd), 150ng/ml arsenic (As), 50ng/ml chlorpyrifos (CP) and 5μg/ml pirimiphos methyl (PM), the mixtures (tertiary mycotoxins plus Cd/As) and (tertiary mycotoxins plus Cd/As/CP/PM) were cytotoxic for NA and MM endpoints with a difference of up to 13.6% (p≤0.0001) and 12% (p≤0.0001) respectively from control values. The most cytotoxic mixture was (tertiary mycotoxins plus Cd/As/CP/PM) across all 4 endpoints (NA, NI, MM and MMP) with increases up to 61.3%, 23.0%, 61.4% and 36.3% (p≤0.0001) respectively. Synergy was evident for two endpoints (NI and MM) at concentrations contaminating maize above legal limits, with differences between expected and measured values of (6.2-12.4% (p≤0.05-p≤0.001) and 4.5-12.3% (p≤0.05-p≤0.001) for NI and MM, respectively. The study introduces for the first time, a holistic approach to identify the impact in terms of toxicity to humans when multiple chemical contaminants are present in foodstuffs. Governmental regulatory bodies must begin to contemplate how to safeguard the population when

  14. Multiple approaches to characterize the microbial community in a thermophilic anaerobic digester running on swine manure: a case study.

    Science.gov (United States)

    Tuan, Nguyen Ngoc; Chang, Yi-Chia; Yu, Chang-Ping; Huang, Shir-Ly

    2014-01-01

    In this study, the first survey of microbial community in thermophilic anaerobic digester using swine manure as sole feedstock was performed by multiple approaches including denaturing gradient gel electrophoresis (DGGE), clone library and pyrosequencing techniques. The integrated analysis of 21 DGGE bands, 126 clones and 8506 pyrosequencing read sequences revealed that Clostridia from the phylum Firmicutes account for the most dominant Bacteria. In addition, our analysis also identified additional taxa that were missed by the previous researches, including members of the bacterial phyla Synergistetes, Planctomycetes, Armatimonadetes, Chloroflexi and Nitrospira which might also play a role in thermophilic anaerobic digester. Most archaeal 16S rRNA sequences could be assigned to the order Methanobacteriales instead of Methanomicrobiales comparing to previous studies. In addition, this study reported that the member of Methanothermobacter genus was firstly found in thermophilic anaerobic digester. Copyright © 2014 Elsevier GmbH. All rights reserved.

  15. Multiple Hereditary Osteochondromatosis: A Case Report

    OpenAIRE

    K???kesmen, ?i?dem; ?zen, Bu?ra; Ak?am, Mustafa

    2007-01-01

    Objectives Common carious lesions owing to vomiting are not widespread in children. In this case, we aimed to report an 11-years-old male patient with common carious lesions due to repeated vomitings, chewing and eating difficulty and retarded growth with Multiple Hereditary Osteochondromatosis (MHO). Case Report An 11-years-old boy was referred to Department of Pediatric Dentistry in Faculty of Dentistry because of eating difficulty owing to common carious lesions. It was seen that the patie...

  16. The Impact of Five VDR Polymorphisms on Multiple Sclerosis Risk and Progression: a Case-Control and Genotype-Phenotype Study.

    Science.gov (United States)

    Křenek, Pavel; Benešová, Yvonne; Bienertová-Vašků, Julie; Vašků, Anna

    2018-04-01

    Vitamin D receptor polymorphisms have been the target of many studies focusing on multiple sclerosis. However, previously reported results have been inconclusive. The objective of this study was to investigate the association between five vitamin D receptor polymorphisms (EcoRV, FokI, ApaI, TaqI, and BsmI) and multiple sclerosis susceptibility and its course. The study was carried out as a case-control and genotype-phenotype study, consisted of 296 Czech multiple sclerosis patients and 135 healthy controls. Genotyping was carried out using polymerase chain reaction and restriction analysis. In multiple sclerosis men, allele and/or genotype distributions differed in EcoRV, TaqI, BsmI, and ApaI polymorphisms as compared to controls (EcoRV, p a = 0.02; Taq, p g = 0.02, p a = 0.02; BsmI, p g = 0.02, p a = 0.04; ApaI, p g = 0.008, p a = 0.005). In multiple sclerosis women, differences in the frequency of alleles and genotypes were found to be significant in ApaI (controls vs multiple sclerosis women: p g = 0.01, p a = 0.05). Conclusive results were observed between multiple sclerosis women in the case of EcoRV [differences in Expanded Disability Status Scale (p = 0.05); CT genotype was found to increase the risk of primary progressive multiple sclerosis 5.5 times (CT vs CC+TT p corr = 0.01, sensitivity 0.833, specificity 0.525, power test 0.823)] and FokI [borderline difference in Multiple Sclerosis Severity Score (p = 0.05)]. Our results indicate that the distribution of investigated vitamin D receptor polymorphisms is a risk factor for multiple sclerosis susceptibility and progression in the Czech population. The association between disease risk and polymorphisms was found to be stronger in men. The association of disease progression with polymorphisms was observed only in women.

  17. Important considerations for feasibility studies in physical activity research involving persons with multiple sclerosis: a scoping systematic review and case study.

    Science.gov (United States)

    Learmonth, Yvonne C; Motl, Robert W

    2018-01-01

    Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis (MS). There is disagreement regarding the strength of this research, perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing. We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS. A systematic scoping review was conducted based on a literature search of five databases to identify feasibility processes described in preliminary studies of physical activity in MS. We read and extracted methodology from each study based on the following feasibility metrics: process (e.g. recruitment), resource (e.g. monetary costs), management (e.g. personnel time requirements) and scientific outcomes (e.g. clinical/participant reported outcome measures). We illustrate the use of the four feasibility metrics within a randomised controlled trial of a home-based exercise intervention in persons with MS. Twenty-five studies were identified. Resource feasibility (e.g. time and resources) and scientific outcomes feasibility (e.g. clinical outcomes) methodologies were applied and described in many studies; however, these metrics have not been systematically addressed. Metrics related to process feasibility (e.g. recruitment) and management feasibility (e.g. human and data management) are not well described within the literature. Our case study successfully enabled us to address the four feasibility metrics, and we provide new information on management feasibility (i.e. estimate data completeness and estimate data entry) and scientific outcomes feasibility (i.e. determining data collection materials appropriateness). Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility. This review serves as a clarion call for feasibility trials that will

  18. Impact on creatinine renal clearance by the interplay of multiple renal transporters: a case study with INCB039110.

    Science.gov (United States)

    Zhang, Yan; Warren, Mark S; Zhang, Xuexiang; Diamond, Sharon; Williams, Bill; Punwani, Naresh; Huang, Jane; Huang, Yong; Yeleswaram, Swamy

    2015-04-01

    Serum creatinine is commonly used as a marker of renal function, but increases in serum creatinine might not represent changes in glomerular filtration rate (GFR). INCB039110 (2-(3-(4-(7H-pyrrolo[2,3-day]pyrimidin-4-yl)-1H-pyrazol-1-yl)-1-(1-(3-fluoro-2-(trifluoromethyl)isonicotinoyl)piperidin-4-yl)azetidin-3-yl)acetonitrile) is an inhibitor of the Janus kinases (JAKs) with selectivity for JAK1. In a phase 1 study, a modest and reversible increase in serum creatinine was observed after treatment with INCB039110. However, a dedicated renal function study with INCB039110, assessed by iohexol plasma clearance, conducted in healthy volunteers indicated no change in GFR. In vitro studies were therefore conducted to investigate the interaction of INCB039110 with five transporters that are likely involved in the renal clearance of creatinine. Cell systems expressing individual or multiple transporters were used, including a novel quintuple-transporter model OAT2/OCT2/OCT3/MATE1/MATE2-K. INCB039110 potently inhibited OCT2-mediated uptake of creatinine as well as MATE1-/MATE2-K-mediated efflux of creatinine. Given the interactions of INCB039110 with multiple transporters affecting creatinine uptake and efflux, an integrated system expressing all five transporters was sought; in that system, INCB039110 caused a dose-dependent decrease in transcellular transport of creatinine with weaker net inhibition compared with the effects on individual transporters. In summary, a molecular mechanism for the increase in serum creatinine by INCB039110 has been established. These studies also underline the limitations of using serum creatinine as a marker of renal function. Copyright © 2015 by The American Society for Pharmacology and Experimental Therapeutics.

  19. Increasing Absorptive Capacity to Improve Internal and External Knowledge Transfer in Multinational Companies: A Multiple Case Study Approach

    Directory of Open Access Journals (Sweden)

    Béla-Gergely RÁCZ

    2016-12-01

    Full Text Available This study investigates how the absorptive capacity could be increased to improve internal and external knowledge transfer in subsidiaries of multinational companies. We look at the way in which the literature on absorptive capacity has evolved, and how it links the internal and external knowledge transfer. Based on 3 case studies conducted at Romanian subsidiaries of multinational companies, we find some patterns, which could explain how the successful knowledge flows should be managed within the multinational company and outside of it, in the supply chain network.

  20. Free Material Design with Multiple Load Cases

    DEFF Research Database (Denmark)

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2012-01-01

    Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together with a prac......Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together...... with a practical recursive design procedure is presented and illustrated with examples. The presented finite element analysis involve many elements as well as many load cases. Separating the local amount of material from a description with unit trace for the local anisotropy, gives the free materials formulation...... a more physical interpretation of the material constraint....

  1. Blood erythrocyte concentrations of cadmium and lead and the risk of B-cell non-Hodgkin's lymphoma and multiple myeloma: a nested case-control study.

    Directory of Open Access Journals (Sweden)

    Rachel S Kelly

    Full Text Available BACKGROUND: Cadmium (Cd and lead (Pb are hypothesised to be risk factors for non-Hodgkin's lymphoma (NHL, a group of haematological malignancies with a suspected environmental aetiology. Within the EnviroGenoMarkers study we utilised pre-diagnostic erythrocyte concentrations of Cd and Pb to determine whether exposure was associated with risk of B-cell NHL and multiple myeloma. METHODS: 194 incident cases of B-cell NHL and 76 cases of multiple myeloma diagnosed between 1990 and 2006 were identified from two existing cohorts; EPIC-Italy and the Northern Sweden Health and Disease Study. Cases were matched to healthy controls by centre, age, gender and date of blood collection. Cd and Pb were measured in blood samples provided at recruitment using inductively coupled plasma-mass spectrometry. Logistic regression was applied to assess the association with risk. Analyses were stratified by cohort and gender and by subtype where possible. RESULTS: There was little evidence of an increased risk of B-cell NHL or multiple myeloma with exposure to Cd (B-cell NHL: OR 1.09 95%CI 0.61, 1.93, MM: OR 1.16 95% CI: 0.40, 3.40 or Pb (B-cell NHL: 0.93 95% CI 0.43, 2.02, multiple myeloma: OR 1.63 95%CI 0.45, 5.94 in the total population when comparing the highest to the lowest quartile of exposure. However, gender and cohort specific differences in results were observed. In females the risk of B-cell NHL was more than doubled in those with a body burden of Cd >1 µg/L (OR 2.20 95%CI; 1.04, 4.65. CONCLUSIONS: This nested case-control study does not support a consistent positive association between Cd or Pb and NHL, but there is some indication of a gender specific effect suggesting further research is warranted.

  2. CASE STUDY

    African Journals Online (AJOL)

    2011-06-02

    Jun 2, 2011 ... immunosuppression associated with HIV/AIDS puts them at a higher risk of developing oesophageal cancer. 47. CASE STUDY. A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/µl. He was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and ...

  3. Application of Probabilistic Multiple-Bias Analyses to a Cohort- and a Case-Control Study on the Association between Pandemrix™ and Narcolepsy.

    Directory of Open Access Journals (Sweden)

    Kaatje Bollaerts

    Full Text Available An increase in narcolepsy cases was observed in Finland and Sweden towards the end of the 2009 H1N1 influenza pandemic. Preliminary observational studies suggested a temporal link with the pandemic influenza vaccine Pandemrix™, leading to a number of additional studies across Europe. Given the public health urgency, these studies used readily available retrospective data from various sources. The potential for bias in such settings was generally acknowledged. Although generally advocated by key opinion leaders and international health authorities, no systematic quantitative assessment of the potential joint impact of biases was undertaken in any of these studies.We applied bias-level multiple-bias analyses to two of the published narcolepsy studies: a pediatric cohort study from Finland and a case-control study from France. In particular, we developed Monte Carlo simulation models to evaluate a potential cascade of biases, including confounding by age, by indication and by natural H1N1 infection, selection bias, disease- and exposure misclassification. All bias parameters were evidence-based to the extent possible.Given the assumptions used for confounding, selection bias and misclassification, the Finnish rate ratio of 13.78 (95% CI: 5.72-28.11 reduced to a median value of 6.06 (2.5th- 97.5th percentile: 2.49-15.1 and the French odds ratio of 5.43 (95% CI: 2.6-10.08 to 1.85 (2.5th-97.5th percentile: 0.85-4.08.We illustrate multiple-bias analyses using two studies on the Pandemrix™-narcolepsy association and advocate their use to better understand the robustness of study findings. Based on our multiple-bias models, the observed Pandemrix™-narcolepsy association consistently persists in the Finnish study. For the French study, the results of our multiple-bias models were inconclusive.

  4. Polymorphic locus rs10492972 of the KIF1B gene association with multiple sclerosis in Russia: case control study.

    Science.gov (United States)

    Kudryavtseva, Ekaterina A; Rozhdestvenskii, Aleksei S; Kakulya, Anastasia V; Khanokh, Elena V; Delov, Roman A; Malkova, Nadezhda A; Korobko, Denis S; Platonov, Fedor A; Aref Eva, Elena G; Zagorskaya, Natalia N; Aliferova, Valentina M; Titova, Marina A; Babenko, Sergei A; Smagina, Inna V; El Chaninova, Svetlana A; Zolovkina, Anna G; Lifshits, G I; Puzyrev, Valerii P; Filipenko, Maxim L

    2011-11-01

    Axonal degeneration is responsible for the progression of the irreversible destruction caused by multiple sclerosis (MS) resulting ultimately in permanent disability. The KIF1B protein, a member of the kinesin family, is necessary for axon growth and myelination in vertebrates. In the recent paper, Aulchenko et al. suggested that the rs10492972[C] variant of KIF1B increases susceptibility to MS, but three following replication study didn't confirm this association. We studied the association of the polymorphic locus rs10492972 present in the KIF1B gene with genetic predisposition and its occurrence in clinical presentations of MS patients resident in western Siberia and the Sakha Republic (Yakutia), Russia. rs10492972 has been genotype in 833 samples of MS patient and 689 healthy controls. Distribution of rs10492972 genotypes corresponded with a Hardy-Weinberg distribution in both the MS patient and control groups, with the frequency of the C allele being the same in both groups (33%). Frequencies of occurrence of the genotypes were not shown to be associated with different disease courses or other characteristics of the disease, such as age at onset or duration. A complete meta-analysis of all analogous studies published to date showed that the protective effect of the rs10492972[C] allele is statistically significant (OR=0.95, C.I.95% [0.90-0.99], p=0.02). Copyright © 2011. Published by Elsevier Inc.

  5. Creating advantages through franchising in healthcare: a qualitative, multiple embedded case study on the role of the business format.

    Science.gov (United States)

    Nijmeijer, Karlijn J; Huijsman, Robbert; Fabbricotti, Isabelle N

    2014-11-02

    Business format franchising is an organizational form that originates from the business sector. It is increasingly used in healthcare, being a promising organizational form for improving the competitiveness and efficiency of organizations, the quality of care, and the professional work environment. However, evidence is lacking concerning how these healthcare franchises should be designed to actually deliver the promised benefits. This study explores how the design of the central element in franchising, the business format (i.e., brand name, support systems, specification of the products and services), helps or hinders the achievement of positive results. A qualitative comparative embedded case study was conducted. The cases focused on three Dutch healthcare franchises providing mental healthcare, hospital care and care for the intellectually disabled. The data were collected through document analyses, observations, and 96 in-depth, semi-structured interviews with franchisors and unit actors (franchisees, unit managers, professionals). The interviews were recorded and transcribed verbatim. A conceptual model based on a systematic review of studies in other industries was used as an initial method for coding the data. New inductive codes were used to enrich and extend the analysis. The data were subjected to within-case and cross-case comparative thematic analyses. Different business format designs have different effects on results, as perceived by franchisors and unit actors. The analysis revealed how this variation in perceived effects can be explained by different dynamics with regard to system-wide adaptation, local adaptation, professionals' resistance to change, ease of knowledge sharing, bureaucracy, overhead, uniform brand presentation, accelerating effects and reliable performance levels. The analysis resulted in a new typology of four types of business formats, showing how combinations of business format elements facilitate or hinder the achievement of

  6. Using macroinvertebrate assemblages and multiple stressors to infer urban stream system condition: A case study in the central US

    Science.gov (United States)

    Nichols, John W.; Hubbart, Jason A.; Poulton, Barry C.

    2016-01-01

    Characterizing the impacts of hydrologic alterations, pollutants, and habitat degradation on macroinvertebrate species assemblages is of critical value for managers wishing to categorize stream ecosystem condition. A combination of approaches including trait-based metrics and traditional bioassessments provides greater information, particularly in anthropogenic stream ecosystems where traditional approaches can be confounded by variously interacting land use impacts. Macroinvertebrates were collected from two rural and three urban nested study sites in central Missouri, USA during the spring and fall seasons of 2011. Land use responses of conventional taxonomic and trait-based metrics were compared to streamflow indices, physical habitat metrics, and water quality indices. Results show that biotic index was significantly different (p habitats in urban reaches contained 21 % more (p = 0.03) multivoltine organisms, which was positively correlated to the magnitude of peak flows (r2 = 0.91, p = 0.012) suggesting that high flow events may serve as a disturbance in those areas. Results support the use of macroinvertebrate assemblages and multiple stressors to characterize urban stream system condition and highlight the need to better understand the complex interactions of trait-based metrics and anthropogenic aquatic ecosystem stressors.

  7. Stroke patients' utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation.

    Science.gov (United States)

    Parker, Jack; Mawson, Susan; Mountain, Gail; Nasr, Nasrin; Zheng, Huiru

    2014-06-05

    Evidence indicates that post-stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner.Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, 'what works for whom and in what circumstances and respects?' Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Findings suggest that the theory-driven mechanisms

  8. Multiple parameters anomalies for verifying the geosystem spheres coupling effect: a case study of the 2010 Ms7.1 Yushu earthquake in China

    Directory of Open Access Journals (Sweden)

    Shuo Zheng

    2014-08-01

    Full Text Available In the research of earthquake anomaly recognition, the coupling effect of multiple geosystem spheres can be expected to reasonably interpretating the correlation between various anomalous signals before strong earthquake. Specially, the development of the Lithosphere–Atmosphere–Ionosphere (LAI coupling model has been accepted as verified by some experimental, thermal and electromagnetic data. However, quasi-synchronous anomalies of the multiple parameters, including thermal, radon and electromagnetic data, have not been reported in a single event case for verifying the geosystem spheres coupling effect. In this paper, we firstly summarized the reported studies on the power spectrum density (PSD in the ELF/VLF band and radon data recorded from Guza seismic station. Then, historical surface latent heat flux (SLHF data from the NCEP/NCAR Reanalysis Project was employed for investigating anomalous change in a month before the April 14, 2010, Ms7.1 Yushu earthquake which is one of the typical intra-continental earthquakes in Tibet Plateau. The results from spatial and temporal analysis revealed that anomalous fields of PSD and SLHF data were located close to the epicenter and the ends of some active faults at Bayan Har Block and all anomalous dates converged between April 8 and 11 (6 to 3 days before the Yushu earthquake. Therefore, we suggest that the anomalies of multiple parameters before the main shock are related with the Yushu earthquake. This paper could give an ideal case study to verify the geosystem spheres coupling effect happened in a single event.

  9. Multiple Drivers of Local (Non- Compliance in Community-Based Marine Resource Management: Case Studies from the South Pacific

    Directory of Open Access Journals (Sweden)

    Janne R. Rohe

    2017-05-01

    Full Text Available The outcomes of marine conservation and related management interventions depend to a large extent on people's compliance with these rule systems. In the South Pacific, community-based marine resource management (CBMRM has gained wide recognition as a strategy for the sustainable management of marine resources. In current practice, CBMRM initiatives often build upon customary forms of marine governance, integrating scientific advice and management principles in collaboration with external partners. However, diverse socio-economic developments as well as limited legal mandates can challenge these approaches. Compliance with and effective (legally-backed enforcement of local management strategies constitute a growing challenge for communities—often resulting in considerable impact on the success or failure of CBMRM. Marine management arrangements are highly dynamic over time, and similarly compliance with rule systems tends to change depending on context. Understanding the factors contributing to (non- compliance in a given setting is key to the design and function of adaptive management approaches. Yet, few empirical studies have looked in depth into the dynamics around local (non- compliance with local marine tenure rules under the transforming management arrangements. Using two case studies from Solomon Islands and Fiji, we investigate what drives local (non- compliance with CBMRM and what hinders or supports its effective enforcement. The case studies reveal that non-compliance is mainly driven by: (1 diminishing perceived legitimacy of local rules and rule-makers; (2 increased incentives to break rules due to market access and/ or lack of alternative income; and (3 relatively weak enforcement of local rules (i.e., low perceptions of risk from sanctions for rule-breaking. These drivers do not stand alone but can act together and add up to impair effective management. We further analyze how enforcement of CBMRM is challenged through a range of

  10. A Tracking Analyst for large 3D spatiotemporal data from multiple sources (case study: Tracking volcanic eruptions in the atmosphere)

    Science.gov (United States)

    Gad, Mohamed A.; Elshehaly, Mai H.; Gračanin, Denis; Elmongui, Hicham G.

    2018-02-01

    This research presents a novel Trajectory-based Tracking Analyst (TTA) that can track and link spatiotemporally variable data from multiple sources. The proposed technique uses trajectory information to determine the positions of time-enabled and spatially variable scatter data at any given time through a combination of along trajectory adjustment and spatial interpolation. The TTA is applied in this research to track large spatiotemporal data of volcanic eruptions (acquired using multi-sensors) in the unsteady flow field of the atmosphere. The TTA enables tracking injections into the atmospheric flow field, the reconstruction of the spatiotemporally variable data at any desired time, and the spatiotemporal join of attribute data from multiple sources. In addition, we were able to create a smooth animation of the volcanic ash plume at interactive rates. The initial results indicate that the TTA can be applied to a wide range of multiple-source data.

  11. Success and failure in integrated models of nursing for long term conditions: multiple case studies of whole systems.

    Science.gov (United States)

    Procter, Susan; Wilson, Patricia Mary; Brooks, Fiona; Kendall, Sally

    2013-05-01

    Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. Case study whole systems analysis using qualitative interview methods. Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. Semi-structured interviews with all participants, thematic analysis within a whole system framework. The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of

  12. Taxation of multiple greenhouse gases and the effects on income distribution : A case study of the Netherlands

    NARCIS (Netherlands)

    Kerkhof, Annemarie C.; Moll, Henri C.; Drissen, Eric; Wilting, Harry C.

    2008-01-01

    Current economic instruments aimed at climate change mitigation focus on CO2 emissions only, but the Kyoto Protocol refers to other greenhouse gases (GHG) as well as CO2. These are CH4, N2O, HFCs, PFCs and SF6. Taxation of multiple greenhouse gases improves the cost-effectiveness of climate change

  13. Statistical methods for QTL mapping and genomic prediction of multiple traits and environments: case studies in pepper

    NARCIS (Netherlands)

    Alimi, Nurudeen Adeniyi

    2016-01-01

    In this thesis we describe the results of a number of quantitative techniques that were used to understand the genetics of yield in pepper as an example of complex trait measured in a number of environments. Main objectives were; i) to propose a number of mixed models to detect QTLs for multiple

  14. [Association of Kaposi sarcoma--multiple myeloma. A new case].

    Science.gov (United States)

    Cohen, J D; Thomas, E; Garnier, N; Hellier, I; Durand, L; Guilhou, J J; Baldet, P; Blotman, F

    2000-11-01

    Kaposi's disease is an angiogenic multifocal cancer process that has several forms, namely Mediterranean, African, HIV-associated, and secondary to a preexisting immunodepressive state (hematological disorder, corticosteroid therapy, immunodepressive treatment). Whatever its form, Kaposi's sarcoma is probably associated with a chronic viral human herpes type 8 infection (HHV8). This virus has been implicated in the pathogenesis of multiple myeloma (17 cases recorded to date). In the present study, a further case of Kaposi's sarcoma associated with multiple myeloma has been reported. However, Epstein-Barr virus, cytomegalovirus, hepatitis B and C, HIV and HHV8 serologies were negative. Radiotherapy on the lower limbs was initiated. It is concluded that HHV8 does not appear to play a pathogenic role in cases of multiple myeloma, given the rarity of the association between Kaposi's sarcoma/multiple myeloma/HHV8.

  15. Distribution of maternal age and birth order groups in cases with unclassified multiple congenital abnormalities according to the number of component abnormalities: a national population-based case-control study.

    Science.gov (United States)

    Csermely, Gyula; Czeizel, Andrew E; Veszprémi, Béla

    2015-02-01

    Multiple congenital abnormalities are caused by chromosomal aberrations, mutant major genes and teratogens. A minor proportion of these patients are identified as syndromes but the major part belonging to the group of unclassified multiple CAs (UMCAs). The main objective of this study was to evaluate the maternal age and birth order in pregnant women who had offspring affected with UMCA. The strong association between numerical chromosomal aberrations, e.g., Down syndrome and advanced maternal age is well-known and tested here. The Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980 to 1996, yielded a large population-based national data set with 22,843 malformed newborns or fetuses ("informative cases") included 1349 UMCA cases with their 2407 matched controls. Case-control comparison of maternal age and birth order was made for cases with UMCA, stratified by component numbers and their controls. In addition, 834 cases with Down syndrome were compared to 1432 matched controls. The well-known advanced maternal age with the higher risk for Down syndrome was confirmed. The findings of the study suggest that the young age of mothers associates with the higher risk of UMCA, in addition birth order 4 or more associates with the higher risk for UMCA with 2 and 3 component CAs. This study was the first to analyze the possible maternal and birth order effect for cases with UMCA, and the young age and higher birth order associated with a higher risk for UMCA. © 2014 Wiley Periodicals, Inc.

  16. Casing study

    Energy Technology Data Exchange (ETDEWEB)

    Roche, P.

    2000-12-01

    An unorthodox method of casing drilling used by Tesco Corporation at a gas well in Wyoming to drill deeper using casings as drillpipe is discussed. The process involves either rotating the casing as drill string or using a downhole mud motor to rotate the bit. In this instance, the surface hole and the production hole were casing-drilled to a record 8,312 feet by rotating the casing. The 8 1/2-inch surface hole was drilled with 7-inch casing to 1,200 feet using a Tesco underreamer and a polycrystalline pilot bit; drilling and cementing was completed in 12 1/2 hours. The 6 1/4-inch production hole was drilled with 4 1/2-inch casing and the bottomhole assembly was retrieved after 191 hours rotating. This case was the first in which the entire well was casing-drilled from surface to TD. Penetration rate compared favorably with conventional methods: 12 1/2 hours for casing-drilling to 18.9 hours for conventional drilling, despite the fact that the casing-drilling technology is still in its infancy. It is suggested that casing-drilling has the potential to eliminate the need for the drillpipe entirely. If these expectations were to be realised, casing-drilling could be one of the most radical drilling changes in the history of the oil and gas industry. 1 photo.

  17. Human-centered approaches in geovisualization design: investigating multiple methods through a long-term case study.

    Science.gov (United States)

    Lloyd, David; Dykes, Jason

    2011-12-01

    Working with three domain specialists we investigate human-centered approaches to geovisualization following an ISO13407 taxonomy covering context of use, requirements and early stages of design. Our case study, undertaken over three years, draws attention to repeating trends: that generic approaches fail to elicit adequate requirements for geovis application design; that the use of real data is key to understanding needs and possibilities; that trust and knowledge must be built and developed with collaborators. These processes take time but modified human-centred approaches can be effective. A scenario developed through contextual inquiry but supplemented with domain data and graphics is useful to geovis designers. Wireframe, paper and digital prototypes enable successful communication between specialist and geovis domains when incorporating real and interesting data, prompting exploratory behaviour and eliciting previously unconsidered requirements. Paper prototypes are particularly successful at eliciting suggestions, especially for novel visualization. Enabling specialists to explore their data freely with a digital prototype is as effective as using a structured task protocol and is easier to administer. Autoethnography has potential for framing the design process. We conclude that a common understanding of context of use, domain data and visualization possibilities are essential to successful geovis design and develop as this progresses. HC approaches can make a significant contribution here. However, modified approaches, applied with flexibility, are most promising. We advise early, collaborative engagement with data – through simple, transient visual artefacts supported by data sketches and existing designs – before moving to successively more sophisticated data wireframes and data prototypes. © 2011 IEEE

  18. A Case Study Using CRA to Teach Students with Disabilities to Count Using Flexible Numbers: Applying Skip Counting to Multiplication

    Science.gov (United States)

    Gibbs, Anna S.; Hinton, Vanessa M.; Flores, Margaret M.

    2018-01-01

    Children who struggle in mathematics have a limited understanding of the foundational processes of mathematics. A lack of conceptual understanding causes students to fall behind as they progress through the core curriculum. Children at high risk for developing mathematics disabilities fail to gain numeracy knowledge. The purpose of this case study…

  19. A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

    Science.gov (United States)

    Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

    2012-06-01

    Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media

  20. CASE STUDY

    African Journals Online (AJOL)

    HIV infection has several oral manifestations, including oral candidiasis and oral hairy leucoplakia. Occasionally unusual presentations requiring rigorous investigations are seen, and in these cases the diagnosis sometimes remains a dilemma owing to limited investigation facilities.1-3 We present the case of a patient who.

