Need for Orientation, Media Uses and Gratifications, and Media Effects.

Science.gov (United States)

Weaver, David

In order to study the influence of need for orientation and media gratifications on media use and media effects in political communication, two previous surveys were studied to compare the causal modeling approach and the contingent conditions approach. In the first study, 339 personal interviews were conducted with registered voters during a…

Sleep need in adolescents: a longitudinal approach.

Science.gov (United States)

Strauch, I; Meier, B

1988-08-01

A sample of 190 male and female "high school" students completed a sleep questionnaire for the first time when they were 10 to 14 years old. The survey was repeated five times at 2 year intervals. Ninety-three subjects answered the questionnaire each time. Subjective sleep need was assessed by the indicated wish for more sleep. The wish for more sleep was very pronounced, varying between 54.3% and 74.5% across the years. Individual consistency, however, was low since only 14.5% of the adolescents indicated the wish for more sleep in each survey, emphasizing the state dependency of this variable. Within each total sample, subjects with the wish for more sleep (MSL) and with sufficient sleep (SSL) were compared. Subjective sleep need was consistently validated by a syndrome of morning-tiredness. In the last two surveys, there was reduced time in bed (TIB) on weekdays in MSL subjects and longer TIB during vacation in surveys 2 through 5. Furthermore, MSL subjects more often showed irregular sleep habits. The previous sleep history of the MSL subjects in the last survey indicated that concomitants of the wish for more sleep were already experienced earlier in adolescence. The desired sleep duration of these subjects was 1.7 h longer than their current sleep on weekdays, an amount they had not obtained on weekdays since early adolescence. It is concluded that a substantial proportion of the adolescents seem to have had difficulties adapting to the general sleep time reduction occurring in adolescence.

Meeting water needs for sustainable development: an overview of approaches, measures and data sources

Science.gov (United States)

Lissner, Tabea; Reusser, Dominik E.; Sullivan, Caroline A.; Kropp, Jürgen P.

2013-04-01

An essential part of a global transition towards sustainability is the Millennium Development Goals (MDG), providing a blueprint of goals to meet human needs. Water is an essential resource in itself, but also a vital factor of production for food, energy and other industrial products. Access to sufficient water has only recently been recognized as a human right. One central MDG is halving the population without access to safe drinking water and sanitation. To adequately assess the state of development and the potential for a transition towards sustainability, consistent and meaningful measures of water availability and adequate access are thus fundamental. Much work has been done to identify thresholds and definitions to measure water scarcity. This includes some work on defining basic water needs of different sectors. A range of data and approaches has been made available from a variety of sources, but all of these approaches differ in their underlying assumptions, the nature of the data used, and consequently in the final results. We review and compare approaches, methods and data sources on human water use and human water needs. This data review enables identifying levels of consumption in different countries and different sectors. Further comparison is made between actual water needs (based on human and ecological requirements), and recognised levels of water abstraction. The results of our review highlight the differences between different accounts of water use and needs, and reflect the importance of standardised approaches to data definitions and measurements, making studies more comparable across space and time. The comparison of different use and allocation patterns in countries enables levels of water use to be identified which allow for an adequate level of human wellbeing to be maintained within sustainable water abstraction limits. Recommendations are provided of how data can be defined more clearly to make comparisons of water use more meaningful and

REACH, non-testing approaches and the urgent need for a change in mind set

NARCIS (Netherlands)

Schaafsma, G.; Kroese, E.D.; Tielemans, E.L.J.P.; Sandt, J.J.M. van de; Leeuwen, C.J. van

2009-01-01

The objectives of REACH cannot be achieved under the current risk assessment approach. A change in mind set among all the relevant stakeholders is needed: risk assessment should move away from a labor-intensive and animal-consuming approach to intelligent and pragmatic testing, by combining exposure

The TEACH Method: An Interactive Approach for Teaching the Needs-Based Theories Of Motivation

Science.gov (United States)

Moorer, Cleamon, Jr.

2014-01-01

This paper describes an interactive approach for explaining and teaching the Needs-Based Theories of Motivation. The acronym TEACH stands for Theory, Example, Application, Collaboration, and Having Discussion. This method can help business students to better understand and distinguish the implications of Maslow's Hierarchy of Needs,…

Development and Initial Validation of the Need Satisfaction and Need Support at Work Scales: A Validity-Focused Approach

Directory of Open Access Journals (Sweden)

Susanne Tafvelin

2018-01-01

Full Text Available Although the relevance of employee need satisfaction and manager need support have been examined, the integration of self-determination theory (SDT into work and organizational psychology has been hampered by the lack of validated measures. The purpose of the current study was to develop and validate measures of employees’ perception of need satisfaction (NSa-WS and need support (NSu-WS at work that were grounded in SDT. We used three Swedish samples (total 'N' = 1,430 to develop and validate our scales. We used a confirmatory approach including expert panels to assess item content relevance, confirmatory factor analysis for factorial validity, and associations with theoretically warranted outcomes to assess criterion-related validity. Scale reliability was also assessed. We found evidence of content, factorial, and criterion-related validity of our two scales of need satisfaction and need support at work. Further, the scales demonstrated high internal consistency. Our newly developed scales may be used in research and practice to further our understanding regarding how satisfaction and support of employee basic needs influence employee motivation, performance, and well-being. Our study makes a contribution to the current literature by providing (1 scales that are specifically designed for the work context, (2 an example of how expert panels can be used to assess content validity, and (3 testing of theoretically derived hypotheses that, although SDT is built on them, have not been examined before.

Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission.

Science.gov (United States)

Alenius, Malin; Hammarlund-Udenaes, Margareta; Hartvig, Per; Sundquist, Staffan; Lindström, Leif

2009-01-01

Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. A naturalistic, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations, fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome. In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic or in research.

Towards Current Profile Control in ITER: Potential Approaches and Research Needs

Science.gov (United States)

Schuster, E.; Barton, J. E.; Wehner, W. P.

2014-10-01

Many challenging plasma control problems still need to be addressed in order for the ITER Plasma Control System (PCS) to be able to successfully achieve the ITER project goals. For instance, setting up a suitable toroidal current density profile is key for one possible advanced scenario characterized by noninductive sustainment of the plasma current and steady-state operation. The nonlinearity and high dimensionality exhibited by the plasma demand a model-based current-profile control synthesis procedure that can accommodate this complexity through embedding the known physics within the design. The development of a model capturing the dynamics of the plasma relevant for control design enables not only the design of feedback controllers for regulation or tracking but also the design of optimal feedforward controllers for a systematic model-based approach to scenario planning, the design of state estimators for a reliable real-time reconstruction of the plasma internal profiles based on limited and noisy diagnostics, and the development of a fast predictive simulation code for closed-loop performance evaluation before implementation. Progress towards control-oriented modeling of the current profile evolution and associated control design has been reported following both data-driven and first-principles-driven approaches. An overview of these two approaches will be provided, as well as a discussion on research needs associated with each one of the model applications described above. Supported by the US Department of Energy under DE-SC0001334 and DE-SC0010661.

Swedish approach to information needs in severe accident situations

Energy Technology Data Exchange (ETDEWEB)

Soederman, E. (ES-Konsult AB, Stockholm (Sweden)); Karnik, P. (ES-Konsult AB, Stockholm (Sweden))

1992-07-01

In Sweden, systems for mitigating severe accidents have been installed at all plants and procedures have been implemented for accident management. This work has included the assessment of needs of information and the survivability of existing instrumentation during the various phases of an accident scenario. The approach has been pragmatic and based on existing knowledge of accident phenomenology and MAAP code calculations together with plant staff experience of detailed plant design and installation. During the early phases of accidents, which is defined to remain up to maximum fuel temperatures in the order of 800 C, the ordinary instrumentation is to a great extent useful. The reactor vessel level measurement is however identified to be weak in BWRs as soon as the core is partly uncovered. This has lead to the development of a Core Cooling Monitor. In later phases of accident scenarios, the general basis has been that no intrumentation inside the containment can survive. It has been analysed what information is strictly needed. It has been found that detailed information of the status inside the pressure vessel is of little importance after vessel penetration. Certain important information needs have been identified, that was not safely accessible from existing instrumentation. This had lead to complementary installations, using instruments inserted into the containment through protected guide tubes. Also for sampling of gas and water complementary installations have been made. (orig.)

Swedish approach to information needs in severe accident situations

International Nuclear Information System (INIS)

Soederman, E.; Karnik, P.

1992-01-01

In Sweden, systems for mitigating severe accidents have been installed at all plants and procedures have been implemented for accident management. This work has included the assessment of needs of information and the survivability of existing instrumentation during the various phases of an accident scenario. The approach has been pragmatic and based on existing knowledge of accident phenomenology and MAAP code calculations together with plant staff experience of detailed plant design and installation. During the early phases of accidents, which is defined to remain up to maximum fuel temperatures in the order of 800 C, the ordinary instrumentation is to a great extent useful. The reactor vessel level measurement is however identified to be weak in BWRs as soon as the core is partly uncovered. This has lead to the development of a Core Cooling Monitor. In later phases of accident scenarios, the general basis has been that no intrumentation inside the containment can survive. It has been analysed what information is strictly needed. It has been found that detailed information of the status inside the pressure vessel is of little importance after vessel penetration. Certain important information needs have been identified, that was not safely accessible from existing instrumentation. This had lead to complementary installations, using instruments inserted into the containment through protected guide tubes. Also for sampling of gas and water complementary installations have been made. (orig.)

The Need for an Informational Systems Approach to Security

Directory of Open Access Journals (Sweden)

José María Díaz Nafría

2011-03-01

Full Text Available Different senses of security and its related assumptions, methodologies and contexts are analyzed by first reviewing the liberalistic notions of security and trust, unveiling, on the one hand, the contradictions exhibited between discourse and practice; on the other hand, the historical strategy of concentration of power behind the liberalistic doctrines. The weakness, limits and implications of the liberalistic notions and methods on security and trust are inquired, and subsequently a genuine horizon of security as sustainable and general procurement of positive freedom is advocated. The CyberSyn project successfully implemented in Chile, but tragically and prematurely ending under the hard power in the 9/11 of 1973, serves as model of the posed system approach to security. However, the system model is actualized and completed with elements of the general theory of information in virtue of: the increased complexity of societal systems, its ultimate global dimension, its biospherical closure, the increase of information assets and processes, and some epistemological boundaries. These reasons also set the need of keeping – beside the system approach – a critical and ethical stance.

A quality approach for conducting training needs assessments in the Ministry of Health, State of Bahrain.

Science.gov (United States)

Benjamin, S; al-Darazi, F

2000-01-01

In health care organizations around the world, Training Needs Assessments (TNAs) have generally followed a professions-based approach. For example, the training needs of doctors, nurses, each allied health profession, and distinct support staff have been analyzed separately--individualized TNAs conducted for each speciality and functional area. Although a professions-based TNA model can provide useful information to human resource development (HRD) professionals, there are two major drawbacks: (1) it is possible that important training needs might be overlooked because of lack of information sharing among professions and (2) such an approach does not encourage an interdisciplinary, team orientation to service provision. This paper proposes an improved method of conceptualizing TNAs, using an approach that builds on the quality management literature (TQM, CQI, etc.) which stresses the importance of customer- and service-orientations to organizing and measuring organizational and individual performance.

The need to disentangle key concepts from ecosystem-approach jargon.

Science.gov (United States)

Waylen, K A; Hastings, E J; Banks, E A; Holstead, K L; Irvine, R J; Blackstock, K L

2014-10-01

The ecosystem approach--as endorsed by the Convention on Biological Diversity (CDB) in 2000-is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD's concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD's concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD's concept of the ecosystem approach demands more attention. © 2014 Society for Conservation Biology.

Managing forests in a changing world: the need for a systemic approach. A review

International Nuclear Information System (INIS)

Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

2017-01-01

Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

Managing forests in a changing world: the need for a systemic approach. A review

Energy Technology Data Exchange (ETDEWEB)

Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

2017-11-01

Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

Need for a multidisciplinary approach

International Nuclear Information System (INIS)

Foersund, Hans Martin; Kristoffersen, Lasse; Skaatun, Helge; Dragsund, Egil

2004-01-01

Transportation of oil poses significant environmental risks. Effective reduction of those risks require an integrated approach, including the legal and institutional aspects, waste reception facilities in ports, navigational risk assessment, oil spill modelling, environmental sensitivity mapping and oil spill contingency planning. Proper management starts with an integrated study of oil pollution risk management, covering both oil pollution as a consequence of operational discharges and as a consequence of accidents. However, as the two areas of oil pollution management are different, they therefore require separate approaches

Diversity Management Change Projects: In Need of Alternative Conceptual Approaches?

Directory of Open Access Journals (Sweden)

Christina Evans

2012-09-01

Full Text Available Drawing on a meta-analysis of an evaluation of a European Social Fund project aimed at enhancing employment opportunities for women in Information Technology, Electronic and Computing (ITEC, this paper critically debates how effectual a diversity management approach alone is as an underpinning rationale for change in the complex area of diversity. The paper draws on the experiences of ‘partner organizations’, gathered through interviews conducted during the evaluation stage of the project. The paper discusses some of the tensions experienced by partner organizations, thus providing new insights into why such projects are not as effectual as they might be. The paper concludes by presenting a case for the need to re-conceptualise how change as part of a wider diversity management approach might best be conceptualized. We suggest that a ‘systems approach’ could prove a more fruitful way of conceptualizing change of this nature given the inter-dependences between different organizations and institutions.

Ecosystem approach to inland fisheries: research needs and implementation strategies

Science.gov (United States)

Beard, T. Douglas; Arlinghaus, Robert; Cooke, Steven J.; McIntyre, Peter B.; De Silva, Sena; Bartley, Devin M.; Cowx, Ian G.

2011-01-01

Inland fisheries are a vital component in the livelihoods and food security of people throughout the world, as well as contributing huge recreational and economic benefits. These valuable assets are jeopardized by lack of research-based understanding of the impacts of fisheries on inland ecosystems, and similarly the impact of human activities associated with inland waters on fisheries and aquatic biodiversity. To explore this topic, an international workshop was organized in order to examine strategies to incorporate fisheries into ecosystem approaches for management of inland waters. To achieve this goal, a new research agenda is needed that focuses on: quantifying the ecosystem services provided by fresh waters; quantifying the economic, social and nutritional benefits of inland fisheries; improving assessments designed to evaluate fisheries exploitation potential; and examining feedbacks between fisheries, ecosystem productivity and aquatic biodiversity. Accomplishing these objectives will require merging natural and social science approaches to address coupled social–ecological system dynamics.

Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk.

Science.gov (United States)

Zago, Alexandre C; Saadi, Eduardo K; Zago, Alcides J

2011-10-01

Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications. Copyright © 2011 Wiley-Liss, Inc.

TwitterNEED: a hybrid approach for named entity extraction and disambiguation for tweets

NARCIS (Netherlands)

Habib, Mena Badieh; van Keulen, Maurice

Twitter is a rich source of continuously and instantly updated information. Shortness and informality of tweets are challenges for Natural Language Processing tasks. In this paper, we present TwitterNEED, a hybrid approach for Named Entity Extraction and Named Entity Disambiguation for tweets. We

Risks/Needs of Children/Youth with Behavior Disorders in Correctional Institutions in Croatia

Science.gov (United States)

Ratkajec, Gabrijela; Jedud, Ivana

2010-01-01

Previous research and experience in Croatia show that interventions are not matched with the risk level and intervention needs of children with behavior disorders. As a result of that, the situation in Croatia requires actuarial approach to the risks and needs assessment of children and youth. The purpose of the current research is to put stronger…

Managing forests in a changing world: the need for a systemic approach. A review

Directory of Open Access Journals (Sweden)

Susanna Nocentini

2017-05-01

Full Text Available Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

Taking health needs seriously: against a luck egalitarian approach to justice in health.

Science.gov (United States)

Nielsen, Lasse

2013-08-01

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen's mature position he defends the idea that people should be compensated for "brute luck", i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone's basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson's abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health.

'Vague Oviedo': autonomy, culture and the case of previously competent patients.

Science.gov (United States)

Pascalev, Assya; Vidalis, Takis

2010-03-01

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms.

The need for affect: individual differences in the motivation to approach or avoid emotions.

Science.gov (United States)

Maio, G R; Esses, V M

2001-08-01

The present research developed and tested a new individual-difference measure of the need for affect, which is the motivation to approach or avoid emotion-inducing situations. The first phase of the research developed the need for affect scale. The second phase revealed that the need for affect is related to a number of individual differences in cognitive processes (e.g., need for cognition, need for closure), emotional processes (e.g., affect intensity, repression-sensitization), behavioral inhibition and activation (e.g., sensation seeking), and aspects of personality (Big Five dimensions) in the expected directions, while not being redundant with them. The third phase of the research indicated that, compared to people low in the need for affect, people high in the need for affect are more likely to (a) possess extreme attitudes across a variety of issues, (b) choose to view emotional movies, and (c) become involved in an emotion-inducing event (the death of Princess Diana). Overall, the results indicate that the need for affect is an important construct in understanding emotion-related processes.

Trends and needs in regulatory approaches for future reactors. Annex 16

International Nuclear Information System (INIS)

Kress, T.S.

2002-01-01

For nuclear power to be the future alternative of choice for electric generation capacity, there are two essential elements: (1) cost competitiveness, and (2) an acceptable level of safety. To meet these perhaps conflicting elements, there will need to be significant risk-informed modifications to the regulatory approaches for the licensing and oversight of reactors. This paper discusses some of the trends in the U.S. in this direction and identifies what the author believes will be technical and policy issues that stand in the way. (author)

Paediatric and perinatal postmortem imaging: the need for a subspecialty approach

Energy Technology Data Exchange (ETDEWEB)

Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Rijn, Rick R. van [Emma Children' s Hospital - Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Pathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom)

2015-04-01

Paediatric postmortem imaging is distinct and different from adult postmortem imaging due to differences in disease aetiology, pathology and imaging approaches, which require a particular skill set to maximise its yield and clinical utility. Practitioners need to have expertise in several aspects of radiology, including both plain radiographs and cross-sectional imaging modalities, knowledge of specialist techniques, and familiarity with the unique range of pathologies in this patient population, including perinatal pathology. Here we outline the training requirements that should be considered to establish such a service. (orig.)

Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach.

Science.gov (United States)

Timpel, P; Lang, C; Wens, J; Contel, J C; Gilis-Januszewska, A; Kemple, K; Schwarz, P E

2017-11-13

Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and

Estimating the financial resources needed for local public health departments in Minnesota: a multimethod approach.

Science.gov (United States)

Riley, William; Briggs, Jill; McCullough, Mac

2011-01-01

This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

A Toolkit Modeling Approach for Sustainable Forest Management Planning: Achieving Balance between Science and Local Needs

Directory of Open Access Journals (Sweden)

Brian R. Sturtevant

2007-12-01

Full Text Available To assist forest managers in balancing an increasing diversity of resource objectives, we developed a toolkit modeling approach for sustainable forest management (SFM. The approach inserts a meta-modeling strategy into a collaborative modeling framework grounded in adaptive management philosophy that facilitates participation among stakeholders, decision makers, and local domain experts in the meta-model building process. The modeling team works iteratively with each of these groups to define essential questions, identify data resources, and then determine whether available tools can be applied or adapted, or whether new tools can be rapidly created to fit the need. The desired goal of the process is a linked series of domain-specific models (tools that balances generalized "top-down" models (i.e., scientific models developed without input from the local system with case-specific customized "bottom-up" models that are driven primarily by local needs. Information flow between models is organized according to vertical (i.e., between scale and horizontal (i.e., within scale dimensions. We illustrate our approach within a 2.1 million hectare forest planning district in central Labrador, a forested landscape where social and ecological values receive a higher priority than economic values. However, the focus of this paper is on the process of how SFM modeling tools and concepts can be rapidly assembled and applied in new locations, balancing efficient transfer of science with adaptation to local needs. We use the Labrador case study to illustrate strengths and challenges uniquely associated with a meta-modeling approach to integrated modeling as it fits within the broader collaborative modeling framework. Principle advantages of the approach include the scientific rigor introduced by peer-reviewed models, combined with the adaptability of meta-modeling. A key challenge is the limited transparency of scientific models to different participatory groups

A comprehensive approach to handle the dynamics of customer’s needs in Quality Function Deployment based on linguistic variables

Directory of Open Access Journals (Sweden)

Zohreh Bostaki

2014-04-01

Full Text Available In the contexture of a customer-driven goods or service design process, a well-timed update of customer’s requirements may not only serve as a necessity indicator to observe how things change over time, but also it incorporates the firms a better ground to interoperate different strategies to meet the future needs of its customer. This paper proposes a systematic methodology to deal with the customer needs’ dynamics, in terms of their relative weights, in the QFD. Compared with previous research, the contribution of this paper is fourfold. First, it applies some linguistic variables to get preferences of customers and experts to determine the relative importance of customer requirements (CRs and the relationships between customer requirements and engineering characteristics (ECs. Second, it proposes the implementation of a forecasting technique. Third, it describes more comprehensively on how future uncertainty in the weights of customer’s needs could be estimated and transmitted into the design attributes. Fourth, it proposes the implementation of a quantitative approach, which takes into account the decision maker’s attitude towards risk to optimize the QFD decision making analysis. Finally, a real-world application of QFD is provided to demonstrate the practical applicability of the proposed methodology.

High school teachers' perspectives on effective approaches for teaching biology to students with special needs

Science.gov (United States)

Kos, Agnieszka

The demands of national educational reforms require high school biology teachers to provide high quality instruction to students with and without special needs. The reforms, however, do not provide teachers with adequate teaching strategies to meet the needs of all students in the same context. The purpose of this grounded theory study was to understand high school biology teachers' perspectives, practices, and challenges in relation to teaching students with special needs. This approach was used to develop a substantive model for high school biology teachers who are challenged with teaching students with and without special needs. Data were collected via in-depth interviews with 15 high school teachers in a Midwestern school district. The data were analyzed using open coding, axial coding, and selective coding procedures in accordance with the grounded theory approach. Essential model components included skills and training for teachers, classroom management strategies, teaching strategies, and student skills. The emergent substantive theory indicated that that teacher preparation and acquired skills greatly influence the effectiveness of inclusion implementation. Key findings also indicated the importance of using of a variety of instructional strategies and classroom management strategies that address students' special needs and their learning styles. This study contributes to social change by providing a model for teaching students and effectively implementing inclusion in regular science classrooms. Following further study, this model may be used to support teacher professional development and improve teaching practices that in turn may improve science literacy supported by the national educational reforms.

Erlotinib-induced rash spares previously irradiated skin

International Nuclear Information System (INIS)

Lips, Irene M.; Vonk, Ernest J.A.; Koster, Mariska E.Y.; Houwing, Ronald H.

2011-01-01

Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed. (orig.)

Comparing three different approaches to the measurement of needs concerning fatigue in patients with advanced cancer

DEFF Research Database (Denmark)

Madsen, Ulla Riis; Groenvold, Mogens; Petersen, Morten Aagaard

2015-01-01

PURPOSE: To identify patients having fatigue, it is necessary to assess the patients fatigue systematically. This study investigates three different approaches to the assessment of needs concerning fatigue in patients with advanced cancer and addresses the following questions. METHODS: In a cross......-sectional nationwide survey, patients were asked about their needs concerning fatigue in three different ways: Fatigue intensity was measured with the European Organisation for Research and Treatment of Cancer quality of life questionnaire, fatigue burden (the extent fatigue was a problem) and fatigue felt need...

Forecasting the global shortage of physicians: an economic- and needs-based approach

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Liu, Jenny X; Kinfu, Yohannes; Dal Poz, Mario R

2008-01-01

Abstract Objective Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Methods Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country’s economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. Findings By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. Conclusion The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected. PMID:18670663

Overview of tracheal tissue engineering: clinical need drives the laboratory approach.

Science.gov (United States)

Ott, Lindsey M; Weatherly, Robert A; Detamore, Michael S

2011-08-01

Breathing is a natural function that most of us do not even think about, but for those who suffer from disease or damage of the trachea, the obstruction of breathing can mean severe restrictions to quality of life or may even be fatal. Replacement and reconstruction of the trachea is one of the most difficult procedures in otolaryngology/head and neck surgery, and also one of the most vital. Previous reviews have focused primarily on clinical perspectives or instead on engineering strategies. However, the current review endeavors to bridge this gap by evaluating engineering approaches in a practical clinical context. For example, although contemporary approaches often include in vitro bioreactor pre-culture, or sub-cutaneous in vivo conditioning, the limitations they present in terms of regulatory approval, cost, additional surgery, and/or risk of infection challenge engineers to develop the next generation of biodegradable/resorbable biomaterials that can be directly implanted in situ. Essentially, the functionality of the replacement is the most important requirement. It must be the correct shape and size, achieve an airtight fit, resist collapse as it is replaced by new tissue, and be non-immunogenic. As we look to the future, there will be no one-size-fits-all solution.

Cooperative learning in 'Special Needs in Dentistry' for undergraduate students using the Jigsaw approach.

Science.gov (United States)

Suárez-Cunqueiro, M M; Gándara-Lorenzo, D; Mariño-Pérez, R; Piñeiro-Abalo, S; Pérez-López, D; Tomás, I

2017-11-01

The goals of this study were to (i) describe the use of the Jigsaw approach for the resolution of clinical cases by undergraduate students in the subject 'Special Needs in Dentistry' and (ii) assess the impact of its implementation on academic performance and the students' perception. The Jigsaw approach was applied to the fifth-year in the subject 'Special Needs in Dentistry', as part of the Dentistry degree curriculum of the University of Santiago de Compostela, during the academic years 2012/2013 and 2013/2014. A total of 109 dental students were enrolled in the study, and the final marks of the Jigsaw (n = 55) and the non-Jigsaw groups (n = 54) were compared. Students' perceptions on the Jigsaw technique were assessed using a 13-question questionnaire. Academic performance based on the final examination mark for the Jigsaw and non-Jigsaw groups was 6.45 ± 1.49 and 6.13 ± 1.50, respectively. There were not students in the Jigsaw group who failed to attend the mandatory examination (0% vs. 12.96% in the non-Jigsaw group, P = 0.006). The questionnaire's internal consistency was 0.90. The mean value for all the questionnaire items was 3.80, with the highest response score of 4.35 for the statement 'I have seen the complexity that the resolution of a clinical case can involve'. Based on the students' perceptions, the Jigsaw approach could contribute to a better understanding of the complexity of solving clinical cases in the subject 'Special Needs in Dentistry'. However, further investigations should be conducted to analyse the influence of this technique on students' academic performance in the field of clinical dentistry. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Envisioning a smart home that can learn and negotiate the needs of multiple users

NARCIS (Netherlands)

Chuang, Y.; Chen, L.; Lee, Y-H.

2015-01-01

Most of the previous smart home researches were primarily concerned for single-user scenarios. However, our homes are usually full with social interactions. In order to explore the research challenge, we applied need-finding approaches to envision the possibilities. We visited ten families to prove

Identifying consumer's needs of health information technology through an innovative participatory design approach among English- and Spanish-speaking urban older adults.

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Lucero, R; Sheehan, B; Yen, P; Velez, O; Nobile-Hernandez, D; Tiase, V

2014-01-01

We describe an innovative community-centered participatory design approach, Consumer-centered Participatory Design (C2PD), and the results of applying C2PD to design and develop a web-based fall prevention system. We conducted focus groups and design sessions with English- and Spanish-speaking community-dwelling older adults. Focus group data were summarized and used to inform the context of the design sessions. Descriptive content analysis methods were used to develop categorical descriptions of design session informant's needs related to information technology. The C2PD approach enabled the assessment and identification of informant's needs of health information technology (HIT) that informed the development of a falls prevention system. We learned that our informants needed a system that provides variation in functions/content; differentiates between actionable/non-actionable information/structures; and contains sensory cues that support wide-ranging and complex tasks in a varied, simple, and clear interface to facilitate self-management. The C2PD approach provides community-based organizations, academic researchers, and commercial entities with a systematic theoretically informed approach to develop HIT innovations. Our community-centered participatory design approach focuses on consumer's technology needs while taking into account core public health functions.

Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

Directory of Open Access Journals (Sweden)

P. Timpel

2017-11-01

Full Text Available Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92 of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22 of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650. Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care

Quantitative Risk reduction estimation Tool For Control Systems, Suggested Approach and Research Needs

Energy Technology Data Exchange (ETDEWEB)

Miles McQueen; Wayne Boyer; Mark Flynn; Sam Alessi

2006-03-01

For the past year we have applied a variety of risk assessment technologies to evaluate the risk to critical infrastructure from cyber attacks on control systems. More recently, we identified the need for a stand alone control system risk reduction estimation tool to provide owners and operators of control systems with a more useable, reliable, and credible method for managing the risks from cyber attack. Risk is defined as the probability of a successful attack times the value of the resulting loss, typically measured in lives and dollars. Qualitative and ad hoc techniques for measuring risk do not provide sufficient support for cost benefit analyses associated with cyber security mitigation actions. To address the need for better quantitative risk reduction models we surveyed previous quantitative risk assessment research; evaluated currently available tools; developed new quantitative techniques [17] [18]; implemented a prototype analysis tool to demonstrate how such a tool might be used; used the prototype to test a variety of underlying risk calculational engines (e.g. attack tree, attack graph); and identified technical and research needs. We concluded that significant gaps still exist and difficult research problems remain for quantitatively assessing the risk to control system components and networks, but that a useable quantitative risk reduction estimation tool is not beyond reach.

Designing sustainable work systems: the need for a systems approach.

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Zink, Klaus J

2014-01-01

There is a growing discussion concerning sustainability. While this discussion was at first mainly focused on a society level--and sometimes regarding especially environmental problems, one can now see that this topic is of increasing relevance for companies worldwide and even the social dimension of this three pillar approach is gaining more and more importance. This leads to some questions: Is sustainability already a part of human factors thinking or do we have to further develop our discipline? How can we define sustainable work systems? What are the topics we have to consider? Do we need a new systems ergonomics perspective regarding whole value creation chains and a life-cycle perspective concerning products (and work systems)? How can we deal with potential contradictions about social, ecological, and economic goals? Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

A True Delphi Approach: Developing a Tailored Curriculum in Response to Local Agriscience Need

Energy Technology Data Exchange (ETDEWEB)

Rubenstein, Eric; Thoron, Andrew; Burleson, Sarah

2012-02-07

The Delphi approach is a structured communication technique, developed as a systematic, interactive forecasting method which relies on a panel of experts. In this specific case experts from Industry, Education and Extension fields addressed needs for educational programs in a traditional agriculturally-based community, environmentally conscious practices in order to restore environmental integrity and multi-disciplinary approach to solve sustainability problems facing the agricultural industry. The experts were divided into two main groups, (A) Secondary and (B) Post-secondary, and answered questionnaires in three rounds: • 1st Round – Participants generated a list of knowledge, skills, and competencies followed • 2nd Round – Panelists rated each item • 3rd Round – Panelists were given the opportunity to combine and add additional items As a result, top six items from both groups were not found similar, secondary panelists centralized around employment skills and post-secondary panelists focused on content areas. Implications include a need for content-based curriculum for post-secondary graduates, utilization of true-Delphi technique for future curriculum development research and further examination of students that complete secondary and post-secondary programs in biofuels/sustainable agriculture.

Participative approach to elicit water quality monitoring needs from stakeholder groups - An application of integrated watershed management.

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Behmel, S; Damour, M; Ludwig, R; Rodriguez, M J

2018-07-15

Water quality monitoring programs (WQMPs) must be based on monitoring objectives originating from the real knowledge needs of all stakeholders in a watershed and users of the resource. This paper proposes a participative approach to elicit knowledge needs and preferred modes of communication from citizens and representatives of organized stakeholders (ROS) on water quality and quantity issues. The participative approach includes six steps and is adaptable and transferable to different types of watersheds. These steps are: (1) perform a stakeholder analysis; (2) conduct an adaptable survey accompanied by a user-friendly public participation geographical information system (PPGIS); (3) hold workshops to meet with ROS to inform them of the results of the survey and PPGIS; discuss attainment of past monitoring objectives; exchange views on new knowledge needs and concerns on water quality and quantity; (4) meet with citizens to obtain the same type of input (as from ROS); (5) analyze the data and information collected to identify new knowledge needs and modes of communication and (6) identify, in collaboration with the individuals in charge of the WQMPs, the short-, medium- and long-term monitoring objectives and communication strategies to be pursued. The participative approach was tested on two distinct watersheds in the province of Quebec, Canada. It resulted in a series of optimization objectives of the existing WQMPs, new monitoring objectives and recommendations regarding communication strategies of the WQMPs' results. The results of this study show that the proposed methodology is appreciated by all parties and that the outcomes and monitoring objectives are acceptable. We also conclude that successful integrated watershed management is a question of scale, and that every aspect of integrated watershed management needs to be adapted to the surface watershed, the groundwater watershed (aquifers) and the human catchment area. Copyright © 2018 Elsevier Ltd. All

Sounding the warning bells: the need for a systems approach to understanding behaviour at rail level crossings.

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Read, Gemma J M; Salmon, Paul M; Lenné, Michael G

2013-09-01

Collisions at rail level crossings are an international safety concern and have been the subject of considerable research effort. Modern human factors practice advocates a systems approach to investigating safety issues in complex systems. This paper describes the results of a structured review of the level crossing literature to determine the extent to which a systems approach has been applied. The measures used to determine if previous research was underpinned by a systems approach were: the type of analysis method utilised, the number of component relationships considered, the number of user groups considered, the number of system levels considered and the type of model described in the research. None of research reviewed was found to be consistent with a systems approach. It is recommended that further research utilise a systems approach to the study of the level crossing system to enable the identification of effective design improvements. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view

International Nuclear Information System (INIS)

Sakkary, M.A.; Abdelrahman, A.M.; Mostafa, A.M.; Abbas, A.A.; Zedan, M.H.

2012-01-01

Background and purpose: The incidence of retrosternal goiter (Rg) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria . There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/ or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach. Patients and methods: Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed. Results: The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p< 0.0001. Conclusion: Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

Policies for friendly cities: the need for a new approach by governments and the donor community

Science.gov (United States)

Puccioni, V.

2018-03-01

Since the 1990s, the major issues in the world’s cities of Developing and Emerging Economy Countries have in some few cases improved in terms of the percentage of urban population living without appropriate housing and access to essential services- but in terms of numbers such population has severely increased. The theory by which economic development would automatically produce a trickle down effect that would take care of the needs of the poor has proved ineffective, and while the middle-lower classes have seen their lot improved, the lowest income groups are more destitute then ever- and more and more vulnerable to natural disasters. The approach of Governments and the donor community needs to be radically revisited, with a new urban policy agenda that should put emphasis on support to the lowest income groups, and relying on the informal sector as the main actor in implementing such support. The impacts of Climate Change and the increased frequency and severity of natural catastrophes also call for such a revised approach. The two-step approach to interventions in disasters situations – i.e. providing temporary shelters and only subsequently reconstructing homes- is ineffective and wasteful.

Implant breast reconstruction after salvage mastectomy in previously irradiated patients.

Science.gov (United States)

Persichetti, Paolo; Cagli, Barbara; Simone, Pierfranco; Cogliandro, Annalisa; Fortunato, Lucio; Altomare, Vittorio; Trodella, Lucio

2009-04-01

The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

Taking Health Needs Seriously: Against a Luck Egalitarian Approach to Justice in Health

DEFF Research Database (Denmark)

Nielsen, Lasse

2013-01-01

In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them...... to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck...... egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism...

Anybody Hear Us? Attempting to Meet the Psychological Care Needs of Older People: an Ethnographic Approach

Directory of Open Access Journals (Sweden)

Seyed Zia Tabatabaei

2016-07-01

Full Text Available Older people who live in residential settings need some psychological support because of vicissitudes of life they faced with. The aim of this study is to explore psychological care needs of older people in a residential home. We used an ethnographic approach from May 2011 till January 2012. Through purposeful sampling, 14 knowledgeable participants were selected. Data were gathered from participant observations, in-depth interviews, review of related documents and field notes. Thematic analysis revealed three key themes including: (a Feelings of sadness (b Emotional desires and (c Choice and control. Findings of current study provided rich and useful information that is useful in charting new guideline for policy makers and care providers in order to support elderly residents' psychological care needs.

MAKING THE NEIGHBOURHOOD A BETTER PLACE TO LIVE. A SWB APPROACH IMPLEMENTING FUNDAMENTAL HUMAN NEEDS

Directory of Open Access Journals (Sweden)

Ioanna Anna Papachristou

2015-10-01

Full Text Available Subjective well-being (SWB studies have been at the centre of researchers’ attention during the last years. With the majority of people now living in cities, the necessity for a more anthropocentric approach for the study and betterment of urban environments is constantly increasing. In this sense, defining and measuring SWB in urban contexts can be of particular benefit in urban design and planning processes. In this article, a method for measuring SWB for urban places based on the accomplishment of the fundamental human needs is presented and applied at a neighbourhood of Barcelona; that of Vila de Gràcia. For the measurement, a survey was constructed based on the specific geographical and socio-economic characteristics of the study case. Retrieved from Max-Neef’s Human Scale Development Paradigm (Max-Neef et al. 1991, human needs correspond to the domains of study of the suggested method. The matching of the survey’s questions to each need is the outcome of two consecutive processes: a first qualitative one, involving the work of an expert group, and a second quantitative one, involving the definition of weights among the questions that affect the same need. Although the final result is positive (although low for this study case, results for each need show considerable differences in their level of accomplishment. At the same time people seem to truly believe that most of their feelings are affected by their living environment, with stress and calmness leading the list. In summary, the method defines and applies a simple tool to quantify and evaluate current levels of SWB at different urban scales and to determine more holistic urban indexes in order to improve decision making processes, policies and plans. The classification of the questions per need favours the identification of a potential problem at the urban grid and consequently can be used as a process for implementing related measures of improvement. The method can also be seen

Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

Science.gov (United States)

Cain, Joanna M; Felice, Marianne E; Ockene, Judith K; Milner, Robert J; Congdon, John L; Tosi, Stephen; Thorndyke, Luanne E

2018-03-01

Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

SONOGRAPHIC PREDICTION OF SCAR DEHISCENCE IN WOMEN WITH PREVIOUS CAESAREAN SECTION

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Shubhada Suhas Jajoo

2018-01-01

Full Text Available BACKGROUND Caesarean section (Sectio Caesarea is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after caesarean section was significantly reduced from year to year and the rate of repeated caesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding “cut-off value” for the completion of the delivery method. To better assess the risk of uterine rupture, some authors have proposed sonographic measurement of lower uterine segment thickness near term assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS may increase safety during labour by selecting women with the lowest risk of uterine rupture. The aim of the study is to study the diagnostic accuracy of sonographic measurements of the Lower Uterine Segment (LUS thickness near term in predicting uterine scar defects in women with prior Caesarean Section (CS. We aim to ascertain the best cut-off values for predicting uterine rupture. MATERIALS AND METHODS 100 antenatal women with history of previous one LSCS who come to attend antenatal clinic will be assessed for scar thickness by transabdominal ultrasonography and its correlation with intraoperative findings. This prospective longitudinal study was conducted for 1 year after IEC approval with inclusion criteria previous one LSCS. Exclusion criteria- 1 Previous myomectomy scar; 2 Previous 2 LSCS; 3 Previous hysterotomy scar. RESULTS Our findings indicate that there is a strong association between degree of LUS thinning measured near term and the risk of uterine scar defect at birth. In our study, optimal cut-off value for predicting

Distributed Electrical Energy Systems: Needs, Concepts, Approaches and Vision

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yingchen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhang, Jun [University of Denver; Gao, Wenzhong [University of Denver; Zheng, Xinhu [University of Minnesota; Yang, Liuqing [Colorado State University; Hao, Jun [University of Denver; Dai, Xiaoxiao [University of Denver

2017-09-01

Intelligent distributed electrical energy systems (IDEES) are featured by vast system components, diversifled component types, and difficulties in operation and management, which results in that the traditional centralized power system management approach no longer flts the operation. Thus, it is believed that the blockchain technology is one of the important feasible technical paths for building future large-scale distributed electrical energy systems. An IDEES is inherently with both social and technical characteristics, as a result, a distributed electrical energy system needs to be divided into multiple layers, and at each layer, a blockchain is utilized to model and manage its logic and physical functionalities. The blockchains at difierent layers coordinate with each other and achieve successful operation of the IDEES. Speciflcally, the multi-layer blockchains, named 'blockchain group', consist of distributed data access and service blockchain, intelligent property management blockchain, power system analysis blockchain, intelligent contract operation blockchain, and intelligent electricity trading blockchain. It is expected that the blockchain group can be self-organized into a complex, autonomous and distributed IDEES. In this complex system, frequent and in-depth interactions and computing will derive intelligence, and it is expected that such intelligence can bring stable, reliable and efficient electrical energy production, transmission and consumption.

Reference Data Layers for Earth and Environmental Science: History, Frameworks, Science Needs, Approaches, and New Technologies

Science.gov (United States)

Lenhardt, W. C.

2015-12-01

Global Mapping Project, Web-enabled Landsat Data (WELD), International Satellite Land Surface Climatology Project (ISLSCP), hydrology, solid earth dynamics, sedimentary geology, climate modeling, integrated assessments and so on all have needs for or have worked to develop consistently integrated data layers for Earth and environmental science. This paper will present an overview of an abstract notion of data layers of this types, what we are referring to as reference data layers for Earth and environmental science, highlight some historical examples, and delve into new approaches. The concept of reference data layers in this context combines data availability, cyberinfrastructure and data science, as well as domain science drivers. We argue that current advances in cyberinfrastructure such as iPython notebooks and integrated science processing environments such as iPlant's Discovery Environment coupled with vast arrays of new data sources warrant another look at the how to create, maintain, and provide reference data layers. The goal is to provide a context for understanding science needs for reference data layers to conduct their research. In addition, to the topics described above this presentation will also outline some of the challenges to and present some ideas for new approaches to addressing these needs. Promoting the idea of reference data layers is relevant to a number of existing related activities such as EarthCube, RDA, ESIP, the nascent NSF Regional Big Data Innovation Hubs and others.

