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Sample records for multiple case-study approach

  1. 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.

  2. 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...

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

    Science.gov (United States)

    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,…

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. Linking biomedical engineering ethics case study approach and policy.

    Science.gov (United States)

    Dibrell, William; Dobie, Elizabeth Ann

    2007-01-01

    In this paper we link bioengineering case study methods to the development of policy. The case study approach to ethics is an excellent way to show the complex nature of practical/moral reasoning. This approach can, however, lead to a kind of overwhelming complexity. The individual nature of each case makes it difficult to identify the most important information and difficult to see what moral considerations are most relevant. In order to make the overwhelming complexity less debilitating, we present a framework for moral decision making derived from suggestions made by W.D. Ross and Virginia Held. Ross articulates the multiple sources of morality and Held deepens the discussion by reminding us of the foundational importance of care and sympathy to our moral natures. We show how to use the notion of prima facie duty and discuss moral conflict. In doing this, we show how the framework, applied to cases, can be of assistance in helping us develop policies and codes of ethics with sufficient plasticity to be useful in the complex world of the bioengineer.

  9. 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...

  10. 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

  11. 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

  12. 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

  13. Novel Approach to Tourism Analysis with Multiple Outcome Capability Using Rough Set Theory

    Directory of Open Access Journals (Sweden)

    Chun-Che Huang

    2016-12-01

    Full Text Available To explore the relationship between characteristics and decision-making outcomes of the tourist is critical to keep competitive tourism business. In investigation of tourism development, most of the existing studies lack of a systematic approach to analyze qualitative data. Although the traditional Rough Set (RS based approach is an excellent classification method in qualitative modeling, but it is canarsquo;t deal with the case of multiple outcomes, which is a common situation in tourism. Consequently, the Multiple Outcome Reduct Generation (MORG and Multiple Outcome Rule Extraction (MORE approaches based on RS to handle multiple outcomes are proposed. This study proposes a ranking based approach to induct meaningful reducts and ensure the strength and robustness of decision rules, which helps decision makers understand touristarsquo;s characteristics in a tourism case.

  14. 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.

  15. 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.

  16. 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.

  17. A Monte Carlo Study on Multiple Output Stochastic Frontiers: Comparison of Two Approaches

    DEFF Research Database (Denmark)

    Henningsen, Geraldine; Henningsen, Arne; Jensen, Uwe

    , dividing all other output quantities by the selected output quantity, and using these ratios as regressors (OD). Another approach is the stochastic ray production frontier (SR) which transforms the output quantities into their Euclidean distance as the dependent variable and their polar coordinates......In the estimation of multiple output technologies in a primal approach, the main question is how to handle the multiple outputs. Often an output distance function is used, where the classical approach is to exploit its homogeneity property by selecting one output quantity as the dependent variable...... of both specifications for the case of a Translog output distance function with respect to different common statistical problems as well as problems arising as a consequence of zero values in the output quantities. Although, our results partly show clear reactions to statistical misspecifications...

  18. 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.

  19. 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

  20. 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.

  1. 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

  2. Approaches for building community participation: A qualitative case study of Canadian food security programs.

    Science.gov (United States)

    Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

    2017-10-01

    There is increasing opportunity and support for occupational therapists to expand their scope of practice in community settings. However, evidence is needed to increase occupational therapists' knowledge, confidence, and capacity with building community participation and adopting community-centered practice roles. The purpose of this study is to improve occupational therapists' understanding of an approach to building community participation, through case study of a network of Canadian food security programs. Qualitative case study was utilized. Data were semistructured interviews, field observations, documents, and online social media. Thematic analysis was used to identify and describe four themes that relate to processes used to build community participation. The four themes were use of multiple methods, good leaders are fundamental, growing participation via social media, and leveraging outcomes. Occupational therapists can utilize an approach for building community participation that incorporates resource mobilization. Challenges of sustainability and social exclusion must be addressed.

  3. 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.

  4. Case Studies Approach in Tourism Destination Branding Research

    OpenAIRE

    Adeyinka-Ojo S.F.; Nair V.; Khoo-Lattimore C.

    2014-01-01

    A review of literature indicates that there are different types of qualitative research methods such as action research, content analysis, ethnography, grounded theory, historical analysis, phenomenology and case study. However, which approach is to be used depends on several factors such as the nature and objectives of the research. The aim of this paper is to focus on the research methodology aspects of applying case study as a research approach and its relevance in tourism destination bran...

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

    Science.gov (United States)

    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…

  6. 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

  7. 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

  8. A Two-Stage Penalized Logistic Regression Approach to Case-Control Genome-Wide Association Studies

    Directory of Open Access Journals (Sweden)

    Jingyuan Zhao

    2012-01-01

    Full Text Available We propose a two-stage penalized logistic regression approach to case-control genome-wide association studies. This approach consists of a screening stage and a selection stage. In the screening stage, main-effect and interaction-effect features are screened by using L1-penalized logistic like-lihoods. In the selection stage, the retained features are ranked by the logistic likelihood with the smoothly clipped absolute deviation (SCAD penalty (Fan and Li, 2001 and Jeffrey’s Prior penalty (Firth, 1993, a sequence of nested candidate models are formed, and the models are assessed by a family of extended Bayesian information criteria (J. Chen and Z. Chen, 2008. The proposed approach is applied to the analysis of the prostate cancer data of the Cancer Genetic Markers of Susceptibility (CGEMS project in the National Cancer Institute, USA. Simulation studies are carried out to compare the approach with the pair-wise multiple testing approach (Marchini et al. 2005 and the LASSO-patternsearch algorithm (Shi et al. 2007.

  9. An Integrative Psychotherapy Approach to Foster Community Engagement and Rehabilitation in Schizophrenia: A Case Study Illustration.

    Science.gov (United States)

    Kukla, Marina; Whitesel, Frankie; Lysaker, Paul H

    2016-02-01

    This case study illustrates the use of a long-term integrative psychotherapy approach with a middle- aged man with chronic schizophrenia and a mood disorder. The case of "Holst" describes a man with a history of insecure attachment and trauma who later went on to contract a serious chronic illness, precipitating the onset of psychotic symptoms, depression, and chronic suicidal ideation, resulting in multiple hospitalizations. Combining metacognition-oriented therapy with elements of cognitive behavioral therapy and psychiatric rehabilitation, this approach fostered significantly improved community functioning and attainment of personal goals over time. Through the journey of therapy, the patient also developed a more coherent narrative about his life, established a stable sense of self, and became an active agent in the world. This case illustration demonstrates that these three different approaches can be used in a sequential and complementary fashion to foster recovery in the midst of serious physical and mental illness. © 2015 Wiley Periodicals, Inc.

  10. 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.

  11. 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

  12. Case Studies Approach in Tourism Destination Branding Research

    Directory of Open Access Journals (Sweden)

    Adeyinka-Ojo S.F.

    2014-01-01

    Full Text Available A review of literature indicates that there are different types of qualitative research methods such as action research, content analysis, ethnography, grounded theory, historical analysis, phenomenology and case study. However, which approach is to be used depends on several factors such as the nature and objectives of the research. The aim of this paper is to focus on the research methodology aspects of applying case study as a research approach and its relevance in tourism destination branding research specifically on a single case study (SCS context. There are arguments that the SCS is a weak research strategy. Some of the potentials or shortcomings highlighted in the literature include the primitive nature of SCS, flexibility of sample technique, data collection method and data analysis. Others include lack of rigour, reliability, validity, credibility of findings and generalisation. This paper has adopted content analysis of the literature on tourism destination branding. Findings indicate that the quality of SCS can be verified using specific case study tactics for four design tests such as validity (construct, internal and external; and reliability using the case study protocol. Theoretical implication suggests that SCS is an empirical enquiry use to understand complex phenomena and favoured by practitioners.

  13. 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.

  14. 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.

  15. An alternative approach for socio-hydrology: case study research

    Science.gov (United States)

    Mostert, Erik

    2018-01-01

    Currently the most popular approach in socio hydrology is to develop coupled human-water models. This article proposes an alternative approach, qualitative case study research, involving a systematic review of (1) the human activities affecting the hydrology in the case, (2) the main human actors, and (3) the main factors influencing the actors and their activities. Moreover, this article presents a case study of the Dommel Basin in Belgium and the Netherlands, and compares this with a coupled model of the Kissimmee Basin in Florida. In both basins a pendulum swing from water resources development and control to protection and restoration can be observed. The Dommel case study moreover points to the importance of institutional and financial arrangements, community values, and broader social, economic, and technical developments. These factors are missing from the Kissimmee model. Generally, case studies can result in a more complete understanding of individual cases than coupled models, and if the cases are selected carefully and compared with previous studies, it is possible to generalize on the basis of them. Case studies also offer more levers for management and facilitate interdisciplinary cooperation. Coupled models, on the other hand, can be used to generate possible explanations of past developments and quantitative scenarios for future developments. The article concludes that, given the limited attention they currently get and their potential benefits, case studies deserve more attention in socio-hydrology.

  16. 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.

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

    Science.gov (United States)

    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)

  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. Sustainable Design Approach: A case study of BIM use

    Directory of Open Access Journals (Sweden)

    Abdelhameed Wael

    2017-01-01

    The paper describes the methodology of this design approach through BIM strategies adopted in design creation. Case studies of architectural designs are used to highlight the details and benefits of this proposed approach.

  20. Sensitivity studies on the approaches for addressing multiple initiating events in fire events PSA

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Dae Il; Lim, Ho Gon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2016-10-15

    A single fire event within a fire compartment or a fire scenario can cause multiple initiating events (IEs). As an example, a fire in a turbine building fire area can cause a loss of the main feed-water (LOMF) and loss of off-site power (LOOP) IEs. Previous domestic fire events PSA had considered only the most severe initiating event among multiple initiating events. NUREG/CR-6850 and ANS/ASME PRA Standard require that multiple IEs are to be addressed in fire events PSA. In this paper, sensitivity studies on the approaches for addressing multiple IEs in fire events PSA for Hanul Unit 3 were performed and their results were presented. In this paper, sensitivity studies on the approaches for addressing multiple IEs in fire events PSA are performed and their results were presented. From the sensitivity analysis results, we can find that the incorporations of multiple IEs into fire events PSA model result in the core damage frequency (CDF) increase and may lead to the generation of the duplicate cutsets. Multiple IEs also can occur at internal flooding event or other external events such as seismic event. They should be considered in the constructions of PSA models in order to realistically estimate risk due to flooding or seismic events.

  1. A simulation study to compare three self-controlled case series approaches: correction for violation of assumption and evaluation of bias.

    Science.gov (United States)

    Hua, Wei; Sun, Guoying; Dodd, Caitlin N; Romio, Silvana A; Whitaker, Heather J; Izurieta, Hector S; Black, Steven; Sturkenboom, Miriam C J M; Davis, Robert L; Deceuninck, Genevieve; Andrews, N J

    2013-08-01

    The assumption that the occurrence of outcome event must not alter subsequent exposure probability is critical for preserving the validity of the self-controlled case series (SCCS) method. This assumption is violated in scenarios in which the event constitutes a contraindication for exposure. In this simulation study, we compared the performance of the standard SCCS approach and two alternative approaches when the event-independent exposure assumption was violated. Using the 2009 H1N1 and seasonal influenza vaccines and Guillain-Barré syndrome as a model, we simulated a scenario in which an individual may encounter multiple unordered exposures and each exposure may be contraindicated by the occurrence of outcome event. The degree of contraindication was varied at 0%, 50%, and 100%. The first alternative approach used only cases occurring after exposure with follow-up time starting from exposure. The second used a pseudo-likelihood method. When the event-independent exposure assumption was satisfied, the standard SCCS approach produced nearly unbiased relative incidence estimates. When this assumption was partially or completely violated, two alternative SCCS approaches could be used. While the post-exposure cases only approach could handle only one exposure, the pseudo-likelihood approach was able to correct bias for both exposures. Violation of the event-independent exposure assumption leads to an overestimation of relative incidence which could be corrected by alternative SCCS approaches. In multiple exposure situations, the pseudo-likelihood approach is optimal; the post-exposure cases only approach is limited in handling a second exposure and may introduce additional bias, thus should be used with caution. Copyright © 2013 John Wiley & Sons, Ltd.

  2. Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

    Science.gov (United States)

    Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V

    2017-06-01

    Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

  3. 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…

  4. Qualitative case study data analysis: an example from practice.

    Science.gov (United States)

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

    2015-05-01

    To illustrate an approach to data analysis in qualitative case study methodology. There is often little detail in case study research about how data were analysed. However, it is important that comprehensive analysis procedures are used because there are often large sets of data from multiple sources of evidence. Furthermore, the ability to describe in detail how the analysis was conducted ensures rigour in reporting qualitative research. The research example used is a multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Data analysis was conducted using a framework guided by the four stages of analysis outlined by Morse ( 1994 ): comprehending, synthesising, theorising and recontextualising. The specific strategies for analysis in these stages centred on the work of Miles and Huberman ( 1994 ), which has been successfully used in case study research. The data were managed using NVivo software. Literature examining qualitative data analysis was reviewed and strategies illustrated by the case study example provided. Discussion Each stage of the analysis framework is described with illustration from the research example for the purpose of highlighting the benefits of a systematic approach to handling large data sets from multiple sources. By providing an example of how each stage of the analysis was conducted, it is hoped that researchers will be able to consider the benefits of such an approach to their own case study analysis. This paper illustrates specific strategies that can be employed when conducting data analysis in case study research and other qualitative research designs.

  5. 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.

  6. 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.

  7. A 5-year follow-up case of multiple intrusive luxative injuries

    Directory of Open Access Journals (Sweden)

    Seema Thakur

    2012-01-01

    Full Text Available Introduction: Traumatic intrusive luxation is one of the most severe forms of dental injuries, usually affecting the maxillary incisors. The consequence of such an occurrence is a high risk of healing complications such as pulp necrosis, external inflammatory resorption, and external replacement resorption (ankylosis. Case Report: This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 5 years. Discussion: Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 5 years, no clinical or radiographic pathology was detected.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Advanced language modeling approaches, case study: Expert search

    NARCIS (Netherlands)

    Hiemstra, Djoerd

    2008-01-01

    This tutorial gives a clear and detailed overview of advanced language modeling approaches and tools, including the use of document priors, translation models, relevance models, parsimonious models and expectation maximization training. Expert search will be used as a case study to explain the

  10. 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)

  11. 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,

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

    Science.gov (United States)

    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…

  13. Stakeholders and Apart Hotels: Multiple Case Study

    Directory of Open Access Journals (Sweden)

    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.

  14. Management of multiple intrusive luxative injuries: A case report with 7-year follow-up

    Directory of Open Access Journals (Sweden)

    Seema Thakur

    2014-01-01

    Full Text Available This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 7 years. Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 7 years, no clinical or radiographic pathology was detected.

  15. Integration of case study approach, project design and computer ...

    African Journals Online (AJOL)

    Integration of case study approach, project design and computer modeling in managerial accounting education ... Journal of Fundamental and Applied Sciences ... in the Laboratory of Management Accounting and Controlling Systems at the ...

  16. 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.

  17. 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.

  18. A data-driven multiplicative fault diagnosis approach for automation processes.

    Science.gov (United States)

    Hao, Haiyang; Zhang, Kai; Ding, Steven X; Chen, Zhiwen; Lei, Yaguo

    2014-09-01

    This paper presents a new data-driven method for diagnosing multiplicative key performance degradation in automation processes. Different from the well-established additive fault diagnosis approaches, the proposed method aims at identifying those low-level components which increase the variability of process variables and cause performance degradation. Based on process data, features of multiplicative fault are extracted. To identify the root cause, the impact of fault on each process variable is evaluated in the sense of contribution to performance degradation. Then, a numerical example is used to illustrate the functionalities of the method and Monte-Carlo simulation is performed to demonstrate the effectiveness from the statistical viewpoint. Finally, to show the practical applicability, a case study on the Tennessee Eastman process is presented. Copyright © 2013. Published by Elsevier Ltd.

  19. 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.

  20. 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...

  1. Freestyle multiple propeller flap reconstruction (jigsaw puzzle approach) for complicated back defects.

    Science.gov (United States)

    Park, Sung Woo; Oh, Tae Suk; Eom, Jin Sup; Sun, Yoon Chi; Suh, Hyun Suk; Hong, Joon Pio

    2015-05-01

    The reconstruction of the posterior trunk remains to be a challenge as defects can be extensive, with deep dead space, and fixation devices exposed. Our goal was to achieve a tension-free closure for complex defects on the posterior trunk. From August 2006 to May 2013, 18 cases were reconstructed with multiple flaps combining perforator(s) and local skin flaps. The reconstructions were performed using freestyle approach. Starting with propeller flap(s) in single or multilobed design and sequentially in conjunction with adjacent random pattern flaps such as fitting puzzle. All defects achieved tensionless primary closure. The final appearance resembled a jigsaw puzzle-like appearance. The average size of defect was 139.6 cm(2) (range, 36-345 cm(2)). A total of 26 perforator flaps were used in addition to 19 random pattern flaps for 18 cases. In all cases, a single perforator was used for each propeller flap. The defect and the donor site all achieved tension-free closure. The reconstruction was 100% successful without flap loss. One case of late infection was noted at 12 months after surgery. Using multiple lobe designed propeller flaps in conjunction with random pattern flaps in a freestyle approach, resembling putting a jigsaw puzzle together, we can achieve a tension-free closure by distributing the tension to multiple flaps, supplying sufficient volume to obliterate dead space, and have reliable vascularity as the flaps do not need to be oversized. This can be a viable approach to reconstruct extensive defects on the posterior trunk. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    Science.gov (United States)

    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…

  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. 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

  5. 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…

  6. Multiple Study of Case Involving Implementation of Lean Manufacturing

    Directory of Open Access Journals (Sweden)

    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.

  7. Higher education provision using systems thinking approach - case studies

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Sgouropoulou, Cleo; Feldman, Gerald; Amini, Ardavan

    2018-01-01

    The purpose of this paper is to highlight the complexities involved in higher education provision and how systems thinking and socio-technical systems (STS) thinking approach can be used to understand the education ecosystem. Systems thinking perspective is provided using two case studies: the development of European Learner Mobility (EuroLM) service and the delivery of Enterprise System Management (ESM) course at the Birmingham City University, UK. The case studies present how systems thinking using STS approaches like applied organisational change and Cognitive Work Analysis can be used to capture a conceptual model of the education system for understanding the interactions and relationships between the people, technology, processes and the organisations. Using systems thinking perspective, EuroLM has developed a set of technical standards addressed to the European systems developers and ESM delivery ensures that students communicate and collaborate.

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

    Science.gov (United States)

    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. 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

  10. Evaluating a Tacit Knowledge Sharing Initiative: A Case Study

    Science.gov (United States)

    Gubbins, Claire; Corrigan, Siobhan; Garavan, Thomas N.; O'Connor, Christy; Leahy, Damien; Long, David; Murphy, Eamonn

    2012-01-01

    Purpose: This paper aims to present a case study illustrating the issues involved in the tacit knowledge conversion process and to determine whether such conversion delivers value to the organisation in terms of business value and return on investment (ROI). Design/methodology/approach: A single-case multiple baseline participants experimental…

  11. Integrated Markov-neural reliability computation method: A case for multiple automated guided vehicle system

    International Nuclear Information System (INIS)

    Fazlollahtabar, Hamed; Saidi-Mehrabad, Mohammad; Balakrishnan, Jaydeep

    2015-01-01

    This paper proposes an integrated Markovian and back propagation neural network approaches to compute reliability of a system. While states of failure occurrences are significant elements for accurate reliability computation, Markovian based reliability assessment method is designed. Due to drawbacks shown by Markovian model for steady state reliability computations and neural network for initial training pattern, integration being called Markov-neural is developed and evaluated. To show efficiency of the proposed approach comparative analyses are performed. Also, for managerial implication purpose an application case for multiple automated guided vehicles (AGVs) in manufacturing networks is conducted. - Highlights: • Integrated Markovian and back propagation neural network approach to compute reliability. • Markovian based reliability assessment method. • Managerial implication is shown in an application case for multiple automated guided vehicles (AGVs) in manufacturing networks

  12. Multiple Brand Celebrity Endorsement: Případová studie David Beckham

    OpenAIRE

    Hiblerová, Adéla

    2017-01-01

    The Bachelor's Thesis on the topic of Multiple Brand Celebrity Endorsement: David Beckham Case Study focuses primarily on the issue of multiple endorsement of a number of brands by one celebrity. To be able to put this topic into perspective does this thesis begin with a description of celebrity endorsement as itself, defines 'celebrity', and also introduces various approaches towards cooperation of a celebrity and a brand in general. Consequently, reasons for and risks of such cooperation ar...

  13. An Approach for Integrating Toxicogenomic Data in Risk Assessment: The Dibutyl Phthalate Case Study

    Science.gov (United States)

    An approach for evaluating and integrating genomic data in chemical risk assessment was developed based on the lessons learned from performing a case study for the chemical dibutyl phthalate. A case study prototype approach was first developed in accordance with EPA guidance and ...

  14. 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

  15. MULTIPLE CRITERIA DECISION MAKING APPROACH FOR INDUSTRIAL ENGINEER SELECTION USING FUZZY AHP-FUZZY TOPSIS

    OpenAIRE

    Deliktaş, Derya; ÜSTÜN, Özden

    2018-01-01

    In this study, a fuzzy multiple criteria decision-making approach is proposed to select an industrial engineer among ten candidates in a manufacturing environment. The industrial engineer selection problem is a special case of the personal selection problem. This problem, which has hierarchical structure of criteria and many decision makers, contains many criteria. The evaluation process of decision makers also includes ambiguous parameters. The fuzzy AHP is used to determin...

  16. [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.

  17. Higher Education Provision Using Systems Thinking Approach--Case Studies

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Sgouropoulou, Cleo; Feldman, Gerald; Amini, Ardavan

    2018-01-01

    The purpose of this paper is to highlight the complexities involved in higher education provision and how systems thinking and socio-technical systems (STS) thinking approach can be used to understand the education ecosystem. Systems thinking perspective is provided using two case studies: the development of European Learner Mobility (EuroLM)…

  18. 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.

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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…

  1. An approach for integrating toxicogenomic data in risk assessment: The dibutyl phthalate case study

    Energy Technology Data Exchange (ETDEWEB)

    Euling, Susan Y., E-mail: euling.susan@epa.gov [National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC (United States); Thompson, Chad M. [ToxStrategies, Inc., 23501 Cinco Ranch Blvd., Suite G265, Katy, TX 77494 (United States); Chiu, Weihsueh A. [National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC (United States); Benson, Robert [U.S. Environmental Protection Agency, Region 8, Mail code 8P-W, 1595 Wynkoop Street, Denver, CO 80202 (United States)

    2013-09-15

    An approach for evaluating and integrating genomic data in chemical risk assessment was developed based on the lessons learned from performing a case study for the chemical dibutyl phthalate. A case study prototype approach was first developed in accordance with EPA guidance and recommendations of the scientific community. Dibutyl phthalate (DBP) was selected for the case study exercise. The scoping phase of the dibutyl phthalate case study was conducted by considering the available DBP genomic data, taken together with the entire data set, for whether they could inform various risk assessment aspects, such as toxicodynamics, toxicokinetics, and dose–response. A description of weighing the available dibutyl phthalate data set for utility in risk assessment provides an example for considering genomic data for future chemical assessments. As a result of conducting the scoping process, two questions—Do the DBP toxicogenomic data inform 1) the mechanisms or modes of action?, and 2) the interspecies differences in toxicodynamics?—were selected to focus the case study exercise. Principles of the general approach include considering the genomics data in conjunction with all other data to determine their ability to inform the various qualitative and/or quantitative aspects of risk assessment, and evaluating the relationship between the available genomic and toxicity outcome data with respect to study comparability and phenotypic anchoring. Based on experience from the DBP case study, recommendations and a general approach for integrating genomic data in chemical assessment were developed to advance the broader effort to utilize 21st century data in risk assessment. - Highlights: • Performed DBP case study for integrating genomic data in risk assessment • Present approach for considering genomic data in chemical risk assessment • Present recommendations for use of genomic data in chemical risk assessment.

  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. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

    Directory of Open Access Journals (Sweden)

    Rodrigo Ramos-Zúñiga

    2015-01-01

    Full Text Available Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma; and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

  4. 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.

  5. Developing the DESCARTE Model: The Design of Case Study Research in Health Care.

    Science.gov (United States)

    Carolan, Clare M; Forbat, Liz; Smith, Annetta

    2016-04-01

    Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered. © The Author(s) 2015.

  6. 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

  7. 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...

  8. Pediatric surgical diseases. A radiological surgical case study approach

    International Nuclear Information System (INIS)

    Esposito, Ciro; Esposito, Giovanni

    2009-01-01

    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  9. Pediatric surgical diseases. A radiological surgical case study approach

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, Ciro [Federico II Univ. of Naples (Italy). Chair of Pediatric Surgery; Esposito, Giovanni (eds.) [Federico II Univ. of Naples (Italy). School of Medicine

    2009-07-01

    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  10. The state of case study approach in mergers and acquisitions literature: A bibliometric analysis

    Directory of Open Access Journals (Sweden)

    K.S. Reddy

    2015-12-01

    Full Text Available The purpose of this paper is to survey the state of case study research in mergers and acquisitions (M&A literature. Thus, it is an original attempt at presenting the current state and review of the case method in M&A research, provided no earlier study claims this. The stylized review reveals that 93 journal articles adopted the case method of which 66 (27 articles examined developed (emerging markets, and single (multiple case based studies were 44 (46 and remaining three adopted survey and interview method during survey period 1991–2015. Albeit, very few studies accomplished the purpose of case study research in business management, that is, testing extant theory and building new theory. Lastly, we recall various methodological guidelines to establish the sound research environment in the qualitative case method.

  11. 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…

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. A nested case-control approach to interactions between radiation dose and other factors as causes of cancer

    Energy Technology Data Exchange (ETDEWEB)

    Land, Charles E [Department of Epidemiology, Radiation Epidemiology Branch, US National Cancer Institute, Bethesda, MD (United States)

    1992-04-01

    Often a nested case-control study is the most practicable approach to estimating the interaction of two cancer risk factors in a large cohort. If one of the factors has already been evaluated for the entire cohort, however, more information is already available about its relationship to risk than could be obtained from a nested study. A modified case-control approach is proposed, in which information about the second, unknown factor is sought for cases and controls matched on the first factor. The approach requires, for interaction models other than the multiplicative, a nonstandard analytical approach incorporating cohort-based information about the first factor. The problem is discussed in the context of breast cancer risk in a defined cohort of female Japanese atomic bomb survivors, in relation to radiation dose and reproductive history. (author)

  17. 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.

  18. The interactive business case approach for multiple land use: more efficiency, less costs!

    NARCIS (Netherlands)

    Franssen, R.J.M.; Ellen, G.J.; van der Heijden, G.M.A.; van Lamoen, F.; Melisie, E.J.; Peerdeman, K.; Wind, M.H.A.; Paalman, M.

    2011-01-01

    This paper describes Interactive Business Case Approach (IBCA) in a participatory planning setting concerning multifunctional land use, as an instrument for climate adaptation strategies. Multifunctional land use is an solution to optimize the use of scare spatial resources, especially in densely

  19. Optimal Route Searching with Multiple Dynamical Constraints—A Geometric Algebra Approach

    Directory of Open Access Journals (Sweden)

    Dongshuang Li

    2018-05-01

    Full Text Available The process of searching for a dynamic constrained optimal path has received increasing attention in traffic planning, evacuation, and personalized or collaborative traffic service. As most existing multiple constrained optimal path (MCOP methods cannot search for a path given various types of constraints that dynamically change during the search, few approaches for dynamic multiple constrained optimal path (DMCOP with type II dynamics are available for practical use. In this study, we develop a method to solve the DMCOP problem with type II dynamics based on the unification of various types of constraints under a geometric algebra (GA framework. In our method, the network topology and three different types of constraints are represented by using algebraic base coding. With a parameterized optimization of the MCOP algorithm based on a greedy search strategy under the generation-refinement paradigm, this algorithm is found to accurately support the discovery of optimal paths as the constraints of numerical values, nodes, and route structure types are dynamically added to the network. The algorithm was tested with simulated cases of optimal tourism route searches in China’s road networks with various combinations of constraints. The case study indicates that our algorithm can not only solve the DMCOP with different types of constraints but also use constraints to speed up the route filtering.

  20. 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.

  1. 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.

  2. Comparing Case Study and Ethnography as Qualitative Research Approaches

    OpenAIRE

    Suryani, Anne

    2008-01-01

    Abstract: This article reviews several differences between case study and ethnography in terms of definitions, characteristics, strengths and limitations. It provides current information by comparing these approaches from various social researchers’ perspectives. Although each method has strong points, they both have differences in conducting observation and interview as data collection techniques; choosing the length of time of data gathering and reporting details of a particular reality....

  3. Guidelines for Conducting Positivist Case Study Research in Information Systems

    Directory of Open Access Journals (Sweden)

    Graeme Shanks

    2002-11-01

    Full Text Available The case study research approach is widely used in a number of different ways within the information systems community. This paper focuses on positivist, deductive case study research in information systems. It provides clear definitions of important concepts in positivist case study research and illustrates these with an example research study. A critical analysis of the conduct and outcomes of two recently published positivist case studies is reported. One is a multiple case study that validated concepts in a framework for viewpoint development in requirements definition. The other is a single case study that examined the role of social enablers in enterprise resource planning systems implementation. A number of guidelines for successfully undertaking positivist case study research are identified including developing a clear understanding of key concepts and assumptions within the positivist paradigm; providing clear and unambiguous definitions of the units and interactions when using any theory; carefully defining the boundary of the theory used in the case study; using hypotheses rather than propositions in the empirical testing of theory; using fuzzy or probabilistic propositions in recognising that reality can never be perfectly known; selecting case studies carefully, particularly single case studies; and recognising that generalisation from positivist, single case studies is inherently different from generalisation from single experiments. When properly undertaken, positivist, deductive case study research is a valuable research approach for information systems researchers, particularly when used within pluralist research programs that use a number of different research approaches from different paradigms.

  4. 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

  5. Comparing Case Study and Ethnography as Qualitative Research Approaches

    Directory of Open Access Journals (Sweden)

    Anne Suryani

    2013-12-01

    Full Text Available Abstract: This article reviews several differences between case study and ethnography in terms of definitions, characteristics, strengths and limitations. It provides current information by comparing these approaches from various social researchers’ perspectives. Although each method has strong points, they both have differences in conducting observation and interview as data collection techniques; choosing the length of time of data gathering and reporting details of a particular reality.

  6. Assessing compositional variability through graphical analysis and Bayesian statistical approaches: case studies on transgenic crops.

    Science.gov (United States)

    Harrigan, George G; Harrison, Jay M

    2012-01-01

    New transgenic (GM) crops are subjected to extensive safety assessments that include compositional comparisons with conventional counterparts as a cornerstone of the process. The influence of germplasm, location, environment, and agronomic treatments on compositional variability is, however, often obscured in these pair-wise comparisons. Furthermore, classical statistical significance testing can often provide an incomplete and over-simplified summary of highly responsive variables such as crop composition. In order to more clearly describe the influence of the numerous sources of compositional variation we present an introduction to two alternative but complementary approaches to data analysis and interpretation. These include i) exploratory data analysis (EDA) with its emphasis on visualization and graphics-based approaches and ii) Bayesian statistical methodology that provides easily interpretable and meaningful evaluations of data in terms of probability distributions. The EDA case-studies include analyses of herbicide-tolerant GM soybean and insect-protected GM maize and soybean. Bayesian approaches are presented in an analysis of herbicide-tolerant GM soybean. Advantages of these approaches over classical frequentist significance testing include the more direct interpretation of results in terms of probabilities pertaining to quantities of interest and no confusion over the application of corrections for multiple comparisons. It is concluded that a standardized framework for these methodologies could provide specific advantages through enhanced clarity of presentation and interpretation in comparative assessments of crop composition.

  7. MANGO: a new approach to multiple sequence alignment.

    Science.gov (United States)

    Zhang, Zefeng; Lin, Hao; Li, Ming

    2007-01-01

    Multiple sequence alignment is a classical and challenging task for biological sequence analysis. The problem is NP-hard. The full dynamic programming takes too much time. The progressive alignment heuristics adopted by most state of the art multiple sequence alignment programs suffer from the 'once a gap, always a gap' phenomenon. Is there a radically new way to do multiple sequence alignment? This paper introduces a novel and orthogonal multiple sequence alignment method, using multiple optimized spaced seeds and new algorithms to handle these seeds efficiently. Our new algorithm processes information of all sequences as a whole, avoiding problems caused by the popular progressive approaches. Because the optimized spaced seeds are provably significantly more sensitive than the consecutive k-mers, the new approach promises to be more accurate and reliable. To validate our new approach, we have implemented MANGO: Multiple Alignment with N Gapped Oligos. Experiments were carried out on large 16S RNA benchmarks showing that MANGO compares favorably, in both accuracy and speed, against state-of-art multiple sequence alignment methods, including ClustalW 1.83, MUSCLE 3.6, MAFFT 5.861, Prob-ConsRNA 1.11, Dialign 2.2.1, DIALIGN-T 0.2.1, T-Coffee 4.85, POA 2.0 and Kalign 2.0.