  1. Seasonal climate signals from multiple tree ring metrics: A case study of Pinus ponderosa in the upper Columbia River Basin

    Science.gov (United States)

    Dannenberg, Matthew P.; Wise, Erika K.

    2016-04-01

    Projected changes in the seasonality of hydroclimatic regimes are likely to have important implications for water resources and terrestrial ecosystems in the U.S. Pacific Northwest. The tree ring record, which has frequently been used to position recent changes in a longer-term context, typically relies on signals embedded in the total ring width of tree rings. Additional climatic inferences at a subannual temporal scale can be made using alternative tree ring metrics such as earlywood and latewood widths and the density of tree ring latewood. Here we examine seasonal precipitation and temperature signals embedded in total ring width, earlywood width, adjusted latewood width, and blue intensity chronologies from a network of six Pinus ponderosa sites in and surrounding the upper Columbia River Basin of the U.S. Pacific Northwest. We also evaluate the potential for combining multiple tree ring metrics together in reconstructions of past cool- and warm-season precipitation. The common signal among all metrics and sites is related to warm-season precipitation. Earlywood and latewood widths differ primarily in their sensitivity to conditions in the year prior to growth. Total and earlywood widths from the lowest elevation sites also reflect cool-season moisture. Effective correlation analyses and composite-plus-scale tests suggest that combining multiple tree ring metrics together may improve reconstructions of warm-season precipitation. For cool-season precipitation, total ring width alone explains more variance than any other individual metric or combination of metrics. The composite-plus-scale tests show that variance-scaled precipitation reconstructions in the upper Columbia River Basin may be asymmetric in their ability to capture extreme events.

  2. Final report on case studies

    DEFF Research Database (Denmark)

    Ljungberg, Daniel; McKelvey, Maureen; Lassen, Astrid Heidemann

    2012-01-01

    Case study as a research design means investigating a single or multiple instance(s) or setting(s) (i.e. a case) and its entire context to explain a phenomenon and its processes. This is achieved through detailed understanding, usually comprised of multiple sources of information. In this way, case...... studies attempt to provide as a complete an understanding of a (complex) phenomenon as possible. Within the AEGIS project, survey and case study research are complementary. They are complementary in the sense that the former can provide more generalizable evidence on a phenomenon in terms of cross......-sectional data, while the latter can provide more in-depth (qualitative) understanding on specific issues. In systematically examining the case studies, however, this report goes beyond a typical single case study. Here we provide a synthesis of 86 case studies. Multiple case studies, following similar focus...

  3. Structural characterization and discrimination of Chinese medicinal materials with multiple botanical origins based on metabolite profiling and chemometrics analysis: Clematidis Radix et Rhizoma as a case study.

    Science.gov (United States)

    Guo, Lin-Xiu; Li, Rui; Liu, Ke; Yang, Jie; Li, Hui-Jun; Li, Song-Lin; Liu, Jian-Qun; Liu, Li-Fang; Xin, Gui-Zhong

    2015-12-18

    Traditional Chinese medicines (TCMs)-based products are becoming more and more popular over the world. To ensure the safety and efficacy, authentication of Chinese medicinal materials has been an important issue, especially for that with multiple botanical origins (one-to-multiple). Taking Clematidis Radix et Rhizoma (CRR) as a case study, we herein developed an integrated platform based on metabolite profiling and chemometrics analysis to characterize, classify, and predict the "one-to-multiple" herbs. Firstly, the predominant constituents, triterpenoid saponins, in three Clematis CRR were rapid characterized by a novel UPLC-QTOF/MS-based strategy, and a total of 49 triterpenoid saponins were identified. Secondly, metabolite profiling was performed by UPLC-QTOF/MS, and 4623 variables were extracted and aligned as dataset. Thirdly, by using pattern recognition analysis, a clear separation of the three Clematis CRR was achieved as well as a total number of 28 variables were screened as the valuable variables for discrimination. By matching with identified saponins, these 28 variables were corresponding to 10 saponins which were identified as marker compounds. Fourthly, based on the relative intensity of the marker compounds-related variables, genetic algorithm optimized support vector machines (GA-SVM) was employed to predict the species of CRR samples. The obtained model showed excellent prediction performance with a prediction accuracy of 100%. Finally, a heatmap visualization was employed for clarifying the distribution of identified saponins, which could be useful for phytochemotaxonomy study of Clematis herbs. These results indicated that our proposed platform was a powerful tool for chemical profiling and discrimination of herbs with multiple botanical origins, providing promising perspectives in tracking the formulation processes of TCMs products. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Case study of conservation and community concerns for present and future multiple use of the Great Australian Bight

    Energy Technology Data Exchange (ETDEWEB)

    Flaherty, T. [Marine and Coastal Community Network, Henley Beach, SA (Australia)

    1996-12-31

    As part of the Australian National Strategy for ecologically sustainable development, State and Federal Governments have agreed to cooperate on action under the Ocean Rescue 2000 Program to develop a national representative system of Marine Protected Areas. As a component of this program an area of the Great Australian Bight has been the focus of a proposal for a large area multiple use marine park. Within the context of this workshop, however, the conservation and community considerations extend beyond this proposed area. There is a need for resolution of apparent and real conflict with conservation, fishing, tourism and mining objectives in the development of equitable policies in establishing a marine protected area for the significant region. In this paper current activities in the Great Australian Bight, conservation values and concerns, fisheries and conservation, and fisheries and potential conflict with future petroleum exploitation, are discussed. The marine animals of the area are outlined, and community conservation concerns are detailed. It is concluded that there is an increasing need for States to develop a strategic approach to marine management. The adoption of marine bio-regionalisation methodology to define areas of significant biodiversity, representative marine protected areas and the development of a marine conservation and management strategy can be seen as essential components in the management of the marine environment. (author). refs.

  5. InGaN/GaN multiple-quantum well heterostructures for solar cells grown by MOVPE: case studies

    Energy Technology Data Exchange (ETDEWEB)

    Mukhtarova, Anna; Valdueza-Felip, Sirona; Durand, Christophe; Pan, Qing; Monroy, Eva; Eymery, Joel [CEA-CNRS-UJF Group ' ' Nanophysique et semi-conducteurs' ' , CEA/INAC/SP2M, Grenoble (France); Grenet, Louis [CEA-LITEN, Grenoble (France); Peyrade, David [Laboratoire des Technologies de la Microelectronique (LTM/CNRS), Grenoble (France); Bougerol, Catherine [CEA-CNRS-UJF Group ' ' Nanophysique et semi-conducteurs' ' , Institut Neel-CNRS, Grenoble (France); Chikhaoui, Walf [CEA-LETI, Grenoble (France)

    2013-03-15

    We investigate the influence of growth temperature, p -doping with bis-cyclopentadienyl magnesium (Cp{sub 2}Mg) and number N of multi-quantum wells on the surface morphology, the electrical and optical properties of InGaN-based solar cells grown by metal-organic vapour phase epitaxy. Atomic force microscopy measurements show no influence of multiple-quantum well number on the surface morphology, but a smoothing with the increase of the Cp{sub 2}Mg flow. Electrochemical capacitance-voltage profiling exhibits an increase of the N{sub a}-N{sub d} concentration when increasing the Cp{sub 2}Mg flow from 250 to 700 sccm. X-ray diffraction analysis and transmission electron microscopy measurements confirm completely strained quantum wells with similar superlattice period for N=5 to 30. Finally, first solar cells have been demonstrated with a maximum external quantum efficiency of 38% at 380 nm wavelength for N=30. (copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

  6. Monitoring forest cover loss using multiple data streams, a case study of a tropical dry forest in Bolivia

    Science.gov (United States)

    Dutrieux, Loïc Paul; Verbesselt, Jan; Kooistra, Lammert; Herold, Martin

    2015-09-01

    Automatically detecting forest disturbances as they occur can be extremely challenging for certain types of environments, particularly those presenting strong natural variations. Here, we use a generic structural break detection framework (BFAST) to improve the monitoring of forest cover loss by combining multiple data streams. Forest change monitoring is performed using Landsat data in combination with MODIS or rainfall data to further improve the modelling and monitoring. We tested the use of the Normalized Difference Vegetation Index (NDVI) from the Moderate Resolution Imaging Spectroradiometer (MODIS) with varying spatial aggregation window sizes as well as a rainfall derived index as external regressors. The method was evaluated on a dry tropical forest area in lowland Bolivia where forest cover loss is known to occur, and we validated the results against a set of ground truth samples manually interpreted using the TimeSync environment. We found that the addition of an external regressor allows to take advantage of the difference in spatial extent between human induced and naturally induced variations and only detect the processes of interest. Of all configurations, we found the 13 by 13 km MODIS NDVI window to be the most successful, with an overall accuracy of 87%. Compared with a single pixel approach, the proposed method produced better time-series model fits resulting in increases of overall accuracy (from 82% to 87%), and decrease in omission and commission errors (from 33% to 24% and from 3% to 0% respectively). The presented approach seems particularly relevant for areas with high inter-annual natural variability, such as forests regularly experiencing exceptional drought events.

  7. MULTIPLE SELECTIONS OF ALTERNATIVES UNDER CONSTRAINTS: CASE STUDY OF EUROPEAN COUNTRIES IN AREA OF RESEARCH AND DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Andrea Furková

    2015-04-01

    Full Text Available This paper is given over to a multicriteria evaluation approach to the issue of international comparison of research and development indicators. The policy activities in R&D (Research & Development area are significant parts of many national programs of many EU member states. There are several reasons for governments to take active role in stimulation investment in R&D. R&D are generally considered to be the main engine of long-run economic growth. Also The European Commission pays more attention to R&D activities and provides more and more resources to these activities through Community Framework Programs. We decided to exploit multi-attribute decision-making to evaluate R&D indicators of European countries. As multi-attribute decision-making method Topsis method was applied. Topis method has provided us complete ranking of the countries taking into account indicators such as patent applications, total intramural R&D expenditure, human resources in science and technology, employment in knowledge-intensive activities and business enterprise R&D expenditure. Having these results in a hand; we proceed to making multiple selections of countries under constraints. Our main goal was to suggest an optimization model for resources distribution - subsides for R&D encouragement, i.e. to find an optimal selection of several alternatives given a set of constraints. To make a decision concerning proper countries selection we employed optimization model inspired by Promethee V, which enables us to take into account the results of previous empirical part and, at the same time, to take into account defined constraints. Formulated binary linear programming model could be useful support decision making tool in the process of resources distribution - subsides for R&D encouragement.

  8. An application of multiple attribute group decision making in ranking investors’ concerns: A case study of Tehran Stock Exchange

    OpenAIRE

    Amir Mohammadzadeh; Naser Hamidi; Sadegh Abedi; Fehimeh Jabari

    2013-01-01

    During the past few years, stock exchange investors confront numerous problems in terms of legal, environmental issues, etc. In this paper, we present an empirical study to detect important issues as barriers for investment in Tehran Stock Exchange. The study has categorized the issues into two groups of real world and legal issues. Since there are different issues involved as major barriers, the study uses analytical hierarchy process to rank them. The study extracts 18 important factors, wh...

  9. Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.

    Science.gov (United States)

    Liang, Shuting; Kegler, Michelle C; Cotter, Megan; Emily, Phillips; Beasley, Derrick; Hermstad, April; Morton, Rentonia; Martinez, Jeremy; Riehman, Kara

    2016-08-02

    Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover

  10. Case Study on the Meaning of Citizen Formation and its Relationship to Multiple Intelligences from the Standpoint of Families and Educational Facilities in Barranquilla, Colombia

    Directory of Open Access Journals (Sweden)

    Marco antonio turbay*

    2009-12-01

    Full Text Available Socialization of the individual is one of the main challenges in regional development, just as important as politics, economics and ecology; and a key component of this process is Citizen Formation, which provides people with knowledge and coexistence principles that lead them to recognize themselves as social beings, with rights and obligations in society. This mixed-model study aims to describe meanings attached to Citizen Formation by a father, his daughter, and a teacher. This case studies let actors developnarratives which they use to build the meaning of Citizen Formation. Bruner’s narrative technique is privileged, with its foundational concept of “meaning”. The search is complemented by the idea of “multiple intelligences” by Gardner.

  11. Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design.

    Science.gov (United States)

    Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; van Achterberg, Theo

    2016-07-01

    People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Working with the 'Diagnostic Guideline for Anxiety and CB' leads to improved diagnoses and treatment plans compared with care as usual. © 2015 John Wiley & Sons Ltd.

  12. case study

    African Journals Online (AJOL)

    Elton

    particularly in patients who commence ART with low CD4 counts and established opportunistic infections. IRIS results from a pathological inflammatory response to pre-existing infective, host or other antigens, alive or dead, causing clinical deterioration in HIV-infected patients after initiating ART.1 A case definition for IRIS ...

  13. CASE STUDY

    African Journals Online (AJOL)

    2010-09-01

    Sep 1, 2010 ... of the two diseases surgery can be successful, recovery can be similar to that .... lymphocytes predominated in 68% of cases, and that there was an .... using ferritin is the fact that it acts as an acute-phase reactant and will be ...

  14. Developing an Exemplary Fine Arts Program: A Multiple Case-Study of Three Private Institutions of Higher Education

    Science.gov (United States)

    Filippelli, James Anthony

    2014-01-01

    This study intended to identify commonalities of fine arts programs at selected private liberal arts colleges and universities in order to ultimately develop an exemplary fine arts program in a similar setting. This study searched for answers to three research questions within the context of art, music, dance, and theatre. The first research…

  15. An application of multiple attribute group decision making in ranking investors’ concerns: A case study of Tehran Stock Exchange

    Directory of Open Access Journals (Sweden)

    Amir Mohammadzadeh

    2013-02-01

    Full Text Available During the past few years, stock exchange investors confront numerous problems in terms of legal, environmental issues, etc. In this paper, we present an empirical study to detect important issues as barriers for investment in Tehran Stock Exchange. The study has categorized the issues into two groups of real world and legal issues. Since there are different issues involved as major barriers, the study uses analytical hierarchy process to rank them. The study extracts 18 important factors, which influence investors’ participation in Tehran Stock Exchange and using Borda method, prioritize them. The results of the survey indicate that in terms of real issues, Increase in quality of firms Financial Statement is number one priority followed by Increase stock exchange and agents’ proficiency and electronic equipment, Unchangeable investment market rules and bounding organization managers to flow them and Strict supervision on agents’ activities. In terms of legal issues, good supervision of provisions to force firms to reveal information correctly and restrict their secret bargaining is the most important factor followed by Using indirect investment guideline instead of direct investment, Increase in quality of firms’ Financial Statement and Investors’ training toward their rights.

  16. Restaurants as Learning Organizations: A Multiple-Site Case Study of U.S. Non-Chain Restaurants

    Science.gov (United States)

    Boccia, Mark

    2016-01-01

    This study investigated the construct of the learning organization in the restaurant industry. Descriptive accounts of learning were gleaned from face-to-face interviews, focus groups, observations, document analysis, and data from the Dimensions of the Learning Organization Questionnaire (DLOQ) from 52 participants employed in three US…

  17. Engagement and avoidance in support staff working with people with intellectual disability and challenging behavior : A multiple-case study

    NARCIS (Netherlands)

    Zijlmans, L.J.M.; Bosman, A.M.T.; Gerits, L.; Derksen, J.; Embregts, P.J.C.M.

    2014-01-01

    Background Challenging behaviour of clients influences emotional wellbeing of staff; this in turn affects levels of staff engagement and avoidance within interactions with clients. The main goal of this study was to investigate to what extent levels of staff engagement and staff avoidance are

  18. Critical Success Factors For M-Commerce In Saudi Arabia's Private Sector: A Multiple Case Study Analysis

    OpenAIRE

    Norah Suliman Alturaigi

    2018-01-01

    Many developing country firms are investing huge money in the sector of mobile commerce (m-commerce). Simplifying and understanding the factors which can impact on m-commerce success enables the organisations’ managers to focus their efforts on the key areas of their m-commerce businesses, thereby contributing to the successful implementation of m-commerce. This study provides a clear understanding of m-commerce in the private sector in the Kingdom of Saudi Arabia and identifies the critical ...

  19. Creating advantages through franchising in healthcare: a qualitative, multiple embedded case study on the role of the business format

    OpenAIRE

    Nijmeijer, Karlijn J; Huijsman, Robbert; Fabbricotti, Isabelle N

    2014-01-01

    Background Business format franchising is an organizational form that originates from the business sector. It is increasingly used in healthcare, being a promising organizational form for improving the competitiveness and efficiency of organizations, the quality of care, and the professional work environment. However, evidence is lacking concerning how these healthcare franchises should be designed to actually deliver the promised benefits. This study explores how the design of the central el...

  20. Coupling the effect of mental practice and Pilates on ambulation of individuals with multiple sclerosis: Five case studies

    OpenAIRE

    Darshpreet Kaur; Nidhi Billore; Kirandeep Kaur; Gunjan Kumar; Ajay Kumar Singh

    2016-01-01

    Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates ...

  1. Corporate rebranding processes in small companies:a multiple case study from the B2B software industry

    OpenAIRE

    Juntunen, M. (Mari)

    2011-01-01

    Abstract The purpose of the present study is to build a theoretically based and empirically grounded framework that enables a better understanding of corporate rebranding processes among small companies. Corporate rebranding is addressed from a visual viewpoint concentrating on changes to corporate name and logo. The theoretical background is based on corporate branding, corporate rebranding and organisational change literature. The research setting is small software companies that op...

  2. Assessing future suitability of tree species under climate change by multiple methods: a case study in southern Germany

    Directory of Open Access Journals (Sweden)

    Helge Walentowski

    2017-07-01

    Full Text Available We compared results derived using three different approaches to assess the suitability of common tree species on the Franconian Plateau in southern Germany under projected warmer and drier climate conditions in the period 2061-2080. The study area is currently a relatively warm and dry region of Germany. We calculated species distribution models (SDMs using information on species’ climate envelopes to predict regional species spectra under 63 different climate change scenarios. We complemented this with fine-scale ecological niche analysis using data from 51 vegetation surveys in seven forest reserves in the study area, and tree-ring analysis (TRA from local populations of five tree species to quantify their sensitivity to climatic extreme years. The SDMs showed that predicted future climate change in the region remains within the climate envelope of certain species (e.g. Quercus petraea, whilst for e.g. Fagus sylvatica, future climate conditions in one third of the scenarios are too warm and dry. This was confirmed by the TRA: sensitivity to drought periods is lower for Q. petraea than for F. sylvatica. The niche analysis shows that the local ecological niches of Quercus robur and Fraxinus excelsior are mainly characterized by soils providing favorable water supply than by climate, and Pinus sylvestris (planted is strongly influenced by light availability. The best adapted species for a warmer and potentially drier climate in the study region are Acer campestre, Sorbus torminalis, S. aria, Ulmus minor, and Tilia platyphyllos, which should therefore play a more prominent role in future climate-resilient mixed forest ecosystems.

  3. Strategic venture capital in the financial industry : A multiple-case study on autonomy and its implications

    OpenAIRE

    KONGSHÖJ, MATILDA; LJUNGQVIST, EMILIE

    2016-01-01

    Den tidigare stabila finansbranschen har snabbt blivit hotad av den digitala transformationen. Ett strategiskt verktyg som används av etablerade banker som står inför denna nya och föränderliga miljö är strategiska riskkapitalinvesteringar i det närliggande området av finansiella teknologier (FinTech). Denna studie undersöker strategiskt riskkapital i termer av organisatorisk design; närmare bestämt graden av autonomi i riskkapitalverksamhetens investeringsprocess. Studien undersöker koncepte...

  4. Is the desire for amputation related to disturbed emotion processing? A multiple case study analysis in BIID.

    Science.gov (United States)

    Bottini, Gabriella; Brugger, Peter; Sedda, Anna

    2015-01-01

    Body integrity identity disorder (BIID) is characterized by the overwhelming desire to amputate one or more healthy limbs or to be paraplegic. Recently, a neurological explanation of this condition has been proposed, in part on the basis of findings that the insular cortex might present structural anomalies in these individuals. While these studies focused on body representation, much less is known about emotional processing. Importantly, emotional impairments have been found in psychiatric disorders, and a psychiatric etiology is still a valid alternative to purely neurological accounts of BIID. In this study, we explored, by means of a computerized experiment, facial emotion recognition and emotional responses to disgusting images in seven individuals with BIID, taking into account their clinical features and investigating in detail disgust processing, strongly linked to insular functioning. We demonstrate that BIID is not characterized by a general emotional impairment; rather, there is a selectively reduced disgust response to violations of the body envelope. Taken together, our results support the need to explore this condition under an interdisciplinary perspective, taking into account also emotional connotations and the social modulation of body representation.

  5. Social influences on adolescents' dietary behavior in Catalonia, Spain: A qualitative multiple-cases study from the perspective of social capital.

    Science.gov (United States)

    Carrillo-Álvarez, Elena; Riera-Romaní, Jordi; Canet-Vélez, Olga

    2018-04-01

    Adolescence has been referred to as the last best chance to prevent adult non-communicable diseases. Gaining further evidence on the psychosocial determinants of health behaviors, particularly the impact of peers, social networks and media on diet, is necessary to develop appropriate preventive strategies. Based on a multiple-cases study, our aim was to discuss the social influences on adolescents' dietary behavior from a social capital perspective. Participants were reached through four high-schools in different Catalan rural-urban and socioeconomic contexts. Our results confirm the different layout of social capital in the community, school, peers and family. In our sample, family and peers are the most influent sources of social capital in relation to dietary behaviors, inducing both protective and damaging effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Learn and apply: using multi-sensory storytelling to gather knowledge about preferences and abilities of children with profound intellectual and multiple disabilities--three case studies.

    Science.gov (United States)

    Brug, Annet Ten; Van der Putten, Annette A J; Vlaskamp, Carla

    2013-12-01

    Knowledge about the preferences and abilities of children with profound intellectual and multiple disabilities (PIMDs) is crucial for providing appropriate activities. Multi-sensory storytelling (MSST) can be an ideal activity for gathering such knowledge about children with PIMDs. The aim of this study was to analyse whether using MSST did lead to changes in teachers' knowledge about preferences and abilities and whether this knowledge was then applied in practice. Three dyads of children with PIMDs and their teachers read an MSST book 20 times during a 10-week period. A questionnaire designed to identify the teachers' current knowledge was filled in before the 1st and again after the 10th and 20th reading sessions. Also, the teachers were asked for their opinion about their newly gathered knowledge. In all three cases, changes in the teachers' knowledge were observed. However, teachers are insufficiently aware of their new knowledge and do not apply it in practice.

  7. Campgrounds Suitability Evaluation Using GIS-based Multiple Criteria Decision Analysis: A Case Study of Kuerdening, China

    Science.gov (United States)

    Cuirong, Wang; Zhaoping, Yang; Huaxian, Liu; Fang, Han; Wenjin, Xia

    2016-04-01

    The main objective of this study was to evaluate the suitability and select the most appropriate areas for building campgrounds in Kuerdening, China. To achieve this aim, AHP and GIS-based weighted overlay methods were adopted. AHP was used to determine the weights of the indexes, and ArcGIS 10 was used to calculate and map the campground suitability. In pursuit of minimum environmental effects and sustainable development, this paper identifies four factors to evaluate the suitability of areas for building campgrounds: natural environment condition, landscape condition, safety condition and infrastructure condition. The final outcome of this studywas the suitability map for building campgrounds. This research not only provides a theoretical guide for the construction of campgrounds in this area but also provides a scientific and efficientworkflow to evaluate the appropriateness of other areas. The result is reasonable and operable for camping facilities development and also useful for managers and planners working in local governments as well as investors.

  8. [Challenges in the implementation of clinical practice guidelines in major public health institutions in Mexico: A multiple case study].

    Science.gov (United States)

    Gutiérrez-Alba, Gaudencio; González-Block, Miguel Ángel; Reyes-Morales, Hortensia

    2015-01-01

    To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish). We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire. The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment. The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.

  9. The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales.

    Science.gov (United States)

    Wilson, Patricia Mary; Brooks, Fiona; Procter, Susan; Kendall, Sally

    2012-01-01

    The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was

  10. Multiple-resolution Modeling of flood processes in urban catchments using WRF-Hydro: A Case Study in south Louisiana.

    Science.gov (United States)

    Saad, H.; Habib, E. H.

    2017-12-01

    In August 2016, the city of Lafayette and many other urban centers in south Louisiana experienced catastrophic flooding resulting from prolonged rainfall. Statewide, this historic storm displaced more than 30,000 people from their homes, resulted in damages up to $8.7 billion, put rescue workers at risk, interrupted institutions of education and business, and worst of all, resulted in the loss of life of at least 13 Louisiana residents. With growing population and increasing signs of climate change, the frequency of major floods and severe storms is expected to increase, as will the impacts of these events on our communities. Local communities need improved capabilities for forecasting flood events, monitoring of flood impacts on roads and key infrastructure, and effectively communicating real-time flood dangers at scales that are useful to the public. The current study presents the application of the WRF-Hydro modeling system to represent integrated hydrologic, hydraulic and hydrometeorological processes that drive flooding in urban basins at temporal and spatial scales that can be useful to local communities. The study site is the 25- mile2 Coulee mine catchment in Lafayette, south Louisiana. The catchment includes two tributaries with natural streams located within mostly agricultural lands. The catchment crosses the I-10 highway and through the metropolitan area of the City of Lafayette into a man-made channel, which eventually drains into the Vermilion River and the Gulf of Mexico. Due to its hydrogeomorphic setting, local and rapid diversification of land uses, low elevation, and interdependent infrastructure, the integrated modeling of this coulee is considered a challenge. A nested multi-scale model is being built using the WRF-HYDRO, with 500m and 10m resolutions for the NOAH land-surface model and diffusive wave terrain routing grids, respectively.

  11. Assessment of Long-Term Evolution of Groundwater Hydrochemical Characteristics Using Multiple Approaches: A Case Study in Cangzhou, Northern China

    Directory of Open Access Journals (Sweden)

    Wei Li

    2015-03-01

    Full Text Available Water shortage is severe in the North China Plain (NCP. In addition to a deficiency of water resources, deterioration of groundwater quality should be of great concern. In this study, hydrogeological analysis was conducted in combination with principal component analysis, correlation analysis and the co-kriging method to identify factors controlling the content of major ions and total dissolved solids (TDS in areal shallow and deep groundwater and to assess groundwater evolution in Cangzhou, China. The results suggested that groundwater quality degradation occurred and developed in the study area, as indicated by increasing concentrations of major ions, TDS and hardness in both shallow and deep groundwater. In shallow groundwater, whose hydrochemical water types changed from HCO3–Ca.Na.Mg and HCO3.Cl–Na in the west (Zone II to Cl.SO4–Na and Cl–Na in the east (Zone III. Areas with TDS concentrations between 1500 and 2000 mg/L occupied 79.76% of the total in the 1980s, while areas with a TDS concentration ranging from 2500 to 3000 mg/L comprised 59.11% of the total in the 2010s. In deep groundwater, the area with TDS over 1000 mg/L expanded from 5366.39 km2 in the 1960s to 7183.52 km2 in the 2010s. Natural processes (water-rock interactions and anthropogenic activities (groundwater exploitation were the dominant factors controlling the major ions’ content in local groundwater. Dissolution of dolomite, calcite, feldspar and gypsum were the primary sources of major ions in groundwater, and the ion exchange reaction had a strong effect on the cation content, especially for deep groundwater.

  12. Substituting random forest for multiple linear regression improves binding affinity prediction of scoring functions: Cyscore as a case study.

    Science.gov (United States)

    Li, Hongjian; Leung, Kwong-Sak; Wong, Man-Hon; Ballester, Pedro J

    2014-08-27

    State-of-the-art protein-ligand docking methods are generally limited by the traditionally low accuracy of their scoring functions, which are used to predict binding affinity and thus vital for discriminating between active and inactive compounds. Despite intensive research over the years, classical scoring functions have reached a plateau in their predictive performance. These assume a predetermined additive functional form for some sophisticated numerical features, and use standard multivariate linear regression (MLR) on experimental data to derive the coefficients. In this study we show that such a simple functional form is detrimental for the prediction performance of a scoring function, and replacing linear regression by machine learning techniques like random forest (RF) can improve prediction performance. We investigate the conditions of applying RF under various contexts and find that given sufficient training samples RF manages to comprehensively capture the non-linearity between structural features and measured binding affinities. Incorporating more structural features and training with more samples can both boost RF performance. In addition, we analyze the importance of structural features to binding affinity prediction using the RF variable importance tool. Lastly, we use Cyscore, a top performing empirical scoring function, as a baseline for comparison study. Machine-learning scoring functions are fundamentally different from classical scoring functions because the former circumvents the fixed functional form relating structural features with binding affinities. RF, but not MLR, can effectively exploit more structural features and more training samples, leading to higher prediction performance. The future availability of more X-ray crystal structures will further widen the performance gap between RF-based and MLR-based scoring functions. This further stresses the importance of substituting RF for MLR in scoring function development.

  13. Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level

    Directory of Open Access Journals (Sweden)

    Olson Joanne

    2008-12-01

    Full Text Available Abstract Background There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised. Methods Guided by Dobrow et al.'s (2004 conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review

  14. Campgrounds Suitability Evaluation Using GIS-based Multiple Criteria Decision Analysis: A Case Study of Kuerdening, China

    Directory of Open Access Journals (Sweden)

    Cuirong Wang

    2016-04-01

    Full Text Available The main objective of this study was to evaluate the suitability and select the most appropriate areas for building campgrounds in Kuerdening, China. To achieve this aim, AHP and GIS-based weighted overlay methods were adopted. AHP was used to determine the weights of the indexes, and ArcGIS 10 was used to calculate and map the campground suitability. In pursuit of minimum environmental effects and sustainable development, this paper identifies four factors to evaluate the suitability of areas for building campgrounds: natural environment condition, landscape condition, safety condition and infrastructure condition. The final outcome of this studywas the suitability map for building campgrounds. This research not only provides a theoretical guide for the construction of campgrounds in this area but also provides a scientific and efficientworkflow to evaluate the appropriateness of other areas. The result is reasonable and operable for camping facilities development and also useful for managers and planners working in local governments as well as investors.