Reasoning with Previous Decisions: Beyond the Doctrine of Precedent

DEFF Research Database (Denmark)

Komárek, Jan

2013-01-01

in different jurisdictions use previous judicial decisions in their argument, we need to move beyond the concept of precedent to a wider notion, which would embrace practices and theories in legal systems outside the Common law tradition. This article presents the concept of ‘reasoning with previous decisions...... law method’, but they are no less rational and intellectually sophisticated. The reason for the rather conceited attitude of some comparatists is in the dominance of the common law paradigm of precedent and the accompanying ‘case law method’. If we want to understand how courts and lawyers......’ as such an alternative and develops its basic models. The article first points out several shortcomings inherent in limiting the inquiry into reasoning with previous decisions by the common law paradigm (1). On the basis of numerous examples provided in section (1), I will present two basic models of reasoning...

Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

Science.gov (United States)

Christensen, Leif; Karle, Hans; Nystrup, Jørgen

2007-09-01

An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

The hierarchy-by-interval approach to identifying important models that need improvement in severe-accident simulation codes

International Nuclear Information System (INIS)

Heames, T.J.; Khatib-Rahbar, M.; Kelly, J.E.

1995-01-01

The hierarchy-by-interval (HBI) methodology was developed to determine an appropriate phenomena identification and ranking table for an independent peer review of severe-accident computer codes. The methodology is described, and the results of a specific code review are presented. Use of this systematic and structured approach ensures that important code models that need improvement are identified and prioritized, which allows code sponsors to more effectively direct limited resources in future code development. In addition, critical phenomenological areas that need more fundamental work, such as experimentation, are identified

Atomic and Molecular Data Needs for Radiation Damage Modeling: Multiscale Approach

International Nuclear Information System (INIS)

Yakubovich, Alexander V.; Solov'yov, Andrey V.; Surdutovich, Eugene

2011-01-01

We present a brief overview of the multiscale approach towards understanding of the processes responsible for the radiation damage caused by energetic ions. This knowledge is very important, because it can be utilized in the ion-beam cancer therapy, which is one of the most advanced modern techniques to cure certain type of cancer. The central element of the multiscale approach is the theoretical evaluation and quantification of the DNA damage within cell environment. To achieve this goal one needs a significant amount of data on various atomic and molecular processes involved into the cascade of events starting with the ion entering and propagation in the biological medium and resulting in the DNA damage. The discussion of the follow up biological processes are beyond the scope of this brief overview. We consider different paths of the DNA damage and focus on the the illustration of the thermo-mechanical effects caused by the propagation of ions through the biological environment and in particular on the possibility of the creation of the shock waves in the vicinity of the ion tracks. We demonstrate that at the initial stages after ion's passage the shock wave is so strong that it can contribute to the DNA damage due to large pressure gradients developed at the distances of a few nanometers from the ionic tracks. This novel mechanism of the DNA damage provides an important contribution to the cumulative biodamage caused by low-energy secondary electrons, holes and free radicals.

The strategic approach to contraceptive introduction.

Science.gov (United States)

Simmons, R; Hall, P; Díaz, J; Díaz, M; Fajans, P; Satia, J

1997-06-01

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

Science.gov (United States)

Parcover, Jason; Mays, Sally; McCarthy, Amy

2015-01-01

The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

Basic psychological need experiences, fatigue, and sleep in individuals with unexplained chronic fatigue.

Science.gov (United States)

Campbell, Rachel; Tobback, Els; Delesie, Liesbeth; Vogelaers, Dirk; Mariman, An; Vansteenkiste, Maarten

2017-12-01

Grounded in self-determination theory, this study tested the hypothesis that the satisfaction and frustration of the psychological needs for autonomy, competence, and relatedness would relate to fatigue and subjective and objective sleep parameters, with stress and negative sleep cognitions playing an explanatory role in these associations. During a stay at a sleep laboratory in Belgium, individuals with unexplained chronic fatigue (N = 160; 78% female) underwent polysomnography and completed a questionnaire at 3 different points in time (i.e., after arrival in the sleep lab, before bedtime, and the following morning) that assessed their need-based experiences and stress during the previous week, fatigue during the preceding day, and sleep-related cognitions and sleep during the previous night. Results indicated that need frustration related to higher stress, which in turn, related to higher evening fatigue. Need frustration also related to poorer subjective sleep quality and shorter sleep duration, as indicated by both subjective and objective shorter total sleep time and subjective (but not objective) longer sleep latency. These associations were accounted for by stress and negative sleep cognitions. These findings suggest that health care professionals working with individuals with unexplained chronic fatigue may consider focusing on basic psychological needs within their therapeutic approach. Copyright © 2017 John Wiley & Sons, Ltd.

Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

Directory of Open Access Journals (Sweden)

Ali Sadrizadeh

2015-11-01

Full Text Available Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21% males and 64 (78% females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95% and dyspnea (73%. In most patients, the surgical approach was cervical (90.2%, while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%. Malignancy was reported in the histopathology of seven patients (8.5%. The most common malignant histopathology was papillary thyroid carcinoma (7.3%. Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (P

Use of comparative genomics approaches to characterize interspecies differences in response to environmental chemicals: Challenges, opportunities, and research needs

International Nuclear Information System (INIS)

Burgess-Herbert, Sarah L.; Euling, Susan Y.

2013-01-01

A critical challenge for environmental chemical risk assessment is the characterization and reduction of uncertainties introduced when extrapolating inferences from one species to another. The purpose of this article is to explore the challenges, opportunities, and research needs surrounding the issue of how genomics data and computational and systems level approaches can be applied to inform differences in response to environmental chemical exposure across species. We propose that the data, tools, and evolutionary framework of comparative genomics be adapted to inform interspecies differences in chemical mechanisms of action. We compare and contrast existing approaches, from disciplines as varied as evolutionary biology, systems biology, mathematics, and computer science, that can be used, modified, and combined in new ways to discover and characterize interspecies differences in chemical mechanism of action which, in turn, can be explored for application to risk assessment. We consider how genetic, protein, pathway, and network information can be interrogated from an evolutionary biology perspective to effectively characterize variations in biological processes of toxicological relevance among organisms. We conclude that comparative genomics approaches show promise for characterizing interspecies differences in mechanisms of action, and further, for improving our understanding of the uncertainties inherent in extrapolating inferences across species in both ecological and human health risk assessment. To achieve long-term relevance and consistent use in environmental chemical risk assessment, improved bioinformatics tools, computational methods robust to data gaps, and quantitative approaches for conducting extrapolations across species are critically needed. Specific areas ripe for research to address these needs are recommended

Previous Repeated Exposure to Food Limitation Enables Rats to Spare Lipid Stores during Prolonged Starvation.

Science.gov (United States)

McCue, Marshall D; Albach, Audrey; Salazar, Giovanni

The risk of food limitation and, ultimately, starvation dates back to the dawn of heterotrophy in animals, yet starvation remains a major factor in the regulation of modern animal populations. Researchers studying starvation more than a century ago suggested that animals subjected to sublethal periods of food limitation are somehow more tolerant of subsequent starvation events. This possibility has received little attention over the past decades, yet it is highly relevant to modern science for two reasons. First, animals in natural populations are likely to be exposed to bouts of food limitation once or more before they face prolonged starvation, during which the risk of mortality becomes imminent. Second, our current approach to studying starvation physiology in the laboratory focuses on nourished animals with no previous exposure to nutritional stress. We examined the relationship between previous exposure to food limitation and potentially adaptive physiological responses to starvation in adult rats and found several significant differences. On two occasions, rats were fasted until they lost 20% of their body mass maintained lower body temperatures, and had presumably lower energy requirements when subjected to prolonged starvation than their naive cohort that never experienced food limitation. These rats that were trained in starvation also had lower plasma glucose set -points and reduced their reliance on endogenous lipid oxidation. These findings underscore (1) the need for biologists to revisit the classic hypothesis that animals can become habituated to starvation, using a modern set of research tools; and (2) the need to design controlled experiments of starvation physiology that more closely resemble the dynamic nature of food availability.

Share| The Need for Person-Centered Education

Directory of Open Access Journals (Sweden)

Alberto Zucconi

2016-10-01

Full Text Available We, the children of the Anthropocene Era, are entering the 4th industrial revolution and the impact is going to be pervasive and of greater magnitude compared to the previous industrial revolutions. The incoming changes, approaching at an accelerating speed, will be impacting everything and everybody and blurring the lines between the physical, digital, and biological spheres; they will affect the bio-psycho-social dimensions, our narratives and even what it means to be human. If we are not farsighted and do not plan effectively, the results could be very problematic for all life forms on Earth. If we manage the 4th industrial revolution with the same blindness and forms of denial with which we managed the previous industrial revolutions, the negative effects will be exponential. But we are not impotent; we can manage this revolution wisely, increase the positive effects and mitigate the negative ones since technology is designed, made and managed by us. We cannot afford to be naïve and just hope that technology will automatically improve our lives; new and effective tools for understanding and governing such epochal changes are needed apart from the need for facilitating awareness in all stakeholders about the dangers and opportunities offered by the incoming changes. Effective forms of education are crucial. The fourth revolution could be an unprecedented success if we are able to manage complex processes and at the same time assure that each innovation will not only bring change but also foster a more humane, sustainable, peaceful and prosperous future for all. For effective governance, we need effective tools. One much-needed tool is the clear understanding of the crucial role played by the processes by which we humans construe experiences of ourselves, of others and other life forms. In other words, most of us still think we live in a unidimensional reality, but we live in a socially construed consensus reality, ignoring which may create

76 FR 12963 - Request for Information (NOT-ES-11-007): Needs and Approaches for Assessing the Human Health...

Science.gov (United States)

2011-03-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Information (NOT-ES-11-007): Needs and Approaches for Assessing the Human Health Impacts of Exposure to Mixtures AGENCY: National Institutes of... analyzes its findings to assess potential hazards to human health from exposure to environmental substances...

78 FR 20672 - Literature Review Approach “Identifying Research Needs for Assessing Safe Use of High Intakes of...

Science.gov (United States)

2013-04-05

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Literature Review Approach... Needs for Assessing Safe Use of High Intakes of Folic Acid,'' for review of the pertinent literature... folate and folic acid, screening of the literature was undertaken to identify the potential adverse...

A Hybrid Approach to Finding Relevant Social Media Content for Complex Domain Specific Information Needs.

Science.gov (United States)

Cameron, Delroy; Sheth, Amit P; Jaykumar, Nishita; Thirunarayan, Krishnaprasad; Anand, Gaurish; Smith, Gary A

2014-12-01

While contemporary semantic search systems offer to improve classical keyword-based search, they are not always adequate for complex domain specific information needs. The domain of prescription drug abuse, for example, requires knowledge of both ontological concepts and "intelligible constructs" not typically modeled in ontologies. These intelligible constructs convey essential information that include notions of intensity, frequency, interval, dosage and sentiments, which could be important to the holistic needs of the information seeker. In this paper, we present a hybrid approach to domain specific information retrieval that integrates ontology-driven query interpretation with synonym-based query expansion and domain specific rules, to facilitate search in social media on prescription drug abuse. Our framework is based on a context-free grammar (CFG) that defines the query language of constructs interpretable by the search system. The grammar provides two levels of semantic interpretation: 1) a top-level CFG that facilitates retrieval of diverse textual patterns, which belong to broad templates and 2) a low-level CFG that enables interpretation of specific expressions belonging to such textual patterns. These low-level expressions occur as concepts from four different categories of data: 1) ontological concepts, 2) concepts in lexicons (such as emotions and sentiments), 3) concepts in lexicons with only partial ontology representation, called lexico-ontology concepts (such as side effects and routes of administration (ROA)), and 4) domain specific expressions (such as date, time, interval, frequency and dosage) derived solely through rules. Our approach is embodied in a novel Semantic Web platform called PREDOSE, which provides search support for complex domain specific information needs in prescription drug abuse epidemiology. When applied to a corpus of over 1 million drug abuse-related web forum posts, our search framework proved effective in retrieving

Antirandom Testing: A Distance-Based Approach

Directory of Open Access Journals (Sweden)

Shen Hui Wu

2008-01-01

Full Text Available Random testing requires each test to be selected randomly regardless of the tests previously applied. This paper introduces the concept of antirandom testing where each test applied is chosen such that its total distance from all previous tests is maximum. This spans the test vector space to the maximum extent possible for a given number of vectors. An algorithm for generating antirandom tests is presented. Compared with traditional pseudorandom testing, antirandom testing is found to be very effective when a high-fault coverage needs to be achieved with a limited number of test vectors. The superiority of the new approach is even more significant for testing bridging faults.

Improving accuracy for identifying related PubMed queries by an integrated approach.

Science.gov (United States)

Lu, Zhiyong; Wilbur, W John

2009-10-01

PubMed is the most widely used tool for searching biomedical literature online. As with many other online search tools, a user often types a series of multiple related queries before retrieving satisfactory results to fulfill a single information need. Meanwhile, it is also a common phenomenon to see a user type queries on unrelated topics in a single session. In order to study PubMed users' search strategies, it is necessary to be able to automatically separate unrelated queries and group together related queries. Here, we report a novel approach combining both lexical and contextual analyses for segmenting PubMed query sessions and identifying related queries and compare its performance with the previous approach based solely on concept mapping. We experimented with our integrated approach on sample data consisting of 1539 pairs of consecutive user queries in 351 user sessions. The prediction results of 1396 pairs agreed with the gold-standard annotations, achieving an overall accuracy of 90.7%. This demonstrates that our approach is significantly better than the previously published method. By applying this approach to a one day query log of PubMed, we found that a significant proportion of information needs involved more than one PubMed query, and that most of the consecutive queries for the same information need are lexically related. Finally, the proposed PubMed distance is shown to be an accurate and meaningful measure for determining the contextual similarity between biological terms. The integrated approach can play a critical role in handling real-world PubMed query log data as is demonstrated in our experiments.

Nematode parasite control of livestock in the tropics/subtropics: the need for novel approaches.

Science.gov (United States)

Waller, P J

1997-10-01

Because parasites are more abundant, small ruminants in the tropical/subtropical regions of the world experience much greater ravages from internal parasitic disease than those in the temperate regions. In the tropics/subtropics, the limiting ecological factor influencing the severity of parasitism is rainfall, as temperatures almost always favour hatching and development of the free-living stages. Attempts to expand sheep and goat production by replacing traditional village production systems, which rarely involve anthelmintic treatment, with large-scale intensive commercial enterprises invariably induce complete reliance on anthelmintics to control nematode parasites. This has led to the widespread development of high level, multiple anthelmintic resistance throughout the tropics/subtropics, and in certain regions this has reached the ultimate disastrous scenario of total chemotherapeutic failure. Immediate concerted efforts are needed to resolve this crisis. Significant benefits are likely to emerge from research into non-chemotherapeutic approaches to nematode parasite control, such as grazing management, worm vaccines, breed selection and biological control. However, it is likely that none, in isolation or collectively, will completely replace the need for effective anthelmintics. What is needed is the integration of all methods of parasite control as they come to hand, with the underlying aim of reducing the use and thus preserving the effectiveness of anthelmintics. Although cheap and simple procedures, based on sound epidemiological principles, can achieve dramatic benefits in worm control, they have been poorly adopted by livestock owners. Clearly then, the greatest need is for technology transfer and education programmes, but these activities are generally found to be chronically under-resourced.

Critical review of forensic trace evidence analysis and the need for a new approach.

Science.gov (United States)

Stoney, David A; Stoney, Paul L

2015-06-01

The historical development, contributions and limitations of the two traditional approaches to trace evidence analysis are reviewed. The first approach was as generalist practitioner, looking broadly at an assemblage of many different particle types. The second was that of specialist practitioner, with attention focused on one specific particle type. Four factors have significantly impacted the effectiveness of these approaches: (1) increasing technological capabilities, (2) increasing complexity in the character of manufactured materials, (3) changes in forensic laboratory management, and (4) changing scientific and legal expectations. The effectiveness of each approach is assessed within the context of these changes. More recently, new technologies have been applied to some trace evidence problems, intended to address one or more limitations. This has led to a third approach founded on discrete, highly technical methods addressing specific analytical problems. After evaluating the contributions and limitations of this third approach, we consider the different ways that technologies could be developed to address unmet needs in forensic trace evidence analysis. The route toward effective use of new technologies is contrasted with how forensic science laboratories are currently choosing and employing them. The conclusion is that although new technologies are contributing, we are not on a path that will result in their most effective and appropriate use. A new approach is required. Based on an analysis of the contributions of each of the three exisiting approaches, seven characteristics of an effective trace evidence analysis capability were determined: (1) particle traces should be a major problem-solving tool, (2) there should be readily available, straightforward methods to enable their use, (3) all available and potentially useful particle types should be considered, (4) decisions to use them should be made in the context of each case, guided by what they can

New EDF approach to the mentification of NPP personnel training needs

International Nuclear Information System (INIS)

Hazet, Jean-Christophe

2003-01-01

The EDF ambition today is to be among the best electricity producers in the world. To do so, we have to take more responsibilities, to motivate and to give our employees a better level of competence, and to make them more involved in the culture and the success of our company. In order to reach these objectives a deeper analysis of the NPP training needs must be completed. Our answer, named 'Local Competencies Development System' (LCDS) consists in implementing a large decentralisation of the competencies management, done by the EDF Production Department in conjunction with the EDF Training Department. It takes place in a logical approach bound up with the historical development of our nuclear program. In addition to this LCDS a new organization of training centers instructors, in dedicated training teams, has been implemented in order to co-ordinate the different actions directly with the NPP. The purpose of this presentation is to take into account the LCDS on the operation personnel training side, a similar organization has been implemented for the maintenance side

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach.

Science.gov (United States)

Wikman, Anna; Kukkola, Laura; Börjesson, Helene; Cernvall, Martin; Woodford, Joanne; Grönqvist, Helena; von Essen, Louise

2018-04-18

Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child's cancer disease after end of treatment. One aim of this study was to develop an internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention. Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection. A 10-week, internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in

Research needs

International Nuclear Information System (INIS)

Anon.

1993-01-01

Research needs were identified during working sessions for several potential separation options. These options include sequestering agents, solvent extraction, membranes, solid sorbents, novel approaches, organic separation and destruction methods, and radiation and chemical stability of separation materials

Predicting fruit consumption: the role of habits, previous behavior and mediation effects

NARCIS (Netherlands)

de Vries, H.; Eggers, S.M.; Lechner, L.; van Osch, L.; van Stralen, M.M.

2014-01-01

Background: This study assessed the role of habits and previous behavior in predicting fruit consumption as well as their additional predictive contribution besides socio-demographic and motivational factors. In the literature, habits are proposed as a stable construct that needs to be controlled

The Power of Behavioural Approaches--We Need a Revival

Science.gov (United States)

Buckley, Sue

2008-01-01

Behavioural approaches can be used effectively to teach new skills and to change behaviours that are challenging and not socially adaptive. The behaviour modification approach--now called applied behaviour analysis--is based on the assumption that all behaviours are learned, both the useful ones (new skills) and the ones that are not so useful…

SCIENCE NEEDS AFRICA AS MUCH AS AFRICA NEEDS ...

African Journals Online (AJOL)

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their study on the needs of science education in Tanzania (2, p. 12): ... qualified teachers of mathematics and science at the primary- and secondary-school level, inadequate ... perform competently in the classroom. Second ... knowledge nor adequate knowledge/application of the competency based approaches that are the ...

ldentification of Needs for Higher Education of Adults

Directory of Open Access Journals (Sweden)

Darka Podmenik

1997-12-01

Full Text Available The paper, which is a summary of a longer study, presents the most important conceptual and methodological approaches to the identification of the needs for adult education. The conceptual approaches are related to the theoretical treatment of the needs, such as the behaviourist and development-humanist theory of the needs applied in psychology, the class-strata needs theory developed by sociologists, and an understanding of the needs characteristic of marketing. A special chapter considers the applicability of individual conceptual approaches to identification of the needs for adult education within higher education. A consequence of multiplicity of conceptual approaches to the identification of the needs is a methodological pluralism which becomes evident in empirical work. In the subsequent chapter the author outlines the already established methods for identification of the needs and "a case study" carried out by the researchers of the former Centre for the Development of the University. In the conclusion the author makes a few proposals for improvement of the identification of the needs for adult education in the sphere of Slovenian higher education.

Too Much or Not Enough? An Examination of Special Education Provision and School District Leaders' Perceptions of Current Needs and Common Approaches

Science.gov (United States)

Cameron, David Lansing

2016-01-01

The purpose of this study was to examine the relationship between special education provision in Norway and school district leaders' perspectives regarding (a) the need for special education and (b) the importance and prevalence of integrated and segregated approaches. Findings indicate that the percentage of students perceived as being in need of…

Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms.

Science.gov (United States)

Werner, Nicole E; Stanislawski, Barbara; Marx, Katherine A; Watkins, Daphne C; Kobayashi, Marissa; Kales, Helen; Gitlin, Laura N

2017-02-22

Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer's Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. This study used a sociotechnical systems approach to identify barriers to meeting caregivers' information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies. We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver's needs and contexts, and 3) usable information that can directly inform how caregivers' manage behaviors. The sociotechnical system framework is a useful approach for identifying information

Junk-food enhances conditioned food cup approach to a previously established food cue, but does not alter cue potentiated feeding; implications for the effects of palatable diets on incentive motivation.

Science.gov (United States)

Derman, Rifka C; Ferrario, Carrie R

2018-03-16

Efforts to stem the global rise in obesity have been minimally effective, perhaps in part because our understanding of the psychological and behavioral drivers of obesity is limited. It is well established that stimuli that are paired with palatable foods can powerfully influence food-seeking and feeding behaviors. However, how consumption of sugary, fatty "junk-foods" affects these motivational responses to food cues is poorly understood. Here, we determined the effects of short- and long-term "junk-food" consumption on the expression of cue potentiated feeding and conditioned food cup approach to Pavlovian conditioned stimuli (CS). Further, to determine the degree to which effects of "junk-food" were selective to Pavlovian motivational processes, we varied the predictive validity of the CS by including training groups conditioned with unique CS-US contingencies ranging from -1.0 to +1.0. "Junk-food" did not enhance cue potentiated feeding in any group, but expression of this potentiation effect varied with the CS-US contingency independent of diet. In contrast, "junk-food" consistently enhanced conditioned approach to the food cup; this effect was dependent on the previously established CS-US contingency. That is, consumption of "junk-food" following training enhanced approach to the food cup only in response to CSs with previously positive CS-US contingencies. This was accompanied by reduced motivation for the US itself. Together these data show that "junk-food" consumption selectively enhances incentive motivational responses to previously established food CSs, without altering cue potentiated feeding induced by these same CSs, and in the absence of enhanced motivation for food itself. Copyright © 2018 Elsevier Inc. All rights reserved.

Marketing Management Relational Approaches Focused on Consumer’s and Customer’s Needs and Desires

Directory of Open Access Journals (Sweden)

Gheorghe MINCULETE

2014-12-01

Full Text Available Currently, because of the evolution in the knowledge-based society, the marketing reveals another dimension, the one of relational marketing, which represents the special relationship established between the company and its consumers, with win-win advantages over a long period. In these circumstances, the managerial approach of marketing has new connotations for a more efficient managerial approach of the new national and international business environment. Within the marketing management process of a company, consumers or customers play a very critical role as these are the people who finally buy the goods and services of the organization, and the firm is always on the move to make them buy so as to earn revenue.This article presents the managerial approach of marketing management concept toward the strategic planning of a company and the marketing planning focused on needs and desires of consumers and customers. Therefore, consumers are the beneficiaries of the general and marketing strategy of the company while customers are those who respond to the loyalty process established by the firm. In this context, the purpose of this analysis is to highlight the strategic planning process of a company by integrating the strategic and operational marketing.In addition, we also consider important the issues related to Michael Porter’s generic strategies, which are thus presented in the context of relational knowledge within the process of marketing management. All these approaches are related to winning customers’ loyalty and obviously to customers' value that determines the company to achieve a value chain in the business process. Hence, the consumers and customers are the most important people for any organization. They are the resources which trigger the success of the business.

A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status.

Science.gov (United States)

Hicks, C; Hennessy, D

1998-01-01

The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.

Respiratory sensitization and allergy: Current research approaches and needs

International Nuclear Information System (INIS)

Boverhof, Darrell R.; Billington, Richard; Gollapudi, B. Bhaskar; Hotchkiss, John A.; Krieger, Shannon M.; Poole, Alan; Wiescinski, Connie M.; Woolhiser, Michael R.

2008-01-01

There are currently no accepted regulatory models for assessing the potential of a substance to cause respiratory sensitization and allergy. In contrast, a number of models exist for the assessment of contact sensitization and allergic contact dermatitis (ACD). Research indicates that respiratory sensitizers may be identified through contact sensitization assays such as the local lymph node assay, although only a small subset of the compounds that yield positive results in these assays are actually respiratory sensitizers. Due to the increasing health concerns associated with occupational asthma and the impending directives on the regulation of respiratory sensitizers and allergens, an approach which can identify these compounds and distinguish them from contact sensitizers is required. This report discusses some of the important contrasts between respiratory allergy and ACD, and highlights several prominent in vivo, in vitro and in silico approaches that are being applied or could be further developed to identify compounds capable of causing respiratory allergy. Although a number of animal models have been used for researching respiratory sensitization and allergy, protocols and endpoints for these approaches are often inconsistent, costly and difficult to reproduce, thereby limiting meaningful comparisons of data between laboratories and development of a consensus approach. A number of emerging in vitro and in silico models show promise for use in the characterization of contact sensitization potential and should be further explored for their ability to identify and differentiate contact and respiratory sensitizers. Ultimately, the development of a consistent, accurate and cost-effective model will likely incorporate a number of these approaches and will require effective communication, collaboration and consensus among all stakeholders

"The Maasai Need Cows and the Cows Need Maasai," the Use of a Photovoice Approach to Assess Animal Health Needs.

Science.gov (United States)

van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

2015-01-01

The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai's animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher-participant communications, thereby facilitating new insights across language and cultural barriers.

New Antimicrobial Approaches: Reuse of Old Drugs.

Science.gov (United States)

Savoia, Dianella

2016-01-01

The global situation of antibiotic resistance and the reduction of investments in antibiotics research by the pharmaceutical industry suggest the need for specific cost-effective approaches in order to identify drugs for the therapy of many microbial infections. Among the viable alternative anti-infective compounds, drug repurposing, i.e. to find new uses for previously approved medicines, revealed some encouraging in vitro and in vivo results. In this article the reader has a panoramic view of the updated references on the strategies encountered during the repositioning process. New findings are reported about the anti-microbial efficacy of antipsychotic, cardiovascular, anti-inflammatory and anti-neoplastic drugs. This approach may enhance the portfolio of pharmaceutical companies reducing the need for pharmacokinetic and toxicity studies; the development of new uses of old drugs for different infectious diseases, leading to better health for patients, also in poor, tropical countries, appears to be having better results.

Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach.

Science.gov (United States)

Chan, Dara V; Gopal, Sucharita; Helfrich, Christine A

2014-11-01

Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community. Copyright © 2014 Elsevier Ltd. All rights reserved.

Training Needs Analysis: Weaknesses in the Conventional Approach.

Science.gov (United States)

Leat, Michael James; Lovel, Murray Jack

1997-01-01

Identification of the training and development needs of administrative support staff is not aided by conventional performance appraisal, which measures summary or comparative effectiveness. Meaningful diagnostic evaluation integrates three levels of analysis (organization, task, and individual), using behavioral expectation scales. (SK)

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

Science.gov (United States)

Bujold, Mathieu; Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Eve; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Beatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Therese; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel

2017-11-12

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt

Collaborative Approaches Needed to Close the Big Data Skills Gap

Directory of Open Access Journals (Sweden)

Steven Miller

2014-04-01

Full Text Available The big data and analytics talent discussion has largely focused on a single role – the data scientist. However, the need is much broader than data scientists. Data has become a strategic business asset. Every professional occupation must adapt to this new mindset. Universities in partnership with industry must move quickly to ensure that the graduates they produce have the required skills for the age of big data. Existing curricula should be reviewed and adapted to ensure relevance. New curricula and degree programs are needed to meet the needs of industry.

Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach.

Science.gov (United States)

Schalkwijk, Annemarie A H; Nijpels, Giel; Bot, Sandra D M; Elders, Petra J M

2016-03-08

In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard. A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'. Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural

Comprehensive Approach Training Toolkit: Training Needs Analysis

Science.gov (United States)

2013-03-01

general. t necessarily lea to act). Very litt Yoruba . entations liarization (FAM ology Integratio es. Content is p given cultural g nd pertinent lan...and focus-g training the C cially other g ncrease its th ng with CA c cation and re e cultural aw needs to con ; and g) traini g schedules a s are...milita tifs, de cultur olton, Febbra t, 2013; Thom es FC dans l’ la formation borer une boî alisée chez n ons se sont d ir compte dan é à clarifier l

Response to health insurance by previously uninsured rural children.

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Tilford, J M; Robbins, J M; Shema, S J; Farmer, F L

1999-08-01

To examine the healthcare utilization and costs of previously uninsured rural children. Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

Science.gov (United States)

Asadi-Lari, M; Farshad, A A; Assaei, S E; Vaez Mahdavi, M R; Akbari, M E; Ameri, A; Salimi, Z; Gray, D

2005-06-01

Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development

Previously unidentified changes in renal cell carcinoma gene expression identified by parametric analysis of microarray data

International Nuclear Information System (INIS)

Lenburg, Marc E; Liou, Louis S; Gerry, Norman P; Frampton, Garrett M; Cohen, Herbert T; Christman, Michael F

2003-01-01

carcinogenesis. This highlights the need for rigorous statistical approaches in microarray studies

The Need to Disentangle Key Concepts from Ecosystem-Approach Jargon

Science.gov (United States)

WAYLEN, K A; HASTINGS, E J; BANKS, E A; HOLSTEAD, K L; IRVINE, R J; BLACKSTOCK, K L

2014-01-01

The ecosystem approach—as endorsed by the Convention on Biological Diversity (CDB) in 2000—is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD’s concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD’s concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD’s concept of the ecosystem approach demands more attention. La Necesidad de Desenredar Conceptos Clave del

Comparative efficacy of tadalafil once daily in men with erectile dysfunction who demonstrated previous partial responses to as-needed sildenafil, tadalafil, or vardenafil.

Science.gov (United States)

Kim, Edward; Seftel, Allen; Goldfischer, Evan; Baygani, Simin; Burns, Patrick

2015-02-01

Phosphodiesterase type-5 inhibitors (PDE5Is) are first-line therapies for erectile dysfunction (ED). Sildenafil (SIL) and vardenafil (VAR) are approved for as-needed (PRN) dosing; tadalafil (TAD) is approved for both PRN and once-a-day (OaD) dosing for ED. Recent evidence suggests that TAD-OaD may be effective as therapy in men with an incomplete response to PRN-PDE5I therapy. This study evaluated whether TAD-OaD provides similar efficacy in men with ED who had previously demonstrated a partial response to PRN-PDE5I therapy. In this randomized, double-blind, placebo-controlled trial, men with a ≥3 month ED history received SIL 100 mg, TAD 20 mg, or VAR 20 mg during a 4 week open-label lead-in period. Those with International Index of Erectile Function - Erectile Function (IIEF-EF) domain scores TAD 2.5 mg up-titrated to 5 mg, TAD 5 mg, or placebo (PBO) OaD for 12 weeks. MAIN OUTCOME MEASURES obtained from patients treated with TAD-OaD were compared to PBO-treated patients. Additionally, results of treatment with TAD-OaD were compared to results obtained from 4 week PRN-PDE5I therapy to determine whether OaD and PRN regimens provided comparable efficacy. NCT01130532. International Index of Erectile Function (IIEF) domain scores; Sexual Encounter Profile (SEP) questions 2-5. Endpoint data was obtained from 590 men (391 TAD; 199 PBO). RESULTS for all IIEF and SEP measures were significantly better for TAD-OaD (p TAD 2.5 mg and TAD 5 mg OaD therapy were safe and generally well tolerated. Tadalafil once daily is a viable alternative to as-needed PDE5I therapy in men with ED. Key limitations include the lack of a PRN PDE5I study group during the double-blind period, and that many more patients took tadalafil than sildenafil or vardenafil during the PRN period.

A Multifaceted Mathematical Approach for Complex Systems

Energy Technology Data Exchange (ETDEWEB)

Alexander, F.; Anitescu, M.; Bell, J.; Brown, D.; Ferris, M.; Luskin, M.; Mehrotra, S.; Moser, B.; Pinar, A.; Tartakovsky, A.; Willcox, K.; Wright, S.; Zavala, V.

2012-03-07

Applied mathematics has an important role to play in developing the tools needed for the analysis, simulation, and optimization of complex problems. These efforts require the development of the mathematical foundations for scientific discovery, engineering design, and risk analysis based on a sound integrated approach for the understanding of complex systems. However, maximizing the impact of applied mathematics on these challenges requires a novel perspective on approaching the mathematical enterprise. Previous reports that have surveyed the DOE's research needs in applied mathematics have played a key role in defining research directions with the community. Although these reports have had significant impact, accurately assessing current research needs requires an evaluation of today's challenges against the backdrop of recent advances in applied mathematics and computing. To address these needs, the DOE Applied Mathematics Program sponsored a Workshop for Mathematics for the Analysis, Simulation and Optimization of Complex Systems on September 13-14, 2011. The workshop had approximately 50 participants from both the national labs and academia. The goal of the workshop was to identify new research areas in applied mathematics that will complement and enhance the existing DOE ASCR Applied Mathematics Program efforts that are needed to address problems associated with complex systems. This report describes recommendations from the workshop and subsequent analysis of the workshop findings by the organizing committee.

Challenging empowerment: AIDS-affected South African children and the need for a multi-level relational approach.

Science.gov (United States)

Ansell, Nicola

2014-01-01

Critics of empowerment have highlighted the concept's mutability, focus on individual transformation, one-dimensionality and challenges of operationalisation. Relating these critiques to children's empowerment raises new challenges. Drawing on scholarship on children's subjecthood and exercise of power, alongside empirical research with children affected by AIDS, I argue that empowerment envisaged as individual self-transformation and increased capacity to act independently offers little basis for progressive change. Rather it is essential to adopt a relational approach that recognises the need to transform power relationships at multiple levels. This analysis has implications for our wider understanding of empowerment in the 21st century.

Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.

Science.gov (United States)

Templeman, Kate; Robinson, Anske; McKenna, Lisa

2015-04-01

Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. Medical school education faculties in Australian universities. Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessing Language Needs Within an Institutional Context: An Ethnographic Approach.

Science.gov (United States)

Holliday, Adrian

1995-01-01

This article describes an analysis of English-language needs of an oil company in the Middle East, exploring the role of ethnography in carrying out the holistic research necessary to obtain a clear picture of the company's needs. It includes a discussion of the project's findings and recommendations for language training. (11 references) (MDM)

Experiences of parents of children with special needs at school entry: a mixed method approach.

Science.gov (United States)

Siddiqua, A; Janus, M

2017-07-01

The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry. © 2017 John Wiley & Sons Ltd.

A systematic approach to the training in the nuclear power industry: The need for standard

International Nuclear Information System (INIS)

Wilkinson, J.D.

1995-01-01

The five elements of a open-quotes Systematic Approach to Trainingclose quotes (SAT) are analysis, design, development, implementation and evaluation. These elements are also present in the effective application of basic process control. The fundamental negative feedback process control loop is therefore an excellent model for a successful, systematic approach to training in the nuclear power industry. Just as standards are required in today's manufacturing and service industries, eg ISO 9000, so too are control standards needed in the training industry and in particular in the training of nuclear power plant staff. The International Atomic Energy Agency (IAEA) produced its TECDOC 525 on open-quotes Training to Establish and Maintain the Qualification and Competence of Nuclear Power Plant Operations Personnelclose quotes in 1989 and the American Nuclear Society published its open-quotes Selection, Qualification, and Training of Personnel for Nuclear Power Plants, an American National Standardclose quotes in 1993. It is important that community colleges, training vendors and organizations such as the Instrument Society of America (ISA), who may be supplying basic or prerequisite training to the nuclear power industry, become aware of these and other standards relating to training in the nuclear power industry

Technical Approach for Determining Key Parameters Needed for Modeling the Performance of Cast Stone for the Integrated Disposal Facility Performance Assessment

Energy Technology Data Exchange (ETDEWEB)

Yabusaki, Steven B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Serne, R. Jeffrey [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rockhold, Mark L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wang, Guohui [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Westsik, Joseph H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2015-03-30

Washington River Protection Solutions (WRPS) and its contractors at Pacific Northwest National Laboratory (PNNL) and Savannah River National Laboratory (SRNL) are conducting a development program to develop / refine the cementitious waste form for the wastes treated at the ETF and to provide the data needed to support the IDF PA. This technical approach document is intended to provide guidance to the cementitious waste form development program with respect to the waste form characterization and testing information needed to support the IDF PA. At the time of the preparation of this technical approach document, the IDF PA effort is just getting started and the approach to analyze the performance of the cementitious waste form has not been determined. Therefore, this document looks at a number of different approaches for evaluating the waste form performance and describes the testing needed to provide data for each approach. Though the approach addresses a cementitious secondary aqueous waste form, it is applicable to other waste forms such as Cast Stone for supplemental immobilization of Hanford LAW. The performance of Cast Stone as a physical and chemical barrier to the release of contaminants of concern (COCs) from solidification of Hanford liquid low activity waste (LAW) and secondary wastes processed through the Effluent Treatment Facility (ETF) is of critical importance to the Hanford Integrated Disposal Facility (IDF) total system performance assessment (TSPA). The effectiveness of cementitious waste forms as a barrier to COC release is expected to evolve with time. PA modeling must therefore anticipate and address processes, properties, and conditions that alter the physical and chemical controls on COC transport in the cementitious waste forms over time. Most organizations responsible for disposal facility operation and their regulators support an iterative hierarchical safety/performance assessment approach with a general philosophy that modeling provides

Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery

Science.gov (United States)

Yeom, Seung-Seop; Jung, Sung Woo; Oh, Se Heon; Lee, Jong Lyul; Yoon, Yong Sik; Park, In Ja; Lim, Seok-Byung; Yu, Chang Sik; Kim, Jin Cheon

2018-01-01

Purpose Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique. Methods We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation. Results One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P colostomy was feasible for a diversion colostomy (P colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery. PMID:29742862

Development and initial validation of the Three-Levels-of-Needs Questionnaire for self-assessment of palliative needs in patients with cancer

DEFF Research Database (Denmark)

Johnsen, Anna Thit; Petersen, Morten Aagaard; Pedersen, Lise

2011-01-01

To improve palliative care, it is important that questionnaires accurately assess the needs of the patients. No questionnaire existed that combined three different and important approaches to needs assessment. We developed such a questionnaire, called the Three-Levels-of-Needs Questionnaire (3LNQ......), based on literature searches. The 3LNQ measures 12 important needs with three different approaches when used as a supplement to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): problem intensity, problem burden, and felt need....

Malaria Vaccine Development: The Need for Novel Approach-es: A Review Article

Directory of Open Access Journals (Sweden)

Shima MAHMOUDI

2018-03-01

Full Text Available Background: Although rigorous efforts have substantially decreased the malaria burden through decades, it still threatens the lives of millions of children. Development of an effective vaccine can provide important approach in malaria control strategies. Unfortunately, development of an effective vaccine for falciparum malaria has been hindered by the extreme complexity of malaria parasite biology, complex and diverse parasite genomes, and immune evasion by the parasites as well as the intricate nature of the parasites infection cycle. The aim of this review was to discuss the different approaches to malaria vaccine development until now.Methods: Scientific databases, including MEDLINE (via PubMed and SCOPUS were searched up to 30 Jan 2017 and the articles regarding malaria vaccine development were taken into examination.Results: Several strategies for malaria vaccine development including pre-erythrocytic vaccines, antibody-based subunit vaccines, vectored vaccines, whole sporozoite vaccines, genetically Attenuated parasites and sporozoite subunit vaccine, erythrocytic vaccines, sexual stage vaccine, transmission-blocking vaccine as well as synthetic peptides and conjugate vaccine has been introduced. However, the success has been limited thus far.Conclusion: Although development of malaria vaccine over the past 70 year has been continued, the discovery, development, and licensing of a malaria vaccine formulation, which meets safety, affordability, accessibility, applicability, and efficacy has not yet been achieved.

Operating plant safety analysis needs

International Nuclear Information System (INIS)

Young, M.Y.; Love, D.S.

1992-01-01

The primary objective for nuclear power station owners is to operate and manage their plants safely. However, there is also a need to provide economical electric power, which requires that the unit be operated as efficiently as possible, consistent with the safety requirements. The objectives cited above can be achieved through the identification and use of available margins inherent in the plant design. As a result of conservative licensing and analytical approaches taken in the past, many of these margins may be found in the safety analysis limits within which plants currently operate. Improvements in the accuracy of the safety analysis, and a more realistic treatment of plant initial and boundary conditions, can make this margin available for a variety of uses which enhance plant performance, help to reduce O and M costs, and may help to extend licensed operation. Opportunities for improvement exist in several areas in the accident analysis normally performed for Chapter 15 of the FSAR. For example, recent modifications to the ECCS rule, 10CFR50.46 and Appendix K, allow use of margins previously unavailable in the analysis of the Loss of Coolant Accident (LOCA). To take advantage of this regulatory change, new methods are being developed to analyze both the large and small break loss of coolant accident (LOCA). As this margin is used, enhancements in the analysis of other transients will become necessary. The paper discusses accident analysis methods, future development needs, and analysis margin utilization in specific accident scenarios

Perceived oral health status and treatment needs of dental auxiliaries.