  8. 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.

  9. 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.

  10. Managing change in performance measures – An inter-company case study approach

    Directory of Open Access Journals (Sweden)

    Salloum, M.

    2012-01-01

    Full Text Available The field of performance measurement and management (PMM is well filled with frameworks, models and guidelines addressing what to measure and how to design a performance measurement system (PMS. However, what has been less examined so far is how to ensure that PM evolve in tandem with their environments. Further, the few approaches available today are prescriptive and outlines how or what practitioners should do in order to manage change in their PM. Thus, a gap exists in understanding how organisations manage change in their PM in practice. Thus, the purpose of this paper is to outline and compare the approaches of three case companies for managing PM change. In order to fulfil the purpose of the paper, the data presented has been collected through the deployment of case studies. The choice of case studies as means for data collection stems from the possibility of an in-depth and holistic examination of the formulated phenomenon. All three case companies belong to the same company-group that operates within the transportation industry. The industrial footprint of the company is global with operations and sales spread out over the world. The findings suggest that all three companies have processes in place for managing change in PM. However, the approaches differ in design and context. Even though the case companies had different approaches in place to manage change in PM, they shared several commonalities. Commonalities were shared in the way of execution, process input and challenges in IT and culture. Furthermore, employee involvement seemed to be the biggest challenge for all three companies. The findings put forward in this paper are limited as they are confined to three companies from the same company-group. More studies, both from within and outside the company-group, are needed in order to establish a solid base of empirical data for generalisation. However, this paper makes a contribution both through describing how three companies

  11. A Monte Carlo Study on Multiple Output Stochastic Frontiers

    DEFF Research Database (Denmark)

    Henningsen, Géraldine; Henningsen, Arne; Jensen, Uwe

    , dividing all other output quantities by the selected output quantity, and using these ratios as regressors (OD). Another approach is the stochastic ray production frontier (SR) which transforms the output quantities into their Euclidean distance as the dependent variable and their polar coordinates......In the estimation of multiple output technologies in a primal approach, the main question is how to handle the multiple outputs. Often an output distance function is used, where the classical approach is to exploit its homogeneity property by selecting one output quantity as the dependent variable...... of both specifications for the case of a Translog output distance function with respect to different common statistical problems as well as problems arising as a consequence of zero values in the output quantities. Although, our results partly show clear reactions to statistical misspecifications...

  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. Multiple-Use Services as an Alternative to Rural Water Supply Services: A Characterisation of the Approach

    Directory of Open Access Journals (Sweden)

    Stef Smits

    2010-02-01

    Full Text Available Multiple-use services (MUS have recently gained increased attention as an alternative form of providing rural water services in an integrated manner. This stems from the growing recognition that users anyway tend to use water systems for multiple purposes. This paper aims to characterise this practice on the basis of case evidence collected in eight countries in Africa, Asia and Latin America. The cases show that people almost universally use water for both domestic and productive activities at and around the homestead. Although seldom the main source of people’s income or food production, these activities are of considerable importance for people’s livelihoods. The extent to which people use water for multiple purposes is closely related to the level of access to water expressed in the form of a water ladder in this paper. The case studies presented demonstrate how access is created by different types and combinations of well-known technologies. Additional financial and management measures are required to ensure sustainability of services. Despite the practical feasibility of the MUS approach, it is not yet widely applied by service providers and sector agencies due to observed barriers in institutional uptake. A better characterisation of MUS, alongside a learning-driven stakeholder process was able to overcome some of these barriers and improve the consideration of multiple uses of water in policy and practice.

  14. 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.

  15. 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...

  16. A Unified Approach to Functional Principal Component Analysis and Functional Multiple-Set Canonical Correlation.

    Science.gov (United States)

    Choi, Ji Yeh; Hwang, Heungsun; Yamamoto, Michio; Jung, Kwanghee; Woodward, Todd S

    2017-06-01

    Functional principal component analysis (FPCA) and functional multiple-set canonical correlation analysis (FMCCA) are data reduction techniques for functional data that are collected in the form of smooth curves or functions over a continuum such as time or space. In FPCA, low-dimensional components are extracted from a single functional dataset such that they explain the most variance of the dataset, whereas in FMCCA, low-dimensional components are obtained from each of multiple functional datasets in such a way that the associations among the components are maximized across the different sets. In this paper, we propose a unified approach to FPCA and FMCCA. The proposed approach subsumes both techniques as special cases. Furthermore, it permits a compromise between the techniques, such that components are obtained from each set of functional data to maximize their associations across different datasets, while accounting for the variance of the data well. We propose a single optimization criterion for the proposed approach, and develop an alternating regularized least squares algorithm to minimize the criterion in combination with basis function approximations to functions. We conduct a simulation study to investigate the performance of the proposed approach based on synthetic data. We also apply the approach for the analysis of multiple-subject functional magnetic resonance imaging data to obtain low-dimensional components of blood-oxygen level-dependent signal changes of the brain over time, which are highly correlated across the subjects as well as representative of the data. The extracted components are used to identify networks of neural activity that are commonly activated across the subjects while carrying out a working memory task.

  17. 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

  18. 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…

  19. 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 ...

  20. 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.

  1. Robust Tests for Additive Gene-Environment Interaction in Case-Control Studies Using Gene-Environment Independence

    DEFF Research Database (Denmark)

    Liu, Gang; Lee, Seunggeun; Lee, Alice W

    2018-01-01

    test with case-control data. Our simulation studies suggest that the EB approach uses the gene-environment independence assumption in a data-adaptive way and provides power gain compared to the standard logistic regression analysis and better control of Type I error when compared to the analysis......There have been recent proposals advocating the use of additive gene-environment interaction instead of the widely used multiplicative scale, as a more relevant public health measure. Using gene-environment independence enhances the power for testing multiplicative interaction in case......-control studies. However, under departure from this assumption, substantial bias in the estimates and inflated Type I error in the corresponding tests can occur. This paper extends the empirical Bayes (EB) approach previously developed for multiplicative interaction that trades off between bias and efficiency...

  2. An Application of Graphical Approach to Construct Multiple Testing Procedure in a Hypothetical Phase III Design

    Directory of Open Access Journals (Sweden)

    Naitee eTing

    2014-01-01

    Full Text Available Many multiple testing procedures (MTP have been developed in recent years. Among these new procedures, the graphical approach is flexible and easy to communicate with non-statisticians. A hypothetical Phase III clinical trial design is introduced in this manuscript to demonstrate how graphical approach can be applied in clinical product development. In this design, an active comparator is used. It is thought that this test drug under development could potentially be superior to this comparator. For comparison of efficacy, the primary endpoint is well established and widely accepted by regulatory agencies. However, an important secondary endpoint based on Phase II findings looks very promising. The target dose may have a good opportunity to deliver superiority to the comparator. Furthermore, a lower dose is included in case the target dose may demonstrate potential safety concerns. This Phase III study is designed as a non-inferiority trial with two doses, and two endpoints. This manuscript will illustrate how graphical approach is applied to this design in handling multiple testing issues.

  3. 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.

  4. 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…

  5. 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.

  6. Multiculturalism in Technology-Based Education: Case Studies on ICT-Supported Approaches

    Science.gov (United States)

    Garcia-Penalvo, Francicso Jose

    2013-01-01

    Our differences in language, cultures, and history around the world play a vital role in the way we learn. As technology-based education continues to be used worldwide, there is an ever growing interest in how multiculturalism comes into effect. Multiculturalism in Technology-Based Education: Case Studies on ICT-Supported Approaches explores the…

  7. An iterative approach to case study analysis: insights from qualitative analysis of quantitative inconsistencies

    Directory of Open Access Journals (Sweden)

    Allain J Barnett

    2016-09-01

    Full Text Available Large-N comparative studies have helped common pool resource scholars gain general insights into the factors that influence collective action and governance outcomes. However, these studies are often limited by missing data, and suffer from the methodological limitation that important information is lost when we reduce textual information to quantitative data. This study was motivated by nine case studies that appeared to be inconsistent with the expectation that the presence of Ostrom’s Design Principles increases the likelihood of successful common pool resource governance. These cases highlight the limitations of coding and analysing Large-N case studies. We examine two issues: 1 the challenge of missing data and 2 potential approaches that rely on context (which is often lost in the coding process to address inconsistencies between empirical observations theoretical predictions.  For the latter, we conduct a post-hoc qualitative analysis of a large-N comparative study to explore 2 types of inconsistencies: 1 cases where evidence for nearly all design principles was found, but available evidence led to the assessment that the CPR system was unsuccessful and 2 cases where the CPR system was deemed successful despite finding limited or no evidence for design principles.  We describe inherent challenges to large-N comparative analysis to coding complex and dynamically changing common pool resource systems for the presence or absence of design principles and the determination of “success”.  Finally, we illustrate how, in some cases, our qualitative analysis revealed that the identity of absent design principles explained inconsistencies hence de-facto reconciling such apparent inconsistencies with theoretical predictions.  This analysis demonstrates the value of combining quantitative and qualitative analysis, and using mixed-methods approaches iteratively to build comprehensive methodological and theoretical approaches to understanding

  8. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence.

    Science.gov (United States)

    Dara, Ravi C; Tiwari, Aseem K; Pandey, Prashant; Arora, Dinesh

    2015-01-01

    Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  9. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

    Directory of Open Access Journals (Sweden)

    Ravi C Dara

    2015-01-01

    Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  10. 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.

  11. Pediatric Multiple Sclerosis: Genes, Environment, and a Comprehensive Therapeutic Approach.

    Science.gov (United States)

    Cappa, Ryan; Theroux, Liana; Brenton, J Nicholas

    2017-10-01

    Pediatric multiple sclerosis is an increasingly recognized and studied disorder that accounts for 3% to 10% of all patients with multiple sclerosis. The risk for pediatric multiple sclerosis is thought to reflect a complex interplay between environmental and genetic risk factors. Environmental exposures, including sunlight (ultraviolet radiation, vitamin D levels), infections (Epstein-Barr virus), passive smoking, and obesity, have been identified as potential risk factors in youth. Genetic predisposition contributes to the risk of multiple sclerosis, and the major histocompatibility complex on chromosome 6 makes the single largest contribution to susceptibility to multiple sclerosis. With the use of large-scale genome-wide association studies, other non-major histocompatibility complex alleles have been identified as independent risk factors for the disease. The bridge between environment and genes likely lies in the study of epigenetic processes, which are environmentally-influenced mechanisms through which gene expression may be modified. This article will review these topics to provide a framework for discussion of a comprehensive approach to counseling and ultimately treating the pediatric patient with multiple sclerosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Whole-body voxel-based personalized dosimetry: Multiple voxel S-value approach for heterogeneous media with non-uniform activity distributions.

    Science.gov (United States)

    Lee, Min Sun; Kim, Joong Hyun; Paeng, Jin Chul; Kang, Keon Wook; Jeong, Jae Min; Lee, Dong Soo; Lee, Jae Sung

    2017-12-14

    Personalized dosimetry with high accuracy is becoming more important because of the growing interests in personalized medicine and targeted radionuclide therapy. Voxel-based dosimetry using dose point kernel or voxel S-value (VSV) convolution is available. However, these approaches do not consider medium heterogeneity. Here, we propose a new method for whole-body voxel-based personalized dosimetry for heterogeneous media with non-uniform activity distributions, which is referred to as the multiple VSV approach. Methods: The multiple numbers (N) of VSVs for media with different densities covering the whole-body density ranges were used instead of using only a single VSV for water. The VSVs were pre-calculated using GATE Monte Carlo simulation; those were convoluted with the time-integrated activity to generate density-specific dose maps. Computed tomography-based segmentation was conducted to generate binary maps for each density region. The final dose map was acquired by the summation of N segmented density-specific dose maps. We tested several sets of VSVs with different densities: N = 1 (single water VSV), 4, 6, 8, 10, and 20. To validate the proposed method, phantom and patient studies were conducted and compared with direct Monte Carlo, which was considered the ground truth. Finally, patient dosimetry (10 subjects) was conducted using the multiple VSV approach and compared with the single VSV and organ-based dosimetry approaches. Errors at the voxel- and organ-levels were reported for eight organs. Results: In the phantom and patient studies, the multiple VSV approach showed significant improvements regarding voxel-level errors, especially for the lung and bone regions. As N increased, voxel-level errors decreased, although some overestimations were observed at lung boundaries. In the case of multiple VSVs ( N = 8), we achieved voxel-level errors of 2.06%. In the dosimetry study, our proposed method showed much improved results compared to the single VSV and

  13. 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)

  14. Bayesian approach to the assessment of the population-specific risk of inhibitors in hemophilia A patients: a case study.

    Science.gov (United States)

    Cheng, Ji; Iorio, Alfonso; Marcucci, Maura; Romanov, Vadim; Pullenayegum, Eleanor M; Marshall, John K; Thabane, Lehana

    2016-01-01

    .3] and 1.4 [1.1, 1.8], respectively). Increasing the number of studies by two and ten times for the multiple study scenarios (Case 2: 1.9 [0.6, 4.0] and 1.9 [1.5, 2.6]; Case 3: 2.4 [0.9, 5.0] and 2.6 [1.9, 3.5], respectively) had a similar effect. Bayesian approach as a robust, transparent, and reproducible analytic method can be efficiently used to estimate the inhibitor rate of hemophilia A in complex clinical settings.

  15. Education-growth dynamics for Australia: A case study approach

    Directory of Open Access Journals (Sweden)

    Kunofiwa Tsaurai

    2015-04-01

    Full Text Available The main focus of this research is to establish the relevancy of the Keynesian theory in explaining education expenditure on the economy of Austria using a case study approach. Wagner (1890 and Keynes (1936 have been for a long time been the two major theorists on the relationship between education expenditure and economic growth. Both theoretical and empirical literature review concludes that the two variables relate to each other in two distinct ways, the popular one being that education boost the economy (Keynes view followed by the Wagner view that says it is the economy that is doing well that pushes investment in education. A case study review for Austria clearly shows that an increase in education expenditure does not only constitute a significant portion of the GDP per capita in Austria but also provided a positive influence on economic growth and development. The author recommends Austria policymakers and responsible authorities to up their education development programmes and budgets in order to lay a strong foundation for sustainable economic growth and prosperity.

  16. 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)

  17. 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 ...

  18. Enhanced ergonomics approaches for product design: a user experience ecosystem perspective and case studies.

    Science.gov (United States)

    Xu, Wei

    2014-01-01

    This paper first discusses the major inefficiencies faced in current human factors and ergonomics (HFE) approaches: (1) delivering an optimal end-to-end user experience (UX) to users of a solution across its solution lifecycle stages; (2) strategically influencing the product business and technology capability roadmaps from a UX perspective and (3) proactively identifying new market opportunities and influencing the platform architecture capabilities on which the UX of end products relies. In response to these challenges, three case studies are presented to demonstrate how enhanced ergonomics design approaches have effectively addressed the challenges faced in current HFE approaches. Then, the enhanced ergonomics design approaches are conceptualised by a user-experience ecosystem (UXE) framework, from a UX ecosystem perspective. Finally, evidence supporting the UXE, the advantage and the formalised process for executing UXE and methodological considerations are discussed. Practitioner Summary: This paper presents enhanced ergonomics approaches to product design via three case studies to effectively address current HFE challenges by leveraging a systematic end-to-end UX approach, UX roadmaps and emerging UX associated with prioritised user needs and usages. Thus, HFE professionals can be more strategic, creative and influential.

  19. Case Report: Multiple Myeloma with Gangrene of Extremities

    Directory of Open Access Journals (Sweden)

    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.

  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. The Special Place Project: Efficacy of a Place-Based Case Study Approach for Teaching Geoscience

    Science.gov (United States)

    Moosavi, Sadredin

    2014-05-01

    Achieving geoscience literacy of the general population has become increasingly important world wide as ever more connected and growing societies depend more and more on our planet's limited natural resource base. Building citizen understanding of their dependence on the local environment, and the geologic processes which created and continue to change it, has become a great challenge to educators at all levels of the education system. The Special Place Project described in this presentation explores use of a place-based case study approach combining instruction in geoscience content with development of observation, reasoning, writing and presentation skills. The approach allows students to select the locations for their individual case studies affording development of personal connections between the learner and his environment. The approach gives instructors at many grade levels the ability to develop core pedagogical content and skills while exploring the unique geologic environments relevant to the local population including such critical issues as land use, resource depletion, energy, climate change and the future of communities in a changing world. The geologic reasons for the location of communities and key events in their histories can be incorporated into the students' case studies as appropriate. The project is unique in placing all course instruction in the context of the quest to explore and gain understanding of the student's chosen location by using the inherently more generalized course content required by the curriculum. By modeling how scientists approach their research questions, this pedagogical technique not only integrates knowledge and skills from across the curriculum, it captures the excitement of scientific thinking on real world questions directly relevant to students' lives, increasing student engagement and depth of learning as demonstrated in the case study reports crafted by the students and exam results. Student learning of topics

  2. 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)

  3. 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)

  4. Strongly and weakly directed approaches to teaching multiple representation use in physics

    Directory of Open Access Journals (Sweden)

    Patrick B. Kohl

    2007-06-01

    Full Text Available Good use of multiple representations is considered key to learning physics, and so there is considerable motivation both to learn how students use multiple representations when solving problems and to learn how best to teach problem solving using multiple representations. In this study of two large-lecture algebra-based physics courses at the University of Colorado (CU and Rutgers, the State University of New Jersey, we address both issues. Students in each of the two courses solved five common electrostatics problems of varying difficulty, and we examine their solutions to clarify the relationship between multiple representation use and performance on problems involving free-body diagrams. We also compare our data across the courses, since the two physics-education-research-based courses take substantially different approaches to teaching the use of multiple representations. The course at Rutgers takes a strongly directed approach, emphasizing specific heuristics and problem-solving strategies. The course at CU takes a weakly directed approach, modeling good problem solving without teaching a specific strategy. We find that, in both courses, students make extensive use of multiple representations, and that this use (when both complete and correct is associated with significantly increased performance. Some minor differences in representation use exist, and are consistent with the types of instruction given. Most significant are the strong and broad similarities in the results, suggesting that either instructional approach or a combination thereof can be useful for helping students learn to use multiple representations for problem solving and concept development.

  5. 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.

  6. The role of the observational approach in RI planning: WAG 5 case study

    International Nuclear Information System (INIS)

    Brill, A.K.; Kuhaida, A.J. Jr.

    1992-10-01

    A Remedial Investigation (RI) Plan was developed for the Oak Ridge National Laboratory (ORNL) Waste Area Grouping (WAG) 5 in March 1988 and submitted to the Environmental Protection Agency (EPA) Region IV and the State of Tennessee for review and approval. The observational approach was evaluated by the ORNL Environmental Restoration (ER) Program and accepted by EPA as an accelerated and cost-effective approach to the RI/Feasibility Study (FS) process for remediation of WAG 5. The traditional approach used in preparing the 1988 RI Plan focused on data completeness, included a typical range of RI data-gathering activities for determining the nature and extent of contamination at WAG 5, and used multiple iterations of sampling activities to deal with uncertainties without consideration of potential deviations. In fall 1991, a revised Field Sampling Plan (FSP) was developed that used the observational approach to integrate site characterization with site remediation needs. This approach recognized the uncertainties of site characterization/remedial planning and developed contingency plans for dealing with them. The observational approach emphasizes data sufficiency to support remedial planning decisions for WAG 5

  7. 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…

  8. A multimedia case based approach to the study of office ergonomics.

    Science.gov (United States)

    August-Dalfen, Sharon; Snider, Laurie

    2003-01-01

    Multimedia technology has the capacity to provide students with an interactive approach to problem based learning and to bridge the gap between theoretical knowledge and clinical practice. The present paper describes the design and development of the program ErgoROM, a CD which presents a case study to assist occupational therapy students in their studies of office ergonomics. A pilot study showed that overall, 91% of respondents rated the ErgoROM as either "Excellent" or "Very Good". Additionally they reported that ErgoROM had a positive impact on active learning and critical thinking.

  9. 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 ...

  10. 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

    Full Text Available Leadership measurement, feedback, and development have grown in importance for the field of management. The Mexico–US Border defined as the area of land within 100 km (62.5 miles north and south of the international boundary, shares common challenges, and requires the development of multicultural change agents who conduct binational actions toward the improvement of public health and quality of life of the population in the region. Leaders across Borders (LaB was established in 2010 as an advanced certified binational leadership development program aimed at building the capacity of public health, health care, and other community sector leaders working to improve the health of the communities in the Mexico–US Border region. Leadership as a social interaction process requires leader skills development to achieve goals promoting unity and reducing polarization to optimize interactions between all resources, thus improving teamwork. Therefore, measurement and feedback model of general values and beliefs that guide effective behavior, not only individual personality assessments need to drive a proactive learning and action plan development to improve interactions in a team, thus optimizing leadership. Starting 2014, we administered a new model named Systemic Multiple Level Observation of Groups (SYMLOG to measure the values and beliefs that guide the behavior of learners and team facilitators. We also evaluated the effectiveness of each team of the program and established benchmarks and action plans to optimize interactions and communication between all the learners during the 8-month program. This leads to a stronger systemic network upon graduation from the program. The SYMLOG approach measured initial and improved situations of individual leadership and team performance effectiveness because of the LaB Program training and skills development sessions. The SYMLOG also provided positive feedback to each participant, which had a direct impact

  11. Facilitating progress in health behaviour theory development and modification: the reasoned action approach as a case study.

    Science.gov (United States)

    Head, Katharine J; Noar, Seth M

    2014-01-01

    This paper explores the question: what are barriers to health behaviour theory development and modification, and what potential solutions can be proposed? Using the reasoned action approach (RAA) as a case study, four areas of theory development were examined: (1) the theoretical domain of a theory; (2) tension between generalisability and utility, (3) criteria for adding/removing variables in a theory, and (4) organisational tracking of theoretical developments and formal changes to theory. Based on a discussion of these four issues, recommendations for theory development are presented, including: (1) the theoretical domain for theories such as RAA should be clarified; (2) when there is tension between generalisability and utility, utility should be given preference given the applied nature of the health behaviour field; (3) variables should be formally removed/amended/added to a theory based on their performance across multiple studies and (4) organisations and researchers with a stake in particular health areas may be best suited for tracking the literature on behaviour-specific theories and making refinements to theory, based on a consensus approach. Overall, enhancing research in this area can provide important insights for more accurately understanding health behaviours and thus producing work that leads to more effective health behaviour change interventions.

  12. Bridging the Research to Practice Gap: A Case Study Approach to Understanding EIBI Supports and Barriers in Swedish Preschools

    Directory of Open Access Journals (Sweden)

    Lise ROLL-PETTERSSON

    2016-12-01

    Full Text Available The present study examined proximal and distal barriers and supports within the Swedish service system that may affect implementation of early and intensive behavioral intervention (EIBI for children with autism. A case study approach with roots in ethnography was chosen to explore this issue. Two preschools exemplifying ‘high quality practice’ were studied and information was collected through multiple sources during a 12 month period, this included participant observations, direct observations, semi-structured interviews with key informants; paraprofessionals, parents, special educators, habilitation specialists and a focus group interview. Interview transcripts and field notes were combined and analyzed using an abductive grounded theory approach. Findings highlight the relevance of researchers understanding and taking into consideration the effect that distal variables have on implementation within proximal settings. A theoretical model of factors affecting implementation was conceptualised to include: staff entry knowledge and competence, development through supervision, the role of the preschool administrator, as well as distal influences and inter-organizational tensions, values, and bridges. Findings are discussed within the context of implementation science. Implications for future research are discussed as well as areas in need of further development to bridge the gap between research and practice.

  13. 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.

  14. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study.

    Science.gov (United States)

    Fukuda, Hiroyuki; Morishita, Takashi; Ogata, Toshiyasu; Saita, Kazuya; Hyakutake, Koichi; Watanabe, Junko; Shiota, Etsuji; Inoue, Tooru

    2016-01-01

    This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

  15. Optimal planning of multiple distributed generation sources in distribution networks: A new approach

    Energy Technology Data Exchange (ETDEWEB)

    AlRashidi, M.R., E-mail: malrash2002@yahoo.com [Department of Electrical Engineering, College of Technological Studies, Public Authority for Applied Education and Training (PAAET) (Kuwait); AlHajri, M.F., E-mail: mfalhajri@yahoo.com [Department of Electrical Engineering, College of Technological Studies, Public Authority for Applied Education and Training (PAAET) (Kuwait)

    2011-10-15

    Highlights: {yields} A new hybrid PSO for optimal DGs placement and sizing. {yields} Statistical analysis to fine tune PSO parameters. {yields} Novel constraint handling mechanism to handle different constraints types. - Abstract: An improved particle swarm optimization algorithm (PSO) is presented for optimal planning of multiple distributed generation sources (DG). This problem can be divided into two sub-problems: the DG optimal size (continuous optimization) and location (discrete optimization) to minimize real power losses. The proposed approach addresses the two sub-problems simultaneously using an enhanced PSO algorithm capable of handling multiple DG planning in a single run. A design of experiment is used to fine tune the proposed approach via proper analysis of PSO parameters interaction. The proposed algorithm treats the problem constraints differently by adopting a radial power flow algorithm to satisfy the equality constraints, i.e. power flows in distribution networks, while the inequality constraints are handled by making use of some of the PSO features. The proposed algorithm was tested on the practical 69-bus power distribution system. Different test cases were considered to validate the proposed approach consistency in detecting optimal or near optimal solution. Results are compared with those of Sequential Quadratic Programming.

  16. Optimal planning of multiple distributed generation sources in distribution networks: A new approach

    International Nuclear Information System (INIS)

    AlRashidi, M.R.; AlHajri, M.F.

    2011-01-01

    Highlights: → A new hybrid PSO for optimal DGs placement and sizing. → Statistical analysis to fine tune PSO parameters. → Novel constraint handling mechanism to handle different constraints types. - Abstract: An improved particle swarm optimization algorithm (PSO) is presented for optimal planning of multiple distributed generation sources (DG). This problem can be divided into two sub-problems: the DG optimal size (continuous optimization) and location (discrete optimization) to minimize real power losses. The proposed approach addresses the two sub-problems simultaneously using an enhanced PSO algorithm capable of handling multiple DG planning in a single run. A design of experiment is used to fine tune the proposed approach via proper analysis of PSO parameters interaction. The proposed algorithm treats the problem constraints differently by adopting a radial power flow algorithm to satisfy the equality constraints, i.e. power flows in distribution networks, while the inequality constraints are handled by making use of some of the PSO features. The proposed algorithm was tested on the practical 69-bus power distribution system. Different test cases were considered to validate the proposed approach consistency in detecting optimal or near optimal solution. Results are compared with those of Sequential Quadratic Programming.

  17. Explaining the Evolution of Performance Measures - A Dual Case-Study Approach

    Directory of Open Access Journals (Sweden)

    Mohammed Salloum

    2013-07-01

    Full Text Available Few empirical studies have examined how performance measures change in practice and the driving forces behind this change. The existing body of literature has taken a prescriptive approach to how managers and organisations ought to manage change in performance measures without any concern for studying the phenomenon itself and thus a theoretical gap exists. With this gap in mind, the purpose of this paper is to outline how and why the performance measures have changed at two case companies over the time period 2008-2011. In order to fulfil the purpose of this paper two case studies at two different case companies have been conducted. The choice of data collection method is justified by the ambition to attain an in-depth and holistic understanding of the phenomenon. For each case, the data collection was based on four components: an interview study, analysis of archived data, documentation and direct observations. In total, 28 interviews were conducted, 14 at each case company. The empirical findings exhibit that the performance measures are exposed to continuous and considerable change from several perspectives. The measurement scopes at both case companies are steadily expanding, the individual performance measures are constantly replaced and their characteristics are continuously altered. An array of change triggers has been identified in the empirical findings. In contrast to what is advocated in literature, the findings illustrate that the most frequent reason for change is the will to improve the performance measures, the measurement process and the overall performance rather than changing internal and external environments. There are several challenges that need to be addressed in the future research agenda.

  18. Approaches to data analysis of multiple-choice questions

    OpenAIRE

    Lin Ding; Robert Beichner

    2009-01-01

    This paper introduces five commonly used approaches to analyzing multiple-choice test data. They are classical test theory, factor analysis, cluster analysis, item response theory, and model analysis. Brief descriptions of the goals and algorithms of these approaches are provided, together with examples illustrating their applications in physics education research. We minimize mathematics, instead placing emphasis on data interpretation using these approaches.

  19. 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....

  20. 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...

  1. A management approach that drives actions strategically: balanced scorecard in a mental health trust case study.

    Science.gov (United States)

    Schmidt, Stefan; Bateman, Ian; Breinlinger-O'Reilly, Jochen; Smith, Peter

    2006-01-01

    Achieving excellence is a current preoccupation in U.K. public health organisations. This article aims to use a case study to explain how a mental health trust delivers excellent performance using a balanced scorecard (BSC) management approach. Reports a project to implement a BSC approach in the South West Yorkshire Mental Health NHS Trust to achieve its "excellence" objectives. The authors were participants in the project. The design of the pilot project was informed theoretically by the work of Kaplan and Norton and practically by in-house discussions on a strategy to achieve excellence. Explains the process of building a BSC strategy step-by-step. Discusses how the vision and strategies of a mental health trust can be translated into tangible measures, which are the basis for actions that are driven strategically. There are many possibilities for a BSC management approach and this case study is specific to mental health trusts in the UK, although it is believed that the case has a universally applicable modus operandi. This article will help healthcare managers to evaluate the benefits of a BSC management approach. This article explains how actions can be structured in connection with a BSC management approach.

  2. Approaches to Feminist Therapy: A Case Study Illustration

    Directory of Open Access Journals (Sweden)

    Selvira Draganović

    2011-01-01

    Full Text Available This paper deals with the emergence and development of feminism in general and feminist psychology with special emphasis on feminist's reaction to traditional assumptions in Freudian psychology and male dominated theory and research. Feminist movement simply started as a women's activism which later claimed political identity and finally ended as women's liberation movement. Feminists simply advocate gender equality. Emergence of feminist psychology movement and appearance of significant female figures in psychology is further explained along with their contribution to the theory, personality and specific developmental issues along with its input to the therapy and counseling field. The influence of four feminist philosophical approaches namely, liberal feminism, cultural feminism, radical feminism and social feminism are also shortly discussed alongside with their practical implications. Above and beyond, feminist contribution to the therapy field reflected in offering specific therapy goals are also discussed. Self esteem as a core issue and one of feminist therapy goals is finally discussed and presented through a specific case study illustration. Feminist therapy is important therapy approach with significant therapy goals contribution in relation to women's mental health issues. Consideration of sex, gender, cultural diversity, etiology, diagnosis and treatment is feminist request for successful therapy because fixing woman for functioning in a dysfunctional society seems not enough.

  3. Environmental release of living modified organisms: current approaches and case studies.

    Science.gov (United States)

    Thomas, E; Nickson, Ph D

    2005-01-01

    Agricultural biotechnology is being rapidly adopted as evidenced by the acreage of genetically modified (GM) crops planted and tonnes of product (grain and fiber) harvested. Concurrent with this technological progress, is a growing concern that the worlds biological diversity is coming under increasing threat from human activities. As such, ecological risk assessment approaches are being developed for GM crop plants as international agreements regulating the transboundary movements of these products are being implemented. This paper reviews the ecological risk assessment approach that has been used to date to approve GM crops to date. The process has been case-by-case, using a comparative, science-based approach balancing the potential risks and benefits of the new technology versus those present with the currently accepted practices. The approach used to evaluate and approve these products is consistent with the conditions and requirements outlined in the Cartagena Protocol.

  4. 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.

  5. Multiple sclerosis: general features and pharmacologic approach

    International Nuclear Information System (INIS)

    Nielsen Lagumersindez, Denis; Martinez Sanchez, Gregorio

    2009-01-01

    Multiple sclerosis is an autoimmune, inflammatory and desmyelinization disease central nervous system (CNS) of unknown etiology and critical evolution. There different etiological hypotheses talking of a close interrelation among predisposing genetic factors and dissimilar environmental factors, able to give raise to autoimmune response at central nervous system level. Hypothesis of autoimmune pathogeny is based on study of experimental models, and findings in biopsies of affected patients by disease. Accumulative data report that the oxidative stress plays a main role in pathogenesis of multiple sclerosis. Oxygen reactive species generated by macrophages has been involved as mediators of demyelinization and of axon damage, in experimental autoimmune encephalomyelitis and strictly in multiple sclerosis. Disease diagnosis is difficult because of there is not a confirmatory unique test. Management of it covers the treatment of acute relapses, disease modification, and symptoms management. These features require an individualized approach, base on evolution of this affection, and tolerability of treatments. In addition to diet, among non-pharmacologic treatments for multiple sclerosis it is recommended physical therapy. Besides, some clinical assays have been performed in which we used natural extracts, nutrition supplements, and other agents with promising results. Pharmacology allowed neurologists with a broad array of proved effectiveness drugs; however, results of research laboratories in past years make probable that therapeutical possibilities increase notably in future. (Author)

  6. Approaches to data analysis of multiple-choice questions

    Directory of Open Access Journals (Sweden)

    Lin Ding

    2009-09-01

    Full Text Available This paper introduces five commonly used approaches to analyzing multiple-choice test data. They are classical test theory, factor analysis, cluster analysis, item response theory, and model analysis. Brief descriptions of the goals and algorithms of these approaches are provided, together with examples illustrating their applications in physics education research. We minimize mathematics, instead placing emphasis on data interpretation using these approaches.