  15. The human resource management contribute six sigma program: multiple-case study in companies situated in Rio Grande do Sul

    Directory of Open Access Journals (Sweden)

    Jaqueline T. M. Corrêa Rodrigues

    2011-09-01

    Full Text Available The world is going through rapid changes and the companies seek alternatives to improve its products and processes and maintain their competitiveness. One alternative is the implementation of programs of quality management that combine human’s and technical’s factors. Six Sigma has gained evidence on the last years because aggregate tools and methodology. However, all quality program factors need management. The main goal of this paper is classify what assignments of Human Resource Management can contribute to reduction of the difficulties that can be encountered on implementation and maintenance of Six Sigma program in companies that was situated in the Rio Grande do Sul. For carry this work was necessary contact companies of the Rio Grande do Sul that use this program and was applied one questionnaire to classify the contribution of the Human Resource Management for the success of Six Sigma. The statistical tools, contents analyze, tables of relationship and qualitative analysis were applied for analysis. It’s evidence in this research the existence of potentials difficulties of Six Sigma listed in the literature and the influence that some assignments of Human Resource Management can be for solve this difficulties. The result of the research indicate that the participative and compromised leadership and the clear and objective communication of program are the assignments of Human Resource Management among the studied that more contribute for reduction of the difficulties of Six Sigma in the companies of this research.

  16. Driving factors for the regional implementation of renewable energy ‐ A multiple case study on the German energy transition

    International Nuclear Information System (INIS)

    Lutz, Lotte Marie; Fischer, Lisa-Britt; Newig, Jens; Lang, Daniel Johannes

    2017-01-01

    Understanding what drives the regional implementation of renewable energy is a prerequisite for energy transitions toward a post-fossil-based energy economy. This paper presents an empirical analysis of driving factors for the regional implementation and use of renewable energy. We tested literature-derived driving factors in a comparative analysis of 18 selected study regions using Rough Set Analysis and performance analysis. We paid special attention to common combinations of driving factors, which we understand as established practices concerning the use and implementation of renewable energy. Our findings confirm most of the driving factors identified in the literature, for example the existence of key actors, knowledge exchange, or the use of goals and milestones. We also observe differences in key driving factors between highly successful and less successful regions, especially regarding funding opportunities. The results may support policy makers who aim to successfully implement renewable energy at a regional level. - Highlights: • We analyzed driving factors for RE implementation in 18 best-practice regions. • Most driving factors from transition and governance literature were confirmed. • We identified common successful practices concerning RE implementation.

  17. Multiple Linear Regression Analysis of Factors Affecting Real Property Price Index From Case Study Research In Istanbul/Turkey

    Science.gov (United States)

    Denli, H. H.; Koc, Z.

    2015-12-01

    Estimation of real properties depending on standards is difficult to apply in time and location. Regression analysis construct mathematical models which describe or explain relationships that may exist between variables. The problem of identifying price differences of properties to obtain a price index can be converted into a regression problem, and standard techniques of regression analysis can be used to estimate the index. Considering regression analysis for real estate valuation, which are presented in real marketing process with its current characteristics and quantifiers, the method will help us to find the effective factors or variables in the formation of the value. In this study, prices of housing for sale in Zeytinburnu, a district in Istanbul, are associated with its characteristics to find a price index, based on information received from a real estate web page. The associated variables used for the analysis are age, size in m2, number of floors having the house, floor number of the estate and number of rooms. The price of the estate represents the dependent variable, whereas the rest are independent variables. Prices from 60 real estates have been used for the analysis. Same price valued locations have been found and plotted on the map and equivalence curves have been drawn identifying the same valued zones as lines.

  18. Writing disorders in Italian aphasic patients. A multiple single-case study of dysgraphia in a language with shallow orthography.

    Science.gov (United States)

    Luzzatti, C; Laiacona, M; Allamano, N; De Tanti, A; Inzaghi, M G

    1998-09-01

    We report results of a writing task given to 53 mildly to moderately aphasic Italian subjects. The task was designed to test the writing performance along the subword-level routine for the spelling of regular words and non-words, and along the lexical routine for the spelling of irregular words. The aim of the study was to identify the incidence of different dysgraphic subtypes in Italian, a language that is considered to have shallow orthography. Its spelling, however, is not completely free of ambiguity. A five-part writing task was used: (i) words with regular one-sound-to-one-grapheme conversion; (ii) words with regular syllabic conversion; (iii) words with ambiguous transcription; (iv) loan-words; and (v) non-words. For regular words, the effects of word length and word frequency, and of the variables determining the complexity of the acoustic-to-phonological conversion (continuant versus plosive phones; consonant-vowel sequence versus doubled consonants or consonant clusters) were also considered. Patients' performances were classified according to the presence of a dissociation between (i) regular words and non-words, (ii) regular words and words with unpredictable spellings, and (iii) one-to-one and syllabic conversions. The 53 aphasic patients span the whole spectrum of dysgraphic taxonomy. Thirty-nine patients, in particular, manifested a dissociated pattern of performance. Eighteen patients showed a prevalent surface dysgraphic pattern and seven a phonological one, while 11 patients showed a mixed pattern (i.e. a better performance for regular words than for ambiguous words or regular non-words). Three patients showed a specific deficit for regular syllabic conversion rules only. A high rate of 'mixed dysgraphia' suggests either a mutual interaction of the two impaired routines when regular words are written, or two separate functional lesions: one at the level of the auditory-to-phonological conversion procedure, the other at the level of the

  19. Case Study: Testing with Case Studies

    Science.gov (United States)

    Herreid, Clyde Freeman

    2015-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

  20. Identifying Topics for E-Cigarette User-Generated Contents: A Case Study From Multiple Social Media Platforms.

    Science.gov (United States)

    Zhan, Yongcheng; Liu, Ruoran; Li, Qiudan; Leischow, Scott James; Zeng, Daniel Dajun

    2017-01-20

    platforms. This study examined Reddit, JuiceDB, and Twitter as social media data sources for e-cigarette research. These mined findings could be further used by other researchers and policy makers. By utilizing the automatic topic-modeling method, the proposed unified feedback model could be a useful tool for policy makers to comprehensively consider how to collect valuable feedback from social media. ©Yongcheng Zhan, Ruoran Liu, Qiudan Li, Scott James Leischow, Daniel Dajun Zeng. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.01.2017.

  1. Female entrepreneurship and challenges faced by women entrepreneurs to reconcile conflicts between work and family: multiple case study in travel agencies

    Directory of Open Access Journals (Sweden)

    Rivanda Meira Teixeira

    2016-03-01

    Full Text Available Women have gained more and more space in various professional areas and this development also occurs in the field of entrepreneurship. In Brazil GEM 2013 identified for the first time, that the number of new woman entrepreneurs was higher than male entrepreneurs. However, it is recognized that women entrepreneurs face many difficulties when trying to reconcile their companies with the family. The main objective of this research is to analyse the challenges faced by women entrepreneurs of travel agencies to reconcile the conflict between work and family. This study adopted the multiple cases research strategy and were selected seven women creators and managers of travel agencies in the cities of Aracaju and the Barra dos Coqueiros, in the state of Sergipe (east coast of Brazil. In an attempt to reconcile well the multiple roles these women often face the frustration and guilt. At this moment, it shows the importance of emotional contribution of husband and children. It is noticed that the search for balance between the conflicting demands generate emotional distress and / or physical.

  2. Staff and students' perceptions and experiences of teaching and assessment in Clinical Skills Laboratories: interview findings from a multiple case study.

    Science.gov (United States)

    Houghton, Catherine E; Casey, Dympna; Shaw, David; Murphy, Kathy

    2012-08-01

    The Clinical Skills Laboratory has become an essential structure in nurse education and several benefits of its use have been identified. However, the literature identifies the need to examine the transferability of skills learned there into the reality of practice. This research explored the role of the Clinical Skills Laboratory in preparing nursing students for the real world of practice. This paper focuses specifically on the perceptions of the teaching and assessment strategies employed there. Qualitative multiple case study design. Five case study sites. Interviewees (n=58) included academic staff, clinical staff and nursing students. Semi-structured interviews. The Clinical Skills Laboratory can provide a pathway to practice and its authenticity is significant. Teaching strategies need to incorporate communication as well as psychomotor skills. Including audio-visual recording into assessment strategies is beneficial. Effective relationships between education institutions and clinical settings are needed to enhance the transferability of the skills learned. The Clinical Skills Laboratory should provide an authentic learning environment, with the appropriate use of teaching strategies. It is crucial that effective links between educators and clinical staff are established and maintained. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2009-01-01

    Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes

  4. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    Directory of Open Access Journals (Sweden)

    Beaulieu Marie-Dominique

    2009-02-01

    Full Text Available Abstract Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs. The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis and field of family medicine (macro-level of analysis. The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original

  5. Deltoid contracture: a case with multiple muscle contractures.

    Science.gov (United States)

    Chen, Hsin-Chang; Huang, Tung-Fu; Chou, Po-Hsin; Chen, Tain-Hsiung

    2008-11-01

    Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

  6. Combining evidence from multiple electronic health care databases: performances of one-stage and two-stage meta-analysis in matched case-control studies.

    Science.gov (United States)

    La Gamba, Fabiola; Corrao, Giovanni; Romio, Silvana; Sturkenboom, Miriam; Trifirò, Gianluca; Schink, Tania; de Ridder, Maria

    2017-10-01

    Clustering of patients in databases is usually ignored in one-stage meta-analysis of multi-database studies using matched case-control data. The aim of this study was to compare bias and efficiency of such a one-stage meta-analysis with a two-stage meta-analysis. First, we compared the approaches by generating matched case-control data under 5 simulated scenarios, built by varying: (1) the exposure-outcome association; (2) its variability among databases; (3) the confounding strength of one covariate on this association; (4) its variability; and (5) the (heterogeneous) confounding strength of two covariates. Second, we made the same comparison using empirical data from the ARITMO project, a multiple database study investigating the risk of ventricular arrhythmia following the use of medications with arrhythmogenic potential. In our study, we specifically investigated the effect of current use of promethazine. Bias increased for one-stage meta-analysis with increasing (1) between-database variance of exposure effect and (2) heterogeneous confounding generated by two covariates. The efficiency of one-stage meta-analysis was slightly lower than that of two-stage meta-analysis for the majority of investigated scenarios. Based on ARITMO data, there were no evident differences between one-stage (OR = 1.50, CI = [1.08; 2.08]) and two-stage (OR = 1.55, CI = [1.12; 2.16]) approaches. When the effect of interest is heterogeneous, a one-stage meta-analysis ignoring clustering gives biased estimates. Two-stage meta-analysis generates estimates at least as accurate and precise as one-stage meta-analysis. However, in a study using small databases and rare exposures and/or outcomes, a correct one-stage meta-analysis becomes essential. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Multiple primary cancer in cases of atomic bomb survivors

    International Nuclear Information System (INIS)

    Tanaka, Tsuneo; Matsuda, Masahiro; Matsugu, Yasuhiro; Ishimoto, Tatsuro; Nakahara, Hideki; Kagawa, Naoki; Fukuda, Yasuhiko

    2006-01-01

    Multiple primary cancer was investigated in individual atomic bomb survivors more than 50 years after exposure. During the decade from 1995 to 2004, double cancer was detected in 275 individuals visiting our facility. These 275 patients with multiple primary cancer were divided into an atomic bomb-exposed group and a non-exposed group. In terms of age at the time of definite diagnosis of double cancer and age upon onset of the first cancer, there was no significant difference between the atomic bomb-exposed group and the non-exposed group. In both groups, the percentage of males was higher than that of females. However, the percentage of females was higher in the exposed group than in the non-exposed group. Synchronous double cancer (cases where a second cancer develops within one year after onset of the first cancer) was seen in 32 individuals from the exposed group. Triple cancer was seen in 3 cases. In the exposed group, the site affected by cancer was the stomach in 28% and the colon/rectum in 27% of cases. Thus, cancer affected the stomach or colon/rectum in the majority of cases. The most frequent combination of organs affected by double cancer was the stomach+colon/rectum (20 cases, 25%). In a study of multiple primary cancer patients, the percentage of females was higher in the atomic bomb exposed group compared to the non-exposed group. There was no other difference between the two groups. (author)

  8. Hermeneutic phenomenological multiple case study of the cultural references of elementary teachers and the place of fundamentalist Southern Baptist religion in teaching science

    Science.gov (United States)

    Thomas, Susan Elizabeth Shelton

    It has been said, "The two greatest forces in human history are science and religion" (Schachter-Shalomi & Smith, 1999, p. 220). It is those forces and their influence on science teaching that motivated the focus of this study to explore the cultural referents of elementary teachers and the place of fundamentalist Southern Baptist religious beliefs in teaching elementary science. Through a hermeneutic phenomenological framework, multiple case study method was used to interpret the individual consciousness and classroom lived experiences of three elementary teachers. The particularities surrounding elementary science instruction by devout Southern Baptist teachers was explored through several data sources, which included: personal interactions with the teachers, classroom observations, journaling, and interviews (Stake, 1995; Yin, 2003). Insights gained from this study indicate that the religious component of the culture of elementary teachers affects science teaching and learning. In Alabama, Southern Baptist beliefs influence both the public and private lives of educators. Replicated themes revealed the following themes: (a) a lack of concern for occasionally mentioning God in class due to the conservatively religious nature of Southern culture, (b) the teachers' beliefs affected classroom instruction and student interaction, (c) a commitment to science teaching in the context of the elementary classrooms, and (d) the teachers' as mediators. In addition, the theoretical framework provided an awareness of how the lives of the three educators could yield replicated themes. Indications are for a better understanding of how religion, as part of culture, influences science classroom instruction, including teacher education programs and aspects of science teaching and learning.

  9. Familial multiple lipomatosis: a case report

    NARCIS (Netherlands)

    Veger, H. T. C.; Ravensbergen, N. J. C.; Ottenhof, A.; da Costa, S. A.

    2010-01-01

    Lipoma is the most common type of soft tissue tumour. Multiple lipomas localised in different areas of the body are rare and can occur in specific hereditary syndromes. Familial multiple lipomatosis is a rare benign hereditary syndrome with a proposed autosomal-dominant inheritance. We present the

  10. The approaches Hong Kong Chinese mothers adopt to teach their preschool children to prevent influenza: a multiple case study at household level.

    Science.gov (United States)

    Lam, Winsome; Fowler, Cathrine; Dawson, Angela

    2016-01-01

    In Hong Kong, the population is at risk of seasonal influenza infection twice a year. Seasonal influenza is significantly associated with the increased hospitalization of children. Maintaining personal hygiene and vaccination are the most effective measures to prevent influenza infection. Research demonstrates a positive relationship between the health practices applied by parents and the behaviour of their children highlighting the importance of parental heath education. However, there is minimal research that provides an understanding of how Hong Kong Chinese parents teach their children to prevent seasonal influenza. Mixed methods research was undertaken that employed a multiple-case study approach to gain an understanding of parental teaching practices regarding seasonal influenza prevention. Purposive intensity sampling was adopted to recruit twenty parents and their healthy children. A thematic analysis was employed to examine the qualitative interview data and the quantitative survey data were examined descriptively. These data were then integrated to provide a more rigorous understanding of parental teaching strategies. Comparisons were made across cases to reveal commonalities and differences. Five major themes were identified: processes parents used to teach personal hygiene; parent-child interaction during teaching; approaches to managing children's health behaviours; enhancing children's healthy practices; and parents' perspective of the role of the nurse in health promotion. This study provided valuable insight into the approach of Hong Kong Chinese parents in teaching their children to prevent seasonal influenza. The results indicate that parents can be better supported to develop effective strategies to teach their preschool children hygiene practices for seasonal influenza prevention. Partnerships with community nurses can play a role in building effective parent-child interactions to enhance children's learning and adoption of healthy practices.

  11. Verifying the performance of artificial neural network and multiple linear regression in predicting the mean seasonal municipal solid waste generation rate: A case study of Fars province, Iran.

    Science.gov (United States)

    Azadi, Sama; Karimi-Jashni, Ayoub

    2016-02-01

    Predicting the mass of solid waste generation plays an important role in integrated solid waste management plans. In this study, the performance of two predictive models, Artificial Neural Network (ANN) and Multiple Linear Regression (MLR) was verified to predict mean Seasonal Municipal Solid Waste Generation (SMSWG) rate. The accuracy of the proposed models is illustrated through a case study of 20 cities located in Fars Province, Iran. Four performance measures, MAE, MAPE, RMSE and R were used to evaluate the performance of these models. The MLR, as a conventional model, showed poor prediction performance. On the other hand, the results indicated that the ANN model, as a non-linear model, has a higher predictive accuracy when it comes to prediction of the mean SMSWG rate. As a result, in order to develop a more cost-effective strategy for waste management in the future, the ANN model could be used to predict the mean SMSWG rate. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Areas of Hospitality Management and Stakeholders in Recruitment and Selection Multiple Case Study: Estanplaza, Travel in and Transamérica.

    Directory of Open Access Journals (Sweden)

    Thiago Sbarai Santos Alves

    2014-06-01

    Full Text Available This research aims to analyze the relationships between recruitment and selection and its stakeholders, considering the areas of hospitality and its characteristics as influential factors to recruit and select new employees. The research approach was qualitative methodologies for the study of multiple cases, which contributed to the form of empirical research. For this investigation were selected by three chains together features that enabled a comparative analysis of the study, which were used for data collection, three sources of evidence: interviews, direct observations and documentation. The selected networks, Estanplaza Hotels, Hotels Transamerica and Travel Inn Hotels The overall goal was to understand the processes used in recruitment and selection set features the fields of hospitality. From this issue were established specific objectives: to observe the dynamics of recruitment and selection of chains; analyze the content related to the fields of hospitality in the tools used in the process of recruitment and selection, and meet stakeholders in this area. The research was conducted through interviews with managers of lodging facilities and with stakeholders in the area of recruitment and selection, based on a semistructured interview guide. Through this research, we found that some features of the fields of hospitality are considered in the process of recruitment and selection. Chains surveyed, however, point out that it is necessary to use tools and processes that enable this type of analysis.

  13. Dynamic Competition and Cooperation of Road Infrastructure Investment of Multiple Tourism Destinations: A Case Study of Xidi and Hongcun World Cultural Heritage

    Directory of Open Access Journals (Sweden)

    Jun Li

    2015-01-01

    Full Text Available The transportation infrastructure always plays an important role in the development of the local tourism. A system dynamics method incorporated with a destination choice model is proposed in this paper to analyze the dynamic impacts of transportation infrastructure on the tourism development, where multiple tourism destinations share a common market. Tourists’ destination choice behaviors are characterized by a multinomial logit choice model based on the utility of destinations, which depends heavily on the accessibility of destinations that the local administration has strong willingness to improve. The system dynamics method is used to model dynamic interactions among destinations and to simulate the dynamic evolution of the competition on the tourism market. A case study of the World Cultural Heritage Sites, Xidi and Hongcun villages, shows the competition for road infrastructure investment can produce a win-win situation and bring the cooperation on investment due to the positive externality of transport infrastructure and two villages show a tendency to merge into one bigger destination. Finally, the tourism development strategies for two villages are discussed based on the scenario analysis.

  14. Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

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    Neale Smith

    2016-01-01

    Full Text Available Background In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA processes at a Canadian healthcare institution reached the decision agenda of the organization’s senior leadership. We adopt key concepts from an established policy studies framework – Kingdon’s multiple streams theory – to inform our analysis. Methods Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process – Program Budgeting and Marginal Analysis (PBMA – in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon’s model as a template. Results The introduction of PBMA can be understood as the opening of a policy window. A problem stream – defined as lack of broad engagement and information sharing across service lines in past practice – converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. Conclusion Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources.

  15. The complex clinical issues involved in an athlete's decision to retire from collision sport due to multiple concussions: a case study of a professional athlete

    Directory of Open Access Journals (Sweden)

    Andrew eGardner

    2013-09-01

    Full Text Available The issue of retirement from athletic participation due to repetitive concussive injuries remains controversial. The complexity of providing recommendations to elite athletes is highlighted by the prospect that offering inappropriate advice may foreseeably lead to engagement in a medico-legal challenge. Currently no evidenced-based, scientifically validated guidelines for forming the basis of such a decision exist. The current paper discusses the complexities of this challenge in addition to presenting a case study of a professional athlete. A number of central issues to consider when discussing athlete retirement revolve around the player’s medical and concussion histories, the current clinical profile, the athlete’s long-term life goals and understanding of the potential long-terms risks. Ensuring that thorough investigations of all possible differential diagnosis, that may explain the presenting symptoms, are conducted is also essential. Discussion pertaining to recommendations for guiding the clinical approach to the retirement issue for athletes with a history of multiple concussions is presented.

  16. CASE STUDY CRITIQUE; UPPER CLINCH CASE STUDY

    Science.gov (United States)

    Case study critique: Upper Clinch case study (from Research on Methods for Integrating Ecological Economics and Ecological Risk Assessment: A Trade-off Weighted Index Approach to Integrating Economics and Ecological Risk Assessment). This critique answers the questions: 1) does ...

  17. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  18. Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study.

    Science.gov (United States)

    Manley, Kim; Martin, Anne; Jackson, Carolyn; Wright, Toni

    2016-08-09

    Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols. The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning. In this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients' experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single

  19. Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

    Science.gov (United States)

    Markle-Reid, Maureen; Dykeman, Cathy; Ploeg, Jenny; Kelly Stradiotto, Caralyn; Andrews, Angela; Bonomo, Susan; Orr-Shaw, Sarah; Salker, Niyati

    2017-02-16

    Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. To align stakeholders working

  20. Determinants of Buying Behavior of Grain Producers: A Multiple Case Study with Mid and Large Size Producers in the State of Mato Grosso

    Directory of Open Access Journals (Sweden)

    Roberto Fava Scare

    2013-12-01

    Full Text Available In recent years, Brazilian agribusiness has demanded for inputs, capital goods, financial services and technology. In addition, there have been changes in the size of the properties, as well as in risk management and commercialization practices, and level of education and posture of those responsible for the decision making of agricultural enterprises. It is fundamental for companies that supply inputs and services to farmers to understand some variables in such changing environment, considering that they influence the business model and the buying behavior of rural producers. The purpose of this study is to develop knowledge and familiarity with the buying behavior of grain farmers in the State of Mato Grosso, with the intent of understanding how this behavior can be influenced by theproducer's profile and the farm features, as well as the risk and business management practices, the decision making, the sources of information, and the products and suppliers. In order to achieve such a goal,a multiple case study was developed by interviewing, face to face, three grain producers, from the State of Mato Grosso. The results demonstrate that the most influential determinants on the buying behavior of the interviewed producers were their level of involvement in the decision making process, the benefit they expect from each type of product, the size of their farming operation, the kind of yield production, and the crop rotation and its relation to productivity. Additionally, the ownership or not of the land, the business profitability, credit restrictions and risk management, they all influence the level of the producer's capitalization and consequently his choices of channels for acquiring inputs and capital goods. Last, though not less important, the sources of information and their reliability have an impact on the producer's loyalty to a brand, or to a local distributor or to a salesperson.

  1. Maps From Mud—Using the Multiple Scenario Approach to Reconstruct Land Cover Dynamics From Pollen Records: A Case Study of Two Neolithic Landscapes

    Directory of Open Access Journals (Sweden)

    M. Jane Bunting

    2018-04-01

    Full Text Available Pollen records contain a wide range of information about past land cover, but translation from the pollen diagram to other formats remains a challenge. In this paper, we present LandPolFlow, a software package enabling Multiple Scenario Approach (MSA based land cover reconstruction from pollen records for specific landscapes. It has two components: a basic Geographic Information System which takes grids of landscape constraints (e.g., topography, geology and generates possible “scenarios” of past land cover using a combination of probabilistic and deterministic placement rules to distribute defined plant communities within the landscape, and a pollen dispersal and deposition model which simulates pollen loading at specified points within each scenario and compares that statistically with actual pollen assemblages from the same location. Goodness of fit statistics from multiple pollen site locations are used to identify which scenarios are likely reconstructions of past land cover. We apply this approach to two case studies of Neolithisation in Britain, the first from the Somerset Levels and Moors and the second from Mainland, Orkney. Both landscapes contain significant evidence of Neolithic activity, but present contrasting contexts. In Somerset, wet-preserved Neolithic remains such as trackways are abundant, but little dry land settlement archaeology is known, and the pre-Neolithic landscape was extensively wooded. In Orkney, the Neolithic archaeology includes domestic and monumental stone-built structures forming a UNESCO World Heritage Site, and the pre-Neolithic landscape was largely treeless. Existing pollen records were collated from both landscapes and correlated within new chronological frameworks (presented elsewhere. This allowed pollen data to be grouped into 200 year periods, or “timeslices,” for reconstruction of land cover through time using the MSA. Reconstruction suggests that subtle but clear and persistent impacts of

  2. A Case of Multiple Spontaneous Keloid Scars

    Directory of Open Access Journals (Sweden)

    Abdulhadi Jfri

    2015-07-01

    Full Text Available Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body.

  3. Implementation of Policy, Systems, and Environmental Community-Based Interventions for Cardiovascular Health Through a National Not-for-Profit: A Multiple Case Study.

    Science.gov (United States)

    Garney, Whitney R; Szucs, Leigh E; Primm, Kristin; King Hahn, Laura; Garcia, Kristen M; Martin, Emily; McLeroy, Kenneth

    2018-05-01

    In 2014, the Centers for Disease Control and Prevention funded the American Heart Association to implement policy, systems, and environment-focused strategies targeting access to healthy food and beverages, physical activity, and smoke-free environments. To understand factors affecting implementation and variations in success across sites, evaluators conducted a multiple case study. Based on past literature, community sites were categorized as capacity-building or implementation-ready, for comparison. A sample of six communities were selected using a systematic selection tool. Through site visits, evaluators conducted interviews with program staff and community partners and assessed action plans. Evaluators identified important implications for nationally coordinated community-based prevention programming. Differences in implementation varied by the communities' readiness, with the most notable differences in how they planned activities and defined success. Existing partner relationships (or lack thereof) played a significant role, regardless of the American Heart Association's existing presence within the communities, in the progression of initiatives and the differences observed among phases. Last, goals in capacity-building sites were tied to organizational goals while goals in implementation-ready sites were more incremental with increased community influence and buy-in. Using national organizations as a mechanism to carry out large-scale community-based prevention work is a viable option that provides coordinated, wide-scale implementation without sacrificing a community's priorities or input. In funding future initiatives, the presence of relationships and the time needed to cultivate such relationships should be accounted for in the planning and implementation processes, as well as both local and national expectations.

  4. The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system -a multiple case study.

    Science.gov (United States)

    Keugoung, Basile; Macq, Jean; Buve, Anne; Meli, Jean; Criel, Bart

    2013-03-22

    Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level. We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs. The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers. Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs

  5. Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia - a multiple case study using mixed methods.

    Science.gov (United States)

    Schadewaldt, Verena; McInnes, Elizabeth; Hiller, Janet E; Gardner, Anne

    2016-07-29

    In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of

  6. Assessment of factors which affect multiple uses of water sources at household level in rural Zimbabwe - A case study of Marondera, Murehwa and Uzumba Maramba Pfungwe districts

    Science.gov (United States)

    Katsi, Luckson; Siwadi, Japson; Guzha, Edward; Makoni, Fungai S.; Smits, Stef

    Water with all its multiple uses plays a pivotal role in the sustenance of rural livelihoods, especially the poor. As such, the provision of water which go beyond domestic to include water for small-scale productive uses should be encouraged to enhance peoples’ livelihood options by making significant contribution to household income, food security, improved nutrition and health. All these multiple benefits, if combined can assist in the fight against hunger and poverty. This study was conducted in Mashonaland East province, covering Marondera, Murehwa and Uzumba Maramba Pfungwe districts in Zimbabwe for the period December 2005-May 2006 to assess factors which affect multiple uses of water sources at household level. Participatory Rural Appraisal tools such as discussions, observations and interviews were used for data collection. The survey found that people indeed require water for productive purposes apart from domestic uses, which are often given top priority. The study found out that multiple uses of water sources at household level can be affected by segmentation of water services into domestic and productive water supply schemes, technology and system design, water quality and quantity and distance to water sources among other factors. The study recommends that water service providers to be able to provide appropriate, efficient and sustainable services, they should understand and appreciate that people’s water needs are integrated and are part and parcel of their multifaceted livelihood strategies.

  7. Case Report: Multiple Myeloma with Gangrene of Extremities

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    N Gharahi

    2009-07-01

    Full Text Available Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities. Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.

  8. Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

    Science.gov (United States)

    Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

    2015-02-27

    The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the

  9. Multiple bone metastasis of medulloblastoma; a case report

    International Nuclear Information System (INIS)

    Oh, Jae Cheon; Lee, Seoung Ro; Kim, Yong Soo; Park, Dong Woo; Joo, Kyung Bin; Hahm, Chang Kok

    1996-01-01

    Medulloblastoma is one of the most undifferentiated primitive neuroectodermal tumors and represents about 30% of all posterior fossa tumors in children. Disseminated medulloblastoma, mainly involving cerebral surfaces, ventricles and the subarachnoid space can, in 50% of patients, be identified on intial imaging studies. One third of these lesions metastasize to an extracranial sity, primarily to bone. Osseous metastases, which occur mainly after craniectomy are typically lytic, but osteoblastic lesions also may occur. We experienced the case of a 14 year-old female patient with multiple bone metastases of medulloblastoma after craniectomy. Bone metastatic lesions were present in the right femur and thoracic spine and were osteoblastic or osteolytic

  10. Numerical simulation of multiple-physical fields coupling for thermal anomalies before earthquakes: A case study of the 2008 Wenchuan Ms8.0 earthquake in southwest China

    Science.gov (United States)

    Deng, Z.