Science.gov (United States)

Azodo, Clement C; Ehizele, Adebola O; Umoh, Agnes; Ojehanon, Patrick I; Akhionbare, Osagie; Okechukwu, Robinson; Igbinosa, Lawrence

2010-03-15

To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students. A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need. The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3%) rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5%) agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life. Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%), tooth restoration (10.3%), to extraction (1.2%). This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.

Prioritizing the refactoring need for critical component using combined approach

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Rajni Sehgal

2018-10-01

Full Text Available One of the most promising strategies that will smooth out the maintainability issues of the software is refactoring. Due to lack of proper design approach, the code often inherits some bad smells which may lead to improper functioning of the code, especially when it is subject to change and requires some maintenance. A lot of studies have been performed to optimize the refactoring strategy which is also a very expensive process. In this paper, a component based system is considered, and a Fuzzy Multi Criteria Decision Making (FMCDM model is proposed by combining subjective and objective weights to rank the components as per their urgency of refactoring. Jdeodorant tool is used to detect the code smells from the individual components of a software system. The objective method uses the Entropy approach to rank the component having the code smell. The subjective method uses the Fuzzy TOPSIS approach based on decision makers’ judgement, to identify the critically and dependency of these code smells on the overall software. The suggested approach is implemented on component-based software having 15 components. The constitute components are ranked based on refactoring requirements.

Severe radiation morbidity in carcinoma of the cervix: impact of pretherapy surgical staging and previous surgery

International Nuclear Information System (INIS)

Fine, Bruce A.; Hempling, Ronald E.; Piver, M. Steven; Baker, Trudy R.; McAuley, Michael; Driscoll, Deborah

1995-01-01

Purpose: The purpose of this study is to delineate the factors which (a) contribute to an increase in the severe, radiation induced complication rate and (b) have a significant effect on survival in patients with International Federation of Gynecologists and Obstetricians (FIGO) Stage I-IVA cervical cancer undergoing pretherapy surgical staging. Methods and Materials: From 1971-1991, 189 patients underwent pretherapy surgical staging via a retroperitoneal approach (67) or transperitoneal approach (122). Seventy-nine patients had previously experienced a laparotomy. Patients subsequently received a median of 85 Gy to point A. In patients receiving paraaortic radiation, a median of 45 Gy was administered. One hundred and thirty-two (69.8%) patients received hydroxyurea as a radiation sensitizer. Results: Pretherapy surgical evaluation revealed that 21 of 89 (23.6%) Stage II patients and 32 of 85 (37.6%) Stage III patients had paraaortic lymph node metastases. Multivariate logistic regression analysis detailed the significant factors favorably influencing the radiation-induced complication rate to be a retroperitoneal approach of pretherapy surgical staging and no previous laparotomy. Survival was significantly prolonged in patients receiving hydroxyurea, evaluated via a retroperitoneal incision, with negative paraaortic lymph nodes, and with an early stage of disease. Conclusion: A retroperitoneal approach to pretherapy surgical staging and absence of previous surgery reduced the incidence of subsequent radiation-induced complications. Despite improvements in the detection of occult disease, prolonged survival is impaired when the therapeutic measures currently available are used

The Technical Communicator as Advocate: Integrating a Social Justice Approach in Technical Communication

Science.gov (United States)

Jones, Natasha N.

2016-01-01

This article argues for the need for a social justice approach to technical communication research and pedagogy. Given previous calls by scholars in technical and professional communication (TPC) for an attention to diversity, inclusion, and equality, the author examines the place and purpose of social justice in TPC and provides useful approaches…

Mobility needs and wireless solutions

DEFF Research Database (Denmark)

Saugstrup, Dan; Henten, Anders

The main purpose of this report is to spell out a methodological approach to the analysis of user needs with respect to mobility. Furthermore, this methodological approach is used in an exemplary analysis of the relationship between user needs and technology solutions offered by different wireless...... technologies. The report is based on a research approach, emphasizing important aspects in relation to developing more user oriented mobile services and applications in a heterogeneous network environment. As a staring point, Scandinavian research within the field of social science concerning mobility...... is described and discussed. Furthermore different wireless technologies are briefly described and discussed in relation to possible transmission capacities and coverage areas. In addition to this, a preliminary framework regarding the implications of mobility on the use and development of mobile services...

A Theoretical Approach to Information Needs Across Different Healthcare Stakeholders

Science.gov (United States)

Raitoharju, Reetta; Aarnio, Eeva

Increased access to medical information can lead to information overload among both the employees in the healthcare sector as well as among healthcare consumers. Moreover, medical information can be hard to understand for consumers who have no prerequisites for interpreting and understanding it. Information systems (e.g. electronic patient records) are normally designed to meet the demands of one professional group, for instance those of physicians. Therefore, the same information in the same form is presented to all the users of the systems regardless of the actual need or prerequisites. The purpose of this article is to illustrate the differences in information needs across different stakeholders in healthcare. A literature review was conducted to collect examples of these different information needs. Based on the findings the role of more user specific information systems is discussed.

Computing and information services at the Jet Propulsion Laboratory - A management approach to a diversity of needs

Science.gov (United States)

Felberg, F. H.

1984-01-01

The Jet Propulsion Laboratory, a research and development organization with about 5,000 employees, presents a complicated set of requirements for an institutional system of computing and informational services. The approach taken by JPL in meeting this challenge is one of controlled flexibility. A central communications network is provided, together with selected computing facilities for common use. At the same time, staff members are given considerable discretion in choosing the mini- and microcomputers that they believe will best serve their needs. Consultation services, computer education, and other support functions are also provided.

The colloquial approach: An active learning technique

Science.gov (United States)

Arce, Pedro

1994-09-01

This paper addresses the very important problem of the effectiveness of teaching methodologies in fundamental engineering courses such as transport phenomena. An active learning strategy, termed the colloquial approach, is proposed in order to increase student involvement in the learning process. This methodology is a considerable departure from traditional methods that use solo lecturing. It is based on guided discussions, and it promotes student understanding of new concepts by directing the student to construct new ideas by building upon the current knowledge and by focusing on key cases that capture the essential aspects of new concepts. The colloquial approach motivates the student to participate in discussions, to develop detailed notes, and to design (or construct) his or her own explanation for a given problem. This paper discusses the main features of the colloquial approach within the framework of other current and previous techniques. Problem-solving strategies and the need for new textbooks and for future investigations based on the colloquial approach are also outlined.

Internationalization of Business English communication at university: A three-fold needs analysis

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Guzman Mancho-Barés

2013-10-01

Full Text Available This paper provides an example of a thorough needs analysis previous to the syllabus planning of a Business English (BE course at a Catalan university. Three types of sources for linguistic needs are considered. Firstly, the institutional foreign language (FL policy of the university, which requires a CEFR level B1 for all graduates. Secondly, students’ needs, collected through an entry test and a self-report questionnaire, which provide statistical evidence of the effect of experience abroad and number of years studying English on results of the entry test and perceptions of their own reading skills. Lastly, the opinions of six local business people representing the main sectors with international activity in the area of influence of the university. These business representatives, gathered in a focus-group discussion session, emphasize the importance of comprehension skills and accuracy in BE lexical selection for international business. The triangulation of these data reveals the need to enhance communicative efficiency in business routine tasks in the BE syllabus, instead of promoting approaches oriented towards native-speaker models. Finally, inconsistencies are revealed between institutional and business representatives’ expectations regarding students’ FL target level.

Study of some physical aspects previous to design of an exponential experiment

International Nuclear Information System (INIS)

Caro, R.; Francisco, J. L. de

1961-01-01

This report presents the theoretical study of some physical aspects previous to the design of an exponential facility. The are: Fast and slow flux distribution in the multiplicative medium and in the thermal column, slowing down in the thermal column, geometrical distribution and minimum needed intensity of sources access channels and perturbations produced by possible variations in its position and intensity. (Author) 4 refs

“The Maasai Need Cows and the Cows Need Maasai,” the Use of a Photovoice Approach to Assess Animal Health Needs

Science.gov (United States)

van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

2015-01-01

The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai’s animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher–participant communications, thereby facilitating new insights across language and cultural barriers. PMID:26664973

The Development of Ethnobotany Curriculum for Students in Rural Schools: An Approach that Incorporates the Needs and Insights of Local Communities

Science.gov (United States)

Kraipeerapun, Kittima; Thongthew, Sumlee

2007-01-01

In this paper, an ethnobotany curriculum is used as a case example of one approach to incorporating the insights and needs of the local community into the curriculum development process. This curriculum development was carried out in the "Kiriwong Community" in Nakornsrithammarat Province, Southern Thailand. The ethnobotany curriculum…

Needs of the CSAU uncertainty method

International Nuclear Information System (INIS)

Prosek, A.; Mavko, B.

2000-01-01

The use of best estimate codes for safety analysis requires quantification of the uncertainties. These uncertainties are inherently linked to the chosen safety analysis methodology. Worldwide, various methods were proposed for this quantification. The purpose of this paper was to identify the needs of the Code Scaling, Applicability, and Uncertainty (CSAU) methodology and then to answer the needs. The specific procedural steps were combined from other methods for uncertainty evaluation and new tools and procedures were proposed. The uncertainty analysis approach and tools were then utilized for confirmatory study. The uncertainty was quantified for the RELAP5/MOD3.2 thermalhydraulic computer code. The results of the adapted CSAU approach to the small-break loss-of-coolant accident (SB LOCA) show that the adapted CSAU can be used for any thermal-hydraulic safety analysis with uncertainty evaluation. However, it was indicated that there are still some limitations in the CSAU approach that need to be resolved. (author)

Systems approach to chemical spill response information needs

Energy Technology Data Exchange (ETDEWEB)

Parnarouskis, M.C.; Flessner, M.F.; Potts, R.G.

1980-01-01

The Chemical Hazards Response Information System (CHRIS) has been specifically designed to meet the emergency needs of US Coast Guard field personnel, currently providing them with information on 900 hazardous chemicals, with methods of predicting hazards resulting from accidental discharges, and with procedures for selecting and implementing response to accident discharges. The major components of CHRIS and the computerized hazard assessment models within the Hazard Assessment Computer System are described in detail.

Analysis of current research addressing complementary use of life-cycle assessment and risk assessment for engineered nanomaterials: have lessons been learned from previous experience with chemicals?

International Nuclear Information System (INIS)

Grieger, Khara D.; Laurent, Alexis; Miseljic, Mirko; Christensen, Frans; Baun, Anders; Olsen, Stig I.

2012-01-01

While it is generally agreed that successful strategies to address the health and environmental impacts of engineered nanomaterials (NM) should consider the well-established frameworks for conducting life-cycle assessment (LCA) and risk assessment (RA), scientific research, and specific guidance on how to practically apply these methods are still very much under development. This paper evaluates how research efforts have applied LCA and RA together for NM, particularly reflecting on previous experiences with applying these methods to chemicals. Through a literature review and a separate analysis of research focused on applying LCA and RA together for NM, it appears that current research efforts have taken into account some key “lessons learned” from previous experience with chemicals while many key challenges remain for practically applying these methods to NM. We identified two main approaches for using these methods together for NM: “LC-based RA” (traditional RA applied in a life-cycle perspective) and “RA-complemented LCA” (conventional LCA supplemented by RA in specific life-cycle steps). Hence, the latter is the only identified approach which genuinely combines LC- and RA-based methods for NM-risk research efforts to date as the former is rather a continuation of normal RA according to standard assessment procedures (e.g., REACH). Both these approaches along with recommendations for using LCA and RA together for NM are similar to those made previously for chemicals, and thus, there does not appear to be much progress made specific for NM. We have identified one issue in particular that may be specific for NM when applying LCA and RA at this time: the need to establish proper dose metrics within both methods.

Mentoring to develop research selfefficacy, with particular reference to previously disadvantaged individuals

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S. Schulze

2010-07-01

Full Text Available The development of inexperienced researchers is crucial. In response to the lack of research self-efficacy of many previously disadvantaged individuals, the article examines how mentoring can enhance the research self-efficacy of mentees. The study is grounded in the self-efficacy theory (SET – an aspect of the social cognitive theory (SCT. Insights were gained from an in-depth study of SCT, SET and mentoring, and from a completed mentoring project. This led to the formulation of three basic principles. Firstly, institutions need to provide supportive environmental conditions that facilitate research selfefficacy. This implies a supportive and efficient collective system. The possible effects of performance ratings and reward systems at the institution also need to be considered. Secondly, mentoring needs to create opportunities for young researchers to experience successful learning as a result of appropriate action. To this end, mentees need to be involved in actual research projects in small groups. At the same time the mentor needs to facilitate skills development by coaching and encouragement. Thirdly, mentors need to encourage mentees to believe in their ability to successfully complete research projects. This implies encouraging positive emotional states, stimulating self-reflection and self-comparison with others in the group, giving positive evaluative feedback and being an intentional role model.

Robotic approaches for rehabilitation of hand function after stroke.

Science.gov (United States)

Lum, Peter S; Godfrey, Sasha B; Brokaw, Elizabeth B; Holley, Rahsaan J; Nichols, Diane

2012-11-01

The goal of this review was to discuss the impairments in hand function after stroke and present previous work on robot-assisted approaches to movement neurorehabilitation. Robotic devices offer a unique training environment that may enhance outcomes beyond what is possible with conventional means. Robots apply forces to the hand, allowing completion of movements while preventing inappropriate movement patterns. Evidence from the literature is emerging that certain characteristics of the human-robot interaction are preferable. In light of this evidence, the robotic hand devices that have undergone clinical testing are reviewed, highlighting the authors' work in this area. Finally, suggestions for future work are offered. The ability to deliver therapy doses far higher than what has been previously tested is a potentially key advantage of robotic devices that needs further exploration. In particular, more efforts are needed to develop highly motivating home-based devices, which can increase access to high doses of assisted movement therapy.

Need to use probabilistic risk approach in performance assessment of waste disposal facilities

International Nuclear Information System (INIS)

Bonano, E.J.; Gallegos, D.P.

1991-01-01

Regulations governing the disposal of radioactive, hazardous, and/or mixed wastes will likely require, either directly or indirectly, that the performance of disposal facilities be assessed quantitatively. Such analyses, commonly called ''performance assessments,'' rely on the use of predictive models to arrive at a quantitative estimate of the potential impact of disposal on the environment and the safety and health of the public. It has been recognized that a suite of uncertainties affect the results of a performance assessment. These uncertainties are conventionally categorized as (1) uncertainty in the future state of the disposal system (facility and surrounding medium), (2) uncertainty in models (including conceptual models, mathematical models, and computer codes), and (3) uncertainty in data and parameters. Decisions regarding the suitability of a waste disposal facility must be made in light of these uncertainties. Hence, an approach is needed that would allow the explicit consideration of these uncertainties so that their impact on the estimated consequences of disposal can be evaluated. While most regulations for waste disposal do not prescribe the consideration of uncertainties, it is proposed that, even in such cases, a meaningful decision regarding the suitability of a waste disposal facility cannot be made without considering the impact of the attendant uncertainties. A probabilistic risk assessment (PRA) approach provides the formalism for considering the uncertainties and the technical basis that the decision makers can use in discharging their duties. A PRA methodology developed and demonstrated for the disposal of high-level radioactive waste provides a general framework for assessing the disposal of all types of wastes (radioactive, hazardous, and mixed). 15 refs., 1 fig., 1 tab

Higher education needs for the ICT Spanish market Higher education needs for the ICT Spanish market Higher education needs for the ICT Spanish market

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Antoni Ras

2011-11-01

Full Text Available Purpose: The main objective of the paper is to clarify the expectations held in the realm of business and by employers, in relation to the main educational parameters that respond to the employment needs of the Information and Communication Technology (ICT market in Spain, considering both technical and managerial knowledge. It also assesses whether the Spanish Technical University is providing its graduates with the knowledge currently demanded by the sector.Design/methodology/approach: The report is based on a survey completed by 43 companies, which constitutes more than 60% of the sector and is representative of the entire range of subsectors that constitute the vast ICT industry in Spain. According to the sample construction, post-stratification has been used for analyzing global results. Responses have been weighted according to the proportion that represents the employees’ population of the Spanish ICT sector.Findings: As a first conclusion of the current research it should be noted that in terms of technological knowledge, the gap between what the industry requires and the skills graduates can offer is, in general, much smaller than the gap relating to business management skills, where differences exceeding 25% have been demonstrated. This would suggest that the Spanish ICT sector needs to improve learning in the subjects related to business management.Originality/value: Finally, as an innovate factor since there are no previous bibliographic references on this topic, a surprising conclusion is that a significant segment of the Spanish ICT sector, specifically 51,2 % of the companies surveyed, did not distinguish between professional profiles, expressed indifference, and were equally likely to employ graduates as postgraduates. Although when the market was asked about the preferred profile for managerial positions, the results are quite different: 83.7% of respondents preferred a superior engineer qualification; 16.3%Purpose: The

A review of systematic and quantifiable methods of estimating the needs of a community for alcohol treatment services.

Science.gov (United States)

Crook, G M; Oei, T P

1998-01-01

The purpose of this paper was to review a variety of systematic and quantifiable methodologies for planning and evaluating the provision of alcohol treatment services for communities. These methods include: (a) developing and evaluating indicators of alcohol-related harm in and across defined geographic areas, to assess the relative need for services; (b) demand-oriented techniques that involve the prediction of future demand for services based on the previous utilisation of treatment facilities; (c) comprehensive systems approaches to planning services; and (d) the estimation of the prevalence of individuals who need or would benefit from an intervention for their alcohol problem. In practice, service planners may incorporate a combination of approaches that could be compared and contrasted to assess the convergent validity of results. These methodologies can also be used to provide information for planning and evaluating prevention/health promotion and early intervention initiatives.

Unmet needs for comprehensive services in outpatient addiction treatment.

Science.gov (United States)

Pringle, Janice L; Emptage, Nicholas P; Hubbard, Robert L

2006-04-01

Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

Persona Development and Educational Needs to Support Informal Caregivers.

Science.gov (United States)

Al Awar, Zeina; Kuziemsky, Craig

2017-01-01

Informal caregivers are playing an increasing role in community based care delivery. Research is needed that looks at the educational needs of informal caregivers as a precursor to HIT design to support community care delivery. A challenge is informal caregivers have very diverse educational needs. Personas are an approach to describe user characteristics as part of systems design and this approach could be used to understand and categorize the various educational needs of informal caregivers. This paper addresses this research need and provides a method for persona development and the identification of educational needs for informal caregivers.

Lean approach in knowledge work

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Hanna Kropsu-Vehkapera

2018-05-01

Full Text Available Purpose: Knowledge work productivity is a key area of improvement for many organisations. Lean approach is a sustainable way to achieve operational excellence and can be applied in many areas. The purpose of this novel study is to examine the potential of using lean approach for improving knowledge work practices. Design/methodology/approach: A systematic literature review has been carried out to study how lean approach is realised in knowledge work. The research is conceptual in nature and draws upon earlier research findings. Findings: This study shows that lean studies’ in knowledge work is an emerging research area. This study documents the methods and practices implemented in knowledge work to date, and presents a knowledge work continuum, which is an essential framework for effective lean approach deployment and to frame future research focus in knowledge work productivity. Research limitations/implications: This study structures the concept of knowledge work and outlines a concrete concept derived from earlier literature. The study summarises the literature on lean in knowledge work and highlights, which methods are used. More research is needed to understand how lean can be implemented in complex knowledge work environment and not only on the repetitive knowledge work. The limitations of this research are due to the limited availability of previous research. Practical implications: To analyse the nature of knowledge work, we implicate the areas where lean methods especially apply to improving knowledge work productivity. When applying lean in knowledge work context the focus should be using the people better and improving information flow. Originality/value: This study focuses on adapting lean methods into a knowledge work context and summarises earlier research done in this field. The study discusses the potential to improve knowledge work productivity by implementing lean methods and presents a unique knowledge work continuum to

Mental health research in the criminal justice system: The need for common approaches and international perspectives.

Science.gov (United States)

Roesch, R; Ogloff, J R; Eaves, D

1995-01-01

There is a need for researchers and policy makers in the area of mental health and law to collaborate and develop common methods of approach to research. Although we have learned a great deal about the prevalence and needs of mentally ill offenders in jails and prisons, there are a number of research questions that remain. If the "second generation" of research is to be fruitful--and useful to policy makers--we need to be sure that the methods we employ are valid and that the findings we obtain are reliable. By collaborating with colleagues in other jurisdictions, we can begin to learn whether some of the existing findings are of a general nature, or dependent upon the system in which they were found. Similarly, while the first-generation research has alerted us to the needs of mentally ill offenders in jails and prisons, second-generation research is needed to help identify factors that may help prevent the "revolving door phenomenon," which results in mentally ill people being volleyed among mental health, criminal justice, and community settings. One area that has received embarrassingly little attention has been the need for considering the relationship between substance abuse and mental disorders. In our own work, we have found an alarmingly high degree of substance abuse among offenders, including mentally ill offenders. We have come to realize the importance of considering the role that substance abuse coupled with other mental disorders may play in the criminal justice system. As a result of this concern, the Surrey Mental Health Project recently hired a full-time drug and alcohol counselor whose job it is to work with inmates with substance abuse disorders while in the jail, and to help arrange continuing treatment resources upon their release. As Wilson et al. (1995) discuss, intensive case management projects may be particularly useful at targeting the unique needs of mentally ill offenders with multiple problems. Much of the research conducted with

Why health care corruption needs a new approach.

Science.gov (United States)

Radin, Dagmar

2016-07-01

While corruption has been at the center of academic studies and on the agenda of international organizations for a couple of decades, in the health care sector corruption has not generated much interest or progress. At the centre of this issue is the lack of an interdisciplinary approach, which is warranted given the complexity of the issue and the lack of cooperation between STET scientifically rigorous academics and policy-makers, leaving room for more cooperation and progress. © The Author(s) 2015.

Post graduate ESP curriculum: reading and writing needs.

Directory of Open Access Journals (Sweden)

Afsaneh Dehnad

2014-05-01

Full Text Available Assessing learners' needs is an integral part of any curriculum and course design , namely English for specific purposes (ESP, syllabus design, materials development, teaching methods and testing issues. Critical approach to needs analysis, which is a relatively recent approach, acknowledges the rights of different stakeholders including teachers, students and administrators in the process of needs analysis. However, there has been no formal need analysis for syllabus design at postgraduate level in Medical Universities affiliated to the Ministry of Health in Iran. This study, conducted in 2011, was an attempt to assess the reading and writing needs of postgraduate students in ESP courses on the basis of critical approach to needs analysis. The study population consisted of 67 people: 56 postgraduate students, 5 heads of departments, 5 ESP instructors and 1 executive manager at the Ministry of Health in Iran. Ethical and demographic forms, needs analysis questionnaires, and a form of semi-structured interview were the instruments of the study. According to the findings, there was a discrepancy between students' and instructors' perception of learners' needs and the assumed needs appearing in the syllabi prescribed by the Ministry of Health in Iran. This study showed that a call for critical needs analysis in which the rights of different stakeholders are acknowledged is necessary for meeting the requirements of any ESP classes especially at postgraduate level where the instructors and learners are fully aware of learners' needs.

Perceived oral health status and treatment needs of dental auxiliaries

Directory of Open Access Journals (Sweden)

Clement C. Azodo

2010-03-01

Full Text Available Objective: To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students. Methods: A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need. Results: The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3% rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5% agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life.Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%, tooth restoration (10.3%, to extraction (1.2%. Conclusion: This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.

Laparoscopy After Previous Laparotomy

Directory of Open Access Journals (Sweden)

Zulfo Godinjak

2006-11-01

Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

User needs in television archive access

DEFF Research Database (Denmark)

Kirkegaard Lunn, Brian

2009-01-01

This paper presents a methodical approach for generating deep knowledge about users, as a prerequisite for design and construction of digital information access to cultural heritage information objects. We exemplify this methodical approach by reporting on an explorative study of information need...... topic or content; and 4) Muddled topic or content. Fourthly, the interviewees' needs consist of four phases: 1) Getting an overview of transmitted broadcasts; 2) Identification of borderline exemplars; 3) Selection of specific programmes; and 4) Verification of facts. The present paper presents novel...... research on characteristics of information needs in a television broadcast context. We demonstrate how one may go about generating knowledge which is imperative for the design and construction of future broadcast retrieval systems. Udgivelsesdato: 2009...

Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs.

Science.gov (United States)

McRae, Robert J

2016-12-01

Cancer has recently overtaken heart disease to become the number 1 cause of mortality both globally and in Australia. As such, adequate oncology education must be an integral component of medical school if students are to achieve learning outcomes that meet the needs of the population. The aim of this review is to evaluate the current state of undergraduate oncology education and identify how Australian medical schools can improve oncology learning outcomes for students and, by derivative, improve healthcare outcomes for Australians with cancer. The review shows that oncology is generally not well represented in medical school curricula, that few medical schools offer mandatory oncology or palliative care rotations, and that junior doctors are exhibiting declining oncology knowledge and skills. To address these issues, Australian medical schools should implement the Oncology Education Committee's Ideal Oncology Curriculum, enact mandatory oncology and palliative care clinical rotations for students, and in doing so, appreciate the importance of students' differing approaches to learning.

From computer-assisted intervention research to clinical impact: The need for a holistic approach.

Science.gov (United States)

Ourselin, Sébastien; Emberton, Mark; Vercauteren, Tom

2016-10-01

The early days of the field of medical image computing (MIC) and computer-assisted intervention (CAI), when publishing a strong self-contained methodological algorithm was enough to produce impact, are over. As a community, we now have substantial responsibility to translate our scientific progresses into improved patient care. In the field of computer-assisted interventions, the emphasis is also shifting from the mere use of well-known established imaging modalities and position trackers to the design and combination of innovative sensing, elaborate computational models and fine-grained clinical workflow analysis to create devices with unprecedented capabilities. The barriers to translating such devices in the complex and understandably heavily regulated surgical and interventional environment can seem daunting. Whether we leave the translation task mostly to our industrial partners or welcome, as researchers, an important share of it is up to us. We argue that embracing the complexity of surgical and interventional sciences is mandatory to the evolution of the field. Being able to do so requires large-scale infrastructure and a critical mass of expertise that very few research centres have. In this paper, we emphasise the need for a holistic approach to computer-assisted interventions where clinical, scientific, engineering and regulatory expertise are combined as a means of moving towards clinical impact. To ensure that the breadth of infrastructure and expertise required for translational computer-assisted intervention research does not lead to a situation where the field advances only thanks to a handful of exceptionally large research centres, we also advocate that solutions need to be designed to lower the barriers to entry. Inspired by fields such as particle physics and astronomy, we claim that centralised very large innovation centres with state of the art technology and health technology assessment capabilities backed by core support staff and open

THE NEED FOR STATE IN THE ECONOMY- EPISTEMOLOGICAL APPROACH

Directory of Open Access Journals (Sweden)

ANCA-ŞTEFANIA SAVA

2010-01-01

Full Text Available The aim of this paper is to discuss the need for state in the economy, in an epistemological viewpoint. It presents in a critical manner the ideas on the state of the mercantilism and physiocracy representatives, of the classical and Keynesian economists and of the so-called current „the new liberal orthodoxy”. It is noticed that the need for a minimal state, as a condition of proper functioning of the society, has been justified even by those who have criticized it (classical liberals, being recognized that a society can not be conceived anarchic and utopian. If during ’29-’33s, the philosophy of laisser-faire was replaced by the Keynesian doctrine, and ’70s have placed the welfare state in a crisis of legitimacy, starting from 2008 we can talk of a resurgence of the Keynesian paradigm, according to which government intervention is seen as a way to stimulate the economic recovery.

Hierachy of needs of geriatric patients.

Science.gov (United States)

Majercsik, E

2005-01-01

The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care. Copyright (c) 2005 S. Karger AG, Basel

The Northridge earthquake: community-based approaches to unmet recovery needs.

Science.gov (United States)

Bolin, R; Stanford, L

1998-03-01

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

Teaching Music to Students with Special Needs: A Label-Free Approach

Science.gov (United States)

Hammel, Alice; Hourigan, Ryan

2011-01-01

A practical guide & reference manual, "Teaching Music to Students with Special Needs" addresses special needs in the broadest possible sense to equip teachers with proven, research-based curricular strategies that are grounded in both best practice and current special education law. Chapters address the full range of topics and issues music…

Radiation protection/shield design: a need for a systems approach

International Nuclear Information System (INIS)

Disney, R.K.

1977-01-01

Radiation protection/shielding design of a nuclear facility requires a coordinated effort of many engineering disciplines to meet the requirements imposed by regulations. The system approach to Clinch River Breeder Reactor Plant (CRBRP) radiation protection is described, and the program developed to implement this approach is defined. In addition, the principal shielding design problems for LMFBR nuclear reactor systems are discussed in relation to LWR nuclear reactor system shielding designs. The methodology used to analyze these problems in the U.S. LMFBR program, the resultant design solutions, and the experimental verification of these designs and/or methods are discussed

Preoperative screening: value of previous tests.

Science.gov (United States)

Macpherson, D S; Snow, R; Lofgren, R P

1990-12-15

To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

National Needs Drivers for Nanotechnology

Energy Technology Data Exchange (ETDEWEB)

Yonas, G.; Picraux, S.T.

2000-10-09

Societal needs related to demographics, resources, and human behavior will drive technological advances over the next 20 years. Nanotechnology is anticipated to be an important enabler of these advances, and thus maybe anticipated to have significant influence on new systems approaches to solving societal problems as well as on extending current science and technology-based applications. To examine the potential implications of nanotechnology a societal needs-driven approach is taken. Thus the methodology is to present the definition of the problem, and then examine system concepts, technology issues, and promising future directions. We approach the problem definition from a national and global security perspective and identify three key areas involving the condition of the planet, the human condition, and global security. In anticipating societal issues in the context of revolutionary technologies, such as maybe enabled by nanoscience, the importance of working on the entire life cycle of any technological solution is stressed.

Multisite Assessment of Nursing Continuing Education Learning Needs Using an Electronic Tool.

Science.gov (United States)

Winslow, Susan; Jackson, Stephanie; Cook, Lesley; Reed, Joanne Williams; Blakeney, Keshia; Zimbro, Kathie; Parker, Cindy

2016-02-01

A continued education needs assessment and associated education plan are required for organizations on the journey for American Nurses Credentialing Center Magnet® designation. Leveraging technology to support the assessment and analysis of continuing education needs was a new venture for a 12-hospital regional health system. The purpose of this performance improvement project was to design and conduct an enhanced process to increase the efficiency and effectiveness of gathering data on nurses' preferences and increase nurse satisfaction with the learner assessment portion of the process. Educators trialed the use of a standardized approach via an electronic survey tool to replace the highly variable processes previously used. Educators were able to view graphical summary of responses by category and setting, which substantially decreased analysis and action planning time for education implementation plans at the system, site, or setting level. Based on these findings, specific continuing education action plans were drafted for each category and classification of nurses. Copyright 2016, SLACK Incorporated.

Approaching an Extended Role for Meeting Special Educational Needs in High Schools.

Science.gov (United States)

Mills, Keith

1988-01-01

The paper looks at staffing issues in meeting special educational needs in high schools in Manchester, United Kingdom. The concerns of Heads of Departments (N=26) included improved training and inservice, their extended roles within their schools, the support role of special needs staff, and the need for more planning and evaluation. (Author/DB)

Priority Setting in Indigenous Health: Why We Need an Explicit Decision Making Approach

Directory of Open Access Journals (Sweden)

Michael E. Otim

2015-06-01

Full Text Available Indigenous Australians have significantly poorer health outcomes than the non-Indigenous population worldwide. The Australian government has increased its investment in Indigenous health through the "Closing the Health Gap" initiative. Deciding where to invest scarce resources so as to maximize health outcomes for Indigenous peoples may require improved priority setting processes. Current government practice involves a mix of implicit and explicit processes to varying degrees at the macro and meso decision making levels. In this article, we argue that explicit priority setting should be emphasized in Indigenous health, as it can ensure that the decision making process is accountable, systematic, and transparent. Following a review of the literature, we outline four key issues that need to be considered for explicit priority setting: developing an Indigenous health "constitution," strengthening the evidence base, selecting mechanisms for priority setting, and establishing appropriate incentives and institutional structure. We then summarize our findings into a checklist that can help a decision makers ensure that explicit priority setting is undertaken in Indigenous health. By addressing these key issues, the benefits of an explicit approach, which include increased efficiency, equity, and use of evidence, can be realized, thereby maximizing Indigenous health outcomes.

The Need for Integrated Approaches in Metabolic Engineering

Energy Technology Data Exchange (ETDEWEB)

Lechner, Anna; Brunk, Elizabeth; Keasling, Jay D.

2016-08-15

This review highlights state-of-the-art procedures for heterologous small-molecule biosynthesis, the associated bottlenecks, and new strategies that have the potential to accelerate future accomplishments in metabolic engineering. We emphasize that a combination of different approaches over multiple time and size scales must b e considered for successful pathway engineering in a heterologous host. We have classified these optimization procedures based on the "system" that is being manipulated: transcriptome, translatome, proteome, or reactome. By bridging multiple disciplines, including molecular biology, biochemistry, biophysics, and computational sciences, we can create an integral framework for the discovery and implementation of novel biosynthetic production routes.

What Drives Students' Loyalty-Formation in Social Media Learning within a Personal Learning Environment Approach? The Moderating Role of Need for Cognition

Science.gov (United States)

Arquero, José L.; del Barrio-García, Salvador; Romero-Frías, Esteban

2017-01-01

Our study analyzes an educational experience based on the integrated use of social media within a higher education course under a personal learning environment approach and investigates the factors that determine students' loyalty to social media learning. We examined the moderating role of need for cognition (NFC) in students' formation of…

Needs for R and D and innovations to address challenges of nuclear facility decommissioning after its normal shutdown versus advanced approaches required for Fukushima Daiichi NPS decommissioning. Needs and emergency technologies for decommissioning

International Nuclear Information System (INIS)

Laurent, G.

2017-01-01

Taking into account several attempts to address variety of needs for R and D related to the decommissioning challenges such as: - Characterisation and survey prior to dismantling, - Technologies for dismantling, - Decontamination and on-site remediation, - Material and waste management, - Site characterisation and environmental monitoring. This presentation will give an update of approaches in several countries for R and D to aim at more efficient and effective decommissioning and, above all, to reduce current labour intensive needs to implement this kind of work. The evidence of the particular needs to coordinate efforts both for 'normal decommissioning' and accident cases like Fukushima Daiichi will be offered by demonstrating that, for a large part, that needs might be considered as similar. Some examples of particular interest will be given and it will be emphasized the need to adapt existing and/or new technologies from 'non-nuclear' areas to use them for nuclear decommissioning. The global interest to evaluate and to coordinate R and D efforts will be demonstrated. Consequently there might be a large international interest to increase the consensus where R and D can be better directed. The more comprehensive coordination should support improvement of the overview of future decommissioning needs to implement the decommissioning activities more effectively in terms of time and finance, not compromising safety. (author)

Root canal treatment and special needs patients.

Science.gov (United States)

Yap, E; Parashos, P; Borromeo, G L

2015-04-01

To identify current trends of root canal treatment for patients with special needs. A postal questionnaire was sent to General Dentists in Victoria, Australia and Endodontists and Special Needs Dentists across Australia to determine the extent of root canal treatment performed on special needs patients. Over a four-month period, 1120 questionnaires were distributed with an overall response rate of 63.9% (n = 716). Response rates were 63.2% (n = 655), 68.5% (n = 50) and 100.0% (n = 11) amongst General Dentists, Endodontists and Special Needs Dentists, respectively. Endodontists (95.7%) and Special Needs Dentists (100.0%) performed significantly more root canal treatment on adult patients with special needs compared with 51.2% of General Dentists, (P special needs patients compared with only 29.7% of General Dentists (P special needs patients was more likely to be carried out by specialist dental practitioners who were more likely to utilize a pharmacological approach for behaviour guidance and to perform single-visit root canal treatment compared with General Dentists. A multidisciplinary approach for special needs patients who require root canal treatment provides an opportunity for these patients to retain their dentition. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Analysis of previous screening examinations for patients with breast cancer

International Nuclear Information System (INIS)

Lee, Eun Hye; Cha, Joo Hee; Han, Dae Hee; Choi, Young Ho; Hwang, Ki Tae; Ryu, Dae Sik; Kwak, Jin Ho; Moon, Woo Kyung

2007-01-01

We wanted to improve the quality of subsequent screening by reviewing the previous screening of breast cancer patients. Twenty-four breast cancer patients who underwent previous screening were enrolled. All 24 took mammograms and 15 patients also took sonograms. We reviewed the screening retrospectively according to the BI-RADS criteria and we categorized the results into false negative, true negative, true positive and occult cancers. We also categorized the causes of false negative cancers into misperception, misinterpretation and technical factors and then we analyzed the attributing factors. Review of the previous screening revealed 66.7% (16/24) false negative, 25.0% (6/24) true negative, and 8.3% (2/24) true positive cancers. False negative cancers were caused by the mammogram in 56.3% (9/16) and by the sonogram in 43.7% (7/16). For the false negative cases, all of misperception were related with mammograms and this was attributed to dense breast, a lesion located at the edge of glandular tissue or the image, and findings seen on one view only. Almost all misinterpretations were related with sonograms and attributed to loose application of the final assessment. To improve the quality of breast screening, it is essential to overcome the main causes of false negative examinations, including misperception and misinterpretation. We need systematic education and strict application of final assessment categories of BI-RADS. For effective communication among physicians, it is also necessary to properly educate them about BI-RADS

Critical infrastructures at risk: A need for a new conceptual approach and extended analytical tools

International Nuclear Information System (INIS)

Kroeger, Wolfgang

2008-01-01

Recent decades have witnessed on the one hand a much greater and tighter integration of goods or services supply systems and growing interconnectedness as well as changing organizational and operational factors, and on the other hand an increased social vulnerability in the face of accidental or intentional disruption. The work of the International Risk Governance Council (IRGC) in the field of critical infrastructures has focused on both the risks associated with five individual infrastructures and the issues associated with the increasing interdependence between them. This paper presents a selection of system weaknesses and a number of policy options that have been identified and highlights issues for further investigation and dialogue with stakeholders. Furthermore, the need to extend current modeling and simulation techniques in order to cope with the increasing system complexity is elaborated. An object-oriented, hybrid modeling approach promising to overcome some of the shortcomings of traditional methods is presented

Forecasting need and demand for home health care: a selective review.

Science.gov (United States)

Sharma, R K

1980-01-01

THREE MODELS FOR FORECASTING HOME HEALTH CARE (HHC) NEEDS ARE ANALYZED: HSA/SP model (Health Systems Agency of Southwestern Pennsylvania); Florida model (Florida State Department of Health and Rehabilitative Services); and Rhode Island model (Rhode Island Department of Community Affairs). A utilization approach to forecasting is also presented.In the HSA/SP and Florida models, need for HHC is based on a certain proportion of (a) hospital admissions and (b) patients entering HHC from other sources. The major advantage of these models is that they are relatively easy to use and explain; their major weaknesses are an imprecise definition of need and an incomplete model specification.The Rhode Island approach defines need for HHC in terms of the health status of the population as measured by chronic activity limitations. The major strengths of this approach are its explicit assumptions and its emphasis on consumer needs. The major drawback is that it requires considerable local area data.The utilization approach is based on extrapolation from observed utilization experience of the target population. Its main limitation is that it is based on current market imperfections; its major advantage is that it exposes existing deficiencies in HHC.The author concludes that each approach should be tested empirically in order to refine it, and that need and demand approaches be used jointly in the planning process.

Placenta paraaortic with bladder invasion: A plea for multidisciplinary approach

International Nuclear Information System (INIS)

Shawish, Fahmy M. I.; Hammad, Fayez T.; Kazim, Essa M.

2007-01-01

Placenta previa percreta with the urinary bladder invasion is a rare but potentially lethal condition. It has an increasing clinical significance due to its association with previous cesarean sections and uterine curettage. Herein, we report on a patient with placenta percreta and bladder invasion, who presented with hematuria and in whom delivery was delayed to almost full term highlighting the potential catastrophic results and the need for a multidisciplinary approach with the need to involve surgeons who are familiar with vascular and urologic surgery. We also present an elegant MRI of placenta percreta invading the urinary bladder, which shows that MRI is potentially an excellent diagnostic diagnostic modality in this difficult condition. (author)

HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment.

Science.gov (United States)

Baker, A; Kochan, N; Dixon, J; Wodak, A; Heather, N

1995-04-01

This study compares the injecting and sexual risk-taking behaviour among injecting drug users (IDUs) currently, previously and never enrolled in methadone maintenance treatment (MMT). All subjects had injected during the 6 months prior to the day of interview. The current MMT group showed significantly lower injecting risk-taking behaviour subscale scores on the HIV Risk-taking Behaviour Scale (HRBS) of the Opiate Treatment Index than the previous MMT and non-MMT groups together. The current MMT group differed from the other two groups in the frequency of injecting and cleaning of injection equipment with bleach. There was no difference between the current MMT group and the other two groups combined in sexual risk-taking behaviour scores on the HRBS. There were no differences between the previous MMT and non-MMT groups in injecting and sexual risk-taking behaviour. HIV seroprevalence was low and there was no difference in seroprevalence between groups. Thus, IDUs currently enrolled in MMT are at reduced risk for HIV infection when compared with IDUs who have previously or never been enrolled in MMT. However, the absence of a difference between the current MMT and other two groups in frequency of sharing behaviours suggests the need for additional strategies among MMT clients to reduce needle-sharing. Possible strategies include the application of relapse prevention interventions and the availability of sterile injecting equipment in MMT clinics. Further research is needed to identify factors which increase attraction and retention of IDUs to MMT.

Response to deep TMS in depressive patients with previous electroconvulsive treatment.