  7. Approaches to Data Analysis of Multiple-Choice Questions

    Science.gov (United States)

    Ding, Lin; Beichner, Robert

    2009-01-01

    This paper introduces five commonly used approaches to analyzing multiple-choice test data. They are classical test theory, factor analysis, cluster analysis, item response theory, and model analysis. Brief descriptions of the goals and algorithms of these approaches are provided, together with examples illustrating their applications in physics…

  8. Case study field evaluation of a systems approach to retrofitting a residential HVAC system

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.; McWiliams, Jennifer A.; Konopacki, Steven J.

    2003-09-01

    This case study focusing on a residence in northern California was undertaken as a demonstration of the potential of a systems approach to HVAC retrofits. The systems approach means that other retrofits that can affect the HVAC system are also considered. For example, added building envelope insulation reduces building loads so that smaller capacity HVAC system can be used. Secondly, we wanted to examine the practical issues and interactions with contractors and code officials required to accomplish the systems approach because it represents a departure from current practice. We identified problems in the processes of communication and installation of the retrofit that led to compromises in the final energy efficiency of the HVAC system. These issues must be overcome in order for HVAC retrofits to deliver the increased performance that they promise. The experience gained in this case study was used to optimize best practices guidelines for contractors (Walker 2003) that include building diagnostics and checklists as tools to assist in ensuring the energy efficiency of ''house as a system'' HVAC retrofits. The best practices guidelines proved to be an excellent tool for evaluating the eight existing homes in this study, and we received positive feedback from many potential users who reviewed and used them. In addition, we were able to substantially improve the energy efficiency of the retrofitted case study house by adding envelope insulation, a more efficient furnace and air conditioner, an economizer and by reducing duct leakage.

  9. Organisational culture and learning: a case study.

    Science.gov (United States)

    Bell, Elaine

    2013-11-01

    To explore the impact organisational cultures have on the learning experience of student nurses and identify the influencing factors. A case study approach was used. The single case being a Defence School of Health Care Studies (DSHCS) and the multiple units of analysis: student nurses, the lecturers and Student Standing Orders. An in depth three dimensional picture was achieved using multiple data collection methods: interview, survey, observation and document analysis. The findings suggest that the DSHCS is perceived to be a sub-culture within a dominant civilian learning culture. Generally, the students and staff believed that the DSHCS is an excellent learning environment and that the defence students overall are high achievers. The common themes that appeared from the data were image, ethos, environment, discipline, support, welfare and a civilian versus military way of thinking. The learning experience of defence student nurses is very positive and enhanced by the positive learning culture of the civilian Higher Educational Institution. The factors influencing a positive learning experience that can be impacted by the overarching culture are discipline, image, ethos of adult learning, support and welfare. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. A study of single multiplicative neuron model with nonlinear filters for hourly wind speed prediction

    International Nuclear Information System (INIS)

    Wu, Xuedong; Zhu, Zhiyu; Su, Xunliang; Fan, Shaosheng; Du, Zhaoping; Chang, Yanchao; Zeng, Qingjun

    2015-01-01

    Wind speed prediction is one important methods to guarantee the wind energy integrated into the whole power system smoothly. However, wind power has a non–schedulable nature due to the strong stochastic nature and dynamic uncertainty nature of wind speed. Therefore, wind speed prediction is an indispensable requirement for power system operators. Two new approaches for hourly wind speed prediction are developed in this study by integrating the single multiplicative neuron model and the iterated nonlinear filters for updating the wind speed sequence accurately. In the presented methods, a nonlinear state–space model is first formed based on the single multiplicative neuron model and then the iterated nonlinear filters are employed to perform dynamic state estimation on wind speed sequence with stochastic uncertainty. The suggested approaches are demonstrated using three cases wind speed data and are compared with autoregressive moving average, artificial neural network, kernel ridge regression based residual active learning and single multiplicative neuron model methods. Three types of prediction errors, mean absolute error improvement ratio and running time are employed for different models’ performance comparison. Comparison results from Tables 1–3 indicate that the presented strategies have much better performance for hourly wind speed prediction than other technologies. - Highlights: • Developed two novel hybrid modeling methods for hourly wind speed prediction. • Uncertainty and fluctuations of wind speed can be better explained by novel methods. • Proposed strategies have online adaptive learning ability. • Proposed approaches have shown better performance compared with existed approaches. • Comparison and analysis of two proposed novel models for three cases are provided

  11. 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.

  12. Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

    Science.gov (United States)

    Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

    2002-02-01

    Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

  13. 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.

  14. A Study on Satellite Diagnostic Expert Systems Using Case-Based Approach

    Directory of Open Access Journals (Sweden)

    Young-Tack Park

    1997-06-01

    Full Text Available Many research works are on going to monitor and diagnose diverse malfunctions of satellite systems as the complexity and number of satellites increase. Currently, many works on monitoring and diagnosis are carried out by human experts but there are needs to automate much of the routine works of them. Hence, it is necessary to study on using expert systems which can assist human experts routine work by doing automatically, thereby allow human experts devote their expertise more critical and important areas of monitoring and diagnosis. In this paper, we are employing artificial intelligence techniques to model human experts' knowledge and inference the constructed knowledge. Especially, case-based approaches are used to construct a knowledge base to model human expert capabilities which use previous typical exemplars. We have designed and implemented a prototype case-based system for diagnosing satellite malfunctions using cases. Our system remembers typical failure cases and diagnoses a current malfunction by indexing the case base. Diverse methods are used to build a more user friendly interface which allows human experts can build a knowledge base in as easy way.

  15. 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

  16. 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

  17. Multiple Imputation of a Randomly Censored Covariate Improves Logistic Regression Analysis.

    Science.gov (United States)

    Atem, Folefac D; Qian, Jing; Maye, Jacqueline E; Johnson, Keith A; Betensky, Rebecca A

    2016-01-01

    Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semiparametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.

  18. Multiple regression approach to predict turbine-generator output for Chinshan nuclear power plant

    International Nuclear Information System (INIS)

    Chan, Yea-Kuang; Tsai, Yu-Ching

    2017-01-01

    The objective of this study is to develop a turbine cycle model using the multiple regression approach to estimate the turbine-generator output for the Chinshan Nuclear Power Plant (NPP). The plant operating data was verified using a linear regression model with a corresponding 95% confidence interval for the operating data. In this study, the key parameters were selected as inputs for the multiple regression based turbine cycle model. The proposed model was used to estimate the turbine-generator output. The effectiveness of the proposed turbine cycle model was demonstrated by using plant operating data obtained from the Chinshan NPP Unit 2. The results show that this multiple regression based turbine cycle model can be used to accurately estimate the turbine-generator output. In addition, this study also provides an alternative approach with simple and easy features to evaluate the thermal performance for nuclear power plants.

  19. Multiple regression approach to predict turbine-generator output for Chinshan nuclear power plant

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Yea-Kuang; Tsai, Yu-Ching [Institute of Nuclear Energy Research, Taoyuan City, Taiwan (China). Nuclear Engineering Division

    2017-03-15

    The objective of this study is to develop a turbine cycle model using the multiple regression approach to estimate the turbine-generator output for the Chinshan Nuclear Power Plant (NPP). The plant operating data was verified using a linear regression model with a corresponding 95% confidence interval for the operating data. In this study, the key parameters were selected as inputs for the multiple regression based turbine cycle model. The proposed model was used to estimate the turbine-generator output. The effectiveness of the proposed turbine cycle model was demonstrated by using plant operating data obtained from the Chinshan NPP Unit 2. The results show that this multiple regression based turbine cycle model can be used to accurately estimate the turbine-generator output. In addition, this study also provides an alternative approach with simple and easy features to evaluate the thermal performance for nuclear power plants.

  20. Case Histories of Landslide Impact: A Database-driven Approach

    Science.gov (United States)

    Klose, Martin; Damm, Bodo

    2015-04-01

    Fundamental understanding of landslide risk requires in-depth knowledge of how landslides have impacted society in the past (e.g., Corominas et al., 2014). A key to obtain insights into the evolution of landslide risk at single facilities of critical infrastructures are case histories of landslide impact. The purpose of such historical analyses is to inform about the site-specific interactions between landslides and land-use activity. Case histories support correlating landslide events and associated damages with multiple control variables of landslide risk, including (i) previous construction works, (ii) hazard awareness, (iii) the type of structure or its material properties, and (iv) measures of post-disaster mitigation. It is a key advantage of case histories to provide an overview of the changes in the exposure and vulnerability of infrastructures over time. Their application helps to learn more about changing patterns in risk culture and the effectiveness of repair or prevention measures (e.g., Klose et al., 2014). Case histories of landslide impact are developed on the basis of information extracted from landslide databases. The use of path diagrams and illustrated flowcharts as data modeling techniques is aimed at structuring, condensing, and visualizing complex historical data sets on landslide activity and land-use. Much of the scientific potential of case histories simply depends on the quality of available database information. Landslide databases relying on a bottom-up approach characterized by targeted local data specification are optimally suited for historical impact analyses. Combined with systematic retrieval, extraction, and integration of data from multiple sources, landslide databases constitute a valuable tool for developing case histories that enable to open a whole new window on the study of landslide impacts (e.g., Damm and Klose, 2014). The present contribution introduces such a case history for a well-known landslide site at a heavily

  1. Case studies of transportation investment to identify the impacts on the local and state economy.

    Science.gov (United States)

    2013-01-01

    This project provides case studies of the impact of transportation investments on local economies. We use multiple : approaches to measure impacts since the effects of transportation projects can vary according to the size of a : project and the size...

  2. Non-syndromic multiple odontogenic keratocysts associated with dental anomalies: A report of unusual case and its management

    Directory of Open Access Journals (Sweden)

    Sulabha A Narsapur

    2015-01-01

    Full Text Available Odontogenic keratocyst (OKC, now known as keratocystic odontogenic tumor (KCOT, is the most common cystic lesion occurring in the maxillofacial region. Multiple occurrence of these cysts is less frequent and is usually associated with syndromes, the most common being the Gorlin Goltz syndrome or the nevoid basal cell carcinoma syndrome (NBCCS. We hereby report an unusual case of multiple OKCs in a healthy adult, associated with other dental anomalies. Management approach consisted of enucleation with curettage of the smaller lesions and decortication of buccal cortex in the large lesion. The condition in the present case may be because of the multifocal nature of OKC rather than its association with any syndrome. Concomitant occurrence of multiple OKCs with other dental anomalies may be coincidental. Impacted teeth or missing teeth must be radiographed to rule out the lesions associated with them.

  3. An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia.

    Science.gov (United States)

    Bird, Michael; Llewellyn-Jones, Robert H; Korten, Ailsa

    2009-01-01

    Treatment of challenging behaviour in dementia using standardized psychopharmacological or psychosocial approaches remains problematical. A case-specific approach was trialled in this study, based on extensive evidence that each case is different in aetiology, the effects of the behaviour on others and what interventions are possible given the available resources. Forty-four consecutive referrals for challenging behaviour (two-thirds in residential care) were assessed across multiple causal domains. Both assessment and development of interventions were undertaken in collaboration with family carers and care staff. Measures of behaviour and associated carer distress, as well as medication and service use, were taken pre-intervention and at 2- and 5-month follow-ups. Psychotropic medication was used with a minority of participants but, overall, antipsychotic use was reduced. Psychosocial methods predominated, with 77% of cases judged as mainly or entirely psychosocial by an expert panel. There were significant mean improvements in behaviour and carer distress. Using conservative criteria there was a 65.9% clinical success rate. Results confirm those of other studies which have used multifaceted interventions tailored to the unique needs of each case. They compare favourably with results from trials of standardized psycho-pharmacological or psychosocial approaches. More trials are needed, necessarily involving further development of robust methodologies which reflect the case-specific nature of challenging behaviour associated with dementia.

  4. [GP medication prioritisation in older patients with multiple comorbidities recently discharged from hospital: a case-based bottom-up approach].

    Science.gov (United States)

    Herrmann, M L H; von Waldegg, G H; Kip, M; Lehmann, B; Andrusch, S; Straub, H; Robra, B-P

    2015-01-01

    After the hospital discharge of older patients with multiple morbidities, GPs are often faced with the task of prioritising the patients' drug regimens so as to reduce the risk of overmedication. How do GPs prioritise such medications in multimorbid elderly patients at the transition between inpatient and home care? The experience by the GPs is documented in typical case vignettes. 44 GPs in Sachsen-Anhalt were recruited--they were engaged in focus group discussions and interviewed using semi-standardised questionnaires. Typical case vignettes were developed, relevant to the everyday care that elderly patients would typically receive from their GPs with respect to their drug optimisation. According to the results of the focus groups, the following issues affect GPs' decisions: drug and patient safety, their own competence in the health system, patient health literacy, evidence base, communication between secondary and primary care (and their respective influences on each other). When considering individual cases, patient safety, patient wishes, and quality of life were central. This is demonstrated by the drug dispositions of one exemplary case vignette. GPs do prioritise drug regimens with rational criteria. Initial problem delineation, process documentation and the design of a transferable product are interlinking steps in the development of case vignettes. Care issues of drug therapy in elderly patients with multiple morbidities should be investigated further with larger representative samples in order to clarify whether the criteria used here are applied contextually or consistently. Embedding case vignettes into further education concepts is also likely to be useful. © Georg Thieme Verlag KG Stuttgart · New York.

  5. 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).

  6. Multiplicity distribution and multiplicity moment of black and grey particles in high energy nucleus–nucleus interactions

    International Nuclear Information System (INIS)

    Ghosh, Dipak; Deb, Argha; Datta, Utpal; Bhattacharyya, S.

    2011-01-01

    In this paper we have studied the multiplicity distribution of black and grey particles emitted from 16 O–AgBr interactions at 2.1 AGeV and 60 AGeV. We have also calculated the multiplicity moment up to the fifth order for both the interactions and for both kinds of emitted particles. The variation of multiplicity moment with the order number has been investigated. It is seen that in the case of black particles multiplicity moment up to fourth order remains almost constant as energy increases from 2.1 AGeV to 60 AGeV. Fifth order multiplicity moment increases insignificantly with energy. However in the case of grey particles no such constancy of multiplicity moment with energy of the projectile beam is obtained. Later we have extended our study on the basis of Regge–Mueller approach to find the existence of second order correlation during the emission of black as well as the grey particles. The second Mueller moment is found to be positive and it increases as energy increases in the case of black particles. On the contrary in the case of grey particles the second Mueller moment decreases with energy. It can be concluded that as energy increases correlation among the black particles increases. On the other hand with the increase of energy correlation among the grey particles is found to diminish. (author)

  7. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je [KEPCO Medical foundation Hanil General Hospital, Seoul (Korea, Republic of); Lee, Hye Seung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2007-06-15

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  8. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    International Nuclear Information System (INIS)

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je; Lee, Hye Seung

    2007-01-01

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  9. 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…

  10. Receptivity to Kinetic Fluctuations: A Multiple Scales Approach

    Science.gov (United States)

    Edwards, Luke; Tumin, Anatoli

    2017-11-01

    The receptivity of high-speed compressible boundary layers to kinetic fluctuations (KF) is considered within the framework of fluctuating hydrodynamics. The formulation is based on the idea that KF-induced dissipative fluxes may lead to the generation of unstable modes in the boundary layer. Fedorov and Tumin solved the receptivity problem using an asymptotic matching approach which utilized a resonant inner solution in the vicinity of the generation point of the second Mack mode. Here we take a slightly more general approach based on a multiple scales WKB ansatz which requires fewer assumptions about the behavior of the stability spectrum. The approach is modeled after the one taken by Luchini to study low speed incompressible boundary layers over a swept wing. The new framework is used to study examples of high-enthalpy, flat plate boundary layers whose spectra exhibit nuanced behavior near the generation point, such as first mode instabilities and near-neutral evolution over moderate length scales. The configurations considered exhibit supersonic unstable second Mack modes despite the temperature ratio Tw /Te > 1 , contrary to prior expectations. Supported by AFOSR and ONR.

  11. 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

  12. Multiple scattering approach to X-ray absorption spectroscopy

    International Nuclear Information System (INIS)

    Benfatto, M.; Wu Ziyu

    2003-01-01

    In this paper authors present the state of the art of the theoretical background needed for analyzing X-ray absorption spectra in the whole energy range. The multiple-scattering (MS) theory is presented in detail with some applications on real systems. Authors also describe recent progress in performing geometrical fitting of the XANES (X-ray absorption near-edge structure) energy region and beyond using a full multiple-scattering approach

  13. Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality.

    Science.gov (United States)

    Tatarsky, Andrew; Kellogg, Scott

    2010-02-01

    Harm reduction is a new paradigm that seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence. This article discusses integrative harm reduction psychotherapy, one application of harm reduction principles to psychotherapy. Seven therapeutic tasks are described with attention to clinical process, skills, and strategies. A case is presented that illustrates the application of this approach with life-threatening substance use that was related to multiple trauma and suicidal depression. (c) 2010 Wiley Periodicals, Inc.

  14. Evaluating Approaches to Teaching and Learning Chinese Vocabulary from the Learning Theories Perspective: An Experimental Case Study

    Directory of Open Access Journals (Sweden)

    Katja SIMONČIČ

    2015-06-01

    Full Text Available With Chinese language gaining more and more popularity among Slovenian students and with the growing numbers of learners of Chinese as a foreign language in Slovenia and elsewhere it is crucial to find an approach that will lead to high quality and long-term knowledge of Chinese and that will motivate learners to continue learning. We can speak of two basic approaches to teaching Chinese vocabulary: the approach that first introduces pronunciation and the approach that simultaneously introduces pronunciation and character. The key question that arises is which of the two approaches leads to high quality and long-term knowledge? To answer the question an experimental case study was carried out at Ljubljana’s Faculty of Arts in the academic year 2011/2012. The case study showed that the approach that simultaneously introduces pronunciation and character and is based on the key principles of constructivist learning theory had beneficial effects on the students in terms of motivation and quality of knowledge of Chinese vocabulary.

  15. Teaching Sustainability Using an Active Learning Constructivist Approach: Discipline-Specific Case Studies in Higher Education

    Directory of Open Access Journals (Sweden)

    Maria Kalamas Hedden

    2017-07-01

    Full Text Available In this paper we present our rationale for using an active learning constructivist approach to teach sustainability-related topics in a higher education. To push the boundaries of ecological literacy, we also develop a theoretical model for sustainability knowledge co-creation. Drawing on the experiences of faculty at a major Southeastern University in the United States, we present case studies in architecture, engineering, geography, and marketing. Four Sustainability Faculty Fellows describe their discipline-specific case studies, all of which are project-based learning experiences, and include details regarding teaching and assessment. Easily replicated in other educational contexts, these case studies contribute to the advancement of sustainability education.

  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. Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.

    Science.gov (United States)

    Finney, Andrew; Healey, Emma; Jordan, Joanne L; Ryan, Sarah; Dziedzic, Krysia S

    2016-07-08

    The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most

  18. A Case Study Using Child-Centered Play Therapy Approach to Treat Enuresis and Encopresis.

    Science.gov (United States)

    Cuddy-Casey, Maria

    1997-01-01

    Demonstrates an alternative method (nondirective child-centered therapy) in treating enuresis and encopresis resulting from emotional disturbances. Examines various etiologies and approaches to treating these conditions. Provides a case study example. Claims that professionals must differentiate between primary and secondary occurrences of these…

  19. 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.

  20. 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.

  1. An analytic-geospatial approach for sustainable water resource management: a case study in the province of Perugia

    Directory of Open Access Journals (Sweden)

    Stefano Casadei

    2013-09-01

    Full Text Available Water is a strategic, but also highly vulnerable, natural resource. This because the increasing demand from multiple uses, in many cases competing amongst them, seems to influence the concepts of sustainability of the exploitation. From the operational point of view, the studied system is an integrated decision support system. It is not only a platform to exchange information and assessments, but also a tool for conflict resolution, in the management of water resources, to obtain the consensus among all participants in the decisional processes. So the canonical “top-down” approach has been replaced with a “bottom-up” approach where all stakeholders become decision makers themselves. The application of the aforementioned approach was studied for the Tiber River basin and has been applied to the Province of Perugia area. The study focused to the building of a spatial database of hydrological data and multipurpose water withdrawals, together with the setting of the evaluation model for the surface water resources. This model bases its algorithms on regionalization procedures of flow parameters. For the definition of the river condition, hydrological indices calculated from the hydrological database have been used, while for the existing withdrawals, an analysis procedure has been developed, that from the point of interest directly selected on the map, finds out the upstream basin and, by means of overlay procedures, identifies the upstream water uses and the total flow that could be extracted. The potential of the system and the technologies used are contained in a WEB platform that allows the analysis of the database of water uses/withdrawals on the cartography, and the comparison with the hydrogeological characteristics of the sub-basin examined. The purpose of this study is to provide software tools that can be used as a support in water resource evaluation and management policies at the basin scale.

  2. The parent-child-therapist alliance: A case study using a strategic approach.

    Science.gov (United States)

    Naidu, Thirusha; Behari, Sheethal

    2010-06-01

    In this paper we present a single case study of a clinical approach that addresses the needs of parents and their children in psychotherapy. The approach begins by addressing the child's and parent's concerns separately at first by establishing strong therapeutic alliances with each, and then proceeds to address the concerns of the parent-child dyad. The basic premise is that the therapeutic alliance is the central element to successful outcomes in psychotherapy. The nature of alliance-building and its associated methods and techniques have been extensively considered for adult therapy. However, there is considerably less written on the therapeutic alliance with children and adolescents in the context of family interventions. We briefly examine some theoretical dimensions and applications of the therapeutic alliance in psychotherapy with children/adolescents and their parents. A three-phase alliance-building psychotherapy strategy, founded on the idea that each therapeutic relationship warrants an effective working alliance, is proposed. The case of a single mother and her adolescent daughter is employed to illustrate the strategy.

  3. A Hybrid Approach Combining the Multi-Temporal Scale Spatio-Temporal Network with the Continuous Triangular Model for Exploring Dynamic Interactions in Movement Data: A Case Study of Football

    Directory of Open Access Journals (Sweden)

    Pengdong Zhang

    2018-01-01

    Full Text Available Benefiting from recent advantages in location-aware technologies, movement data are becoming ubiquitous. Hence, numerous research topics with respect to movement data have been undertaken. Yet, the research of dynamic interactions in movement data is still in its infancy. In this paper, we propose a hybrid approach combining the multi-temporal scale spatio-temporal network (MTSSTN and the continuous triangular model (CTM for exploring dynamic interactions in movement data. The approach mainly includes four steps: first, the relative trajectory calculus (RTC is used to derive three types of interaction patterns; second, for each interaction pattern, a corresponding MTSSTN is generated; third, for each MTSSTN, the interaction intensity measures and three centrality measures (i.e., degree, betweenness and closeness are calculated; finally, the results are visualized at multiple temporal scales using the CTM and analyzed based on the generated CTM diagrams. Based on the proposed approach, three distinctive aims can be achieved for each interaction pattern at multiple temporal scales: (1 exploring the interaction intensities between any two individuals; (2 exploring the interaction intensities among multiple individuals, and (3 exploring the importance of each individual and identifying the most important individuals. The movement data obtained from a real football match are used as a case study to validate the effectiveness of the proposed approach. The results demonstrate that the proposed approach is useful in exploring dynamic interactions in football movement data and discovering insightful information.

  4. A Semiparametric Bayesian Approach for Analyzing Longitudinal Data from Multiple Related Groups.

    Science.gov (United States)

    Das, Kiranmoy; Afriyie, Prince; Spirko, Lauren

    2015-11-01

    Often the biological and/or clinical experiments result in longitudinal data from multiple related groups. The analysis of such data is quite challenging due to the fact that groups might have shared information on the mean and/or covariance functions. In this article, we consider a Bayesian semiparametric approach of modeling the mean trajectories for longitudinal response coming from multiple related groups. We consider matrix stick-breaking process priors on the group mean parameters which allows information sharing on the mean trajectories across the groups. Simulation studies are performed to demonstrate the effectiveness of the proposed approach compared to the more traditional approaches. We analyze data from a one-year follow-up of nutrition education for hypercholesterolemic children with three different treatments where the children are from different age-groups. Our analysis provides more clinically useful information than the previous analysis of the same dataset. The proposed approach will be a very powerful tool for analyzing data from clinical trials and other medical experiments.

  5. Breast Cancer and Modifiable Lifestyle Factors in Argentinean Women: Addressing Missing Data in a Case-Control Study

    Science.gov (United States)

    Coquet, Julia Becaria; Tumas, Natalia; Osella, Alberto Ruben; Tanzi, Matteo; Franco, Isabella; Diaz, Maria Del Pilar

    2016-01-01

    A number of studies have evidenced the effect of modifiable lifestyle factors such as diet, breastfeeding and nutritional status on breast cancer risk. However, none have addressed the missing data problem in nutritional epidemiologic research in South America. Missing data is a frequent problem in breast cancer studies and epidemiological settings in general. Estimates of effect obtained from these studies may be biased, if no appropriate method for handling missing data is applied. We performed Multiple Imputation for missing values on covariates in a breast cancer case-control study of Córdoba (Argentina) to optimize risk estimates. Data was obtained from a breast cancer case control study from 2008 to 2015 (318 cases, 526 controls). Complete case analysis and multiple imputation using chained equations were the methods applied to estimate the effects of a Traditional dietary pattern and other recognized factors associated with breast cancer. Physical activity and socioeconomic status were imputed. Logistic regression models were performed. When complete case analysis was performed only 31% of women were considered. Although a positive association of Traditional dietary pattern and breast cancer was observed from both approaches (complete case analysis OR=1.3, 95%CI=1.0-1.7; multiple imputation OR=1.4, 95%CI=1.2-1.7), effects of other covariates, like BMI and breastfeeding, were only identified when multiple imputation was considered. A Traditional dietary pattern, BMI and breastfeeding are associated with the occurrence of breast cancer in this Argentinean population when multiple imputation is appropriately performed. Multiple Imputation is suggested in Latin America’s epidemiologic studies to optimize effect estimates in the future. PMID:27892664

  6. 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

  7. An investigation into international business collaboration in higher education organisations: a case study of international partnerships in four UK leading universities

    OpenAIRE

    Ayoubi, R; Al-Habaibeh, A

    2006-01-01

    Purpose - The purpose of this paper is to develop a comparative analysis of the main objectives of international institutional partnerships in four UK leading universities. Based on the presented case studies, the paper outlines a model for objectives and implementation of international partnership. Design/methodology/approach - Using a multiple case study approach, the paper employs three sources of data: templates of international partnerships, actual agreements of international partnership...

  8. Explosion approach for external safety assessment: a case study

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, D. Michael; Halford, Ann [Germanischer Lloyd, Loughborough (United Kingdom); Mendes, Renato F. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2009-07-01

    Several questions related to the potential for explosions are explored as this became an important subject during an enterprise risk analysis. The understanding of explosions underwent a substantial evolution in the final 20 years of the 20{sup th} century following international research projects in Europe involving several research institutes, as well gas and oil companies. This led to the development of techniques that could be used to assess the potential consequences of explosions on oil, gas and petrochemical facilities. This paper presents an overview of the potential for explosions in communities close to industrial sites or pipelines right of way (RoW), where the standard explosion assessment methods cannot be applied. With reference to experimental studies, the potential for confined explosions in buildings and Vapor Cloud Explosions is explored. Vapor Cloud Explosion incidents in rural or urban areas are also discussed. The method used for incorporating possible explosion and fire events in risk studies is also described using a case study. Standard explosion assessment methodologies and a revised approach are compared as part of an on going evaluation of risk (author)

  9. 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)

  10. Multiplicities of states od equivalent fermion shells

    International Nuclear Information System (INIS)

    Savukinas, A.Yu.; Glembotskij, I.I.

    1980-01-01

    Classification of states of three or four equivalent fermions has been studied, i.e. possible terms and their multiplicities have been determined. For this purpose either the group theory or evident expressions for the fractional-parentage coefficients have been used. In the first approach the formulas obtained by other authors for the multiplicities of terms through the characters of the transformation matrices of bond moments have been used. This approach happens to be more general as compared with the second one, as expressions for the fractional-parentage coefficients in many cases are not known. The multiplicities of separate terms have been determined. It has been shown that the number of terms of any multiplicity becomes constant when l or j is increased [ru

  11. 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.

  12. 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

  13. Teaching Introductory Oceanography through Case Studies: Project based approach for general education students

    Science.gov (United States)

    Farnsworth, K. L.; House, M.; Hovan, S. A.

    2013-12-01

    A recent workshop sponsored by SERC-On the Cutting Edge brought together science educators from a range of schools across the country to discuss new approaches in teaching oceanography. In discussing student interest in our classes, we were struck by the fact that students are drawn to emotional or controversial topics such as whale hunting and tsunami hazard and that these kinds of topics are a great vehicle for introducing more complex concepts such as wave propagation, ocean upwelling and marine chemistry. Thus, we have developed an approach to introductory oceanography that presents students with real-world issues in the ocean sciences and requires them to explore the science behind them in order to improve overall ocean science literacy among non-majors and majors at 2 and 4 year colleges. We have designed a project-based curriculum built around topics that include, but are not limited to: tsunami hazard, whale migration, ocean fertilization, ocean territorial claims, rapid climate change, the pacific trash patch, overfishing, and ocean acidification. Each case study or project consists of three weeks of class time and is structured around three elements: 1) a media analysis; 2) the role of ocean science in addressing the issue; 3) human impact/response. Content resources range from textbook readings, popular or current print news, documentary film and television, and data available on the world wide web from a range of sources. We employ a variety of formative assessments for each case study in order to monitor student access and understanding of content and include a significant component of in-class student discussion and brainstorming guided by faculty input to develop the case study. Each study culminates in summative assessments ranging from exams to student posters to presentations, depending on the class size and environment. We envision this approach for a range of classroom environments including large group face-to-face instruction as well as hybrid

  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. 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…

  16. 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.

  17. 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.

  18. The additive congruential random number generator--A special case of a multiple recursive generator

    Science.gov (United States)

    Wikramaratna, Roy S.

    2008-07-01

    This paper considers an approach to generating uniformly distributed pseudo-random numbers which works well in serial applications but which also appears particularly well-suited for application on parallel processing systems. Additive Congruential Random Number (ACORN) generators are straightforward to implement for arbitrarily large order and modulus; if implemented using integer arithmetic, it becomes possible to generate identical sequences on any machine. Previously published theoretical analysis has demonstrated that a kth order ACORN sequence approximates to being uniformly distributed in up to k dimensions, for any given k. ACORN generators can be constructed to give period lengths exceeding any given number (for example, with period length in excess of 230p, for any given p). Results of empirical tests have demonstrated that, if p is greater than or equal to 2, then the ACORN generator can be used successfully for generating double precision uniform random variates. This paper demonstrates that an ACORN generator is a particular case of a multiple recursive generator (and, therefore, also a special case of a matrix generator). Both these latter approaches have been widely studied, and it is to be hoped that the results given in the present paper will lead to greater confidence in using the ACORN generators.

  19. Treatment of Acute Periodontal Abscesses Using the Biofilm Decontamination Approach: A Case Report Study.

    Science.gov (United States)

    Pini-Prato, Giovanpaolo; Magnani, Cristina; Rotundo, Roberto

    2016-01-01

    The aim of this preliminary study was to show the treatment effect of the biofilm decontamination approach on acute periodontal abscesses. Clinical cases showing acute periodontitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzene acids and sulfuric acid. The material was positioned into the pocket on the root surface and left in the site for 30 seconds. No instrumentation was performed before the treatment. No systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and very rapidly. The infections were quickly resolved without complications, and the pockets associated with marginal tissue recession were also reduced. The momentary pain upon introduction of the material was generally well tolerated in the nonsurgically treated cases, and it completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of acute periodontal abscess. The local application of this material avoids the use of systemic or local antibiotics.

  20. 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.

  1. Data science in R a case studies approach to computational reasoning and problem solving

    CERN Document Server

    Nolan, Deborah

    2015-01-01

    Effectively Access, Transform, Manipulate, Visualize, and Reason about Data and ComputationData Science in R: A Case Studies Approach to Computational Reasoning and Problem Solving illustrates the details involved in solving real computational problems encountered in data analysis. It reveals the dynamic and iterative process by which data analysts approach a problem and reason about different ways of implementing solutions. The book's collection of projects, comprehensive sample solutions, and follow-up exercises encompass practical topics pertaining to data processing, including: Non-standar

  2. 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.