    2017-12-01

    It has become a highly focused issue that thermal anomalies appear before major earthquakes. There are various hypotheses about the mechanism of thermal anomalies. Because of lacking of enough evidences, the mechanism is still require to be further researched. Gestation and occurrence of a major earthquake is related with the interaction of multi-physical fields. The underground fluid surging out the surface is very likely to be the reason for the thermal anomaly. This study tries to answer some question, such as how the geothermal energy transfer to the surface, and how the multiple-physical fields interacted. The 2008 Wenchuan Ms8.0 earthquake, is one of the largest evens in the last decade in China mainland. Remote sensing studies indicate that distinguishable thermal anomalies occurred several days before the earthquake. The heat anomaly value is more than 3 times the average in normal time and distributes along the Longmen Shan fault zone. Based on geological and geophysical data, 2D dynamic model of coupled stress, seepage and thermal fields (HTM model) is constructed. Then using the COMSOL multi-physics filed software, this work tries to reveal the generation process and distribution patterns of thermal anomalies prior to thrust-type major earthquakes. The simulation get the results: (1)Before the micro rupture, with the increase of compression, the heat current flows to the fault in the footwall on the whole, while in the hanging wall of the fault, particularly near the ground surface, the heat flow upward. In the fault zone, heat flow upward along the fracture surface, heat flux in the fracture zone is slightly larger than the wall rock;, but the value is all very small. (2)After the occurrence of the micro fracture, the heat flow rapidly collects to the faults. In the fault zones, the heat flow accelerates up along the fracture surfaces, the heat flux increases suddenly, and the vertical heat flux reaches to the maximum. The heat flux in the 3 fracture

  11. The Leaders across Borders Certification Program—A Systemic Multiple Level Observation of Groups Analysis Approach to Measure Effective Leadership: A Case Study

    Directory of Open Access Journals (Sweden)

    Ricardo Hirata-Okamoto

    2017-10-01

    on the optimization of members’ interactions of all teams, as well as developing effective leadership values and behaviors of participants. This study presents a case study of this application, the challenges in the design and implementation of the SYMLOG measurement model, and the results obtained for last three cohorts 2014–2016 of LaB Program.

  12. Childhood Mourning: Prospective Case Analysis of Multiple Losses

    Science.gov (United States)

    Kaufman, Kenneth R.; Kaufman, Nathaniel D.

    2005-01-01

    Multiple losses within short time periods make one question life and can exponentially influence one's coping skills. But what are the effects on a child and what should be done when the next loss occurs? This case addresses the multiple losses suffered by a child while assessing coping skills of the child and coping strategies used by the parents…

  13. Data Base Design with GIS in Ecosystem Based Multiple Use Forest Management in Artvin, Turkey: A Case Study in Balcı Forest Management Planning Unit.

    Science.gov (United States)

    Yolasığmaz, Hacı Ahmet; Keleş, Sedat

    2009-01-01

    In Turkey, the understanding of planning focused on timber production has given its place on Multiple Use Management (MUM). Because the whole infrastructure of forestry with inventory system leading the way depends on timber production, some cases of bottle neck are expected during the transition period. Database design, probably the most important stage during the transition to MUM, together with the digital basic maps making up the basis of this infrastructure constitute the main point of this article. Firstly, the forest management philosophy of Turkey in the past was shortly touched upon in the article. Ecosystem Based Multiple Use Forest Management (EBMUFM) approaches was briefly introduced. The second stage of the process of EBMUFM, database design was described by examining the classical planning infrastructure and the coverage to be produced and consumed were suggested in the form of lists. At the application stage, two different geographical databases were established with GIS in Balcı Planning Unit of the years 1984 and 2006. Following that the related basic maps are produced. Timely diversity of the planning unit of 20 years is put forward comparatively with regard to the stand parameters such as tree types, age class, development stage, canopy closure, mixture, volume and increment.

  14. Two Cases Of Multiple Sclerosis Accompanying Psychiatric Symptoms

    Directory of Open Access Journals (Sweden)

    Ayşegül Şengel

    2007-10-01

    Full Text Available Scientific bacground: It has been reported that; Multiple Sclerosis (MS may be presented with many psychiatric symptoms such as anxiety, depression, mania and psychosis. MS cases, presented with psychiatric symptoms were also reported. Cases: Two MS cases, diagnosed as psychotic and bipolar disorder respectively, were reported in this paper. Both of the cases were responded to the steroid treatment, and neurological and psychiatric examinations were found to be normal after one month. CONCLUSION: MS cases might be presented with psychiatric complaints and symptoms except neurological ones. We conclude that; psychiatric evaluation as well as the neurological evaluation is important in the MS cases presented with psychiatric symptoms

  15. Project management case studies

    CERN Document Server

    Kerzner, Harold R

    2013-01-01

    A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re

  16. The use of artificial neural network analysis and multiple regression for trap quality evaluation: a case study of the Northern Kuqa Depression of Tarim Basin in western China

    Energy Technology Data Exchange (ETDEWEB)

    Guangren Shi; Xingxi Zhou; Guangya Zhang; Xiaofeng Shi; Honghui Li [Research Institute of Petroleum Exploration and Development, Beijing (China)

    2004-03-01

    Artificial neural network analysis is found to be far superior to multiple regression when applied to the evaluation of trap quality in the Northern Kuqa Depression, a gas-rich depression of Tarim Basin in western China. This is because this technique can correlate the complex and non-linear relationship between trap quality and related geological factors, whereas multiple regression can only describe a linear relationship. However, multiple regression can work as an auxiliary tool, as it is suited to high-speed calculations and can indicate the degree of dependence between the trap quality and its related geological factors which artificial neural network analysis cannot. For illustration, we have investigated 30 traps in the Northern Kuqa Depression. For each of the traps, the values of 14 selected geological factors were all known. While geologists were also able to assign individual trap quality values to 27 traps, they were less certain about the values for the other three traps. Multiple regression and artificial neural network analysis were, therefore, respectively used to ascertain these values. Data for the 27 traps were used as known sample data, while the three traps were used as prediction candidates. Predictions from artificial neural network analysis are found to agree with exploration results: where simulation predicted high trap quality, commercial quality flows were afterwards found, and where low trap quality is indicated, no such discoveries have yet been made. On the other hand, multiple regression results indicate the order of dependence of the trap quality on geological factors, which reconciles with what geologists have commonly recognized. We can conclude, therefore, that the application of artificial neural network analysis with the aid of multiple regression to trap evaluation in the Northern Kuqa Depression has been quite successful. To ensure the precision of the above mentioned geological factors and their related parameters for each

  17. Case Study Research Methodology

    Directory of Open Access Journals (Sweden)

    Mark Widdowson

    2011-01-01

    Full Text Available Commenting on the lack of case studies published in modern psychotherapy publications, the author reviews the strengths of case study methodology and responds to common criticisms, before providing a summary of types of case studies including clinical, experimental and naturalistic. Suggestions are included for developing systematic case studies and brief descriptions are given of a range of research resources relating to outcome and process measures. Examples of a pragmatic case study design and a hermeneutic single-case efficacy design are given and the paper concludes with some ethical considerations and an exhortation to the TA community to engage more widely in case study research.

  18. Multiple myeloma of the jaw: A case report

    Directory of Open Access Journals (Sweden)

    Shubhasini A Raghavan

    2014-01-01

    Full Text Available Multiple myeloma is a systemic B-cell lymphoproliferative disease that causes osteolytic lesions in the vertebra, ribs, pelvic bone, skull and jaw. Rarely jaw lesions are seen as the first sign in multiple myeloma. This is a case report with follow up of a 57-year-old female patient, previously treated for osteoporosis, who presented with a swelling of the jaw. On radiographic examination, she was found to have osteolytic lesions in the mandible and skull bones. These conventional aids led to the diagnosis of multiple myeloma thereby proving that the osteoporotic lesions were a part of the spectrum of multiple myeloma. The patient underwent chemotherapy and is currently on follow-up. This case report emphasizes the importance of early diagnosis of multiple myeloma in the jaw using readily available technologies and illustrates the contribution that oral assessment can provide.

  19. Imaging Finding of Multiple Endocrine Neoplasia Type 1: Case Report

    International Nuclear Information System (INIS)

    Yum, Tae Jun; Cho, Hee Woo

    2012-01-01

    Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited syndrome with characteristic clinical and radiological manifestations. Many reports on MEN1 have been published; however, no cases of radiologically diagnosed MEN1 have been reported. Therefore, we report on a radiologically diagnosed case of MEN1 with clinical symptoms of gastroduodenal ulcer.

  20. Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report.

    Science.gov (United States)

    Das, Sushant K; Zeng, Li-Chuan; Li, Bing; Niu, Xiang-Ke; Wang, Jing-Liang; Bhetuwal, Anup; Yang, Han-Feng

    2014-09-28

    Occasionally systemic complications with high risk of death, such as multiple organ dysfunction syndrome (MODS), can occur following multiple bee stings. This case study reports a patient who presented with MODS, i.e., acute kidney injury, hepatic and cardiac dysfunction, after multiple bee stings. The standard clinical findings were then correlated with magnetic resonance imaging (MRI) findings, which demonstrates that MRI may be utilized as a simpler tool to use than other multiple diagnostics.

  1. All Students Are Not Equal: A Case Study of Geometry Teachers' Instructional Strategies When Trained in Multiple-Intelligence-Based Practices in Secondary Classrooms

    Science.gov (United States)

    Davis, Cassandre Y.

    2017-01-01

    Over 50% of secondary students failed the geometry end-of-course test in a Florida school district, indicating a need to improve academic performance. Secondary school students' learning characteristics and the effectiveness of teachers' instructional strategies are imperative to educational success. In this qualitative case study, geometry…

  2. Usefulness of laser-evoked potentials and quantitative sensory testing in the diagnosis of neuropathic spinal cord injury pain: a multiple case study.

    Science.gov (United States)

    Landmann, G; Berger, M F; Stockinger, L; Opsommer, E

    2017-06-01

    A retrospective study. The aim of this study was to investigate the contribution of laser-evoked potentials (LEPs) and quantitative sensory testing (QST) to the diagnosis of neuropathic pain in patients with spinal cord injury (SCI) and inconclusive magnetic resonance imaging (MRI) findings. A multidisciplinary pain center. QST (DFNS protocol) and Tm-YAG-laser stimulation of the skin were applied within the pain site corresponding with dermatomes of altered sensation. Available MRI scans were reviewed. Thirteen individuals (50±16 years) with SCI were examined. In four cases with no detectable neural lesion on MRI, all QST but three LEP were abnormal. In four patients with poorly defined spinal lesion on MRI, all QST but three LEP only were abnormal. In four cases where pain was not matching adequately with MRI lesions, all patients had abnormal LEP and QST. In one patient showing a spinal cord atrophy, LEP was normal but QST was abnormal. Findings supported the diagnoses at-level (n=5) and below-level (n=8) SCI pain. Spinothalamic tract function assessed by LEP was normal in three cases, but QST was abnormal in all cases. As QST is a psychophysical examination depending on patient cooperation, we suggest that the combination of QST and LEP might be a valuable diagnostic tool to detect lesions of the somatosensory system in a subgroup of patients with neuropathic spinal cord injury pain and inconclusive MRI findings.

  3. The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy.

    Science.gov (United States)

    De Neubourg, D; Bogaerts, K; Wyns, C; Albert, A; Camus, M; Candeur, M; Degueldre, M; Delbaere, A; Delvigne, A; De Sutter, P; Dhont, M; Dubois, M; Englert, Y; Gillain, N; Gordts, S; Hautecoeur, W; Lesaffre, E; Lejeune, B; Leroy, F; Ombelet, W; Perrier D'Hauterive, S; Vandekerckhove, F; Van der Elst, J; D'Hooghe, T

    2013-10-01

    What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a >50% reduction of the multiple pregnancy rate from 27 to 11% between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001. Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system (www.belrap.be) where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero, were associated with a 50% reduction of the multiple pregnancy rate from 27 to 11% without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health. Over the 20

  4. Improving the characterization of fish assemblage structure through the use of multiple sampling methods: a case study in a subtropical tidal flat ecosystem.

    Science.gov (United States)

    Contente, Riguel Feltrin; Del Bianco Rossi-Wongtschowski, Carmen Lucia

    2017-06-01

    The use of multiple sampling gears is indispensible to obtain robust characterizations of fish assemblage structure in species-rich subtropical ecosystems. In this study, such a dependence was demonstrated by characterizing the structure of the high-tide fish assemblage in a subtropical tidal flat ecosystem (the Araçá Bay, southeastern Brazil) using eight different gears along five seasonal surveys and estimating the bay's fish species richness, combining these data with those from local tide pool fish surveys. The high-tide fish assemblage was spatially structured, contained five threatened species, and was dominated by persistent and large populations of Eucinostomus argenteus and of the fisheries species Mugil curema and Diapterus rhombeus that intensively use the bay throughout their life cycles. Large, small-bodied fish populations supported a regular use of the bay by piscivores. The autumn-winter peak in abundance of juvenile fishes caused a subsequent increase in piscivore abundance, and both events explained the bulk of the seasonal variability of the fish assemblage. The estimated richness revealed that the combination of sampling methods was enough for sampling the bulk of the local richness, and the bay may hold a surprisingly high richness compared to other costal ecosystem of the region. This faunal characterization, only viable using multiple gears, will be critical to support the implementation of a future study to monitor the impacts on local fish biodiversity of an imminent port expansion over the tidal flat.

  5. Integration of lexical and sublexical processing in the spelling of regular words: a multiple single-case study in Italian dysgraphic patients.

    Science.gov (United States)

    Laiacona, Marcella; Capitani, Erminio; Zonca, Giusy; Scola, Ilaria; Saletta, Paola; Luzzatti, Claudio

    2009-01-01

    In this study we investigated 12 cases of "mixed dysgraphia", a spelling impairment where regular words are spelt better than either ambiguous words or regular non-words. Two explanations of mixed dysgraphia were formerly offered by Luzzatti et al. (1998): (i) a double functional lesion of the orthographic output lexicon (or damage to its access) and of the acoustic-to-phonological conversion; and (ii) some kind of interaction/summation between lexical and sublexical spelling routes when processing regular words. We first analysed whether a double functional lesion was sufficient to explain the mixed dysgraphia, checking acoustic-to-phonological conversion by means of the repetition of words and non-words: the answer was positive in five cases and uncertain in three. We tested the remaining four cases to see if there was an interaction between lexical and sublexical processing of regular words, quantifying for each patient, on a probabilistic basis, the separate contribution of the residual lexical and sublexical resources. We investigated whether the processing along these routes was simultaneous but independent ("independent cooperation") or if instead there was "interaction", i.e., the simultaneous activity led to an added increase of efficiency over and above the mere combination of separate success probabilities. For one case the processing along the two routes was independent, in the other three cases an interaction resulted. Following the same approach, we found that for the five cases with a double functional lesion, the observed success on regular word spelling was higher than that expected on a probabilistic basis, but the interpretation of this finding was different.

  6. Multiple symmetrical lipomatosis (Madelung's disease) - a case report

    International Nuclear Information System (INIS)

    Vieira, Marcelo Vasconcelos; Abreu, Marcelo de; Furtado, Claudia Dietz; Silveira, Marcio Fleck da; Furtado, Alvaro Porto Alegre; Genro, Carlos Horacio; Grazziotin, Rossano Ughini

    2001-01-01

    Multiple symmetrical lipomatosis (Madelung's disease) is a rare disorder characterized by deep accumulation of fat tissue, involving mainly the neck, shoulders and chest. This disease is associated with heavy alcohol intake and it is more common in men of Mediterranean origin. This disease can cause severe aesthetic deformities and progressive respiratory dysfunction. We report a case of a patient with multiple symmetrical lipomatosis and describe the clinical and radiological features of this disorder. (author)

  7. The case of a multiple myeloma with hyperlipoproteinaemia

    International Nuclear Information System (INIS)

    Paluszewska, M.; Bobilewicz, D.; Gigier, A.; Zwolinski, J.; Kuratowska, Z.

    1994-01-01

    The case of a 52-year-old women with hyperlipoproteinaemia, xantomathosis and multiple myeloma was discussed. The lipid disorder was one of the first symptoms and the base for diagnosis. Hyperlipoproteinaemia was probably due to the monoclonal immunoglobulin and lipoprotein interaction or their impaired catabolism. Lipoprotein lipase activity was normal. Cytostatic therapy led to partial remission of multiple myeloma and lipoproteins concentration became normal. (author)

  8. Primary laryngeal localization of multiple myeloma: A case report

    OpenAIRE

    Allegra, Eugenia; Marino, Nicol?; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

    2017-01-01

    Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Co...

  9. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Directory of Open Access Journals (Sweden)

    Cindy W. Yoon

    2016-09-01

    Full Text Available Only a few cases of Turner syndrome (TS with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  10. A case of multiple tuberculomas in brain presenting as hemiparesis

    Directory of Open Access Journals (Sweden)

    Amit Gupta

    2011-03-01

    Full Text Available Tuberculosis of central nervous system can be present in many different clinical and radiological patterns with disseminated or miliary brain tuberculomas as a rare presentation. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV infection. Tuberculomas develop following haematogenous dissemination of bacilli from an infection elsewhere in the body, usually lung. Here we describe a case of immunocompetent host with a past history of pulmonary tuberculosis, presenting with headache and generalised weakness, and later was diagnosed as a case of multiple tuberculoma brain.

  11. Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves.

    Science.gov (United States)

    Ribáry, Gergő; Lajtai, László; Demetrovics, Zsolt; Maraz, Aniko

    2017-01-01

    Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits). People who identify themselves as "multiple" have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as "multiple." Methods: First, an Internet forum search was performed using the terms "multiplicity" and "multiple system." Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes. Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200-300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each "resident person" or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves. Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID), although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

  12. Assessing human variability in kinetics for exposures to multiple environmental chemicals: a physiologically based pharmacokinetic modeling case study with dichloromethane, benzene, toluene, ethylbenzene, and m-xylene.

    Science.gov (United States)

    Valcke, Mathieu; Haddad, Sami

    2015-01-01

    The objective of this study was to compare the magnitude of interindividual variability in internal dose for inhalation exposure to single versus multiple chemicals. Physiologically based pharmacokinetic models for adults (AD), neonates (NEO), toddlers (TODD), and pregnant women (PW) were used to simulate inhalation exposure to "low" (RfC-like) or "high" (AEGL-like) air concentrations of benzene (Bz) or dichloromethane (DCM), along with various levels of toluene alone or toluene with ethylbenzene and xylene. Monte Carlo simulations were performed and distributions of relevant internal dose metrics of either Bz or DCM were computed. Area under the blood concentration of parent compound versus time curve (AUC)-based variability in AD, TODD, and PW rose for Bz when concomitant "low" exposure to mixtures of increasing complexities occurred (coefficient of variation (CV) = 16-24%, vs. 12-15% for Bz alone), but remained unchanged considering DCM. Conversely, AUC-based CV in NEO fell (15 to 5% for Bz; 12 to 6% for DCM). Comparable trends were observed considering production of metabolites (AMET), except for NEO's CYP2E1-mediated metabolites of Bz, where an increased CV was observed (20 to 71%). For "high" exposure scenarios, Cmax-based variability of Bz and DCM remained unchanged in AD and PW, but decreased in NEO (CV= 11-16% to 2-6%) and TODD (CV= 12-13% to 7-9%). Conversely, AMET-based variability for both substrates rose in every subpopulation. This study analyzed for the first time the impact of multiple exposures on interindividual variability in toxicokinetics. Evidence indicates that this impact depends upon chemical concentrations and biochemical properties, as well as the subpopulation and internal dose metrics considered.

  13. Successful treatment of multiple bilateral impactions - a case report

    OpenAIRE

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-01-01

    Background Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. Case presentation In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of th...

  14. Reduced cortical microvascular oxygenation in multiple sclerosis: a blinded, case-controlled study using a novel quantitative near-infrared spectroscopy method

    Science.gov (United States)

    Yang, Runze; Dunn, Jeff F.

    2015-11-01

    Hypoxia (low oxygen) is associated with many brain disorders as well as inflammation, but the lack of widely available technology has limited our ability to study hypoxia in human brain. Multiple sclerosis (MS) is a poorly understood neurological disease with a significant inflammatory component which may cause hypoxia. We hypothesized that if hypoxia were to occur, there should be reduced microvascular hemoglobin saturation (StO2). In this study, we aimed to determine if reduced StO2 can be detected in MS using frequency domain near-infrared spectroscopy (fdNIRS). We measured fdNIRS data in cortex and assessed disability of 3 clinical isolated syndrome (CIS), 72 MS patients and 12 controls. Control StO2 was 63.5 ± 3% (mean ± SD). In MS patients, 42% of StO2 values were more than 2 × SD lower than the control mean. There was a significant relationship between StO2 and clinical disability. A reduced microvascular StO2 is supportive (although not conclusive) that there may be hypoxic regions in MS brain. This is the first study showing how quantitative NIRS can be used to detect reduced StO2 in patients with MS, opening the door to understanding how microvascular oxygenation impacts neurological conditions.

  15. 451 Case studies Cardiac

    African Journals Online (AJOL)

    Marinda

    Case Studies. 29 ... A case of a 26-year-old ASA I physical status male undergoing septoplasty had an abrupt ... myocardial infarction, severe hypertensive crisis, cerebral .... or no formal management is required in an ASA I patient.8 One.

  16. Tests of Multiplicative Models in Psychology: A Case Study Using the Unified Theory of Implicit Attitudes, Stereotypes, Self-Esteem, and Self-Concept

    Science.gov (United States)

    Blanton, Hart; Jaccard, James

    2006-01-01

    Theories that posit multiplicative relationships between variables are common in psychology. A. G. Greenwald et al. recently presented a theory that explicated relationships between group identification, group attitudes, and self-esteem. Their theory posits a multiplicative relationship between concepts when predicting a criterion variable.…

  17. A case of multiple cardiac calcified amorphous tumours

    Directory of Open Access Journals (Sweden)

    Amrit Chowdhary

    2017-05-01

    Full Text Available Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73 year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.

  18. MULTIPLE RETAINED TEETH IN MANDIBLE: A Case Report

    Directory of Open Access Journals (Sweden)

    Cvetan Cvetanov

    2010-07-01

    Full Text Available Purpose: The aim of this science report is to show a rare case of multiple impacted teeth at adult patient and our propose clinical approach.Materials and methods: The clinical case is showed from adult man /64-year old/ with multiple impacted teeth (6 impacted teeth in the anterior place on the mandible were not suggestive of any syndrome or metabolic disorder. The extraction of the impacted teeth was made on two stage with piezosurgery unit under local anaesthesia. For prevention of postsurgical complications, as a swelling and prevention of postsurgical resorbtion were used coneshapes from pressure xeno colagen. To base on clinical and radiological examination we will discuss the differential diagnosis and we will offer a clinical approach about decided the case.Result and Conclusion: The incidence of multiple retained teeth by literature research range from 10.9% to 40.4%, most frequently is the retention of the third molars. In the literature most rarely have clinical reports about multiple retained teeth which differ from third molars at adult patients. The rare clinical case we showed is very demonstrative and the medicative approach which we used gave excellent result.

  19. Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity, and residents' participation in the Netherlands: study protocol for a longitudinal multiple case study design.

    Science.gov (United States)

    Smit, E; Leenaars, K E F; Wagemakers, M A E; Molleman, G R M; Koelen, M A; van der Velden, J

    2015-11-23

    The number of people with one or more chronic diseases is increasing, but this trend could be reduced by promoting physical activity. Therefore, in 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport Connectors (CSCs), to whom a broker role has been ascribed. The defined outcome of CSCs role is an increased number of residents participating in local sports facilities and being physically active in their own neighbourhood. To realize this, primary care and sports professionals need to collaborate, and local sports facilities and neighbourhoods need to offer accessible physical activities for people in the locality, including people with one or more chronic diseases or at increased risk of chronic disease(s). Adequate scientific research is needed to assess CSCs' impact on: 1) connecting primary care, sport, and physical activity and 2) increasing the number of residents who engage in physical activity to promote their health. To study the role and the impact of CSCs, a longitudinal multiple case study will be conducted, in nine municipalities spread over the Netherlands, from 2014 until 2017. A mixed methodology will be used to perform action research and process evaluation. Study I focuses on the expected alliances of CSCs and the preconditions that facilitate or hinder CSCs in the formation of these alliances. The study population will consist of intermediary target groups. A literature review, interviews, focus groups, and document analysis will be undertaken. Study II will concentrate on lifestyle program participants to identify health and physical activity behavior changes. For this purpose, interviews, literature studies, a Delphi study, fitness tests, and questionnaires will be used. Linking and integrating results gained by multiple methods, at different levels, will provide a validated assessment of CSCs' impact on connecting the primary care and sports sectors. This will reveal changes in residents' physical activity behavior, and

  20. Late diagnosis of multiple myeloma: a case report

    Science.gov (United States)

    Syahreza, A.; Gatot, D.; Mardia, A. I.

    2018-03-01

    Multiple myeloma is a challenging hematologic case to handle. Sometimes the disease is diagnosed too late for the patient and doctor. Therefore, careful approaches are needed to manage the patient. A 66-year-old mansuffersfrom low back pain since one year before he came to the hospital. He was diagnosed multiple compression fractures by orthopedic and had undergone two surgeries in one year. Punched out lesions werein skull radiology and lumbar compression in lumbar MRI. After further investigation, plasmacytoma and M protein in urine electrophoresis were founded. Significant improvement found after bortezomib and dexamethasone were given.Diagnosis and management of multiple myeloma is a challenge for a doctor. Systematically approach is needed for a patient with a recurrent fracture. Even a novel therapies are not widely available in our country.We reported a late diagnosis of multiple myeloma and had a significant improvement after bortezomib and dexamethasone therapy.

  1. Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves

    Directory of Open Access Journals (Sweden)

    Gergő Ribáry

    2017-06-01

    Full Text Available Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits. People who identify themselves as “multiple” have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as “multiple.”Methods: First, an Internet forum search was performed using the terms “multiplicity” and “multiple system.” Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes.Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200–300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each “resident person” or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves.Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID, although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

  2. [Intestinal perforation due to multiple magnet ingestion: a case report].

    Science.gov (United States)

    Cevizci, Mehmet Nuri; Karadağ, Cetin Ali; Demir, Mesut; Dokucu, Ali Ihsan

    2012-03-01

    Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.

  3. Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

    Directory of Open Access Journals (Sweden)

    Gregory Jackson Tung

    2017-09-01

    Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

  4. Monitoring Cloud-prone Complex Landscapes At Multiple Spatial Scales Using Medium And High Resolution Optical Data: A Case Study In Central Africa

    Science.gov (United States)

    Basnet, Bikash

    Tracking land surface dynamics over cloud-prone areas with complex mountainous terrain and a landscape that is heterogeneous at a scale of approximately 10 m, is an important challenge in the remote sensing of tropical regions in developing nations, due to the small plot sizes. Persistent monitoring of natural resources in these regions at multiple spatial scales requires development of tools to identify emerging land cover transformation due to anthropogenic causes, such as agricultural expansion and climate change. Along with the cloud cover and obstructions by topographic distortions due to steep terrain, there are limitations to the accuracy of monitoring change using available historical satellite imagery, largely due to sparse data access and the lack of high quality ground truth for classifier training. One such complex region is the Lake Kivu region in Central Africa. This work addressed these problems to create an effective process for monitoring the Lake Kivu region located in Central Africa. The Lake Kivu region is a biodiversity hotspot with a complex and heterogeneous landscape and intensive agricultural development, where individual plot sizes are often at the scale of 10m. Procedures were developed that use optical data from satellite and aerial observations at multiple scales to tackle the monitoring challenges. First, a novel processing chain was developed to systematically monitor the spatio-temporal land cover dynamics of this region over the years 1988, 2001, and 2011 using Landsat data, complemented by ancillary data. Topographic compensation was performed on Landsat reflectances to avoid the strong illumination angle impacts and image compositing was used to compensate for frequent cloud cover and thus incomplete annual data availability in the archive. A systematic supervised classification, using the state-of-the-art machine learning classifier Random Forest, was applied to the composite Landsat imagery to obtain land cover thematic maps

  5. A Case of Mediastinal Extramedullary Plasmacytoma Associated with Multiple Myeloma

    Energy Technology Data Exchange (ETDEWEB)

    Min, Ji Hye; Kim, Tae Sung; Ko, Young Hyeh; Kim, Ki Hyun [Samsung Medical Center, Sungkyunkwan University, Seoul (Korea, Republic of)

    2010-08-15

    Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 x 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

  6. Nitrate source identification in groundwater of multiple land-use areas by combining isotopes and multivariate statistical analysis: A case study of Asopos basin (Central Greece)

    International Nuclear Information System (INIS)

    Matiatos, Ioannis

    2016-01-01

    Nitrate (NO_3) is one of the most common contaminants in aquatic environments and groundwater. Nitrate concentrations and environmental isotope data (δ"1"5N–NO_3 and δ"1"8O–NO_3) from groundwater of Asopos basin, which has different land-use types, i.e., a large number of industries (e.g., textile, metal processing, food, fertilizers, paint), urban and agricultural areas and livestock breeding facilities, were analyzed to identify the nitrate sources of water contamination and N-biogeochemical transformations. A Bayesian isotope mixing model (SIAR) and multivariate statistical analysis of hydrochemical data were used to estimate the proportional contribution of different NO_3 sources and to identify the dominant factors controlling the nitrate content of the groundwater in the region. The comparison of SIAR and Principal Component Analysis showed that wastes originating from urban and industrial zones of the basin are mainly responsible for nitrate contamination of groundwater in these areas. Agricultural fertilizers and manure likely contribute to groundwater contamination away from urban fabric and industrial land-use areas. Soil contribution to nitrate contamination due to organic matter is higher in the south-western part of the area far from the industries and the urban settlements. The present study aims to highlight the use of environmental isotopes combined with multivariate statistical analysis in locating sources of nitrate contamination in groundwater leading to a more effective planning of environmental measures and remediation strategies in river basins and water bodies as defined by the European Water Frame Directive (Directive 2000/60/EC). - Highlights: • More enriched N-isotope values were observed in the industrial/urban areas. • A Bayesian isotope mixing model was applied in a multiple land-use area. • A 3-component model explained the factors controlling nitrate content in groundwater. • Industrial/urban nitrogen source was

  7. [Case and studies].