Science.gov (United States)

Rosenberg, Oded; Zangen, Abraham; Stryjer, Rafael; Kotler, Moshe; Dannon, Pinhas N

2010-10-01

The efficacy of transcranial magnetic stimulation (TMS) in the treatment of major depression has already been shown. Novel TMS coils allowing stimulation of deeper brain regions have recently been developed and studied. Our study is aimed at exploring the possible efficacy of deep TMS in patients with resistant depression, who previously underwent electroconvalsive therapy (ECT). Using Brainsway's deep TMS H1 coil, six patients who previously underwent ECT, were treated with 120% power of the motor threshold at a frequency of 20 Hz. Patients underwent five sessions per week, up to 4 weeks. Before the study, patients were evaluated using the Hamilton depression rating scale (HDRS, 24 items), the Hamilton anxiety scale, and the Beck depression inventory and were again evaluated after 5, 10, 15, and 20 daily treatments. Response to treatment was considered a reduction in the HDRS of at least 50%, and remission was considered a reduction of the HDRS-24 below 10 points. Two of six patients responded to the treatment with deep TMS, including one who achieved full remission. Our results suggest the possibility of a subpopulation of depressed patients who may benefit from deep TMS treatment, including patients who did not respond to ECT previously. However, the power of the study is small and similar larger samples are needed. Copyright © 2010 Elsevier Inc. All rights reserved.

Domain Approach: An Alternative Approach in Moral Education

Science.gov (United States)

Vengadasalam, Chander; Mamat, Wan Hasmah Wan; Mail, Fauziah; Sudramanian, Munimah

2014-01-01

This paper discusses the use of the domain approach in moral education in an upper secondary school in Malaysia. Moral Education needs a creative and an innovative approach. Therefore, a few forms of approaches are used in the teaching-learning of Moral Education. This research describes the use of domain approach which comprises the moral domain…

Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.

Science.gov (United States)

Jordan, Joanne E; Briggs, Andrew M; Brand, Caroline A; Osborne, Richard H

2008-11-17

Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

Motivational needs on team performance of Korean nursing students.

Science.gov (United States)

Yi, Y J; Park, K H

2015-03-01

The purpose of this study was to examine the effects of an individual's motivational needs on team performance, centering on the needs for affiliation, power and achievement, following the McClelland's Achievement Motivation Theory. Most previous studies related to McClelland's Achievement Motivation Theory have focused on achievement motivation as a predictor of team performance. In contrast, affiliation and power motivations were relatively little known in connection with team performance. This was a descriptive, cross-sectional study using data from 181 junior nursing students in Korea. Data were collected from a questionnaire when the subjects' teamwork task was completed in November 2013. Multiple regression analysis was used to examine the influence of motivational needs on team performance. Each group having high levels of the need for affiliation, or the need for power and/or the need for achievement showed a significantly high level of teamwork skills and team effectiveness. The factors influencing teamwork skills were the need for affiliation and the need for achievement. Additionally, the factors influencing team effectiveness were also the need for affiliation and the need for achievement. The study reconfirmed the positive influence of the need for achievement, which was the focus of most previous research, in regard to personal and organizational growth. Furthermore, it identified that the need for affiliation, another type of internal motive, positively affected team performance as well. Nursing schools and nursing organizations should pay attention to their members' affiliation and achievement needs to enhance organizational efficiencies. Through efforts such as developing diverse continuing education programmes for need training, they could enhance their members' needs for affiliation or achievement and consequently increase nursing team performance. © 2014 International Council of Nurses.

The radiographer-patient relationship: Enhancing understanding using a transactional analysis approach

International Nuclear Information System (INIS)

Booth, Lisa

2008-01-01

Purpose: Government initiatives such as the NHS Plan, the NHS Key Skills Framework and the NHS Career framework place communication at the centre of effective patient care, and role/career development. All advocate a patient-centred approach to dealing with patients, through open communication styles that encourage patients to become active participants in their care. Previous research, that has investigated communication in diagnostic radiography, demonstrated a preference for practitioner-centred, rather than patient-centred approaches to communication, however, there is little evidence to suggest why this should be the case or how a more patient-centred approach might be encouraged. The present study therefore sought to explore factors that influence communication in diagnostic radiography, with the view to understanding the barriers to patient-centred care. Method: Semi-structured group interviews took place with 12 radiographers, across two NHS trusts, with the aim of understanding their communication with patients and the factors that influence it. An open coding approach was used to analyse the data. Results: Four attitude categories were identified as influencing the communication used by diagnostic radiographers. 1. Characteristics of the radiographer. 2. Characteristics of the patient. 3. The need to produce a diagnostic image. 4. The need to keep the department running. Conclusion: Radiographer-patient communication is evidently influenced by these four attitude categories. If patient-centred styles of communication are to be encouraged, these factors need to be recognised and taken account of in the selection, education/training and workforce planning of diagnostic radiographers

Unmet dental and orthodontic need of children with special healthcare needs in West Virginia.

Science.gov (United States)

Wiener, R C; Wiener, M A

2012-01-01

Of children aged 0-17 years in the USA, an estimated 11 203 616 (15.1%; 95% CI: 14.8, 15.3) are Children with Special Health Care Needs (CSHCN). The state of West Virginia, the heart of Appalachia, has a land mass which is 97.65% rural with previously identified high overall dental need and oral health disparities. It is home to an estimated 70 609 CSHCN, or 18.5% (95% CI: 17.0, 19.9) of the state's children in 2009-2010. The purpose of this study was to determine the parent/guardian's perceived unmet dental care need of CSHCN in West Virginia. Data from the National Survey of Children with Special Health Care Needs was used to determine prevalence. A telephone survey of 59 941 parents/guardians of CSHCN (1149 from West Virginia) for the dental interview was conducted in 2009-2010. Nationwide, 26.7% (25.9, 27.5) of parents/guardians reported their CSHCN had dental care or orthodontia needs other than preventive care. In West Virginia, the perceived dental care or orthodontia needs other than preventive dental care need was 26.5% (22.2, 30.0). Unmet national dental care need other than preventive dental care was 5.4% (5.0, 5.9) and in West Virginia 5.0% (2.4, 7.5). CSHCN have significant unmet dental needs. Parents/guardians in West Virginia reported similar unmet need compared with national reporting. Policies to address the health care of CSHCN should include dental needs. The clinical implications are that CSHCN have a variety of needs, including orthodontia. The benefits of orthodontic referrals should be considered in treatment planning options for CSHCN.

Low-dose computed tomography image restoration using previous normal-dose scan

International Nuclear Information System (INIS)

Ma, Jianhua; Huang, Jing; Feng, Qianjin; Zhang, Hua; Lu, Hongbing; Liang, Zhengrong; Chen, Wufan

2011-01-01

of the previous normal-dose scan via the presented ndiNLM algorithm is noticeable as compared to a similar approach without using the previous normal-dose scan. Conclusions: For low-dose CT image restoration, the presented ndiNLM method is robust in preserving the spatial resolution and identifying the low-contrast structure. The authors can draw the conclusion that the presented ndiNLM algorithm may be useful for some clinical applications such as in perfusion imaging, radiotherapy, tumor surveillance, etc.

Comparison of different approaches applied in Analytic Hierarchy Process - an example of information needs of patients with rare diseases.

Science.gov (United States)

Pauer, Frédéric; Schmidt, Katharina; Babac, Ana; Damm, Kathrin; Frank, Martin; von der Schulenburg, J-Matthias Graf

2016-09-09

The Analytic Hierarchy Process (AHP) is increasingly used to measure patient priorities. Studies have shown that there are several different approaches to data acquisition and data aggregation. The aim of this study was to measure the information needs of patients having a rare disease and to analyze the effects of these different AHP approaches. The ranking of information needs is then used to display information categories on a web-based information portal about rare diseases according to the patient's priorities. The information needs of patients suffering from rare diseases were identified by an Internet research study and a preliminary qualitative study. Hence, we designed a three-level hierarchy containing 13 criteria. For data acquisition, the differences in outcomes were investigated using individual versus group judgements separately. Furthermore, we analyzed the different effects when using the median and arithmetic and geometric means for data aggregation. A consistency ratio ≤0.2 was determined to represent an acceptable consistency level. Forty individual and three group judgements were collected from patients suffering from a rare disease and their close relatives. The consistency ratio of 31 individual and three group judgements was acceptable and thus these judgements were included in the study. To a large extent, the local ranks for individual and group judgements were similar. Interestingly, group judgements were in a significantly smaller range than individual judgements. According to our data, the ranks of the criteria differed slightly according to the data aggregation method used. It is important to explain and justify the choice of an appropriate method for data acquisition because response behaviors differ according to the method. We conclude that researchers should select a suitable method based on the thematic perspective or investigated topics in the study. Because the arithmetic mean is very vulnerable to outliers, the geometric mean

Training Needs Identification: A Turning Point.

Science.gov (United States)

Thomas, Edwin A.

1982-01-01

Describes a systematic approach to training needs identification that is directly tied to changing organizational events and performance requirements. The discussion includes nine questions which address performance expectations. (JJD)

A need for non-tokamak approaches to magnetic fusion energy

International Nuclear Information System (INIS)

Bathke, C.G.; Krakowski, R.A.; Miller, R.L.

1992-01-01

Focusing exclusively on conventional tokamak physics in the quest for commercial fusion power is premature, and the options for both advanced-tokamak and non-tokamak concepts need continued investigation. The basis for this claim is developed, and promising advanced-tokamak and non-tokamak options are suggested

Lithuanian Publisher’s Needs for Training

Directory of Open Access Journals (Sweden)

Arūnas Gudinavičius

2016-12-01

Full Text Available The survey on the training and professional development needs of Lithuanian publishers was designed and conducted. The pilot research showed that publishers in Lithuania have an interest in professional training. According to the results, the need for training among the employees of Lithuanian publishing houses depends on the previous training experience: the more training courses the employee had before, the greater need for training he/she expresses. 82% of publishing house employees from four different fields agreed and strongly agreed on the need for training. Very few employees would like to pay for training by themselves. The identified need for training appears to reflect the nature of the problems encountered in the publishing field in Lithuania: Copyright, Law & Rights is the most wanted training topic among managing directors. The list of preferred topics for training can be used as the grounds for creating a supply of publishing training courses.

Study of Approaches to Danish-Arab Dialogue

DEFF Research Database (Denmark)

Pace, Michelle; Haugbølle, Rikke Hostrup; Skrubbeltrang, Jørgen

This study responds to previous critique of the ‘dialogue objective’ of the Danish Arab Partnership Programme (DAPP). The ‘dialogue objective’ specifically refers to the second objective of the DAPP which is ‘to improve dialogue, understanding and cooperation between Denmark and the MENA region...... (the Middle East and North Africa)’.1 A 2009 review and an evaluation conducted in 2013 both concluded that the DAPP ‘dialogue objective’ needed to be further clarified. Following from this critique the present study examines the ‘dialogue objective’. The study was given the following three aims: 1....... To analyse dialogue assumptions and approaches of DAPP interventions. 2. To review academic state-of-the-art theories on and methods for promoting dialogue. 3. To create tools for improving and documenting dialogue interventions. In the concluding remarks the study points to the need for future studies...

Antimetabolites in cataract surgery to prevent failure of a previous trabeculectomy.

Science.gov (United States)

Thomas, Roger E; Crichton, Andrew; Thomas, Bennett C

2014-07-28

Patients having cataract surgery have often earlier undergone a trabeculectomy for glaucoma. However, cataract surgery may be associated with failure of the previous glaucoma surgery and antimetabolites may be used with cataract surgery to prevent such failure. There is no systematic review on whether antimetabolites with cataract surgery prevent failure of a previous trabeculectomy. To assess the effects of antimetabolites with cataract surgery on functioning of a previous trabeculectomy. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 June 2014. We also searched the Science Citation Index database (July 2013) and reference lists of potentially relevant studies. Randomised controlled trials (RCTs) of antimetabolites with cataract surgery in people with a functioning trabeculectomy. Two review authors independently reviewed the titles and abstracts from the electronic searches. Two review authors independently assessed relevant full-text articles and entered data. We identified no RCTs to test the effectiveness of antimetabolites with cataract surgery in individuals with the intention of preventing failure of a previous trabeculectomy. There are no RCTs of antimetabolites with cataract surgery in people with a functioning trabeculectomy. Appropriately powered RCTs

An Adjusted Likelihood Ratio Approach Analysing Distribution of Food Products to Assist the Investigation of Foodborne Outbreaks

Science.gov (United States)

Norström, Madelaine; Kristoffersen, Anja Bråthen; Görlach, Franziska Sophie; Nygård, Karin; Hopp, Petter

2015-01-01

In order to facilitate foodborne outbreak investigations there is a need to improve the methods for identifying the food products that should be sampled for laboratory analysis. The aim of this study was to examine the applicability of a likelihood ratio approach previously developed on simulated data, to real outbreak data. We used human case and food product distribution data from the Norwegian enterohaemorrhagic Escherichia coli outbreak in 2006. The approach was adjusted to include time, space smoothing and to handle missing or misclassified information. The performance of the adjusted likelihood ratio approach on the data originating from the HUS outbreak and control data indicates that the adjusted approach is promising and indicates that the adjusted approach could be a useful tool to assist and facilitate the investigation of food borne outbreaks in the future if good traceability are available and implemented in the distribution chain. However, the approach needs to be further validated on other outbreak data and also including other food products than meat products in order to make a more general conclusion of the applicability of the developed approach. PMID:26237468

Using CBPR to Assess Client Needs at a Social Service Agency.

Science.gov (United States)

Amendola, Mary Grace; Nazario, Noelia; Sanchez, Veronica

2016-01-01

Community-based participatory research (CBPR) has become an important research approach for universities to partner with social service agencies by uniting them in project design, planning, implementation, and evaluation. This study involved FOCUS, an urban social service agency, and Rutgers College of Nursing (RUCON) collaboratively conducting a needs assessment to compare the health needs of its clients and their employees' perception of their clients health needs, utilizing CBPR. Qualitative data was collected using the focus group method, field notes, photographs, and observation. The employees of FOCUS facilitated focus groups, participant recruitment, and transcribed and translated data. Three themes emerged: Health Education, Cost of Health Care, and Barriers to Health Care. This study contributes to the growing body of knowledge of integrating the CBPR approach when conducting a community needs assessment with a social service agency. The CBPR approach closely reflects the identified health needs of its clients resulting in interventions that will meet their specific health needs. © 2015 Wiley Periodicals, Inc.

Using a distribution and conservation status weighted hotspot approach to identify areas in need of conservation action to benefit Idaho bird species

Science.gov (United States)

Haines, Aaron M.; Leu, Matthias; Svancara, Leona K.; Wilson, Gina; Scott, J. Michael

2010-01-01

Identification of biodiversity hotspots (hereafter, hotspots) has become a common strategy to delineate important areas for wildlife conservation. However, the use of hotspots has not often incorporated important habitat types, ecosystem services, anthropogenic activity, or consistency in identifying important conservation areas. The purpose of this study was to identify hotspots to improve avian conservation efforts for Species of Greatest Conservation Need (SGCN) in the state of Idaho, United States. We evaluated multiple approaches to define hotspots and used a unique approach based on weighting species by their distribution size and conservation status to identify hotspot areas. All hotspot approaches identified bodies of water (Bear Lake, Grays Lake, and American Falls Reservoir) as important hotspots for Idaho avian SGCN, but we found that the weighted approach produced more congruent hotspot areas when compared to other hotspot approaches. To incorporate anthropogenic activity into hotspot analysis, we grouped species based on their sensitivity to specific human threats (i.e., urban development, agriculture, fire suppression, grazing, roads, and logging) and identified ecological sections within Idaho that may require specific conservation actions to address these human threats using the weighted approach. The Snake River Basalts and Overthrust Mountains ecological sections were important areas for potential implementation of conservation actions to conserve biodiversity. Our approach to identifying hotspots may be useful as part of a larger conservation strategy to aid land managers or local governments in applying conservation actions on the ground.

Human Needs Theory: Applications for Music Education

Science.gov (United States)

Bates, Vincent C.

2009-01-01

In this article the author reviews needs theory as a field of research and scholarship, examines seven needs theories (including Nussbaum's capabilities approach), and synthesizes elements of all of these into a list he used tentatively and speculatively to analyze two common instructional practices in music education. The author's intent is to…

A holistic approach to pastoral care and poverty

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Johan Janse van Rensburg

2010-03-01

Full Text Available The previous approaches to pastoral care are no longer adequate or effective for addressing the many issues related to poverty. The church has done wonderful work in terms of Christian charity. However, more needs to be done to improve the worsening situation of the poor significantly. The clear distinction between pastoral care and Christian charity is a luxury that is no longer affordable. Once we have a holistic understanding of pastoral care and counselling, we will find that we cannot possibly restrict our pastoral attention to encouraging the poor, to giving random advice and to praying. A holistic pastoral theology could lead to empowerment and should be a key concept in pastoral care with poor people and societies. The article offers a theological theory for a holistic approach and some implications of the praxis of counselling.

From basic needs to basic rights.

Science.gov (United States)

Facio, A

1995-06-01

After arriving at an understanding that basic rights refer to all human needs, it is clear that a recognition of the basic needs of female humans must precede the realization of their rights. The old Women in Development (WID) framework only understood women's needs from an androcentric perspective which was limited to practical interests. Instead, women's primary need is to be free from their subordination to men. Such an understanding places all of women's immediate needs in a new light. A human rights approach to development would see women not as beneficiaries but as people entitled to enjoy the benefits of development. Discussion of what equality before the law should mean to women began at the Third World Conference on Women in Nairobi where the issue of violence against women was first linked to development. While debate continues about the distinction between civil and political rights and economic, social, and cultural rights, the realities of women's lives do not permit such a distinction. The concept of the universality of human rights did not become codified until the UN proclaimed the Universal Declaration of Human Rights in 1948. The declaration has been criticized by feminists because the view of human rights it embodies has been too strongly influenced by a liberal Western philosophy which stresses individual rights and because it is ambiguous on the distinction between human rights and the rights of a citizen. The protection of rights afforded by the Declaration, however, should not be viewed as a final achievement but as an ongoing struggle. International conferences have led to an analysis of the human-rights approach to sustainable development which concludes that women continue to face the routine denial of their rights. Each human right must be redefined from the perspective of women's needs, which must also be redefined. Women must forego challenging the concept of the universality of human rights in order to overcome the argument of cultural

Management of Laryngoceles by Transoral Robotic Approach.

Science.gov (United States)

Kayhan, Fatma Tülin; Güneş, Selçuk; Koç, Arzu Karaman; Yiğider, Ayşe Pelin; Kaya, Kamil Hakan

2016-06-01

Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors' clinical experience on laryngocele management with TORS which is a rather new technique. A retrospective patient serial. Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized. Six men (mean age 51.7 years; range 41-62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred. Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

Principal component approach in variance component estimation for international sire evaluation

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Jakobsen Jette

2011-05-01

bias, but increased standard errors of the estimates and notably the computing time. Conclusions In terms of estimation's accuracy, both principal component approaches performed equally well and permitted the use of more parsimonious models through random regression MACE. The advantage of the bottom-up PC approach is that it does not need any previous knowledge on the rank. However, with a predetermined rank, the direct PC approach needs less computing time than the bottom-up PC.

Do we need an integrative approach to food safety at the country level?

International Nuclear Information System (INIS)

Ristic, G.

2002-01-01

Scientific data show increasing evidence of relationship between food safety and food standards on one hand and public health concern on the other hand. In FR Yugoslavia in 1989 the system of reporting on food safety issues on federal and republic level was established. The system provides data on laboratory analysis of 22 food items (bread, milk, meat and meat products, vegetables, processed vegetables etc). Those items were and still are tested on food quality and safety parameters such as microbiological, chemical and radio nuclides. Seldom all required testing on chemical and radio nuclides are performed, so we lack exact risk assessment for those contaminants. Further, during war conflict in FR Yugoslavia and also due to industrial hazards in neighbouring countries (Rumania, Hungary) high quantities of PCBs, dioxins, heavy metals, arsenic compounds and other toxic compounds contaminated the environment. In the soil and in some food products (animal fats predominantly) radionuclides originating from Chernobyl hazard can still be detected. In order to identify the level of exposure to chemical and radio nuclide contaminants in the food chain it is essential to test intensively and systematically food from animal and from plant origin. In order to prevent entering the contaminants to the food chain new recommendations from WHO, FAO and EU suggest implementation of integrative approach to food safety and control over the whole chain of food production from 'farm to table'. This approach provides control of the contaminants in soil, water, air, control over primary food production (covering animal feed too), intensive control over processing with implementation of HACCP system, but also, over transportation, retail trade, street food and home made food too. In our country creation of the map of the polluted areas, and actions in order to treat the pollution should accompany implementation of this new food safety system. The need for assessment of the level of

Do we need an integrative approach to food safety at the country level?

Energy Technology Data Exchange (ETDEWEB)

Ristic, G E-mail:risticg@eunet yu [Department of Nutrition, Medical Faculty, Belgrade (Yugoslavia)

2002-05-01

Scientific data show increasing evidence of relationship between food safety and food standards on one hand and public health concern on the other hand. In FR Yugoslavia in 1989 the system of reporting on food safety issues on federal and republic level was established. The system provides data on laboratory analysis of 22 food items (bread, milk, meat and meat products, vegetables, processed vegetables etc). Those items were and still are tested on food quality and safety parameters such as microbiological, chemical and radio nuclides. Seldom all required testing on chemical and radio nuclides are performed, so we lack exact risk assessment for those contaminants. Further, during war conflict in FR Yugoslavia and also due to industrial hazards in neighbouring countries (Rumania, Hungary) high quantities of PCBs, dioxins, heavy metals, arsenic compounds and other toxic compounds contaminated the environment. In the soil and in some food products (animal fats predominantly) radionuclides originating from Chernobyl hazard can still be detected. In order to identify the level of exposure to chemical and radio nuclide contaminants in the food chain it is essential to test intensively and systematically food from animal and from plant origin. In order to prevent entering the contaminants to the food chain new recommendations from WHO, FAO and EU suggest implementation of integrative approach to food safety and control over the whole chain of food production from 'farm to table'. This approach provides control of the contaminants in soil, water, air, control over primary food production (covering animal feed too), intensive control over processing with implementation of HACCP system, but also, over transportation, retail trade, street food and home made food too. In our country creation of the map of the polluted areas, and actions in order to treat the pollution should accompany implementation of this new food safety system. The need for assessment of the level of

Modern settlements in special needs education

DEFF Research Database (Denmark)

Ratner, Helene Gad

2016-01-01

. Settlements of this controversy govern whether the pupil or the educational institution becomes the main point of intervention. In Denmark, the particularities of settlements can be identified by juxtaposing the introduction of intelligence testing in the 1930s with the contemporary policy agenda of inclusion....... With intelligence testing, special needs education was to service children whose needs were seen as part of their human nature. Inclusion, in turn, assumes special needs to be stigmatizing cultural labels that need to be abandoned by changing school cultures. Drawing on actor-network theory we can approach......In the history of special needs education, the distinction between human nature and its social environment has been a controversial matter. The controversy regards whether special needs are primarily caused by the child's psycho-medical body or by cultural concepts of normality and deviance...

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

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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.

Relationship between the public's belief in recovery, level of mental illness stigma, and previous contact.

Science.gov (United States)

Barczyk, Amanda N

2015-01-01

Disbelief exits that individuals who have a mental health condition are able to recover and fully function in life. This study analyzed 1,437 adults from the 2006 General Social Survey. Structural equation modeling (1) examined the relationship between respondents' level of prejudicial attitudes and social distance (i.e., stigma) toward individuals who have a mental health condition and their belief in the potential of recovery (2) tested whether previous contact with an individual who received treatment was a mediator. Findings indicated that the belief in recovery led to lower levels of social distance. Prejudicial attitudes were found to be a predictor of one's level of social distance. Previous contact was not a mediator however; males, minorities and those with less education were less likely to have had previous contact. Results indicated a need to emphasize the probability of recovering from a mental health condition when developing target-specific stigma reducing strategies.

Congenital costo-vertebral fibrous band and congenital kyphoscoliosis: a previously unreported combination.

Science.gov (United States)

Eid, Tony; Ghostine, Bachir; Kreichaty, Gaby; Daher, Paul; Ghanem, Ismat

2013-05-01

Congenital kyphoscoliosis (CKS) results from abnormal vertebral chondrification. Congenital fibrous bands occur in several locations with variable impact on vertebral development. We report a previously unreported case of a female infant with CKS presenting with an L2 hypoplastic vertebra and a costo-vertebral fibrous band extending to the skin in the form of a dimple. We also describe the therapeutic approach, consisting of surgical excision of the fibrous band and postoperative fulltime bracing, with a 7-year follow-up. We recommend a high index of suspicion in any unusual presentation of CKS and insist on case by case management in such cases.

A mixed-methods approach to conducting Internal Revenue Service-compliant community health needs assessments: a case example for nonprofit hospital leaders

Directory of Open Access Journals (Sweden)

Oglesby WH

2014-10-01

Full Text Available Willie H Oglesby, Ken Slenkovich Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA Background: The Patient Protection and Affordable Care Act created new requirements for nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA at least once every 3 years, with a significant tax penalty for noncompliance. While some resources exist to help nonprofit hospital leaders conduct various aspects of a CHNA, few reflect the new Internal Revenue Service requirements. Methods: Many different models of CHNAs have emerged over the years. Although each has its unique features, the essential elements of a CHNA include engaging stakeholders, defining the community, gathering sufficient representative data, prioritizing information, and reporting results. In this paper, we expand upon this basic approach by offering a practical step-by-step guide to conducting CHNAs that meets new Internal Revenue Service regulations. Results: We developed and tested this methodology in partnership with several nonprofit hospital systems in Northeast Ohio, USA. In this paper, we discuss our use of the methodology and identify recommendations for other nonprofit hospital leaders. Conclusion: The methodology presented in this paper is a cost-effective approach to satisfying new CHNA requirements and nonprofit hospital leaders should consider using it or modifying it to fit their unique needs. Keywords: Affordable Care Act, CHNA, community benefit, community hospital

Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

Energy Technology Data Exchange (ETDEWEB)

Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Bello, Juliana Hiromi Silva Matsumoto [Instituto do Coracao (InCor/FM/USP), Sao paulo, SP (Brazil); Magalhaes, Tiago Augusto [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil); Moreira, Valeria de Melo; Carlos Eduardo Rochitte, E-mail: rochitte@gmail.com, E-mail: crochitte@hcor.com.br [Hospital do Coracao (HCOR), Sao Paulo, SP (Brazil)

2012-10-15

Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

Is Cup Positioning Challenged in Hips Previously Treated With Periacetabular Osteotomy?

DEFF Research Database (Denmark)

Hartig-Andreasen, Charlotte; Stilling, Maiken; Søballe, Kjeld

2014-01-01

After periacetabular osteotomy (PAO), some patients develop osteoarthritis with need of a total hip arthroplasty (THA). We evaluated the outcome of THA following PAO and explored factors associated with inferior cup position and increased polyethylene wear. Follow-up were performed 4 to 10years...... after THA in 34 patients (38 hips) with previous PAO. Computer analysis evaluated cup position and wear rates. No patient had dislocations or revision surgery. Median scores were: Harris hip 96, Oxford hip 38 and WOMAC 78. Mean cup anteversion and abduction angles were 22(o) (range 7°-43°) and 45......° (range 28°-65°). Outliers of cup abduction were associated with persisting dysplasia (CE...

Subgroup on engineering needs: summary report

International Nuclear Information System (INIS)

Gupta, G.D.; Blass, J.; Coffin, L.F.; Cramer, B.A.; Hart, E.W.; McClintock, F.A.; Moon, D.M.; Richerson, D.

1979-01-01

The need to bridge the gap between academic knowledge and industrial application was generally agreed upon in the summary report. Five areas were identified in which future work needs to be performed. These areas refer to metallic as well as ceramic materials and include cumulative damage concepts for crack initiation, environmental studies, more realistic approaches to contitutive equations, design methodology, and fabrication problems in welding, casting, forging, machining, forming, coatings, and powder sintering

The History of Petroleum Pollution in Malaysia; Urgent Need for Integrated Prevention Approach

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Mahyar Sakari

2010-01-01

Full Text Available Petroleum pollution is known as point and non-point source of contaminations in the environment. A major class of petroleum contaminant is groups of compounds consist of two or more fused benzene rings called polycyclic aromatic hydrocarbons (PAHs that are carcinogenic, mutagenic and toxic. Source identification of petroleum pollution is necessary to prevent pollution entry into the environment. Eight sedimentary cores were obtained from developed and developing areas around Peninsular Malaysia to investigate the historical profile of PAHs, their characteristics and its possible origins. The results showed that the PAHs concentrations varied from very minimum to 2400 ng/g d. w. in average quarter century intervals. Most of the studied locations showed high contribution of PAHs from combusted fuel, coal, biomasses and wood materials except for the southern part of Peninsular Malaysia in which revealed dominance of petroleum products. The findings indicate that PAHs are delivered from different intermediate materials such as asphalt, street dust, vehicular emission and crankcase oil. However, there has been a decline of PAHs input into the marine environment in recent years; petroleum is shown to be a significant cause of marine pollution since the second quarter of 20th century. An overview on sourced materials of petroleum pollution indicates multi-approach necessity toward pollution control, regardless of concentration and possible degradation processes. Various sectors both governmental and non-governmental are needed for prevention and control of petroleum pollution where different sources apparently contribute to the pollution generation process.

Proteomics Analysis Reveals Previously Uncharacterized Virulence Factors in Vibrio proteolyticus

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Ann Ray

2016-07-01

Full Text Available Members of the genus Vibrio include many pathogens of humans and marine animals that share genetic information via horizontal gene transfer. Hence, the Vibrio pan-genome carries the potential to establish new pathogenic strains by sharing virulence determinants, many of which have yet to be characterized. Here, we investigated the virulence properties of Vibrio proteolyticus, a Gram-negative marine bacterium previously identified as part of the Vibrio consortium isolated from diseased corals. We found that V. proteolyticus causes actin cytoskeleton rearrangements followed by cell lysis in HeLa cells in a contact-independent manner. In search of the responsible virulence factor involved, we determined the V. proteolyticus secretome. This proteomics approach revealed various putative virulence factors, including active type VI secretion systems and effectors with virulence toxin domains; however, these type VI secretion systems were not responsible for the observed cytotoxic effects. Further examination of the V. proteolyticus secretome led us to hypothesize and subsequently demonstrate that a secreted hemolysin, belonging to a previously uncharacterized clan of the leukocidin superfamily, was the toxin responsible for the V. proteolyticus-mediated cytotoxicity in both HeLa cells and macrophages. Clearly, there remains an armory of yet-to-be-discovered virulence factors in the Vibrio pan-genome that will undoubtedly provide a wealth of knowledge on how a pathogen can manipulate host cells.

Household level domestic fuel consumption and forest resource in relation to agroforestry adoption: Evidence against need-based approach

Energy Technology Data Exchange (ETDEWEB)

Sood, Kamal Kishor [Division of Agroforestry, Shere-Kashmir University of Agricultural Sciences and Technology of Jammu Main Campus-Chatha, Jammu (J and K) 180 009 (India); Mitchell, C. Paul [Institute of Energy Technologies, Fraser Noble Building, University of Aberdeen, Aberdeen AB24 3UE (United Kingdom)

2011-01-15

The need-based approach (assuming that higher consumption of tree products would motivate farmers to adopt agroforestry) has led to uneven success, in many cases failure, of many agroforestry projects. Current study investigated the association between fuelwood and forest resource use, and agroforestry adoption based on a survey of 401 households in the Indian Western Himalaya. Data on household domestic fuel utilisation and forest resource use were collected using a questionnaire in personal interviews. Agroforestry adoption increased significantly with increase in distance of nearest State forest from the house, distance travelled to collect fuelwood, and consumption of cattle dung, crop residues, charcoal, kerosene and liquid petroleum gas as domestic fuels by the household. Agroforestry adoption was also significantly higher in households with non-forest than those with State forests as primary source of fuelwood and timber. The proportion of adopters decreased significantly with increase in quantity of fuelwood used for domestic consumption, frequency of collection from State forests, total domestic energy consumption, fuelwood dependency, timber consumption and availability of timber through rights of households on State forests. Logistic regression analysis revealed that none of the factors related to need (quantity of fuelwood and timber used) appeared in the model but primary source of fuelwood, distance travelled to collect fuelwood and availability of timber through rights on the State forests appeared as important factors. This implies that need of the tree products is not a necessary condition to motivate farmers to adopt agroforestry, rather, it is accessibility of tree products which influence agroforestry adoption. (author)

UNDERSTANDING STUDENTS NEEDS FOR A MORE EFFECTIVE ONLINE MARKETING IN THE HIGHER EDUCATION SYSTEM

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Popa Adela Laura

2015-07-01

Full Text Available Considering that the results of previously conducted research revealed that higher education institutions (HEIs of Romania consider their own websites as rather a communication tool with current students than a marketing tool by which to communicate and attract potential students, the aim of the research presented in this paper is to analyze and verify whether the approach of higher education institutions is consistent with the expectations of potential students. Moreover, it is trying to evaluate whether they expect that the information from the official websites of these institutions address them. The research also seeks to capture which were the different search methods and the importance of online information sources for admission to university/faculty, which are the devices used in the search, what information the students consider that would be needed to make the right choice on university, faculty and specialization, the importance given to activities ranging from email marketing and search engine marketing etc. Finally, based on primary data resulted from research conducted and the analysis of secondary data resulted from other research, we identify the main pillars that the online marketing strategy of a higher education institution should be built on according to the needs of potential students: the official Internet pages designed so as to meet the needs of the prospective students (and even parents thereof, activities specific to email marketing and Pay Per Click campaigns meant to attract the prospective students to the pages that have a potential interest to them. The results of the study confirm the results of previous research according to which higher education institutions should attach great importance to the way they think their online presence.

Advanced control approach for hybrid systems based on solid oxide fuel cells

International Nuclear Information System (INIS)

Ferrari, Mario L.

2015-01-01

Highlights: • Advanced new control system for SOFC based hybrid plants. • Proportional–Integral approach with feed-forward technology. • Good control of fuel cell temperature. • All critical properties maintained inside safe conditions. - Abstract: This paper shows a new advanced control approach for operations in hybrid systems equipped with solid oxide fuel cell technology. This new tool, which combines feed-forward and standard proportional–integral techniques, controls the system during load changes avoiding failures and stress conditions detrimental to component life. This approach was selected to combine simplicity and good control performance. Moreover, the new approach presented in this paper eliminates the need for mass flow rate meters and other expensive probes, as usually required for a commercial plant. Compared to previous works, better performance is achieved in controlling fuel cell temperature (maximum gradient significantly lower than 3 K/min), reducing the pressure gap between cathode and anode sides (at least a 30% decrease during transient operations), and generating a higher safe margin (at least a 10% increase) for the Steam-to-Carbon Ratio. This new control system was developed and optimized using a hybrid system transient model implemented, validated and tested within previous works. The plant, comprising the coupling of a tubular solid oxide fuel cell stack with a microturbine, is equipped with a bypass valve able to connect the compressor outlet with the turbine inlet duct for rotational speed control. Following model development and tuning activities, several operative conditions were considered to show the new control system increased performance compared to previous tools (the same hybrid system model was used with the new control approach). Special attention was devoted to electrical load steps and ramps considering significant changes in ambient conditions

Enhancing participatory approach in water resources management: development of a survey to evaluate stakeholders needs and priorities related to software capabilities

Science.gov (United States)

Foglia, L.; Rossetto, R.; Borsi, I.; Josef, S.; Boukalova, Z.; Triana, F.; Ghetta, M.; Sabbatini, T.; Bonari, E.; Cannata, M.; De Filippis, G.

2016-12-01

The EU H2020 FREEWAT project (FREE and open source software tools for WATer resource management) aims at simplifying the application of EU-water related Directives, by developing an open source and public domain, GIS-integrated platform for planning and management of ground- and surface-water resources. The FREEWAT platform is conceived as a canvas, where several distributed and physically-based simulation codes are virtually integrated. The choice of such codes was supported by the result of a survey performed by means of questionnaires distributed to 14 case study FREEWAT project partners and several stakeholders. This was performed in the first phase of the project within the WP 6 (Enhanced science and participatory approach evidence-based decision making), Task 6.1 (Definition of a "needs/tools" evaluation grid). About 30% among all the invited entities and institutions from several EU and non-EU Countries expressed their interest in contributing to the survey. Most of them were research institutions, government and geoenvironmental companies and river basin authorities.The result of the questionnaire provided a spectrum of needs and priorities of partners/stakeholders, which were addressed during the development phase of the FREEWAT platform. The main needs identified were related to ground- and surface-water quality, sustainable water management, interaction between groundwater/surface-water bodies, and design and management of Managed Aquifer Recharge schemes. Needs and priorities were then connected to the specific EU Directives and Regulations to be addressed.One of the main goals of the questionnaires was to collect information and suggestions regarding the use of existing commercial/open-source software tools to address needs and priorities, and regarding the needs to address specific water-related processes/problems.

[New approaches in pharmacology: numerical modelling and simulation].

Science.gov (United States)

Boissel, Jean-Pierre; Cucherat, Michel; Nony, Patrice; Dronne, Marie-Aimée; Kassaï, Behrouz; Chabaud, Sylvie

2005-01-01

The complexity of pathophysiological mechanisms is beyond the capabilities of traditional approaches. Many of the decision-making problems in public health, such as initiating mass screening, are complex. Progress in genomics and proteomics, and the resulting extraordinary increase in knowledge with regard to interactions between gene expression, the environment and behaviour, the customisation of risk factors and the need to combine therapies that individually have minimal though well documented efficacy, has led doctors to raise new questions: how to optimise choice and the application of therapeutic strategies at the individual rather than the group level, while taking into account all the available evidence? This is essentially a problem of complexity with dimensions similar to the previous ones: multiple parameters with nonlinear relationships between them, varying time scales that cannot be ignored etc. Numerical modelling and simulation (in silico investigations) have the potential to meet these challenges. Such approaches are considered in drug innovation and development. They require a multidisciplinary approach, and this will involve modification of the way research in pharmacology is conducted.

Health status transitions in community-living elderly with complex care needs: a latent class approach.

Science.gov (United States)

Lafortune, Louise; Béland, François; Bergman, Howard; Ankri, Joël

2009-02-03

For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164), we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles) based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability) Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical information for the planning of longitudinal studies of aging

Perception of orthodontic treatment need among Swedish children, adolescents and young adults.

Science.gov (United States)

Salih, Firas Nafi; Lindsten, Rune; Bågesund, Mats

2017-08-01

Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19. A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo. The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19. The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

Clinician–Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce

Science.gov (United States)

Hall, Alison K.; Lund, P. Kay

2017-01-01

Clinician–investigators, also called physician–scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce. The authors summarize the recent literature on training for clinician–investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician–investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician–investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician–investigators themselves, in addition to support from the National Institutes of Health. PMID:28767499

Clinician-Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce.

Science.gov (United States)

Hall, Alison K; Mills, Sherry L; Lund, P Kay

2017-10-01

Clinician-investigators, also called physician-scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce.The authors summarize the recent literature on training for clinician-investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician-investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician-investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician-investigators themselves, in addition to support from the National Institutes of Health.

The Need for New Dosimetric Approach in CT Dosimetry

International Nuclear Information System (INIS)

Ben-Shlomo, A.; Iacobovici, E.

2004-01-01

Three decades after the invention of the first CT in 1972, it became a major tool in diagnostic radiology. The use of CT for various applications is getting wider every year. The quantity of CT procedures performed in Israel every year is estimated as 500,000. About 10% of those are pediatric procedures, for children under age 10. CT procedures increase is estimated at 5-10 % per annum. In spite the fact that CT contributes to about 1/8 of the total number of diagnostic X-ray procedures in Israel, the CT collective dosage is about 40% of the total collective dosage in the said procedures (about 3,500 Man*Sv per year). Medical radiation dosage is the first contributor to population dosage, resulting from artificial radiation sources. Diagnostic X-ray radiation dosage is the first contributor to medical radiation dose (including radiation dose from diagnostic X-ray, nuclear medicine and radiotherapy with exclusion of the target organ dose). Among medical X-ray different applications, CT procedure is the first cause to radiation dose of the population according to X-ray diagnostic procedures. The above facts emphasize the need to focus on CT in order to reduce the medical collective dose of the public. Several dosimetric units have appeared in recent years in order to comply with the need for CT Dosimetry. The CTDI Unit that served so well during the first CT years is no longer sufficient, as is, for modern instruments. This basic unit has become a complex concept that covers new units: CTDI W , CTDI VOL , CTDI 100 , MSAD and DLP. The search for a simple way to apply these units in order to calculate effective dosage during CT examinations is not straightforward. Modern equipment is simultaneously using 4 and 16 slices. Manufacturers are endeavoring to develop the next generation equipment with 256 slices used simultaneously (expected on the market in the next 1-2 years). This situation sets technology one step forward regarding the dosimetry methods used for organ

Assessing the Needs of Adults for Continuing Education: A Model.

Science.gov (United States)

Moore, Donald E., Jr.

1980-01-01

Reviews the needs assessment studies described in this journal issue. Concludes that (1) lessons from completed needs assessments can help continuing education practitioners plan and conduct future studies, and (2) a rational, need-reduction, decision-making approach can improve continuing education programs. (CT)

THE REAL NEED OF NURSES BASED ON WORKLOAD INDICATOR STAFF NEED (WISN

Directory of Open Access Journals (Sweden)

Ni Luh Ade Kusuma Ernawati

2017-04-01

Full Text Available Introduction: Nurses are health workers in hospitals that provide nursing care to patients for 24 hours. Workload of nurses was high due to insufficient numbers of nurses. It will have an impact on the decrease in work productivity that may affect nurses care for patients. To get the human resources necessary to suit the needs of nursing manpower planning to increase the competitiveness of hospitals in the era of globalization. The research objective was to analyze the real needs of nurses on staff workload indicators need (WISN. Method: The study design was observational analytic. Analysis of workload using the method of approach to time and motion study. Sample were 24 nurses who met the inclusion criteria. Analysis of the needs of staff nurses using the workload indicators need (WISN. Result: The results obtained based on the calculation of nurses with WISN method needs of nurses in the medical-surgical nurses as many as 54 people. Objective workload of nurses in the room medical surgery general state hospital of Bali is the average 82.61%, including height. The total time required to complete the productive activities of more than 80%. Discussion: Conclusion of this study show the number of nurses in the medical-surgical general hospital bali is still lacking as many as 30 people. It is suggest to the hospital management to increase gradually the number of nurses in the medical room.