  3. A Collaborative Neurodynamic Approach to Multiple-Objective Distributed Optimization.

    Science.gov (United States)

    Yang, Shaofu; Liu, Qingshan; Wang, Jun

    2018-04-01

    This paper is concerned with multiple-objective distributed optimization. Based on objective weighting and decision space decomposition, a collaborative neurodynamic approach to multiobjective distributed optimization is presented. In the approach, a system of collaborative neural networks is developed to search for Pareto optimal solutions, where each neural network is associated with one objective function and given constraints. Sufficient conditions are derived for ascertaining the convergence to a Pareto optimal solution of the collaborative neurodynamic system. In addition, it is proved that each connected subsystem can generate a Pareto optimal solution when the communication topology is disconnected. Then, a switching-topology-based method is proposed to compute multiple Pareto optimal solutions for discretized approximation of Pareto front. Finally, simulation results are discussed to substantiate the performance of the collaborative neurodynamic approach. A portfolio selection application is also given.

  4. Pro-active approaches to the identification of emerging risks in the food chain: Retrospective case studies.

    NARCIS (Netherlands)

    Hagenaars, T.H.J.; Elbers, A.R.W.; Kleter, G.A.; Kreft, F.; Leeuwen, van P.; Waalwijk, C.; Hoogenboom, L.A.P.; Marvin, H.J.P.

    2006-01-01

    In this report six case studies are carried out on food-safety and animal-health crises that have occurred in the recent past. The aim is to learn from these cases if and how the identification of emerging food-safety (and animal-health) risks can be improved by adopting a (more) pro-active approach

  5. Bayesian approach to the assessment of the population-specific risk of inhibitors in hemophilia A patients: a case study

    Directory of Open Access Journals (Sweden)

    Cheng J

    2016-10-01

    significant inhibitor (10/100, 5/100 [high rates], and 1/86 [the Food and Drug Administration mandated cutoff rate in PTPs] were calculated. The effect of discounting prior information or scaling up the study data was evaluated.Results: Results based on noninformative priors were similar to the classical approach. Using priors from PTPs lowered the point estimate and narrowed the 95% credible intervals (Case 1: from 1.3 [0.5, 2.7] to 0.8 [0.5, 1.1]; Case 2: from 1.9 [0.6, 6.0] to 0.8 [0.5, 1.1]; Case 3: 2.3 [0.5, 6.8] to 0.7 [0.5, 1.1]. All probabilities of satisfying a threshold of 1/86 were above 0.65. Increasing the number of patients by two and ten times substantially narrowed the credible intervals for the single cohort study (1.4 [0.7, 2.3] and 1.4 [1.1, 1.8], respectively. Increasing the number of studies by two and ten times for the multiple study scenarios (Case 2: 1.9 [0.6, 4.0] and 1.9 [1.5, 2.6]; Case 3: 2.4 [0.9, 5.0] and 2.6 [1.9, 3.5], respectively had a similar effect.Conclusion: Bayesian approach as a robust, transparent, and reproducible analytic method can be efficiently used to estimate the inhibitor rate of hemophilia A in complex clinical settings. Keywords: inhibitor rate, meta-analysis, multicentric study, Bayesian, hemophilia A

  6. 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.

  7. OUTSOURCING FAILURES IN SME’S: CASE STUDY APPROACH

    Directory of Open Access Journals (Sweden)

    Kaja Prystupa

    2015-06-01

    Full Text Available Outsourcing, which is a popular business strategy among large companies, is also an attractive option for small entities. However, in order to bring expected results, outsourcing requires knowledge of potential risks and ability of managing them. Even large companies need to face various outsourcing challenges, however, at least they dispose richer resources than small organizations and their success is less dependent on single product delivery. Therefore the aim of the research was to examine the reasons of failure of outsourcing initiatives in SMEs. The authors followed the qualitative approach based on case study method. The obtained results brought contributions in both areas: theoretical as the issue of outsourcing initiatives in SMEs has been analysed to a limited extent; as well as practical because it brought important insight for managers by indicating risks of that they should be aware and properly prepared. The findings indicated the importance of: strategic planning on outsourcing initiative and the development and maintenance of close relations of outsourcing companies with its vendor.

  8. [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.

  9. 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.

  10. Practical considerations for sensitivity analysis after multiple imputation applied to epidemiological studies with incomplete data

    Science.gov (United States)

    2012-01-01

    Background Multiple Imputation as usually implemented assumes that data are Missing At Random (MAR), meaning that the underlying missing data mechanism, given the observed data, is independent of the unobserved data. To explore the sensitivity of the inferences to departures from the MAR assumption, we applied the method proposed by Carpenter et al. (2007). This approach aims to approximate inferences under a Missing Not At random (MNAR) mechanism by reweighting estimates obtained after multiple imputation where the weights depend on the assumed degree of departure from the MAR assumption. Methods The method is illustrated with epidemiological data from a surveillance system of hepatitis C virus (HCV) infection in France during the 2001–2007 period. The subpopulation studied included 4343 HCV infected patients who reported drug use. Risk factors for severe liver disease were assessed. After performing complete-case and multiple imputation analyses, we applied the sensitivity analysis to 3 risk factors of severe liver disease: past excessive alcohol consumption, HIV co-infection and infection with HCV genotype 3. Results In these data, the association between severe liver disease and HIV was underestimated, if given the observed data the chance of observing HIV status is high when this is positive. Inference for two other risk factors were robust to plausible local departures from the MAR assumption. Conclusions We have demonstrated the practical utility of, and advocate, a pragmatic widely applicable approach to exploring plausible departures from the MAR assumption post multiple imputation. We have developed guidelines for applying this approach to epidemiological studies. PMID:22681630

  11. Multiple sclerosis: general features and pharmacologic approach; Esclerosis multiple: aspectos generales y abordaje farmacologico

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen Lagumersindez, Denis; Martinez Sanchez, Gregorio [Instituto de Farmacia y Alimentos, Universidad de La Habana, La Habana (Cuba)

    2009-07-01

    Multiple sclerosis is an autoimmune, inflammatory and desmyelinization disease central nervous system (CNS) of unknown etiology and critical evolution. There different etiological hypotheses talking of a close interrelation among predisposing genetic factors and dissimilar environmental factors, able to give raise to autoimmune response at central nervous system level. Hypothesis of autoimmune pathogeny is based on study of experimental models, and findings in biopsies of affected patients by disease. Accumulative data report that the oxidative stress plays a main role in pathogenesis of multiple sclerosis. Oxygen reactive species generated by macrophages has been involved as mediators of demyelinization and of axon damage, in experimental autoimmune encephalomyelitis and strictly in multiple sclerosis. Disease diagnosis is difficult because of there is not a confirmatory unique test. Management of it covers the treatment of acute relapses, disease modification, and symptoms management. These features require an individualized approach, base on evolution of this affection, and tolerability of treatments. In addition to diet, among non-pharmacologic treatments for multiple sclerosis it is recommended physical therapy. Besides, some clinical assays have been performed in which we used natural extracts, nutrition supplements, and other agents with promising results. Pharmacology allowed neurologists with a broad array of proved effectiveness drugs; however, results of research laboratories in past years make probable that therapeutical possibilities increase notably in future. (Author)

  12. 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.

  13. Sustainable Design Approach: A case study of BIM use

    Science.gov (United States)

    Abdelhameed, Wael

    2017-11-01

    alternative's consequences. The architect would settle down and proceed in the alternative design of the best sustainable analysis. In later design stages, using the sustainable types of materials such as insulation, cladding, etc., and applying sustainable building components such as doors, windows, etc. would add more improvements and enhancements in reaching better values and metrics. The paper describes the methodology of this design approach through BIM strategies adopted in design creation. Case studies of architectural designs are used to highlight the details and benefits of this proposed approach.

  14. 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)

  15. 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…

  16. Experimental Evaluation of Multi-Round Matrix Multiplication on MapReduce

    DEFF Research Database (Denmark)

    Ceccarello, Matteo; Silvestri, Francesco

    2015-01-01

    required by reduce functions. Then, we present an extensive study of this library on an in-house cluster and on Amazon Web Services aiming at showing its performance and at comparing monolithic and multi-round approaches. The experiments show that, even without a low level optimization, it is possible...... not be the best approach in cloud systems. Indeed, multi-round algorithms may exploit some features of cloud platforms by suitably setting the round number according to the execution context. In this paper we carry out an experimental study of multi-round MapReduce algorithms aiming at investigating...... the performance of the multi-round approach. We use matrix multiplication as a case study. We first propose a scalable Hadoop library, named M3, for matrix multiplication in the dense and sparse cases which allows to tradeoff round number with the amount of data shuffled in each round and the amount of memory...

  17. Android arcade game app a real world project : case study approach

    CERN Document Server

    DiMarzio, Jerome

    2012-01-01

    Apress, the leading Android books publisher, continues to provide you with very hands-on, practical books for teaching and showing app developers how to build and design apps, including game apps, that can be built and deployed in the various Android app stores out there. Android Arcade Game App:  A Real World Project - Case Study Approach is no different in that it walks you through creating an arcade style Prison Break game app-top to bottom-for an Android smartphone or tablet.  This book teaches you the unique characteristics and challenges of creating an Arcade style game And it provides y

  18. Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient

    Directory of Open Access Journals (Sweden)

    Karunakar Shetty

    2016-01-01

    Full Text Available This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion.

  19. Compton scatter correction in case of multiple crosstalks in SPECT imaging.

    Science.gov (United States)

    Sychra, J J; Blend, M J; Jobe, T H

    1996-02-01

    A strategy for Compton scatter correction in brain SPECT images was proposed recently. It assumes that two radioisotopes are used and that a significant portion of photons of one radioisotope (for example, Tc99m) spills over into the low energy acquisition window of the other radioisotope (for example, Tl201). We are extending this approach to cases of several radioisotopes with mutual, multiple and significant photon spillover. In the example above, one may correct not only the Tl201 image but also the Tc99m image corrupted by the Compton scatter originating from the small component of high energy Tl201 photons. The proposed extension is applicable to other anatomical domains (cardiac imaging).

  20. 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.

  1. A Hybrid One-Way ANOVA Approach for the Robust and Efficient Estimation of Differential Gene Expression with Multiple Patterns.

    Directory of Open Access Journals (Sweden)

    Mohammad Manir Hossain Mollah

    Full Text Available Identifying genes that are differentially expressed (DE between two or more conditions with multiple patterns of expression is one of the primary objectives of gene expression data analysis. Several statistical approaches, including one-way analysis of variance (ANOVA, are used to identify DE genes. However, most of these methods provide misleading results for two or more conditions with multiple patterns of expression in the presence of outlying genes. In this paper, an attempt is made to develop a hybrid one-way ANOVA approach that unifies the robustness and efficiency of estimation using the minimum β-divergence method to overcome some problems that arise in the existing robust methods for both small- and large-sample cases with multiple patterns of expression.The proposed method relies on a β-weight function, which produces values between 0 and 1. The β-weight function with β = 0.2 is used as a measure of outlier detection. It assigns smaller weights (≥ 0 to outlying expressions and larger weights (≤ 1 to typical expressions. The distribution of the β-weights is used to calculate the cut-off point, which is compared to the observed β-weight of an expression to determine whether that gene expression is an outlier. This weight function plays a key role in unifying the robustness and efficiency of estimation in one-way ANOVA.Analyses of simulated gene expression profiles revealed that all eight methods (ANOVA, SAM, LIMMA, EBarrays, eLNN, KW, robust BetaEB and proposed perform almost identically for m = 2 conditions in the absence of outliers. However, the robust BetaEB method and the proposed method exhibited considerably better performance than the other six methods in the presence of outliers. In this case, the BetaEB method exhibited slightly better performance than the proposed method for the small-sample cases, but the the proposed method exhibited much better performance than the BetaEB method for both the small- and large

  2. Mathematical modelling a case studies approach

    CERN Document Server

    Illner, Reinhard; McCollum, Samantha; Roode, Thea van

    2004-01-01

    Mathematical modelling is a subject without boundaries. It is the means by which mathematics becomes useful to virtually any subject. Moreover, modelling has been and continues to be a driving force for the development of mathematics itself. This book explains the process of modelling real situations to obtain mathematical problems that can be analyzed, thus solving the original problem. The presentation is in the form of case studies, which are developed much as they would be in true applications. In many cases, an initial model is created, then modified along the way. Some cases are familiar, such as the evaluation of an annuity. Others are unique, such as the fascinating situation in which an engineer, armed only with a slide rule, had 24 hours to compute whether a valve would hold when a temporary rock plug was removed from a water tunnel. Each chapter ends with a set of exercises and some suggestions for class projects. Some projects are extensive, as with the explorations of the predator-prey model; oth...

  3. A time warping approach to multiple sequence alignment.

    Science.gov (United States)

    Arribas-Gil, Ana; Matias, Catherine

    2017-04-25

    We propose an approach for multiple sequence alignment (MSA) derived from the dynamic time warping viewpoint and recent techniques of curve synchronization developed in the context of functional data analysis. Starting from pairwise alignments of all the sequences (viewed as paths in a certain space), we construct a median path that represents the MSA we are looking for. We establish a proof of concept that our method could be an interesting ingredient to include into refined MSA techniques. We present a simple synthetic experiment as well as the study of a benchmark dataset, together with comparisons with 2 widely used MSA softwares.

  4. 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.

  5. Bridging the research to practice gap: A case study approach to understanding eıbı supports and barriers in Swedish preschools

    Directory of Open Access Journals (Sweden)

    Lise Roll-Petterson

    2016-12-01

    Full Text Available The present study examined proximal and distal barriers and supports within the Swedish service system that may affect implementation of early and intensive behavioral intervention (EIBI for children with autism. A case study approach with roots in ethnography was chosen to explore this issue. Two preschools exemplifying ‘high quality practice’ were studied and information was collected through multiple sources during a 12 month period, this included participant observations, direct observations, semi-structured interviews with key informants; paraprofessionals, parents, special educators, habilitation specialists and a focus group interview. Interview transcripts and field notes were combined and analyzed using an abductive grounded theory approach. Findings highlight the relevance of researchers understanding and taking into consideration the effect that distal variables have on implementation within proximal settings. A theoretical model of factors affecting implementation was conceptualised to include: staff entry knowledge and competence, development through supervision, the role of the preschool administrator, as well as distal influences and inter-organizational tensions, values, and bridges. Findings are discussed within the context of implementation science. Implications for future research are discussed as well as areas in need of further development to bridge the gap between research and practice.

  6. A Multiple Identity Approach to Gender: Identification with Women, Identification with Feminists, and Their Interaction

    Directory of Open Access Journals (Sweden)

    Jolien A. van Breen

    2017-06-01

    Full Text Available Across four studies, we examine multiple identities in the context of gender and propose that women's attitudes toward gender group membership are governed by two largely orthogonal dimensions of gender identity: identification with women and identification with feminists. We argue that identification with women reflects attitudes toward the content society gives to group membership: what does it mean to be a woman in terms of group characteristics, interests and values? Identification with feminists, on the other hand, is a politicized identity dimension reflecting attitudes toward the social position of the group: what does it mean to be a woman in terms of disadvantage, inequality, and relative status? We examine the utility of this multiple identity approach in four studies. Study 1 showed that identification with women reflects attitudes toward group characteristics, such as femininity and self-stereotyping, while identification with feminists reflects attitudes toward the group's social position, such as perceived sexism. The two dimensions are shown to be largely independent, and as such provide support for the multiple identity approach. In Studies 2–4, we examine the utility of this multiple identity approach in predicting qualitative differences in gender attitudes. Results show that specific combinations of identification with women and feminists predicted attitudes toward collective action and gender stereotypes. Higher identification with feminists led to endorsement of radical collective action (Study 2 and critical attitudes toward gender stereotypes (Studies 3–4, especially at lower levels of identification with women. The different combinations of high vs. low identification with women and feminists can be thought of as reflecting four theoretical identity “types.” A woman can be (1 strongly identified with neither women nor feminists (“low identifier”, (2 strongly identified with women but less so with feminists (

  7. A Multiple Identity Approach to Gender: Identification with Women, Identification with Feminists, and Their Interaction

    Science.gov (United States)

    van Breen, Jolien A.; Spears, Russell; Kuppens, Toon; de Lemus, Soledad

    2017-01-01

    Across four studies, we examine multiple identities in the context of gender and propose that women's attitudes toward gender group membership are governed by two largely orthogonal dimensions of gender identity: identification with women and identification with feminists. We argue that identification with women reflects attitudes toward the content society gives to group membership: what does it mean to be a woman in terms of group characteristics, interests and values? Identification with feminists, on the other hand, is a politicized identity dimension reflecting attitudes toward the social position of the group: what does it mean to be a woman in terms of disadvantage, inequality, and relative status? We examine the utility of this multiple identity approach in four studies. Study 1 showed that identification with women reflects attitudes toward group characteristics, such as femininity and self-stereotyping, while identification with feminists reflects attitudes toward the group's social position, such as perceived sexism. The two dimensions are shown to be largely independent, and as such provide support for the multiple identity approach. In Studies 2–4, we examine the utility of this multiple identity approach in predicting qualitative differences in gender attitudes. Results show that specific combinations of identification with women and feminists predicted attitudes toward collective action and gender stereotypes. Higher identification with feminists led to endorsement of radical collective action (Study 2) and critical attitudes toward gender stereotypes (Studies 3–4), especially at lower levels of identification with women. The different combinations of high vs. low identification with women and feminists can be thought of as reflecting four theoretical identity “types.” A woman can be (1) strongly identified with neither women nor feminists (“low identifier”), (2) strongly identified with women but less so with feminists (

  8. A Multiple Identity Approach to Gender: Identification with Women, Identification with Feminists, and Their Interaction.

    Science.gov (United States)

    van Breen, Jolien A; Spears, Russell; Kuppens, Toon; de Lemus, Soledad

    2017-01-01

    Across four studies, we examine multiple identities in the context of gender and propose that women's attitudes toward gender group membership are governed by two largely orthogonal dimensions of gender identity: identification with women and identification with feminists. We argue that identification with women reflects attitudes toward the content society gives to group membership: what does it mean to be a woman in terms of group characteristics, interests and values? Identification with feminists, on the other hand, is a politicized identity dimension reflecting attitudes toward the social position of the group: what does it mean to be a woman in terms of disadvantage, inequality, and relative status? We examine the utility of this multiple identity approach in four studies. Study 1 showed that identification with women reflects attitudes toward group characteristics, such as femininity and self-stereotyping, while identification with feminists reflects attitudes toward the group's social position, such as perceived sexism. The two dimensions are shown to be largely independent, and as such provide support for the multiple identity approach. In Studies 2-4, we examine the utility of this multiple identity approach in predicting qualitative differences in gender attitudes. Results show that specific combinations of identification with women and feminists predicted attitudes toward collective action and gender stereotypes. Higher identification with feminists led to endorsement of radical collective action (Study 2) and critical attitudes toward gender stereotypes (Studies 3-4), especially at lower levels of identification with women. The different combinations of high vs. low identification with women and feminists can be thought of as reflecting four theoretical identity "types." A woman can be (1) strongly identified with neither women nor feminists ("low identifier"), (2) strongly identified with women but less so with feminists ("traditional identifier"), (3

  9. A Preliminary Multiple Case Report of Neurocognitive Training for Children With AD/HD in China

    Directory of Open Access Journals (Sweden)

    Han Jiang

    2015-06-01

    Full Text Available This preliminary multiple case study examined the behavioral outcomes of neurocognitive training on children with attention-deficit/hyperactivity disorder (AD/HD in China, as well as parent acceptance of the treatment. The training approach targeted working memory, impulse control, and attention/relaxation (via brain electrical activity. Outcome measures included overt behavior as rated by parents and teachers, AD/HD symptom frequency, and parent opinion/feedback. Training was completed by five individuals and delivered via a themed computer game with electroencephalogram (EEG input via a wireless, single-channel, dry-sensor, portable measurement device. The objective (i.e., training outcomes and EEG and subjective (i.e., parent ratings/feedback and teacher ratings data suggested that use of the neurocognitive training resulted in reduced AD/HD behaviors and improvement in socially meaningful outcomes. The parents expressed satisfaction with the training procedure and outcomes. It is concluded that the innovative neurocognitive training approach is effective for improving behavior and reducing symptoms of AD/HD for children in China.

  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. 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.

  12. 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 ...

  13. 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.

  14. Case Study Approaches for Implementing the 2007 NRC Report “Toxicity Testing in the 21st Century: A Vision and A Strategy”

    Science.gov (United States)

    Andersen, Melvin E.; Clewell, Harvey J.; Carmichael, Paul L.; Boekelheide, Kim

    2013-01-01

    The 2007 report “Toxicity Testing in the 21st Century: A Vision and A Strategy” argued for a change in toxicity testing for environmental agents and discussed federal funding mechanisms that could be used to support this transformation within the USA. The new approach would test for in vitro perturbations of toxicity pathways using human cells with high throughput testing platforms. The NRC report proposed a deliberate timeline, spanning about 20 years, to implement a wholesale replacement of current in-life toxicity test approaches focused on apical responses with in vitro assays. One approach to accelerating implementation is to focus on well-studied prototype compounds with known toxicity pathway targets. Through a series of carefully executed case studies with four or five pathway prototypes, the various steps required for implementation of an in vitro toxicity pathway approach to risk assessment could be developed and refined. In this article, we discuss alternative approaches for implementation and also outline advantages of a case study approach and the manner in which the cases studies could be pursued using current methodologies. A case study approach would be complementary to recently proposed efforts to map the human toxome, while representing a significant extension toward more formal risk assessment compared to the profiling and prioritization approaches offered by programs such as the EPA’s ToxCast effort. PMID:21993955

  15. 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

  16. 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

  17. 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

  18. Multiple flood vulnerability assessment approach based on fuzzy comprehensive evaluation method and coordinated development degree model.

    Science.gov (United States)

    Yang, Weichao; Xu, Kui; Lian, Jijian; Bin, Lingling; Ma, Chao

    2018-05-01

    Flood is a serious challenge that increasingly affects the residents as well as policymakers. Flood vulnerability assessment is becoming gradually relevant in the world. The purpose of this study is to develop an approach to reveal the relationship between exposure, sensitivity and adaptive capacity for better flood vulnerability assessment, based on the fuzzy comprehensive evaluation method (FCEM) and coordinated development degree model (CDDM). The approach is organized into three parts: establishment of index system, assessment of exposure, sensitivity and adaptive capacity, and multiple flood vulnerability assessment. Hydrodynamic model and statistical data are employed for the establishment of index system; FCEM is used to evaluate exposure, sensitivity and adaptive capacity; and CDDM is applied to express the relationship of the three components of vulnerability. Six multiple flood vulnerability types and four levels are proposed to assess flood vulnerability from multiple perspectives. Then the approach is applied to assess the spatiality of flood vulnerability in Hainan's eastern area, China. Based on the results of multiple flood vulnerability, a decision-making process for rational allocation of limited resources is proposed and applied to the study area. The study shows that multiple flood vulnerability assessment can evaluate vulnerability more completely, and help decision makers learn more information about making decisions in a more comprehensive way. In summary, this study provides a new way for flood vulnerability assessment and disaster prevention decision. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. An agent-based negotiation approach for balancing multiple coupled control domains

    DEFF Research Database (Denmark)

    Umair, Aisha; Clausen, Anders; Jørgensen, Bo Nørregaard

    2015-01-01

    Solving multi-objective multi-issue negotiation problems involving interdependent issues distributed among multiple control domains is inherent to most non-trivial cyber-physical systems. In these systems, the coordinated operation of interconnected subsystems performing autonomous control....... The proposed approach can solve negotiation problems with interdependent issues across multiple coupled control domains. We demonstrate our approach by solving a coordination problem where a Combined Heat and Power Plant must allocate electricity for three commercial greenhouses to ensure the required plant...

  20. 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.

  1. Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

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    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. The application of multiple intelligence approach to the learning of human circulatory system

    Science.gov (United States)

    Kumalasari, Lita; Yusuf Hilmi, A.; Priyandoko, Didik

    2017-11-01

    The purpose of this study is to offer an alternative teaching approach or strategies which able to accommodate students’ different ability, intelligence and learning style. Also can gives a new idea for the teacher as a facilitator for exploring how to teach the student in creative ways and more student-center activities, for a lesson such as circulatory system. This study was carried out at one private school in Bandung involved eight students to see their responses toward the lesson that delivered by using Multiple Intelligence approach which is include Linguistic, Logical-Mathematical, Visual-Spatial, Musical, Bodily-Kinesthetic, Interpersonal, Intrapersonal, and Naturalistic. Students were test by using MI test based on Howard Gardner’s MI model to see their dominant intelligence. The result showed the percentage of top three ranks of intelligence are Bodily-Kinesthetic (73%), Visual-Spatial (68%), and Logical-Mathematical (61%). The learning process is given by using some different multimedia and activities to engaged their learning style and intelligence such as mini experiment, short clip, and questions. Student response is given by using self-assessment and the result is all students said the lesson gives them a knowledge and skills that useful for their life, they are clear with the explanation given, they didn’t find difficulties to understand the lesson and can complete the assignment given. At the end of the study, it is reveal that the students who are learned by Multiple Intelligence instructional approach have more enhance to the lesson given. It’s also found out that the students participated in the learning process which Multiple Intelligence approach was applied enjoyed the activities and have great fun.

  3. eCompetence Case Studies

    DEFF Research Database (Denmark)

    Jensen, Helle Bækkelund

    2006-01-01

    In this paper we present some details of the processes undertaken in the European eCompetence Initiative. We present two illustrative and representative case studies. The research aims to identify and understand patterns of individual and organisational eCompetence approaches.......In this paper we present some details of the processes undertaken in the European eCompetence Initiative. We present two illustrative and representative case studies. The research aims to identify and understand patterns of individual and organisational eCompetence approaches....

  4. 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.

  5. 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.

  6. An Approach to Using Toxicogenomic Data in U.S. EPA Human Health Risk Assessments: A Dibutyl Phthalate Case Study (Final Report, 2010)

    Science.gov (United States)

    EPA announced the availability of the final report, An Approach to Using Toxicogenomic Data in U.S. EPA Human Health Risk Assessments: A Dibutyl Phthalate Case Study. This report outlines an approach to evaluate genomic data for use in risk assessment and a case study to ...

  7. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature

    Directory of Open Access Journals (Sweden)

    Vigo Federica

    2012-08-01

    Full Text Available Abstract Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.

  8. Why is the Arkavathy River drying? A multiple hypothesis approach in a data scarce region

    Science.gov (United States)

    Srinivasan, V.; Thompson, S.; Madhyastha, K.; Penny, G.; Jeremiah, K.; Lele, S.

    2015-01-01

    The developing world faces unique challenges in achieving water security as it is disproportionately exposed to stressors such as climate change while also undergoing demographic growth, agricultural intensification and industrialization. Investigative approaches are needed that can inform sound policy development and planning to address the water security challenge in the context of data scarcity. We investigated the "predictions under change" problem in the Thippagondanahalli (TG Halli) catchment of the Arkavathy sub-basin in South India. River inflows into the TG Halli reservoir have declined since the 1970s, and the reservoir is currently operating at only 20% of its built capacity. The mechanisms responsible for the drying of the river are not understood, resulting in uncoordinated and potentially counter-productive management responses. The objective of this study was to investigate potential explanations of the drying trend and thus obtain predictive insight. We used a multiple working hypothesis approach to investigate the decline in inflow into TG Halli reservoir. Five hypotheses were tested using data from field surveys and reliable secondary sources: (1) changes in rainfall amount, timing and storm intensity, (2) rising temperatures, (3) increased groundwater extraction, (4) expansion of eucalyptus plantations, and (5) increased fragmentation of the river channel. Our results indicate that proximate anthropogenic drivers of change such as groundwater pumping, expansion of eucalyptus plantations, and to a lesser extent channel fragmentation, are much more likely to have caused the decline in surface flows in the TG Halli catchment than changing climate. The case study shows that direct human interventions play a significant role in altering the hydrology of watersheds. The multiple working hypotheses approach presents a systematic way to quantify the relative contributions of anthropogenic drivers to hydrologic change. The approach not only yields a

  9. 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.

  10. Soft computing based on hierarchical evaluation approach and criteria interdependencies for energy decision-making problems: A case study

    International Nuclear Information System (INIS)

    Gitinavard, Hossein; Mousavi, S. Meysam; Vahdani, Behnam

    2017-01-01

    In numerous real-world energy decision problems, decision makers often encounter complex environments, in which existent imprecise data and uncertain information lead us to make an appropriate decision. In this paper, a new soft computing group decision-making approach is introduced based on novel compromise ranking method and interval-valued hesitant fuzzy sets (IVHFSs) for energy decision-making problems under multiple criteria. In the proposed approach, the assessment information is provided by energy experts or decision makers based on interval-valued hesitant fuzzy elements under incomplete criteria weights. In this respect, a new ranking index is presented respecting to interval-valued hesitant fuzzy Hamming distance measure to prioritize energy candidates, and criteria weights are computed based on an extended maximizing deviation method by considering the preferences experts' judgments about the relative importance of each criterion. Also, a decision making trial and evaluation laboratory (DEMATEL) method is extended under an IVHF-environment to compute the interdependencies between and within the selected criteria in the hierarchical structure. Accordingly, to demonstrate the applicability of the presented approach a case study and a practical example are provided regarding to hierarchical structure and criteria interdependencies relations for renewable energy and energy policy selection problems. Hence, the obtained computational results are compared with a fuzzy decision-making method from the recent literature based on some comparison parameters to show the advantages and constraints of the proposed approach. Finally, a sensitivity analysis is prepared to indicate effects of different criteria weights on ranking results to present the robustness or sensitiveness of the proposed soft computing approach versus the relative importance of criteria. - Highlights: • Introducing a novel interval-valued hesitant fuzzy compromise ranking method. • Presenting

  11. Developing a quality by design approach to model tablet dissolution testing: an industrial case study.

    Science.gov (United States)

    Yekpe, Ketsia; Abatzoglou, Nicolas; Bataille, Bernard; Gosselin, Ryan; Sharkawi, Tahmer; Simard, Jean-Sébastien; Cournoyer, Antoine

    2017-11-02

    This study applied the concept of Quality by Design (QbD) to tablet dissolution. Its goal was to propose a quality control strategy to model dissolution testing of solid oral dose products according to International Conference on Harmonization guidelines. The methodology involved the following three steps: (1) a risk analysis to identify the material- and process-related parameters impacting the critical quality attributes of dissolution testing, (2) an experimental design to evaluate the influence of design factors (attributes and parameters selected by risk analysis) on dissolution testing, and (3) an investigation of the relationship between design factors and dissolution profiles. Results show that (a) in the case studied, the two parameters impacting dissolution kinetics are active pharmaceutical ingredient particle size distributions and tablet hardness and (b) these two parameters could be monitored with PAT tools to predict dissolution profiles. Moreover, based on the results obtained, modeling dissolution is possible. The practicality and effectiveness of the QbD approach were demonstrated through this industrial case study. Implementing such an approach systematically in industrial pharmaceutical production would reduce the need for tablet dissolution testing.

  12. 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 ...

  13. 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

  14. 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.

  15. 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

  16. Participant perceptions of a novel physiotherapy approach ("Blue Prescription") for increasing levels of physical activity in people with multiple sclerosis: a qualitative study following intervention.

    Science.gov (United States)

    Smith, Catherine M; Hale, Leigh A; Mulligan, Hilda F; Treharne, Gareth J

    2013-07-01

    The aim of this study was to investigate experiences of participating in a feasibility trial of a novel physiotherapy intervention (Blue Prescription). The trial was designed to increase participation in physical activity for people with multiple sclerosis living in the community. We individually interviewed 27 volunteers from two New Zealand metropolitan areas at the conclusion of their participation in Blue Prescription. We asked volunteers about what participation in Blue Prescription had meant to them; how participants intended to continue with their physical activity; how the approach differed from previous experiences of physiotherapy encounters; and how Blue Prescription could be improved. Interviews were semi-structured, audio-recorded, transcribed verbatim, and analysed using a General Inductive Approach. 'Support' was identified as a key theme with three sub-themes: 'The therapeutic relationship'; 'The Blue Prescription approach'; and 'Supporting themselves'. We identified two additional themes 'Motivation to participate' and 'Improving the Blue Prescription approach'. A novel approach (Blue Prescription) which facilitates engagement in higher levels of desirable physical activity was perceived by participants to be supportive, motivating and enabling. This approach might be particularly useful for people with multiple sclerosis ready to adopt new health-related behaviours. For future studies, this approach requires further refinement, particularly with regards to methods of communication and evaluation.