    Science.gov (United States)

    Schubert, András

    2015-11-15

    Case studies and case reports form an important and ever growing part of scientific and scholarly literature. The paper deals with the share and citation rate of these publication types on different fields of research. In general, evidence seems to support the opinion that an excessive number of such publications may negatively influence the impact factor of the journal. In the literature of scientometrics, case studies (at least the presence of the term "case study" in the titles of the papers) have a moderate share, but their citation rate is practically equal to that of other publication types.

  8. ENVIRONMENTAL MANAGEMENT AND ORGANIZATIONAL STRUCTURE: MULTIPLE CASE STUDIES GESTÃO AMBIENTAL E ESTRUTURA ORGANIZACIONAL: ESTUDO DE MÚLTIPLOS CASOS

    Directory of Open Access Journals (Sweden)

    Ana Beatriz Lopes de Sousa Jabbour

    2013-01-01

    Full Text Available The main objective of this article is to analyze the insertion of environmental management in theorganizational structure of 9 Brazilian companies, in search of a better relationship with the environment.Further, we intend to show an agenda with research opportunities for future research in this area ofknowledge. A theoretical review of the relationship between environmental management and organizationalstructure was done. This theoretical review was the big picture to development of 9 case studies withISO14001 certified companies located in São Paulo State. The results show that: (a for all the cases,environmental management is under quality management area; (b only two companies adopt moreadvanced environmental management practices and these two companies have more complex organizationalstructure; (c only two companies have the environmental management structure named “matrix”, while theother companies have the type named “limited environmental management insertion”; (d it is possible todevelop a framework designed to understanding the process of greening organization to the 9 cases in study.Further these results, we designed a research agenda as a guide to future research initiatives.O objetivo deste artigo é analisar a incorporação da gestão ambiental na estrutura organizacional de nove empresas brasileiras, engajadas na busca pela melhoria do seu relacionamento com o meio ambiente.Adicionalmente, persegue-se o objetivo de delinear uma agenda de pesquisas futuras para  o tema. Para aconsecução desses objetivos, realizou-se uma fundamentação teórica sobre estrutura organizacional e suarelação com a gestão ambiental organizacional. Essa construção teórica serviu de pano de fundo para arealização de nove estudos de caso, em empresas com certificação ISO 14001, localizadas no Estado de SãoPaulo. Os resultados indicam que: (a a área de gestão ambiental tende a ser subordinada à área de qualidade;(b dentre as

  9. Extranodal Rosai Dorfman disease in multiple sites: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Jong Joon; Kim, Ho Kyun; Shim, Jae Chan; Lee, Kyoung Eun; Lee, Ghi Jai; Suh, Jung Ho; Hong, Seong Woo; Lee, Hye Kyung [Seoul Paik Hospital/Inje Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    Rosai Dorfman disease involves an abnormal proliferation of histiocytes. This abnormal growth tends to occur within the lymph nodes, with occasional extranodal presentation. Rosai Dorfman disease is a rare disease, and the extranodal cases are even more uncommon. We report a rare case of extranodal Rosai Dorfman disease in multiple sites in a 56 year old male patient. Abdominopelvic CT revealed soft tissue attenuation masses, encasing both the renal pelvis and both ureters, as well as the thoracic vertebra. Following the neck sonography, both submandibular glands had an enlarged honey combed appearance. Although Rosai Dorfman disease is rare, it should be considered as a potential differential diagnosis when multiple sites involving soft tissue attenuation masses are observed with sonogram and CT.

  10. Two cases of multiple skeletal tuberculosis with spina ventosa

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Byung Hee; Choi, Sung Wook; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

    1974-10-15

    Two cases of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathological methods, were reported. One of the cases was 3 years old boy who had multiple abscess formations in both lower legs, intermittent high fever and soft tissue swelling in both hands, and the other was 19 years old boy who had soft tissue swelling in both hands and feet. Radiologically, the former showed active hilar tuberculosis of the chest, and destructive changes with cortical expansion in the left humerus, left tibra, left calcaneus and both hands; the latter showed almost fibroconsolidated lesions of the chest, and the bony lesions in both radii, left calcaneus, and both hands and feet. Biopsy specimen showed tubercles composed of epithelial cells, small round cells and fibroblasts with caseous necrosis in part.

  11. Multiple intraoral neurofibromas: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    C Krithika

    2009-01-01

    Full Text Available Neurofibromatosis type I (NF I is an autosomal dominant disease transmitted with a high degree of penetrance. The disease is expressed in different forms. NF I accounts for almost 90% of the cases although nine types have been described to date. We report one such case of a 40-year-old male who presented with multiple nodules on the body and multiple intraoral soft tissue swellings. He was diagnosed to have NF I, having satisfied the diagnostic criteria for the same. This paper highlights the clinical features and diagnostic criteria of NF, the prevalence and the significance of intraoral neurofibromas and the need for the general practitioner to be aware of this condition.

  12. [A case of multiple cavernous angioma with dementia].

    Science.gov (United States)

    Kariya, S; Kawahara, M; Suzumura, A

    2000-10-01

    We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.

  13. A rare case of multiple meningiomas with different histology

    Directory of Open Access Journals (Sweden)

    Toma I. Papacocea

    2017-11-01

    Full Text Available Meningiomas are generally benign tumors but sometimes they manifest tendency to progress towards malignancy. It is not yet clear if anaplastic meningiomas have an innate malignancy characteristic, or an initially beginning histological appearance that degenerates malignantly in time. According to literature data, the risk of a benign meningioma to progress towards malignant phenotype is about 0.16-2%, such malignant transformation occurring after a variable period of time (2-16 years. A still unanswered question is how many of the malignant meningiomas present this appearance as an innate feature and how many of them originate from benign meningiomas. Multiple meningiomas are defined as the presence of two or more distinct meningiomas. They occur in 6-10% of all patients that present meningiomas. Multiple meningiomas with a distinct histological appearance are rarely discovered. They support the theory of meningiomas that develop independently in the same patient. Different histology of multiple meningiomas is found in less than a third of the patients who suffer from this pathology. We are presenting the case of a patient with multiple meningiomas with distinct histology, one being benign and the other malignant. In connection with this case we are raising a question of therapeutic management in patients diagnosed with malignant meningiomas, namely if other possible small/ benign meningiomas should be also entirely resected.

  14. Case report 554: Osteonecrosis at multiple sites as noted

    Energy Technology Data Exchange (ETDEWEB)

    Archer, A G; Nelson, M C [Georgetown Univ., Washington, DC (USA). Dept. of Radiology; Abbondanzo, S L [Georgetown Univ., Washington, DC (USA). Dept. of Pathology; Bogumill, G P [Georgetown Univ., Washington, DC (USA). Div. of Orthopaedics

    1989-08-01

    This is a case of a 31-year-old man who presented with persistent pain of the left knee and was found to have avascular necrosis at multiple sites. Plain film roentgenograms with tomography, bone scanning and magnetic resonance imaging were utilized in the diagnostic work-up. The history of treatment with steroids eight years previously was elicited only after the diagnosis was made radiographically and pathologically. (orig./GDG).

  15. Nitrate source identification in groundwater of multiple land-use areas by combining isotopes and multivariate statistical analysis: A case study of Asopos basin (Central Greece)

    Energy Technology Data Exchange (ETDEWEB)

    Matiatos, Ioannis, E-mail: i.matiatos@iaea.org

    2016-01-15

    Nitrate (NO{sub 3}) is one of the most common contaminants in aquatic environments and groundwater. Nitrate concentrations and environmental isotope data (δ{sup 15}N–NO{sub 3} and δ{sup 18}O–NO{sub 3}) from groundwater of Asopos basin, which has different land-use types, i.e., a large number of industries (e.g., textile, metal processing, food, fertilizers, paint), urban and agricultural areas and livestock breeding facilities, were analyzed to identify the nitrate sources of water contamination and N-biogeochemical transformations. A Bayesian isotope mixing model (SIAR) and multivariate statistical analysis of hydrochemical data were used to estimate the proportional contribution of different NO{sub 3} sources and to identify the dominant factors controlling the nitrate content of the groundwater in the region. The comparison of SIAR and Principal Component Analysis showed that wastes originating from urban and industrial zones of the basin are mainly responsible for nitrate contamination of groundwater in these areas. Agricultural fertilizers and manure likely contribute to groundwater contamination away from urban fabric and industrial land-use areas. Soil contribution to nitrate contamination due to organic matter is higher in the south-western part of the area far from the industries and the urban settlements. The present study aims to highlight the use of environmental isotopes combined with multivariate statistical analysis in locating sources of nitrate contamination in groundwater leading to a more effective planning of environmental measures and remediation strategies in river basins and water bodies as defined by the European Water Frame Directive (Directive 2000/60/EC). - Highlights: • More enriched N-isotope values were observed in the industrial/urban areas. • A Bayesian isotope mixing model was applied in a multiple land-use area. • A 3-component model explained the factors controlling nitrate content in groundwater. • Industrial

  16. Experience with multiple control groups in a large population-based case-control study on genetic and environmental risk factors.

    Science.gov (United States)

    Pomp, E R; Van Stralen, K J; Le Cessie, S; Vandenbroucke, J P; Rosendaal, F R; Doggen, C J M

    2010-07-01

    We discuss the analytic and practical considerations in a large case-control study that had two control groups; the first control group consisting of partners of patients and the second obtained by random digit dialling (RDD). As an example of the evaluation of a general lifestyle factor, we present body mass index (BMI). Both control groups had lower BMIs than the patients. The distribution in the partner controls was closer to that of the patients, likely due to similar lifestyles. A statistical approach was used to pool the results of both analyses, wherein partners were analyzed with a matched analysis, while RDDs were analyzed without matching. Even with a matched analysis, the odds ratio with partner controls remained closer to unity than with RDD controls, which is probably due to unmeasured confounders in the comparison with the random controls as well as intermediary factors. However, when studying injuries as a risk factor, the odds ratio remained higher with partner control subjects than with RRD control subjects, even after taking the matching into account. Finally we used factor V Leiden as an example of a genetic risk factor. The frequencies of factor V Leiden were identical in both control groups, indicating that for the analyses of this genetic risk factor the two control groups could be combined in a single unmatched analysis. In conclusion, the effect measures with the two control groups were in the same direction, and of the same order of magnitude. Moreover, it was not always the same control group that produced the higher or lower estimates, and a matched analysis did not remedy the differences. Our experience with the intricacies of dealing with two control groups may be useful to others when thinking about an optimal research design or the best statistical approach.

  17. Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers.

    Science.gov (United States)

    Kramer, Desre M; Tenkate, Thomas; Strahlendorf, Peter; Kushner, Rivka; Gardner, Audrey; Holness, D Linn

    2015-07-10

    CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection. This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers. Solar UV and heat are both health and safety hazards

  18. Multiple cerebral aneurysms of middle cerebral artery. Case report

    Directory of Open Access Journals (Sweden)

    D.A. Nica1, Tatiana Rosca1, A. Dinca2, M. Stroi3, Mirela Renta4, A.V. Ciurea5

    2010-11-01

    Full Text Available Multiple cerebral aneurysms present awide variation in incidence with averages of13% at angiographic studies and 22.7% atautopsy.High blood pressue, cigarette smoking,stress and possible also age and female sexseem to be risk factors for multipleintracranial aneurysms (MIAn in patientsof working age who have suffered asubarachnoid hemorrhage (SAH.Aneurysms were situated on the same sidein one-third of the patients with twoaneurysms and the most common site wasthe middle cerebral artery (MCA. Tomanage these challenging lesionsneurosurgeons must use all availableinnovations and advances, includingdiagnostic, technical and perioperativeadjuncts. The author presents a case ofmiddle age female, with two saccularaneurysms situated on the same side (rightMCA, who was operated in our clinic, 20days after first SAH episode, I grade onHunt/Hess scale. The angio MRI wasperformed before, and control DSangiography after operation. After pterionalapproach, the author used themagnification, microsurgical technics,temporal clip, and two permanent Yasargilcurved clips. A postoperative good recoveryenable the patient go to work and drive onemonth later.

  19. Aerosol transport and wet scavenging in deep convective clouds: a case study and model evaluation using a multiple passive tracer analysis approach

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Qing; Easter, Richard C.; Campuzano-Jost, Pedro; Jimenez, Jose L.; Fast, Jerome D.; Ghan, Steven J.; Wang, Hailong; Berg, Larry K.; Barth, Mary; Liu, Ying; Shrivastava, ManishKumar B.; Singh, Balwinder; Morrison, H.; Fan, Jiwen; Ziegler, Conrad L.; Bela, Megan; Apel, Eric; Diskin, G. S.; Mikoviny, Tomas; Wisthaler, Armin

    2015-08-20

    The effect of wet scavenging on ambient aerosols in deep, continental convective clouds in the mid-latitudes is studied for a severe storm case in Oklahoma during the Deep Convective Clouds and Chemistry (DC3) field campaign. A new passive-tracer based transport analysis framework is developed to characterize the convective transport based on the vertical distribution of several slowly reacting and nearly insoluble trace gases. The passive gas concentration in the upper troposphere convective outflow results from a mixture of 47% from the lower level (0-3 km), 21% entrained from the upper troposphere, and 32% from mid-atmosphere based on observations. The transport analysis framework is applied to aerosols to estimate aerosol transport and wet-scavenging efficiency. Observations yield high overall scavenging efficiencies of 81% and 68% for aerosol mass (Dp < 1μm) and aerosol number (0.03< Dp < 2.5μm), respectively. Little chemical selectivity to wet scavenging is seen among observed submicron sulfate (84%), organic (82%), and ammonium (80%) aerosols, while nitrate has a much lower scavenging efficiency of 57% likely due to the uptake of nitric acid. Observed larger size particles (0.15 - 2.5μm) are scavenged more efficiently (84%) than smaller particles (64%; 0.03 - 0.15μm). The storm is simulated using the chemistry version of the WRF model. Compared to the observation based analysis, the standard model underestimates the wet scavenging efficiency for both mass and number concentrations with low biases of 31% and 40%, respectively. Adding a new treatment of secondary activation significantly improves simulation results, so that the bias in scavenging efficiency in mass and number concentrations is reduced to <10%. This supports the hypothesis that secondary activation is an important process for wet removal of aerosols in deep convective storms.

  20. Clinical evaluation of multiple exostoses (17 cases) on bonescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Takayuki; Nakamura, Mamoru; Sugita, Reiji; Satou, Akihiro; Sakamoto, Kiyohiko (Tohoku Univ., Sendai (Japan). School of Medicine)

    1991-03-01

    Seventeen patients with multiple exostoses were examined on bone scintigraphy. Inheritance was recognized on seven patients (41%). Onset age of 15 patients was under 20 years old and 10 patients were under 10. The number of lesions was 211 and they were usually recognized at metaphyses of long bones. The degree of accumulation was classified into four grades: 0 (non increased), 1 (slightly-mild), 2 (moderate), and 3 (strong). One hundred and fifty-three lesions (73%) did not show definite increased activity (Grade 0, 1). Grade 3 included 14 lesions and they tended to be strongly calcified on X-P. This disease was said to transform into chondrosarcoma in 10 to 20%. Transformation was said to occur preferably in adults at heavily calcified lesion or one which showed irregularly thick hyaline cartilage. Such lesions showed more increased accumulation than normal bones. In our cases three cases were resected for this reason but turned out to be benign histologically. One case showed malignant transformation. In this case, a large malignant tumor replaced the parent bone and bone scan showed the cold lesion. Bone scintigraphy was considered useful to evaluate the biological activity of multiple exostoses. (author).

  1. A Study of Multiplicities in Hadronic Interactions

    Energy Technology Data Exchange (ETDEWEB)

    Estrada Tristan, Nora Patricia; /San Luis Potosi U.

    2006-02-01

    Using data from the SELEX (Fermilab E781) experiment obtained with a minimum-bias trigger, we study multiplicity and angular distributions of secondary particles produced in interactions in the experimental targets. We observe interactions of {Sigma}{sup -}, proton, {pi}{sup -}, and {pi}{sup +}, at beam momenta between 250 GeV/c and 650 GeV/c, in copper, polyethylene, graphite, and beryllium targets. We show that the multiplicity and angular distributions for meson and baryon beams at the same momentum are identical. We also show that the mean multiplicity increases with beam momentum, and presents only small variations with the target material.

  2. Multiple Symmetric Lipomatosis: A Review of 3 Cases

    Directory of Open Access Journals (Sweden)

    Emilio Mevio

    2012-01-01

    Full Text Available Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngotacheal area and of the esophagus. This disease usually affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Since the patients were asymptomatic temperance and diet was proposed, surgical removal of the lipomatose mass is the treatment of choice in case of complications due to fat mass compression on upper aerodigestive tract. The authors present three cases of Madelung's disease with different and particular manifestations.

  3. A unit-level perspective on the long-term sustainability of a nursing best practice guidelines program: An embedded multiple case study.

    Science.gov (United States)

    Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

    2016-01-01

    Best practice guidelines are a tool for narrowing research-to-practice gaps and improving care outcomes. There is some empirical understanding of guideline implementation in nursing settings, yet there has been almost no consideration of the longer-term sustainability of guideline-based practice improvements. Many healthcare innovations are not sustained, underscoring the need for knowledge about how to promote their survival. To understand how a nursing best practice guidelines program was sustained on acute healthcare center nursing units. We undertook a qualitative descriptive case study of an organization-wide nursing best practice guidelines program with four embedded nursing unit subcases. The setting was a large, tertiary/quaternary urban health center in Canada. The nursing department initiated a program to enhance patient safety through the implementation of three guidelines: falls prevention, pressure ulcer prevention, and pain management. We selected four inpatient unit subcases that had differing levels of program sustainability at an average of almost seven years post initial program implementation. Data sources included 39 key informant interviews with nursing leaders/administrators and frontline nurses; site visits; and program-related documents. Data collection and content analysis were guided by a framework for the sustainability of healthcare innovations. Program sustainability was characterized by three elements: benefits, routinization, and development. Seven key factors most accounted for the differences in the level of program sustainability between subcases. These factors were: perceptions of advantages, collaboration, accountability, staffing, linked levels of leadership, attributes of formal unit leadership, and leaders' use of sustainability activities. Some prominent relationships between characteristics and factors explained long-term program sustainability. Of primary importance was the extent to which unit leaders used sustainability

  4. A case of multiple brown tumors with primary hyperparathyroidism.

    Science.gov (United States)

    Mori, Hiroko; Okada, Yosuke; Arao, Tadashi; Shimaziri, Shohei; Tanaka, Yoshiya

    2013-01-01

    We report a case of large multiple brown tumors in a patient with primary hyperparathyroidism. A 52-year-old woman suffered from pain in the ribs and developed left facial swelling and deformity. CT showed a large destructive osteolytic lesion in the left maxillary sinus. Biopsy showed a lesion with newly formed bone tissue, diffuse giant cells and deposits of hemosiderin. In addition, similar lesions were also observed in the ribs, iliac bones and pelvis. The laboratory data showed hypercalcemia and hyperparathyroidism. Cervical echo and (201)Tl-(99m)TcO(4-) scintigraphy demonstrated a right lower swollen parathyroid adenoma. The diagnosis was multiple brown tumors with primary hyperparathyroidism and parathyroidectomy was performed. Follow-up CT showed marked decreases in the size of osteolytic lesions with calcification in the brown tumors compared to pre-treatment findings. These changes were associated with marked improvement in pain and facial deformity. We described a rare case of multiple brown tumors appeared in the maxilla associated with primary hyperparathyroidism.

  5. Septic Systems Case Studies

    Science.gov (United States)

    A collection of septic systems case studies to help community planners, elected officials, health department staff, state officials, and interested citizens explore alternatives for managing their decentralized wastewater treatment systems.

  6. HYDROGEOLOGIC CASE STUDIES

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  7. A Psychobiographical Case Study

    African Journals Online (AJOL)

    man, and cancer fighter. This psychobiographical case study entailed a psychosocial-historical ... does not draw more attention as a research method, as this approach has .... of the applied Levinsonian theory to the life of Jobs against the ...

  8. Qualitative Case Study Guidelines

    Science.gov (United States)

    2013-11-01

    Introduction to Sociological Methods. 2nd ed. New York, McGraw-Hill 14. Denzin , N. K. and Lincoln , Y. S. (2011) The SAGE Handbook of Qualitative...The Art of Science. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage 19. GAO (1990) Case Study...Rinehart & Winston 39. Stake, R. E. (1994) Case Studies. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage

  9. Implications of multiple risk factors for delineation of disease control zones: Case study on foot-and-mouth disease occurrence in Uganda

    DEFF Research Database (Denmark)

    Chrisostom, Ayebazibwe; Okurut, Ademun Anna Rose; Tjørnehøj, Kirsten

    2013-01-01

    strategies to promote disease control and livestock trade in endemic countries was to introduce the concept of disease-free zones within which specific sanitary and market standards have to be met. In Africa, it is only Namibia, Botswana and South Africa that have ever had FMD free OIE-declared zones......, water, animal products, utensils and livestock-human contacts. Like other developing countries, animal production and marketing are heavily constrained by limited access to lucrative international markets because of failure to meet the required standards by the World Trade Organization. One of the major....... In pursuit of possibilities of beef export to EU and other markets within Africa by the year 2020, Uganda delineated two disease control zones (DCZs) in areas with large livestock populations and as a consequence high risk for FMD, thus requiring high capital investment. This paper highlights the multiple...

  10. Co-creating Polyphony or Cacophony? A case study of an organization’s current brand co-creation process and the challenge of integrating multiple voices

    DEFF Research Database (Denmark)

    Schmeltz, Line; Kjeldsen, Anna Karina

    The latest wave within branding theory suggests a move toward enterprise branding or co-created branding (cf. Hatch and Schultz, 2010; Johansen and Andersen, 2012; Karmark, 2013). This entails that organizations to a large extent involve both external and internal stakeholders in an ongoing......, dynamic process of creating and developing the corporate brand. In theory, this approach holds great promise in terms of increasing organizational transparency, creating stakeholder engagement, as well as true stakeholder dialogue. But, a brand co-creation process also exposes the organization to danger......, e.g. loss of control, dilution of identity, and potential disharmony between the multiple voices co-creating the brand. Therefore, this paper empirically explores how an organization endeavoring into a brand co-creation process struggles to orchestrate the many voices in practice. Implications focus...

  11. An unusual case of idiopathic multiple invasive cervical resorption

    Directory of Open Access Journals (Sweden)

    Sathya Prakash Reddy Kesary

    2014-01-01

    Full Text Available Invasive cervical resorption is a rare form of root resorption, characterized by destruction of the cervical region of teeth resulting from the action of tooth resorbing cells. Being an asymptomatic condition, it is often discovered on routine radiographic examination. This multifactorial disease process can most commonly occur as a sequel to orthodontic treatment, dental trauma, bleaching procedures, and less commonly, as an outcome of segmental orthognathic surgery, periodontal root planning, tetracycline conditioning of the root canal, bruxism, transplantation of tooth, guided tissue regeneration, cementoenamel disjunction. In the absence of these predisposing factors, it can be labeled as ′idiopathic multiple cervical resorption′. This article describes the case of a medically fit Indian male, who displayed idiopathic invasive cervical resorption in multiple teeth.

  12. Extraosseous Multiple Myeloma with Retroperitoneal Manifestation: A Case Report

    International Nuclear Information System (INIS)

    Berdugo, Juan Oswaldo; Nieto, Sonia Janeth; Garzon, Julian Gonzalo

    2008-01-01

    This paper presents a case of a 57 years old man (patient of Hospital Militar Central of Bogota, Colombia) with weight loss and a mass in the right clavicle. Plain film radiography shows a lytic lesion in the sternum side of the clavicle. biopsy reports a plasmacytomas, radiotherapy was performed. Three years later lesions of similar characteristics within ribs and a focal lesion in left testicle were detected. The diagnosis was multiple myeloma, Chemotherapy and orquidectomy were performed. One year after, patient complained of diffuse abdominal pain and loss weight, contrast abdominal CT was performed. Computed tomography showed a left heterogeneous mass with irregular contours that involved the retroperitoneal space occupying its three compartments. Biopsy was performed and reported pleomorphicplasmocytic proliferation with nuclear enlargement and hyperchromic nuclei consistent with multiple myeloma with abdominal involvement.

  13. Anesthetic management of a patient with multiple sclerosis - case report

    Directory of Open Access Journals (Sweden)

    Eduardo Barbin Zuccolotto

    Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

  14. Interference profiles with multiple spherical waves: general case

    International Nuclear Information System (INIS)

    Zerbino, L.M.; Torroba, R.; Rodriquez, N.; Garavaglia, M.

    1984-01-01

    Characteristics of multiple-beam interference fringes, as in a Fabry-Perot interferometer with monochromatic light, are analyzed. The optical path and the optical-path difference between interfering beams are calculated for the most general case. Different refractive indices in the inner and outer media, and arbitrary locations of the light source and the point of observation, are taken into account. An expression of the impulse response of the system is given. The results obtained from experimental tests confirm the theoretical predictions. 8 references

  15. A new method to quantify and compare the multiple components of fitness--a study case with kelp niche partition by divergent microstage adaptations to temperature.

    Directory of Open Access Journals (Sweden)

    Vasco M N C S Vieira

    Full Text Available Management of crops, commercialized or protected species, plagues or life-cycle evolution are subjects requiring comparisons among different demographic strategies. The simpler methods fail in relating changes in vital rates with changes in population viability whereas more complex methods lack accuracy by neglecting interactions among vital rates.The difference between the fitness (evaluated by the population growth rate λ of two alternative demographies is decomposed into the contributions of the differences between the pair-wised vital rates and their interactions. This is achieved through a full Taylor expansion (i.e. remainder = 0 of the demographic model. The significance of each term is determined by permutation tests under the null hypothesis that all demographies come from the same pool.An example is given with periodic demographic matrices of the microscopic haploid phase of two kelp cryptic species observed to partition their niche occupation along the Chilean coast. The method provided clear and synthetic results showing conditional differentiation of reproduction is an important driver for their differences in fitness along the latitudinal temperature gradient. But it also demonstrated that interactions among vital rates cannot be neglected as they compose a significant part of the differences between demographies.This method allows researchers to access the effects of multiple effective changes in a life-cycle from only two experiments. Evolutionists can determine with confidence the effective causes for changes in fitness whereas population managers can determine best strategies from simpler experimental designs.

  16. Multiple sclerosis in the Faroe Islands. 7. Results of a case control questionnaire with multiple controls

    DEFF Research Database (Denmark)

    Kurtzke, J F; Hyllested, K; Arbuckle, J D

    1997-01-01

    Detailed questionnaires were completed in 1978-79 by 23 of the 28 then known resident Faroese multiple sclerosis (MS) patients and 127 controls. These controls were divided into 69 Group A (patient sibs and other relatives), 37 Group B (matched neighbor controls, their spouses and sibs, plus...... facilities, and nature of house construction or heating. Detailed dietary histories, available for half the subjects, revealed no differences, cases versus controls, for four age periods between age 0 and 30 years, and for 16 specified foodstuffs. Animal exposures showed overall no consistent differences...

  17. A Case of Multiple Sclerosis and Celiac Disease

    Directory of Open Access Journals (Sweden)

    H. Z. Batur-Caglayan

    2013-01-01

    Full Text Available Objectives. Multiple sclerosis (MS is an inflammatory autoimmune disorder of the central nervous system (CNS. Since a correlation between gluten intake and incidence of MS had been reported, the relationship of antigliadin antibodies and MS was debated. Case Report. We report the case of a 45-year-old female MS patient who is under interferon treatment. After seven years of monitoring, during her routine gastroenterological assessment, she was diagnosed with celiac disease. Conclusion. Beside the neurological manifestations that have been demonstrated in about 10% of celiac disease (CD patients, white-matter abnormalities in brain MRI are uncommon and controversial. But in the literature, MS seems to be associated with CD as in our patient. We suggest that MS patients with gastroenterological complaints should undergo an assessment for CD.

  18. Multiple Levels of Lumbar Spondylolysis - A Case Report -

    Science.gov (United States)

    Park, Kwang-Hwan; Ha, Joong-Won; Kim, Hak-Sun; Moon, Seong-Hwan; Lee, Hwan-Mo; Kim, Ho-Joong; Kim, Ju-Young

    2009-01-01

    We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery. PMID:20404945

  19. Differentiation among Multiple Sources of Anthropogenic Nitrate in a Complex Groundwater System using Dual Isotope Systematics: A case study from Mortandad Canyon, New Mexico

    Science.gov (United States)

    Larson, T. E.; Perkins, G.; Longmire, P.; Heikoop, J. M.; Fessenden, J. E.; Rearick, M.; Fabyrka-Martin, J.; Chrystal, A. E.; Dale, M.; Simmons, A. M.