Research needs for a better understanding of wilderness visitor experiences

Science.gov (United States)

Stephen F. McCool; Chad P. Dawson

2012-01-01

What information is needed to facilitate enhanced management of visitor experiences in wilderness? The final session of the workshop comprised a facilitated process with the 20 participants to identify research and information needs to support wilderness visitor experience management. The Wilderness Act and the previous presentations and discussions not only provided a...

49 CFR 173.23 - Previously authorized packaging.

Science.gov (United States)

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Previously authorized packaging. 173.23 Section... REQUIREMENTS FOR SHIPMENTS AND PACKAGINGS Preparation of Hazardous Materials for Transportation § 173.23 Previously authorized packaging. (a) When the regulations specify a packaging with a specification marking...

Does Individual Placement and Support satisfy the users` needs?

Directory of Open Access Journals (Sweden)

Sandra eViering

2015-06-01

Full Text Available This study aims to investigate clients’ satisfaction with Individual Placement and Support (IPS at the University Hospital for Psychiatry Zurich (PUK. Furthermore this study aims to investigate if clients feel the approach of IPS as a useful approach to fulfill their needs. 125 people were recruited from one of the three IPS services of PUK and were asked to complete a structured questionnaire. The following IPS services were available: i randomized controlled trial ZHEPP (www.zhepp.ch, ii randomized controlled trial ZInEP (www.zinep.ch and iii us clinical SE service of PUK (IPS-PUK. The clients mostly indicated that the IPS was generally useful and fitted their needs. Overall satisfaction of the participants with the IPS services of PUK was very high. Furthermore, this study confirms that client satisfaction and symptom severity are associated. In conclusion, participants of the IPS services received the support they were looking for. This means that the approach of IPS fits the needs of different patient groups and can be used without any modifications. The most important limitation is the unequal group sizes. Therefore, the obtained results need to be strengthen by future research.

22 CFR 40.91 - Certain aliens previously removed.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Certain aliens previously removed. 40.91... IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Aliens Previously Removed § 40.91 Certain aliens previously removed. (a) 5-year bar. An alien who has been found inadmissible, whether as a result...

Cancer Patients' Informational Needs: Qualitative Content Analysis.

Science.gov (United States)

Heidari, Haydeh; Mardani-Hamooleh, Marjan

2016-12-01

Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.

Addressing tuberculosis patients' medical and socio-economic needs: a comprehensive programmatic approach.

Science.gov (United States)

Contreras, Carmen C; Millones, Ana K; Santa Cruz, Janeth; Aguilar, Margot; Clendenes, Martin; Toranzo, Miguel; Llaro, Karim; Lecca, Leonid; Becerra, Mercedes C; Yuen, Courtney M

2017-04-01

For a cohort of patients with tuberculosis in Carabayllo, Peru, we describe the prevalence of medical comorbidities and socio-economic needs, the efforts required by a comprehensive support programme ('TB Cero') to address them and the success of this programme in linking patients to care. Patients diagnosed with tuberculosis in Carabayllo underwent evaluations for HIV, diabetes, mental health and unmet basic needs. For patients initiating treatment during 14 September, 2015-15 May, 2016, we abstracted data from evaluation forms and a support request system. We calculated the prevalence of medical comorbidities and the need for socio-economic support at the time of tuberculosis diagnosis, as well as the proportion of patients successfully linked to care or support. Of 192 patients, 83 (43%) had at least one medical comorbidity other than tuberculosis. These included eight (4%) patients with HIV, 12 (6%) with diabetes and 62 (32%) deemed at risk for a mental health condition. Of patients who required follow-up for a comorbidity, 100% initiated antiretroviral therapy, 71% attended endocrinology consultations and 66% attended psychology consultations. Of 126 (65%) patients who completed the socio-economic evaluation, 58 (46%) reported already receiving food baskets from the municipality, and 79 (63%) were given additional support, most commonly food vouchers and assistance in accessing health care. Carabayllo tuberculosis patients face many challenges in addition to tuberculosis. A collaborative, comprehensive treatment support programme can achieve high rates of linkage to care for these needs. © 2017 John Wiley & Sons Ltd.

Are Current Physical Match Performance Metrics in Elite Soccer Fit for Purpose or is the Adoption of an Integrated Approach Needed?

Science.gov (United States)

Bradley, Paul S; Ade, Jack D

2018-01-18

Time-motion analysis is a valuable data-collection technique used to quantify the physical match performance of elite soccer players. For over 40 years researchers have adopted a 'traditional' approach when evaluating match demands by simply reporting the distance covered or time spent along a motion continuum of walking through to sprinting. This methodology quantifies physical metrics in isolation without integrating other factors and this ultimately leads to a one-dimensional insight into match performance. Thus, this commentary proposes a novel 'integrated' approach that focuses on a sensitive physical metric such as high-intensity running but contextualizes this in relation to key tactical activities for each position and collectively for the team. In the example presented, the 'integrated' model clearly unveils the unique high-intensity profile that exists due to distinct tactical roles, rather than one-dimensional 'blind' distances produced by 'traditional' models. Intuitively this innovative concept may aid the coaches understanding of the physical performance in relation to the tactical roles and instructions given to the players. Additionally, it will enable practitioners to more effectively translate match metrics into training and testing protocols. This innovative model may well aid advances in other team sports that incorporate similar intermittent movements with tactical purpose. Evidence of the merits and application of this new concept are needed before the scientific community accepts this model as it may well add complexity to an area that conceivably needs simplicity.

Pregnancy in a Previously Conjoined Thoracopagus Twin with a Crisscross Heart

Directory of Open Access Journals (Sweden)

Bassam H. Rimawi

2015-01-01

Full Text Available Background. Crisscross heart (CCH is a complex, rare, congenital, rotational, cardiac abnormality that accounts for <0.1% of congenital heart defects (CHD. CCH is characterized by the crossing of the inflow streams of the two ventricles due to an abnormal twisting of the heart. A case of maternal CCH has not been previously reported. Case. We report a case of a primigravida with a CCH, who was separated at birth from her thoracopagus conjoined twin. Pregnancy was managed by congenital cardiology, maternal-fetal medicine, anesthesiology, and obstetrics. She underwent a 39-week vaginal delivery without maternal or neonatal complication. Conclusion. A successful term pregnancy outcome was achieved in a patient with CCH using a multidisciplinary approach to address her cardiac condition.

Patients’ needs for care in public mental health: unity and diversity of self-assessed needs for care

Directory of Open Access Journals (Sweden)

Tanja eBellier-Teichmann

2016-02-01

Full Text Available Purpose. Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients’ needs are organized. This study investigates both general and specific dimensions of patients’ needs for care. Methods. Patients’ needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients’ perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients’ personal motivations, needs and wants. 471 patients’ profiles were analyzed through exploratory factor analysis. Results. A four-factor bi-factor model, including one general factor and three specific factors of needs was most adequate. Specific factors were: (a ‘finances’ and ‘administrative tasks’; (b ‘transports’, ‘public places’, ‘self-care’, ‘housework’ and ‘food’; (c ‘family’, ‘children’, ‘intimate relationships’ and ‘friendship’.Conclusions. As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management; functional disabilities; familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

The needs of foster children : A Q-sort study on the differences between the psychosocial needs of foster children with and without a history of sexual abuse

NARCIS (Netherlands)

Steenbakkers, Anne; van der Steen, Steffie; Ellingsen, Ingunn T.; Grietens, Hans

2016-01-01

Children in family foster care have a specific set of psychosocial needs, stemming from previous caregiving, (traumatic) experiences, and living in a foster family. Foster parents are expected to learn about these needs and incorporate them into their parenting and nurturing. When foster children

Workplace Learning: Differential Learning Needs of Novice and More Experienced Workers.

Science.gov (United States)

Cornford, Ian R.; Beven, Fred A.

1999-01-01

A literature review identified differing learning needs of new and more experienced workers. Novices need to learn over extended time periods with deliberate practice and feedback. Experienced workers need to develop existing knowledge and skills. Different approaches to training and supervision are needed. (SK)

Materials needs for compact fusion reactors

International Nuclear Information System (INIS)

Krakowski, R.A.

1983-01-01

The economic prospects for magnetic fusion energy can be dramatically improved if for the same total power output the fusion neutron first-wall (FW) loading and the system power density can be increased by factors of 3 to 5 and 10 to 30, respectively. A number of compact fusion reactor embodiments have been proposed, all of which would operate with increased FW loadings, would use thin (0.5 to 0.6 m) blankets, and would confine quasi-steady-state plasma with resistive, water-cooled copper or aluminum coils. Increased system power density (5 to 15 MWt/m 3 versus 0.3 to 0.5 MW/m 3 ), considerably reduced physical size of the fusion power core (FPC), and appreciably reduced economic leverage exerted by the FPC and associated physics result. The unique materials requirements anticipated for these compact reactors are outlined against the well documented backdrop provided by similar needs for the mainline approaches. Surprisingly, no single materials need that is unique to the compact systems is identified; crucial uncertainties for the compact approaches must also be addressed by the mainline approaches, particularly for in-vacuum components (FWs, limiters, divertors, etc.)

Blame, Guilt and the Need for "Labels"; Insights from Parents of Children with Special Educational Needs and Educational Practitioners

Science.gov (United States)

Broomhead, Karen

2013-01-01

Previous research on home-school relationships and blame has concentrated on the experiences of parents with children with behavioural, emotional and social difficulties (BESD). This has led to the voices of educational practitioners, as well as parents of children with other special educational needs, being neglected. This article, by Karen…

HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

Directory of Open Access Journals (Sweden)

R. Sh. Saitgareev

2016-01-01

cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

Psychosocial Needs of Children in Foster Care and the Impact of Sexual Abuse

NARCIS (Netherlands)

Steenbakkers, Annemarie; Ellingsen, Ingunn; van der Steen, Stephanie; Grietens, Hans

Children in family foster care, especially those who have experienced sexual abuse, require a safe and nurturing environment in which their psychosocial needs are met. However, there is limited knowledge on how youth prioritize various needs and what impact previous experiences have on these needs.

Learning intervention and the approach to study of engineering undergraduates

Science.gov (United States)

Solomonides, Ian Paul

suggested that more co-ordinated and coherent action for changing the local course demands is needed before an improvement in student Approaches will be observed. These conclusions were broadly supported by the results from the qualitative analysis which also indicated the dominating effects of course context over Approach. However, some students appeared to have gained from the intervention in that they reported being in a better position to evaluate their relationships with the course demands following the workshops. It therefore appeared that some students could be described as being in tension between the desire to take a Deep Approach and the adoption of less desirable Approaches as promoted and encouraged by the course context. It is suggested that questions regarding the integrity of the intervention are thereby left unresolved even though the immediate effects of it are quite clear. It is also suggested that the integrity of the research instrument is open to question in that the Strategic Approach to Study scale failed to be defined by one factor under common factor analysis. The intentional or motivational element which previously defined this scale was found to be associated with a Deep Approach factor within the local context. The Strategic Approach was found to be defined by skill rather than motivation. This indicated that some reinterpretation of the RASI and in particular the Strategic Approach to Study scale is needed.

Licensing support system preliminary needs analysis: Volume 1

International Nuclear Information System (INIS)

1989-01-01

This Preliminary Needs Analysis, together with the Preliminary Data Scope Analysis (next in this series of reports), is a first effort under the LSS Design and Implementation Contract toward developing a sound requirements foundation for subsequent design work. Further refinements must be made before requirements can be specified in sufficient detail to provide a basis for suitably specific system specifications. This preliminary analysis of the LSS requirements has been divided into a ''needs'' and a ''data scope'' portion only for project management and scheduling reasons. The Preliminary Data Scope Analysis will address all issues concerning the content and size of the LSS data base; providing the requirements basis for data acquisition, cataloging and storage sizing specifications. This report addresses all other requirements for the LSS. The LSS consists of both computer subsystems and non-computer archives. This study addresses only the computer subsystems, focusing on the Access Subsystems. After providing background on previous LSS-related work, this report summarizes the findings from previous examinations of needs and describes a number of other requirements that have an impact on the LSS. The results of interviews conducted for this report are then described and analyzed. The final section of the report brings all of the key findings together and describes how these needs analyses will continue to be refined and utilized in on-going design activities. 14 refs., 2 figs., 1 tab

We need theoretical physics approaches to study living systems

Science.gov (United States)

Blagoev, Krastan B.; Shukla, Kamal; affil="3" >Herbert Levine,

2013-08-01

, nor collect data on the kinetics of the many complex reactions. Instead, the focus was on formulating two- or three-component reaction-diffusion equations (e.g. the Oregonator), which could explain such generic features as the existence of rotating spiral waves (and their instability), the transition to chaos, the control of the reaction by light etc. By stressing mechanism instead of meticulous detail, one could understand the system even if there were still components and interactions waiting to be cataloged and quantified. In living systems, this way of thinking is even more crucial. A leading biologist once remarked to one of us that a calculation of in vivo cytoskeletal dynamics that did not take into account the fact that the particular cell in question had more than ten isoforms of actin could not possibly be correct. We need to counter that any calculation which takes into account all these isoforms is overwhelmingly likely to be vastly under-constrained and ultimately not useful. Adding more details can often bring us further from reality. Of course, the challenge for models is then falsification, i.e., finding robust predictions which can be directly tested experimentally. The most severe criticism, to quote Pauli, remains that 'your model is not even wrong.' Is this approach proving successful? In many cases it is too early to tell, but simple models have already proved useful in understanding protein folding, directed cell motility, gene expression variability and even laboratory-scale Darwinian evolution. One could argue as well that the extremely influential Hodgkin-Huxley approach to the action potential in neurons is a vastly oversimplified description and that is why it is tractable and compelling. There are other cases, however, where the model was too simple—the simple Turing instability does not account for Drosophila segment formation [2] and the binary state relaxational dynamics of the Hopfield model may prove incapable of explaining memory

Why narcissists are at risk for developing Facebook addiction: The need to be admired and the need to belong.

Science.gov (United States)

Casale, Silvia; Fioravanti, Giulia

2018-01-01

Building upon previous research establishing a positive association between grandiose and vulnerable narcissism and problematic social networking use, the present study tests a model that explains how grandiose and vulnerable narcissists might develop Facebook (Fb) addiction symptoms through the need for admiration and the need to belong. A sample of 535 undergraduates (50.08% F; mean age 22.70±2.76years) completed measures of grandiose narcissism, vulnerable narcissism, Fb addiction symptoms, and two brief scales measuring the need for admiration and the need to belong. Results from structural equation modelling show that the association between grandiose narcissism and Fb addiction levels was completely mediated by the need for admiration and the need to belong. On the other hand, vulnerable narcissism was not found to be associated either directly or indirectly with Fb addiction levels. The variables in the model accounted for 30% of the variance in Fb addiction levels. The present study represents a step toward a better understanding of the psychological mechanisms underlying the link between grandiose narcissism and problematic Fb use. Copyright © 2017 Elsevier Ltd. All rights reserved.

Endoscopic "step-up approach" using a dedicated biflanged metal stent reduces the need for direct necrosectomy in walled-off necrosis (with videos).

Science.gov (United States)

Lakhtakia, Sundeep; Basha, Jahangeer; Talukdar, Rupjyoti; Gupta, Rajesh; Nabi, Zaheer; Ramchandani, Mohan; Kumar, B V N; Pal, Partha; Kalpala, Rakesh; Reddy, P Manohar; Pradeep, R; Singh, Jagadish R; Rao, G V; Reddy, D Nageshwar

2017-06-01

EUS-guided drainage using plastic stents may be inadequate for treatment of walled-off necrosis (WON). Recent studies report variable outcomes even when using covered metal stents. The aim of this study was to evaluate the efficacy of a dedicated covered biflanged metal stent (BFMS) when adopting an endoscopic "step-up approach" for drainage of symptomatic WON. We retrospectively evaluated consecutive patients with symptomatic WON who underwent EUS-guided drainage using BFMSs over a 3-year period. Reassessment was done between 48 and 72 hours for resolution. Endoscopic reinterventions were tailored in nonresponders in a stepwise manner. Step 1 encompassed declogging the blocked lumen of the BFMS. In step 2, a nasocystic tube was placed via BFMSs with intermittent irrigation. Step 3 involved direct endoscopic necrosectomy (DEN). BFMSs were removed between 4 and 8 weeks of follow-up. The main outcome measures were technical success, clinical success, adverse events, and need for DEN. Two hundred five WON patients underwent EUS-guided drainage using BFMSs. Technical success was achieved in 203 patients (99%). Periprocedure adverse events occurred in 8 patients (bleeding in 6, perforation in 2). Clinical success with BFMSs alone was seen in 153 patients (74.6%). Reintervention adopting the step-up approach was required in 49 patients (23.9%). Incremental success was achieved in 10 patients with step 1, 16 patients with step 2, and 19 patients with step 3. Overall clinical success was achieved in 198 patients (96.5%), with DEN required in 9.2%. Four patients failed treatment and required surgery (2) or percutaneous drainage (2). The endoscopic step-up approach using BFMSs was safe, effective, and yielded successful outcomes in most patients, reducing the need for DEN. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Service Approaches to Young People with Complex Needs Leaving Out-of-Home Care

Science.gov (United States)

Malvaso, Catia; Delfabbro, Paul; Hackett, Louisa; Mills, Hayley

2016-01-01

Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of…

Human Spaceflight Technology Needs - A Foundation for JSC's Technology Strategy

Science.gov (United States)

Stecklein, Jonette M.

2013-01-01

Human space exploration has always been heavily influenced by goals to achieve a specific mission on a specific schedule. This approach drove rapid technology development, the rapidity of which adds risks as well as provides a major driver for costs and cost uncertainty. The National Aeronautics and Space Administration (NASA) is now approaching the extension of human presence throughout the solar system by balancing a proactive yet less schedule-driven development of technology with opportunistic scheduling of missions as the needed technologies are realized. This approach should provide cost effective, low risk technology development that will enable efficient and effective manned spaceflight missions. As a first step, the NASA Human Spaceflight Architecture Team (HAT) has identified a suite of critical technologies needed to support future manned missions across a range of destinations, including in cis-lunar space, near earth asteroid visits, lunar exploration, Mars moons, and Mars exploration. The challenge now is to develop a strategy and plan for technology development that efficiently enables these missions over a reasonable time period, without increasing technology development costs unnecessarily due to schedule pressure, and subsequently mitigating development and mission risks. NASA's Johnson Space Center (JSC), as the nation s primary center for human exploration, is addressing this challenge through an innovative approach in allocating Internal Research and Development funding to projects. The HAT Technology Needs (TechNeeds) Database has been developed to correlate across critical technologies and the NASA Office of Chief Technologist Technology Area Breakdown Structure (TABS). The TechNeeds Database illuminates that many critical technologies may support a single technical capability gap, that many HAT technology needs may map to a single TABS technology discipline, and that a single HAT technology need may map to multiple TABS technology

Human spaceflight technology needs-a foundation for JSC's technology strategy

Science.gov (United States)

Stecklein, J. M.

Human space exploration has always been heavily influenced by goals to achieve a specific mission on a specific schedule. This approach drove rapid technology development, the rapidity of which added risks and became a major driver for costs and cost uncertainty. The National Aeronautics and Space Administration (NASA) is now approaching the extension of human presence throughout the solar system by balancing a proactive yet less schedule-driven development of technology with opportunistic scheduling of missions as the needed technologies are realized. This approach should provide cost effective, low risk technology development that will enable efficient and effective manned spaceflight missions. As a first step, the NASA Human Spaceflight Architecture Team (HAT) has identified a suite of critical technologies needed to support future manned missions across a range of destinations, including in cis-lunar space, near earth asteroid visits, lunar exploration, Mars moons, and Mars exploration. The challenge now is to develop a strategy and plan for technology development that efficiently enables these missions over a reasonable time period, without increasing technology development costs unnecessarily due to schedule pressure, and subsequently mitigating development and mission risks. NASA's Johnson Space Center (JSC), as the nation's primary center for human exploration, is addressing this challenge through an innovative approach in allocating Internal Research and Development funding to projects. The HAT Technology Needs (Tech Needs) Database has been developed to correlate across critical technologies and the NASA Office of Chief Technologist Technology Area Breakdown Structure (TABS). The TechNeeds Database illuminates that many critical technologies may support a single technical capability gap, that many HAT technology needs may map to a single TABS technology discipline, and that a single HAT technology need may map to multiple TABS technology disciplines. Th

Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes.

Science.gov (United States)

Ferranti, Erin Poe; Narayan, K M Venkat; Reilly, Carolyn M; Foster, Jennifer; McCullough, Marjorie; Ziegler, Thomas R; Guo, Ying; Dunbar, Sandra B

2014-01-01

The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes. A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality. Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables. There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors. © 2014 The Author(s).

Systematic review of the risk of uterine rupture with the use of amnioinfusion after previous cesarean delivery.

Science.gov (United States)

Hicks, Paul

2005-04-01

Amnioinfusion is commonly used for the intrapartum treatment of women with pregnancy complicated by thick meconium or oligohydramnios with deep variable fetal heart rate decelerations. Its benefit in women with previous cesarean deliveries is less known. Theoretically, rapid increases in intrauterine volume would lead to a higher risk of uterine rupture. Searches of the Cochrane Library from inception to the third quarter of 2001 and MEDLINE, 1966 to November 2001, were performed by using keywords "cesarean" and "amnioinfusion." Search terms were expanded to maximize results. All languages were included. Review articles, editorials, and data previously published in other sites were not analyzed. Four studies were retrieved having unduplicated data describing amnioinfusion in women who were attempting a trial of labor after previous cesarean section. As the studies were of disparate types, meta-analysis was not possible. The use of amnioinfusion in women with previous cesarean delivery who are undergoing a trial of labor may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.

Ibrutinib versus previous standard of care: an adjusted comparison in patients with relapsed/refractory chronic lymphocytic leukaemia.

Science.gov (United States)

Hansson, Lotta; Asklid, Anna; Diels, Joris; Eketorp-Sylvan, Sandra; Repits, Johanna; Søltoft, Frans; Jäger, Ulrich; Österborg, Anders

2017-10-01

This study explored the relative efficacy of ibrutinib versus previous standard-of-care treatments in relapsed/refractory patients with chronic lymphocytic leukaemia (CLL), using multivariate regression modelling to adjust for baseline prognostic factors. Individual patient data were collected from an observational Stockholm cohort of consecutive patients (n = 144) diagnosed with CLL between 2002 and 2013 who had received at least second-line treatment. Data were compared with results of the RESONATE clinical trial. A multivariate Cox proportional hazards regression model was used which estimated the hazard ratio (HR) of ibrutinib versus previous standard of care. The adjusted HR of ibrutinib versus the previous standard-of-care cohort was 0.15 (p ibrutinib in the RESONATE study were significantly longer than with previous standard-of-care regimens used in second or later lines in routine healthcare. The approach used, which must be interpreted with caution, compares patient-level data from a clinical trial with outcomes observed in a daily clinical practice and may complement results from randomised trials or provide preliminary wider comparative information until phase 3 data exist.

Self-determining medical leadership needs of occupational health physicians.

Science.gov (United States)

Giri, Prosenjit; Aylott, Jill; Kilner, Karen

2017-10-02

Purpose The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination Theory (SDT) to identify the extent to which a group of occupational health physicians (OHPs) was able to self-determine their leadership needs, using a National Health Service (NHS) England competency approach promoted by the NHS England Leadership Academy as a self-assessment leadership diagnostic. Medical leadership is seen as crucial to the transformation of health-care services, yet leadership programmes are often designed with a top-down and centrally commissioned "one-size-fits-all" approach. In the UK, the Smith Review (2015) concluded that more decentralised and locally designed leadership development programmes were needed to meet the health-care challenges of the future. However, there is an absence of empirical research to inform the design of effective strategies that will engage and motivate doctors to take up leadership roles, while at the same time, health-care organisations continue to develop formal leadership roles as a way to secure medical leadership engagement. The problem is further compounded by a lack of validated leadership qualities assessment instruments which support researching this problem. Design/Methodology/approach The analysis draws on a sample of about 25 per cent of the total population size of the Faculty of Occupational Medicine ( n = 1,000). The questionnaire used was the Leadership Qualities Framework tool as a form of online self-assessment ( NHS Leadership Academy, 2012 ). The data were analysed using descriptive statistics and simple inferential methods. Findings OHPs are open about reporting their leadership strengths and leadership development needs and recognise leadership learning as an ongoing development need regardless of their level of personal competence. This study found that the single most important factor to affect a doctor

Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

DEFF Research Database (Denmark)

Lukac, Peter; Hjortdal, Vibeke E; Pedersen, Anders K

2006-01-01

retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis...... to adjust for possible confounders. RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation...... in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses...

Evaluating an ensemble classification approach for crop diversityverification in Danish greening subsidy control

DEFF Research Database (Denmark)

Chellasamy, Menaka; Ferre, Ty; Greve, Mogens Humlekrog

2016-01-01

Beginning in 2015, Danish farmers are obliged to meet specific crop diversification rules based on total land area and number of crops cultivated to be eligible for new greening subsidies. Hence, there is a need for the Danish government to extend their subsidy control system to verify farmers......’ declarations to war-rant greening payments under the new crop diversification rules. Remote Sensing (RS) technology has been used since 1992 to control farmers’ subsidies in Denmark. However, a proper RS-based approach is yet to be finalised to validate new crop diversity requirements designed for assessing...... compliance under the recent subsidy scheme (2014–2020); This study uses an ensemble classification approach(proposed by the authors in previous studies) for validating the crop diversity requirements of the new rules. The approach uses a neural network ensemble classification system with bi-temporal (spring...

Modeling needs assessment for Hanford Tank Farm Operations. Vadose Zone Characterization Project at the Hanford Tank Farms

International Nuclear Information System (INIS)

1996-04-01

This report presents the results of a modeling-needs assessment conducted for Tank Farm Operations at the Hanford Site. The goal of this project is to integrate geophysical logging and subsurface transport modeling into a broader decision-based framework that will be made available to guide Tank Farm Operations in implementing future modeling studies. In support of this goal, previous subsurface transport modeling studies were reviewed, and stakeholder surveys and interviews were completed (1) to identify regulatory, stakeholder, and Native American concerns and the impacts of these concerns on Tank Farm Operations, (2) to identify technical constraints that impact site characterization and modeling efforts, and (3) to assess how subsurface transport modeling can best be used to support regulatory, stakeholder, Native American, and Tank Farm Operations needs. This report is organized into six sections. Following an introduction, Section 2.0 discusses background issues that relate to Tank Farm Operations. Section 3.0 summarizes the technical approach used to appraise the status of modeling and supporting characterization. Section 4.0 presents a detailed description of how the technical approach was implemented. Section 5.0 identifies findings and observations that relate to implementation of numerical modeling, and Section 6.0 presents recommendations for future activities

How many people will need palliative care in 2040? Past trends, future projections and implications for services.

Science.gov (United States)

Etkind, S N; Bone, A E; Gomes, B; Lovell, N; Evans, C J; Higginson, I J; Murtagh, F E M

2017-05-18

Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries. We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure. By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need. If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with

Negative Emissions Technologies, the Paris Agreement, and the Need for a Human-Rights Based Approach

Science.gov (United States)

Burns, W. C. G.

2016-12-01

The new Paris Agreement under the United Nations Framework Convention on Climate Change contemplates that its prospective Parties will balance emissions and sinks by 2050 as a means to effectuate the goal of holding temperature increases to well below 2°C from pre-industrial levels, as well as the more aspirational goal of holding temperature increases to 1.5°C. Most of the IPCC's AR5 scenarios that achieve these objectives contemplate the large-scale deployment of so-called "negative emissions technologies," with an emphasis on bioenergy and carbon capture and storage (BECCS), and to a lesser degree afforestation. BECCS could assuredly help society avoid passing critical climatic thresholds, or address overshoot scenarios in this century and beyond. However, it could also profound implications for food production, the status of forests, access to lands for livelihoods by vulnerable populations, and the integrity of critical ecosystems. This, in turn could have serious ramifications for human rights of some of the world's most vulnerable populations, including the rights to food, water, livelihoods and the benefits of biodiversity. The Preamble to the Paris Agreement acknowledges the need to take into consideration the potential impact of responses to climate change, providing that "Parties should, when taking action to address climate change, respect, promote and consider their respective obligations on human rights." This presentation will outline how application of a human rights-based approach to assessing such options could help to reconcile the objectives of ameliorating potential climatic impacts while protecting the human rights of potentially affected individuals and groups. This will include the potential role of Human Rights Impacts Assessments and potential configuration of HRIAs at the national and international level. It will also briefly suggest how to operationalize this approach within the Paris Agreement framework, including institutional

Health status transitions in community-living elderly with complex care needs: a latent class approach

Directory of Open Access Journals (Sweden)

Béland François

2009-02-01

Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

Impact of previously disadvantaged land-users on sustainable ...

African Journals Online (AJOL)

Impact of previously disadvantaged land-users on sustainable agricultural ... about previously disadvantaged land users involved in communal farming systems ... of input, capital, marketing, information and land use planning, with effect on ...

“İhtiyaç” Kavramı Ekseninde Sosyal Koruma: Temel İhtiyaçlar Yaklaşımı / Social Protection on the Base of “Needs”: Basic Needs Approach

Directory of Open Access Journals (Sweden)

Doğa Başar SARIİPEK

2017-05-01

Full Text Available İhtiyaç, somutlaştırılması ve tanımlanması güç bir kavramdır. Bu bağlamda, ihtiyaçların hangi ölçütlere göre belirleneceği, temel ve ileri ihtiyaçların neler olduğu, ihtiyaç içinde olanlarla olmayanların neye göre ve nasıl kesin olarak ayrılacağı gibi sorular sosyal refah ve koruma politikaları tasarlanırken sürekli sorulan ve tartışılan sorulardır. İhtiyaç temelli yaklaşım bu sorulara cevap olarak geliştirilmiş bir sosyal koruma yaklaşımıdır. Ancak genel anlamda ihtiyaç kavramının özünde bulunan sübjektif nitelikler ve içerdiği belirsizlikler nedeniyle, uygulaması kolay bir yöntem değildir. Bu nedenle, uygulamada herkesi kapsayabilmek adına “temel ihtiyaçlar” şeklinde bir daraltmaya gidilmiştir. Temel ihtiyaçlar yaklaşımının amacı, bireyin tam gelişimi için gereken fırsatları sağlamak ve bu amaçla belli gruplar için belli kaynakları tahsis etmektir. Temel ihtiyaçlar yaklaşımının özü, gerçek yaşam düzeyiyle ihtiyaçlar arasındaki boşluğun diğer alternatif yaklaşımlara göre çok daha kısa sürede ve mümkün olan en az miktarda kaynak kullanılarak doldurulmasıdır. Ancak bu yaklaşım, teoriden kaynaklanan ciddi eksiklikleri nedeniyle hak temelli yaklaşımın sağladığı sosyal koruma güvence düzeyini sağlamaktan uzak görünmektedir. / Needs are not easy to define. In this sense, the questions of which criteria are applied to determine needs, what the basic and further needs are, how the ones who are in need are distinguished from the others etc. are constantly asked while designing policies of social welfare and protection. Needs based approach is a social protection mechanism which was introduced as a response for these questions. Yet, it is not an easy measure to take due to the subjective features and uncertainties in the very nature of the concept of need itself. Therefore, a conceptual restriction, in the form of “basic needs”, was

Accident management information needs

International Nuclear Information System (INIS)

Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R.

1990-04-01

In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs

Accident management information needs

Energy Technology Data Exchange (ETDEWEB)

Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R. (EG and G Idaho, Inc., Idaho Falls, ID (USA))

1990-04-01

In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs.

Predicting Radiation Pneumonitis After Stereotactic Ablative Radiation Therapy in Patients Previously Treated With Conventional Thoracic Radiation Therapy

International Nuclear Information System (INIS)

Liu Hui; Zhang Xu; Vinogradskiy, Yevgeniy Y.; Swisher, Stephen G.; Komaki, Ritsuko; Chang, Joe Y.

2012-01-01

Purpose: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. Methods and Materials: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T 10 and mean lung dose (MLD) of the previous plan and the V 10 -V 40 and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1 ≤65% before SABR (P=.012), V 20 ≥30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. Conclusions: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1 ≤65%, a previous PTV spanning the bilateral mediastinum, and V 20 ≥30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

A Statistical Approach for Selecting Buildings for Experimental Measurement of HVAC Needs

Directory of Open Access Journals (Sweden)

Malinowski Paweł

2017-03-01

Full Text Available This article presents a statistical methodology for selecting representative buildings for experimentally evaluating the performance of HVAC systems, especially in terms of energy consumption. The proposed approach is based on the k-means method. The algorithm for this method is conceptually simple, allowing it to be easily implemented. The method can be applied to large quantities of data with unknown distributions. The method was tested using numerical experiments to determine the hourly, daily, and yearly heat values and the domestic hot water demands of residential buildings in Poland. Due to its simplicity, the proposed approach is very promising for use in engineering applications and is applicable to testing the performance of many HVAC systems.

The Nigerian System of Education and the Need for Pragmatic Approach

Science.gov (United States)

Oyebamiji, M. A.

2011-01-01

This paper attempted to reveal some inadequacies inherent in the Nigerian system of education and, how the pragmatic approach to education can help solve the problems of disfunctionality of the system. It does this by explaining the aims and features of the pragmatic philosophy of education. Furthermore, the paper gave answers to two basic…

8 Different approaches needed to manage ED demand among different age-groups.

Science.gov (United States)

Rimmer, Melanie; Ablard, Suzanne; O'Keeffe, Colin; Mason, Suzanne

2017-12-01

including patient education, co-location of other services with ED ('ED hubs'), and extending community-based services. ED staff attribute distinctly different patterns of ED attendance to patients of different age groups, including reasons for attending ED, the route to the ED, and the rate of non-urgent attendance. Given this variation, proposed demand management interventions are likely to impact differently on different age groups, and one solution is unlikely to be optimal for all ages. Therefore a number of different approaches will be needed to manage ED demand among different age groups. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Conceptual Modeling Approach for OLAP Personalization

Science.gov (United States)

Garrigós, Irene; Pardillo, Jesús; Mazón, Jose-Norberto; Trujillo, Juan

Data warehouses rely on multidimensional models in order to provide decision makers with appropriate structures to intuitively analyze data with OLAP technologies. However, data warehouses may be potentially large and multidimensional structures become increasingly complex to be understood at a glance. Even if a departmental data warehouse (also known as data mart) is used, these structures would be also too complex. As a consequence, acquiring the required information is more costly than expected and decision makers using OLAP tools may get frustrated. In this context, current approaches for data warehouse design are focused on deriving a unique OLAP schema for all analysts from their previously stated information requirements, which is not enough to lighten the complexity of the decision making process. To overcome this drawback, we argue for personalizing multidimensional models for OLAP technologies according to the continuously changing user characteristics, context, requirements and behaviour. In this paper, we present a novel approach to personalizing OLAP systems at the conceptual level based on the underlying multidimensional model of the data warehouse, a user model and a set of personalization rules. The great advantage of our approach is that a personalized OLAP schema is provided for each decision maker contributing to better satisfy their specific analysis needs. Finally, we show the applicability of our approach through a sample scenario based on our CASE tool for data warehouse development.

A linear programming approach for placement of applicants to academic programs.

Science.gov (United States)

Kassa, Biniyam Asmare

2013-01-01

This paper reports a linear programming approach for placement of applicants to study programs developed and implemented at the college of Business & Economics, Bahir Dar University, Bahir Dar, Ethiopia. The approach is estimated to significantly streamline the placement decision process at the college by reducing required man hour as well as the time it takes to announce placement decisions. Compared to the previous manual system where only one or two placement criteria were considered, the new approach allows the college's management to easily incorporate additional placement criteria, if needed. Comparison of our approach against manually constructed placement decisions based on actual data for the 2012/13 academic year suggested that about 93 percent of the placements from our model concur with the actual placement decisions. For the remaining 7 percent of placements, however, the actual placements made by the manual system display inconsistencies of decisions judged against the very criteria intended to guide placement decisions by the college's program management office. Overall, the new approach proves to be a significant improvement over the manual system in terms of efficiency of the placement process and the quality of placement decisions.

Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors

Directory of Open Access Journals (Sweden)

Ali Harlak

2010-01-01

Full Text Available PURPOSE: Sacrococcygeal pilonidal disease is a source of one of the most common surgical problems among young adults. While male gender, obesity, occupations requiring sitting, deep natal clefts, excessive body hair, poor body hygiene and excessive sweating are described as the main risk factors for this disease, most of these need to be verified with a clinical trial. The present study aimed to evaluate the value and effect of these factors on pilonidal disease. METHOD: Previously proposed main risk factors were evaluated in a prospective case control study that included 587 patients with pilonidal disease and 2,780 healthy control patients. RESULTS: Stiffness of body hair, number of baths and time spent seated per day were the three most predictive risk factors. Adjusted odds ratios were 9.23, 6.33 and 4.03, respectively (p<0.001. With an adjusted odds ratio of 1.3 (p<.001, body mass index was another risk factor. Family history was not statistically different between the groups and there was no specific occupation associated with the disease. CONCLUSIONS: Hairy people who sit down for more than six hours a day and those who take a bath two or less times per week are at a 219-fold increased risk for sacrococcygeal pilonidal disease than those without these risk factors. For people with a great deal of hair, there is a greater need for them to clean their intergluteal sulcus. People who engage in work that requires sitting in a seat for long periods of time should choose more comfortable seats and should also try to stand whenever possible.

Determining root correspondence between previously and newly detected objects

Science.gov (United States)

Paglieroni, David W.; Beer, N Reginald

2014-06-17

A system that applies attribute and topology based change detection to networks of objects that were detected on previous scans of a structure, roadway, or area of interest. The attributes capture properties or characteristics of the previously detected objects, such as location, time of detection, size, elongation, orientation, etc. The topology of the network of previously detected objects is maintained in a constellation database that stores attributes of previously detected objects and implicitly captures the geometrical structure of the network. A change detection system detects change by comparing the attributes and topology of new objects detected on the latest scan to the constellation database of previously detected objects.

Residents' perceived needs in communication skills training across in- and outpatient clinical settings.

Science.gov (United States)

Junod Perron, Noelle; Sommer, Johanna; Hudelson, Patricia; Demaurex, Florence; Luthy, Christophe; Louis-Simonet, Martine; Nendaz, Mathieu; De Grave, Willem; Dolmans, Diana; Van der Vleuten, Cees

2009-05-01

Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). Outpatient residents' perceived needs in communication skills were more patient

Risk Factors for the Need of Surgical Necrosectomy After Percutaneous Catheter Drainage in the Management of Infection Secondary to Necrotizing Pancreatitis.

Science.gov (United States)

Ji, Liang; Wang, Gang; Li, Le; Li, Yi-Long; Hu, Ji-Sheng; Zhang, Guang-Quan; Chen, Hong-Ze; Chen, Hua; Kong, Rui; Bai, Xue-Wei; Sun, Bei

2018-04-01

This study aimed to assess the need of surgical necrosectomy after percutaneous catheter drainage (PCD) for infected necrotizing pancreatitis. The clinical data of documented/suspected patients who were treated with a step-up approach were extracted and analyzed. Of the 329 patients enrolled, the initial PCD was performed at 12 (interquartile range, 9-15) days since onset and 35.3% were cured by PCD alone. In the pre-PCD model, mean computed tomographic (CT) density of necrotic fluid collection (NFC; P the initial PCD were independent risk factors, and a combination of the previously mentioned 2 factors produced an area under the curve of 0.775. In the post-PCD model, mean CT density of NFC (P = 0.041), MOF (P = 0.002), and serum procalcitonin level (P = 0.035) 3 days after the initial PCD were independent risk factors, and a combination of these previously mentioned factors produced an area under the curve of 0.642. Both mean CT density of NFC and MOF are independent pre- and post-PCD risk factors for the need of necrosectomy after PCD. Post-PCD serum procalcitonin level might be a respondent factor that is correlated with the necessity of necrosectomy.

Support Needs of Siblings of People with Developmental Disabilities

Science.gov (United States)

Arnold, Catherine K.; Heller, Tamar; Kramer, John

2012-01-01

This qualitative study examines the support needs of adult siblings of people with developmental disabilities. A survey completed by 139 siblings of people with developmental disabilities captured the needs of adult siblings through 2 open-ended questions. A grounded theory approach was used, and the sibling responses anchored the analysis,…

A Second Look at Maslow's Hierarchy of Basic Needs.

Science.gov (United States)

White, Charles M.

Implications of Maslow's Need Hierarchy are considered in this paper, along with possible qualifications to the suggested structure and potential effects of superimposing relative deprivation theory onto the hierarchy as an approach to adult education. The interfacing of needs and alternative structurings is discussed in terms of two theories: (1)…

Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment.

Science.gov (United States)

Geber, Selmo; Ferreira, Daniela Parreiras; Spyer Prates, Luis Felipe Víctor; Sales, Liana; Sampaio, Marcos

2002-01-01

Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients 35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, for infertile patients, non-surgical treatment might be a better option to avoid reduction of the ovarian response.

Urethrotomy has a much lower success rate than previously reported.