  17. A multi-method approach toward de novo glycan characterization: a Man-5 case study.

    Science.gov (United States)

    Prien, Justin M; Prater, Bradley D; Cockrill, Steven L

    2010-05-01

    Regulatory agencies' expectations for biotherapeutic approval are becoming more stringent with regard to product characterization, where minor species as low as 0.1% of a given profile are typically identified. The mission of this manuscript is to demonstrate a multi-method approach toward de novo glycan characterization and quantitation, including minor species at or approaching the 0.1% benchmark. Recently, unexpected isomers of the Man(5)GlcNAc(2) (M(5)) were reported (Prien JM, Ashline DJ, Lapadula AJ, Zhang H, Reinhold VN. 2009. The high mannose glycans from bovine ribonuclease B isomer characterization by ion trap mass spectrometry (MS). J Am Soc Mass Spectrom. 20:539-556). In the current study, quantitative analysis of these isomers found in commercial M(5) standard demonstrated that they are in low abundance (2-aminobenzoic acid to detect and chromatographically resolve multiple M(5) isomers in bovine ribonuclease B. With this multi-method approach, we have the capabilities to comprehensively characterize a biotherapeutic's glycan array in a de novo manner, including structural isomers at >/=0.1% of the total chromatographic peak area.

  18. The third spatial dimension risk approach for individual risk and group risk in multiple use of space

    International Nuclear Information System (INIS)

    Suddle, Shahid; Ale, Ben

    2005-01-01

    Buildings above roads and railways are examples of multiple use of space. Safety is one of the critical issues for such projects. Risk analyses can be undertaken to investigate what safety measures that are required to realise these projects. The results of these analyses can also be compared to risk acceptance criteria, if they are applicable. In The Netherlands, there are explicit criteria for acceptability of individual risk and societal risk. Traditionally calculations of individual risk result in contours of equal risk on a map and thus are considered in two-dimensional space only. However, when different functions are layered the third spatial dimension, height, becomes an important parameter. The various activities and structures above and below each other impose mutual risks. There are no explicit norms or policies about how to deal with the individual or group risk approach in the third dimension. This paper proposes an approach for these problems and gives some examples. Finally, the third dimension risk approach is applied in a case study of Bos en Lommer, Amsterdam

  19. Multiple scattering approach to the vibrational excitation of molecules by slow electrons

    International Nuclear Information System (INIS)

    Drukarev, G.

    1976-01-01

    Another approach to the problem of vibrational excitation of homonuclear two-atomic molecules by slow electrons possibly accompanied by rotational transitions is presented based on the picture of multiple scattering of an electron inside the molecule. The scattering of two fixed centers in the zero range potential model is considered. The results indicate that the multiple scattering determines the order of magnitude of the vibrational excitation cross sections in the energy region under consideration even if the zero range potential model is used. Also the connection between the multiple scattering approach and quasi-stationary molecular ion picture is established. 9 refs

  20. Case Studies of Interactive Whole-Class Teaching in Primary Science: Communicative approach and pedagogic purposes

    Science.gov (United States)

    McMahon, Kendra

    2012-07-01

    By developing two case studies of expert teaching in action, this study aimed to develop knowledge of talk in whole-class teaching in UK primary science lessons and understand this in relation to both the teachers' interpretations and sociocultural theoretical frameworks. Lessons were observed and video-recorded and the teachers engaged in video-stimulated-reflective dialogue to capture participants' reflections upon their own pedagogic purposes and interactions in the classroom. The analytic framework was developed at three levels: sequence of lessons, lesson, and episode. For each episode, the 'communicative approach' and teaching purposes were recorded. Transcripts were developed for fine grain analysis of selected episodes and a quantitative analysis was undertaken of the use of communicative approaches. Findings exemplify how different communicative approaches were used by the case-study teachers for different pedagogical purposes at different points in the sequence of lessons, contributing to primary teachers' repertoire for planning and practice. The initial elicitation of children's ideas can be understood as pooling them to enhance multivoicedness and develop a shared resource for future dialogues. Whole-class talk can support univocality by rehearsing procedural knowledge and exploring the meanings of scientific terminology. Identifying salient features of phenomena in the context of the whole-class marks them as significant as shared knowledge but valuing other observations extends the multivoicedness of the discourse.

  1. A Signal Detection Approach in a Multiple Cohort Study: Different Admission Tools Uniquely Select Different Successful Students

    Directory of Open Access Journals (Sweden)

    Linda van Ooijen-van der Linden

    2018-05-01

    Full Text Available Using multiple admission tools in university admission procedures is common practice. This is particularly useful if different admission tools uniquely select different subgroups of students who will be successful in university programs. A signal-detection approach was used to investigate the accuracy of Secondary School grade point average (SSGPA, an admission test score (ACS, and a non-cognitive score (NCS in uniquely selecting successful students. This was done for three consecutive first year cohorts of a broad psychology program. Each applicant's score on SSGPA, ACS, or NCS alone—and on seven combinations of these scores, all considered separate “admission tools”—was compared at two different (medium and high cut-off scores (criterion levels. Each of the tools selected successful students who were not selected by any of the other tools. Both sensitivity and specificity were enhanced by implementing multiple tools. The signal-detection approach distinctively provided useful information for decisions on admission instruments and cut-off scores.

  2. Feedback structure based entropy approach for multiple-model estimation

    Institute of Scientific and Technical Information of China (English)

    Shen-tu Han; Xue Anke; Guo Yunfei

    2013-01-01

    The variable-structure multiple-model (VSMM) approach, one of the multiple-model (MM) methods, is a popular and effective approach in handling problems with mode uncertainties. The model sequence set adaptation (MSA) is the key to design a better VSMM. However, MSA methods in the literature have big room to improve both theoretically and practically. To this end, we propose a feedback structure based entropy approach that could find the model sequence sets with the smallest size under certain conditions. The filtered data are fed back in real time and can be used by the minimum entropy (ME) based VSMM algorithms, i.e., MEVSMM. Firstly, the full Markov chains are used to achieve optimal solutions. Secondly, the myopic method together with particle filter (PF) and the challenge match algorithm are also used to achieve sub-optimal solutions, a trade-off between practicability and optimality. The numerical results show that the proposed algorithm provides not only refined model sets but also a good robustness margin and very high accuracy.

  3. 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.

  4. 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.

  5. The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies.

    Science.gov (United States)

    Walshe, Catherine

    2011-12-01

    Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research. This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings. Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature. Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.

  6. Elastic-net regularization approaches for genome-wide association studies of rheumatoid arthritis.

    Science.gov (United States)

    Cho, Seoae; Kim, Haseong; Oh, Sohee; Kim, Kyunga; Park, Taesung

    2009-12-15

    The current trend in genome-wide association studies is to identify regions where the true disease-causing genes may lie by evaluating thousands of single-nucleotide polymorphisms (SNPs) across the whole genome. However, many challenges exist in detecting disease-causing genes among the thousands of SNPs. Examples include multicollinearity and multiple testing issues, especially when a large number of correlated SNPs are simultaneously tested. Multicollinearity can often occur when predictor variables in a multiple regression model are highly correlated, and can cause imprecise estimation of association. In this study, we propose a simple stepwise procedure that identifies disease-causing SNPs simultaneously by employing elastic-net regularization, a variable selection method that allows one to address multicollinearity. At Step 1, the single-marker association analysis was conducted to screen SNPs. At Step 2, the multiple-marker association was scanned based on the elastic-net regularization. The proposed approach was applied to the rheumatoid arthritis (RA) case-control data set of Genetic Analysis Workshop 16. While the selected SNPs at the screening step are located mostly on chromosome 6, the elastic-net approach identified putative RA-related SNPs on other chromosomes in an increased proportion. For some of those putative RA-related SNPs, we identified the interactions with sex, a well known factor affecting RA susceptibility.

  7. Implementing the Project Approach: A Case Study of Hybrid Pedagogy in a Hong Kong Kindergarten

    Science.gov (United States)

    Chen, Jennifer J.; Li, Hui; Wang, Jing-ying

    2017-01-01

    The Project Approach has been promoted in Hong Kong kindergartens since the 1990s. However, the dynamic processes and underlying mechanisms involved in the teachers' implementation of this pedagogical method there have not yet been fully investigated. This case study of one typical kindergarten in Hong Kong documented how and why eight teachers…

  8. Bias due to differential participation in case-control studies and review of available approaches for adjustment.

    Science.gov (United States)

    Aigner, Annette; Grittner, Ulrike; Becher, Heiko

    2018-01-01

    Low response rates in epidemiologic research potentially lead to the recruitment of a non-representative sample of controls in case-control studies. Problems in the unbiased estimation of odds ratios arise when characteristics causing the probability of participation are associated with exposure and outcome. This is a specific setting of selection bias and a realistic hazard in many case-control studies. This paper formally describes the problem and shows its potential extent, reviews existing approaches for bias adjustment applicable under certain conditions, compares and applies them. We focus on two scenarios: a characteristic C causing differential participation of controls is linked to the outcome through its association with risk factor E (scenario I), and C is additionally a genuine risk factor itself (scenario II). We further assume external data sources are available which provide an unbiased estimate of C in the underlying population. Given these scenarios, we (i) review available approaches and their performance in the setting of bias due to differential participation; (ii) describe two existing approaches to correct for the bias in both scenarios in more detail; (iii) present the magnitude of the resulting bias by simulation if the selection of a non-representative sample is ignored; and (iv) demonstrate the approaches' application via data from a case-control study on stroke. The bias of the effect measure for variable E in scenario I and C in scenario II can be large and should therefore be adjusted for in any analysis. It is positively associated with the difference in response rates between groups of the characteristic causing differential participation, and inversely associated with the total response rate in the controls. Adjustment in a standard logistic regression framework is possible in both scenarios if the population distribution of the characteristic causing differential participation is known or can be approximated well.

  9. A data fusion approach for track monitoring from multiple in-service trains

    Science.gov (United States)

    Lederman, George; Chen, Siheng; Garrett, James H.; Kovačević, Jelena; Noh, Hae Young; Bielak, Jacobo

    2017-10-01

    We present a data fusion approach for enabling data-driven rail-infrastructure monitoring from multiple in-service trains. A number of researchers have proposed using vibration data collected from in-service trains as a low-cost method to monitor track geometry. The majority of this work has focused on developing novel features to extract information about the tracks from data produced by individual sensors on individual trains. We extend this work by presenting a technique to combine extracted features from multiple passes over the tracks from multiple sensors aboard multiple vehicles. There are a number of challenges in combining multiple data sources, like different relative position coordinates depending on the location of the sensor within the train. Furthermore, as the number of sensors increases, the likelihood that some will malfunction also increases. We use a two-step approach that first minimizes position offset errors through data alignment, then fuses the data with a novel adaptive Kalman filter that weights data according to its estimated reliability. We show the efficacy of this approach both through simulations and on a data-set collected from two instrumented trains operating over a one-year period. Combining data from numerous in-service trains allows for more continuous and more reliable data-driven monitoring than analyzing data from any one train alone; as the number of instrumented trains increases, the proposed fusion approach could facilitate track monitoring of entire rail-networks.

  10. 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.

  11. 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...

  12. 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. 

  13. Case Study: Guidelines for Producing Videos to Accompany Flipped Cases

    Science.gov (United States)

    Prud'homme-Généreux, Annie; Schiller, Nancy A.; Wild, John H.; Herreid, Clyde Freeman

    2017-01-01

    Three years ago, the "National Center for Case Study Teaching in Science" (NCCSTS) was inspired to merge the case study and flipped classroom approaches. The resulting project aimed to create the materials required to teach a flipped course in introductory biology by assigning videos as homework and case studies in the classroom. Three…

  14. Heuristic Solution Approaches to the Double TSP with Multiple Stacks

    DEFF Research Database (Denmark)

    Petersen, Hanne Løhmann

    This paper introduces the Double Travelling Salesman Problem with Multiple Stacks and presents a three different metaheuristic approaches to its solution. The Double Travelling Salesman Problem with Multiple Stacks is concerned with finding the shortest route performing pickups and deliveries in ...... are developed for the problem and used with each of the heuristics. Finally some computational results are given along with lower bounds on the objective value....

  15. Heuristic Solution Approaches to the Double TSP with Multiple Stacks

    DEFF Research Database (Denmark)

    Petersen, Hanne Løhmann

    2006-01-01

    This paper introduces the Double Travelling Salesman Problem with Multiple Stacks and presents a three different metaheuristic approaches to its solution. The Double Travelling Salesman Problem with Multiple Stacks is concerned with finding the shortest route performing pickups and deliveries in ...... are developed for the problem and used with each of the heuristics. Finally some computational results are given along with lower bounds on the objective value....

  16. 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).

  17. Application of information retrieval approaches to case classification in the vaccine adverse event reporting system.

    Science.gov (United States)

    Botsis, Taxiarchis; Woo, Emily Jane; Ball, Robert

    2013-07-01

    Automating the classification of adverse event reports is an important step to improve the efficiency of vaccine safety surveillance. Previously we showed it was possible to classify reports using features extracted from the text of the reports. The aim of this study was to use the information encoded in the Medical Dictionary for Regulatory Activities (MedDRA(®)) in the US Vaccine Adverse Event Reporting System (VAERS) to support and evaluate two classification approaches: a multiple information retrieval strategy and a rule-based approach. To evaluate the performance of these approaches, we selected the conditions of anaphylaxis and Guillain-Barré syndrome (GBS). We used MedDRA(®) Preferred Terms stored in the VAERS, and two standardized medical terminologies: the Brighton Collaboration (BC) case definitions and Standardized MedDRA(®) Queries (SMQ) to classify two sets of reports for GBS and anaphylaxis. Two approaches were used: (i) the rule-based instruments that are available by the two terminologies (the Automatic Brighton Classification [ABC] tool and the SMQ algorithms); and (ii) the vector space model. We found that the rule-based instruments, particularly the SMQ algorithms, achieved a high degree of specificity; however, there was a cost in terms of sensitivity in all but the narrow GBS SMQ algorithm that outperformed the remaining approaches (sensitivity in the testing set was equal to 99.06 % for this algorithm vs. 93.40 % for the vector space model). In the case of anaphylaxis, the vector space model achieved higher sensitivity compared with the best values of both the ABC tool and the SMQ algorithms in the testing set (86.44 % vs. 64.11 % and 52.54 %, respectively). Our results showed the superiority of the vector space model over the existing rule-based approaches irrespective of the standardized medical knowledge represented by either the SMQ or the BC case definition. The vector space model might make automation of case definitions for

  18. 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…

  19. A case study detailing key considerations for implementing a telehealth approach to office ergonomics.

    Science.gov (United States)

    Ritchie, Catherine L W; Miller, Linda L; Antle, David M

    2017-01-01

    Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.

  20. [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.

  1. In silico approaches to study mass and energy flows in microbial consortia: a syntrophic case study

    Directory of Open Access Journals (Sweden)

    Mallette Natasha

    2009-12-01

    Full Text Available Abstract Background Three methods were developed for the application of stoichiometry-based network analysis approaches including elementary mode analysis to the study of mass and energy flows in microbial communities. Each has distinct advantages and disadvantages suitable for analyzing systems with different degrees of complexity and a priori knowledge. These approaches were tested and compared using data from the thermophilic, phototrophic mat communities from Octopus and Mushroom Springs in Yellowstone National Park (USA. The models were based on three distinct microbial guilds: oxygenic phototrophs, filamentous anoxygenic phototrophs, and sulfate-reducing bacteria. Two phases, day and night, were modeled to account for differences in the sources of mass and energy and the routes available for their exchange. Results The in silico models were used to explore fundamental questions in ecology including the prediction of and explanation for measured relative abundances of primary producers in the mat, theoretical tradeoffs between overall productivity and the generation of toxic by-products, and the relative robustness of various guild interactions. Conclusion The three modeling approaches represent a flexible toolbox for creating cellular metabolic networks to study microbial communities on scales ranging from cells to ecosystems. A comparison of the three methods highlights considerations for selecting the one most appropriate for a given microbial system. For instance, communities represented only by metagenomic data can be modeled using the pooled method which analyzes a community's total metabolic potential without attempting to partition enzymes to different organisms. Systems with extensive a priori information on microbial guilds can be represented using the compartmentalized technique, employing distinct control volumes to separate guild-appropriate enzymes and metabolites. If the complexity of a compartmentalized network creates an

  2. Delusional parasitosis--study of 3 cases.

    Directory of Open Access Journals (Sweden)

    Hanumantha K

    1994-10-01

    Full Text Available Delusional disorder-somatic (parasitosis type is a rare psychiatric disorder which poses a challenge to diagnostic and therapeutic skills. Pimozide, a highly specific dopamine blocker has shown promising results in the 3 cases illustrated here. These cases were seen over a period of 3 years. All the three patients believed that an insect has entered through the ear and is burrowing tracts/laying multiple eggs. They approached the ENT surgeons or neurosurgeon with a fear that their brain will be invaded. On psychiatric evaluation, no past or present history of major psychiatric illness was found. Premorbid personalities were well adjusted. Only for two patients, acute moderate stressors were detected. Delusions disappeared by the end of 2 wks but therapy was continued for 5 months.

  3. A Soft Systems Approach Case Study. Faustin Kamuzora Abstrac

    African Journals Online (AJOL)

    Kamuzora

    The paper details a case study conducted in Lushoto District, Tanzania ... area's cultural and natural resources through sustainable tourism. To achieve .... As stated above, the case study used the SSM for solving the problems in ..... Constraints: time, political environment, level of education of FoUS members. ... Road sector.

  4. 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

  5. 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.

  6. CT scan findings in three cases of multiple sclerosis with homonymous hemianopsia

    International Nuclear Information System (INIS)

    Arikado, Takuji; Ariga, Hiroko; Kase, Manabu; Nagata, Renpei; Tashiro, Kunio

    1983-01-01

    Three cases of clinically definite multiple sclerosis manifested homonymous hemianopsia. A 35-year-old female, in whom right optic neuritis developed as the initial symptom, manifested right homonymous hemianopsia 4 months later followed by cerebral symptoms another 4 months later. A 25-year-old male developed sudden brain stem and cerebellar symptoms associated with right abducens palsy and right homonymous hemianopsia. In a 26-year-old female developed right homonymous hemianopsia 13 years after the first attack of recurrent optic neuritis. CT-scan in these three cases revealed the presence of a ''plaque'' located in the white matter of the left occipital lobe in cases 1 and 2 and in the left peririgone white matter in case 3 as the causative lesion for the right homonymous hemianopsia. These findings indicate that the optic radiation may be involved in multiple sclerosis resulting in homonymous hemianopsia. CT scan is of value in determining the location of the affected intracranial lesion in multiple sclerosis. (author)

  7. 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

  8. Multiple impacts in dissipative granular chains

    CERN Document Server

    Nguyen, Ngoc Son

    2014-01-01

    The extension of collision models for single impacts between two bodies, to the case of multiple impacts (which take place when several collisions occur at the same time in a multibody system) is a challenge in Solid Mechanics, due to the complexity of such phenomena, even in the frictionless case. This monograph aims at presenting the main multiple collision rules proposed in the literature. Such collisions typically occur in granular materials, the simplest of which are made of chains of aligned balls. These chains are used throughout the book to analyze various multiple impact rules which extend the classical Newton (kinematic restitution), Poisson (kinetic restitution) and Darboux-Keller (energetic or kinetic restitution) approaches for impact modelling. The shock dynamics in various types of chains of aligned balls (monodisperse, tapered, decorated, stepped chains) is carefully studied and shown to depend on several parameters: restitution coefficients, contact stiffness ratios, elasticity coefficients (...

  9. Case study: Malingering or multiple personality disorder?

    Directory of Open Access Journals (Sweden)

    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.

  10. 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,…

  11. Energy management study: A proposed case of government building

    International Nuclear Information System (INIS)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

    2015-01-01

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building

  12. Energy management study: A proposed case of government building

    Science.gov (United States)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

    2015-05-01

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  13. Energy management study: A proposed case of government building

    Energy Technology Data Exchange (ETDEWEB)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd [School of Technology Management and Logistics, Universiti Utara Malaysia, 06010 Sintok, Kedah (Malaysia); Baharum, Mohd Faizal [School of Building, Housing and Planning, Universiti Sains Malaysia, 11800 Penang (Malaysia)

    2015-05-15

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  14. 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.

  15. The Effectiveness of Using a Multiple Gating Approach to Discriminate among ADHD Subtypes

    Science.gov (United States)

    Simonsen, Brandi M.; Bullis, Michael D.

    2007-01-01

    This study explored the ability of Systematically Progressive Assessment (SPA), a multiple gating approach for assessing students with attention-deficit/hyperactivity disorder (ADHD), to discriminate between subtypes of ADHD. A total of 48 students with ADHD (ages 6-11) were evaluated with three "gates" of assessment. Logistic regression analysis…

  16. Contextualising case studies in entrepreneurship: A tandem approach to conducting a longitudinal cross-country case study

    DEFF Research Database (Denmark)

    Chetty, S. K.; Partanen, J.; Rasmussen, Erik Stavnsager

    2014-01-01

    Using predictive and effectuation logics as a framework, this research note explains how case study research was conducted to demonstrate rigour and relevance. The study involves a longitudinal cross-country case study on small and medium-sized firm growth and networks undertaken by research teams...... in three countries (Finland, Denmark and New Zealand) involving 33 firms. This research note outlines the implications of this research and provides valuable guidance and reflections upon opportunities for future research regarding the conduct of contextual studies in entrepreneurship without compromising...

  17. 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.)

  18. Training Post-9/11 Police Officers with a Counter-Terrorism Reality-Based Training Model: A Case Study

    Science.gov (United States)

    Biddle, Christopher J.

    2013-01-01

    The purpose of this qualitative holistic multiple-case study was to identify the optimal theoretical approach for a Counter-Terrorism Reality-Based Training (CTRBT) model to train post-9/11 police officers to perform effectively in their counter-terrorism assignments. Post-9/11 police officers assigned to counter-terrorism duties are not trained…

  19. 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

  20. Case Studies of Integrated Pedagogy in Vocational Education: A Three-Tier Approach to Empowering Vulnerable Youth in Urban Cambodia

    Science.gov (United States)

    Cheng, I-Hsuan

    2010-01-01

    This paper starts with the real-life issues pertaining to the educational, economic and socio-cultural vulnerability of young Cambodians; and the latter in turn has called for greater integrated stance in vocational education. A multiple-case study of nine educational NGOs located in four cities was conducted, whereby what constitutes an…

  1. 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.

  2. 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.

  3. Case Study: A Picture Worth a Thousand Words? Making a Case for Video Case Studies

    Science.gov (United States)

    Pai, Aditi

    2014-01-01

    A picture, they say, is worth a thousand words. If a mere picture is worth a thousand words, how much more are "moving pictures" or videos worth? The author poses this not merely as a rhetorical question, but because she wishes to make a case for using videos in the traditional case study method. She recommends four main approaches of…

  4. A holistic approach to improving indoor environmental quality: A case study

    International Nuclear Information System (INIS)

    Milam, J.A.; Kinser, D.E.

    1993-01-01

    One of the big six accounting firms recently consolidated several offices into a regional headquarters located in a southern metropolitan city. This regional headquarters involved seven floors totalling 187,000 square feet of tenant space in a new high rise building. The accounting firm realized that improving their employees' work environment would provide significant savings from increased worker productivity and reduced absenteeism. Therefore, the firm retained Environmental Design International (EDI) to provide consulting services to create and maintain an environmentally healthy office space. The creation of a healthy, productive and safe indoor environment involves a total, holistic approach to the various elements that affect indoor environmental quality (IEQ) in a building. A holistic approach requires detailed evaluation of all areas that impact indoor environmental quality and not just the more common review of HVAC systems. This case study shows that the optimization of a healthy indoor environment is an endless, all inclusive process: beginning with the initial construction material selections and environmental systems design; continuing through the construction and commissioning phases; and progressing to pro-active monitoring of IEQ parameters to protect the tenant's investment in a healthy, productive and safe indoor environment

  5. A multiple multicomponent approach to chimeric peptide-peptoid podands.

    Science.gov (United States)

    Rivera, Daniel G; León, Fredy; Concepción, Odette; Morales, Fidel E; Wessjohann, Ludger A

    2013-05-10

    The success of multi-armed, peptide-based receptors in supramolecular chemistry traditionally is not only based on the sequence but equally on an appropriate positioning of various peptidic chains to create a multivalent array of binding elements. As a faster, more versatile and alternative access toward (pseudo)peptidic receptors, a new approach based on multiple Ugi four-component reactions (Ugi-4CR) is proposed as a means of simultaneously incorporating several binding and catalytic elements into organizing scaffolds. By employing α-amino acids either as the amino or acid components of the Ugi-4CRs, this multiple multicomponent process allows for the one-pot assembly of podands bearing chimeric peptide-peptoid chains as appended arms. Tripodal, bowl-shaped, and concave polyfunctional skeletons are employed as topologically varied platforms for positioning the multiple peptidic chains formed by Ugi-4CRs. In a similar approach, steroidal building blocks with several axially-oriented isocyano groups are synthesized and utilized to align the chimeric chains with conformational constrains, thus providing an alternative to the classical peptido-steroidal receptors. The branched and hybrid peptide-peptoid appendages allow new possibilities for both rational design and combinatorial production of synthetic receptors. The concept is also expandable to other multicomponent reactions. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Gender-Based Violence Causing Severe Multiple Injuries; a Case Report

    Directory of Open Access Journals (Sweden)

    Adalard Falschung

    2018-04-01

    Full Text Available Introduction: Gender-based violence (GBV against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk.

  7. The slice balance approach (SBA): a characteristic-based, multiple balance SN approach on unstructured polyhedral meshes

    International Nuclear Information System (INIS)

    Grove, R.E.

    2005-01-01

    The Slice Balance Approach (SBA) is an approach for solving geometrically-complex, neutral-particle transport problems within a multi-group discrete ordinates (S N ) framework. The salient feature is an angle-dependent spatial decomposition. We approximate general surfaces with arbitrary polygonal faces and mesh the geometry with arbitrarily-shaped polyhedral cells. A cell-local spatial decomposition divides cells into angle-dependent slices for each S N direction. This subdivision follows from a characteristic-based view of the transport problem. Most balance-based characteristic methods use it implicitly; we use it explicitly and exploit its properties. Our mathematical approach is a multiple balance approach using exact spatial moments balance equations on cells and slices along with auxiliary relations on slices. We call this the slice balance approach; it is a characteristic-based multiple balance approach. The SBA is intentionally general and can extend differencing schemes to arbitrary 2-D and 3-D meshes. This work contributes to development of general-geometry deterministic transport capability to complement Monte Carlo capability for large, geometrically-complex transport problems. The purpose of this paper is to describe the SBA. We describe the spatial decomposition and mathematical framework and highlight a few interesting properties. We sketch the derivation of two solution schemes, a step characteristic scheme and a diamond-difference-like scheme, to illustrate the approach and we present interesting results for a 2-D problem. (author)

  8. An ensemble prediction approach to weekly Dengue cases forecasting based on climatic and terrain conditions

    Directory of Open Access Journals (Sweden)

    Sougata Deb

    2017-11-01

    Full Text Available Introduction: Dengue fever has been one of the most concerning endemic diseases of recent times. Every year, 50-100 million people get infected by the dengue virus across the world. Historically, it has been most prevalent in Southeast Asia and the Pacific Islands. In recent years, frequent dengue epidemics have started occurring in Latin America as well. This study focused on assessing the impact of different short and long-term lagged climatic predictors on dengue cases. Additionally, it assessed the impact of building an ensemble model using multiple time series and regression models, in improving prediction accuracy. Materials and Methods: Experimental data were based on two Latin American cities, viz. San Juan (Puerto Rico and Iquitos (Peru. Due to weather and geographic differences, San Juan recorded higher dengue incidences than Iquitos. Using lagged cross-correlations, this study confirmed the impact of temperature and vegetation on the number of dengue cases for both cities, though in varied degrees and time lags. An ensemble of multiple predictive models using an elaborate set of derived predictors was built and validated. Results: The proposed ensemble prediction achieved a mean absolute error of 21.55, 4.26 points lower than the 25.81 obtained by a standard negative binomial model. Changes in climatic conditions and urbanization were found to be strong predictors as established empirically in other researches. Some of the predictors were new and informative, which have not been explored in any other relevant studies yet. Discussion and Conclusions: Two original contributions were made in this research. Firstly, a focused and extensive feature engineering aligned with the mosquito lifecycle. Secondly, a novel covariate pattern-matching based prediction approach using past time series trend of the predictor variables. Increased accuracy of the proposed model over the benchmark model proved the appropriateness of the analytical approach

  9. 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.

  10. Multiple commodities in statistical microeconomics: Model and market

    Science.gov (United States)

    Baaquie, Belal E.; Yu, Miao; Du, Xin

    2016-11-01

    A statistical generalization of microeconomics has been made in Baaquie (2013). In Baaquie et al. (2015), the market behavior of single commodities was analyzed and it was shown that market data provides strong support for the statistical microeconomic description of commodity prices. The case of multiple commodities is studied and a parsimonious generalization of the single commodity model is made for the multiple commodities case. Market data shows that the generalization can accurately model the simultaneous correlation functions of up to four commodities. To accurately model five or more commodities, further terms have to be included in the model. This study shows that the statistical microeconomics approach is a comprehensive and complete formulation of microeconomics, and which is independent to the mainstream formulation of microeconomics.

  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. 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.

  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. 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.

  15. Per-Sample Multiple Kernel Approach for Visual Concept Learning

    Directory of Open Access Journals (Sweden)

    Ling-Yu Duan

    2010-01-01

    Full Text Available Learning visual concepts from images is an important yet challenging problem in computer vision and multimedia research areas. Multiple kernel learning (MKL methods have shown great advantages in visual concept learning. As a visual concept often exhibits great appearance variance, a canonical MKL approach may not generate satisfactory results when a uniform kernel combination is applied over the input space. In this paper, we propose a per-sample multiple kernel learning (PS-MKL approach to take into account intraclass diversity for improving discrimination. PS-MKL determines sample-wise kernel weights according to kernel functions and training samples. Kernel weights as well as kernel-based classifiers are jointly learned. For efficient learning, PS-MKL employs a sample selection strategy. Extensive experiments are carried out over three benchmarking datasets of different characteristics including Caltech101, WikipediaMM, and Pascal VOC'07. PS-MKL has achieved encouraging performance, comparable to the state of the art, which has outperformed a canonical MKL.

  16. Per-Sample Multiple Kernel Approach for Visual Concept Learning

    Directory of Open Access Journals (Sweden)

    Tian Yonghong

    2010-01-01

    Full Text Available Abstract Learning visual concepts from images is an important yet challenging problem in computer vision and multimedia research areas. Multiple kernel learning (MKL methods have shown great advantages in visual concept learning. As a visual concept often exhibits great appearance variance, a canonical MKL approach may not generate satisfactory results when a uniform kernel combination is applied over the input space. In this paper, we propose a per-sample multiple kernel learning (PS-MKL approach to take into account intraclass diversity for improving discrimination. PS-MKL determines sample-wise kernel weights according to kernel functions and training samples. Kernel weights as well as kernel-based classifiers are jointly learned. For efficient learning, PS-MKL employs a sample selection strategy. Extensive experiments are carried out over three benchmarking datasets of different characteristics including Caltech101, WikipediaMM, and Pascal VOC'07. PS-MKL has achieved encouraging performance, comparable to the state of the art, which has outperformed a canonical MKL.

  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. The role of international policy transfer within the Multiple Streams Approach: the case of smart electricity metering in Australia

    OpenAIRE

    Lovell, Heather

    2016-01-01

    This paper draws on Kingdon’s Multiple Streams Approach (MSA) to consider international flows of policy, not just domestic. It is argued that using the MSA in conjunction with international policy transfer and mobility theories allows for a fuller explanation of the development of smart electricity metering policy in Australia. The MSA is based originally on empirical research within a single country - the USA - in the late 1970s, and all three of the ‘streams’ identified as important to poli...

  19. 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

  20. When to Use Methadone for pain: A Case-Based Approach.

    Science.gov (United States)

    Palat, Gayatri; Vallath, Nandini; Chary, Srini; Broderick, Ann

    2018-01-01

    The case studies are written in this article to illustrate how methadone might be used for pain in the Indian context. These cases might be used for discussion in a multidisciplinary team, or for individual study. It is important to understand that pain requires a multidisciplinary approach as opioids will assist only with physical, i.e. neuropathic and nociceptive pain, but not emotional, spiritual, or relational pain or the pain of immobility. The social determinants of pain were included to demonstrate how emotional, relational, and psychological dimensions of pain amplify the physical aspects of pain. The case studies follow a practical step-wise approach to pain while undergoing cancer treatment, pain toward the end-of-life and needing longer acting opioid. Methadone in children, and methadone in conditions of opioid toxicity or where there is a need for absorption in the proximal intestine cases are included.