    2009-12-01

    The groundwater system beneath Los Alamos National Laboratory has been affected by multiple sources of anthropogenic nitrate contamination. Average NO3-N concentrations of up to 18.2±1.7 mg/L have been found in wells in the perched intermediate aquifer beneath one of the more affected sites within Mortandad Canyon. Sources of nitrate potentially reaching the alluvial and intermediate aquifers include: (1) sewage effluent, (2) neutralized nitric acid, (3) neutralized 15N-depleted nitric acid (treated waste from an experiment enriching nitric acid in 15N), and (4) natural background nitrate. Each of these sources is unique in δ18O and δ15N space. Using nitrate stable isotope ratios, a mixing model for the three anthropogenic sources of nitrate was established, after applying a linear subtraction of the background component. The spatial and temporal variability in nitrate contaminant sources through Mortandad Canyon is clearly shown in ternary plots. While microbial denitrification has been shown to change groundwater nitrate stable isotope ratios in other settings, the redox potential, relatively high dissolved oxygen content, increasing nitrate concentrations over time, and lack of observed NO2 in these wells suggest minimal changes to the stable isotope ratios have occurred. Temporal trends indicate that the earliest form of anthropogenic nitrate in this watershed was neutralized nitric acid. Alluvial wells preserve a trend of decreasing nitrate concentrations and mixing models show decreasing contributions of 15N-depleted nitric acid. Nearby intermediate wells show increasing nitrate concentrations and mixing models indicate a larger component derived from 15N-depleted nitric acid. These data indicate that the pulse of neutralized 15N-depleted nitric acid that was released into Mortandad Canyon between 1986 and 1989 has infiltrated through the alluvial aquifer and is currently affecting two intermediate wells. This hypothesis is consistent with previous

  20. Understanding Whole Systems Change in Health Care: Insights into System Level Diffusion from Nursing Service Delivery Innovations--A Multiple Case Study

    Science.gov (United States)

    Berta, Whitney; Virani, Tazim; Bajnok, Irmajean; Edwards, Nancy; Rowan, Margo

    2014-01-01

    Our study responds to calls for theory-driven approaches to studying innovation diffusion processes in health care. While most research on diffusion in health care is situated at the service delivery level, we study innovations and associated processes that have diffused to the system level, and refer to work on complex adaptive systems and whole…

  1. A Comparative, Holistic, Multiple-Case Study of the Implementation of the Strategic Thinking Protocol© and Traditional Strategic Planning Processes at a Southeastern University

    Science.gov (United States)

    Robinson, Deborah J.

    2012-01-01

    This study explores the strategic thinking and strategic planning efforts in a department, college and university in the Southeastern United States. The goal of the study was to identify elements of strategic planning processes that meet the unique organizational features and complexities of a higher education institution. The study employed a…

  2. Hereditary multiple exostosis with secondary malignization: case report

    Energy Technology Data Exchange (ETDEWEB)

    Coutinho, A.M.N.; Pitella, F.A.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Radiologia. Centro de Medicna Nuclear

    2008-07-01

    Full text: Introduction: Hereditary Multiple Exostosis (HME) or multiple osteochondromatosis is a skeletal development anomaly which is characterized by generalized exostoses in the bones, mainly in long bone metaphyses, appearing during childhood and adolescence. The transmission is autosomal dominant, its prevalence varies from 1/50,000 to 9/1,000,000 in Europe, and around 10% of cases show no family history. Case Report: Description of an HME case with two secondary malignization episodes. The data was taken from the patient's chart and from imaging exams from the hospital files. WASB, a 19-year-old male, hospitalized after being pre-diagnosed with HME and complaints of bone-consistent mass in the right gluteal region and a lump in the posterior region of the right leg, associated to multiple bone lumps all over the body. A magnetic resonance imaging (MRI) was performed along with a bone scintillography with {sup 99m}Tc-MDP which showed multiple osteogenic lesions in the thorax, pelvic bones and long bones with periarticular prevalence in the lower limbs. The suspicion of malignancy in the right iliac area was raised due to the MRI result and to the higher intensity captured in the scintillography, confirming chondrosarcoma grade I of malignancy in the biopsy. The patient suffered interileo abdominalis amputation of the right lower limb with good evolution and control scintillography performed after 1 and 1,5 years. In the second controlling procedure, the patient complained about pain in the left knee, and a MRI suggested a new secondary malignization. The hypothesis of a head of left fibula osteochondroma with signs of aggressiveness was confirmed following surgery. Discussion: In HME, the exostoses grow along with the individual, ceasing with the epiphyseal fusion. The growth of these formations after skeletal maturation suggests activity of exostoses and, in most times, it is a sign of malignant transformation, which turns almost every time into

  3. [A case of focal epilepsy manifesting multiple psychiatric auras].

    Science.gov (United States)

    Ezura, Michinori; Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Fujikawa, Mayu; Aoki, Masashi; Nakasato, Nobukazu

    2015-01-01

    We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.

  4. Successful treatment of multiple bilateral impactions - a case report.

    Science.gov (United States)

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-07-25

    Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.

  5. Gigantism in sibling unrelated to multiple endocrine neoplasia: case report.

    Science.gov (United States)

    Matsuno, A; Teramoto, A; Yamada, S; Kitanaka, S; Tanaka, T; Sanno, N; Osamura, R Y; Kirino, T

    1994-11-01

    The cases of gigantism sisters with somatotroph adenomas unrelated to multiple endocrine neoplasia (MEN) Type 1 are reported. The sisters grew rapidly since they were 5 or 6 years old and were diagnosed to have gigantism with pituitary adenoma by computed tomographic scan and magnetic resonance imaging. A serum endocrinological examination showed the elevated growth hormone values. After thyroxine-releasing hormone stimulation, growth hormone values exhibited a paradoxical rise. They were supposed to be unrelated to MEN Type 1, because analysis of the 11th chromosomes and the other endocrine functions were normal. They were operated on by the transphenoidal method. Immunohistochemical staining of both tumor specimens confirmed somatotroph adenomas. Pituitary adenoma associated with MEN Type 1 is a well-recognized entity. However, the sporadic occurrence of pituitary adenoma unrelated to MEN Type 1, especially in siblings, is extremely rare. Fifteen cases of pituitary adenomas in siblings were described in the literature. As for gigantism, only two brothers were reported. Our case of gigantism sisters is the second sporadic case. In our review of the isolated cases of pituitary adenoma in siblings described in the literature, 12 (70%) of 17 cases including ours are acromegaly or gigantism. This incidence is much higher than that of MEN Type 1 patients with pituitary adenomas. The cause of the familial occurrence of pituitary adenomas is still unclear, although autosomal recessive inheritance has been suggested. It has been stated that point mutations in codon 201 or 227 of the Gs alpha gene located in chromosome 20 were found in about 35 to 40% of somatotroph adenomas.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. The purpose, function, and performance of streetcar transit in the modern U.S. city : a multiple-case-study investigation.

    Science.gov (United States)

    2015-02-01

    The streetcar has made a remarkable resurgence in the United States in recent years. However, despite the proliferation of : streetcar projects, there is remarkably little work on the streetcars role as a transportation service. This study examine...

  7. Objectivist case study research

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Fachner, Jörg

    2016-01-01

    be achieved through the use of objectivist case study research. The strength of the case study design is that it allows for uncovering or suggesting causal relationships in real-life settings through an intensive and rich collection of data. According to Hilliard (1993), the opposite applies for extensive......In order to comprehend the impact of music therapy or music therapy processes, a researcher might look for an approach where the topic under investigation can be understood within a broader context. This calls for a rich inclusion of data and consequently a limited number of participants and may...... designs, in which a small amount of data is gathered on a large number of subjects. With the richness of data, the intensive design is ―the primary pragmatic reason for engaging in single-case or small N research‖ (p. 374) and for working from an idiographic rather than a nomothetic perspective....

  8. Teacher behaviour in learning contexts for gifted and talented students : A multiple case study focusing on basic needs satisfaction and motivational differentiation

    NARCIS (Netherlands)

    de Boer, Greet C.; Opdenakker, Marie-Christine J.L.; Minnaert, Alexander E.M.G.

    2015-01-01

    In the international comparative study on reading, mathematics, and science of 2009 (OECD, 2010) especially Dutch gifted and talented (G&T) students underachieved compared to 17 countries. These students require a differentiated, adaptive curriculum embedded within an optimal learning environment

  9. Multicultural Education in Action: A Multiple Case Study of Black Elementary Aged Children's Identity Development and Engagement with Civil Rights Literature

    Science.gov (United States)

    Piper, Rebekah Elizabeth

    2015-01-01

    In the United States education system a large achievement gap between African American and Latino students compared to White American students exists. Various studies have documented the gap, but there has not been much success in closing it. Recognizing that the educational system is growing more, not less, diverse, including due to the rise in…

  10. Evaluating the outcome of an individual functional therapy program focused on children with cerebral palsy and cerebral visual impairment: A multiple case study

    NARCIS (Netherlands)

    Salavati, M.; Rameckers, E.A.A.; Waninge, A.; Krijnen, W.P.; Schans, C.P. van der; Steenbergen, B.

    2018-01-01

    Background: To date, there is no evidence-based functional therapy programme available for children with both cerebral palsy (CP) and cerebral visual impairment (CVI). This study evaluates an individually targeted functional therapy programme adapted for these children experiencing difficulties with

  11. Physiotherapy, based on the Bobath concept, may influence the gait pattern in persons with limb-girdle muscle dystrophy: a multiple case series study.

    Science.gov (United States)

    Oygard, Kjellaug; Haestad, Helge; Jørgensen, Lone

    2011-03-01

     There are few studies on possible effects of physiotherapy for adults with muscular dystrophy. The aim of this study was to examine if treatment based on the Bobath concept may influence specific gait parameters in some of these patients.   A single-subject experimental design with A-B-A-A phases was used, and four patients, three with limb-girdle muscular dystrophy (LGMD) and one with fascioscapulohumeral muscular dystrophy (FSHD), were included. The patients had 1 hour of individually tailored physiotherapy at each working day for a period of 3 weeks. Step length, step width and gait velocity were measured during the A-B-A-A phases by use of an electronic walkway. Walking distance and endurance were measured by use of the '6 minute walk test'.  . The three LGMD patients, who initially walked with a wide base of support, had a narrower, velocity-adjusted step width after treatment, accompanied with the same or even longer step length. These changes lasted throughout follow-up. Moreover, two of the patients were able to walk a longer distance within 6 minutes after the treatment period. The fourth patient (with FSHD) had a normal step width at baseline, which did not change during the study.   The results indicate that physiotherapy treatment based on the Bobath concept may influence the gait pattern in patients with LGMD. However, in order to evaluate the effectiveness of physiotherapy to patients with muscular dystrophies, we call for larger studies and controlled trials. Copyright © 2010 John Wiley & Sons, Ltd.

  12. The Entrepreneurial Network of Muslim Women Entrepreneurs: The Study of Multiple-Cases of Small Businesses in the Southern Region of Malaysia

    OpenAIRE

    Omar, Siti Sarah

    2015-01-01

    This paper seeks to empirically explore the dynamics roles of strong and weak ties within Muslim female entrepreneurs’ networks during critical problems (“tipping points”), and how this affects the subsequent performance of the small businesses. The literature review shows that many studies have explored the mix of strong and weak ties in small businesses linking them to stages of business development. More recent literature, however, has conceptualized firm growth through the notion of criti...

  13. Case Studies - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about several case studies for cervical cancer screening and management.

  14. Nuclear forensics case studies

    International Nuclear Information System (INIS)

    Fedchenko, Vitaly

    2016-01-01

    The objective of this presentation is to share three case studies from the Institute of Transuranium Elements (ITU) which describe the application of nuclear forensics to events where nuclear and other radioactive material was found to be out of regulatory control

  15. SCA12 case study

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Genetics; Volume 88; Issue 1. Utilizing linkage disequilibrium information from Indian Genome Variation Database for mapping mutations: SCA12 case study. Samira Bahl Ikhlak Ahmed The Indian Genome Variation Consortium Mitali Mukerji. Research Article Volume 88 Issue 1 April 2009 pp 55- ...

  16. national Case study

    African Journals Online (AJOL)

    This national case study reports on the development of a national network, ... system under the new policy), tends to be limited by content on problems and ... 20 credit programme; and within two Post Graduate Certificate of Education contexts, ...... descriptive with an issues focus (empirical) towards awareness production to.

  17. Analysis by multiple criteria for the definition of environmental fragility levels – A case study: watershed of Cará-Cará River, Ponta Grossa/PR

    Directory of Open Access Journals (Sweden)

    Marcos Antonio Miara

    2007-06-01

    Full Text Available The GIS (Geographical Information Systems, as a tool for theenvironmental analyses of specific modules, makes possiblethe use of different sources of information simultaneously. Inorder to exploit this characteristic, the present research applieda Multi criteria evaluation (MCE, using also the AHP (AnalyticHierarchy Process for the identification of differentiated levelsof environmental fragility from the definition of weights for theconsidered physical variables. The work has used the Cará-Cará River watershed, Ponta Grossa/PR, as its study area.The results have shown a five-class variation of environmentalfragility, which have been correlated witch the reality, givingsupport to a positive evaluation of the methods which wereused.

  18. MRI case studies

    International Nuclear Information System (INIS)

    Huggett, S.; Barber, J.

    1989-01-01

    Three case studies are presented to show the value of magnetic resonance imaging used in conjunction with other imaging techniques. In each case MRI proved a vital diagnostic tool and superior to CT in showing firstly the haematoma in a patient with aphasia and right-sided weakness, secondly the size of the disc herniation in a patient with severe leg and ankle pains and thirdly the existence of a metastatic lesion in a patient with a previous history of breast cancer. 11 figs

  19. Multiple timescale analysis of the urban heat island effect based on the Community Land Model: a case study of the city of Xi'an, China.

    Science.gov (United States)

    Gao, Meiling; Shen, Huanfeng; Han, Xujun; Li, Huifang; Zhang, Liangpei

    2017-12-06

    Urban heat islands (UHIs) are the phenomenon of urban regions usually being warmer than rural regions, which significantly impacts both the regional ecosystem and societal activities. Numerical simulation can provide spatially and temporally continuous datasets for UHI analysis. In this study, a spatially and temporally continuous ground temperature dataset of Xi'an, China was obtained through numerical simulation based on the Community Land Model version 4.5 (CLM4.5), at a temporal resolution of 30 min and a spatial resolution of 0.05 ∘ × 0.05 ∘ . Based on the ground temperature, the seasonal average UHI intensity (UHII) was calculated and the seasonal variation of the UHI effect was analyzed. The monthly variation tendency of the urban heat stress was also investigated. Based on the diurnal cycle of ground temperature and the UHI effect in each season, the variation tendencies of the maximum, minimum, and average UHII were analyzed. The results show that the urban heat stress in summer is the strongest among all four seasons. The heat stress in urban areas is very significant in July, and the UHII is the weakest in January. Regarding the diurnal cycle of UHII, the maximum always appears at 06:30 UTC to 07:30 UTC, while the minimum intensity of the UHI effect occurs at different times in the different seasons. The results of this study could provide a reference for policymakers about how to reduce the damage caused by heat stress.

  20. Multiple endocrine diseases in cats: 15 cases (1997-2008).

    Science.gov (United States)

    Blois, Shauna L; Dickie, Erica L; Kruth, Stephen A; Allen, Dana G

    2010-08-01

    The objective of this retrospective study was to characterize a population of cats from a tertiary care center diagnosed with multiple endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Medical records of 15 cats diagnosed with more than one endocrine disorder were reviewed. The majority of cats were domestic shorthairs, and the mean age at the time of diagnosis of the first disorder was 10.3 years. The most common combination of disorders was diabetes mellitus and hyperthyroidism. Two cats had concurrent diabetes mellitus and hyperadrenocorticism, one cat had concurrent central diabetes insipidus and diabetes mellitus. A mean of 25.7 months elapsed between diagnoses of the first and second endocrine disorder, but this was variable. This study suggests the occurrence of multiple endocrine disorders is uncommon in cats. Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  1. Investigating the Effects of Information Technology on the Capabilities and Performance of the Supply Chain of Dairy Companies in Fars Province: A Multiple Case Study

    Directory of Open Access Journals (Sweden)

    Ali Mohammadi

    2011-09-01

    Full Text Available Nowadays all organizations are somehow involved with information technology revolutions and the applicable aspects of information technology are evident in any field of supply chain, from the relationship with suppliers and producers to the relationship with the customers. In other words, the application of information technology is influential in the improvement of the supply chain. In this study, the effect of information technology tools on the capabilities and performance of the supply chain in the dairy companies of Fars province is investigated. In this research, in information technology sets of tools ,supply chain communication system (SCCS, electronic data interchange (EDI, electronic mail (Email, bar-coding, and radio frequency identification (RFID, in supply chain capabilities, four dimensions including information exchange, coordination, interfirm activity integration, and supply chain responsiveness, and in performance of supply chain, two variables of performance including marketing performance and financial performance will be examined. The results indicate that using information technology tools is effective on the capabilities and hence performance of the supply chain.

  2. Innovation in creative economy micro-enterprises: a multiple case study / Inovação em microempresas da economia criativa: um estudo de múltiplos casos

    Directory of Open Access Journals (Sweden)

    Mariana Bianchini Galuk

    2016-10-01

    Full Text Available Purpose: Research about how creative economy grew considerably in last years, mainly by the increase of representation that this sector has in the global economy. It is believed that creative economy’s organizations have some characteristics that differentiate them for the traditional areas where creativity is relevant in the innovation process. Thus, this paper aims to analyse the process of innovation in the creative economy organizations. Originality/gap/relevance/implications: Due to still early literature in the Brazilian context, we expect to contribute to it in the business studies field. Key methodological aspects: We conducted an exploratory qualitative research study on four micro enterprises that are part of the creative industries. The theoretical approach was about innovation in creative organizations, so as it was possible to realize an analysis of innovation in the investigated business from three categories identified in the literature: organization, technology options and customers. Summary of key results: It was found that these organizations have some characteristics that differ from traditional sectors of the economy, both in the type of innovation and in the way the innovation process is managed. However, it is questionable whether the flexibility that both aids in the flow of ideas and information would be a reality in larger companies. Key considerations/conclusions: As contributions, this article raised a reflection on creativity and innovation in this segment and also on innovation in creative microenterprises. Objetivo: As pesquisas relacionadas a Economia Criativa vêm aumentando consideravelmente nos últimos anos, principalmente pelo aumento de sua representatividade na economia global. Acredita-se que as organizações da economia criativa possuem características organizacionais diversas dos setores econômicos tradicionais, em que a criatividade é relevante no processo de inovação. Assim, o objetivo deste

  3. Nitrate source identification in groundwater of multiple land-use areas by combining isotopes and multivariate statistical analysis: A case study of Asopos basin (Central Greece).

    Science.gov (United States)

    Matiatos, Ioannis

    2016-01-15

    Nitrate (NO3) is one of the most common contaminants in aquatic environments and groundwater. Nitrate concentrations and environmental isotope data (δ(15)N-NO3 and δ(18)O-NO3) from groundwater of Asopos basin, which has different land-use types, i.e., a large number of industries (e.g., textile, metal processing, food, fertilizers, paint), urban and agricultural areas and livestock breeding facilities, were analyzed to identify the nitrate sources of water contamination and N-biogeochemical transformations. A Bayesian isotope mixing model (SIAR) and multivariate statistical analysis of hydrochemical data were used to estimate the proportional contribution of different NO3 sources and to identify the dominant factors controlling the nitrate content of the groundwater in the region. The comparison of SIAR and Principal Component Analysis showed that wastes originating from urban and industrial zones of the basin are mainly responsible for nitrate contamination of groundwater in these areas. Agricultural fertilizers and manure likely contribute to groundwater contamination away from urban fabric and industrial land-use areas. Soil contribution to nitrate contamination due to organic matter is higher in the south-western part of the area far from the industries and the urban settlements. The present study aims to highlight the use of environmental isotopes combined with multivariate statistical analysis in locating sources of nitrate contamination in groundwater leading to a more effective planning of environmental measures and remediation strategies in river basins and water bodies as defined by the European Water Frame Directive (Directive 2000/60/EC).

  4. Conjunctival Aspergilloma with Multiple Mulberry Nodules: A Case Report

    Directory of Open Access Journals (Sweden)

    Jiunn-Liang Chen

    2005-06-01

    Full Text Available A 30-year-old healthy female presented with a 1-year history of chronic mucous discharge, tearing, and irritation in the left eye. Slit-lamp examination revealed severe papillary and follicular reaction surrounding a movable subconjunctival mass on the left upper tarsal conjunctiva. Incision and curettage were performed to establish the diagnosis. Multiple peculiar black mulberry nodules were obtained. The clumps of septate hyphae seen with periodic acid-Schiff stain were characteristic of fungus ball (aspergilloma. The patient's symptoms improved significantly after surgery without any antifungal therapy. Although rarely reported, aspergillus is a common fungus in the conjunctiva that may seed into the subconjunctiva. We present this case to remind ophthalmologists of such a rare cause of recalcitrant conjunctival inflammation in immunocompetent patients.

  5. Synchronous GISTs associated with multiple sporadic tumors: a case report

    Directory of Open Access Journals (Sweden)

    Danila Comandini

    2017-08-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are rare neoplasms, but they also represent the most common mesenchymal tumors of the gastrointestinal tract originating from the cell of Cajal. GIST incidence ranges around 1% of all gastrointestinal malignancies. Approximately 5% of all GISTs have a hereditary etiology. The remaining 95% of GISTs are considered sporadic events, with up to 75% of cases driven by a constitutional activation of the c-KIT proto-oncogene. GISTs are generally solitary lesions. Nonetheless, multiple sporadic GISTs can occur and present as synchronous or metachronous tumors, usually associated with familial GIST. Here, we report a case of primary prostate and lung tumors associated with gastric and small bowel GISTs, unrelated to any known hereditary syndrome. Also, in the case we describe, the prostatic tumor came before the GISTs, while the lung tumor occurred later in time and led to pulmonary lobectomy plus lymphoadenectomy, with a diagnosis of nonsmall cell lung cancer. With the exception of a slight difference in lymphoid infiltration, the abdominal and gastric GIST nodules shared the same proliferative MIB1 index and mitotic count. However, the genetic analysis revealed that the gastric GIST and abdominal tumors were characterized by two different c-KIT mutations. This molecular heterogeneity supported the hypothesis of two different synchronous GISTs arising from stomach and ileum. At present, the patient is disease free and has already completed the third year of adjuvant therapy with imatinib. This case supports the importance of the analysis of c-KIT mutational status to distinguish metastases from synchronous multicentric GISTs, with relevant implications in therapeutic decisions, as well as the importance of a dedicated multidisciplinary team and of a radiological follow-up after the diagnosis of a primary GIST, to discover a relapse of the GIST or, possibly, additional malignancies.

  6. Characteristics and outcomes of patients with multiple myeloma aged 21-40 years versus 41-60 years: a multi-institutional case-control study.

    Science.gov (United States)

    Jurczyszyn, Artur; Nahi, Hareth; Avivi, Irit; Gozzetti, Alessandro; Niesvizky, Ruben; Yadlapati, Sujitha; Jayabalan, David S; Robak, Paweł; Pika, Tomas; Andersen, Kristian T; Rasche, Leo; Mądry, Krzysztof; Woszczyk, Dariusz; Raźny, Małgorzata; Usnarska-Zubkiewicz, Lidia; Knopińska-Posłuszny, Wanda; Wojciechowska, Małgorzata; Guzicka-Kazimierczak, Renata; Joks, Monika; Grosicki, Sebastian; Ciepłuch, Hanna; Rymko, Marcin; Vesole, David H; Castillo, Jorge J

    2016-12-01

    We compared the outcomes of multiple myeloma (MM) patients aged 21-40 and 41-60 years in the novel agent era. This case-control study included 1089 patients between 2000 and 2015. Cases and controls were matched for sex, International Staging System (ISS) stage and institution. There were 173 patients in the younger group and 916 patients in the older group. Younger patients presented with a higher incidence of lytic lesions (82% vs. 72%; P = 0·04) and high-risk cytogenetic abnormalities (83% vs. 68%; P = 0·007), but lower rate of elevated lactate dehydrogenase (21% vs. 44%; P < 0·001). Five- and 10-year overall survival (OS) in younger versus older patients was 83% vs. 67% and 56% vs. 39%, respectively (P < 0·001). Similar results were seen when studying the subset of 780 patients who underwent autologous transplantation. Younger patients with ISS stage 1 had a better OS than older patients (P < 0·001). There was no survival difference between younger and older patients with ISS stage 2 or 3. Younger MM patients, aged 21-40 years, treated in the era of novel agents have a better OS than their counterparts aged 41-60 years, but the survival advantage observed in younger patients was lost in more advanced stages of MM. © 2016 John Wiley & Sons Ltd.

  7. LEAN SIX SIGMA – MULTIPLE CASE STUDY

    Directory of Open Access Journals (Sweden)

    Delvio Venanzi

    2017-12-01

    Full Text Available Lean Six Sigma é uma gestão focada na qualidade e desempenho produtivo em sistemas operacionais. Este artigo discute os fundamentos desta metodologia através de duas diferentes concepções de gestão, Lean Manufacturing e Six Sigma. Primeiro, o artigo explica o DMAIC (definir, medir, analisar, melhorar e controlar e suas respectivas fases, após a filosofia Lean com o sipoc e técnicas de mapeamento de fluxo de valor. O artigo pretende mostrar a integração destes dois conceitos e seus resultados. A metodologia consistiu em uma teoria baseada em uma pesquisa bibliográfica de pesquisa exploratória que consistiu de três estudos de caso em empresas de diferenças localizadas em Sorocaba, São Paulo. Neste artigo estuda a aplicação de Lean Seis Sigma e seus resultados.

  8. Case Study: Shiraz Women

    Directory of Open Access Journals (Sweden)

    Bijan Khajehnoori

    2011-04-01

    Full Text Available This study investigated the relationship between lifestyle which seems as a scale of globalization process with body image. Required data was collected by systematic random sampling among 508 women in Shiraz. Based on existing theories and studies theoretical framework has constituted based on Giddens theory. Six hypotheses have been established. For collecting information, survey method and self reported questionnaire were used. In data analysis and explanation, multiple regression and unilateral dispersion analyses were used. The result showed that among effective factors on body image, modern musical lifestyle, religious' lifestyle, leisure lifestyle and participative lifestyle explained 23 percent of variations of body image. Among these variables, only religious lifestyle had negative relationship with body image and other variables had positive relationship with dependant variable.

  9. Case study - Czechoslovakia

    International Nuclear Information System (INIS)

    Kovar, P.

    1986-01-01

    In the lecture Case Study - Czechoslovakia with the sub-title 'Unified System of Personnel Preparation for Nuclear Programme in Czechoslovakia' the actual status and the current experience of NPP personnel training and preparation in Czechoslovakia are introduced. The above mentioned training system is presented and demonstrated by the story of a proxy person who is going to become shift engineer in a nuclear power plant in Czechoslovakia. (orig./HP)

  10. Case Studies - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2010-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about several case studies for cervical cancer screening and management.  Created: 10/15/2010 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  11. Surgical plate fixation of multiple rib fractures: a case report.

    Science.gov (United States)

    Mitev, Konstantin; Neziri, Dashurie; Stoicovski, Emil; Mitrev, Zan

    2018-05-29

    The healthcare system in developing countries is limited; particularly, medical specialties such as emergency and trauma medicine are underdeveloped. Consequently, trauma injuries sustained in traffic accidents result in chronic morbidity more often than similar cases in developed countries. Multiple rib fractures induce significant patient morbidity. Current international guidelines recommend a multidisciplinary, surgery-based treatment approach to achieve optimal clinical benefit. We admitted a 41-year-old Albanian man to our emergency department following a pedestrian-vehicle accident 5 days earlier. He presented with severe upper thoracic pain, chest deformity, dyspnea, tachycardia, subcutaneous emphysema, and hematoma. Chest radiography pointed to hypoventilated lung fields and a minor pleural effusion. Computed tomographic scans indicated displaced fractures of right lateral ribs 5 -11, hyperdensity regions from bone fragments, and pulmonary contusion. The treatment consisted of surgical fixation of ribs 7-10 using titanium reconstruction plates and cortical locking screws. The patient's clinical condition rapidly improved postoperatively. Follow-up at 6 weeks confirmed a full return to preoperative daily activities and a high quality of life. In this case report, we present a novel and promising development in the field of trauma medicine in the Republic of Macedonia. Trauma injuries can be treated via advanced multidisciplinary medical care according to international standards, allowing optimal health recovery.

  12. Twelve cases of multiple myeloma in Nagasaki (especially seven atomic bombing casualty cases). [In Japanese

    Energy Technology Data Exchange (ETDEWEB)

    Ichimaru, M; Yasuhi, S; Ouchuru, S

    1963-12-01

    Since 1958, there have been 12 cases of multiple myeloma in Nagasaki, and among them were 7 cases representing atomic bombing casualties, with 3 cases being with 2 km distance from the hypocenter. The age of onset was between 51 and 69 years, and the sex ratio was 8:4, it occurring mostly in males. Symptoms were predominantly low back pain and chest pain caused by the bone changes in 8 cases. Two cases complained of general malaise and palpitation which resulted from anemia. One developed persistent epistaris, and another complained of diplopia caused by the paralysis of the oculomotor nerve. Peripheral blood in all cases showed anemia, 9 with hyperchromic and 3 with normochromic or hypochromic anemia. Low platelet counts were seen in 3 cases. All showed leukopenia. All cases showed typical ..gamma..-globulin change with a myeloma peak, and in 4 cases showed an increase of ..beta..-globulin. Bence-Jones proteinuria was present in 5 cases. Average course was 1 year 4 months. Among complications, myeloma nephrosis, aplastic anemia, and pneumonia were the most important ones.

  13. Case Study - Alpha

    Directory of Open Access Journals (Sweden)

    Stephen Leybourne

    2016-11-01

    Full Text Available This case study was developed from an actual scenario by Dr. Steve Leybourne of Boston University.  The case documents the historical evolution of an organization, and has been used successfully in courses dealing with organizational and cultural change, and the utilization of ‘soft skills’ in project-based management. This is a short case, ideal for classroom use and discussion.  The issues are easily accessible to students, and there is a single wide ranging question that allows for the inclusion of many issues surrounding strategic decision-making, and behavioural and cultural change. Alpha was one of the earlier companies in the USA to invest in large, edge-of-town superstores, with plentiful free vehicle parking, selling food and related household products. Alpha was created in the 1950s as a subsidiary of a major publicly quoted retail group.  It started business by opening a string of very large discount stores in converted industrial and warehouse premises in the south of the United States. In the early days shoppers were offered a limited range of very competitively priced products. When Alpha went public in 1981 it was the fourth largest food retailer in the US, selling an ever-widening range of food and non-food products.  Its success continued to be based on high volume, low margins and good value for money, under the slogan of ‘Alpha Price.’