Science.gov (United States)

Santucci, Richard; Eisenberg, Lauren

2010-05-01

We evaluated the success rate of direct vision internal urethrotomy as a treatment for simple male urethral strictures. A retrospective chart review was performed on 136 patients who underwent urethrotomy from January 1994 through March 2009. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth and fifth urethrotomy. Patients with complex strictures (36) were excluded from the study for reasons including previous urethroplasty, neophallus or previous radiation, and 24 patients were lost to followup. Data were available for 76 patients. The stricture-free rate after the first urethrotomy was 8% with a median time to recurrence of 7 months. For the second urethrotomy stricture-free rate was 6% with a median time to recurrence of 9 months. For the third urethrotomy stricture-free rate was 9% with a median time to recurrence of 3 months. For procedures 4 and 5 stricture-free rate was 0% with a median time to recurrence of 20 and 8 months, respectively. Urethrotomy is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer followup and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Innovative Approach for IBS Vendor Selection Problem

Directory of Open Access Journals (Sweden)

Omar Mohd Faizal

2016-01-01

Full Text Available Supply chain management in Industrialised Building System (IBS construction management has significantly determined the successful of company and project performance. Due to the wide variety of criteria and vendor available, the vendor selection process for a specific project needs is becoming more difficult. The need of decision aid for vendor selection in other areas is widely discussed in previous research. However, study on vendor selection for IBS project is largely neglected. Decision Support System (DSS is proposed for this purpose. Yet, most of the DSS models are impractical since they are complicated and difficult for a layman such as project managers to use. Research indicates that the rapid development of ICT has highly potential towards simple and effective DSS. Thus, this paper highlights the importance and research approach for vendor selection in IBS project management. The study is based on Design Science Research Methodology with combination of case studies. It is anticipates that this study will yield an effective value-for-money decision making platform to manage vendor selection process.

Capturing information need by learning user context

OpenAIRE

Goker, A.S.

1999-01-01

Learning techniques can be applied to help information retrieval systems adapt to users' specific needs. They can be used to learn from user searches to improve subsequent searches. This paper describes the approach taken to learn about particular users' contexts in order to improve document ranking produced by a probabilistic information retrieval system. The approach is based on the argument that there is a pattern in user queries in that they tend to remain within a particular context over...

FOREIGN LANGUAGES: Human Capital Approach Needed to Correct Staffing and Proficiency Shortfalls

National Research Council Canada - National Science Library

2002-01-01

Although more than 70 federal agencies have foreign language needs, some of the largest programs are concentrated in the Army, the State Department, the Central Intelligence Agency, and the Federal...

Do we need sustainability as a new approach in human factors and ergonomics?

Science.gov (United States)

Zink, Klaus J; Fischer, Klaus

2013-01-01

The International Ergonomics Association Technical Committee 'Human Factors and Sustainable Development' was established to contribute to a broad discourse about opportunities and risks resulting from current societal 'mega-trends' and their impacts on the interactions among humans and other elements of a system, e.g. in work systems. This paper focuses on the underlying key issues: how do the sustainability paradigm and human factors/ergonomics interplay and interact, and is sustainability necessary as a new approach for our discipline? Based on a discussion of the sustainability concept, some general principles for designing new and enhancing existent approaches of human factors and ergonomics regarding their orientation towards sustainability are proposed. The increasing profile of sustainability on the international stage presents new opportunities for human factors/ergonomics. Positioning of the sustainability paradigm within human factors/ergonomics is discussed. Approaches to incorporating sustainability in the design of work systems are considered.

The Role of Psychological Needs in Ceasing Music and Music Learning Activities

Science.gov (United States)

Evans, Paul; McPherson, Gary E.; Davidson, Jane W.

2013-01-01

This article addresses individuals' decisions to continue or cease playing a musical instrument from a basic psychological needs perspective. Participants began learning music 10 years prior to the study and were the subject of previous longitudinal research. They completed a survey investigating the three psychological needs of competence,…

Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

Directory of Open Access Journals (Sweden)

Jabu T. Mabunda

2016-07-01

Full Text Available Background: Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. Aim: To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. Setting: This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Methods: Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. Results: A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Conclusion: Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community. Keywords: Health seeking, Adherence, Community based participatory research, Tuberculosis

Assessing basic needs in frail older persons calls for aesthetic nursing skills – an ethnographic approach

DEFF Research Database (Denmark)

Kollerup, Mette Geil; Angel, Sanne

2015-01-01

Background: Despite research on caring for older persons' basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated if they are ......Background: Despite research on caring for older persons' basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated...

Risk assessment concept in the new approach directives and its integration in the Enterprise Risk Management (ERM

Directory of Open Access Journals (Sweden)

Đapić Mirko

2012-03-01

Full Text Available In the nineties years of the previous century, the European Union achieved, through introducing the New and Global Approach to technical harmonization and standardization, a significant improvement in the approach to conformity assessment of products, by integrating the requirements for technical products safety into the process of its designing. This was achieved by preventive analyzing and quantifying of risk levels in the design process with the objective of determining the scope of the needed safety systems. On the other hand, we have witnessed a rapid development and implementation of holistic approaches to risks management in enterprises, unified in the modern business practice by the name of Enterprise Risk Management (ERM. Going along that line, the paper presents, through the basis of the EU New and Global Approach, the concept of risk assessment in the New Approach directives (Machinery, Lifts, ATEX, etc and provides the concept of its integration into the holistic approach of risks management in enterprises, such as ERM.

Designing with users to meet people needs: a teaching model.

Science.gov (United States)

Anselmi, Laura; Canina, Marita; Coccioni, Elisabetta

2012-01-01

Being in a context of great transformations of the whole system company-product-market, design becomes interpreter of the society and strategic key-point for production realities. Design must assume an ergonomic approach and a methodology oriented to product innovation where people are the main focus of the system. Today it is visible the need for a methodological approach able to include the context of use employing user's "creative skills". In this scenario, a design educational model based only on knowledge doesn't seem to be fulfilling; the traditional "deductive" method doesn't meet the needs of new productive assets, here the urgency to experiment within the "inductive" method for the development of a method where to know and to know how, theory and practice, act synergistically. The aim is to teach a method able to help a young designer to understand people's needs and desires considering both the concrete/cognitive level and the emotional level. The paper presents, through some case studies, an educational model developed combining theoretical/conceptual and practical/applicatory aspects with user experiential aspects. The proposed approach to design enables the students to investigate users' needs and desires and helps them proposing innovative ideas and projects better fitting today's market realities.

The Iowa K-12 Climate Science Education Initiative: a comprehensive approach to meeting in-service teachers' stated needs for teaching climate literacy with NGSS

Science.gov (United States)

Stanier, C. O.; Spak, S.; Neal, T. A.; Herder, S.; Malek, A.; Miller, Z.

2017-12-01

The Iowa Board of Education voted unanimously in 2015 to adopt NGSS performance standards. The CGRER - College of Education Iowa K-12 Climate Science Education Initiative was established in 2016 to work directly with Iowa inservice teachers to provide what teachers need most to teach climate literacy and climate science content through investigational learning aligned with NGSS. Here we present teachers' requests for teaching climate with NGSS, and an approach to provide resources for place-based authentic inquiry on climate, developed, tested, and refined in partnership with inservice and preservice teachers. A survey of inservice middle school and high school science teachers was conducted at the 2016 Iowa Council of Teachers of Mathematics/Iowa Academy of Sciences - Iowa Science Teaching Section Fall Conference and online in fall 2016. Participants (n=383) were asked about their prior experience and education, the resources they use and need, their level of comfort in teaching climate science, perceived barriers, and how they address potential controversy. Teachers indicated preference for professional development on climate content and complete curricula packaged with lessons and interactive models aligned to Iowa standards, as well as training on instructional strategies to enhance students' ability to interpret scientific evidence. We identify trends in responses by teaching experience, climate content knowledge and its source, grade level, and urban and rural districts. Less than 20% of respondents reported controversy or negativity in teaching climate to date, and a majority were comfortable teaching climate science and climate change, with equal confidence in teaching climate and other STEM content through investigational activities. We present an approach and materials to meet these stated needs, created and tested in collaboration with Iowa teachers. We combine professional development and modular curricula with bundled standards, concepts, models, data

Basic psychological need satisfaction in leisure activities and adolescents' life satisfaction.

Science.gov (United States)

Leversen, Ingrid; Danielsen, Anne G; Birkeland, Marianne S; Samdal, Oddrun

2012-12-01

Participation in leisure activities is an important arena for the positive psychological development of adolescents. The present study set out to examine the relationship between adolescents' satisfaction of the psychological needs for competence, relatedness, and autonomy in their participation in leisure activities and their perceived life satisfaction. The aim was to identify the extent to which satisfaction of the three needs explained the relationship between participation in leisure activities and life satisfaction. These proposed mechanisms were based on previous empirical work and the theoretical frameworks of self-determination theory, and were tested in a nationally representative sample of Norwegian adolescents (N = 3,273) aged 15 and 16 years (51.8 % boys). The structural equation analysis showed that competence and relatedness satisfaction fully mediated the association between participation in activities and life satisfaction. Autonomy satisfaction had a direct positive effect on life satisfaction but did not show any mediation effect. The positive processes of psychological need satisfaction, and especially the need for competence and relatedness, experienced in the leisure activity domain thus seem to be beneficial for adolescents' well-being. These findings add to previous research investigating the positive impact of need satisfaction in other important domains in the lives of children and adolescents.

Borderline personality disorder and unmet needs.

Science.gov (United States)

Grambal, Ales; Prasko, Jan; Ociskova, Marie; Slepecky, Milos; Kotianova, Antonia; Sedlackova, Zuzana; Zatkova, Marta; Kasalova, Petra; Kamaradova, Dana

2017-08-01

Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families. A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151). The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy. Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social

CORRELATION BETWEEN HUMAN NEEDS SYSTEM - PERSONALITY - HUMAN MOTIVATION

Directory of Open Access Journals (Sweden)

Mirela MINICA

2015-07-01

Full Text Available The article highlights the main attributes of an economic approach of needs and preferences, with detailed focus on the correlation between meta-needs and personality, by correlating the principle of hierarchy established by Maslow with the balance theory. Adopting an integrated system of human capital motivation, which takes into account the complex aspects involved in the knowledge society, represents a managerial requirement for any organisation.

A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks.

Science.gov (United States)

Tsao, Hsiao-Mei; Sun, Ying-Chou; Liou, Der-Ming

2015-01-01

Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs. To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks. Based on a nationwide research database in Taiwan, we extracted the monthly volumes of major surgery types for the period 1998-2003, which covered the SARS period, in order to carry out a time series analysis. The demand elasticity of each surgery type was then estimated by autoregressive integrated moving average (ARIMA) analysis. During the study period, the surgical volumes of most selected surgery types either increased or remained steady. We categorized these surgery types into low-, moderate- and high-elastic groups according to their demand elasticity. Appendectomy, 'open reduction of fracture with internal fixation' and 'free skin graft' were in the low demand elasticity group. Transurethral prostatectomy and extracorporeal shockwave lithotripsy (ESWL) were in the high demand elasticity group. The manpower of the departments carrying out the surgeries with low demand elasticity should be maintained during outbreaks. In contrast, departments in charge of surgeries mainly with high demand elasticity, like urology departments, may be in a position to have part of their staff reallocated. Taking advantage of the demand variation during the SARS period in 2003, we adopted the concept of demand elasticity and used a time series approach to figure out an effective index of demand elasticity for various types of surgery that could be used as a rational reference to carry out manpower reallocation during contagious outbreak situations.

Masculinities and young men's sex education needs in Ireland: problematizing client-centred health promotion approaches.

Science.gov (United States)

Hyde, Abbey; Howlett, Etaoine; Drennan, Jonathan; Brady, Dympna

2005-12-01

In recent decades, dominant discourses in health promotion have emphasized empowerment, client participation and the notion of people identifying and being facilitated to meet their own health needs. However, there has been little analysis of the concept of 'need' and the possibility, at least, that the fulfillment of some such self-defined needs are not in the interest of social justice and equality. In this article, we present an account of the sex education needs of secondary school pupils from their own perspectives, and problematize the concept of self-identified needs in health education. Twenty-nine focus group interviews were conducted with 226 secondary school pupils in Ireland, and data were subjected to a qualitative analysis. Findings suggested that young men tended to prioritize practical guidance that would provide them with the skills and confidence to take the lead in sexual encounters, and display competence in the act of penetrative sex. We argue that these self-defined sex education needs emanate from a culture of traditional masculinity where, for a male, one's place in the pecking order is derived from one's capacity to conquer, lead and display mastery with regard to sex. In the discussion, we attempt to unpack the notion of clients identifying their own needs and the concept of empowerment as it relates to our data, in the context of gender-based structural inequalities.

Need for Uniqueness Determines Reactions to Web-Based Personalized Advertising.

Science.gov (United States)

Stiglbauer, Barbara; Kovacs, Carrie

2018-01-01

The presented empirical study among a sample of n = 256 participants addressed the relationship between consumers' need for uniqueness and their reactions to web-based personalized advertising. Drawing on regulatory focus theory, we argue that the consumers' need for uniqueness dimensions creative choice and similarity avoidance may relate to promotion and prevention regulatory orientations, respectively. Accordingly, we hypothesized that creative choice and similarity avoidance would differentially predict self-reported approach and avoidance behavior toward personalized advertising. These direct relationships were further expected to be mediated by subjective evaluations of personalized advertising (i.e., perceived value and irritation). In line with these hypotheses, we found that creative choice predicted approach behavior through increased web-based personalized advertising value, whereas similarity avoidance predicted avoidance behavior through increased irritation. Creative choice also predicted decreased irritation, which in turn was related to decreased approach behavior. In sum, the results suggest that the consumers' need for uniqueness dimensions should not be investigated as a composite, as they seem to reflect different regulatory orientations and are therefore likely to evoke different affective, cognitive, and behavioral responses.

IITET and shadow TT: an innovative approach to training at the point of need

Science.gov (United States)

Gross, Andrew; Lopez, Favio; Dirkse, James; Anderson, Darran; Berglie, Stephen; May, Christopher; Harkrider, Susan

2014-06-01

The Image Intensification and Thermal Equipment Training (IITET) project is a joint effort between Night Vision and Electronics Sensors Directorate (NVESD) Modeling and Simulation Division (MSD) and the Army Research Institute (ARI) Fort Benning Research Unit. The IITET effort develops a reusable and extensible training architecture that supports the Army Learning Model and trains Manned-Unmanned Teaming (MUM-T) concepts to Shadow Unmanned Aerial Systems (UAS) payload operators. The training challenge of MUM-T during aviation operations is that UAS payload operators traditionally learn few of the scout-reconnaissance skills and coordination appropriate to MUM-T at the schoolhouse. The IITET effort leveraged the simulation experience and capabilities at NVESD and ARI's research to develop a novel payload operator training approach consistent with the Army Learning Model. Based on the training and system requirements, the team researched and identified candidate capabilities in several distinct technology areas. The training capability will support a variety of training missions as well as a full campaign. Data from these missions will be captured in a fully integrated AAR capability, which will provide objective feedback to the user in near-real-time. IITET will be delivered via a combination of browser and video streaming technologies, eliminating the requirement for a client download and reducing user computer system requirements. The result is a novel UAS Payload Operator training capability, nested within an architecture capable of supporting a wide variety of training needs for air and ground tactical platforms and sensors, and potentially several other areas requiring vignette-based serious games training.

Automatic electromagnetic valve for previous vacuum

International Nuclear Information System (INIS)

Granados, C. E.; Martin, F.

1959-01-01

A valve which permits the maintenance of an installation vacuum when electric current fails is described. It also lets the air in the previous vacuum bomb to prevent the oil ascending in the vacuum tubes. (Author)

A new approach to assessing skill needs of senior managers.

Science.gov (United States)

Griffith, John R; Warden, Gail L; Neighbors, Kamilah; Shim, Beth

2002-01-01

Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. We propose using formal lists of technical, interpersonal, and strategic competencies and specific real events chosen by the respondent to identify and prioritize competencies. Results of a trial with 30 large health care system CEOs and 15 early careerists demonstrate that the method reveals useful depth and detail about managers' educational needs. The results suggest that current thinking about managerial education and learning patterns may be seriously inadequate in several respects. The continued improvement of U.S. health care is a pressing national concern. Quality of care is highly variable and substantially deficient in many institutions (Chassin and Galvin 1998; Committee on Quality of Health Care in America 2001). "Quality improvement should be the essential business strategy for healthcare in the 21st century (Kizer 2001)." Productivity improvements will be essential to balance cost pressures from an aging population and growing technology (Heffler, et al. 2002). Skillful management is necessary to improve quality and productivity. Teams of dozens of caregivers are often required to improve a patient's health. The organizations that provide care have grown larger in response to the greater cost, complexity of operation and finance, and evidence of the success of scale in other industries. While many small professional practices, hospitals, and nursing homes remain, consolidation has created a few dozen provider and intermediary organizations exceeding a billion dollars a year in expenditures. These large health care

Childhood obesity: Current and novel approaches.

Science.gov (United States)

Sabin, Matthew A; Kiess, Wieland

2015-06-01

The prevalence of childhood obesity has increased over the last fifty years by approximately 5% per decade, and approximately a quarter of all children are now either overweight or obese. These children have a significantly increased risk of many future health problems including adult obesity, type 2 diabetes and heart disease. Despite this relentless increase, common-sense approaches aimed at prevention and treatment have failed to solve the problem. Current approaches at prevention have faced major challenges with some progress in implementing smaller scale programs and social marketing, but little action on broad public policy approaches which often appears unpalatable to society or individual governments. Meanwhile, treatment approaches have mainly focused on lifestyle change, and novel approaches are urgently needed. Prevention needs to shift to improving maternal health prior to conception, with more research focussed on the impact of early years in programming offspring to future overweight/obesity. Likewise, treatment paradigms need to move from simply thinking that obesity can be solved by readdressing diet and activity levels. Novel approaches are needed which take into consideration the complex physiology which regulates early childhood growth and the development of obesity in susceptible individuals. Copyright © 2015 Elsevier Ltd. All rights reserved.

In vitro fertilization outcome in women with endometriosis & previous ovarian surgery

Directory of Open Access Journals (Sweden)

Sonja Pop-Trajkovic

2014-01-01

Full Text Available Background & objectives: Women with endometriosis often need in vitro fertilization (IVF to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. Methods: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH levels. Outcome measures included number of follicles, number of ocytes, peak oestradiol (E2 concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. Results: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. Interpretation & conclusions: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries

DEFF Research Database (Denmark)

Byskov, Jens; Bloch, Paul; Blystad, Astrid

2009-01-01

Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived...... from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability...... and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must...

Innovative approaches for improving maternal and newborn health--A landscape analysis.

Science.gov (United States)

Lunze, Karsten; Higgins-Steele, Ariel; Simen-Kapeu, Aline; Vesel, Linda; Kim, Julia; Dickson, Kim

2015-12-17

Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study's aim was to analyze the landscape of innovative MNH approaches and related published evidence. Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Future implementation and evaluation efforts need to assess innovations' effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative

On the need for phylogenetic ‘corrections’ in functional trait-based approaches

NARCIS (Netherlands)

de Bello, F.; Berg, M.P.; Dias, A.T.C.; Diniz-Filho, J.A.F.; Götzenberger, L.; Hortal, J.; Ladle, R.J.; Lepš, J.

2015-01-01

There is considerable uncertainty about if, and when, phylogenetic information is needed to answer various ecological questions about trait-based ecological studies. It has been recommended that both functional and phylogenetic information should be combined, and some researchers have even suggested

Why we need new approaches to low-dose risk modeling

International Nuclear Information System (INIS)

Alvarez, J.L.; Seiler, F.A.

1996-01-01

The linear no-threshold model for radiation effects was introduced as a conservative model for the design of radiation protection programs. The model has persisted not only as the basis for such programs, but has come to be treated as a dogma and is often confused with scientific fact. In this examination a number of serious problems with the linear no-threshold model of radiation carcinogenesis were demonstrated, many of them invalidating the hypothesis. It was shown that the relative risk formalism did not approach 1 as the dose approaches zero. When morality ratios were used instead, the data in the region below 0.3 Sv were systematically below the predictions of the linear model. It was also shown that the data above 0.3 Sv were of little use in formulating a model at low doses. In addition, these data are valid only for doses accumulated at high dose rates, and there is no scientific justification for using the model in low-dose, low-dose-rate extrapolations for purposes of radiation protection. Further examination of model fits to the Japanese survivor data were attempted. Several such models were fit to the data including an unconstrained linear, linear-square root, and Weibull, all of which fit the data better than the relative risk, linear no-threshold model. These fits were used to demonstrate that the linear model systematically over estimates the risk at low doses in the Japanese survivor data set. It is recommended here that an unbiased re-analysis of the data be undertaken and the results used to construct a new model, based on all pertinent data. This model could then form the basis for managing radiation risks in the appropriate regions of dose and dose rate

Sex ratio at birth in India, its relation to birth order, sex of previous children and use of indigenous medicine.

Directory of Open Access Journals (Sweden)

Samiksha Manchanda

Full Text Available OBJECTIVE: Sex-ratio at birth in families with previous girls is worse than those with a boy. Our aim was to prospectively study in a large maternal and child unit sex-ratio against previous birth sex and use of traditional medicines for sex selection. MAIN OUTCOME MEASURES: Sex-ratio among mothers in families with a previous girl and in those with a previous boy, prevalence of indigenous medicine use and sex-ratio in those using medicines for sex selection. RESULTS: Overall there were 806 girls to 1000 boys. The sex-ratio was 720:1000 if there was one previous girl and 178:1000 if there were two previous girls. In second children of families with a previous boy 1017 girls were born per 1000 boys. Sex-ratio in those with one previous girl, who were taking traditional medicines for sex selection, was 928:1000. CONCLUSION: Evidence from the second children clearly shows the sex-ratio is being manipulated by human interventions. More mothers with previous girls tend to use traditional medicines for sex selection, in their subsequent pregnancies. Those taking such medication do not seem to be helped according to expectations. They seem to rely on this method and so are less likely use more definitive methods like sex selective abortions. This is the first such prospective investigation of sex ratio in second children looked at against the sex of previous children. More studies are needed to confirm the findings.

Policy needs and options for a common transatlantic approach towards measuring adoption, usage and benefits of eHealth.

Science.gov (United States)

Stroetmann, Karl A; Middleton, Blackford

2011-01-01

The European Union (EU) sponsored ARGOS project analysed current eHealth policy thinking in both the EU and the USA, compared strategic challenges and outcomes in selected fields, and drafted roadmaps towards developing advanced global approaches for these issues. This policy brief focuses on better understanding the benefits and costs of eHealth investments, assessing their overall socio-economic impact, identifying challenges and success factors, as well as measuring and globally benchmarking the concrete usage of eHealth solutions. These are by now key policy priorities not only of national governments and the European Commission, but also of international institutions like WHO or OECD. There is a strong felt transatlantic need for stocktaking, identifying lessons learned, sharing of experience, and working together to advance these issues for the benefit of health systems. A growing number of national and international activities can be taken advantage of. Recommendations on how to proceed with such transatlantic activities are proposed.

Assessing Need in School-Aged Children with an Autism Spectrum Disorder

Science.gov (United States)

Brown, Hilary K.; Ouellette-Kuntz, Helene; Hunter, Duncan; Kelley, Elizabeth

2010-01-01

The assessment of support needs of children with an autism spectrum disorder and their families has been hindered by the ambiguity surrounding the definition of need and the lack of a conceptual framework to guide investigations. This paper examines two major approaches to measuring need and discusses their appropriateness for use in autism. We…

Angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid artery

International Nuclear Information System (INIS)

Na, Dong Gyu; Han, Moon Hee; Chang, Kee Hyun; Han, Gi Seok; Yeon, Kung Mo

1995-01-01

The purpose of this study is to describe the angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of angiographic assessment needed before embolization. We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous malformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n = 5), branches of external carotid artery (n = 2) and common carotid artery (n = 3). Common carotid artery or internal carotid artery (n = 9), vertebral artery (n = 5), ipsilateral external carotid artery (n = 4), contralateral external carotid artery (n = 5), costocervical trunk (n = 2), thyrocervical trunk (n = 2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. The collateral vascular channels were inferolateral trunk of internal carotid artery (n = 8), vertebral artery (n = 5), contralateral external carotid artery (n = 5), ipsilateral external carotid artery (n = 4), deep cervical artery (n = 2) and ascending cervical artery (n = 1). Embolization were performed in 9 cases with operative cannulation (n = 4), embolization via collateral branches of ipsilateral external carotid artery (n = 1), embolization via collateral branches of contralateral external carotid artery (n = 3) and balloon occlusion via direct puncture (n = 1). The collateral channels in cervicofacial vascular lesions with previously ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete angiographic assessment of possible collateral channels is mandatory for the

USI: a fast and accurate approach for conceptual document annotation.

Science.gov (United States)

Fiorini, Nicolas; Ranwez, Sylvie; Montmain, Jacky; Ranwez, Vincent

2015-03-14

Semantic approaches such as concept-based information retrieval rely on a corpus in which resources are indexed by concepts belonging to a domain ontology. In order to keep such applications up-to-date, new entities need to be frequently annotated to enrich the corpus. However, this task is time-consuming and requires a high-level of expertise in both the domain and the related ontology. Different strategies have thus been proposed to ease this indexing process, each one taking advantage from the features of the document. In this paper we present USI (User-oriented Semantic Indexer), a fast and intuitive method for indexing tasks. We introduce a solution to suggest a conceptual annotation for new entities based on related already indexed documents. Our results, compared to those obtained by previous authors using the MeSH thesaurus and a dataset of biomedical papers, show that the method surpasses text-specific methods in terms of both quality and speed. Evaluations are done via usual metrics and semantic similarity. By only relying on neighbor documents, the User-oriented Semantic Indexer does not need a representative learning set. Yet, it provides better results than the other approaches by giving a consistent annotation scored with a global criterion - instead of one score per concept.

The need for a new approach to reactor safety

International Nuclear Information System (INIS)

Cave, L.; Holmes, R.E.; Holmes, P.J.

1981-01-01

The public's acceptance of nuclear power appears to be decreasing in many countries, partly owing to fears about the safety of reactors. In the paper the usefulness of an approach based on comparative risks is examined in the light of the view, expressed by behavioural scientists, that the public find the concept of risk difficult to understand and are more concerned with the possible consequences and benefits of nuclear power. On the premise that this view is correct, its implications in relation to reactor siting, reactor design, choice of reactor system and the economics of nuclear power are examined. This examination leads to some specific suggestions for future action in relation to the reduction of the possible consequences of nuclear accidents. It leads also to the view that there appears to be a close correlation between the public's perception of the strength of the national economy, the extent of its indigenous fuel resources and the degree of public hostility to nuclear power in any one country, although this concept requires further detailed study. (author)

The relationship between unmet needs and distress amongst young people with cancer.

Science.gov (United States)

Dyson, Gavin J; Thompson, Kate; Palmer, Susan; Thomas, David M; Schofield, Penelope

2012-01-01

Most psychosocial research in cancer has been restricted to paediatric or older adult populations. This study aimed to explore psychological distress and unmet needs in adolescents and young adults (AYA) with cancer and identify predictors of distress among demographic and illness characteristics and supportive care needs. Fifty-three patients between 16 and 30 years completed a cross-sectional survey, administered shortly after presentation to an AYA oncology service and within 4 months of diagnosis. Measures included the Beck Depression Inventory-Fast Screen (BDI-FS), State-Trait Anxiety Inventory-State Form (STAI-S) and the Supportive Care Needs Survey. Level of distress-related sypmtomatology in this population was based on previous work, whereby a cut-off score of 4 or greater was used for the BDI-FS, and one standard deviation above the sample population mean was used for the STAI-S. Prevalence of distress (25%) was lower than that found previously in AYA with cancer. Physical and daily living needs were the most frequently unmet needs overall, followed by psychological needs, health system and information needs and care and support needs. Lastly, being pre-treatment predicted increased depression and state anxiety, while having treatment post-surgery predicted reduced state anxiety. After controlling for treatment status, however, the main predictors of depression and state anxiety were physical and daily living needs and health system and information needs, respectively. Lower levels of distress and unmet psychological needs were related to the few participants (17%) in this study who were pre-treatment, when distress was most likely. However, physical needs and information needs, which are almost inevitable throughout treatment and beyond, were more important predictors of distress. Further exploration must consider the psychosocial difficulties underlying this association and the needs of AYA at transitions between critical periods in their cancer journey

The new ICRP recommendations' project: A broader approach of the optimisation of radiation protection

International Nuclear Information System (INIS)

Lochard, J.

2005-01-01

In the framework of the preparation of its new recommendations ICRP has developed a new text on the optimisation of radiological protection. This text prolongs the previous publications on the principle (Publications 37 and 45) reminding the need to adopt a pragmatic approach combining quantitative techniques when they are relevant as well as know-how and past experience which are often sufficient to ensure good protection. Moreover, it aims at adapting the optimisation process to the recent evolutions of risk management with the increasing role of stakeholder involvement in the decision framing. (author)

Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis.

Science.gov (United States)

Kabiru, Caroline W; Ushie, Boniface A; Mutua, Michael M; Izugbara, Chimaraoke O

2016-05-14

Unsafe abortion is a leading cause of death among young women aged 10-24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12-24 years seeking abortion-related care in Kenya. We used data on 1,378 young women aged 12-24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %). Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post

Understanding the Steiner Waldorf Approach: Early Years Education in Practice. Understanding the... Approach

Science.gov (United States)

Nicol, Janni; Taplin, Jill

2012-01-01

Understanding the Steiner Waldorf Approach is a much needed source of information for those wishing to extend and consolidate their understanding of the Steiner Waldorf High Scope Approach. It will enable the reader to analyse the essential elements of the Steiner Waldorf Approach to early childhood and its relationship to quality early years…

SOFTWARE DEFINED NETWORKS (SDN): APPROACHES NEEDED FOR UP-GRADATION OF SDN'S

OpenAIRE

Deepak Kumar*, Manu Sood

2017-01-01

SDN has changed the way of thinking about networks. SDN networks are flexible, scalable and easily manageable. Application that runs on the management plane actually utilize the network efficiency, So application developed should be capable of handling the controllers functionality. Each of the application that runs should be free from viruses, so that it does not affect the controller. Also we need to increase the level of security in all layers of the SDN architecture. SDN is growing faster...

A Patient-centered Approach to Evaluate the Information Needs of Women With Ductal Carcinoma In Situ.

Science.gov (United States)

Lo, Andrea C; Olson, Robert; Feldman-Stewart, Deb; Truong, Pauline T; Aquino-Parsons, Christina; Bottorff, Joan L; Carolan, Hannah

2017-12-01

To evaluate the information needs of ductal carcinoma in situ (DCIS) patients. Four focus groups involving 24 previously treated DCIS patients were conducted to develop a comprehensive list of questions they felt were important to have answered at the time of diagnosis. Using a survey, a separate group of patients treated for DCIS then rated the importance of having each of these questions addressed before treatment decision making. Response options were "essential," "desired," "not important," "no opinion," and "avoid." For each essential/desired question, respondents specified how addressing it would help them: "understand," "decide," "plan," "not sure," or "other." Focus group participants generated 117 questions used in the survey. Fifty-seven patients completed the survey (55% response rate). Respondents rated a median of 66 questions as essential. The most commonly cited reason for rating a question essential was to "understand," followed by to "decide." The top questions women deemed essential to help them understand were disease specific, whereas the top questions deemed essential to help women decide were predominantly treatment specific, pertaining to available options, recurrence and survival outcomes, and timelines to decide and start treatment. DCIS patients want a large number of questions answered, mostly for understanding, and also for deciding and planning. A core set of questions that most patients consider essential for decision making has been formulated and may be used in the clinical setting and in research to develop educational resources and decision-making tools specific to DCIS.

APPROACHES FOR SUSTAINABLE MANUFACTURING

Institute of Scientific and Technical Information of China (English)

G(U)NTHER Seliger; SEBASTIAN Kernbaum; MARCO Zettl

2007-01-01

Sustainable development is a holistic approach harmonizing ecological, economical and socio-political needs with respect to the superior objective of enhancing human living standards. Thereby the availability of natural resources and the conservation of the ecosystems have to be considered that future generations have the possibility to meet their own needs. A long-term economical development demands the transition from a source-sink economy to a cycle economy as a result of limited resources, limited environmental capacities to absorb waste and emissions as well as increasing needs of a growing population. A reference model for sustainability in manufacturing is presented and used to illustrate sustainable approaches with respect to management, technology, process and product. Adaptation of products and components is a vital element for supporting efficient reuse of products and components. Consequently adaptation contributes to the ambitious goals of sustainability. Technological enablers for adaptation as modularity, information and communication technology are exemplarily introduced. Moreover, approaches for disseminating knowledge in sustainability are given.

Differences between previously married and never married 'gay' men: family background, childhood experiences and current attitudes.

Science.gov (United States)

Higgins, Daryl J

2004-01-01

Despite a large body of literature on the development of sexual orientation, little is known about why some gay men have been (or remain) married to a woman. In the current study, a self-selected sample of 43 never married gay men ('never married') and 26 gay men who were married to a woman ('previously married') completed a self-report questionnaire. Hypotheses were based on five possible explanations for gay men's marriages: (a) differences in sexual orientation (i.e., bisexuality); (b) internalized homophobia; (c) religious intolerance; (d) confusion created because of childhood/adolescent sexual experiences; and/or (e) poor psychological adjustment. Previously married described their families' religious beliefs as more fundamentalist than never married. No differences were found between married' and never married' ratings of their sexual orientation and identity, and levels of homophobia and self-depreciation. Family adaptability and family cohesion and the degree to which respondents reported having experienced child maltreatment did not distinguish between previously married and never married. The results highlight how little is understood of the reasons why gay men marry, and the need to develop an adequate theoretical model.

Influence of Previous Knowledge in Torrance Tests of Creative Thinking

Directory of Open Access Journals (Sweden)

María Aranguren

2015-07-01

Full Text Available The aim of this work is to analyze the influence of study field, expertise and recreational activities participation in Torrance Tests of Creative Thinking (TTCT, 1974 performance. Several hypotheses were postulated to explore the possible effects of previous knowledge in TTCT verbal and TTCT figural university students’ outcomes. Participants in this study included 418 students from five study fields: Psychology;Philosophy and Literature, Music; Engineering; and Journalism and Advertising (Communication Sciences. Results found in this research seem to indicate that there in none influence of the study field, expertise and recreational activities participation in neither of the TTCT tests. Instead, the findings seem to suggest some kind of interaction between certain skills needed to succeed in specific studies fields and performance on creativity tests, such as the TTCT. These results imply that TTCT is a useful and valid instrument to measure creativity and that some cognitive process involved in innovative thinking can be promoted using different intervention programs in schools and universities regardless the students study field.

Optimizing the Office Visit for Adolescents with Special Health Care Needs.

Science.gov (United States)

Nathawad, Rita; Hanks, Christopher

2017-08-01

Youth with special health care needs (YSHCN) experience health care disparities and often need additional support to receive optimal medical care, particularly in adolescence as they prepare to transition to adult care. Many medical practices struggle to address their needs. Here, we discuss approaches to improve medical care in office-based settings for YSHCN. Office visits can be optimized by training staff in developmentally appropriate care and ensuring that the physical office space facilitates care. Participating in previsit preparation, including managing patient registries of YSHCN, engaging in regular team huddles, and incorporating previsit planning, can improve preparation and ensure that important needs are not overlooked. Additionally, approaches to improve patient and medical provider comfort with office visits with YSHCN, including approaches to measuring vital signs, examining patients, and communicating with patients with various disabilities, are reviewed. Finally, we discuss methods of supporting adolescents with special health care needs in developing self-management skills that will allow them to be better prepared to enter adult health care settings when appropriate. Although YSHCN can present challenges to medical teams, their care can be improved by developing office-based changes and processes to support improved care for these patients. This may help overcome the health care disparities they experience and increase comfort for all members of the medical team. Copyright © 2017. Published by Elsevier Inc.

Diagnostic laboratory tests for systemic autoimmune rheumatic diseases: unmet needs towards harmonization.

Science.gov (United States)

Meroni, Pier Luigi; Borghi, Maria Orietta

2018-05-01

Autoantibodies are helpful tools not only for the diagnosis and the classification of systemic autoimmune rheumatic diseases (SARD) but also for sub-grouping patients and/or for monitoring disease activity or specific tissue/organ damage. Consequently, the role of the diagnostic laboratory in the management of SARD is becoming more and more important. The advent of new techniques raised the need of updating and harmonizing our use/interpretation of the assays. We discuss in this opinion paper some of these issues. Indirect immunofluorescence (IIF) was originally suggested as the reference technique for anti-nuclear antibody (ANA) detection as previous solid phase assays (SPA) displayed lower sensitivity. The new available SPA are now offering better results and can represent alternative or even complementary diagnostic tools for ANA detection. The improved sensitivity of SPA technology is also changing our interpretation of the results for other types of autoantibody assays, but we need updating their calibration and new reference materials are going to be obtained in order to harmonize the assays. There is growing evidence that the identification of autoantibody combinations or profiles is helpful in improving diagnosis, patients' subgrouping and predictivity for disease evolution in the field of SARD. We report some explanatory examples to support the idea to make the use of these autoantibody profiles more and more popular. The technological evolution of the autoimmune assays is going to change our routine diagnostic laboratory tests for SARD and validation of new algorithms is needed in order to harmonize our approach to the issue.

Image subsampling and point scoring approaches for large-scale marine benthic monitoring programs

Science.gov (United States)

Perkins, Nicholas R.; Foster, Scott D.; Hill, Nicole A.; Barrett, Neville S.

2016-07-01

Benthic imagery is an effective tool for quantitative description of ecologically and economically important benthic habitats and biota. The recent development of autonomous underwater vehicles (AUVs) allows surveying of spatial scales that were previously unfeasible. However, an AUV collects a large number of images, the scoring of which is time and labour intensive. There is a need to optimise the way that subsamples of imagery are chosen and scored to gain meaningful inferences for ecological monitoring studies. We examine the trade-off between the number of images selected within transects and the number of random points scored within images on the percent cover of target biota, the typical output of such monitoring programs. We also investigate the efficacy of various image selection approaches, such as systematic or random, on the bias and precision of cover estimates. We use simulated biotas that have varying size, abundance and distributional patterns. We find that a relatively small sampling effort is required to minimise bias. An increased precision for groups that are likely to be the focus of monitoring programs is best gained through increasing the number of images sampled rather than the number of points scored within images. For rare species, sampling using point count approaches is unlikely to provide sufficient precision, and alternative sampling approaches may need to be employed. The approach by which images are selected (simple random sampling, regularly spaced etc.) had no discernible effect on mean and variance estimates, regardless of the distributional pattern of biota. Field validation of our findings is provided through Monte Carlo resampling analysis of a previously scored benthic survey from temperate waters. We show that point count sampling approaches are capable of providing relatively precise cover estimates for candidate groups that are not overly rare. The amount of sampling required, in terms of both the number of images and

Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology.

Science.gov (United States)

Lazure, Patrice; Bartel, Robert C; Biller, Beverly M K; Molitch, Mark E; Rosenthal, Stephen M; Ross, Judith L; Bernsten, Brock D; Hayes, Sean M

2014-07-24

The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF. This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques. The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain. The TDF categorization of

Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology

Science.gov (United States)

2014-01-01

Background The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF. Methods This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques. Results The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain

A CRITICAL NEEDS PLAN FOR GENERAL MOTORS: A CULTURAL PLURALISM APPROACH

OpenAIRE

Gregory W. Goussak; Jon K. Webber; Elliot M. Ser

2012-01-01

The purpose of this paper is to create a critical needs plan for General Motors Corporation in the 21st century. General Motors (GM), once the most dominant manufacturer in the automotive industry, finds itself in financial crisis with a Chapter 11 bankruptcy and a necessary government infusion of capital. The foundation of this paper applies the Supportive Model as an effective strategy for creating a new corporate culture and focusing GM as a competitive manufacturer in the global automotiv...

Towards an Agile Approach to Adapting Dynamic Collaboration Support to Student Needs

Science.gov (United States)

Adamson, David; Dyke, Gregory; Jang, Hyeju; Rosé, Carolyn Penstein

2014-01-01

This paper investigates the use of conversational agents to scaffold on-line collaborative learning discussions through an approach called Academically Productive Talk (APT). In contrast to past work on dynamic support for collaborative learning, where agents were used to elevate conceptual depth by leading students through directed lines of…

The vulnerable elderly's need for recognizing relationships

DEFF Research Database (Denmark)

Liveng, Anne

2011-01-01

this approach, staff have to possess certain competencies, and there needs to be some organisational backup for developing this type of relationship. Home-based care in Denmark is founded on new public management (NPM) theory, although rules and regulations implied in NPM do not always provide home helpers...

Task structure, need for structure, and creativity

NARCIS (Netherlands)

Rietzschel, Eric; Slijkhuis, Marjette; Van Yperen, Nico W.

2014-01-01

Although creativity is often seen as requiring spontaneity and flexibility, recent work suggests that there is creative potential in a structured and systematic approach as well. In a series of four experiments, we show that when Personal Need for Structure (PNS) is high, either chronic (Study 1) or

Needs assessment in health research projects: a new approach to project management in iran.

Science.gov (United States)

Peykari, Niloofar; Owlia, Parviz; Malekafzali, Hossein; Ghanei, Mostafa; Babamahmoodi, Abdolreza; Djalalinia, Shirin

2013-01-01

The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran. THE PROJECT MANAGEMENT LIFE CYCLE HAS FOUR PHASES: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study. Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation. We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.

Secondary recurrent miscarriage is associated with previous male birth.

LENUS (Irish Health Repository)

Ooi, Poh Veh

2012-01-31

Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

Secondary recurrent miscarriage is associated with previous male birth.

LENUS (Irish Health Repository)

Ooi, Poh Veh

2011-01-01

Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

The need for strategic development of safety sciences.