  1. Archaeology, historical site risk assessment and monitoring by UAV: approaches and case studies

    Science.gov (United States)

    Pecci, Antonio; Masini, Nicola

    2016-04-01

    multiple overlapping images. The usefulness of UAV-based investigations has been given by its integrability with other methods of remote sensing including geophysics, optical and SAR satellite remote sensing. The presentation deals with the methodological approaches and the results in three historical sites for different applications such as: 1) archaeological site discovery, 2) the study and observation of archaeological looting and 3) the 3d reconstruction of building and sites. In the case 1) UAV has been used for the creation of orthophotos and digital elevantion models (DEMs) as well as the identification of archaeological marks and microrelief, as proxy indicators of the presence of archaeological buried remains. The obtained information have been compared and integrated with those provided by georadar and geomagnetic prospections. The investigated site is a medieval settlement, including a benedectine monastery, dated to 12-15th century. It is San Pietro a Cellaria, located in the territory of Calvello, in Basilicata (Southern Italy). The multisensor integrated approach allowed to identify several features referable to buried structures of the monastery (Leucci et al. 2015; Roubis et al. 2015). In the case 2) UAVs have been used for the identification and analysis of traces of grave robbers, in the territory of Anzi (Basilicata). Since the end of the 18th century to the first half of the 20th century, hundreds of tombs of the Archaic, Lucan and Roman age have been destroyed and stolen. The case 3) is related to the ceremonial centre of Pachacamac in Peru, which was investigated for several years by the international mission ITACA (Italian scientific mission for heritage Conservation and Archaeogeophysics) of IBAM/IMAA CNR of Potenza (Italy) (Lasaponara et al. 2016b). For more than 2,000 years, Pachacamac was one of the main centers of religious cult keeping this role unchanged in different historical periods and for different cultures such as Chavin, Lima, Huari

  2. Case studies on the use of the 'risk matrix' approach for accident prevention in radiotherapy

    International Nuclear Information System (INIS)

    Dumenigo, Cruz; Vilaragut, Juan J.; Soler, Karen; Cruz, Yoanis; Batista, Fidel; Morales, Jorge L.; Perez, Adrian; Farlane, Teresa Mc.; Guerrero, Mayrka

    2010-01-01

    External beam radiotherapy is the only practice during which humans are directly exposed to a radiation beam to receive high doses. Accidental exposures have occurred throughout the world, thus showing the need for systematic safety assessments, capable to identify preventive measures and to minimize consequences of accidental exposure. The 'risk matrix' approach is a semi quantitative method to evaluate the likelihood and the severity of events by means of a scale, and defines acceptability criteria on the basis of the risk. For each accident sequence identified, the following questions come up: how often is it?, how severe are the consequences? and, what safety measures should be taken to prevent it?. From these answers we can obtain the resulting risk by using the 'Risk Matrix' table. In this study we have used this method to conduct the study in 3 cases (real radiotherapy departments). The case study identified the major weaknesses in radiotherapy service and proposed measures to reduce the risk of accidents. The method is practical and it could be applied in hospitals. This approach allows regulators to improve the quality of their inspections and the rigor of the assessments made to grant the operating license to the entities working with radiotherapy. (author)

  3. Benefit of Doubt Approach to Case Weighting

    DEFF Research Database (Denmark)

    Wittrup, Jesper; Bogetoft, Peter

    The implementation of an efficient and reliable case weighting system (CWS) is currently considered essential for running an efficient judiciary. However, traditional models for establishing case weights are time-consuming and expensive. Furthermore, since such case weights are often viewed...... as indications of the relative " importance " of different types of court cases, they are bound to raise controversy. The most elaborate weighting system is likely to have its critics who question whether the established weights are fair. To address these issues, we suggest a new " benefit of the doubt...... between 150 and 250 minutes, or as simple ordinal rankings, e.g., case type B requires more time than case type A. The use of partial weight information and a benefit of the doubt approach reduces the need for detailed time-studies and prolonged " negotiations " among stakeholders. Moreover, most...

  4. Case Study Research: Foundations and Methodological Orientations

    Directory of Open Access Journals (Sweden)

    Helena Harrison

    2017-01-01

    Full Text Available Over the last forty years, case study research has undergone substantial methodological development. This evolution has resulted in a pragmatic, flexible research approach, capable of providing comprehensive in-depth understanding of a diverse range of issues across a number of disciplines. Change and progress have stemmed from parallel influences of historical transformations in approaches to research and individual researcher's preferences, perspectives, and interpretations of this design. Researchers who have contributed to the development of case study research come from diverse disciplines with different philosophical perspectives, resulting in a variety of definitions and approaches. For the researcher new to using case study, such variety can create a confusing platform for its application. In this article, we explore the evolution of case study research, discuss methodological variations, and summarize key elements with the aim of providing guidance on the available options for researchers wanting to use case study in their work. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1701195

  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. Multiple Intelligences within the Cross-Curricular Approach

    Directory of Open Access Journals (Sweden)

    Anthoula Vaiou

    2010-02-01

    Full Text Available The present study was realized in a Greek 6th grade State Primary School class and was based on Howard Gardner’s theory of multiple intelligences, which was first introduced in 1983. More particularly, it was explored to what extent the young learners possess multiple intelligences through the use of a specially-designed questionnaire and a series of interviews. The findings of the above have served as a tool to the construction of a project work based on students’ learning preferences within a cross-curricular framework, easily applicable to the Greek State School curriculum. All learners were activated to participate within a school environment that traditionally promotes linguistic and mathematical skills matching dominant multiple intelligences or a combination of some of them to thematic units already taught by Greek teachers. The suggested project was assessed through observation and student portfolio, showing that the young learners’ multiple intelligences were exploited to a great extent, promoting the learning process satisfactorily. The results of this study can provide a contribution to the literature of multiple intelligences in the Greek reality and suggest a need for further consideration and exploration in the field. Finally, the researcher of this study hopes the present work could function as a springboard for more elaborated studies in the future.

  7. 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.

  8. 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.

  9. An Automated Approach to Reasoning Under Multiple Perspectives

    Science.gov (United States)

    deBessonet, Cary

    2004-01-01

    This is the final report with emphasis on research during the last term. The context for the research has been the development of an automated reasoning technology for use in SMS (symbolic Manipulation System), a system used to build and query knowledge bases (KBs) using a special knowledge representation language SL (Symbolic Language). SMS interpreters assertive SL input and enters the results as components of its universe. The system operates in two basic models: 1) constructive mode (for building KBs); and 2) query/search mode (for querying KBs). Query satisfaction consists of matching query components with KB components. The system allows "penumbral matches," that is, matches that do not exactly meet the specifications of the query, but which are deemed relevant for the conversational context. If the user wants to know whether SMS has information that holds, say, for "any chow," the scope of relevancy might be set so that the system would respond based on a finding that it has information that holds for "most dogs," although this is not exactly what was called for by the query. The response would be qualified accordingly, as would normally be the case in ordinary human conversation. The general goal of the research was to develop an approach by which assertive content could be interpreted from multiple perspectives so that reasoning operations could be successfully conducted over the results. The interpretation of an SL statement such as, "{person believes [captain (asserted (perhaps)) (astronaut saw (comet (bright)))]}," which in English would amount to asserting something to the effect that, "Some person believes that a captain perhaps asserted that an astronaut saw a bright comet," would require the recognition of multiple perspectives, including some that are: a) epistemically-based (focusing on "believes"); b) assertion-based (focusing on "asserted"); c) perception-based (focusing on "saw"); d) adjectivally-based (focusing on "bight"); and e) modally

  10. Flood probability quantification for road infrastructure: Data-driven spatial-statistical approach and case study applications.

    Science.gov (United States)

    Kalantari, Zahra; Cavalli, Marco; Cantone, Carolina; Crema, Stefano; Destouni, Georgia

    2017-03-01

    Climate-driven increase in the frequency of extreme hydrological events is expected to impose greater strain on the built environment and major transport infrastructure, such as roads and railways. This study develops a data-driven spatial-statistical approach to quantifying and mapping the probability of flooding at critical road-stream intersection locations, where water flow and sediment transport may accumulate and cause serious road damage. The approach is based on novel integration of key watershed and road characteristics, including also measures of sediment connectivity. The approach is concretely applied to and quantified for two specific study case examples in southwest Sweden, with documented road flooding effects of recorded extreme rainfall. The novel contributions of this study in combining a sediment connectivity account with that of soil type, land use, spatial precipitation-runoff variability and road drainage in catchments, and in extending the connectivity measure use for different types of catchments, improve the accuracy of model results for road flood probability. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. 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....

  12. Managing Institutional and Sociocultural Challenges through Sociotransformative Constructivism: A Longitudinal Case Study of a High School Science Teacher

    Science.gov (United States)

    Rodriguez, Alberto J.

    2015-01-01

    Using a case study approach, this manuscript describes the professional transformation of Gary--an Anglo, male novice teacher--by focusing on his first two years of teaching in a culturally diverse and economically disadvantaged school. As a participant of a larger hybrid, intervention project with peers, Gary received multiple hands-on and…

  13. 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.

  14. Comparing Multiple Intelligences Approach with Traditional Teaching on Eight Grade Students' Achievement in and Attitudes toward Science

    Science.gov (United States)

    Kaya, Osman Nafiz; Dogan, Alev; Gokcek, Nur; Kilic, Ziya; Kilic, Esma

    2007-01-01

    The purpose of this study was to investigate the effects of multiple intelligences (MI) teaching approach on 8th Grade students' achievement in and attitudes toward science. This study used a pretest-posttest control group experimental design. While the experimental group (n=30) was taught a unit on acids and bases using MI teaching approach, the…

  15. Management Communication Strategy in Case Assignments: The Double-Message Approach.

    Science.gov (United States)

    Stevens, Betsy

    1994-01-01

    Offers a solution to the limitations of using case studies in business communication classes that use the double-message approach, in which students write a context memorandum along with their response to the case protagonist, thus providing instructors with a social context for cases and additional dimensions that enhance the instructor's ability…

  16. Non-syndromic multiple keratocyst odontogenic tumor: A rare case report

    Directory of Open Access Journals (Sweden)

    Abhijeet Alok

    2015-01-01

    Full Text Available Keratocystic odontogenic tumors (KCOTs are one of the most frequent features of nevoid basal cell carcinoma syndrome (NBCCS. The condition is linked with mutation in the PTCH gene. Partial expression of the gene may result in occurrence of multiple recurring odontogenic keratocysts (OKCs. Although KCOTs are common in clinical practice, simultaneous occurrence of multiple cysts in both the maxilla and mandible of a patient is rare. These patients have early propensity to develop multiple neoplasms like basal cell carcinoma and medulloblastoma. Hence, early diagnosis and treatment is of utmost importance in reducing the severity of the long-term sequelae of NBCCS. We report a rare case of multiple KCOTs in a non-syndromic male patient, with emphasis on its diagnosis, radiographic features, and treatment.

  17. Place Branding – Geographical Approach. Case Study: Waterloo

    Directory of Open Access Journals (Sweden)

    Marius-Cristian Neacşu

    2016-11-01

    Full Text Available This study represents an exploratory analysis of the evolution of the place branding concept, with an important focus on the geographical perspective. How has this notion, a newcomer into the geographers' analysis, changed over time and what role does it have in the decision making process of intervening into the way a certain place is organised or as an instrument of economic revival and territorial development? At least from the perspective of Romanian geographical literature, the originality and novelty of this study is obvious. An element of the originality of this research is the attempt of redefining the concept of place branding so that it is more meaningful from the perspective of spatial analyses. The reason for which Waterloo was chosen as a case study is multi-dimensional: the case studies so far have mainly focused on large cities (urban branding instead of place branding and this site has all the theoretical elements to create a stand-alone brand.

  18. Blockchain-Oriented Coalition Formation by CPS Resources: Ontological Approach and Case Study

    Directory of Open Access Journals (Sweden)

    Alexey Kashevnik

    2018-05-01

    Full Text Available Cyber-physical systems (CPS, robotics, Internet of Things, information and communication technologies have become more and more popular over the last several years. These topics open new perspectives and scenarios that can automate processes in human life. CPS are aimed at interaction support in information space for physical entities communicated in physical space in real time. At the same time the blockchain technology that becomes popular last years allows to organize immutable distributed database that store all significant information and provide access for CPS participants. The paper proposes an approach that is based on ontology-based context management, publish/subscribe semantic interoperability support, and blockchain techniques. Utilization of these techniques provide possibilities to develop CPS that supports dynamic, distributed, and stable coalition formation of the resources. The case study presented has been implemented for the scenario of heterogeneous mobile robots’ collaboration for the overcoming of obstacles. There are two types of robots and an information service participating in the scenario. Evaluation shows that the proposed approach is applicable for the presented class of scenarios.

  19. 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.

  20. The CASE Project: Evaluation of Case-Based Approaches to Learning and Teaching in Statistics Service Courses

    Science.gov (United States)

    Fawcett, Lee

    2017-01-01

    The CASE project (Case-based Approaches to Statistics Education; see www.mas.ncl.ac.uk/~nlf8/innovation) was established to investigate how the use of real-life, discipline-specific case study material in Statistics service courses could improve student engagement, motivation, and confidence. Ultimately, the project aims to promote deep learning…

  1. Semantic Web Ontology and Data Integration: a Case Study in Aiding Psychiatric Drug Repurposing.

    Science.gov (United States)

    Liang, Chen; Sun, Jingchun; Tao, Cui

    2015-01-01

    There remain significant difficulties selecting probable candidate drugs from existing databases. We describe an ontology-oriented approach to represent the nexus between genes, drugs, phenotypes, symptoms, and diseases from multiple information sources. We also report a case study in which we attempted to explore candidate drugs effective for bipolar disorder and epilepsy. We constructed an ontology incorporating knowledge between the two diseases and performed semantic reasoning tasks with the ontology. The results suggested 48 candidate drugs that hold promise for further breakthrough. The evaluation demonstrated the validity our approach. Our approach prioritizes the candidate drugs that have potential associations among genes, phenotypes and symptoms, and thus facilitates the data integration and drug repurposing in psychiatric disorders.

  2. Hybrid Optimization-Based Approach for Multiple Intelligent Vehicles Requests Allocation

    Directory of Open Access Journals (Sweden)

    Ahmed Hussein

    2018-01-01

    Full Text Available Self-driving cars are attracting significant attention during the last few years, which makes the technology advances jump fast and reach a point of having a number of automated vehicles on the roads. Therefore, the necessity of cooperative driving for these automated vehicles is exponentially increasing. One of the main issues in the cooperative driving world is the Multirobot Task Allocation (MRTA problem. This paper addresses the MRTA problem, specifically for the problem of vehicles and requests allocation. The objective is to introduce a hybrid optimization-based approach to solve the problem of multiple intelligent vehicles requests allocation as an instance of MRTA problem, to find not only a feasible solution, but also an optimized one as per the objective function. Several test scenarios were implemented in order to evaluate the efficiency of the proposed approach. These scenarios are based on well-known benchmarks; thus a comparative study is conducted between the obtained results and the suboptimal results. The analysis of the experimental results shows that the proposed approach was successful in handling various scenarios, especially with the increasing number of vehicles and requests, which displays the proposed approach efficiency and performance.

  3. Treatments of Missing Values in Large National Data Affect Conclusions: The Impact of Multiple Imputation on Arthroplasty Research.

    Science.gov (United States)

    Ondeck, Nathaniel T; Fu, Michael C; Skrip, Laura A; McLynn, Ryan P; Su, Edwin P; Grauer, Jonathan N

    2018-03-01

    Despite the advantages of large, national datasets, one continuing concern is missing data values. Complete case analysis, where only cases with complete data are analyzed, is commonly used rather than more statistically rigorous approaches such as multiple imputation. This study characterizes the potential selection bias introduced using complete case analysis and compares the results of common regressions using both techniques following unicompartmental knee arthroplasty. Patients undergoing unicompartmental knee arthroplasty were extracted from the 2005 to 2015 National Surgical Quality Improvement Program. As examples, the demographics of patients with and without missing preoperative albumin and hematocrit values were compared. Missing data were then treated with both complete case analysis and multiple imputation (an approach that reproduces the variation and associations that would have been present in a full dataset) and the conclusions of common regressions for adverse outcomes were compared. A total of 6117 patients were included, of which 56.7% were missing at least one value. Younger, female, and healthier patients were more likely to have missing preoperative albumin and hematocrit values. The use of complete case analysis removed 3467 patients from the study in comparison with multiple imputation which included all 6117 patients. The 2 methods of handling missing values led to differing associations of low preoperative laboratory values with commonly studied adverse outcomes. The use of complete case analysis can introduce selection bias and may lead to different conclusions in comparison with the statistically rigorous multiple imputation approach. Joint surgeons should consider the methods of handling missing values when interpreting arthroplasty research. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. 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.

  5. Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis: Case report

    Directory of Open Access Journals (Sweden)

    Ahmed Abroaf

    2014-03-01

    Full Text Available We describe the case of a 65 year-old male presenting with a tender right testicular mass, confirmed to be a tumour on ultrasound. The patient underwent a radical inguinal orchidectomy and histology revealed multiple adenomatoid tumours in epididymis and tunica vaginalis. This is an infrequent benign tumour of mesothelial origin that has rarely been reported as multiple lesions in the literature. Immunohistochemistry demonstrates that adenomatoid tumour and mesotheliomas share the expression of podoplanin (D2-40 which is helpful to differentiate them from carcinomas. On the other hand adenomatoid tumour is differentiated from mesothelioma on morphological grounds since the former does not exhibit cellular atypia, mitotic activity or bland focal tumour necrosis. Although testis preserving surgery can be an option for benign adenomatoid tumours, most patients (as in our case proceed to orchidectomy as diagnosing them confidently can be difficult.---------------------------Cite this article as: Abroaf A, Veeratterapillay R, Vasdev N, Majo J, Sherif AE, Paez E. Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis : Case Report. Int J Cancer Ther Oncol 2014; 2(1:02021.DOI: http://dx.doi.org/10.14319/ijcto.0202.1

  6. 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…

  7. Continuum multiple-scattering approach to electron-molecule scattering and molecular photoionization

    International Nuclear Information System (INIS)

    Dehmer, J.L.; Dill, D.

    1979-01-01

    The multiple-scattering approach to the electronic continuum of molecules is described. The continuum multiple-scattering model (CMSM) was developed as a survey tool and, as such was required to satisfy two requirements. First, it had to have a very broad scope, which means (i) molecules of arbitrary geometry and complexity containing any atom in the periodic system, (ii) continuum electron energies from 0-1000 eV, and (iii) capability to treat a large range of processes involving both photoionization and electron scattering. Second, the structure of the theory was required to lend itself to transparent, physical interpretation of major spectral features such as shape resonances. A comprehensive theoretical framework for the continuum multiple scattering method is presented, as well as its applications to electron-molecule scattering and molecular photoionization. Highlights of recent applications in these two areas are reviewed. The major impact of the resulting studies over the last few years has been to establish the importance of shape resonances in electron collisions and photoionization of practically all (non-hydride) molecules

  8. 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.

  9. Te Kotahitanga: A Case Study of a Repositioning Approach to Teacher Professional Development for Culturally Responsive Pedagogies

    Science.gov (United States)

    Hynds, Anne; Sleeter, Christine; Hindle, Rawiri; Savage, Catherine; Penetito, Wally; Meyer, Luanna H.

    2011-01-01

    This article presents a case study of a unique New Zealand professional development programme, Te Kotahitanga, for mainstream secondary school teachers. Findings discussed are drawn from an independent evaluation of the programme across 22 secondary schools. The professional development approach attempted to reposition the relationship between…

  10. Qualitative Case Study Research as Empirical Inquiry

    Science.gov (United States)

    Ellinger, Andrea D.; McWhorter, Rochell

    2016-01-01

    This article introduces the concept of qualitative case study research as empirical inquiry. It defines and distinguishes what a case study is, the purposes, intentions, and types of case studies. It then describes how to determine if a qualitative case study is the preferred approach for conducting research. It overviews the essential steps in…

  11. [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.

  12. Field theoretical approach to proton-nucleus reactions: II-Multiple-step excitation process

    International Nuclear Information System (INIS)

    Eiras, A.; Kodama, T.; Nemes, M.

    1989-01-01

    A field theoretical formulation to multiple step excitation process in proton-nucleus collision within the context of a relativistic eikonal approach is presented. A closed form expression for the double differential cross section can be obtained whose structure is very simple and makes the physics transparent. Glauber's formulation of the same process is obtained as a limit of ours and the necessary approximations are studied and discussed. (author) [pt

  13. A case of disseminated hydatid disease by surgery involving multiple organs

    Directory of Open Access Journals (Sweden)

    Asli Tanrivermis Sayit

    2014-09-01

    Full Text Available Hydatid disease is the most common parasitic infection in the world, and is caused by the parasite Echinococcus granulosus. The most common site of this disease is the liver (75%, followed by the lungs, kidney, bones, and brain. Multiple abdominal organ and peritoneal involvement can also be seen in some cases. The dissemination of hydatid cyst disease can develop spontaneously or secondary to trauma or surgery. Here, we present the case of a 69-year-old man with multiple cyst hydatidosis, who underwent surgery for acute appendicitis approximately 20 years previously. Computed tomography of the abdomen shows the multiple active and inactive cystic lesions in the liver, spleen, right kidney, and mesentery. This patient required surgery several times, as well as medical treatment, after the rupture of a mesenteric hydatid cyst during the appendectomy. Combined anthelmintic treatment was recommended to the patient who refused further surgical treatment.

  14. 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....

  15. On strength design using free material subjected to multiple load cases

    DEFF Research Database (Denmark)

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2013-01-01

    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...

  16. Knowledge-Based Approaches: Two cases of applicability

    DEFF Research Database (Denmark)

    Andersen, Tom

    1997-01-01

    Basic issues of the term: A knowledge-based approach (KBA) are discussed. Two cases of applicable to KBA are presented, and its concluded that KBA is more than just IT.......Basic issues of the term: A knowledge-based approach (KBA) are discussed. Two cases of applicable to KBA are presented, and its concluded that KBA is more than just IT....

  17. 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.

  18. D3.3 : report on “good practice” case studies of professional development in three countries

    DEFF Research Database (Denmark)

    Jensen, Bente

    This report presents ‘good practice case studies’ of exemplary approaches to innovative in-service professional development of ECEC practitioners in three countries: Denmark, Italy and Poland. The report is part of the project CARE “Curriculum Quality Analyses and Impact Review of European......, findings, limitations and discussion of results. This multiple case study involved data collection on innovative in-service professional development approaches in each of the three countries (Denmark, Italy, Poland) that were considered good examples of “innovative approaches to in-service PD” by local......’s well-being and learning. There is also a need for contact and exchange in the field and at the managers’ level, to single out possible paths for innovation, so as to understand how they work and how they can be adapted culturally in order to inspire and contribute to the development of effective...

  19. Loss-of-benefits analysis for nuclear power plant shutdowns: methodology and illustrative case study

    International Nuclear Information System (INIS)

    Peerenboom, J.P.; Buehring, W.A.; Guziel, K.A.

    1983-11-01

    A framework for loss-of-benefits analysis and a taxomony for identifying and categorizing the effects of nuclear power plant shutdowns or accidents are presented. The framework consists of three fundamental steps: (1) characterizing the shutdown; (2) identifying benefits lost as a result of the shutdown; and (3) quantifying effects. A decision analysis approach to regulatory decision making is presented that explicitly considers the loss of benefits. A case study of a hypothetical reactor shutdown illustrates one key loss of benefits: net replacement energy costs (i.e., change in production costs). Sensitivity studies investigate the responsiveness of case study results to changes in nuclear capacity factor, load growth, fuel price escalation, and discount rate. The effects of multiple reactor shutdowns on production costs are also described

  20. The double travelling salesman problem with multiple stacks - Formulation and heuristic solution approaches

    DEFF Research Database (Denmark)

    Petersen, Hanne Løhmann; Madsen, Oli B.G.

    2009-01-01

    This paper introduces the double travelling salesman problem with multiple stacks and presents four different metaheuristic approaches to its solution. The double TSP with multiple stacks is concerned with determining the shortest route performing pickups and deliveries in two separated networks...

  1. Approaches to dog health education programs in Australian rural and remote Indigenous communities: four case studies.

    Science.gov (United States)

    Constable, S E; Dixon, R M; Dixon, R J; Toribio, J-A

    2013-09-01

    Dog health in rural and remote Australian Indigenous communities is below urban averages in numerous respects. Many Indigenous communities have called for knowledge sharing in this area. However, dog health education programs are in their infancy, and lack data on effective practices. Without this core knowledge, health promotion efforts cannot progress effectively. This paper discusses a strategy that draws from successful approaches in human health and indigenous education, such as dadirri, and culturally respectful community engagement and development. Negotiating an appropriate education program is explored in its practical application through four case studies. Though each case was unique, the comparison of the four illustrated the importance of listening (community consultation), developing and maintaining relationships, community involvement and employment. The most successful case studies were those that could fully implement all four areas. Outcomes included improved local dog health capacity, local employment and engagement with the program and significantly improved dog health.

  2. 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.

  3. Teaching Business French through Case Studies: Presentation of a Marketing Case.

    Science.gov (United States)

    Federico, Salvatore; Moore, Catherine

    The use of case studies as a means for teaching business French is discussed. The approach is advocated because of the realism of case studies, which are based on actual occurrences. Characteristics of a good case are noted: it tells a story, focuses on interest-arousing issues, is set in the past 10 years, permits empathy with the main…

  4. 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

  5. Breeding approaches in simultaneous selection for multiple stress tolerance of maize in tropical environments

    Directory of Open Access Journals (Sweden)

    Denić M.

    2007-01-01

    Full Text Available Maize is the principal crop and major staple food in the most countries of Sub-Saharan Africa. However, due to the influence of abiotic and biotic stress factors, maize production faces serious constraints. Among the agro-ecological conditions, the main constraints are: lack and poor distribution of rainfall; low soil fertility; diseases (maize streak virus, downy mildew, leaf blights, rusts, gray leaf spot, stem/cob rots and pests (borers and storage pests. Among the socio-economic production constraints are: poor economy, serious shortage of trained manpower; insufficient management expertise, lack of use of improved varieties and poor cultivation practices. To develop desirable varieties, and thus consequently alleviate some of these constraints, appropriate breeding approaches and field-based methodologies in selection for multiple stress tolerance, were implemented. These approaches are mainly based on: a Crossing selected genotypes with more desirable stress tolerant and other agronomic traits; b Using the disease/pest spreader row method, combined with testing and selection of created progenies under strong to intermediate pressure of drought and low soil fertility in nurseries; and c Evaluation of the varieties developed in multi-location trials under low and "normal" inputs. These approaches provide testing and selection of large number of progenies, which is required for simultaneous selection for multiple stress tolerance. Data obtained revealed that remarkable improvement of the traits under selection was achieved. Biggest progress was obtained in selection for maize streak virus and downy mildew resistance, flintiness and earliness. In the case of drought stress, statistical analyses revealed significant negative correlation between yield and anthesis-silking interval, and between yield and days to silk, but positive correlation between yield and grain weight per ear.

  6. 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.

  7. Interventionist and participatory approaches to flood risk mitigation decisions: two case studies in the Italian Alps

    Science.gov (United States)

    Bianchizza, C.; Del Bianco, D.; Pellizzoni, L.; Scolobig, A.

    2012-04-01

    Flood risk mitigation decisions pose key challenges not only from a technical but also from a social, economic and political viewpoint. There is an increasing demand for improving the quality of these processes by including different stakeholders - and especially by involving the local residents in the decision making process - and by guaranteeing the actual improvement of local social capacities during and after the decision making. In this paper we analyse two case studies of flood risk mitigation decisions, Malborghetto-Valbruna and Vipiteno-Sterzing, in the Italian Alps. In both of them, mitigation works have been completed or planned, yet following completely different approaches especially in terms of responses of residents and involvement of local authorities. In Malborghetto-Valbruna an 'interventionist' approach (i.e. leaning towards a top down/technocratic decision process) was used to make decisions after the flood event that affected the municipality in the year 2003. In Vipiteno-Sterzing, a 'participatory' approach (i.e. leaning towards a bottom-up/inclusive decision process) was applied: decisions about risk mitigation measures were made by submitting different projects to the local citizens and by involving them in the decision making process. The analysis of the two case studies presented in the paper is grounded on the results of two research projects. Structured and in-depth interviews, as well as questionnaire surveys were used to explore residents' and local authorities' orientations toward flood risk mitigation. Also a SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) involving key stakeholders was used to better understand the characteristics of the communities and their perception of flood risk mitigation issues. The results highlight some key differences between interventionist and participatory approaches, together with some implications of their adoption in the local context. Strengths and weaknesses of the two approaches

  8. 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…

  9. Rare case of multiple meningiomas in nonneurofibromatosis patient at unusual locations

    Directory of Open Access Journals (Sweden)

    Setia Vikrant

    2017-06-01

    Full Text Available Multiple meningioma is a condition in which more than one intracranial lesion is seen in different location and these lesions may occur with or without signs of neurofibromatosis. Incidence of multiple meningioma range from 1 to 10% in different series. We report a case of multiple meningioma in a 33 years old female who had 14 intracranial lesions both supratentorially and infratentorially, and underwent surgery for large right lateral intraventricular meningioma. She had two meningiomas located in posterior fossa associated with supratentorial meningioma, which has been rarely reported.

  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. Nonfunctioning parathyromatosis after endoscopic thyroid lobectomy via an axillo-breast approach: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jong Chun; Jeong, Young Ju [School of Medicine, Catholic University of Daegu, Daegu (Korea, Republic of)

    2015-04-15

    Parathyromatosis is characterized by multiple lesions of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is caused by proliferation of embryonic remnant or seeding of parathyroid tissue after parathyroidectomy. Parathyromatosis is rare but is the common cause of recurrent hyperparathyroidism. We describe a unique case of non-functional parathyromatosis in a 16-year-old girl with a history of right thyroid lobectomy via an axillo-breast approach for a nonfunctioning parathyroid adenoma in the right side of the neck.

  12. Multiple Supernumerary Teeth in a Non-Syndromic Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    Majid Eshgh Pour

    2013-01-01

    Full Text Available Introduction: Multiple supernumerary teeth are a rare phenomenon. It occurs more often in patients with syndromes such as Gardner's syndrome, cleidocranial dysplasia and so on. This phenomenon in absence of such syndromes is rare. The purpose of this report was to introduce a case of non-syndromic multiple supernumerary impacted teeth.Case Report: A 29-year-old woman with no skeletal, metabolic, systemic and mental disorder was referred to oral and maxillofacial department of Mashhad dental school. In clinical evaluation, seven Permanent teeth were missing. In radiographic evaluation, there were a total of 15 impacted teeth which 7 of them were supernumerary.Conclusion: Missing or Excess of one or more teeth usually leads to occlusal and functional problems. In these cases, a complete clinical and radiographic examination accompanieal by a precise history should be performed to plan a suitable surgical-orthodontic-prosthetic treatment.

  13. Applying adaptive management in resource use in South African National Parks: A case study approach

    Directory of Open Access Journals (Sweden)

    Kelly Scheepers

    2011-05-01

    Conservation implications: There is no blueprint for the development of sustainable resource use systems and resource use is often addressed according to multiple approaches in national parks. However, the SANParks resource use policy provides a necessary set of guiding principles for resource use management across the national park system that allows for monitoring progress.

  14. 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.

  15. 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.

  16. 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...

  17. 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.

  18. Case Study of An Adopted Chinese Woman with Bulimia Nervosa: A Cultural and Transcultural Approach.

    Science.gov (United States)

    de Montgremier, Marion Vu-Augier; Chen, Liangliang; Chen, Jue; Moro, Marie Rose

    2017-08-25

    For a long time, eating disorders were considered as culture-bound syndromes, specific to Western countries. This theory has been refuted for anorexia, but few transcultural studies have been carried out on bulimia nervosa. As a result, knowledge concerning this disorder is limited. On the basis of a clinical case involving a bulimic Chinese girl, we attempt to demonstrate the impact of cultural factors on the disorder. We discuss the atypical characteristics of her symptom profile, in particular the absence of preoccupations concerning her appearance and the psycho-pathological impact of the secrecy surrounding her adoption. In this particular case, bulimia triggered a search for filiation and identity that could have later enabled her to restore harmonious family ties and to gain autonomy. We also examine the case in the context of adoption in China. This clinical case points out how important it is to take cultural factors into account and how useful a transcultural approach is in order to understand bulimia, and suggest effective methods of care.