  14. NOx trade. Case studies

    International Nuclear Information System (INIS)

    Jantzen, J.

    2002-01-01

    Some of the questions with respect to the trade of nitrogen oxides that businesses in the Netherlands have to deal with are dealt with: should a business buy or sell rights for NOx emission; which measures must be taken to reduce NOx emission; how much must be invested; and how to deal with uncertainties with regard to prices. Simulations were carried out with the MOSES model to find the answers to those questions. Results of some case studies are presented, focusing on the chemical sector in the Netherlands. Finally, the financial (dis)advantages of NOx trade and the related uncertainties for a single enterprise are discussed [nl

  15. OBSESSIONS: CASE REPORT STUDY

    Directory of Open Access Journals (Sweden)

    Miloš Židanik

    2004-01-01

    Full Text Available Background. Obsessions are one of the most refractory psychiatric disorders. The therapeutic guidelines include a psychopharmacotherapy and the use of behavioural and supportive psychotherapy.Methods. This case report study presents a patient with a homicide obsessions at the forefront and narcissistic personality disorder in background. The use of analytical oriented psychotherapy, which helped to resolve axis-1 symptoms, is described.Conclusions. In the therapy of patients it is important to have the knowledge about the national therapeutic guidelines and critical distance toward them as well. Which therapy to use should be decided by the individual patient’s needs.

  16. Case Study: Puttin' on the Ritz: How to Put Science into Cases

    Science.gov (United States)

    Herreid, Clyde Freeman

    2017-01-01

    There are multiple ways to put science into a case. This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses different ways of presenting science in case studies.

  17. Multiple thymoma in a patient with myasthenia gravis: case report

    International Nuclear Information System (INIS)

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong; Kang, Duk Sik

    2004-01-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis

  18. Multiple thymoma in a patient with myasthenia gravis: case report

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong [College of Medicine, Gyeongsang National Univ., Jinju (Korea, Republic of); Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-02-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis.

  19. Multiple endocrine diseases in dogs: 35 cases (1996-2009).

    Science.gov (United States)

    Blois, Shauna L; Dickie, Erica; Kruth, Stephen A; Allen, Dana G

    2011-06-15

    To characterize a population of dogs from a tertiary care center with 2 or more endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Retrospective case series. 35 dogs with 2 or more endocrine disorders. Medical records were reviewed, and the following was recorded: clinical signs, physical examination findings, and the results of CBC, serum biochemical analysis, urinalysis, aerobic bacterial culture of urine samples, endocrine testing, diagnostic imaging, and necropsy. 35 dogs with more than 1 endocrine disorder were identified. Seventy-seven percent (27/35) of the dogs were male, and the mean age at the time of diagnosis of the first endocrinopathy was 7.9 years. Miniature Schnauzer was the most common breed. Twenty-eight of 35 (80%) dogs had 2 disorders; 7 (20%) had 3 disorders. The most common combinations of disorders included diabetes mellitus and hyperadrenocorticism in 57.1 % (20/35) of dogs; hypoadrenocorticism and hypothyroidism in 22.9% (8/35) of dogs; and diabetes mellitus and hypothyroidism in 28.6% (10/35) of dogs. A mean of 14.5 months elapsed between diagnosis of the first and second endocrine disorders, whereas there was a mean of 31.1 months between diagnosis of the first and third endocrine disorders. Results suggested that the occurrence of multiple endocrine disorders was uncommon in dogs. The most common combinations of endocrine disorders in this population of dogs were diabetes mellitus and hyperadrenocorticism, followed by hypoadrenocorticism and hypothyroidism.

  20. Analysis of multiple primary cancer autopsy cases associated with breast cancer: 2002-2010.

    Science.gov (United States)

    Shibahara, Yukiko; Sugawara, Yumi; Miki, Yasuhiro; Hata, Shuko; Takahashi, Hiroaki; Nakamura, Yasuhiro; Suzuki, Takashi; Ohuchi, Noriaki; Tsuji, Ichiro; Sasano, Hironobu

    2016-12-01

    Breast cancer patients have a generally increased risk of developing second cancers. The object of this study was to clarify the increased as well as decreased incidence of cancers in breast cancer patients using autopsy cases. 164 211 autopsy cases in the Annual of Pathological Autopsy Cases in Japan from 2002 to 2010 were analyzed for multiple primary cancer (MPC). Female MPC cases (4222 cases) were selected. We investigated the cancer incidence observed in breast cancer associated MPC. The Chi-squared test was used for analysis. All P-values were two-sided, and differences at P autopsy data on MPC which provide new evidence clinically and pathologically. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

  1. Case Study Research Methodology in Nursing Research.

    Science.gov (United States)

    Cope, Diane G

    2015-11-01

    Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants' perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

  2. The intergenerational multiple deficit model and the case of dyslexia

    Directory of Open Access Journals (Sweden)

    Elsje evan Bergen

    2014-06-01

    Full Text Available Which children go on to develop dyslexia? Since dyslexia has a multifactorial aetiology, this question can be restated as: What are the factors that put children at high risk for developing dyslexia? It is argued that a useful theoretical framework to address this question is Pennington’s (2006 multiple deficit model (MDM. This model replaces models that attribute dyslexia to a single underlying cause. Subsequently, the generalist genes hypothesis for learning (disabilities (Plomin & Kovas, 2005 is described and integrated with the MDM. Finally, findings are presented from a longitudinal study with children at family risk for dyslexia. Such studies can contribute to testing and specifying the MDM. In this study, risk factors at both the child and family level were investigated. This led to the proposed intergenerational MDM, in which both parents confer liability via intertwined genetic and environmental pathways. Future scientific directions are discussed to investigate parent-offspring resemblance and transmission patterns, which will shed new light on disorder aetiology.

  3. A case of multiple myeloma presenting as a bullous dermatosis

    Directory of Open Access Journals (Sweden)

    Gul Ulker

    2008-01-01

    Full Text Available Multiple myeloma is a malignant plasma cell proliferative disorder that produces a monoclonal immunoglobulin protein. The skin involvement and the development of bullous disease are rarely seen features in multiple myeloma. We present a 55-year-old man with a longstanding, large, tense bullous eruption and hypertrophic scars over his body accompanied recently with weight loss and fatique. He had no response to the previous treatments, which included oral glucocorticoids and dapsone. Histologic examination of the lesions revealed subepidermal bullae, while no immunoflourescence staining was observed. In a further detailed labarotory examination, multiple myeloma was detected. After the treatment of multiple myeloma with chemotherapy, the lesions regressed. Patients with longstanding, recurrent, unusual bullous eruption should be investigated for the development of multiple myeloma.

  4. Teaching Business Intelligence through Case Studies

    Science.gov (United States)

    Pomykalski, James J.

    2015-01-01

    In teaching business students about the application and implementation of technology, especially involving business intelligence, it is important to discover that project success in enterprise systems development efforts often depend on the non-technological problems or issues. The focus of this paper will be on the use of multiple case studies in…

  5. Goiania incident case study

    International Nuclear Information System (INIS)

    Petterson, J.S.

    1988-06-01

    The reasons for wanting to document this case study and present the findings are simple. According to USDOE technical risk assessments (and our own initial work on the Hanford socioeconomic study), the likelihood of a major accident involving exposure to radioactive materials in the process of site characterization, construction, operation, and closure of a high-level waste repository is extremely remote. Most would agree, however, that there is a relatively high probability that a minor accident involving radiological contamination will occur sometime during the lifetime of the repository -- for example, during transport, at an MRS site or at the permanent site itself during repacking and deposition. Thus, one of the major concerns of the Yucca Mountain Socioeconomic Study is the potential impact of a relatively minor radiation-related accident. A large number of potential impact of a relatively minor radiation-related accident. A large number of potential accident scenarios have been under consideration (such as a transportation or other surface accident which results in a significant decline in tourism, the number of conventions, or the selection of Nevada as a retirement residence). The results of the work in Goiania make it clear, however, that such a significant shift in established social patterns and trends is not likely to occur as a direct outcome of a single nuclear-related accident (even, perhaps, a relatively major one), but rather, are likely to occur as a result of the enduring social interpretations of such an accident -- that is, as a result of the process of understanding, communicating, and socially sustaining a particular set of associations with respect to the initial incident

  6. FMCT verification: Case studies

    International Nuclear Information System (INIS)

    Hui Zhang

    2001-01-01

    Full text: How to manage the trade-off between the need for transparency and the concern about the disclosure of sensitive information would be a key issue during the negotiations of FMCT verification provision. This paper will explore the general concerns on FMCT verification; and demonstrate what verification measures might be applied to those reprocessing and enrichment plants. A primary goal of an FMCT will be to have the five declared nuclear weapon states and the three that operate unsafeguarded nuclear facilities become parties. One focus in negotiating the FMCT will be verification. Appropriate verification measures should be applied in each case. Most importantly, FMCT verification would focus, in the first instance, on these states' fissile material production facilities. After the FMCT enters into force, all these facilities should be declared. Some would continue operating to produce civil nuclear power or to produce fissile material for non- explosive military uses. The verification measures necessary for these operating facilities would be essentially IAEA safeguards, as currently being applied to non-nuclear weapon states under the NPT. However, some production facilities would be declared and shut down. Thus, one important task of the FMCT verifications will be to confirm the status of these closed facilities. As case studies, this paper will focus on the verification of those shutdown facilities. The FMCT verification system for former military facilities would have to differ in some ways from traditional IAEA safeguards. For example, there could be concerns about the potential loss of sensitive information at these facilities or at collocated facilities. Eventually, some safeguards measures such as environmental sampling might be seen as too intrusive. Thus, effective but less intrusive verification measures may be needed. Some sensitive nuclear facilities would be subject for the first time to international inspections, which could raise concerns

  7. On a Diagnosed Case of Multiple Personality Disorder -A Supplementary Report with Special Reference to Psychotherapy-

    OpenAIRE

    藤田, 裕司

    2000-01-01

    As a supplement of the study on a dignosed case of MPD (Multiple Personality Disorder), the effect of the psychotherapy was discussed. The patient was a twenty-four-year-old woman suspected of an attempted murder. In this article, continued from the previous one reporting the process of a series of ten psychotherapeutic interviews with her, the general comment on that was made, and the merits and demerits of the psychotherapy were clarified.

  8. 425 Case study

    African Journals Online (AJOL)

    Marinda

    Anaesthesia management of acute aortic dissection type B in ... of a severe, constant abdominal and chest pain radiating to the ... Continuous spinal anaesthesia was induced ... these cases surgical intervention is critical.1,2 Type B of AAD is.

  9. Animal attack: an unusual case of multiple trauma in childhood.

    LENUS (Irish Health Repository)

    O'Grady, E

    2014-11-01

    A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.

  10. A comparison of two follow-up analyses after multiple analysis of variance, analysis of variance, and descriptive discriminant analysis: A case study of the program effects on education-abroad programs

    Science.gov (United States)

    Alvin H. Yu; Garry. Chick

    2010-01-01

    This study compared the utility of two different post-hoc tests after detecting significant differences within factors on multiple dependent variables using multivariate analysis of variance (MANOVA). We compared the univariate F test (the Scheffé method) to descriptive discriminant analysis (DDA) using an educational-tour survey of university study-...

  11. An unusual case of multiple self-inflicted punctures to the precordium

    LENUS (Irish Health Repository)

    Borhan, F

    2017-06-01

    Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.

  12. Epidemiological study of multiple sclerosis in La Rioja.

    Science.gov (United States)

    Bártulos Iglesias, M; Marzo Sola, M E; Estrella Ruiz, L A; Bravo Anguiano, Y

    2015-01-01

    Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range, 12 to 70). Most EDSS scores were mostly ≤ 2. Untreated MS cases account for 47.6% of the total and the most commonly used therapy is interferon. We detected 4 haematological tumours and 7 families with multiple members affected by MS. Prevalence and incidence are similar to those found in other regions Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Exploring barriers to remaining physically active: a case report of a person with multiple sclerosis.

    Science.gov (United States)

    Zalewski, Kathryn

    2007-03-01

    Physical therapy intervention for those with chronic disabling conditions typically follows an episode of care approach: therapists provide services when a decrement in functional performance occurs such that individuals require intervention to return to baseline performance. Attention to the psychosocial supports required for successful transition can be unintentionally minimized when the focus of an episode of care follows a change in physical function. The purpose of this case report is to present and discuss the challenges to successful community reintegration following physical therapy intervention with an emphasis on developing independent exercise habits in management of a person with multiple sclerosis. RW, presented in this case study, is a 52-year-old man diagnosed with progressive multiple sclerosis five years before self-referral to a pro bono physical therapy clinic.

  14. MRI study of degenerative process in multiple system atrophy

    International Nuclear Information System (INIS)

    Yagishita, Toshiyuki; Kojima, Shigeyuki; Hirayama, Keizo

    1995-01-01

    The characteristic morphological changes of the brainstem and cerebellar regions of multiple system atrophy (MSA) were studied by MRI in varing subtypes, that is olivoponto cerebellar atrophy (OPCA: 23 cases), striatonigral degeneration (SND: 7 cases) and Shy-Drager's syndrome (SDS: 9 cases). OPCA was characterized by atrophy of the entire regions of the brainstem and the cerebellum. SND and SDS tended to show atrophy similar in type but lessin extent to OPCA. The common lesions in MSA were atrophy of the pontine base and cerebellum, and dilation of the fourth ventricle. Atrophy of the pontine base was more dominant in the inferior part than in the superior part, and cerebellar atrophy was more dominant in the superior part than in the inferior part, indicating that degeneration of the pontocerebellar pathway proceeds principally along fibers connecting the inferior part of the pons and the superior part of the cerebellum. Dilation of the fourth ventricle indicated atrophy of the middle cerebellar peduncle. In almost all the cases of OPCA and about a half the cases of SND and SDS, the pontine base and the middle cerebellar peduncle appeared as high signal intensity on T 2 weighted image and as low intensity on T 1 , suggesting degeneration and demyelination. In a few cases of OPCA, the dorsolateral part of the putamen were demonstrated as low signal intensity on T 2 weighted image. (author)

  15. MRI study of degenerative process in multiple system atrophy

    Energy Technology Data Exchange (ETDEWEB)

    Yagishita, Toshiyuki; Kojima, Shigeyuki; Hirayama, Keizo [Chiba Univ. (Japan). School of Medicine

    1995-02-01

    The characteristic morphological changes of the brainstem and cerebellar regions of multiple system atrophy (MSA) were studied by MRI in varing subtypes, that is olivoponto cerebellar atrophy (OPCA: 23 cases), striatonigral degeneration (SND: 7 cases) and Shy-Drager`s syndrome (SDS: 9 cases). OPCA was characterized by atrophy of the entire regions of the brainstem and the cerebellum. SND and SDS tended to show atrophy similar in type but lessin extent to OPCA. The common lesions in MSA were atrophy of the pontine base and cerebellum, and dilation of the fourth ventricle. Atrophy of the pontine base was more dominant in the inferior part than in the superior part, and cerebellar atrophy was more dominant in the superior part than in the inferior part, indicating that degeneration of the pontocerebellar pathway proceeds principally along fibers connecting the inferior part of the pons and the superior part of the cerebellum. Dilation of the fourth ventricle indicated atrophy of the middle cerebellar peduncle. In almost all the cases of OPCA and about a half the cases of SND and SDS, the pontine base and the middle cerebellar peduncle appeared as high signal intensity on T{sub 2} weighted image and as low intensity on T{sub 1}, suggesting degeneration and demyelination. In a few cases of OPCA, the dorsolateral part of the putamen were demonstrated as low signal intensity on T{sub 2} weighted image. (author).

  16. On using the Multiple Signal Classification algorithm to study microbaroms

    Science.gov (United States)

    Marcillo, O. E.; Blom, P. S.; Euler, G. G.

    2016-12-01

    Multiple Signal Classification (MUSIC) (Schmidt, 1986) is a well-known high-resolution algorithm used in array processing for parameter estimation. We report on the application of MUSIC to infrasonic array data in a study of the structure of microbaroms. Microbaroms can be globally observed and display energy centered around 0.2 Hz. Microbaroms are an infrasonic signal generated by the non-linear interaction of ocean surface waves that radiate into the ocean and atmosphere as well as the solid earth in the form of microseisms. Microbaroms sources are dynamic and, in many cases, distributed in space and moving in time. We assume that the microbarom energy detected by an infrasonic array is the result of multiple sources (with different back-azimuths) in the same bandwidth and apply the MUSIC algorithm accordingly to recover the back-azimuth and trace velocity of the individual components. Preliminary results show that the multiple component assumption in MUSIC allows one to resolve the fine structure in the microbarom band that can be related to multiple ocean surface phenomena.

  17. A case of multiple intracranial tuberculomas accompanied by tuberculous meningitis

    International Nuclear Information System (INIS)

    Fukabori, Takashi; Takamatsu, Hajime; Nakanishi, Yasuhiro

    1986-01-01

    A 63-year-old man was admitted for headache and progressive drowsiness. In spite of negative results from cerebrospinal fluid (CSF) stains and cultures of tuberculosis and other bacteria, CSF findings and tuberculosis-positive sputum culture led to a tentative diagnosis of tuberculous meningitis. Symptoms and neurological test results both improved remarkably during antituberculous chemotherapy. Although the brain CT scan taken on admission showed no abnormal findings, one taken two months later revealed multiple high-density areas after enhancement with a contrast medium, suggesting multiple intracranial tuberculomas accompanied by tuberculous meningitis. The size of the multiple high-density areas gradually decreased during antituberculous chemotherapy. The CT scan can clearly locate lesions, detect complications, and evaluate the effects of treatment in patients with intracranial tuberculosis. (author)

  18. Multiple eschars in scrub typhus: a case report.

    Science.gov (United States)

    Koraluru, Munegowda; Nandigam, Manideep; Bairy, Indira; Vidyasagar, Sudha; Varma, Muralidhar

    2017-01-01

    Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was not observed previously. An eschar in an acute febrile patient from the "tsutsugamushi triangle" is a valuable sign in scrub typhus diagnosis. A search for multiple eschars in scrub typhus must be made by clinicians. © The Author(s) 2016.

  19. The use of the bootstrap in the analysis of case-control studies with missing data

    DEFF Research Database (Denmark)

    Siersma, Volkert Dirk; Johansen, Christoffer

    2004-01-01

    nonparametric bootstrap, bootstrap confidence intervals, missing values, multiple imputation, matched case-control study......nonparametric bootstrap, bootstrap confidence intervals, missing values, multiple imputation, matched case-control study...

  20. Multiple cavernous malformations presenting in a patient with Poland syndrome: A case report

    Directory of Open Access Journals (Sweden)

    De Salles Antonio AF

    2011-09-01

    Full Text Available Abstract Introduction Poland syndrome is a congenital disorder related to chest and hand anomalies on one side of the body. Its etiology remains unclear, with an ipsilateral vascular alteration (of unknown origin to the subclavian artery in early embryogenesis being the currently accepted theory. Cavernous malformations are vascular hamartomas, which have been linked to a genetic etiology, particularly in familial cases, which commonly present with multiple lesions. Our case report is the first to describe multiple cavernous malformations associated with Poland syndrome, further supporting the vascular etiology theory, but pointing to a genetic rather than a mechanistic factor disrupting blood flow in the corresponding vessels. Case presentation A 41-year-old Caucasian man with Poland syndrome on the right side of his body presented to our hospital with a secondary generalized seizure and was found to have multiple cavernous malformations distributed in his brain, cerebellum, and brain stem, with a predominance of lesions in the left hemisphere. Conclusion The distribution of cavernous malformations in the left hemisphere and the right-sided Poland syndrome in our patient could not be explained by a mechanistic disruption of one of the subclavian arteries. A genetic alteration, as in familial cavernous malformations, would be a more appropriate etiologic diagnosis of Poland syndrome in our patient. Further genetic and pathological studies of the involved blood vessels in patients with Poland syndrome could lead to a better understanding of the disease.

  1. Multiple brain abscesses in an infant: a case report | Mathews ...

    African Journals Online (AJOL)

    An ex-preterm baby who was treated successfully for staphylococcus aureus septicaemia and skin abscess in the neonatal period represented at the age of 13 weeks (corrected gestation 41 weeks) with gradual enlargement of the head size. A diagnosis of multiple staphylococcus aureus brain abscesses was made.

  2. A study of the treatment of oral multiple primary cancers

    International Nuclear Information System (INIS)

    Sato, Takayuki; Kamata, Shin-etsu; Kawabata, Kazuyoshi

    2003-01-01

    The subjects were 30 multiple primary cancers (out of 2,169 oral squamous cell carcinoma including lip cancers), which were treated at the Division of Head and Neck, Cancer Institute Hospital. Seven synchronous carcinomas and 23 metachronous cases were seen. The most common site of the primary cancer was the tongue. Surgical treatment was performed for the first treatment in 5 cases of the 7 synchronous cancers. On the other hand, radical treatment was performed in 11 cases of the 23 metachronous cancers. Fourteen of the 18 cases were treated by surgical treatment and controlled. It is suggested that surgical treatment is the most effective for oral multiple primary cancers. (author)

  3. Emotion, Engagement, and Case Studies

    Science.gov (United States)

    Herreid, Clyde Freeman; Terry, David R.; Lemons, Paula; Armstrong, Norris; Brickman, Peggy; Ribbens, Eric

    2014-01-01

    Three college faculty taught large general biology classes using case studies and personal response systems (clickers). Each instructor taught the same eight cases in two different sections, except the questions within the cases differed. In one section the questions were lower order (LO) factual inquiries, and in the other they were largely…

  4. Case Report: Multiple Unerupted Permanent Teeth Associated with ...

    African Journals Online (AJOL)

    The present report describes a case of Noonan's syndrome from a dental viewpoint. ... and malocclusions are some of the frequently observed clinical features. ... fixed orthodontic therapy for forced eruption of unerupted permanent teeth.

  5. Multiple calcifying hyperplastic dental follicles: A case report

    International Nuclear Information System (INIS)

    Aydin, Ulkem; Baykul, Timucin; Yildirim, Benay; Yildirim, Derya; Bozdemir, Esin; Karaduman, Ayse

    2013-01-01

    This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made.

  6. Multiple calcifying hyperplastic dental follicles: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Aydin, Ulkem [Dept. of Dentomaxillofacial Radiology, Baskent University Faculty of Dentistry, Ankara (Turkey); Baykul, Timucin [Dept. of Oral and Maxillofacial Surgery, Suleyman Demirel University Faculty of Dentistry, Isparta (Turkey); Yildirim, Benay [Dept. of Oral Pathology, Gazi University Faculty of Dentistry, Ankara (Turkey); Yildirim, Derya; Bozdemir, Esin [Dept. of Dentomaxillofacial Radiology, Suleyman Demirel University Faculty of Dentistry, Isparta (Turkey); Karaduman, Ayse [Atlas Dent Dental Health Center, Aydin (Turkey)

    2013-12-15

    This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made.

  7. Chronic periodontitis with multiple risk factor syndrome: a case report.

    Science.gov (United States)

    Shimoe, Masayuki; Yamamoto, Tadashi; Iwamoto, Yoshihiro; Shiomi, Nobuyuki; Maeda, Hiroshi; Nishimura, Fusanori; Takashiba, Shogo

    2011-07-01

    Multiple risk factor syndrome is a clustering of cardiovascular risk factors, such as diabetes, dyslipidemia, hypertension, and obesity associated epidemiologically with insulin resistance. This report describes the clinical course of a patient suffering from severe periodontitis with multiple risk factor syndrome, and discusses the association between periodontal infection and systemic health. The patient had a history of type 2 diabetes, dyslipidemia, and hypertension for over 10 years. At baseline, her hemoglobin A1 c was 8.1%. However, she had no diabetic complications except periodontitis. The IgG antibody titers against Porphyromonas gingivalis FDC 381 and SU63 were elevated above the mean of healthy subjects +2 standard deviations. Intensive periodontal treatment, including periodontal surgery, was performed to reduce periodontal infection and bacteremia. Her systemic and periodontal conditions were evaluated longitudinally for 10 years. Following periodontal treatment, antibody titers against Porphyromonas gingivalis and hemoglobin A1c values were significantly improved. The other clinical data and medication for her systemic condition also remained stable during supportive periodontal therapy. However, she developed myocardial infarction, and showed continuous deterioration of hemoglobin A1 c level and periodontitis. The long-term clustering of risk factors, such as diabetes, dyslipidemia, hypertension, and periodontitis, are associated with the development of myocardial infarction. Treatment of systemic conditions in combination with comprehensive periodontal treatment is important in management of patients with multiple risk factor syndrome.

  8. Horseshoe lung with multiple congenital anomalies. Case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Hawass, N.D.; Badawi, M.G.; Fatani, J.A.; Meshari, A.A.; Edrees, Y.B.

    A detailed radiologic and anatomic study of a 20-week old fetus is presented. In addition to conventional radiography, various contrast medium injection techniques were used. The findings were followed up at autopsy. The fetus showed multiple congenital abnormalities comprising phocomelia, horseshoe lung, horseshoe kidney, urethral stenosis with megacystis, bilateral hydronephrosis, hydroureters, imperforate anus, and a single tracheo-esophageal tube (persistent esophago-trachea). The association of horseshoe lung with persistent esophago-trachea, microurethra, megacystis, bilateral hydroureters, hydronephrosis and phocomelia is, we believe, the first ever to have been recorded in the literature. Twenty-one cases of horseshoe lung have been reported in the literature. These cases were reviewed and a comparison with the present case is presented. The embryologic basis for these anomalies is also briefly discussed.

  9. Building theories from case study research: the progressive case study

    NARCIS (Netherlands)

    Steenhuis, H.J.; de Bruijn, E.J.

    2006-01-01

    Meredith (1998) argues for more case and field research studies in the field of operations management. Based on a literature review, we discuss several existing approaches to case studies and their characteristics. These approaches include; the Grounded Theory approach which proposes no prior

  10. Theory Testing Using Case Studies

    DEFF Research Database (Denmark)

    Møller, Ann-Kristina Løkke; Dissing Sørensen, Pernille

    2014-01-01

    The appropriateness of case studies as a tool for theory testing is still a controversial issue, and discussions about the weaknesses of such research designs have previously taken precedence over those about its strengths. The purpose of the paper is to examine and revive the approach of theory...... testing using case studies, including the associated research goal, analysis, and generalisability. We argue that research designs for theory testing using case studies differ from theorybuilding case study research designs because different research projects serve different purposes and follow different...... research paths....

  11. A study of biorthogonal multiple vector-valued wavelets

    International Nuclear Information System (INIS)

    Han Jincang; Cheng Zhengxing; Chen Qingjiang

    2009-01-01

    The notion of vector-valued multiresolution analysis is introduced and the concept of biorthogonal multiple vector-valued wavelets which are wavelets for vector fields, is introduced. It is proved that, like in the scalar and multiwavelet case, the existence of a pair of biorthogonal multiple vector-valued scaling functions guarantees the existence of a pair of biorthogonal multiple vector-valued wavelet functions. An algorithm for constructing a class of compactly supported biorthogonal multiple vector-valued wavelets is presented. Their properties are investigated by means of operator theory and algebra theory and time-frequency analysis method. Several biorthogonality formulas regarding these wavelet packets are obtained.

  12. Orthodontic exposure of multiple lmpactions: a case report.

    Science.gov (United States)

    Munda-Lacson, Maridin C; Venugopal, Adith

    2014-01-01

    There are rare cases of impacted permanent central incisors with dilacerations, a dental deformity characterized by pronounced angulations of the longitudinal tooth axis. Impaction of maxillary canines is an orthodontic anomaly that causes facial and dentoalveolar system problems, both functional and esthetic. A combination of surgery and orthodontics is important in bringing impacted teeth to their ideal position in the dental arch. This is a case report of a 10-year-old patient with impacted and dilacerated right central incisor and impacted left maxillary canine, following surgical exposure and appropriate orthodontic traction, the impacted teeth were surgically exposed and aligned into the dental arch.

  13. Missed cases of multiple forms of child abuse and neglect.

    Science.gov (United States)

    Koc, Feyza; Oral, Resmiye; Butteris, Regina

    2014-01-01

    Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family. System-related factors may also enable abuse or prevent the early recognition of abuse. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. In this report, we present two siblings who missed early diagnosis and we emphasize the importance of systems issues to allow early recognition of child abuse and neglect.

  14. [A review of multiple sclerosis (1). Presentation of a case].

    Science.gov (United States)

    Martinez-Altarriba, M C; Ramos-Campoy, O; Luna-Calcaño, I M; Arrieta-Antón, E

    2015-01-01

    Multiple sclerosis is a major demyelinating disease of the central nervous system. It has a significant economic and social impact. Its etiology is unclear, although there are several hypotheses, such as infections or genetics. In its pathophysiology, it seems that immune activation attacks the myelin sheath, causing a progressive and irreversible axonal degeneration. The disease produces a variety of symptoms, and diagnosis requires fulfilling a number of criteria and the exclusion of other possible causes. The role of neuroimaging, especially MRI, is very important. Despite the availability of disease-modifying drugs, none of them are able to halt its progress, and the most useful drugs are those designed to alleviate the symptoms of outbreaks. Overall, multiple sclerosis requires a significant effort in research to clarify not only why and how it occurs, but also to develop of new measures to improve the life of affected patients. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Rigour in qualitative case-study research.