Science.gov (United States)

Busquet, Francois; Hartung, Thomas

2017-01-01

The practice of risk assessment and regulation of substances has largely developed as a patchwork of circumstantial additions to a nowadays more or less shared international toolbox. The dominant drivers from the US and Europe have pursued remarkably different approaches in the use of these tools for regulation, i.e., a more risk-based approach in the US and a more precautionary approach in Europe. We argue that there is need for scientific developments not only for the tools but also for their application, i.e., a need for Regulatory Science or, perhaps better, Safety Science. While some of this is emerging on the US side as strategic reports, e.g., from the National Academies, the NIH and the regulatory agencies, especially the EPA and the FDA, such strategic developments beyond technological developments are largely lacking in Europe or have started only recently at EFSA, ECHA or within the flagship project EU-ToxRisk. This article provides a rationale for the creation of a European Safety Sciences Institute (ESSI) based on regulatory and scientific needs, political context and current EU missions. Moreover, the possible modus operandi of ESSI will be described along with possible working formats as well as anticipated main tasks and duties. This mirrors the triple alliance on the American side (US EPA, NIH and FDA) in revamping regulatory sciences. Moreover, this could fit the political agenda of the European Commission for better implementation of existing EU legislation rather than creating new laws.

A basic need theory approach to problematic Internet use and the mediating effect of psychological distress.

Science.gov (United States)

Wong, Ting Yat; Yuen, Kenneth S L; Li, Wang On

2014-01-01

The Internet provides an easily accessible way to meet certain needs. Over-reliance on it leads to problematic use, which studies show can be predicted by psychological distress. Self-determination theory proposes that we all have the basic need for autonomy, competency, and relatedness. This has been shown to explain the motivations behind problematic Internet use. This study hypothesizes that individuals who are psychologically disturbed because their basic needs are not being met are more vulnerable to becoming reliant on the Internet when they seek such needs satisfaction from online activities, and tests a model in which basic needs predict problematic Internet use, fully mediated by psychological distress. Problematic Internet use, psychological distress, and basic needs satisfaction were psychometrically measured in a sample of 229 Hong Kong University students and structural equation modeling was used to test the hypothesized model. All indices showed the model has a good fit. Further, statistical testing supported a mediation effect for psychological distress between needs satisfaction and problematic Internet use. The results extend our understanding of the development and prevention of problematic Internet use based on the framework of self-determination theory. Psychological distress could be used as an early predictor, while preventing and treating problematic Internet use should emphasize the fulfillment of unmet needs.

Employees older than 50 on Croatian labour market – need for a new approach

Directory of Open Access Journals (Sweden)

Srecko Goic

2017-10-01

Full Text Available Croatia has reached demographic maturity, with ever lower cohorts of youngers (and younger labour force numbers, longer life expectations, and rapidly growing share of older population. In such situation, working population older than 50 becomes more and more significant, not only by number, but also as an important pool of knowledge and experiences. 28,36% of total employed in Croatia in 2014 were 50+ years old. That same year (2014 27,7% of total unemployed in Croatia were 50+ years old. The share of persons 50+ in total number of unemployed grew to 29,6% in 2015, and 31,7% in 2016. Long duration of unemployment is especially accentuated among persons older than 50: in 2016 older persons made 41,91% among those with unemployment duration between 2 and 3 years, 44,00% among those with unemployment duration between 4 and 5 years, 53,23% among those with unemployment duration between 6 and 8 years, and even 70,04% among those with unemployment duration over 8 years. Although Croatian governments for almost quarter of century were devising different “active labour market policies” directed to older persons, their results are questionable. With growing problems to acquire and retain necessary workforce in Croatian enterprises, there is obviously strong need to develop new approach (es towards people older than 50. This paper is trying to shed new light on this problem and offer new ideas in the field of labour market policies, and human resources management oriented towards older employees in Croatia. The Croatian example (changes, problems, and experiences may be of interest to other, particularly European, countries in a similar situation.

“Health in the Mirror”: An Unconventional Approach to Unmet Psychological Needs in Oncology

Directory of Open Access Journals (Sweden)

Valentina E. Di Mattei

2017-09-01

Full Text Available Background: The introduction of aesthetic care programs for cancer patients inside hospitals could help patients cope with the side effects of both disease and treatment. The specific objective of this study is to evaluate whether a complementary and supportive program, called “Health in the Mirror,” has a positive effect on participants by analyzing certain psychological variables.Methods: Eighty-eight female cancer patients were included in this analysis. The support program is composed of three group aesthetic interventions that address both physical and psychological aspects that accompany cancer and its treatment. Patients were asked to complete a battery of tests in order to measure the impact of the program on certain psychological variables including anxiety, depression, body image, self-esteem, and quality of life. Outcome variables were measured at three different time-points: prior to participation, on the last day of the program, and after a 3-month follow-up.Results: Participating in the psychosocial support program “Health in the Mirror” determines an improvement in the psychological variables measured. Results revealed a significant reduction in depressive symptoms, anxiety and body image issues, as well as an improvement in self-esteem levels; this suggests that participating in this program could facilitate better adjustment to disease and treatment.Discussion: This study legitimizes the importance of implementing supportive and complementary therapies together with conventional therapies; the therapeutic approach to cancer cannot be restricted solely to medical care, but it must consider the patient as a whole person with needs that are not only physical or medical, but also psychological, social, and existential.

Seniors’ unmet mobility needs – how important is a driving licence?

DEFF Research Database (Denmark)

Haustein, Sonja; Siren, Anu Kristiina

2014-01-01

Previous studies have come to different conclusions regarding how important a driving licence is for seniors to fulfil their mobility needs. We investigated this question based on three groups of Danish seniors: persons who were licensed as drivers (‘‘drivers’’); persons who have never been...... it became insignificant for unmet shopping needs. The effect of never having had a licence was hardly affected by the inclusion of control variables. The results emphasise the importance of a driving licence in fulfilling seniors’ mobility needs. Contrary to our hypotheses, more experience with, and better...

Complex Solutions for Complex Needs: Towards Holistic and Collaborative Practice

Science.gov (United States)

Beadle, Sally

2009-01-01

While the need for holistic health and social service responses is increasingly being articulated in Australia, the discussion is not always matched by improvements in service delivery. This project looked at one service setting where youth workers were encouraged to take a holistic approach to their clients' often-complex needs. Interviews with…

Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach

Energy Technology Data Exchange (ETDEWEB)

Mackillop, William J., E-mail: william.mackillop@krcc.on.ca [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Kong, Weidong [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada)

2016-01-01

Purpose: Palliative radiation therapy (PRT) benefits many patients with incurable cancer, but the overall need for PRT is unknown. Our primary objective was to estimate the appropriate rate of use of PRT in Ontario. Methods and Materials: The Ontario Cancer Registry identified patients who died of cancer in Ontario between 2006 and 2010. Comprehensive RT records were linked to the registry. Multivariate analysis identified social and health system-related factors affecting the use of PRT, enabling us to define a benchmark population of patients with unimpeded access to PRT. The proportion of cases treated at any time (PRT{sub lifetime}), the proportion of cases treated in the last 2 years of life (PRT{sub 2y}), and number of courses of PRT per thousand cancer deaths were measured in the benchmark population. These benchmarks were standardized to the characteristics of the overall population, and province-wide PRT rates were then compared to benchmarks. Results: Cases diagnosed at hospitals with no RT on-site and residents of poorer communities and those who lived farther from an RT center, were significantly less likely than others to receive PRT. However, availability of RT at the diagnosing hospital was the dominant factor. Neither socioeconomic status nor distance from home to nearest RT center had a significant effect on the use of PRT in patients diagnosed at a hospital with RT facilities. The benchmark population therefore consisted of patients diagnosed at a hospital with RT facilities. The standardized benchmark for PRT{sub lifetime} was 33.9%, and the corresponding province-wide rate was 28.5%. The standardized benchmark for PRT{sub 2y} was 32.4%, and the corresponding province-wide rate was 27.0%. The standardized benchmark for the number of courses of PRT per thousand cancer deaths was 652, and the corresponding province-wide rate was 542. Conclusions: Approximately one-third of patients who die of cancer in Ontario need PRT, but many of them are never

Training of Residential Social Care Staff to Meet the Needs of Older People with Intellectual Disabilities who Develop Age-Related Health Problems: An Exploratory Study.

Science.gov (United States)

Northway, Ruth; Jenkins, Robert; Holland-Hart, Daniella

2017-09-01

Despite awareness of the age related health needs of people with intellectual disabilities little is known regarding how residential social care staff are prepared to meet such needs. Data were gathered via semi-structured interviews from 14 managers of supported living settings. Transcripts were thematically analysed. Staff may work in supported living settings with no prior experience of care work, and previous knowledge/experience of supporting people in relation to their health is not required. Whilst health related training is provided there is a lack of specific training regarding healthy ageing, and training seems to be reactive to changing needs of tenants meaning that proactive monitoring for changes in health status may not occur. Whilst some training is provided for residential social care staff in relation to health and ageing a more proactive approach is required which should include a focus on healthy ageing. © 2016 John Wiley & Sons Ltd.

Reoperative sentinel lymph node biopsy after previous mastectomy.

Science.gov (United States)

Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

2008-10-01

Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

Economic impact of feeding a phenylalanine-restricted diet to adults with previously untreated phenylketonuria.

Science.gov (United States)

Brown, M C; Guest, J F

1999-02-01

The aim of the present study was to estimate the direct healthcare cost of managing adults with previously untreated phenylketonuria (PKU) for one year before any dietary restrictions and for the first year after a phenylalanine- (PHE-) restricted diet was introduced. The resource use and corresponding costs were estimated from medical records and interviews with health care professionals experienced in caring for adults with previously untreated PKU. The mean annual cost of caring for a client being fed an unrestricted diet was estimated to be 83 996 pound silver. In the first year after introducing a PHE-restricted diet, the mean annual cost was reduced by 20 647 pound silver to 63 348 pound silver as a result of a reduction in nursing time, hospitalizations, outpatient clinic visits and medications. However, the economic benefit of the diet depended on whether the clients were previously high or low users of nursing care. Nursing time was the key cost-driver, accounting for 79% of the cost of managing high users and 31% of the management cost for low users. In contrast, the acquisition cost of a PHE-restricted diet accounted for up to 6% of the cost for managing high users and 15% of the management cost for low users. Sensitivity analyses showed that introducing a PHE-restricted diet reduces the annual cost of care, provided that annual nursing time was reduced by more than 8% or more than 5% of clients respond to the diet. The clients showed fewer negative behaviours when being fed a PHE-restricted diet, which may account for the observed reduction in nursing time needed to care for these clients. In conclusion, feeding a PHE-restricted diet to adults with previously untreated PKU leads to economic benefits to the UK's National Health Service and society in general.

Social Justice, Children's Needs and Rights: An Approach to Planning

Science.gov (United States)

Sims, Margaret

2015-01-01

Commonly, planning for children involves comparing what they know against a curriculum or learning framework which identifies what they should know. Early childhood educators are then expected to create learning opportunities to help fill the gap between these two extremes. In this paper I argue that such an approach does not honour the…

Typing DNA profiles from previously enhanced fingerprints using direct PCR.

Science.gov (United States)

Templeton, Jennifer E L; Taylor, Duncan; Handt, Oliva; Linacre, Adrian

2017-07-01

Fingermarks are a source of human identification both through the ridge patterns and DNA profiling. Typing nuclear STR DNA markers from previously enhanced fingermarks provides an alternative method of utilising the limited fingermark deposit that can be left behind during a criminal act. Dusting with fingerprint powders is a standard method used in classical fingermark enhancement and can affect DNA data. The ability to generate informative DNA profiles from powdered fingerprints using direct PCR swabs was investigated. Direct PCR was used as the opportunity to generate usable DNA profiles after performing any of the standard DNA extraction processes is minimal. Omitting the extraction step will, for many samples, be the key to success if there is limited sample DNA. DNA profiles were generated by direct PCR from 160 fingermarks after treatment with one of the following dactyloscopic fingerprint powders: white hadonite; silver aluminium; HiFi Volcano silk black; or black magnetic fingerprint powder. This was achieved by a combination of an optimised double-swabbing technique and swab media, omission of the extraction step to minimise loss of critical low-template DNA, and additional AmpliTaq Gold ® DNA polymerase to boost the PCR. Ninety eight out of 160 samples (61%) were considered 'up-loadable' to the Australian National Criminal Investigation DNA Database (NCIDD). The method described required a minimum of working steps, equipment and reagents, and was completed within 4h. Direct PCR allows the generation of DNA profiles from enhanced prints without the need to increase PCR cycle numbers beyond manufacturer's recommendations. Particular emphasis was placed on preventing contamination by applying strict protocols and avoiding the use of previously used fingerprint brushes. Based on this extensive survey, the data provided indicate minimal effects of any of these four powders on the chance of obtaining DNA profiles from enhanced fingermarks. Copyright © 2017

77 FR 70176 - Previous Participation Certification

Science.gov (United States)

2012-11-23

... participants' previous participation in government programs and ensure that the past record is acceptable prior... information is designed to be 100 percent automated and digital submission of all data and certifications is... government programs and ensure that the past record is acceptable prior to granting approval to participate...

Stochastic hydrogeology: what professionals really need?

Science.gov (United States)

Renard, Philippe

2007-01-01

Quantitative hydrogeology celebrated its 150th anniversary in 2006. Geostatistics is younger but has had a very large impact in hydrogeology. Today, geostatistics is used routinely to interpolate deterministically most of the parameters that are required to analyze a problem or make a quantitative analysis. In a small number of cases, geostatistics is combined with deterministic approaches to forecast uncertainty. At a more academic level, geostatistics is used extensively to study physical processes in heterogeneous aquifers. Yet, there is an important gap between the academic use and the routine applications of geostatistics. The reasons for this gap are diverse. These include aspects related to the hydrogeology consulting market, technical reasons such as the lack of widely available software, but also a number of misconceptions. A change in this situation requires acting at different levels. First, regulators must be convinced of the benefit of using geostatistics. Second, the economic potential of the approach must be emphasized to customers. Third, the relevance of the theories needs to be increased. Last, but not least, software, data sets, and computing infrastructure such as grid computing need to be widely available.

Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously

DEFF Research Database (Denmark)

Simony, Ane; Hansen, Emil Jesper; Christensen, Steen Bach

2016-01-01

, is comparable to modern equipment. This is to our knowledge the first study to report increased rates of endometrial cancers in a cohort of AIS patients, and future attention is needed to reduce the radiation dose distributed to the AIS patients both pre-operatively and during surgery.......PURPOSE: To report the incidence of cancer in a cohort of adolescent idiopathic scoliosis (AIS) patients treated 25 years previously. METHODS: 215 consecutive AIS patients treated between 1983 and 1990 were identified and requested to return for clinical and radiographic examination. The incidence....... RESULTS: From the original cohort of 215 consecutive AIS patients, radiation information was available in 211 of the patients, and medical charts were available in 209 AIS patients. 170 (83 %) of the 205 AIS patients participated in the follow-up study with questionnaires. The calculated mean total...

[The future of clinical research: why do we need an ecological approach?].

Science.gov (United States)

Liberati, Alessandro; Moja, Lorenzo P; Moschetti, Ivan

2006-11-01

In this paper we try to define the future goals of the clinical research, with particular reference to methodological and policy issues. There is an increasing tension between the real drivers of clinical research and its scientific and ethical aims. To consumers the goal is to strengthen the relevance and usefulness of clinical research. This is possible only if consumers are empowered and actively involved. For the health care systems it is mandatory to re-engineer the process, enforcing national and international legislation. This should help to fill the research-clinical practice gap and to balance the research agenda, better reflecting health priorities. Finally the scientific community should reflect on its own conflicts of interests and analyse the causes of the ethical divide between the needs and the market. Scientists too often seem to loose sight of the original cumulative nature of research and of the idea of research as a collective good. More non-commercial research is needed, integrated with the health care systems, to support a transparent, more realistic and valid information useful for patient care, scientific information.

Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

Science.gov (United States)

Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

2015-01-01

Purpose The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Patients and methods Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Results Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80) mm, corneal diameter was 14.71±1.07 (13.0–16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0), and IOP was 39.5±5.7 (30–55) mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (Pglaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications. PMID:26082610

Impact of vocational interests, previous academic experience, gender and age on Situational Judgement Test performance.

Science.gov (United States)

Schripsema, Nienke R; van Trigt, Anke M; Borleffs, Jan C C; Cohen-Schotanus, Janke

2017-05-01

Situational Judgement Tests (SJTs) are increasingly implemented in medical school admissions. In this paper, we investigate the effects of vocational interests, previous academic experience, gender and age on SJT performance. The SJT was part of the selection process for the Bachelor's degree programme in Medicine at University of Groningen, the Netherlands. All applicants for the academic year 2015-2016 were included and had to choose between learning communities Global Health (n = 126), Sustainable Care (n = 149), Intramural Care (n = 225), or Molecular Medicine (n = 116). This choice was used as a proxy for vocational interest. In addition, all graduate-entry applicants for academic year 2015-2016 (n = 213) were included to examine the effect of previous academic experience on performance. We used MANCOVA analyses with Bonferroni post hoc multiple comparisons tests for applicant performance on a six-scenario SJT. The MANCOVA analyses showed that for all scenarios, the independent variables were significantly related to performance (Pillai's Trace: 0.02-0.47, p performance on three scenarios (p performance on two scenarios (p performance, as was previous academic experience. Gender and age were related to performance on SJT scenarios in different settings. Especially the first effect might be helpful in selecting appropriate candidates for areas of health care in which more professionals are needed.

Novel approaches are needed to develop tomorrow's antibacterial therapies.

Science.gov (United States)

Spellberg, Brad; Bartlett, John; Wunderink, Rich; Gilbert, David N

2015-01-15

Society faces a crisis of rising antibiotic resistance even as the pipeline of new antibiotics has been drying up. Antibiotics are a public trust; every individual's use of antibiotics affects their efficacy for everyone else. As such, responses to the antibiotic crisis must take a societal perspective. The market failure of antibiotics is due to a combination of scientific challenges to discovering and developing new antibiotics, unfavorable economics, and a hostile regulatory environment. Scientific solutions include changing the way we screen for new antibiotics. More transformationally, developing new treatments that seek to disarm pathogens without killing them, or that modulate the host inflammatory response to infection, will reduce selective pressure and hence minimize resistance emergence. Economic transformation will require new business models to support antibiotic development. Finally, regulatory reform is needed so that clinical development programs are feasible, rigorous, and clinically relevant. Pulmonary and critical care specialists can have tremendous impact on the continued availability of effective antibiotics. Encouraging use of molecular diagnostic tests to allow pathogen-targeted, narrow-spectrum antibiotic therapy, using short rather than unnecessarily long course therapy, reducing inappropriate antibiotic use for probable viral infections, and reducing infection rates will help preserve the antibiotics we have for future generations.

Sociotechnical approaches to workplace safety: Research needs and opportunities

Science.gov (United States)

Robertson, Michelle M.; Hettinger, Lawrence J.; Waterson, Patrick E.; Ian Noy, Y.; Dainoff, Marvin J.; Leveson, Nancy G.; Carayon, Pascale; Courtney, Theodore K.

2015-01-01

The sociotechnical systems perspective offers intriguing and potentially valuable insights into problems associated with workplace safety. While formal sociotechnical systems thinking originated in the 1950s, its application to the analysis and design of sustainable, safe working environments has not been fully developed. To that end, a Hopkinton Conference was organised to review and summarise the state of knowledge in the area and to identify research priorities. A group of 26 international experts produced collaborative articles for this special issue of Ergonomics, and each focused on examining a key conceptual, methodological and/or theoretical issue associated with sociotechnical systems and safety. In this concluding paper, we describe the major conference themes and recommendations. These are organised into six topic areas: (1) Concepts, definitions and frameworks, (2) defining research methodologies, (3) modelling and simulation, (4) communications and decision-making, (5) sociotechnical attributes of safe and unsafe systems and (6) potential future research directions for sociotechnical systems research. Practitioner Summary: Sociotechnical complexity, a characteristic of many contemporary work environments, presents potential safety risks that traditional approaches to workplace safety may not adequately address. In this paper, we summarise the investigations of a group of international researchers into questions associated with the application of sociotechnical systems thinking to improve worker safety. PMID:25728246

Effectively Serving the Needs of Today's Business Student: The Product Life Cycle Approach to Class Organization

Science.gov (United States)

Eastman, Jacqueline K.; Aviles, Maria; Hanna, Mark

2012-01-01

We illustrate a class organization process utilizing the concept of the Product Life Cycle to meet the needs of today's millennial student. In the Introduction stage of a business course, professors need to build structure to encourage commitment. In the Growth stage, professors need to promote the structure through multiple, brief activities that…

[Prevalence of previously diagnosed diabetes mellitus in Mexico.

Science.gov (United States)

Rojas-Martínez, Rosalba; Basto-Abreu, Ana; Aguilar-Salinas, Carlos A; Zárate-Rojas, Emiliano; Villalpando, Salvador; Barrientos-Gutiérrez, Tonatiuh

2018-01-01

To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.

Assessing palliative care needs: views of patients, informal carers and healthcare professionals.

Science.gov (United States)

McIlfatrick, Sonja

2007-01-01

This paper reports a study to assess the palliative care needs of the adult population served by a healthcare provider organization in Northern Ireland from the perspectives of patients, informal carers and healthcare providers. Assessing palliative care need is a key factor for health service planning. Traditionally, palliative care has been associated with end-of-life care and cancer. More recently, the concept has been extended to include care for both cancer and non-cancer populations. Various approaches have been advocated for assessing need, including the exploration of professional provider and user perspectives of need. Semi-structured qualitative interviews were undertaken with a purposive sample of patients and lay carers receiving palliative care services (n = 24). Focus groups were also conducted with multi-professional palliative care providers (n = 52 participants) and face to face interviews were undertaken with key managerial stakeholders in the area (n = 7). The focus groups and interviews concentrated on assessment of palliative care need. All the interviews were transcribed verbatim and analysed using Burnard's framework. Professional providers experienced difficulty in defining the term palliative care. Difficulties in communication and information exchange, and fragmented co-ordination between services were identified. The main areas of need identified by all participants were social and psychological support; financial concerns; and the need for choice and information. All participants considered that there was inequity between palliative care service provision for patients with cancer and non-cancer diseases. All patients, regardless of diagnosis, should be able to access palliative care appropriate to their individual needs. For this to happen in practice, an integrated approach to palliative care is essential. The study methodology confirms the value of developing a comprehensive approach to assessing palliative care need.

Need for and use of family leave among parents of children with special health care needs.

Science.gov (United States)

Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Carey, Colleen; Eriksson, Carl; Schuster, Mark A

2007-05-01

Parents of children with special health care needs are especially vulnerable to work-family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time-employed parents of children with special health care needs. We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the sample's 574 full-time-employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them. Forty-eight percent of full-time-employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them. Full-time-employed parents of children with special health care needs experience severe work-family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and

Using an Ecosystem Approach to complement protection schemes based on organism-level endpoints

International Nuclear Information System (INIS)

Bradshaw, Clare; Kapustka, Lawrence; Barnthouse, Lawrence; Brown, Justin; Ciffroy, Philippe; Forbes, Valery; Geras'kin, Stanislav; Kautsky, Ulrik; Bréchignac, François

2014-01-01

Radiation protection goals for ecological resources are focussed on ecological structures and functions at population-, community-, and ecosystem-levels. The current approach to radiation safety for non-human biota relies on organism-level endpoints, and as such is not aligned with the stated overarching protection goals of international agencies. Exposure to stressors can trigger non-linear changes in ecosystem structure and function that cannot be predicted from effects on individual organisms. From the ecological sciences, we know that important interactive dynamics related to such emergent properties determine the flows of goods and services in ecological systems that human societies rely upon. A previous Task Group of the IUR (International Union of Radioecology) has presented the rationale for adding an Ecosystem Approach to the suite of tools available to manage radiation safety. In this paper, we summarize the arguments for an Ecosystem Approach and identify next steps and challenges ahead pertaining to developing and implementing a practical Ecosystem Approach to complement organism-level endpoints currently used in radiation safety. - Highlights: • An Ecosystem Approach to radiation safety complements the organism-level approach. • Emergent properties in ecosystems are not captured by organism-level endpoints. • The proposed Ecosystem Approach better aligns with management goals. • Practical guidance with respect to system-level endpoints is needed. • Guidance on computational model selection would benefit an Ecosystem Approach

Strengthening the Focus on Business Results: The Need for Systems Approaches in Organizational Behavior Management

Science.gov (United States)

Hyten, Cloyd

2009-01-01

Current Organizational Behavior Management (OBM) research and practice may be characterized as either behavior focused or results focused. These two approaches stem from different origins and have different characteristics. The behavior-focused approach stems from applied behavior analysis (ABA) methods and emphasizes direct observation of and…

Roaming Reference: Reinvigorating Reference through Point of Need Service

Directory of Open Access Journals (Sweden)

Kealin M. McCabe

2011-11-01

Full Text Available Roaming reference service was pursued as a way to address declining reference statistics. The service was staffed by librarians armed with iPads over a period of six months during the 2010-2011 academic year. Transactional statistics were collected in relation to query type (Research, Facilitative or Technology, location and approach (librarian to patron, patron to librarian or via chat widget. Overall, roaming reference resulted in an additional 228 reference questions, 67% (n=153 of which were research related. Two iterations of the service were implemented, roaming reference as a standalone service (Fall 2010 and roaming reference integrated with traditional reference desk duties (Winter 2011. The results demonstrate that although the Weller Library’s reference transactions are declining annually, they are not disappearing. For a roaming reference service to succeed, it must be a standalone service provided in addition to traditional reference services. The integration of the two reference models (roaming reference and reference desk resulted in a 56% decline in the total number of roaming reference questions from the previous term. The simple act of roaming has the potential to reinvigorate reference services as a whole, forcing librarians outside their comfort zones, allowing them to reach patrons at their point of need.

The need for multisectoral food chain approaches to reduce trans fat consumption in India.

Science.gov (United States)

Downs, Shauna M; Singh, Archna; Gupta, Vidhu; Lock, Karen; Ghosh-Jerath, Suparna

2015-07-22

The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production.

Clinical roundtable monograph: unmet needs in the treatment of chronic lymphocytic leukemia: integrating a targeted approach.

Science.gov (United States)

O'Brien, Susan M; Furman, Richard R; Byrd, John C; Smith, Ashbel

2014-01-01

Chronic lymphocytic leukemia (CLL) is the most frequently diagnosed hematologic malignancy in the United States. Although several features can be useful in the diagnosis of CLL, the most important is the immunophenotype.Two staging systems--the Binet system and the Rai classification--are used to assess risk. After diagnosis, the first major therapeutic decision is when to initiate therapy, as a watchful waiting approach is often appropriate for patients with asymptomatic disease. Once a patient has met the criteria for treatment, the choice of therapy is the next major decision. Younger patients (<65 years) often receive more aggressive treatment that typically consists of cytotoxic chemotherapy. There is a great unmet need concerning treatment of older patients with CLL, who often present with more comorbid conditions that can decrease their ability to tolerate particular regimens. The current standard of care for older patients with CLL is rituximab plus chlorambucil. The concept of targeted agents is currently an area of intense interest in CLL. The Bruton’s tyrosine kinase inhibitor ibrutinib is the targeted agent that is furthest along in clinical development. It is associated with an overall survival rate of 83%. Idelalisib targets the phosphatidyl inositol 3-kinase and is under evaluation in pivotal trials. Targeted agents offer much promise in terms of efficacy, toxicity, and oral availability. They will change the management of patients with CLL.

Targeting the unmet medical need: the Abbott Laboratories oncology approach.

Science.gov (United States)

Carlson, Dawn M; Steinberg, Joyce L; Gordon, Gary

2005-09-01

While significant advances in the treatment of cancer occured during the last half of the twentieth century, parallel decreases in overall cancer death rates were not observed. Cancer therapy remains an area of significant unmet medical need. Abbott's oncology research programs are focused on pioneering trageted, less toxic therapies, aimed at different aspects of tumor growth and development. Oncology drugs in development at Abbott target several mechanisms of cancer progression by interfering with multiple processes necessary for tumor growth: recruitment of a blood supply, cell proliferation, and the development of metastases. They include a selective endothelin A-receptor antagonist (atrasentan/Xinlay), 3 angiogenesis inhibitors (ABT 510, a thrombospondin mimetic: ABT-869, a multitargeted receptor tyrosine kinase inhibitor; and ABT 828, recombinant human plasminogen kringle 5), a cell proliferation inhibitor (ABT-751, an antimitotic agent), an apoptosis inducer (ABT 737, a Bcl-2 family inhibitor), and a poly(ADP-ribose)polymerase inhibitor.

Basic Employability Skills: A Triangular Design Approach

Science.gov (United States)

Rosenberg, Stuart; Heimler, Ronald; Morote, Elsa-Sofia

2012-01-01

Purpose: This paper seeks to examine the basic employability skills needed for job performance, the reception of these skills in college, and the need for additional training in these skills after graduation. Design/methodology/approach: The research was based on a triangular design approach, in which the attitudes of three distinct groups--recent…

Lack of Cetuximab induced skin toxicity in a previously irradiated field: case report and review of the literature

Science.gov (United States)

2010-01-01

Introduction Mutation, amplification or dysregulation of the EGFR family leads to uncontrolled division and predisposes to cancer. Inhibiting the EGFR represents a form of targeted cancer therapy. Case report We report the case of 79 year old gentlemen with a history of skin cancer involving the left ear who had radiation and surgical excision. He had presented with recurrent lymph node in the left upper neck. We treated him with radiation therapy concurrently with Cetuximab. He developed a skin rash over the face and neck area two weeks after starting Cetuximab, which however spared the previously irradiated area. Conclusion The etiology underlying the sparing of the previously irradiated skin maybe due to either decrease in the population of EGFR expressing cells or decrease in the EGFR expression. We raised the question that "Is it justifiable to use EGFR inhibitors for patients having recurrence in the previously irradiated field?" We may need further research to answer this question which may guide the physicians in choosing appropriate drug in this scenario. PMID:20478052

Balancing the needs and preferences of humans against concerns for fishes

DEFF Research Database (Denmark)

Sandøe, Peter; Gamborg, Christian; Kadri, S.

2009-01-01

How can stakeholders within the fisheries community engage in constructive ethical discussions? Drawing on experiences from previous debates surrounding the human use of animals, this paper presents a proactive approach whereby stakeholders can create a framework for ethical discussion of capture...

The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: a cross sectional analysis.

Science.gov (United States)

Snowden, Austyn; Stenhouse, Rosie; Young, Jenny; Carver, Hannah; Carver, Fiona; Brown, Norrie

2015-01-01

Emotional Intelligence (EI), previous caring experience and mindfulness training may have a positive impact on nurse education. More evidence is needed to support the use of these variables in nurse recruitment and retention. To explore the relationship between EI, gender, age, programme of study, previous caring experience and mindfulness training. Cross sectional element of longitudinal study. 938year one nursing, midwifery and computing students at two Scottish Higher Education Institutes (HEIs) who entered their programme in September 2013. Participants completed a measure of 'trait' EI: Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF); and 'ability' EI: Schutte's et al. (1998) Emotional Intelligence Scale (SEIS). Demographics, previous caring experience and previous training in mindfulness were recorded. Relationships between variables were tested using non-parametric tests. Emotional intelligence increased with age on both measures of EI [TEIQ-SF H(5)=15.157 p=0.001; SEIS H(5)=11.388, p=0.044]. Females (n=786) scored higher than males (n=149) on both measures [TEIQ-SF, U=44,931, z=-4.509, pemotional intelligence. Mindfulness training was associated with higher 'ability' emotional intelligence. Implications for recruitment, retention and further research are explored. Copyright © 2014. Published by Elsevier Ltd.

Multi-UAV Flight using Virtual Structure Combined with Behavioral Approach

Directory of Open Access Journals (Sweden)

Kownacki Cezary

2016-06-01

Full Text Available Implementations of multi-UAV systems can be divided mainly into two different approaches, centralised system that synchronises positions of each vehicle by a ground station and an autonomous system based on decentralised control, which offers more flexibility and independence. Decentralisation of multi-UAV control entails the need for information sharing between all vehicles, what in some cases could be problematic due to a significant amount of data to be sent over the wireless network. To improve the reliability and the throughput of information sharing inside the formation of UAVs, this paper proposes an approach that combines virtual structure with a leader and two flocking behaviours. Each UAV has assigned different virtual migration point referenced to the leader's position which is simultaneously the origin of a formation reference frame. All migration points create together a virtual rigid structure. Each vehicle uses local behaviours of cohesion and repulsion respectively, to track its own assigned point in the structure and to avoid a collision with the previous UAV in the structure. To calculate parameters of local behaviours, each UAV should know position and attitude of the leader to define the formation reference frame and also the actual position of the previous UAV in the structure. Hence, information sharing can be based on a chain of local peer-to-peer communication between two consecutive vehicles in the structure. In such solution, the information about the leader could be sequentially transmitted from one UAV to another. Numerical simulations were prepared and carried out to verify the effectiveness of the presented approach. Trajectories recorded during those simulations show collective, coherence and collision-free flights of the formation created with five UAVs.

75 FR 76056 - FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT:

Science.gov (United States)

2010-12-07

... SECURITIES AND EXCHANGE COMMISSION Sunshine Act Meeting FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT: STATUS: Closed meeting. PLACE: 100 F Street, NE., Washington, DC. DATE AND TIME OF PREVIOUSLY ANNOUNCED MEETING: Thursday, December 9, 2010 at 2 p.m. CHANGE IN THE MEETING: Time change. The closed...

Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

Science.gov (United States)

Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

2015-01-01

The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs.

Science.gov (United States)

St-Maurice, Justin D; Burns, Catherine M

2017-07-28

Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a

Clinical outcomes of Laparoscopically Assisted Vaginal Hysterectomy at patients who had previous abdominopelvic surgery

Directory of Open Access Journals (Sweden)

Ali Riza Odabasi

2007-03-01

Full Text Available OBJECTIVE: To determine clinical outcomes of Laparoscopically Assisted Vaginal Hysterectomy (LAVH at patients who had previous abdominopelvic surgery.\tDesign: A clinical observational, prospective, non randomised trial comparing outcomes of 13 patients who had previous abdominopelvic surgery with outcomes of 19 patients who had not surgery.\tSetting: Adnan Menderes University Faculty of Medicine, Department of Obstetrics and Gynecology.\tPatients: Thirty-two subjects [average age 51,1±6,9 (37-66] who had indication of total abdominal hysterectomy and bilateral\tsalpingooferectomy due to benign pathologies.\tInterventions: According to ACOG, LAVH was performed by using the Garry technique at the trocar insertions, the Reich technique\tat the laparoscopic phase and the Heaney technique at the vaginal phase by the same operator. After adhesiolysis and diagnostic procedures, ureters were dissected medially. By coagulating, bilateral round and infundibulopelvic ligaments were cut after the\tmobilisation of bladder. The operation was completed by the same operation team by vaginal approach consequently. At all operations, 80 W unipolar or 150 W bipolar diathermic dissection and 25-35 W unipolar diathermic cutting were performed.\tMain outcome measures: Age, parity, menopausal status, preoperative indications, type of previous abdominopelvic surgey and incision, intraoperative indications, adhesion scores, rate of unintended laparotomy, operative time, uterus weight, loss of blood,\tcomplications, postoperative pain scores and analgesic requirements, time necessary for returning to normal intestinal function, length of hospitalisation and rate of readmission to hospital.\tRESULTS: When compared with the patients who had not previous abdominopelvic surgery, all adhesion scores, uterus weight, operative time and the number of total postoperative complications were found significantly high at patients who had previous\tsurgery. Loss of blood, the rate

Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation.

Science.gov (United States)

de Freitas, Cláudia; Dos Reis, Vanessa; Silva, Susana; Videira, Paula A; Morava, Eva; Jaeken, Jaak

2017-09-26

Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the

Maslow’s Needs Hierarchy and the Effect of Income on Happiness Levels

OpenAIRE

Drakopoulos, Stavros A.; Grimani, Katerina

2013-01-01

Abraham Maslow’s theory of hierarchical needs has been employed by a large variety of conceptual frameworks. The theory can also offer additional insights to the research field which investigates the relationship between income and reported happiness levels. The incorporation of needs hierarchy into a happiness framework implies that individuals have a priority approach to happiness. This means that the most important needs must be satisfied first before the secondary needs come into the pict...

28 CFR 10.5 - Incorporation of papers previously filed.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Incorporation of papers previously filed... CARRYING ON ACTIVITIES WITHIN THE UNITED STATES Registration Statement § 10.5 Incorporation of papers previously filed. Papers and documents already filed with the Attorney General pursuant to the said act and...

Share| The Need for Person-Centered Education

OpenAIRE

Alberto Zucconi

2016-01-01

We, the children of the Anthropocene Era, are entering the 4th industrial revolution and the impact is going to be pervasive and of greater magnitude compared to the previous industrial revolutions. The incoming changes, approaching at an accelerating speed, will be impacting everything and everybody and blurring the lines between the physical, digital, and biological spheres; they will affect the bio-psycho-social dimensions, our narratives and even what it means to be human. If we are not f...

A Practical Solution Using A New Approach To Robot Vision

Science.gov (United States)

Hudson, David L.

1984-01-01

Up to now, robot vision systems have been designed to serve both application development and operational needs in inspection, assembly and material handling. This universal approach to robot vision is too costly for many practical applications. A new industrial vision system separates the function of application program development from on-line operation. A Vision Development System (VDS) is equipped with facilities designed to simplify and accelerate the application program development process. A complimentary but lower cost Target Application System (TASK) runs the application program developed with the VDS. This concept is presented in the context of an actual robot vision application that improves inspection and assembly for a manufacturer of electronic terminal keyboards. Applications developed with a VDS experience lower development cost when compared with conventional vision systems. Since the TASK processor is not burdened with development tools, it can be installed at a lower cost than comparable "universal" vision systems that are intended to be used for both development and on-line operation. The VDS/TASK approach opens more industrial applications to robot vision that previously were not practical because of the high cost of vision systems. Although robot vision is a new technology, it has been applied successfully to a variety of industrial needs in inspection, manufacturing, and material handling. New developments in robot vision technology are creating practical, cost effective solutions for a variety of industrial needs. A year or two ago, researchers and robot manufacturers interested in implementing a robot vision application could take one of two approaches. The first approach was to purchase all the necessary vision components from various sources. That meant buying an image processor from one company, a camera from another and lens and light sources from yet others. The user then had to assemble the pieces, and in most instances he had to write

The Need for Conflict Management in the Post-Crisis Period

Directory of Open Access Journals (Sweden)

Gheorghe Popovici

2014-06-01

Full Text Available The paper presents the results of the study regarding the need for conflict management in the post-crisis period for the Romanian organisations. The 2008-2013 economic crisis placed the organisations on new coordinates by which a new approach is needed for the management activity. On the one hand, managers should adapt to the new requirements of the market and behaviour of customers, and on the other hand we also need a redefinition and practical solving of conflicts within an organisation.

Perception approaches and practices of local farming and development: an anthropological approach

International Nuclear Information System (INIS)

Hadi, S.A.; Chaudhry, A.G.

2015-01-01

The study focused on recognizing the local approaches of farming in designing and implementation of development projects. These approaches are representative of a particular ecological, social, economical, and political system, shaped by the constraints and opportunities associated to the area. Effective and successful development projects must include the local perceptions, their approaches and practices, as the locals are the ones most representative of their issues and have the most workable solution to them. The traditional agriculture has completely been clutched into the nexus of modern farming methods, due to which they are being abandoned by the farmers. Modern farming which is representative of development has increased the competition, transitioning, breaking the community into people experimenting on modern technology and those who are still finding means to adapt their traditional agriculture to the fast changing needs of the societies. The research was carried out in the villages of Ghora Gali and Aruka through qualitative and quantitative methods. Sustainable development in Pakistan thus needs to be reinvented in the local perspective considering approaches and practices and, eradicating the alien chains of development completely. (author)

Effective source approach to self-force calculations

International Nuclear Information System (INIS)

Vega, Ian; Wardell, Barry; Diener, Peter

2011-01-01

Numerical evaluation of the self-force on a point particle is made difficult by the use of delta functions as sources. Recent methods for self-force calculations avoid delta functions altogether, using instead a finite and extended 'effective source' for a point particle. We provide a review of the general principles underlying this strategy, using the specific example of a scalar point charge moving in a black hole spacetime. We also report on two new developments: (i) the construction and evaluation of an effective source for a scalar charge moving along a generic orbit of an arbitrary spacetime, and (ii) the successful implementation of hyperboloidal slicing that significantly improves on previous treatments of boundary conditions used for effective-source-based self-force calculations. Finally, we identify some of the key issues related to the effective source approach that will need to be addressed by future work.

New, strategic outsourcing models to meet changing clinical development needs

Directory of Open Access Journals (Sweden)

Janet Jones

2010-01-01

Full Text Available The impact of increasing clinical costs and the need for more data to support higher efficacy demands and overcome regulatory hurdles for market entry means that every Company is faced with the challenge of how to do more with a smaller budget. As budgets get squeezed the pharmaceutical Industry has been looking at how to contain or reduce cost and support an increased number of projects. With the growing sophistication of outsourcing, this is an increasingly important area of focus. Some Pharmaceutical Companies have moved from tactical, case by case, outsourcing to new, more strategic relationships, which involve outsourcing functions that were historically held as core pharmaceutical functions. An increasing number of Sponsors are looking at strategic relationships which are based on more creative outsourcing approaches. As the need and sophistication of these outsourcing models and the sponsors / CROs involved in them, these approaches are becoming more transformational and need to be based on a strong partnership. Lessons learned from working with sponsors in a partnership model have been examined and two key challenges addressed in detail: the need for bilateral central control though a strong governance model and the importance of early planning and commitment.

New, strategic outsourcing models to meet changing clinical development needs.