  19. 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

  20. The application of microcatheter superselective catheterization in interventional chemoembolization for multiple hepatocarcinomas: an initial experience in 34 cases

    International Nuclear Information System (INIS)

    Xu Xiaolu; Chen Yongqiang; Wang Qing

    2012-01-01

    Objective: To assess the clinical value of superselective catheterization by using microcatheter in interventional chemoembolization for multiple hepatocarcinomas. Methods: A total of 68 patients with multiple hepatocarcinomas were enrolled in this study. The clinical data were retrospectively analyzed. Superselective catheterization by using a microcatheter was carried out in 34 cases (study group) and superselective catheterization by using a 4-5 F common catheter was performed in 34 cases (control group). The hepatic dysfunctions and the survival rate at 0.5, 1, 2 years were compared between the two groups. Results: The liver function of the patients in study group was much better than that of the patients in control group (P<0.05), and the survival time of the patients in study group was much longer than that of the patients in control group (P<0.05). Conclusion: For the treatment of multiple hepatocarcinomas, interventional chemoembolization by using microcatheter superselective catheterization technique is technically simple and clinically effective with high success rate and fewer complications. (authors)

  1. 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

  2. Understanding factors associated with the translation of cardiovascular research: a multinational case study approach

    Science.gov (United States)

    2014-01-01

    Background Funders of health research increasingly seek to understand how best to allocate resources in order to achieve maximum value from their funding. We built an international consortium and developed a multinational case study approach to assess benefits arising from health research. We used that to facilitate analysis of factors in the production of research that might be associated with translating research findings into wider impacts, and the complexities involved. Methods We built on the Payback Framework and expanded its application through conducting co-ordinated case studies on the payback from cardiovascular and stroke research in Australia, Canada and the United Kingdom. We selected a stratified random sample of projects from leading medical research funders. We devised a series of innovative steps to: minimize the effect of researcher bias; rate the level of impacts identified in the case studies; and interrogate case study narratives to identify factors that correlated with achieving high or low levels of impact. Results Twenty-nine detailed case studies produced many and diverse impacts. Over the 15 to 20 years examined, basic biomedical research has a greater impact than clinical research in terms of academic impacts such as knowledge production and research capacity building. Clinical research has greater levels of wider impact on health policies, practice, and generating health gains. There was no correlation between knowledge production and wider impacts. We identified various factors associated with high impact. Interaction between researchers and practitioners and the public is associated with achieving high academic impact and translation into wider impacts, as is basic research conducted with a clinical focus. Strategic thinking by clinical researchers, in terms of thinking through pathways by which research could potentially be translated into practice, is associated with high wider impact. Finally, we identified the complexity of

  3. A hybrid simulation approach for integrating safety behavior into construction planning: An earthmoving case study.

    Science.gov (United States)

    Goh, Yang Miang; Askar Ali, Mohamed Jawad

    2016-08-01

    One of the key challenges in improving construction safety and health is the management of safety behavior. From a system point of view, workers work unsafely due to system level issues such as poor safety culture, excessive production pressure, inadequate allocation of resources and time and lack of training. These systemic issues should be eradicated or minimized during planning. However, there is a lack of detailed planning tools to help managers assess the impact of their upstream decisions on worker safety behavior. Even though simulation had been used in construction planning, the review conducted in this study showed that construction safety management research had not been exploiting the potential of simulation techniques. Thus, a hybrid simulation framework is proposed to facilitate integration of safety management considerations into construction activity simulation. The hybrid framework consists of discrete event simulation (DES) as the core, but heterogeneous, interactive and intelligent (able to make decisions) agents replace traditional entities and resources. In addition, some of the cognitive processes and physiological aspects of agents are captured using system dynamics (SD) approach. The combination of DES, agent-based simulation (ABS) and SD allows a more "natural" representation of the complex dynamics in construction activities. The proposed hybrid framework was demonstrated using a hypothetical case study. In addition, due to the lack of application of factorial experiment approach in safety management simulation, the case study demonstrated sensitivity analysis and factorial experiment to guide future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Traditional and Alternative Approaches to the Method of Situational Analysis in Russia: Evidence from the Case Study “Istanbul in the Life and Works of Martiros Saryan”

    Directory of Open Access Journals (Sweden)

    Olga Fedotova

    2017-09-01

    Full Text Available The article analyzes the transformation of the methodological toolkit for teaching humanities and sciences in the Russian Federation. The method of case study, being widely spread in modern higher education research, is used as an example to illustrate the attempts to implement the best practices of foreign educational technology into tertiary academic process in Russia. The author provides some historical aspects of introducing case studies in modern teaching practice. The article features peculiarities of the Soviet approach to the structure of cases. Content analysis helps identify similarities and differences in Soviet/post-Soviet approaches to case study construction and brings into focus the problem points which reveal misinterpretation and/or misuse of didactic materials designated as cases. The approach suggested in the article implies presenting the content of a case study as a collection of documents related to a certain topic. The case study "Istanbul in the life and work of the artist Martiros Saryan" demonstrates that a case can have invariable and variable parts to reflect the specificity of the didactic task within the discipline. Such approach is expected to support students’ cognitive activity, develop creativity in searching additional sources and missing materials, improve efficiency of students’ autonomous work on solving complex problem solution.

  5. The optimal approach of detecting stochastic gravitational wave from string cosmology using multiple detectors

    International Nuclear Information System (INIS)

    Fan Xilong; Zhu Zonghong

    2008-01-01

    String cosmology models predict a relic background of gravitational wave produced during the dilaton-driven inflation. It's spectrum is most likely to be detected by ground gravitational wave laser interferometers (IFOs), like LIGO, Virgo, GEO, as the energy density grows rapidly with frequency. We show the certain ranges of the parameters that underlying string cosmology model using two approaches, associated with 5% false alarm and 95% detection rate. The result presents that the approach of combining multiple pairs of IFOs is better than the approach of directly combining the outputs of multiple IFOs for LIGOH, LIGOL, Virgo and GEO

  6. Analysis of eco-innovation with triple helix approach: case-study of biofloc catfish farming in Yogyakarta

    Science.gov (United States)

    Purwadi, D.; Nurlaily, I.

    2018-03-01

    Concerning environmental into focus of innovation process will expand the number of actor involved. Eco-innovation and triple helix are often frameworks applied to analyse how environmental concern are integrated in innovation process and how different stakeholder groups are having inter relation. Case study from biofloc catfish farming in Yogyakarta is presented to demonstrate a possible approach for researching the success of triple helix frameworks. This case is considered on basic of the result of a survey among farmers, academician and government. The paper concludes the creating of full triple helix encounters problem in practice. It also includes suggestion for further research on fisheries development.

  7. Approaches in studying the pharmacology of Chinese Medicine formulas: bottom-up, top-down-and meeting in the middle.

    Science.gov (United States)

    Huang, Tao; Zhong, Linda L D; Lin, Chen-Yuan; Zhao, Ling; Ning, Zi-Wan; Hu, Dong-Dong; Zhang, Man; Tian, Ke; Cheng, Chung-Wah; Bian, Zhao-Xiang

    2018-01-01

    Investigating the pharmacology is key to the modernization of Chinese Medicine (CM) formulas. However, identifying which are the active compound(s) of CM formulas, which biological entities they target, and through which signaling pathway(s) they act to modify disease symptoms, are still difficult tasks for researchers, even when equipped with an arsenal of advanced modern technologies. Multiple approaches, including network pharmacology, pharmaco-genomics, -proteomics, and -metabolomics, have been developed to study the pharmacology of CM formulas. They fall into two general categories in terms of how they tackle a problem: bottom-up and top-down. In this article, we compared these two different approaches in several dimensions by using the case of MaZiRenWan (MZRW, also known as Hemp Seed Pill), a CM herbal formula for functional constipation. Multiple hypotheses are easy to be proposed in the bottom-up approach (e.g. network pharmacology); but these hypotheses are usually false positives and hard to be tested. In contrast, it is hard to suggest hypotheses in the top-down approach (e.g. pharmacometabolomics); however, once a hypothesis is proposed, it is much easier to be tested. Merging of these two approaches could results in a powerful approach, which could be the new paradigm for the pharmacological study of CM formulas.

  8. Modified distal shoe appliance for premature loss of multiple deciduous molars: a case report.

    Science.gov (United States)

    Bhat, Prasanna Kumar; K, Navin H; Idris, Mohammed; Christopher, Pradeep; Rai, Niharika

    2014-08-01

    Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry. The premature loss of second primary molar before the eruption of permanent first molar can create a significant arch space/tooth size discrepancy. Distal shoe space maintainer is a valuable part of the Paediatric Dentist's armamentarium in those cases where the second primary molar is prematurely lost and it helps to guide the first permanent molar into place. Conventional design poses various limitations in cases of premature loss of multiple deciduous molars. Thus, it is required to modify the conventional designs according to the needs of the patient. This case report describes an innovative modification of distal shoe appliance in cases of premature loss of multiple deciduous molars. In the present case, modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars. Bilateral design of distal shoe was planned for unilateral loss of deciduous molars.

  9. Evaluating the Impact of the U.S. National Toxicology Program: A Case Study on Hexavalent Chromium.

    Science.gov (United States)

    Xie, Yun; Holmgren, Stephanie; Andrews, Danica M K; Wolfe, Mary S

    2017-02-01

    Evaluating the impact of federally funded research with a broad, methodical, and objective approach is important to ensure that public funds advance the mission of federal agencies. We aimed to develop a methodical approach that would yield a broad assessment of National Toxicology Program's (NTP's) effectiveness across multiple sectors and demonstrate the utility of the approach through a case study. A conceptual model was developed with defined activities, outputs (products), and outcomes (proximal, intermediate, distal) and applied retrospectively to NTP's research on hexavalent chromium (CrVI). Proximal outcomes were measured by counting views of and requests for NTP's products by external stakeholders. Intermediate outcomes were measured by bibliometric analysis. Distal outcomes were assessed through Web and LexisNexis searches for documents related to legislation or regulation changes. The approach identified awareness of NTP's work on CrVI by external stakeholders (proximal outcome) and citations of NTP's research in scientific publications, reports, congressional testimonies, and legal and policy documents (intermediate outcome). NTP's research was key to the nation's first-ever drinking water standard for CrVI adopted by California in 2014 (distal outcome). By applying this approach to a case study, the utility and limitations of the approach were identified, including challenges to evaluating the outcomes of a research program. This study identified a broad and objective approach for assessing NTP's effectiveness, including methodological needs for more thorough and efficient impact assessments in the future. Citation: Xie Y, Holmgren S, Andrews DMK, Wolfe MS. 2017. Evaluating the impact of the U.S. National Toxicology Program: a case study on hexavalent chromium. Environ Health Perspect 125:181-188; http://dx.doi.org/10.1289/EHP21.

  10. 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

  11. 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

  12. 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

  13. Using case study within a sequential explanatory design to evaluate the impact of specialist and advanced practice roles on clinical outcomes: the SCAPE study.

    Science.gov (United States)

    Lalor, Joan G; Casey, Dympna; Elliott, Naomi; Coyne, Imelda; Comiskey, Catherine; Higgins, Agnes; Murphy, Kathy; Devane, Declan; Begley, Cecily

    2013-04-08

    The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams. This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design. In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched non-postholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed 'different', and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context. Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms. Multiple approaches to data collection are needed to evaluate the impact

  14. Using data from multiple studies to develop a child growth correlation matrix.

    Science.gov (United States)

    Anderson, Craig; Xiao, Luo; Checkley, William

    2018-04-26

    In many countries, the monitoring of child growth does not occur in a regular manner, and instead, we may have to rely on sporadic observations that are subject to substantial measurement error. In these countries, it can be difficult to identify patterns of poor growth, and faltering children may miss out on essential health interventions. The contribution of this paper is to provide a framework for pooling together multiple datasets, thus allowing us to overcome the issue of sparse data and provide improved estimates of growth. We use data from multiple longitudinal growth studies to construct a common correlation matrix that can be used in estimation and prediction of child growth. We propose a novel 2-stage approach: In stage 1, we construct a raw matrix via a set of univariate meta-analyses, and in stage 2, we smooth this raw matrix to obtain a more realistic correlation matrix. The methodology is illustrated using data from 16 child growth studies from the Bill and Melinda Gates Foundation's Healthy Birth Growth and Development knowledge integration project and identifies strong correlation for both height and weight between the ages of 4 and 12 years. We use a case study to provide an example of how this matrix can be used to help compute growth measures. © 2018 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  15. Applied immuno-epidemiological research: an approach for integrating existing knowledge into the statistical analysis of multiple immune markers.

    Science.gov (United States)

    Genser, Bernd; Fischer, Joachim E; Figueiredo, Camila A; Alcântara-Neves, Neuza; Barreto, Mauricio L; Cooper, Philip J; Amorim, Leila D; Saemann, Marcus D; Weichhart, Thomas; Rodrigues, Laura C

    2016-05-20

    Immunologists often measure several correlated immunological markers, such as concentrations of different cytokines produced by different immune cells and/or measured under different conditions, to draw insights from complex immunological mechanisms. Although there have been recent methodological efforts to improve the statistical analysis of immunological data, a framework is still needed for the simultaneous analysis of multiple, often correlated, immune markers. This framework would allow the immunologists' hypotheses about the underlying biological mechanisms to be integrated. We present an analytical approach for statistical analysis of correlated immune markers, such as those commonly collected in modern immuno-epidemiological studies. We demonstrate i) how to deal with interdependencies among multiple measurements of the same immune marker, ii) how to analyse association patterns among different markers, iii) how to aggregate different measures and/or markers to immunological summary scores, iv) how to model the inter-relationships among these scores, and v) how to use these scores in epidemiological association analyses. We illustrate the application of our approach to multiple cytokine measurements from 818 children enrolled in a large immuno-epidemiological study (SCAALA Salvador), which aimed to quantify the major immunological mechanisms underlying atopic diseases or asthma. We demonstrate how to aggregate systematically the information captured in multiple cytokine measurements to immunological summary scores aimed at reflecting the presumed underlying immunological mechanisms (Th1/Th2 balance and immune regulatory network). We show how these aggregated immune scores can be used as predictors in regression models with outcomes of immunological studies (e.g. specific IgE) and compare the results to those obtained by a traditional multivariate regression approach. The proposed analytical approach may be especially useful to quantify complex immune

  16. 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.

  17. 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.

  18. Endoscopic Endonasal Approach in Skull Base Chondrosarcoma Associated with Maffucci Syndrome: Case Series and Literature Review.

    Science.gov (United States)

    Beer-Furlan, André; Balsalobre, Leonardo; Vellutini, Eduardo A S; Stamm, Aldo C

    2016-01-01

    Maffucci syndrome is a nonhereditary disorder in which patients develop multiple enchondromas and cutaneous, visceral, or soft tissue hemangiomas. The potential malignant progression of enchondroma into a secondary chondrosarcoma is a well-known fact. Nevertheless, chondrosarcoma located at the skull base in patients with Maffuci syndrome is a very rare condition, with only 18 cases reported in the literature. We report 2 other cases successfully treated through an expanded endoscopic endonasal approach and discuss the condition based on the literature review. Skull base chondrosarcoma associated with Maffucci syndrome is a rare condition. The disease cannot be cured, therefore surgical treatment should be performed in symptomatic patients aiming for maximal tumor resection with function preservation. The endoscopic endonasal approach is a safe and reliable alternative for the management of these tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. 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.

  20. A Systematic Approach to Identify Promising New Items for Small to Medium Enterprises: A Case Study

    Directory of Open Access Journals (Sweden)

    Sukjae Jeong

    2016-11-01

    Full Text Available Despite the growing importance of identifying new business items for small and medium enterprises (SMEs, most previous studies focus on conglomerates. The paucity of empirical studies has also led to limited real-life applications. Hence, this study proposes a systematic approach to find new business items (NBIs that help the prospective SMEs develop, evaluate, and select viable business items to survive the competitive environment. The proposed approach comprises two stages: (1 the classification of diversification of SMEs; and (2 the searching and screening of business items. In the first stage, SMEs are allocated to five groups, based on their internal technological competency and external market conditions. In the second stage, based on the types of SMEs identified in the first stage, a set of alternative business items is derived by combining the results of portfolio analysis and benchmarking analysis. After deriving new business items, a market and technology-driven matrix analysis is utilized to screen suitable business items, and the Bruce Merrifield-Ohe (BMO method is used to categorize and identify prospective items based on market attractiveness and internal capability. To illustrate the applicability of the proposed approach, a case study is presented.

  1. A simplified approach for evaluating multiple test outcomes and multiple disease states in relation to the exercise thallium-201 stress test in suspected coronary artery disease

    International Nuclear Information System (INIS)

    Pollock, S.G.; Watson, D.D.; Gibson, R.S.; Beller, G.A.; Kaul, S.

    1989-01-01

    This study describes a simplified approach for the interpretation of electrocardiographic and thallium-201 imaging data derived from the same patient during exercise. The 383 patients in this study had also undergone selective coronary arteriography within 3 months of the exercise test. This matrix approach allows for multiple test outcomes (both tests positive, both negative, 1 test positive and 1 negative) and multiple disease states (no coronary artery disease vs 1-vessel vs multivessel coronary artery disease). Because this approach analyzes the results of 2 test outcomes simultaneously rather than serially, it also negates the lack of test independence, if such an effect is present. It is also demonstrated that ST-segment depression on the electrocardiogram and defects on initial thallium-201 images provide conditionally independent information regarding the presence of coronary artery disease in patients without prior myocardial infarction. In contrast, ST-segment depression on the electrocardiogram and redistribution on the delayed thallium-201 images may not provide totally independent information regarding the presence of exercise-induced ischemia in patients with or without myocardial infarction

  2. Logistics case study based research: Towards higher quality

    DEFF Research Database (Denmark)

    Pedrosa, Alex; Näslund, Dag; Jasmand, Claudia

    2012-01-01

    analysis of 134 case study based articles published in six leading logistics and supply chain management (SCM) journals between 1998 and 2010 is used to assess and evaluate the quality of the case study based research approach as documented in these publications. Findings – This research provides...... to address to ensure high quality of the case study based research approach in published articles. Research limitations/implications – This study is limited to the analysis of published articles in six logistics and SCM journals. Further research should investigate different journals in logistics and other...

  3. 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.

  4. 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.

  5. The organisational context of nursing care in stroke units: a case study approach.

    Science.gov (United States)

    Burton, Christopher R; Fisher, Andrea; Green, Theresa L

    2009-01-01

    Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care. A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units. Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing

  6. Nontesticular cancers in relatives of testicular germ cell tumor (TGCT) patients from multiple-case TGCT families

    Science.gov (United States)

    McMaster, Mary L; Heimdal, Ketil R; Loud, Jennifer T; Bracci, Janet S; Rosenberg, Philip S; Greene, Mark H

    2015-01-01

    Testicular germ cell tumors (TGCT) exhibit striking familial aggregation that remains incompletely explained. To improve the phenotypic definition of familial TGCT (FTGCT), we studied an international cohort of multiple-case TGCT families to determine whether first-degree relatives of FTGCT cases are at increased risk of other types of cancer. We identified 1041 first-degree relatives of TGCT cases in 66 multiple-case TGCT families from Norway and 64 from the United States (combined follow-up of 31,556 person-years). We collected data on all cancers (except nonmelanoma skin cancers) reported by the family informant in these relatives, and we attempted to verify all reported cancer diagnoses through medical or cancer registry records. We calculated observed-to-expected (O/E) standardized incidence ratios, together with 95% confidence intervals (CI), for invasive cancers other than TGCT. We found no increase in risk of cancer overall (Norway O/E = 0.8; 95% CI: 0.6–1.1 and United States O/E = 0.9; 95% CI: 0.7–1.3). Site-specific analyses pooled across the two countries revealed a leukemia excess (O/E = 6.5; 95% CI: 3.0–12.3), deficit of female breast cancer (O/E = 0.0; 95% CI: 0.0–0.6) and increased risk of soft tissue sarcoma (O/E = 7.2; 95% CI: 2.0–18.4); in all instances, these results were based on small case numbers and statistically significant only in Norway. While limited by sample size and potential issues relating to completeness of cancer reporting, this study in multiple-case TGCT families does not support the hypothesis that cancers other than testis cancer contribute to the FTGCT phenotype. PMID:25882629

  7. 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.

  8. 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

  9. 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 ...

  10. Variational Approaches for the Existence of Multiple Periodic Solutions of Differential Delay Equations

    Directory of Open Access Journals (Sweden)

    Rong Cheng

    2010-01-01

    Full Text Available The existence of multiple periodic solutions of the following differential delay equation (=−((− is established by applying variational approaches directly, where ∈ℝ, ∈(ℝ,ℝ and >0 is a given constant. This means that we do not need to use Kaplan and Yorke's reduction technique to reduce the existence problem of the above equation to an existence problem for a related coupled system. Such a reduction method introduced first by Kaplan and Yorke in (1974 is often employed in previous papers to study the existence of periodic solutions for the above equation and its similar ones by variational approaches.

  11. Environment And Genetics in Lung cancer Etiology (EAGLE study: An integrative population-based case-control study of lung cancer

    Directory of Open Access Journals (Sweden)

    Colombi Antonio

    2008-06-01

    Full Text Available Abstract Background Lung cancer is the leading cause of cancer mortality worldwide. Tobacco smoking is its primary cause, and yet the precise molecular alterations induced by smoking in lung tissue that lead to lung cancer and impact survival have remained obscure. A new framework of research is needed to address the challenges offered by this complex disease. Methods/Design We designed a large population-based case-control study that combines a traditional molecular epidemiology design with a more integrative approach to investigate the dynamic process that begins with smoking initiation, proceeds through dependency/smoking persistence, continues with lung cancer development and ends with progression to disseminated disease or response to therapy and survival. The study allows the integration of data from multiple sources in the same subjects (risk factors, germline variation, genomic alterations in tumors, and clinical endpoints to tackle the disease etiology from different angles. Before beginning the study, we conducted a phone survey and pilot investigations to identify the best approach to ensure an acceptable participation in the study from cases and controls. Between 2002 and 2005, we enrolled 2101 incident primary lung cancer cases and 2120 population controls, with 86.6% and 72.4% participation rate, respectively, from a catchment area including 216 municipalities in the Lombardy region of Italy. Lung cancer cases were enrolled in 13 hospitals and population controls were randomly sampled from the area to match the cases by age, gender and residence. Detailed epidemiological information and biospecimens were collected from each participant, and clinical data and tissue specimens from the cases. Collection of follow-up data on treatment and survival is ongoing. Discussion EAGLE is a new population-based case-control study that explores the full spectrum of lung cancer etiology, from smoking addiction to lung cancer outcome, through

  12. Teaching community diagnosis to medical students: evaluation of a case study approach.

    Science.gov (United States)

    Bair, C W

    1980-01-01

    A unique case study approach to training medical students in community diagnosis techniques was initiated at the Medical College of Ohio at Toledo. This paper describes the five elements of this teaching method: preliminary specification of target community and data base; group problem-solving requirement; specification of desired output; defined performance objectives; and regularly scheduled time for analysis. Experience with the case study method over two years was evaluated to identify specific strengths and weaknesses. The identified strengths include use of limited educational time to introduce community health problems, development of experience in a collegial team work setting, and specific awareness of the types of data useful to the analysis of community health service problems. Negative evaluations suggested that the method was not conducive to the development of skills in three areas: ability to establish the relative importance of health problems in communities; ability to identify an appropriate health system response to a community health problem from feasible alternatives; and ability to anticipate the community impact of health program modifications or improvements. Potential explanations for these deficiencies include: need for increased didactic support in the classroom for particular skill areas; need to establish a direct field experience in community diagnosis; inappropriateness of the data base used for evaluation of particular skills; and the probability that quantitative analysis, as used in this evaluation, may not be sufficient in and of itself to measure the outcome of a community diagnosis experience.

  13. Multiple Shooting and Time Domain Decomposition Methods

    CERN Document Server

    Geiger, Michael; Körkel, Stefan; Rannacher, Rolf

    2015-01-01

    This book offers a comprehensive collection of the most advanced numerical techniques for the efficient and effective solution of simulation and optimization problems governed by systems of time-dependent differential equations. The contributions present various approaches to time domain decomposition, focusing on multiple shooting and parareal algorithms.  The range of topics covers theoretical analysis of the methods, as well as their algorithmic formulation and guidelines for practical implementation. Selected examples show that the discussed approaches are mandatory for the solution of challenging practical problems. The practicability and efficiency of the presented methods is illustrated by several case studies from fluid dynamics, data compression, image processing and computational biology, giving rise to possible new research topics.  This volume, resulting from the workshop Multiple Shooting and Time Domain Decomposition Methods, held in Heidelberg in May 2013, will be of great interest to applied...

  14. Treatment of refractory epilepsy with natalizumab in a patient with multiple sclerosis. Case report

    Directory of Open Access Journals (Sweden)

    Constantin Gabriela

    2010-09-01

    Full Text Available Abstract Background Multiple sclerosis (MS is considered an autoimmune disease of the central nervous system and therapeutic inhibition of leukocyte migration with natalizumab, an anti-alpha4 integrin antibody, is highly effective in patients with MS. Recent studies performed in experimental animal models with relevance to human disease suggested a key role for blood-brain barrier damage and leukocyte trafficking mechanisms also in the pathogenesis of epilepsy. In addition, vascular alterations and increased leukocyte accumulation into the brain were recently documented in patients with refractory epilepsy independently on the disease etiology. Case report Here we describe the clinical course of a 24-year-old patient with MS in whom abrupt tonic-clonic generalized seizures manifested at disease onset. Although MS had a more favorable course, treatment with glatiramer acetate and antiepileptic drugs for 7 years had no control on seizure generation and the patient developed severe refractory epilepsy. Interestingly, generalized seizures preceded new MS relapses suggesting that seizure activity may contribute to MS worsening creating a positive feedback loop between the two disease conditions. Notably, treatment with natalizumab for 12 months improved MS condition and led to a dramatic reduction of seizures. Conclusion Our case report suggests that inhibition of leukocyte adhesion may represent a new potential therapeutic approach in epilepsy and complement the traditional therapy with anti-epileptic drugs.

  15. Factors associated with escalation and problematic approaches toward public figures.

    Science.gov (United States)

    Meloy, J Reid; James, David V; Mullen, Paul E; Pathé, Michele T; Farnham, Frank R; Preston, Lulu F; Darnley, Brian J

    2011-01-01

    Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research. © 2010 American Academy of Forensic Sciences.

  16. Multiple Realities and Hybrid Objects: A Creative Approach of Schizophrenic Delusion

    Directory of Open Access Journals (Sweden)

    Michel Cermolacce

    2018-02-01

    Full Text Available Delusion is usually considered in DSM 5 as a false belief based on incorrect inference about external reality, but the issue of delusion raises crucial concerns, especially that of a possible (or absent continuity between delusional and normal experiences, and the understanding of delusional experience. In the present study, we first aim to consider delusion from a perspectivist angle, according to the Multiple Reality Theory (MRT. In this model inherited from Alfred Schütz and recently addressed by Gallagher, we are not confronting one reality only, but several (such as the reality of everyday life, of imaginary life, of work, of delusion, etc.. In other terms, the MRT states that our own experience is not drawing its meaning from one reality identified as the outer reality but rather from a multiplicity of realities, each with their own logic and style. Two clinical cases illustrate how the Multiple Realities Theory (MRT may help address the reality of delusion. Everyday reality and the reality of delusion may be articulated under a few conditions, such as compossibility [i.e., Double Book-Keeping (DBK, in Bleulerian terms] or flexibility. There are indeed possible bridges between them. Possible links with neuroscience or psychoanalysis are evoked. As the subject is confronting different realities, so do the objects among and toward which a subject is evolving. We call such objects Hybrid Objects (HO due to their multiple belonging. They can operate as shifters, i.e., as some functional operators letting one switch from one reality to another. In the final section, we will emphasize how delusion flexibility, as a dynamic interaction between Multiple Realities, may offer psychotherapeutic possibilities within some reality shared with others, entailing relocation of the present subjects in regained access to some flexibility via Multiple Realities and perspectivism.

  17. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature.

    Science.gov (United States)

    Vigo, Federica; Ciammella, Patrizia; Valli, Riccardo; Cagni, Elisabetta; Iotti, Cinzia

    2012-08-10

    Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient.This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.

  18. Using Combinatorial Approach to Improve Students' Learning of the Distributive Law and Multiplicative Identities

    Science.gov (United States)

    Tsai, Yu-Ling; Chang, Ching-Kuch

    2009-01-01

    This article reports an alternative approach, called the combinatorial model, to learning multiplicative identities, and investigates the effects of implementing results for this alternative approach. Based on realistic mathematics education theory, the new instructional materials or modules of the new approach were developed by the authors. From…

  19. Approach to operational mine planning: Case study Tamnava West

    Directory of Open Access Journals (Sweden)

    Stevanović Dejan R.

    2014-01-01

    Full Text Available In contemporary mining industry is very difficult to achieve production targets and profit without investing effort in detailed excavation planning. It is especially true for deposits with complex geological structure and production technology, as is the case for many coal mines in Serbia. The majority of coal production is used for generation of electricity in power plant. This fact is the main reason why production objectives of coal mine and power plant are strongly connected. Due to the fluctuation of the coal quality, operational mine planning (as a part of coal homogenization process, is of critical importance for managing successful coal quality control and meeting criteria of power plant. This paper investigates advantage of proper operational planning on coal quality control process and overall production performance. For better understanding case study is conducted on open pit Tamnava West field. Successful operational mine planning is almost impossible without use of modern software packages. For that reason in presented case study operational mine planning is done with Minex software.

  20. Risk Governance of Multiple Natural Hazards: Centralized versus Decentralized Approach in Europe

    Science.gov (United States)

    Komendantova, Nadejda; Scolobig, Anna; Vinchon, Charlotte

    2014-05-01

    The multi-risk approach is a relatively new field and its definition includes the need to consider multiple hazards and vulnerabilities in their interdependency (Selva, 2013) and the current multi-hazards disasters, such as the 2011 Tohoku earthquake, tsunami and nuclear catastrophe, showed the need for a multi-risk approach in hazard mitigation and management. Our knowledge about multi-risk assessment, including studies from different scientific disciplines and developed assessment tools, is constantly growing (White et al., 2001). However, the link between scientific knowledge, its implementation and the results in terms of improved governance and decision-making have gained significantly less attention (IRGC, 2005; Kappes et al., 2012), even though the interest to risk governance, in general, has increased significantly during the last years (Verweiy and Thompson, 2006). Therefore, the key research question is how risk assessment is implemented and what is the potential for the implementation of a multi-risk approach in different governance systems across Europe. More precisely, how do the characteristics of risk governance, such as the degree of centralization versus decentralization, influence the implementation of a multi-risk approach. The methodology of this research includes comparative case study analysis of top-down and bottom-up interactions in governance in the city of Naples, (Italy), where the institutional landscape is marked by significant autonomy of Italian regions in decision-making processes for assessing the majority of natural risks, excluding volcanic, and in Guadeloupe, French West Indies, an overseas department of France, where the decision-making process is marked by greater centralization in decision making associated with a well established state governance within regions, delegated to the prefect and decentralised services of central ministries. The research design included documentary analysis and extensive empirical work involving

  1. Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study.

    Science.gov (United States)

    Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William

    2014-08-06

    Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach

  2. THE BILINGUAL INTERCULTURAL APPROACH AND ITS IMPACT ON THE QUALITY OF INDIGENOUS EDUCATION: CASE STUDY

    Directory of Open Access Journals (Sweden)

    José Viveros-Márquez

    2014-01-01

    Full Text Available This study presents the results of a systematic evaluation of the implementation of the Bilingual Intercultural approach (EIB in indigenous primary education and its impact on the quality of education, in the dimensions of equity, relevance, effectiveness and efficiency of education; in two indigenous regions of Mexico, with a comparative approach between the cases studied. The study is qualitative descriptive-explanatory section; the evaluation model CIPP (Context, Input, Process and Product and Shinkfield Stufflebeam (1987 was applied. It also appealed to the school ethnography, for data collection techniques of participant observation (class sessions focus group (teachers and parents, and semi-structured interview (managers and supervisors of each indigenous region. The results show that the EIB has had a limited impact on the quality of education; associated internal and external factors of each school and context; shape in the lack of effectiveness of the EIB in elementary school that significantly reduces the outcomes achieved by the indigenous teachers and education regarding bilingualism, multiculturalism and educational quality.

  3. 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.

  4. A Multiple Mobility Support Approach (MMSA Based on PEAS for NCW in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Bong-Joo Koo

    2011-01-01

    Full Text Available Wireless Sensor Networks (WSNs can be implemented as one of sensor systems in Network Centric Warfare (NCW. Mobility support and energy efficiency are key concerns for this application, due to multiple mobile users and stimuli in real combat field. However, mobility support approaches that can be adopted in this circumstance are rare. This paper proposes Multiple Mobility Support Approach (MMSA based on Probing Environment and Adaptive Sleeping (PEAS to support the simultaneous mobility of both multiple users and stimuli by sharing the information of stimuli in WSNs. Simulations using Qualnet are conducted, showing that MMSA can support multiple mobile users and stimuli with good energy efficiency. It is expected that the proposed MMSA can be applied to real combat field.

  5. Evaluating accounting information systems that support multiple GAAP reporting using Normalized Systems Theory

    NARCIS (Netherlands)

    Vanhoof, E.; Huysmans, P.; Aerts, Walter; Verelst, J.; Aveiro, D.; Tribolet, J.; Gouveia, D.