    Science.gov (United States)

    Houghton, Catherine; Casey, Dympna; Shaw, David; Murphy, Kathy

    2013-03-01

    To provide examples of a qualitative multiple case study to illustrate the specific strategies that can be used to ensure the credibility, dependability, confirmability and transferability of a study. There is increasing recognition of the valuable contribution qualitative research can make to nursing knowledge. However, it is important that the research is conducted in a rigorous manner and that this is demonstrated in the final research report. A multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Multiple sources of evidence were collected: semi-structured interviews (n=58), non-participant observations at five sites and documentary sources. Strategies to ensure the rigour of this research were prolonged engagement and persistent observation, triangulation, peer debriefing, member checking, audit trail, reflexivity, and thick descriptions. Practical examples of how these strategies can be implemented are provided to guide researchers interested in conducting rigorous case study research. While the flexible nature of qualitative research should be embraced, strategies to ensure rigour must be in place.

  16. A Diagnostic Study of Pre-Service Teachers' Competency in Multiple-Choice Item Development

    Science.gov (United States)

    Asim, Alice E.; Ekuri, Emmanuel E.; Eni, Eni I.

    2013-01-01

    Large class size is an issue in testing at all levels of Education. As a panacea to this, multiple choice test formats has become very popular. This case study was designed to diagnose pre-service teachers' competency in constructing questions (IQT); direct questions (DQT); and best answer (BAT) varieties of multiple choice items. Subjects were 88…

  17. Theory testing using case studies

    DEFF Research Database (Denmark)

    Dissing Sørensen, Pernille; Løkke Nielsen, Ann-Kristina

    2006-01-01

    on the strengths of theory-testing case studies. We specify research paths associated with theory testing in case studies and present a coherent argument for the logic of theoretical development and refinement using case studies. We emphasize different uses of rival explanations and their implications for research...... design. Finally, we discuss the epistemological logic, i.e., the value to larger research programmes, of such studies and, following Lakatos, conclude that the value of theory-testing case studies lies beyond naïve falsification and in their contribution to developing research programmes in a progressive......Case studies may have different research goals. One such goal is the testing of small-scale and middle-range theories. Theory testing refers to the critical examination, observation, and evaluation of the 'why' and 'how' of a specified phenomenon in a particular setting. In this paper, we focus...

  18. Treatment of multiple unresectable basal cell carcinomas from Gorlin-Goltz syndrome: a case report.

    Science.gov (United States)

    Ojevwe, Fidelis O; Ojevwe, Cindy D; Zacny, James P; Dudek, Arkadiusz Z; Lin, Amy; Kohlitz, Patrick

    2015-03-01

    Nevoid basal cell carcinoma syndrome (NBCCS), which is also known by other names, including Gorlin-Goltz syndrome and multiple basal-cell carcinoma (BCC) syndrome, is a rare multi-systemic disease inherited in a dominant autosomal manner with complete penetrance and variable expressivity. The main clinical manifestations include multiple BCCs, odontogenic keratocysts of the jaw, hyperkeratosis of the palms and soles, skeletal abnormalities, intracranial calcifications and facial deformities. A 31-year-old male diagnosed with Gorlin-Goltz syndrome with multiple unresectable facial BCCs was treated with the Hedgehog inhibitor vismodegib. After one month of therapy on vismodegib, there were significant reductions in the size of multiple BCCs on the patient's face. The patient remains on this therapy. Hedgehog pathway inhibition is an effective strategy to treat unresectable BCCs from Gorlin-Goltz syndrome. Although vismodegib shows some promising clinical results in the early phase of its use, there are concerns of possible resistance developing within months. Duration of therapy, role of maintenance treatment and drug modification to reduce resistance need to be explored in future case studies. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  19. Fuzzy-Set Case Studies

    Science.gov (United States)

    Mikkelsen, Kim Sass

    2017-01-01

    Contemporary case studies rely on verbal arguments and set theory to build or evaluate theoretical claims. While existing procedures excel in the use of qualitative information (information about kind), they ignore quantitative information (information about degree) at central points of the analysis. Effectively, contemporary case studies rely on…

  20. Methodology for the case studies

    NARCIS (Netherlands)

    Smits, M.J.W.; Woltjer, G.B.

    2017-01-01

    This document is about the methodology and selection of the case studies. It is meant as a guideline for the case studies, and together with the other reports in this work package can be a source of inform ation for policy officers, interest groups and researchers evaluating or performing impact

  1. Multiple sclerosis in women having children by multiple partners. A population-based study in Denmark

    DEFF Research Database (Denmark)

    Basso, Olga; Campi, Rita; Frydenberg, Morten

    2004-01-01

    We investigated whether having children with multiple men is a risk factor for being diagnosed with multiple sclerosis (MS). We studied a cohort of 151,328 women, of whom 64,704 had different men fathering their children and 86,624 the same partner for all births. Women were included if they had ...

  2. Strategic alternatives ranking methodology: Multiple RCRA incinerator evaluation test case

    International Nuclear Information System (INIS)

    Baker, G.; Thomson, R.D.; Reece, J.; Springer, L.; Main, D.

    1988-01-01

    This paper presents an important process approach to permit quantification and ranking of multiple alternatives being considered in remedial actions or hazardous waste strategies. This process is a methodology for evaluating programmatic options in support of site selection or environmental analyses. Political or other less tangible motivations for alternatives may be quantified by means of establishing the range of significant variables, weighting their importance, and by establishing specific criteria for scoring individual alternatives. An application of the process to a recent AFLC program permitted ranking incineration alternatives from a list of over 130 options. The process forced participation by the organizations to be effected, allowed a consensus of opinion to be achieved, allowed complete flexibility to evaluate factor sensitivity, and resulted in strong, quantifiable support for any subsequent site-selection action NEPA documents

  3. Studies of the Seasonal Pattern of Multiple Maternities.

    Science.gov (United States)

    Fellman, Johan

    2017-06-01

    The seasonality of population data has been of great interest in demographic studies. When seasonality is analyzed, the population at risk plays a central role. In a study of the monthly number of births and deaths, the population at risk is the product of the size of the population and the length of the month. Usually, the population can be assumed to be constant, and consequently, the population at risk is proportional to the length of the month. Hence, the number of cases per day has to be analyzed. If one studies the seasonal variation in twin or multiple maternities, the population at risk is the total number of monthly confinements, and the study should be based on the rates of the multiple maternities. Consequently, if one considers monthly twinning rates, the monthly number of birth data is eliminated and one obtains an unaffected seasonality measure of the twin maternities. The strength of the seasonality is measured by a chi-squared test or by the standard deviation. When seasonal models are applied, one must pay special attention to how well the model fits the data. If the goodness of fit is poor, it can erroneously result in a statement that the seasonality is slight, although the observed seasonal fluctuations are marked.

  4. "Multiple Papillomas - a case report and review of literature"

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2007-01-01

    Full Text Available We report a unique case of extensive papilIomatosis of the left buccal mucosa in an 80 year old female patient. We document and discuss the probable multifactorial etiology of the lesions and the possible involvement of a syndromic association. This report illustrates the need for careful clinical investigation and follow-up of individuals presenting with multifocal involvement of papillomas.

  5. Case study - Argentina

    International Nuclear Information System (INIS)

    Diaz, E.

    1986-01-01

    Antecedents and experience of nuclear activities in Argentina; the Atomic Energy Commission (CNEA). First development and research activities. Research reactors and radioisotopes plants. Health physics and safety regulations. - Feasibility studies for the first nuclear power plant. Awarding the first plant CNA I (Atucha I). Relevant data related to the different project stages. Plant performance. - Feasibility study for the second nuclear power plant. Awarding the second plant CNE (Central Nuclear Embalse). Relevant data related to established targets. Differences compared with the first station targets. Local participation. Plant performance. (orig./GL)

  6. An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration.

    Science.gov (United States)

    Mumford, Leslie; Lam, Rachel; Wright, Virginia; Chau, Tom

    2014-08-01

    This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.

  7. Centrifugal compressor case study

    Energy Technology Data Exchange (ETDEWEB)

    Eckert, B.

    2010-10-15

    Three centrifugal compressors at a pipeline station were retrofitted with higher head impellers in 2008. The owners of the station experienced vibration problems over the following 2 years that caused transmitter and position failures that were assumed to be flow-induced pulsations. A vibration and pulsation analysis indicated that the shell mode piping vibration excited by the blade pass pulsation was responsible for the failures. This study outlined factors that contributed to the vibration problem. Interferences between the compressor and shell mode piping natural frequencies were predicted, and potential excitation sources were examined. The study demonstrated how centrifugal vibration analyses can be used during the design phase to avoid costly adjustments. Recommendations included the addition of stiffeners to alter the shell modes, and the addition of constrained layer damping material to reduce resonant responses. 2 refs., 1 tab., 12 figs.

  8. Case study: Tourism marketing

    OpenAIRE

    Kennell, James

    2014-01-01

    Tourism can be a challenging subject for students because it is both dynamic and susceptible to economic turbulence and shifts in trends. Tourism: A Modern Synthesis is an essential textbook for tourism students looking for a clear and comprehensive introduction to their studies which helps overcome these challenges. The authors apply a strong business approach to the subject reflecting developments in the teaching and content of modern courses and the text covers both key principles and cont...

  9. Multiple fibromyxomas of the jaws: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Zayet, Mohamed Khalifa; Eiid, Salma Belal [Dept. of Oral Radiology, Faculty of Oral and Dental Medicine, Cairo University, Cairo (Egypt)

    2014-09-15

    Fibromyxoma of the jaw is a rare benign mesenchymal odontogenic tumor with locally aggressive behavior. In the present report, a 13-year-old female patient presented to our university hospital with delayed eruption of some of her teeth. A panoramic radiograph taken at the initial examination revealed four pericoronal radiolucencies related to the four third molars. Thereafter, a magnetic resonance imaging (MRI) examination was performed. After the surgical removal of these molars, the microscopic examination diagnosed the four lesions as fibromyxomas. Here, we have discussed the clinical, panoramic radiography, MRI, and histopathological findings of the case.

  10. Tracking the Gender Pay Gap: A Case Study

    Science.gov (United States)

    Travis, Cheryl B.; Gross, Louis J.; Johnson, Bruce A.

    2009-01-01

    This article provides a short introduction to standard considerations in the formal study of wages and illustrates the use of multiple regression and resampling simulation approaches in a case study of faculty salaries at one university. Multiple regression is especially beneficial where it provides information on strength of association, specific…

  11. Systemic irradiation in multiple myeloma: a report on nineteen cases

    International Nuclear Information System (INIS)

    Rostom, A.Y.; O'Cathail, S.M.; Folkes, A.

    1984-01-01

    Nineteen patients with relapsed or resistant multiple myeloma were treated with sequential half-body irradiation (12) and half-body irradiation only (seven). Haematological toxicity was acceptable and recovery was complete in all but two of the 19 patients following half-body irradiation. However, only six of the 12 patients who subsequently had the remaining half irradiated completely recovered. Blood transfusions were required to correct anaemia in six patients, a platelet transfusion was given to one and one patient required both platelet and blood transfusions. No serious haematological complications were observed. Six of the 13 patients who received upper half-body irradiation of probable chest infection, while one patient of the six who received lower half-body irradiation died of this complication. Some of the seven deaths may have been due to radiation pneumonitis. Two patients developed brain secondaries, possibly indicating a change in the natural history of myeloma produced by this new treatment. Subjective improvement was observed in 17 patients and relief of pain usually occurred within the first 24 h. Objective responses were noted in six patients. The median survival for all patients was 6 months with five patients alive 11-28 months at the time of writing. (author)

  12. [A case of multiple sclerosis with hypothalamic amenorrhea].

    Science.gov (United States)

    Miyamoto, T; Miyamoto, M; Yokota, N; Kubo, J; Hirata, K

    2000-03-01

    We present a 31-year-old woman of multiple sclerosis. At age 28, she was admitted with complaints of echolalia and a gradual onset of weakness affecting the right upper and bilateral lower limbs. Brain MRI showed high intensity areas in the bilateral frontal gyri, lobuli paracentralis, and left anterior thalamus. Although she had been in remission for 3 years, she developed dysesthesia of left upper and lower limbs. Cervical T2 weighted MRI showed a new high signal intensity lesion in the spinal cord from the C2 to C3 level. The combination of the cerebral, thalamic and spinal cord lesions with remission and excerbations allowed the diagnosis of clinically MS to be made. She suffered amenorrhea from the onset of her illness. Serum prolactin was within the normal range. The LH and FSH basal secretions were decreased and there were low delayed secretions of LH and FSH after intravenous injection of 100 micrograms LHRH. We consider that her amenorrhea was caused by the hypothalamic lesion, supported by MR findings of dilatation of the third ventricle.

  13. MULTIPLE PERSONALITY DISORDER FOLLOWING CONVERSION AND DISSOCIATIVE DISORDER NOS : A CASE REPORT

    OpenAIRE

    Jhingan, Harsh Prem; Aggarwal, Neeruj; Saxena, Shekhar; Gupta, Dhanesh K.

    2000-01-01

    A case progressing from symptoms of conversion disorder to dissociative disorder and then to multiple personality disorder as per DSM-III-R criteria is being reported. The clinical implications are discussed.

  14. Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

    Science.gov (United States)

    Preyra, Colin

    2004-01-01

    Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

  15. Case Study: Derechos Digitales

    Directory of Open Access Journals (Sweden)

    Cameron Neylon

    2017-10-01

    Full Text Available Derechos Digitales is a Latin American advocacy and research network focussed on freedom on the internet, privacy and copyright reform. For the pilot project a specific IDRC funded project was the notional focus of study. However in practice the effort for considering data sharing was aimed at being organisation wide. The organisation already shares reports and other resources (particularly images and infographics by default. While open data was described as being “in the DNA of the organisation” there was little practice across the network of sharing preliminary and in-process materials. Some aspects of data collection on research projects, particularly to do with copyright and legal issues, have significant privacy issues and as the organisation focuses on privacy as one of its advocacy areas this is taken very seriously. Many materials from research projects are not placed online at all. Derechos Digitales run distributed projects and this creates challenges for consistent management. Alongside this the main contact at DD changed during the course of the pilot. This exchange exemplified the challenges of maintaining organisational systems and awareness through a personnel change.

  16. Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

    DEFF Research Database (Denmark)

    Ghosh, Sujoy; Wadhwa, P; A, Kumar

    2011-01-01

    and porotic changes. Primary sclerotic manifestations are rare and occur in only 3% of cases. Although exceptional, multiple myeloma must be borne in mind in the presence of bone sclerosis. This report presents a patient with multiple myeloma with a sunburst/hair-on-end pattern on the radiograph and sclerotic...

  17. Case study: Khoramdareh County

    Directory of Open Access Journals (Sweden)

    Vahid Riahi Riahi

    2016-10-01

    Full Text Available Environmental sustainability of rural settlements based on a systematic viewpoint may be defined as a realization of sustainable development in different social, economic and environmental aspects of rural areas. Achieving this goal requires that we pay more attention to effective elements and factors through a set of sustainability indices. This research was meant to analyze sustainable factors of rural settlement in three dimensions: environmental, social and economic context using multi-criteria decision analysis and explanation of the relationships between its active and effective factors in the rural area of the Khorramdarreh County in the province of Zanjan. The research method used is the descriptive analytic approach. Data from 287 households were sampled randomly from a total of 1143 households in the four villages including: Rahmat Abad, Alvand, Baghdareh and, Sukhariz (out of 15 villages in the Khorramdarreh County. In the process of doing this research and after calculating the weights, the difference in the sustainability of environmental, social, economic and physical aspects in rural areas of this county have been determined. Data was collected using library and field research through questionnaires. Data analysis was performed by the One-Sample t Test and the Vikur and path analysis techniques, using statistical software SPSS. The findings show that environmental sustainability in the study area is half desirable. Among the different aspects of environmental sustainability, the most effective factors are physical, economic, social and environmental aspects, respectively. Little attention of policy-making –system to socio-cultural and environmental aspects, especially in practice, and rapid and unplanned utilization of production resources are the most important factors affecting this situation in two given dimensions. Although, in programmed documents the planning system agents emphasize on the socio-cultural sustainability

  18. Multiple Dentogerous Cysts With a Complex Odontoma: An Unusual Case Report

    Directory of Open Access Journals (Sweden)

    Sheikhi

    2016-03-01

    Full Text Available Introduction Multiple dentigerous cysts are rare and mostly associated with syndromes. Case Presentation The present case report is unique, as the dentigerous cysts enclosed the lateral incisor, canine, first and second premolars of the mandible and were accompanied by a complex odontoma, instead of first mandibular molar. Conclusions Multiple unilateral nosyndromic dentigerous cysts with complex odontoma are found only rarely. The periapical inflammation of non-vital deciduous teeth and trauma may be considered ethiological factors.

  19. Analysis of Multidimensional Poverty: Theory and Case Studies ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2009-08-18

    Aug 18, 2009 ... ... of applying a factorial technique, Multiple Correspondence Analysis, to poverty analysis. ... Analysis of Multidimensional Poverty: Theory and Case Studies ... agreement to support joint research projects in December 2017.

  20. SU-F-T-637: Single-Isocenter Versus Multiple-Isocenter VMAT SRS for Unusual Multiple Metastasis Case with Two Widely Separated Lesions

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, EM; Popple, RA; Fiveash, JB [The University of Alabama at Birmingham, Birmingham, AL (United States)

    2016-06-15

    Purpose: Single-isocenter (SI) volumetric modulated arc therapy has been shown to be an effective and efficient approach to multiple metastasis radiosurgery. However, certain extreme cases raise the question of whether multiple-isocenter (MI) approaches can still generate superior plans. In this study, we ask this question with respect to a clinical case with two very widely separated lesions. Methods: A patient with two widely separated (d = 12cm) tumors was treated with SI-VMAT SRS using 10MV flattening filter free (FFF) beam with high-definition multi-leaf collimator (HD-MLC, 2.5/5mm) in two non-coplanar arcs using concentric rings to enforce steep gradient. Because of lesion positioning with respect to collimator angle selection, lesions were treated by 5mm leaves. We re-planned the case with a congruent arc arrangement but separate isocenter for each lesion. In this manner, lesions were treated by 2.5mm leaves. Conformity index (CI), V50%, and mean brain dose were compared. Results: Neither conformity (CI-SI = 1.12, CI-MI = 1.08) nor V50% (V50%-SI =8.82cc, V50%-MI =8.81cc) were improved by utilizing a separate isocenter for each lesion. Mean brain dose was slightly reduced (dmean-SI = 118.4 cGy, dmean-MI = 88.7 cGy) by using multiple isocenters. Conclusion: For this case with a lesion at the apex of the brain and another distantly located at the base of skull, employing a separate isocenter for each target did not meaningfully improve plan quality. Single-isocenter VMAT has been shown feasible and equivalent to multiple-isocenter VMAT for multiple metastasis cases in general. In this extreme case, single- and multiple- isocenter VMAT were also equivalent. If rotational setup errors are appropriately corrected, the increased delivery efficiency of the single-isocenter approach renders it preferable to the multiple isocenter approach. Dr’s Thomas, Popple, and Fiveash have all received honoraria from Varian Medical Systems for discussing their experiences with

  1. Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

    Directory of Open Access Journals (Sweden)

    Gorgan R.M.

    2016-03-01

    Full Text Available Multiple cavernous malformations are associated with familial cases and are present in 10-20% of all cavernoma cases. 5% of cavernomas are located intramedullary and of these only 10% present multiple cavernomas. With the availability of echo gradient MRI the cases of multiple cavernomas are diagnosed earlier and it is not rare that it uncovers multiple cavernomas in cases where only a single lesion can be identified on regular MRI sequences. We present the case of a 55 years old woman presented with a two years history of mild backache, followed by progressive lower legs motor deficit and urinary retention. The spine MRI showed an intramedullary T2/3 lesion and the cerebral MRI established the diagnosis of multiple cavernomas. One year after the intramedullary cavernoma was operated with success, she developed generalized seizures and a new cerebral MRI showed bleeding and volume growth of one right temporal pole cavernoma. The cerebral lesion was resected successfully and the patient was discharged free of seizures. This familial type multiple cavernomas cases should be screened and followed with repeated brain and spine MRI’s every year.

  2. Acute gouty arthritis and rapidly progressive renal failure as manifestation of multiple myeloma: clinical case description

    Directory of Open Access Journals (Sweden)

    O.V. Gudym

    2017-08-01

    Full Text Available The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL, rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %, electrophoresis of blood proteins showed a high M-gradient (30.42 %, and a cytochemical

  3. The Glioma International Case-Control Study

    DEFF Research Database (Denmark)

    Amirian, E. Susan; Armstrong, Georgina N; Zhou, Renke

    2016-01-01

    Decades of research have established only a few etiological factors for glioma, which is a rare and highly fatal brain cancer. Common methodological challenges among glioma studies include small sample sizes, heterogeneity of tumor subtypes, and retrospective exposure assessment. Here, we briefly...... describe the Glioma International Case-Control (GICC) Study (recruitment, 2010-2013), a study being conducted by the Genetic Epidemiology of Glioma International Consortium that integrates data from multiple data collection sites, uses a common protocol and questionnaire, and includes biospecimen...

  4. Case studies of uncommon headaches.

    Science.gov (United States)

    Evans, Randolph W

    2006-05-01

    The following interesting and uncommon headache disorders are presented through case studies: exploding head syndrome, hypnic headache, neck-tongue syndrome, "Alice in Wonderland" syndrome, nummular headache, red ear syndrome, burning mouth syndrome, spontaneous intracranial hypotension syndrome, and cardiac cephalalgia.

  5. HYDROGEOLOGIC CASE STUDIES (DENVER PRESENTATION)

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  6. HYDROGEOLOGIC CASE STUDIES (CHICAGO, IL)

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  7. Hydrogeologic Case Studies (Seattle, WA)

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  8. a case study ondo state

    African Journals Online (AJOL)

    user

    the design of a Government Cloud (G-Cloud) network for Ondo State Government which will ... network for a developing economy; a case study of ... France is one of those countries that favour .... Arequipa city. .... Where region 0 = Akure, 1 =.

  9. An unusual case of non-syndromic occurrence of multiple dental anomalies

    Directory of Open Access Journals (Sweden)

    Suprabha B

    2009-01-01

    Full Text Available Dental anomalies have been known to occur in humans due to a variety of genetic and environmental factors. Combinations of dental anomalies are known to be associated with specific syndromes. A few cases of multiple dental anomalies have been reported in patients with no generalized abnormalities. This case report describes an unusual occurrence of a combination of dental anomalies in an apparently normal healthy 12-year-old female patient. The dental anomalies in this patient were multiple dens invaginatus, generalized enamel hypoplasia, generalized microdontia, root resorption and multiple periapical lesions, shovel shaped incisors, cup shaped premolars, taurodontism, hypodontia and supernumerary teeth.

  10. Multiple sclerosis risk loci and disease severity in 7,125 individuals from 10 studies

    DEFF Research Database (Denmark)

    George, Michaela F; Briggs, Farren B S; Shao, Xiaorong

    2016-01-01

    associated with disease severity after accounting for cohort, sex, age at onset, and HLA-DRB1*15:01. After restricting analyses to cases with disease duration ≥10 years, associations were null (p value ≥0.05). No SNP was associated with disease severity after adjusting for multiple testing. CONCLUSIONS......OBJECTIVE: We investigated the association between 52 risk variants identified through genome-wide association studies and disease severity in multiple sclerosis (MS). METHODS: Ten unique MS case data sets were analyzed. The Multiple Sclerosis Severity Score (MSSS) was calculated using the Expanded...

  11. CUTANEOUS INVOLVEMENT IN MULTIPLE MYELOMA AT AN UNUSUAL SITE: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Lohit Kumar

    2015-05-01

    Full Text Available Multiple myeloma is a rare cancer. According to the most recent data from the Surveillance, Epidemiology, and End Results (SEER program, multiple myeloma is the second most common haematological malignancy in the U.S. (after non - Hodgkin lymphoma, constitutes 1% of all cancers and constitutes 2% of all cancer deaths. Cutaneous involvement of multiple myeloma during treatment period is uncommon with fewer described in literature. Moreover, metastatic cutaneous involvement at the sole of the foot during treatment period of a IgA kappa type multiple myeloma patient followed by death has not encountered in literature. We have reported such a case

  12. Childhood Trauma and Multiple Personality Disorder: The Case of a 9-Year-Old Girl.

    Science.gov (United States)

    LaPorta, Lauren D.

    1992-01-01

    This paper reports the case of a nine-year-old female victim of sexual abuse, evaluated and diagnosed with multiple personality disorder over a six-month period. Included is a description of the child's presentation with historical and developmental data. A discussion of the dynamic and predisposing features of the case follows, along with…

  13. Global Profiling and Novel Structure Discovery Using Multiple Neutral Loss/Precursor Ion Scanning Combined with Substructure Recognition and Statistical Analysis (MNPSS): Characterization of Terpene-Conjugated Curcuminoids in Curcuma longa as a Case Study.

    Science.gov (United States)

    Qiao, Xue; Lin, Xiong-hao; Ji, Shuai; Zhang, Zheng-xiang; Bo, Tao; Guo, De-an; Ye, Min

    2016-01-05

    To fully understand the chemical diversity of an herbal medicine is challenging. In this work, we describe a new approach to globally profile and discover novel compounds from an herbal extract using multiple neutral loss/precursor ion scanning combined with substructure recognition and statistical analysis. Turmeric (the rhizomes of Curcuma longa L.) was used as an example. This approach consists of three steps: (i) multiple neutral loss/precursor ion scanning to obtain substructure information; (ii) targeted identification of new compounds by extracted ion current and substructure recognition; and (iii) untargeted identification using total ion current and multivariate statistical analysis to discover novel structures. Using this approach, 846 terpecurcumins (terpene-conjugated curcuminoids) were discovered from turmeric, including a number of potentially novel compounds. Furthermore, two unprecedented compounds (terpecurcumins X and Y) were purified, and their structures were identified by NMR spectroscopy. This study extended the application of mass spectrometry to global profiling of natural products in herbal medicines and could help chemists to rapidly discover novel compounds from a complex matrix.

  14. The Multiple Use of Tropical Forests by Indigenous Peoples in Mexico: a Case of Adaptive Management

    Directory of Open Access Journals (Sweden)

    Víctor M. Toledo

    2003-12-01

    Full Text Available The quest for an appropriate system of management for tropical ecosystems necessitates that ecologists consider the accumulated experiences of indigenous peoples in their long-term management of local resources, a subject of current ethnoecology. This paper provides data and empirical evidence of an indigenous multiple-use strategy (MUS of tropical forest management existing in Mexico, that can be considered a case of adaptive management. This conclusion is based on the observation that some indigenous communities avoid common modernization routes toward specialized, unsustainable, and ecologically disruptive systems of production, and yet probably achieve the most successful tropical forest utilization design, in terms of biodiversity conservation, resilience, and sustainability. This analysis relies on an exhaustive review of the literature and the authors' field research. Apparently, this MUS represents an endogenous reaction of indigenous communities to the intensification of natural resource use, responding to technological, demographic, cultural, and economic changes in the contemporary world. This transforms traditional shifting cultivators into multiple-use strategists. Based on a case study, three main features (biodiversity, resilience, and permanence considered relevant to achieving adaptive and sustainable management of tropical ecosystems are discussed.

  15. Nonsyndromic Bilateral Multiple Impacted Supernumerary Mandibular Third Molars: A Rare and Unusual Case Report

    Directory of Open Access Journals (Sweden)

    G. Siva Prasad Reddy

    2013-01-01

    Full Text Available A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

  16. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

    1981-09-15

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  17. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    International Nuclear Information System (INIS)

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo

    1981-01-01

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  18. The multiple brain abscesses associated with congenital pulmonary arteriovenous malformations: a case report.

    OpenAIRE

    Han, Seok; Lim, Dong-Jun; Chung, Yong-Gu; Cho, Tai-Hyoung; Lim, Seong-Jun; Kim, Woo-Jae; Park, Jung-Yul; Suh, Jung-Keun

    2002-01-01

    In this report, we describe a case of multiple brain abscesses associated with diffuse congenital pulmonary arteriovenous malformations (PAVM). Although the cases of brain abscesses associated with congenital PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report. PAVM may contribute to the development of a brain abscess by allowing easy bacterial access to systemic circulation through the right-to-left pul...

  19. A strategy for extending the applicability of a validated plasma calibration curve to quantitative measurements in multiple tissue homogenate samples: a case study from a rat tissue distribution study of JI-101, a triple kinase inhibitor.

    Science.gov (United States)

    Gurav, Sandip Dhondiram; Jeniffer, Sherine; Punde, Ravindra; Gilibili, Ravindranath Reddy; Giri, Sanjeev; Srinivas, Nuggehally R; Mullangi, Ramesh

    2012-04-01

    A general practice in bioanalysis is that, whatever the biological matrix the analyte is being quantified in, the validation is performed in the same matrix as per regulatory guidelines. In this paper, we are presenting the applicability of a validated LC-MS/MS method in rat plasma for JI-101, to estimate the concentrations of JI-101 in various tissues that were harvested in a rat tissue distribution study. A simple protein precipitation technique was used to extract JI-101 and internal standard from the tissue homogenates. The recovery of JI-101 in all the matrices was found to be >70%. Chromatographic separation was achieved using a binary gradient using mobile phase A (acetonitrile) and B (0.2% formic acid in water) at a flow rate of 0.30 mL/min on a Prodigy ODS column with a total run time of 4.0 min. The MS/MS ion transitions monitored were 466.1 → 265 for JI-101 and 180.1 → 110.1 for internal standard. The linearity range was 5.02-4017 ng/mL. The JI-101 levels were quantifiable in the various tissue samples harvested in this study. Therefore, the use of a previously validated JI-101 assay in plasma circumvented the tedious process of method development/validation in various tissue matrices. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Genetic Epidemiological Studies of Multiple Sclerose

    NARCIS (Netherlands)

    I.A. Hoppenbrouwers (Ilse)

    2011-01-01

    textabstractThe objective of this thesis was to find new risk alleles for MS. This may finally result in a better understanding of the pathogenesis of MS. Knowledge of MS disease pathways can direct strategies for prevention, diagnosis and therapy. In our study, we included MS patients from a