    2014-01-01

    This paper uses a mixed methods approach of design science and case study research to evaluate structures of Accounting Information Systems (AIS) that report in multiple Generally Accepted Accounting Principles (GAAP), using Normalized Systems Theory (NST). To comply with regulation, many companies

  6. A Unified Spatiotemporal Modeling Approach for Predicting Concentrations of Multiple Air Pollutants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution

    Science.gov (United States)

    Olives, Casey; Kim, Sun-Young; Sheppard, Lianne; Sampson, Paul D.; Szpiro, Adam A.; Oron, Assaf P.; Lindström, Johan; Vedal, Sverre; Kaufman, Joel D.

    2014-01-01

    Background: Cohort studies of the relationship between air pollution exposure and chronic health effects require predictions of exposure over long periods of time. Objectives: We developed a unified modeling approach for predicting fine particulate matter, nitrogen dioxide, oxides of nitrogen, and black carbon (as measured by light absorption coefficient) in six U.S. metropolitan regions from 1999 through early 2012 as part of the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air). Methods: We obtained monitoring data from regulatory networks and supplemented those data with study-specific measurements collected from MESA Air community locations and participants’ homes. In each region, we applied a spatiotemporal model that included a long-term spatial mean, time trends with spatially varying coefficients, and a spatiotemporal residual. The mean structure was derived from a large set of geographic covariates that was reduced using partial least-squares regression. We estimated time trends from observed time series and used spatial smoothing methods to borrow strength between observations. Results: Prediction accuracy was high for most models, with cross-validation R2 (R2CV) > 0.80 at regulatory and fixed sites for most regions and pollutants. At home sites, overall R2CV ranged from 0.45 to 0.92, and temporally adjusted R2CV ranged from 0.23 to 0.92. Conclusions: This novel spatiotemporal modeling approach provides accurate fine-scale predictions in multiple regions for four pollutants. We have generated participant-specific predictions for MESA Air to investigate health effects of long-term air pollution exposures. These successes highlight modeling advances that can be adopted more widely in modern cohort studies. Citation: Keller JP, Olives C, Kim SY, Sheppard L, Sampson PD, Szpiro AA, Oron AP, Lindström J, Vedal S, Kaufman JD. 2015. A unified spatiotemporal modeling approach for predicting concentrations of multiple air pollutants in the Multi

  7. 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.

  8. A kernel regression approach to gene-gene interaction detection for case-control studies.

    Science.gov (United States)

    Larson, Nicholas B; Schaid, Daniel J

    2013-11-01

    Gene-gene interactions are increasingly being addressed as a potentially important contributor to the variability of complex traits. Consequently, attentions have moved beyond single locus analysis of association to more complex genetic models. Although several single-marker approaches toward interaction analysis have been developed, such methods suffer from very high testing dimensionality and do not take advantage of existing information, notably the definition of genes as functional units. Here, we propose a comprehensive family of gene-level score tests for identifying genetic elements of disease risk, in particular pairwise gene-gene interactions. Using kernel machine methods, we devise score-based variance component tests under a generalized linear mixed model framework. We conducted simulations based upon coalescent genetic models to evaluate the performance of our approach under a variety of disease models. These simulations indicate that our methods are generally higher powered than alternative gene-level approaches and at worst competitive with exhaustive SNP-level (where SNP is single-nucleotide polymorphism) analyses. Furthermore, we observe that simulated epistatic effects resulted in significant marginal testing results for the involved genes regardless of whether or not true main effects were present. We detail the benefits of our methods and discuss potential genome-wide analysis strategies for gene-gene interaction analysis in a case-control study design. © 2013 WILEY PERIODICALS, INC.

  9. 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.

  10. 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

  11. Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.

    Science.gov (United States)

    Birkhead, Guthrie S; Klein, Susan J; Candelas, Alma R; O'Connell, Daniel A; Rothman, Jeffrey R; Feldman, Ira S; Tsui, Dennis S; Cotroneo, Richard A; Flanigan, Colleen A

    2007-10-01

    New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

  12. 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

  13. Cure in a patient with multiple osseus metastases in non-small cell lung cancer: a case report.

    Science.gov (United States)

    Hawighorst, H; Gademann, G

    1993-10-01

    This case was reported to describe a case of cure in a 61-year old patient with squamous cell lung cancer and multiple extrathoracic metastasis. A left upper lobectomy of lung for a squamous cell carcinoma was performed on a 61-year old man with curative intent. Four months later two osseus metastases were irradiated with Cobalt 60 up to 40 Gy. The two irradiated lesions showed continuously shrinkage as well as signs of recalcification. Eleven years later the patient shows clinically absolute well being and on CT there are no signs of recurrent disease of the lung or bone anymore. To our knowledge has nobody so far reported of a case of as squamous cell lung cancer which was operated and irradiated on thus resulting in cure. Further on the authors discuss that it might well be worthwhile to define subgroups in stage 4 non-small cell lung cancer (presence of extrathoracic metastases) which might benefit from a more aggressive treatment approach than pure palliation.

  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 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.

  16. 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)

  17. Methodology or method? A critical review of qualitative case study reports

    Directory of Open Access Journals (Sweden)

    Nerida Hyett

    2014-05-01

    Full Text Available Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12, social sciences and anthropology (n=7, or methods (n=15 case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

  18. Methodology or method? A critical review of qualitative case study reports

    Science.gov (United States)

    Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

    2014-01-01

    Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners. PMID:24809980

  19. Capability Approach for well-being Evaluation in Regional Development Planning : Case Study in Magelang Regency. Central java, Indonesia

    NARCIS (Netherlands)

    Pramono, Retno Widodo Dwi

    2016-01-01

    The thesis uses Amartya Sen’s Capability Approach (1993, 2000) to devise a set of criteria to evaluate the well-being and quality of life of economic groups in a case study of Magelang, a small rural area in Central Java, Indonesia. In applying this method, the researcher examines how the spatial

  20. 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…

  1. 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.

  2. Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study.

    Science.gov (United States)

    Gonzalez, Carolina

    2017-10-01

    In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients' development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners' specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.

  3. 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.

  4. Demonstration of statistical approaches to identify component's ageing by operational data analysis-A case study for the ageing PSA network

    International Nuclear Information System (INIS)

    Rodionov, Andrei; Atwood, Corwin L.; Kirchsteiger, Christian; Patrik, Milan

    2008-01-01

    The paper presents some results of a case study on 'Demonstration of statistical approaches to identify the component's ageing by operational data analysis', which was done in the frame of the EC JRC Ageing PSA Network. Several techniques: visual evaluation, nonparametric and parametric hypothesis tests, were proposed and applied in order to demonstrate the capacity, advantages and limitations of statistical approaches to identify the component's ageing by operational data analysis. Engineering considerations are out of the scope of the present study

  5. The impact of a multiple intelligences teaching approach drug education programme on drug refusal skills of Nigerian pupils.

    Science.gov (United States)

    Nwagu, Evelyn N; Ezedum, Chuks E; Nwagu, Eric K N

    2015-09-01

    The rising incidence of drug abuse among youths in Nigeria is a source of concern for health educators. This study was carried out on primary six pupils to determine the effect of a Multiple Intelligences Teaching Approach Drug Education Programme (MITA-DEP) on pupils' acquisition of drug refusal skills. A programme of drug education based on the Multiple Intelligences Teaching Approach (MITA) was developed. An experimental group was taught using this programme while a control group was taught using the same programme but developed based on the Traditional Teaching Approach. Pupils taught with the MITA acquired more drug refusal skills than those taught with the Traditional Teaching Approach. Urban pupils taught with the MITA acquired more skills than rural pupils. There was no statistically significant difference in the mean refusal skills of male and female pupils taught with the MITA. © The Author(s) 2014.

  6. Aircraft operational reliability—A model-based approach and a case study

    International Nuclear Information System (INIS)

    Tiassou, Kossi; Kanoun, Karama; Kaâniche, Mohamed; Seguin, Christel; Papadopoulos, Chris

    2013-01-01

    The success of an aircraft mission is subject to the fulfillment of some operational requirements before and during each flight. As these requirements depend essentially on the aircraft system components and the mission profile, the effects of failures can be very severe if they are not anticipated. Hence, one should be able to assess the aircraft operational reliability with regard to its missions in order to be able to cope with failures. We address aircraft operational reliability modeling to support maintenance planning during the mission achievement. We develop a modeling approach, based on a meta-model that is used as a basis: (i) to structure the information needed to assess aircraft operational reliability and (ii) to build a stochastic model that can be tuned dynamically, in order to take into account the aircraft system operational state, a mission profile and the maintenance facilities available at the flight stop locations involved in the mission. The aim is to enable operational reliability assessment online. A case study, based on an aircraft subsystem, is considered for illustration using the Stochastic Activity Networks (SANs) formalism

  7. Comparing routine neurorehabilitation program with trunk exercises based on Bobath concept in multiple sclerosis: pilot study.

    Science.gov (United States)

    Keser, Ilke; Kirdi, Nuray; Meric, Aydin; Kurne, Asli Tuncer; Karabudak, Rana

    2013-01-01

    This study compared trunk exercises based on the Bobath concept with routine neurorehabilitation approaches in multiple sclerosis (MS). Bobath and routine neurorehabilitation exercises groups were evaluated. MS cases were divided into two groups. Both groups joined a 3 d/wk rehabilitation program for 8 wk. The experimental group performed trunk exercises based on the Bobath concept, and the control group performed routine neurorehabilitation exercises. Additionally, both groups performed balance and coordination exercises. All patients were evaluated with the Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), and Multiple Sclerosis Functional Composite (MSFC) before and after the physiotherapy program. In group analysis, TIS, BBS, ICARS, and MSFC scores and strength of abdominal muscles were significantly different after treatment in both groups (p 0.05). Although trunk exercises based on the Bobath concept are rarely applied in MS rehabilitation, the results of this study show that they are as effective as routine neurorehabilitation exercises. Therefore, trunk exercises based on the Bobath concept can be beneficial in MS rehabilitation programs.

  8. 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.

  9. Approaches to child protection case management for cases involving people with disabilities.

    Science.gov (United States)

    Lightfoot, Elizabeth B; LaLiberte, Traci L

    2006-04-01

    This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.

  10. Spontaneous tumour lysis syndrome in a case of multiple myeloma – A rare occurrence

    Directory of Open Access Journals (Sweden)

    Kavitha Saravu

    2013-03-01

    Full Text Available We describe a case of a 40-year-old male patient who was found to have multiple myeloma with spontaneous tumour lysis syndrome (TLS, following a compression fracture of the L–2 vertebrae. Multiple myeloma was confirmed by bone marrow analysis and the M–band on serum protein electrophoresis. Hyperuricaemia (26.2 mg/dL, hyperkalaemia (> 7.0 mEq/L, hyperphosphatemia (16.2 mg of phosphorus/dL, normocalcemia and acute kidney injury, prior to anticancer treatment suggested spontaneous TLS. Inciting events for tumour lysis, such as chemotherapy, dehydration and exposure to steroids were absent. Patient received hydration, hypourecemic drugs and haemodialysis. This case report highlights the rare presentation of multiple myeloma with spontaneous TLS.

  11. Metaheuristic optimization approaches to predict shear-wave velocity from conventional well logs in sandstone and carbonate case studies

    Science.gov (United States)

    Emami Niri, Mohammad; Amiri Kolajoobi, Rasool; Khodaiy Arbat, Mohammad; Shahbazi Raz, Mahdi

    2018-06-01

    Seismic wave velocities, along with petrophysical data, provide valuable information during the exploration and development stages of oil and gas fields. The compressional-wave velocity (VP ) is acquired using conventional acoustic logging tools in many drilled wells. But the shear-wave velocity (VS ) is recorded using advanced logging tools only in a limited number of wells, mainly because of the high operational costs. In addition, laboratory measurements of seismic velocities on core samples are expensive and time consuming. So, alternative methods are often used to estimate VS . Heretofore, several empirical correlations that predict VS by using well logging measurements and petrophysical data such as VP , porosity and density are proposed. However, these empirical relations can only be used in limited cases. The use of intelligent systems and optimization algorithms are inexpensive, fast and efficient approaches for predicting VS. In this study, in addition to the widely used Greenberg–Castagna empirical method, we implement three relatively recently developed metaheuristic algorithms to construct linear and nonlinear models for predicting VS : teaching–learning based optimization, imperialist competitive and artificial bee colony algorithms. We demonstrate the applicability and performance of these algorithms to predict Vs using conventional well logs in two field data examples, a sandstone formation from an offshore oil field and a carbonate formation from an onshore oil field. We compared the estimated VS using each of the employed metaheuristic approaches with observed VS and also with those predicted by Greenberg–Castagna relations. The results indicate that, for both sandstone and carbonate case studies, all three implemented metaheuristic algorithms are more efficient and reliable than the empirical correlation to predict VS . The results also demonstrate that in both sandstone and carbonate case studies, the performance of an artificial bee

  12. 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

  13. Seamless Digital Environment – Data Analytics Use Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Oxstrand, Johanna [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2017-08-01

    Multiple research efforts in the U.S Department of Energy Light Water Reactor Sustainability (LWRS) Program studies the need and design of an underlying architecture to support the increased amount and use of data in the nuclear power plant. More specifically the three LWRS research efforts; Digital Architecture for an Automated Plant, Automated Work Packages, Computer-Based Procedures for Field Workers, and the Online Monitoring efforts all have identified the need for a digital architecture and more importantly the need for a Seamless Digital Environment (SDE). A SDE provides a mean to access multiple applications, gather the data points needed, conduct the analysis requested, and present the result to the user with minimal or no effort by the user. During the 2016 annual Nuclear Information Technology Strategic Leadership (NITSL) group meeting the nuclear utilities identified the need for research focused on data analytics. The effort was to develop and evaluate use cases for data mining and analytics for employing information from plant sensors and database for use in developing improved business analytics. The goal of the study is to research potential approaches to building an analytics solution for equipment reliability, on a small scale, focusing on either a single piece of equipment or a single system. The analytics solution will likely consist of a data integration layer, predictive and machine learning layer and the user interface layer that will display the output of the analysis in a straight forward, easy to consume manner. This report describes the use case study initiated by NITSL and conducted in a collaboration between Idaho National Laboratory, Arizona Public Service – Palo Verde Nuclear Generating Station, and NextAxiom Inc.

  14. Predicting new indications of compounds with a network pharmacology approach: Liuwei Dihuang Wan as a case study.

    Science.gov (United States)

    Wang, Yin-Ying; Bai, Hong; Zhang, Run-Zhi; Yan, Hong; Ning, Kang; Zhao, Xing-Ming

    2017-11-07

    With the ever increasing cost and time required for drug development, new strategies for drug development are highly demanded, whereas repurposing old drugs has attracted much attention in drug discovery. In this paper, we introduce a new network pharmacology approach, namely PINA, to predict potential novel indications of old drugs based on the molecular networks affected by drugs and associated with diseases. Benchmark results on FDA approved drugs have shown the superiority of PINA over traditional computational approaches in identifying new indications of old drugs. We further extend PINA to predict the novel indications of Traditional Chinese Medicines (TCMs) with Liuwei Dihuang Wan (LDW) as a case study. The predicted indications, including immune system disorders and tumor, are validated by expert knowledge and evidences from literature, demonstrating the effectiveness of our proposed computational approach.

  15. 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.

  16. Exploring the Use of Multiple Analogical Models when Teaching and Learning Chemical Equilibrium

    Science.gov (United States)

    Harrison, Allan G.; De Jong, Onno

    2005-01-01

    This study describes the multiple analogical models used to introduce and teach Grade 12 chemical equilibrium. We examine the teacher's reasons for using models, explain each model's development during the lessons, and analyze the understandings students derived from the models. A case study approach was used and the data were drawn from the…

  17. A case of lung adenocarcinoma with multiple intracranial hemorrhages of brain metastases after whole-brain radiation therapy

    International Nuclear Information System (INIS)

    Nakamichi, Shinji; Hirano, Satoshi; Asao, Tetsuhiko; Takeda, Yuichiro; Sugiyama, Haruhito; Kobayashi, Nobuyuki

    2011-01-01

    Whole-brain radiation therapy (WBRT) is widely applied in cases of brain metastases of non-small cell lung cancer (NSCLC). However, there are few case reports on hemorrhages of brain metastases occurring after WBRT. A 63-year-old woman was given a diagnosis of stage IV (T4N0M1b) lung adenocarcinoma about 4 years previously, and received chemotherapy regimens and gamma knife radiosurgery. However, her brain metastases exacerbated and she received WBRT in November 2010 and docetaxel monotherapy in December 2010. Two weeks after completing WBRT, she experienced dysarthria and an MRI showed multiple hemorrhages within brain metastases. Over a period of careful observation, these hemorrhages repeatedly alternated between improvement and exacerbation. Radiotherapy for metastatic brain tumors is considered to suppress hemorrhagic events of brain metastases. However, multiple intracranial hemorrhages of brain metastases occurred after WBRT in the present case. The accumulation of further studies of similar cases is necessary to identify the exact mechanism of these hemorrhages. (author)

  18. 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…

  19. Examining Preservice Teachers' Classroom Management Decisions in Three Case-Based Teaching Approaches

    Science.gov (United States)

    Cevik, Yasemin Demiraslan; Andre, Thomas

    2013-01-01

    This study was aimed at comparing the impact of three types of case-based approaches (worked example, faded work example, and case-based reasoning) on preservice teachers' decision making and reasoning skills related to realistic classroom management situations. Participants in this study received a short-term implementation of one of these three…

  20. A New Approach for Studying Nonlinear Dynamic Response of a Thin Plate with Internal Resonance in a Fractional Viscoelastic Medium

    Directory of Open Access Journals (Sweden)

    Yury A. Rossikhin

    2015-01-01

    Full Text Available In the previous analysis, the dynamic behaviour of a nonlinear plate embedded into a fractional derivative viscoelastic medium has been studied by the method of multiple time scales under the conditions of the internal resonances two-to-one and one-to-one, as well as the internal combinational resonances for the case when the linear parts of nonlinear equations of motion occur to be coupled. A new approach proposed in this paper allows one to uncouple the linear parts of equations of motion of the plate, while the same method, the method of multiple time scales, has been utilized for solving nonlinear equations. The influence of viscosity on the energy exchange mechanism between interacting nonlinear modes has been analyzed. It has been shown that for some internal resonances there exist such particular cases when it is possible to obtain two first integrals, namely, the energy integral and the stream function, which allows one to reduce the problem to the calculation of elliptic integrals. The new approach enables one to solve the problems of vibrations of thin bodies more efficiently.

  1. 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).

  2. Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis - A case report.

    Science.gov (United States)

    Dalbjerg, Sara Maria; Tsakiri, Anna; Frederiksen, Jette Lautrup

    2016-07-01

    Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis associated with Interferon-beta treatment. We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved. Clinicians should be aware of the possibility of rhabdomyolysis occurring during Interferon-beta-1-alpha therapy. In cases where patients complain of severe myalgia, and in particular if weakness is reported, creatine kinase activity should be measured to prevent irreversible rhabdomyolysis during Interferon-beta-1-alpha therapy in patients with multiple sclerosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. A New Approach to Integrate Internet-of-Things and Software-as-a-Service Model for Logistic Systems: A Case Study

    Directory of Open Access Journals (Sweden)

    Shang-Liang Chen

    2014-03-01

    Full Text Available Cloud computing is changing the ways software is developed and managed in enterprises, which is changing the way of doing business in that dynamically scalable and virtualized resources are regarded as services over the Internet. Traditional manufacturing systems such as supply chain management (SCM, customer relationship management (CRM, and enterprise resource planning (ERP are often developed case by case. However, effective collaboration between different systems, platforms, programming languages, and interfaces has been suggested by researchers. In cloud-computing-based systems, distributed resources are encapsulated into cloud services and centrally managed, which allows high automation, flexibility, fast provision, and ease of integration at low cost. The integration between physical resources and cloud services can be improved by combining Internet of things (IoT technology and Software-as-a-Service (SaaS technology. This study proposes a new approach for developing cloud-based manufacturing systems based on a four-layer SaaS model. There are three main contributions of this paper: (1 enterprises can develop their own cloud-based logistic management information systems based on the approach proposed in this paper; (2 a case study based on literature reviews with experimental results is proposed to verify that the system performance is remarkable; (3 challenges encountered and feedback collected from T Company in the case study are discussed in this paper for the purpose of enterprise deployment.

  4. A New Approach to Integrate Internet-of-Things and Software-as-a-Service Model for Logistic Systems: A Case Study

    Science.gov (United States)

    Chen, Shang-Liang; Chen, Yun-Yao; Hsu, Chiang

    2014-01-01

    Cloud computing is changing the ways software is developed and managed in enterprises, which is changing the way of doing business in that dynamically scalable and virtualized resources are regarded as services over the Internet. Traditional manufacturing systems such as supply chain management (SCM), customer relationship management (CRM), and enterprise resource planning (ERP) are often developed case by case. However, effective collaboration between different systems, platforms, programming languages, and interfaces has been suggested by researchers. In cloud-computing-based systems, distributed resources are encapsulated into cloud services and centrally managed, which allows high automation, flexibility, fast provision, and ease of integration at low cost. The integration between physical resources and cloud services can be improved by combining Internet of things (IoT) technology and Software-as-a-Service (SaaS) technology. This study proposes a new approach for developing cloud-based manufacturing systems based on a four-layer SaaS model. There are three main contributions of this paper: (1) enterprises can develop their own cloud-based logistic management information systems based on the approach proposed in this paper; (2) a case study based on literature reviews with experimental results is proposed to verify that the system performance is remarkable; (3) challenges encountered and feedback collected from T Company in the case study are discussed in this paper for the purpose of enterprise deployment. PMID:24686728

  5. A new approach to integrate Internet-of-things and software-as-a-service model for logistic systems: a case study.

    Science.gov (United States)

    Chen, Shang-Liang; Chen, Yun-Yao; Hsu, Chiang

    2014-03-28

    Cloud computing is changing the ways software is developed and managed in enterprises, which is changing the way of doing business in that dynamically scalable and virtualized resources are regarded as services over the Internet. Traditional manufacturing systems such as supply chain management (SCM), customer relationship management (CRM), and enterprise resource planning (ERP) are often developed case by case. However, effective collaboration between different systems, platforms, programming languages, and interfaces has been suggested by researchers. In cloud-computing-based systems, distributed resources are encapsulated into cloud services and centrally managed, which allows high automation, flexibility, fast provision, and ease of integration at low cost. The integration between physical resources and cloud services can be improved by combining Internet of things (IoT) technology and Software-as-a-Service (SaaS) technology. This study proposes a new approach for developing cloud-based manufacturing systems based on a four-layer SaaS model. There are three main contributions of this paper: (1) enterprises can develop their own cloud-based logistic management information systems based on the approach proposed in this paper; (2) a case study based on literature reviews with experimental results is proposed to verify that the system performance is remarkable; (3) challenges encountered and feedback collected from T Company in the case study are discussed in this paper for the purpose of enterprise deployment.

  6. Multi-criteria selection of offshore wind farms: Case study for the Baltic States

    International Nuclear Information System (INIS)

    Chaouachi, Aymen; Covrig, Catalin Felix; Ardelean, Mircea

    2017-01-01

    This paper presents a multi-criteria selection approach for offshore wind sites assessment. The proposed site selection framework takes into consideration the electricity network’s operating security aspects, economic investment, operation costs and capacity performances relative to each potential site. The selection decision is made through Analytic Hierarchy Process (AHP), with an inherited flexibility that aims to allow end users to adjust the expected benefits accordingly to their respective and global priorities. The proposed site selection framework is implemented as an interactive case study for three Baltic States in the 2020 time horizon, based on real data and exhaustive power network models, taking into consideration the foreseen upgrades and network reinforcements. For each country the optimal offshore wind sites are assessed under multiple weight contribution scenarios, reflecting the characteristics of market design, regulatory aspects or renewable integration targets. - Highlights: • We use a multi-criteria selection approach for offshore wind sites assessment. • Security aspects, economic investment, operation costs and capacity performances are included. • The selection decision is made through an Analytic Hierarchy Process (AHP). • We implement the methodology as a case study for three Baltic States in the 2020 time horizon.

  7. Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman

    African Journals Online (AJOL)

    Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman. Abiola I Balogun. Abstract. No Abstract Available Archives of Ibadan Medicine Vol.1(1) 2000: 21-22. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/aim.v1i1.34534.

  8. 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.

  9. 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.

  10. THE CASE APPROACH TO PREPARING FOR TEACHING.

    Science.gov (United States)

    AMIDON, EDMUND; HUNTER, ELIZABETH

    TO HELP PROSPECTIVE TEACHERS DEVELOP TEACHING SKILLS, PAIRS OF CASES (RECORDS OF REAL TEACHING SITUATIONS) WHICH DEPICT SIGNIFICANTLY DIFFERENT APPROACHES TAKEN BY TEACHERS WITH A SIMILAR CLASSROOM PROBLEM ARE VERBALLY DESCRIBED. EACH PAIR OF CASES IS ANALYZED USING THE CATEGORIES OF THE VERBAL INTERACTION CATEGORY SYSTEM (VICS) WHICH MEASURES…

  11. 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.

  12. A quantitative approach to choose among multiple mutually exclusive decisions: comparative expected utility theory

    OpenAIRE

    Zhu, Pengyu

    2018-01-01

    Mutually exclusive decisions have been studied for decades. Many well-known decision theories have been defined to help people either to make rational decisions or to interpret people's behaviors, such as expected utility theory, regret theory, prospect theory, and so on. The paper argues that none of these decision theories are designed to provide practical, normative and quantitative approaches for multiple mutually exclusive decisions. Different decision-makers should naturally make differ...

  13. Multiple emotions: a person-centered approach to the relationship between intergroup emotion and action orientation.

    Science.gov (United States)

    Fernando, Julian W; Kashima, Yoshihisa; Laham, Simon M

    2014-08-01

    Although a great deal of research has investigated the relationship between emotions and action orientations, most studies to date have used variable-centered techniques to identify the best emotion predictor(s) of a particular action. Given that people frequently report multiple or blended emotions, a profitable area of research may be to adopt person-centered approaches to examine the action orientations elicited by a particular combination of emotions or "emotion profile." In two studies, across instances of intergroup inequality in Australia and Canada, we examined participants' experiences of six intergroup emotions: sympathy, anger directed at three targets, shame, and pride. In both studies, five groups of participants with similar emotion profiles were identified by cluster analysis and their action orientations were compared; clusters indicated that the majority of participants experienced multiple emotions. Each action orientation was also regressed on the six emotions. There were a number of differences in the results obtained from the person-centered and variable-centered approaches. This was most apparent for sympathy: the group of participants experiencing only sympathy showed little inclination to perform prosocial actions, yet sympathy was a significant predictor of numerous action orientations in regression analyses. These results imply that sympathy may only prompt a desire for action when experienced in combination with other emotions. We suggest that the use of person-centered and variable-centered approaches as complementary analytic strategies may enrich research into not only the affective predictors of action, but emotion research in general.

  14. Multiple solid pilocytic astrocytomas in cerebleiium with neurofibromatosis type: A case report

    International Nuclear Information System (INIS)

    Choi, Seo Young; Kim, Myung Soon; Kim, Young Ju

    2014-01-01

    Pilocytic astrocytoma usually has a classic imaging manifestation of a solitary, cyst-like mass with a strong contrast-enhancing mural nodule. There is only one published report so far of multiple solid and cyst type pilocytic astrocytomas in the cerebellum in neurofibromatosis type 1 (NF1) patient from the United States in 2007. We report a case of pilocytic astrocytoma presenting with only solid, multiple pilocytic astrocytomas in the cerebellum in NF1 patient.

  15. GP leadership in clinical commissioning groups: a qualitative multi-case study approach across England.

    Science.gov (United States)

    Marshall, Martin; Holti, Richard; Hartley, Jean; Matharu, Tatum; Storey, John

    2018-06-01

    Clinical commissioning groups (CCGs) were established in England in 2013 to encourage GPs to exert greater influence over the processes of service improvement and redesign in the NHS. Little is known about the extent and the ways in which GPs have assumed these leadership roles. To explore the nature of clinical leadership of GPs in CCGs, and to examine the enablers and barriers to implementing a policy of clinical leadership in the NHS. A qualitative multi-case study approach in six localities across England. The case studies were purposefully sampled to represent different geographical localities and population demographics, and for their commitment to redesigning specified clinical or service areas. Data were collected from the case study CCGs and their partner organisations using a review of relevant documents, semi-structured individual or group interviews, and observations of key meetings. The data were analysed thematically and informed by relevant theories. GPs prefer a collaborative style of leadership that may be unlikely to produce rapid or radical change. Leadership activities are required at all levels in the system from strategy to frontline delivery, and the leadership behaviours of GPs who are not titular leaders are as important as formal leadership roles. A new alliance is emerging between clinicians and managers that draws on their different skillsets and creates new common interests. The uncertain policy environment in the English NHS is impacting on the willingness and the focus of GP leaders. GPs are making an important contribution as leaders of health service improvement and redesign but there are significant professional and political barriers to them optimising a leadership role. © British Journal of General Practice 2018.

  16. Shrinkage Estimators for Robust and Efficient Inference in Haplotype-Based Case-Control Studies

    KAUST Repository

    Chen, Yi-Hau; Chatterjee, Nilanjan; Carroll, Raymond J.

    2009-01-01

    Case-control association studies often aim to investigate the role of genes and gene-environment interactions in terms of the underlying haplotypes (i.e., the combinations of alleles at multiple genetic loci along chromosomal regions). The goal of this article is to develop robust but efficient approaches to the estimation of disease odds-ratio parameters associated with haplotypes and haplotype-environment interactions. We consider "shrinkage" estimation techniques that can adaptively relax the model assumptions of Hardy-Weinberg-Equilibrium and gene-environment independence required by recently proposed efficient "retrospective" methods. Our proposal involves first development of a novel retrospective approach to the analysis of case-control data, one that is robust to the nature of the gene-environment distribution in the underlying population. Next, it involves shrinkage of the robust retrospective estimator toward a more precise, but model-dependent, retrospective estimator using novel empirical Bayes and penalized regression techniques. Methods for variance estimation are proposed based on asymptotic theories. Simulations and two data examples illustrate both the robustness and efficiency of the proposed methods.

  17. Shrinkage Estimators for Robust and Efficient Inference in Haplotype-Based Case-Control Studies

    KAUST Repository

    Chen, Yi-Hau

    2009-03-01

    Case-control association studies often aim to investigate the role of genes and gene-environment interactions in terms of the underlying haplotypes (i.e., the combinations of alleles at multiple genetic loci along chromosomal regions). The goal of this article is to develop robust but efficient approaches to the estimation of disease odds-ratio parameters associated with haplotypes and haplotype-environment interactions. We consider "shrinkage" estimation techniques that can adaptively relax the model assumptions of Hardy-Weinberg-Equilibrium and gene-environment independence required by recently proposed efficient "retrospective" methods. Our proposal involves first development of a novel retrospective approach to the analysis of case-control data, one that is robust to the nature of the gene-environment distribution in the underlying population. Next, it involves shrinkage of the robust retrospective estimator toward a more precise, but model-dependent, retrospective estimator using novel empirical Bayes and penalized regression techniques. Methods for variance estimation are proposed based on asymptotic theories. Simulations and two data examples illustrate both the robustness and efficiency of the proposed methods.

  18. A combined disease management and process modeling approach for assessing and improving care processes: a fall management case-study.

    Science.gov (United States)

    Askari, Marjan; Westerhof, Richard; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E; Abu-Hanna, Ameen

    2013-10-01

    To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study. We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees. The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid. The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Validation of a combined autosomal/Y-chromosomal STR approach for analyzing typical biological stains in sexual-assault cases.

    Science.gov (United States)

    Purps, Josephine; Geppert, Maria; Nagy, Marion; Roewer, Lutz

    2015-11-01

    DNA testing is an established part of the investigation and prosecution of sexual assault. The primary purpose of DNA evidence is to identify a suspect and/or to demonstrate sexual contact. However, due to highly uneven proportions of female and male DNA in typical stains, routine autosomal analysis often fails to detect the DNA of the assailant. To evaluate the forensic efficiency of the combined application of autosomal and Y-chromosomal short tandem repeat (STR) markers, we present a large retrospective casework study of probative evidence collected in sexual-assault cases. We investigated up to 39 STR markers by testing combinations of the 16-locus NGMSElect kit with both the 23-locus PowerPlex Y23 and the 17-locus Yfiler kit. Using this dual approach we analyzed DNA extracts from 2077 biological stains collected in 287 cases over 30 months. To assess the outcome of the combined approach in comparison to stand-alone autosomal analysis we evaluated informative DNA profiles. Our investigation revealed that Y-STR analysis added up to 21% additional, highly informative (complete, single-source) profiles to the set of reportable autosomal STR profiles for typical stains collected in sexual-assault cases. Detection of multiple male contributors was approximately three times more likely with Y-chromosomal profiling than with autosomal STR profiling. In summary, 1/10 cases would have remained inconclusive (and could have been dismissed) if Y-STR analysis had been omitted from DNA profiling in sexual-assault cases. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  20. 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.