Science.gov (United States)

Jones, Janet; Minor, Michael

2010-04-01

The impact of increasing clinical costs and the need for more data to support higher efficacy demands and overcome regulatory hurdles for market entry means that every Company is faced with the challenge of how to do more with a smaller budget. As budgets get squeezed the pharmaceutical Industry has been looking at how to contain or reduce cost and support an increased number of projects. With the growing sophistication of outsourcing, this is an increasingly important area of focus. Some Pharmaceutical Companies have moved from tactical, case by case, outsourcing to new, more strategic relationships, which involve outsourcing functions that were historically held as core pharmaceutical functions. An increasing number of Sponsors are looking at strategic relationships which are based on more creative outsourcing approaches. As the need and sophistication of these outsourcing models and the sponsors / CROs involved in them, these approaches are becoming more transformational and need to be based on a strong partnership. Lessons learned from working with sponsors in a partnership model have been examined and two key challenges addressed in detail: the need for bilateral central control though a strong governance model and the importance of early planning and commitment.

Establishing a Rural School Counseling Agenda: A Multiagency Needs-Assessment Model.

Science.gov (United States)

Braucht, Stephanie; Weime, Barbara

1990-01-01

Developed creative approach to conduct needs assessment in rural schools that involved sending questionnaires to 49 key informants and 145 high school students. Key informants and students agreed that the 2 most serious issues were alcohol-related problems and family dysfunction (violence, divorce). Both groups indicated need for a teen center;…

Behavioral science in video games for children's diet and physical activity change: Key research needs

Science.gov (United States)

Innovative intervention programs are needed to overcome the limitations in previous programs that promoted change in diabetes risk behaviors in children. Serious video games show promise of changing dietary and physical activity behaviors, but research is needed on the optimal design of behavior-cha...

No discrimination against previous mates in a sexually cannibalistic spider

Science.gov (United States)

Fromhage, Lutz; Schneider, Jutta M.

2005-09-01

In several animal species, females discriminate against previous mates in subsequent mating decisions, increasing the potential for multiple paternity. In spiders, female choice may take the form of selective sexual cannibalism, which has been shown to bias paternity in favor of particular males. If cannibalistic attacks function to restrict a male's paternity, females may have little interest to remate with males having survived such an attack. We therefore studied the possibility of female discrimination against previous mates in sexually cannibalistic Argiope bruennichi, where females almost always attack their mate at the onset of copulation. We compared mating latency and copulation duration of males having experienced a previous copulation either with the same or with a different female, but found no evidence for discrimination against previous mates. However, males copulated significantly shorter when inserting into a used, compared to a previously unused, genital pore of the female.

Effective emergency management: reconsidering the bureaucratic approach.

Science.gov (United States)

Neal, D M; Phillips, B D

1995-12-01

The command and control approach is compared with the Emergent Human Resources Model (EHRM) approach to emergency management. Four decades of systematic research shows that a rigid, bureaucratic command and control approach to emergency management generally leads to an ineffective emergency response. Previous studies and our own research suggest that flexible, malleable, loosely coupled, organizational configurations can create a more effective disaster response.

Design of Quiet Rotorcraft Approach Trajectories: Verification Phase

Science.gov (United States)

Padula, Sharon L.

2010-01-01

Flight testing that is planned for October 2010 will provide an opportunity to evaluate rotorcraft trajectory optimization techniques. The flight test will involve a fully instrumented MD-902 helicopter, which will be flown over an array of microphones. In this work, the helicopter approach trajectory is optimized via a multiobjective genetic algorithm to improve community noise, passenger comfort, and pilot acceptance. Previously developed optimization strategies are modified to accommodate new helicopter data and to increase pilot acceptance. This paper describes the MD-902 trajectory optimization plus general optimization strategies and modifications that are needed to reduce the uncertainty in noise predictions. The constraints that are imposed by the flight test conditions and characteristics of the MD-902 helicopter limit the testing possibilities. However, the insights that will be gained through this research will prove highly valuable.

Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?

Science.gov (United States)

Bennett, Amanda C; Rankin, Kristin M; Rosenberg, Deborah

2012-12-01

This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.

A participatory sensing approach to characterize ride quality

Science.gov (United States)

Bridgelall, Raj

2014-03-01

Rough roads increase vehicle operation and road maintenance costs. Consequently, transportation agencies spend a significant portion of their budgets on ride-quality characterization to forecast maintenance needs. The ubiquity of smartphones and social media, and the emergence of a connected vehicle environment present lucrative opportunities for cost-reduction and continuous, network-wide, ride-quality characterization. However, there is a lack of models to transform inertial and position information from voluminous data flows into indices that transportation agencies currently use. This work expands on theories of the Road Impact Factor introduced in previous research. The index characterizes road roughness by aggregating connected vehicle data and reporting roughness in direct proportion to the International Roughness Index. Their theoretical relationships are developed, and a case study is presented to compare the relative data quality from an inertial profiler and a regular passenger vehicle. Results demonstrate that the approach is a viable alternative to existing models that require substantially more resources and provide less network coverage. One significant benefit of the participatory sensing approach is that transportation agencies can monitor all network facilities continuously to locate distress symptoms, such as frost heaves, that appear and disappear between ride assessment cycles. Another benefit of the approach is continuous monitoring of all high-risk intersections such as rail grade crossings to better understand the relationship between ride-quality and traffic safety.

User study: information needs of contracting companies of market research

Directory of Open Access Journals (Sweden)

Frederico Cesar Mafra Pereira

2018-01-01

Full Text Available This paper has as main objective to understand why companies use market research as a source of information for their business, with a comparison between what they want to apply for a research and the effective use of the information received. The main methodological approach was based on the 'Model for identifying needs, seeking and use of information' (MAFRA PEREIRA, 2010, and from this approach has drawn up a script for conducting interviews with clients of research institute located in Belo Horizonte (MG. The results showed the applicability of the model, identifying information needs, gaps of information and the effective use of information in their respective organizational contexts; besides the methodological procedures for conducting and analyzing the results.

Need, Merit or Self-Interest - What Determines the Allocation of Aid?

OpenAIRE

Anke Hoeffler; Verity Outram

2008-01-01

Previous studies into aid allocation have concluded that foreign aid is allocated not only according to development needs but also according to donor self-interest. We revisit this topic and allow for donor as well as recipient specific effects in our analysis. Our results indicate that roughly half of the predicted value of aid is determined by donor specific effects. Of the remaining variation, recipient need accounts for 36 percent and donor self-interest for about 16 percent. This suggest...

An Approach for Foliar Trait Retrieval from Airborne Imaging Spectroscopy of Tropical Forests

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Roberta E. Martin

2018-01-01

Full Text Available Spatial information on forest functional composition is needed to inform management and conservation efforts, yet this information is lacking, particularly in tropical regions. Canopy foliar traits underpin the functional biodiversity of forests, and have been shown to be remotely measurable using airborne 350–2510 nm imaging spectrometers. We used newly acquired imaging spectroscopy data constrained with concurrent light detection and ranging (LiDAR measurements from the Carnegie Airborne Observatory (CAO, and field measurements, to test the performance of the Spectranomics approach for foliar trait retrieval. The method was previously developed in Neotropical forests, and was tested here in the humid tropical forests of Malaysian Borneo. Multiple foliar chemical traits, as well as leaf mass per area (LMA, were estimated with demonstrable precision and accuracy. The results were similar to those observed for Neotropical forests, suggesting a more general use of the Spectranomics approach for mapping canopy traits in tropical forests. Future mapping studies using this approach can advance scientific investigations and applications based on imaging spectroscopy.

A previous hamstring injury affects kicking mechanics in soccer players.

Science.gov (United States)

Navandar, Archit; Veiga, Santiago; Torres, Gonzalo; Chorro, David; Navarro, Enrique

2018-01-10

Although the kicking skill is influenced by limb dominance and sex, how a previous hamstring injury affects kicking has not been studied in detail. Thus, the objective of this study was to evaluate the effect of sex and limb dominance on kicking in limbs with and without a previous hamstring injury. 45 professional players (males: n=19, previously injured players=4, age=21.16 ± 2.00 years; females: n=19, previously injured players=10, age=22.15 ± 4.50 years) performed 5 kicks each with their preferred and non-preferred limb at a target 7m away, which were recorded with a three-dimensional motion capture system. Kinematic and kinetic variables were extracted for the backswing, leg cocking, leg acceleration and follow through phases. A shorter backswing (20.20 ± 3.49% vs 25.64 ± 4.57%), and differences in knee flexion angle (58 ± 10o vs 72 ± 14o) and hip flexion velocity (8 ± 0rad/s vs 10 ± 2rad/s) were observed in previously injured, non-preferred limb kicks for females. A lower peak hip linear velocity (3.50 ± 0.84m/s vs 4.10 ± 0.45m/s) was observed in previously injured, preferred limb kicks of females. These differences occurred in the backswing and leg-cocking phases where the hamstring muscles were the most active. A variation in the functioning of the hamstring muscles and that of the gluteus maximus and iliopsoas in the case of a previous injury could account for the differences observed in the kicking pattern. Therefore, the effects of a previous hamstring injury must be considered while designing rehabilitation programs to re-educate kicking movement.

"Tolerating" Adolescent Needs: Moving beyond Zero Tolerance Policies in High School

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Gregory, Anne; Cornell, Dewey

2009-01-01

The authors contend that zero tolerance discipline policies are inconsistent with adolescent developmental needs for authoritative, as distinguished from authoritarian, discipline. Previous research has applied the notion of authoritative parenting to teaching styles in classrooms, and a similar model of authoritative discipline can guide…

The Importance of Business Model Factors for Cloud Computing Adoption: Role of Previous Experiences

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Bogataj Habjan Kristina

2017-08-01

Full Text Available Background and Purpose: Bringing several opportunities for more effective and efficient IT governance and service exploitation, cloud computing is expected to impact the European and global economies significantly. Market data show that despite many advantages and promised benefits the adoption of cloud computing is not as fast and widespread as foreseen. This situation shows the need for further exploration of the potentials of cloud computing and its implementation on the market. The purpose of this research was to identify individual business model factors with the highest impact on cloud computing adoption. In addition, the aim was to identify the differences in opinion regarding the importance of business model factors on cloud computing adoption according to companies’ previous experiences with cloud computing services.

Methodological approaches and magnitude of the clinical unmet need associated with amotivation in mood disorders.

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Calabrese, Joseph R; Fava, Maurizio; Garibaldi, George; Grunze, Heinz; Krystal, Andrew D; Laughren, Thomas; Macfadden, Wayne; Marin, Robert; Nierenberg, Andrew A; Tohen, Mauricio

2014-10-01

There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration. This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders. The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively. There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

Laparoscopic approach for inflammatory bowel disease surgical managment.

Science.gov (United States)

Maggiori, Léon; Panis, Yves

2012-01-01

For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

Systematic Approach for Decommissioning Planning and Estimating

International Nuclear Information System (INIS)

Dam, A. S.

2002-01-01

Nuclear facility decommissioning, satisfactorily completed at the lowest cost, relies on a systematic approach to the planning, estimating, and documenting the work. High quality information is needed to properly perform the planning and estimating. A systematic approach to collecting and maintaining the needed information is recommended using a knowledgebase system for information management. A systematic approach is also recommended to develop the decommissioning plan, cost estimate and schedule. A probabilistic project cost and schedule risk analysis is included as part of the planning process. The entire effort is performed by a experienced team of decommissioning planners, cost estimators, schedulers, and facility knowledgeable owner representatives. The plant data, work plans, cost and schedule are entered into a knowledgebase. This systematic approach has been used successfully for decommissioning planning and cost estimating for a commercial nuclear power plant. Elements of this approach have been used for numerous cost estimates and estimate reviews. The plan and estimate in the knowledgebase should be a living document, updated periodically, to support decommissioning fund provisioning, with the plan ready for use when the need arises

Managing the language and learning needs of the communication-impaired preschool child. A proactive approach.

Science.gov (United States)

Prelock, P A

1993-01-01

If a proactive approach to assessment and intervention had been used in the case study presented at the beginning of this article, the following might have occurred: The SLP would have asked the parents and brother of the 3 1/2-year-old child referred for a communication evaluation to participate in the assessment activities. The parents would have been asked to prioritize their expectations for their daughter's communication, behavior, and school success. They would have been told the SLP would do the same based on her knowledge of performance expectations in these areas for a 3 1/2-year old. Both the parents and the SLP would have agreed to consider describing the child's communication, behavior, and potential for school success in more than a single setting or context. The child would have been seen in her home as well as in a preschool setting. The clinician would have observed the child's play with both familiar and unfamiliar children and adults. The parents would have kept a log of their child's communication successes and failures for one week. The clinician would have used those situations the parents identified as successful and unsuccessful to specify the child's strengths and weaknesses. The parents would have been asked to write down ideas they had on the type of intervention, if any, they felt their daughter needed to meet the expectations they set. The clinician would do the same and would have consulted with an educational specialist and a psychologist to obtain their perspective on the educational and cognitive needs of a preschooler. The speech-language pathologist would have asked other professionals to assist in assessment of this child. The psychologist would have completed some testing in the home with the SLP providing help in interpreting the child's responses. The educational specialist would have invited the SLP to observe the child in a diagnostic preschool setting to assess the child's ability to understand and communicate in an

Previously unclassified bacteria dominate during thermophilic and mesophilic anaerobic pre-treatment of primary sludge.

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Pervin, Hasina M; Batstone, Damien J; Bond, Philip L

2013-06-01

Thermophilic biological pre-treatment enables enhanced anaerobic digestion for treatment of wastewater sludges but, at present, there is limited understanding of the hydrolytic-acidogenic microbial composition and its contribution to this process. In this study, the process was assessed by comparing the microbiology of thermophilic (50-65 °C) and mesophilic (35 °C) pre-treatment reactors treating primary sludge. A full-cycle approach for the 16S rRNA genes was applied in order to monitor the diversity of bacteria and their abundance in a thermophilic pre-treatment reactor treating primary sludge. For the thermophilic pre-treatment (TP), over 90% of the sequences were previously undetected and these had less than 97% sequence similarity to cultured organisms. During the first 83 days, members of the Betaproteobacteria dominated the community sequences and a newly designed probe was used to monitor a previously unknown bacterium affiliated with the genus Brachymonas. Between days 85 and 183, three phylotypes that affiliated with the genera Comamonas, Clostridium and Lysobacter were persistently dominant in the TP community, as revealed by terminal-restriction fragment length polymorphism (T-RFLP). Hydrolytic and fermentative functions have been speculated for these bacteria. Mesophilic pre-treatment (MP) and TP communities were different but they were both relatively dynamic. Statistical correlation analysis and the function of closely allied reference organisms indicated that previously unclassified bacteria dominated the TP community and may have been functionally involved in the enhanced hydrolytic performance of thermophilic anaerobic pre-treatment. This study is the first to reveal the diversity and dynamics of bacteria during anaerobic digestion of primary sludge. Copyright © 2013 Elsevier GmbH. All rights reserved.

Protecting nuclear material and facilities: Is a new approach needed?

International Nuclear Information System (INIS)

Steinhausler, F.; Bunn, G.

2002-01-01

Full text: The main reason why national physical protection (PP) systems for nuclear and other radioactive material need to be strengthened further is that, after the attacks on the US on 11 September 2001, the threat of dangerous, suicidal radiological and nuclear terrorism can no longer be excluded as a possibility. Existing PP systems were not designed to deal with the threat of suicidal terrorists having the numbers, skills, training, and resources available to the commandos attacking on 11 September. Moreover, there are no mandatory international standards for domestic PP systems for nuclear or radioactive material, and this has produced great variation in protection provided from country to country. IAEA recommended standards, while useful, were not designed with the new terrorist threat in mind. Moreover, they are often not followed in practice. The result is inadequate protection against the new form of terrorism in most countries. The Director General of the IAEA expressed a similar view after 11 September, but achieving a consensus to amend the Convention on the Physical Protection of Nuclear Material (CPPNM) to require specific standards of protection for different amounts and kinds of nuclear material used or stored domestically (not in international transport) has been impossible in the year since 11 September. In the case of radiological materials, a new effort to provide required international standards for protection against the new form of terrorism has not begun. In the summer of 2001, leaders of the G-8 countries agreed to a Global Partnership to prevent the new terrorists from acquiring nuclear and radiological as well as other materials related to weapons of mass destruction. Perhaps in part because of the failure to date to achieve agreement on an effective amendment to the CPPNM, the first principle of this partnership is to strengthen 'multilateral treaties and other instruments whose aim is to prevent the proliferation or illicit

Matching user needs in health care.

Science.gov (United States)

Bremer, G; Leggate, P

1982-01-01

Outlines patterns of library service available to users in the (British) National Health Service (NHS); gives preliminary results of a study detailing the character of the library system users, the nature of their needs and the degree to which the library system output meshes with user needs. The NHS library system is composed of widely scattered but small libraries, many of which can be characterized according to the narrow range of needs they serve. The largest libraries of the system, the teaching hospital library, share features of the NHS and university library systems. The most numerous, however, are the postgraduate medical education center libraries and nurse training school libraries. Until recently, there had been no cohesive organizational structure uniting the facilities and services of these various library groups. Regional library systems dating from 1967 have sought to encourage collaboration among libraries and to take into account user needs in policy planning. Recent research into medical libraries conducted by the British Library Research and Development Department points out the need for medical students and doctors to be able to adapt themselves to extracting needed information from any library which they might need to use during their career. Data showed that both clinical and preclinical medical personnel use a wide range of libraries, and are most satisfied with a multifunction library. Interpretation of data was undertaken within a conceptual framework of modelling developed by Checkland which provides a structure for thinking about the system. It is hoped that this approach will help to identify the sort of model of users which the library must maintain in order to provide them with the services they desire.

Paradigm change in ocean studies: multi-platform observing and forecasting integrated approach in response to science and society needs

Science.gov (United States)

Tintoré, Joaquín

2017-04-01

-platform approach in ocean observation. Three examples from the integration capabilities of SOCIB facilities will be presented and discussed. First the quasi-continuous high frequency glider monitoring of the Ibiza Channel since 2011, an important biodiversity hot spot and a 'choke' point in the Western Mediterranean circulation, has allowed us to reveal a high frequency variability in the North-South exchanges, with very significant changes (0.8 - 0.9 Sv) occurring over periods of days to week of the same order as the previously known seasonal cycle. HF radar data and model results have also contributed more recently to better describe and understand the variability at small scales. Second, the Alborex/Perseus project multi-platform experiment (e.g., RV catamaran, 2 gliders, 25 drifters, 3 Argo type profilers & satellite data) that focused on submesoscale processes and ecosystem response and carried out in the Alborán Sea in May 2014. Glider results showed significant chlorophyll subduction in areas adjacent to the steep density front with patterns related to vertical motion. Initial dynamical interpretations will be presented. Third and final, I will discuss the key relevance of the data centre to guarantee data interoperability, quality control, availability and distribution for this new approach to ocean observation and forecasting to be really efficient in responding to key scientific state of the art priorities, enhancing technology development and responding to society needs.

Wildlife health investigations: needs, challenges and recommendations

Science.gov (United States)

2013-01-01

In a fast changing world with growing concerns about biodiversity loss and an increasing number of animal and human diseases emerging from wildlife, the need for effective wildlife health investigations including both surveillance and research is now widely recognized. However, procedures applicable to and knowledge acquired from studies related to domestic animal and human health can be on partly extrapolated to wildlife. This article identifies requirements and challenges inherent in wildlife health investigations, reviews important definitions and novel health investigation methods, and proposes tools and strategies for effective wildlife health surveillance programs. Impediments to wildlife health investigations are largely related to zoological, behavioral and ecological characteristics of wildlife populations and to limited access to investigation materials. These concerns should not be viewed as insurmountable but it is imperative that they are considered in study design, data analysis and result interpretation. It is particularly crucial to remember that health surveillance does not begin in the laboratory but in the fields. In this context, participatory approaches and mutual respect are essential. Furthermore, interdisciplinarity and open minds are necessary because a wide range of tools and knowledge from different fields need to be integrated in wildlife health surveillance and research. The identification of factors contributing to disease emergence requires the comparison of health and ecological data over time and among geographical regions. Finally, there is a need for the development and validation of diagnostic tests for wildlife species and for data on free-ranging population densities. Training of health professionals in wildlife diseases should also be improved. Overall, the article particularly emphasizes five needs of wildlife health investigations: communication and collaboration; use of synergies and triangulation approaches; investments

A Needs Analysis Approach to the Evaluation of Iranian Third-Grade High School English Textbook

Directory of Open Access Journals (Sweden)

Nasser Rashidi

2014-09-01

Full Text Available Needs analysis as an integral part of evaluative review of English materials, mainly textbooks, requires giving sufficient attention in all English language learning contexts. This issue seems to be more demanding in English as a Foreign Language (EFL contexts where the textbooks are the main sources of input for the learners. However, in some cases, this important factor is excluded entirely or at least limited to the ideas of major stakeholders. This article reports on the findings of a study conducted to evaluate an English textbook (the third-grade high school English book, which is being used in all state high schools in Iran by using a needs analysis framework. First, the needs analysis questionnaires were administered among 180 third-grade female high school students for whom the textbook was designed. Having investigated the students’ perceived foreign language needs, the researcher then used it as the basis for evaluating the textbook. The results of the textbook evaluation revealed that although all language skills and components were almost important for the majority of the students, the textbook could not fully support all of them together. Finally, it was suggested that the textbook be revised or at least supplemented by other instructional materials, so that it could be more effective for the aforementioned learners.

A mixed methods study to investigate needs assessment for knee pain and disability: population and individual perspectives

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Ong Bie

2007-07-01

Full Text Available Abstract Background The new Musculoskeletal Services Framework outlines the importance of health care needs assessment. Our aim was to provide a model for this for knee pain and disability, describing felt need (individual assessment of a need for health care and expressed need (demand for health care. This intelligence is required by health care planners in order to implement the new Framework. Methods A multi-method approach was used. A population survey (n = 5784 was administered to adults aged 50+ registered with 3 general practices. The questionnaire contained a Knee Pain Screening Tool to identify the prevalence of knee pain and health care use in the population, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Survey responders who scored "severe" or "extreme" on at least one item on the pain or physical function scale on the WOMAC were categorised into "severe" groups. Qualitative interviews were undertaken with 22 survey responders to explore in detail the experience of living with knee pain and disability. A sample of interviewees (n = 10 completed an open format patient diary to explore the experience of knee pain in everyday life. Results The 12-month period prevalence of knee pain was 49.5%, of which half was severe. Severe difficulties were reported with domestic duties, bending, bathing, climbing stairs and getting in or out of a car. Some self-care is occurring. The majority (53% of responders with severe pain or disability had not consulted their GP in the last 12 months. The qualitative study revealed reasons for this including a perception that knee pain is part of normal ageing, little effective prevention and treatment is available and the use of medications causes side effects and dependency. Conclusion This study adds to previous work by highlighting a gap between felt and expressed need and the reasons for this mismatch. There is evidence of self-management, but also missed opportunities for

Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment.

Science.gov (United States)

Guerrero, Martha Inírida; Colorado, Claudia Lucía; Torres, José Fernando; León, Clara Inés

2014-04-01

There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods. To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period. We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses. From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined. The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.

The role of duplications in the evolution of genomes highlights the need for evolutionary-based approaches in comparative genomics

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Levasseur Anthony

2011-02-01

Full Text Available Abstract Understanding the evolutionary plasticity of the genome requires a global, comparative approach in which genetic events are considered both in a phylogenetic framework and with regard to population genetics and environmental variables. In the mechanisms that generate adaptive and non-adaptive changes in genomes, segmental duplications (duplication of individual genes or genomic regions and polyploidization (whole genome duplications are well-known driving forces. The probability of fixation and maintenance of duplicates depends on many variables, including population sizes and selection regimes experienced by the corresponding genes: a combination of stochastic and adaptive mechanisms has shaped all genomes. A survey of experimental work shows that the distinction made between fixation and maintenance of duplicates still needs to be conceptualized and mathematically modeled. Here we review the mechanisms that increase or decrease the probability of fixation or maintenance of duplicated genes, and examine the outcome of these events on the adaptation of the organisms. Reviewers This article was reviewed by Dr. Etienne Joly, Dr. Lutz Walter and Dr. W. Ford Doolittle.

A simplified ALARA approach to demonstration of compliance with surface contaminated object regulatory requirements

International Nuclear Information System (INIS)

Pope, R.B.; Shappert, L.B.; Michelhaugh, R.D.; Boyle, R.W.; Cook, J.C.

1998-02-01

The US Department of Transportation (DOT) and the US Nuclear Regulatory Commission (NRC) have jointly prepared a comprehensive set of draft guidance for consignors and inspectors to use when applying the newly imposed regulatory requirements for low specific activity (LSA) material and surface contaminated objects (SCOs). The guidance is being developed to facilitate compliance with the new LSA material and SCO requirements, not to impose additional requirements. These new requirements represent, in some areas, significant departures from the manner in which packaging and transportation of these materials and objects were previously controlled. On occasion, it may be appropriate to use conservative approaches to demonstrate compliance with some of the requirements, ensuring that personnel are not exposed to radiation at unnecessary levels, so that exposures are kept as low as reasonably achievable (ALARA). In the draft guidance, one such approach would assist consignors preparing a shipment of a large number of SCOs in demonstrating compliance without unnecessarily exposing personnel. In applying this approach, users need to demonstrate that four conditions are met. These four conditions are used to categorize non-activated, contaminated objects as SCO-2. It is expected that, by applying this approach, it will be possible to categorize a large number of small contaminated objects as SCO-2 without the need for detailed, quantitative measurements of fixed, accessible contamination, or of total (fixed and non-fixed) contamination on inaccessible surfaces. The method, which is based upon reasoned argument coupled with limited measurements and the application of a sum of fractions rule, is described and examples of its use are provided

Political economy of Central Asia: Initial reflections on the need for a new approach

Directory of Open Access Journals (Sweden)

Assel Rustemova

2011-01-01

I argue that post-structuralist approaches and specifically, the framework of “governmentality” – a term coined by Michel Foucault, allows for more fruitful heuristic exercise. Governmentality as an analytical approach looks at the way the state positions itself in its society and determines the type of governing rationale it adopts. Particularly, it incorporates both discursive and structural-technological conditions of each state into analysis by augmenting the data before constructing the theory to argue what rationale drives government activities in the state. Governmentality speaks to both “resource curse” and the “varieties of capitalism” by enriching and complicating them while allowing identification of how rationales of governing evolve and change over time.

Previously unknown species of Aspergillus.

Science.gov (United States)

Gautier, M; Normand, A-C; Ranque, S

2016-08-01

The use of multi-locus DNA sequence analysis has led to the description of previously unknown 'cryptic' Aspergillus species, whereas classical morphology-based identification of Aspergillus remains limited to the section or species-complex level. The current literature highlights two main features concerning these 'cryptic' Aspergillus species. First, the prevalence of such species in clinical samples is relatively high compared with emergent filamentous fungal taxa such as Mucorales, Scedosporium or Fusarium. Second, it is clearly important to identify these species in the clinical laboratory because of the high frequency of antifungal drug-resistant isolates of such Aspergillus species. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been shown to enable the identification of filamentous fungi with an accuracy similar to that of DNA sequence-based methods. As MALDI-TOF MS is well suited to the routine clinical laboratory workflow, it facilitates the identification of these 'cryptic' Aspergillus species at the routine mycology bench. The rapid establishment of enhanced filamentous fungi identification facilities will lead to a better understanding of the epidemiology and clinical importance of these emerging Aspergillus species. Based on routine MALDI-TOF MS-based identification results, we provide original insights into the key interpretation issues of a positive Aspergillus culture from a clinical sample. Which ubiquitous species that are frequently isolated from air samples are rarely involved in human invasive disease? Can both the species and the type of biological sample indicate Aspergillus carriage, colonization or infection in a patient? Highly accurate routine filamentous fungi identification is central to enhance the understanding of these previously unknown Aspergillus species, with a vital impact on further improved patient care. Copyright © 2016 European Society of Clinical Microbiology and

Tiered Approach to Resilience Assessment.

Science.gov (United States)

Linkov, Igor; Fox-Lent, Cate; Read, Laura; Allen, Craig R; Arnott, James C; Bellini, Emanuele; Coaffee, Jon; Florin, Marie-Valentine; Hatfield, Kirk; Hyde, Iain; Hynes, William; Jovanovic, Aleksandar; Kasperson, Roger; Katzenberger, John; Keys, Patrick W; Lambert, James H; Moss, Richard; Murdoch, Peter S; Palma-Oliveira, Jose; Pulwarty, Roger S; Sands, Dale; Thomas, Edward A; Tye, Mari R; Woods, David

2018-04-25

Regulatory agencies have long adopted a three-tier framework for risk assessment. We build on this structure to propose a tiered approach for resilience assessment that can be integrated into the existing regulatory processes. Comprehensive approaches to assessing resilience at appropriate and operational scales, reconciling analytical complexity as needed with stakeholder needs and resources available, and ultimately creating actionable recommendations to enhance resilience are still lacking. Our proposed framework consists of tiers by which analysts can select resilience assessment and decision support tools to inform associated management actions relative to the scope and urgency of the risk and the capacity of resource managers to improve system resilience. The resilience management framework proposed is not intended to supplant either risk management or the many existing efforts of resilience quantification method development, but instead provide a guide to selecting tools that are appropriate for the given analytic need. The goal of this tiered approach is to intentionally parallel the tiered approach used in regulatory contexts so that resilience assessment might be more easily and quickly integrated into existing structures and with existing policies. Published 2018. This article is a U.S. government work and is in the public domain in the USA.

Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs.

Science.gov (United States)

Ganz, Michael L; Tendulkar, Shalini A

2006-06-01

To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.

Advanced approach to the analysis of a series of in-situ nuclear forward scattering experiments

Energy Technology Data Exchange (ETDEWEB)

Vrba, Vlastimil, E-mail: vlastimil.vrba01@upol.cz [Department of Experimental Physics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc (Czech Republic); Procházka, Vít, E-mail: v.prochazka@upol.cz [Department of Experimental Physics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc (Czech Republic); Smrčka, David, E-mail: david.smrcka@upol.cz [Department of Experimental Physics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc (Czech Republic); Miglierini, Marcel, E-mail: marcel.miglierini@stuba.sk [Slovak University of Technology in Bratislava, Faculty of Electrical Engineering and Information Technology, Institute of Nuclear and Physical Engineering, Ilkovicova 3, 812 19 Bratislava (Slovakia); Department of Nuclear Reactors, Faculty of Nuclear Science and Physical Engineering, Czech Technical University in Prague, V Holešovičkách 2, 180 00 Prague (Czech Republic)

2017-03-01

This study introduces a sequential fitting procedure as a specific approach to nuclear forward scattering (NFS) data evaluation. Principles and usage of this advanced evaluation method are described in details and its utilization is demonstrated on NFS in-situ investigations of fast processes. Such experiments frequently consist of hundreds of time spectra which need to be evaluated. The introduced procedure allows the analysis of these experiments and significantly decreases the time needed for the data evaluation. The key contributions of the study are the sequential use of the output fitting parameters of a previous data set as the input parameters for the next data set and the model suitability crosscheck option of applying the procedure in ascending and descending directions of the data sets. Described fitting methodology is beneficial for checking of model validity and reliability of obtained results.

Advanced approach to the analysis of a series of in-situ nuclear forward scattering experiments

International Nuclear Information System (INIS)

Vrba, Vlastimil; Procházka, Vít; Smrčka, David; Miglierini, Marcel

2017-01-01

This study introduces a sequential fitting procedure as a specific approach to nuclear forward scattering (NFS) data evaluation. Principles and usage of this advanced evaluation method are described in details and its utilization is demonstrated on NFS in-situ investigations of fast processes. Such experiments frequently consist of hundreds of time spectra which need to be evaluated. The introduced procedure allows the analysis of these experiments and significantly decreases the time needed for the data evaluation. The key contributions of the study are the sequential use of the output fitting parameters of a previous data set as the input parameters for the next data set and the model suitability crosscheck option of applying the procedure in ascending and descending directions of the data sets. Described fitting methodology is beneficial for checking of model validity and reliability of obtained results.

22 CFR 40.93 - Aliens unlawfully present after previous immigration violation.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Aliens unlawfully present after previous... TO BOTH NONIMMIGRANTS AND IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Aliens Previously Removed § 40.93 Aliens unlawfully present after previous immigration violation. An alien described...

Pedagogical approaches

DEFF Research Database (Denmark)

Lund Larsen, Lea

questions are: How (much) and what do teachers learn from experience? And how do teachers of adults develop their pedagogical approach? I examine the field of adult learners from the teachers’ perspective. Firstly, I identify some of the commonly described characteristics of adults as learners...... in formal settings, but in most teaching settings, the teachers act alone and develop their pedagogical approaches/- teaching strategies with no synchronous sparring from a colleague. Adult learners have particular needs and characteristics that their teachers must be able to address (cf. Knowles...

EFFICACY OF SUBMUCOSAL DELIVERY THROUGH A PARAPHARYNGEAL APPROACH IN THE TREATMENT OF LIMITED CRICOID CHONDROMA

Directory of Open Access Journals (Sweden)

M.T. Khorsi Y. Amidi

2008-05-01

Full Text Available Cartilaginous tumors comprise 1% of all laryngeal masses. Since they grow slowly and metastasis is rare, long term survival is expected in cases of chondroma and chondrosarcoma. Thus, based on these facts and the fact that total salvage surgery after recurrence of previous tumor does not influence treatment outcomes, "Quality of Life" must be taken into great consideration. Based on 3 cases of limited condrosarcoma that we have successfully operated on using submucosal delivery through a parapharyngeal approach, after several years of recurrence free follow ups, authors determine this technique as an efficient method of approach to these tumors. Since this technique takes less time and there is no need for glottic incision and the patient is discharged in 2 days without insertion of endolaryngeal stent, we believe this method is superior to laryngofissure or total laryngectomy.

A Study of Health Education and Its Needs for Elementary School Students

Science.gov (United States)

Hussain, Irshad; Alamgir, Muhammad Ahmad; Shahzad, Muhammad

2015-01-01

Health Education, particularly in elementary schools, appears to be a neglected area in Pakistan. This study investigated the health education needs of elementary school students. The purpose of the present study is to assess health education needs of elementary school students. The study adopted mix approach of (qualitative and quantitative)…

Students with Mental Health Needs: College Counseling Experiences and Academic Success

Science.gov (United States)

Schwitzer, Alan M.; Moss, Catherine B.; Pribesh, Shana L.; St. John, Dan J.; Burnett, Dana D.; Thompson, Lenora H.; Foss, Jennifer J.

2018-01-01

This study examined college counseling experiences and academic outcomes. About 10% of college students seek counseling for mental health needs, and many would be unable to persist without support. Building on previous research, the research found that participating in counseling was beneficial to academic success. Students who visited the…

Adolescents Who Self-Harm: Professional Staff Knowledge, Attitudes and Training Needs

Science.gov (United States)

Timson, Debbie; Priest, Helena; Clark-Carter, David

2012-01-01

This study aimed to investigate professional staff attitudes and knowledge about adolescents who engage in self-harming behaviour and to identify training needs. Previous research has suggested that medical and health care staff perceptions may reinforce the stigma associated with such behaviour and therefore jeopardise the effectiveness of…

What do coaches want to know about sports-related concussion? A needs assessment study

Directory of Open Access Journals (Sweden)

Lindsay Sullivan

2018-01-01

Conclusion: Our findings reveal a disconnect between the concussion education needs and the education that is currently provided to GAA coaches, in terms of content and delivery modality. Our results suggest a need for a multifaceted approach to concussion education, tailored to the needs and learning preferences of the target population.

Human rights approach to health.

Science.gov (United States)

Haigh, Fiona

2002-04-01

Adopting human rights approach to health carries many benefits, because it emphasizes the equality of all persons and their inherent right to health as the foundation of the health care system. It also argues that promotion and protection of health are fundamentally important social goals, focuses particularly on the needs of the most disadvantaged and vulnerable communities, balances individual needs with the common good, and so forth. However, it also raises some practical issues, such as organization of interdisciplinary education and work, and different use of the language, which often goes unacknowledged. The relationship between human rights and health is a reciprocal one, and can be beneficial or harmful. For the relationship to be beneficial and successful, the differences between human rights and public health approach to health, centered around the perspective taking, attitudes, and abilities of health professionals, need to be acknowledged and reconciled, and the need for interdisciplinarity adequately fulfilled.

Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure.

Science.gov (United States)

Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

2015-01-01

The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56-30.80) mm, corneal diameter was 14.71±1.07 (13.0-16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9-1.0), and IOP was 39.5±5.7 (30-55) mmHg. The mean follow-up time was 18.29±10.96 (5-44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (Pvalve success were 85.7%, 71.4%, and 71.4% at 6, 12, and 18 months, respectively. Severe surgical complications, including erosion of tube, endophthalmitis, retinal detachment, choroidal detachment, and delayed suprachoroidal hemorrhage, occurred in 28.6% cases. AGV implantation remains a viable option for patients with advanced primary congenital glaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications.

Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

Directory of Open Access Journals (Sweden)

Flavia Alencar de Barros Suzuki

Full Text Available ABSTRACT INTRODUCTION: The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE: To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS: A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models were used daily for at least 6 h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS: There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION: There was improvement in quality of life (Tinnitus Handicap Inventory, with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

Health as a basic human need: would this be enough?

Science.gov (United States)

de Campos, Thana Cristina

2012-01-01

's concept of basic needs, an account of basic health needs and, secondly, by mounting a defense of the basic needs approach to the right to health, arguing against James Griffin who opposes the basic needs approach. © 2012 American Society of Law, Medicine & Ethics, Inc.

18 CFR 154.302 - Previously submitted material.

Science.gov (United States)

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Previously submitted material. 154.302 Section 154.302 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... concurrently with the rate change filing. There must be furnished to the Director, Office of Energy Market...

Subsequent pregnancy outcome after previous foetal death

NARCIS (Netherlands)

Nijkamp, J. W.; Korteweg, F. J.; Holm, J. P.; Timmer, A.; Erwich, J. J. H. M.; van Pampus, M. G.

Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to

Artisanal Fisheries Research: A Need for Globalization?

Science.gov (United States)

Oliveira Júnior, José Gilmar C; Silva, Luana P S; Malhado, Ana C M; Batista, Vandick S; Fabré, Nidia N; Ladle, Richard J

2016-01-01

Given limited funds for research and widespread degradation of ecosystems, environmental scientists should geographically target their studies where they will be most effective. However, in academic areas such as conservation and natural resource management there is often a mismatch between the geographic foci of research effort/funding and research needs. The former frequently being focused in the developed world while the latter is greater in the biodiverse countries of the Global South. Here, we adopt a bibliometric approach to test this hypothesis using research on artisanal fisheries. Such fisheries occur throughout the world, but are especially prominent in developing countries where they are important for supporting local livelihoods, food security and poverty alleviation. Moreover, most artisanal fisheries in the Global South are unregulated and unmonitored and are in urgent need of science-based management to ensure future sustainability. Our results indicate that, as predicted, global research networks and centres of knowledge production are predominantly located in developed countries, indicating a global mismatch between research needs and capacity.

Assessing cancer survivors' needs using web-based technology: a pilot study.

Science.gov (United States)

Lavoie Smith, Ellen M; Skalla, Karen; Li, Zhongze; Onega, Tracy; Rhoda, June; Gates, Charlene; Litterini, Amy; Scott, Mary R

2012-02-01

Development of cancer survivor resources has been hampered by lack of knowledge regarding survivors' needs. The main study aim was to pilot test a Web-based cancer survivor needs assessment survey. The second aim was to pilot three sampling approaches. This cross-sectional study was conducted at the Norris Cotton Cancer Center and nine community-based clinics serving urban and rural populations. Population-based and convenience sampling approaches were used to recruit 547 participants over 4 months. Participants completed a Web-based cancer survivor needs assessment survey. Respondents were mainly white (98%), married (71%) women (80%) with a college education (96%). Although most (66%) (n = 362) had been diagnosed with breast cancer, other cancer diagnoses were represented. Participants reported fatigue (47%), forgetfulness (39%), joint pain (34%), anxiety (31%), trouble sleeping (28%), peripheral neuropathy (27%), inflexibility (23%), and weight gain (23%). Survivors with nonbreast solid tumor malignancies reported more problems than those with breast or hematologic malignancies (P range = .037 to losing weight (74.2%), decreasing fatigue (50%), and improving flexibility (69.3%), sleep (68.5%), and memory (60.2%). Results supported that cancer survivors struggle with many enduring problems. Web-based technology will facilitate future exploration of unmet needs.

21 CFR 1315.13 - Adjustments of the assessment of annual needs.

Science.gov (United States)

2010-04-01

... that has been previously fixed pursuant to § 1315.11. (b) In determining to adjust the assessment of annual needs, the Administrator shall consider the following factors: (1) Changes in the demand for that...; (2) Whether any increased demand for that chemical, the national and/or changes in individual rates...

41 CFR 102-37.180 - Does a SASP need special authorization to screen property at Federal facilities?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Does a SASP need special...) Screening and Requesting Property § 102-37.180 Does a SASP need special authorization to screen property at... do not need a screener-ID card to inspect or remove property previously set aside or approved by GSA...

Prospective memory and its correlates and predictors in schizophrenia: an extension of previous findings.

Science.gov (United States)

Ungvari, Gabor S; Xiang, Yu-Tao; Tang, Wai-Kwong; Shum, David

2008-09-01

Prospective memory (PM) is the ability to remember to do something in the future without explicit prompts. Extending the number of subjects and the scope of our previously published study, this investigation examined the relationship between PM and socio-demographic and clinical factors, activities of daily living (ADL) and frontal lobe functions in patients with chronic schizophrenia. One hundred and ten Chinese schizophrenia patients, 60 from the previous study and 50 additional patients recruited for this study, and 110 matched healthy comparison subjects (HC) formed the study sample. Patients' clinical condition and activity of daily living were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Functional Needs Assessment (FNA). Time- and event-based PM tasks and three tests of prefrontal lobe functions (Design Fluency Test [DFT], Tower of London [TOL], Wisconsin Card Sorting Test [WCST]) were also administered. Patients' level of ADL and psychopathology were not associated with PM functions and only anticholinergic medications (ACM) showed a significant negative correlational relationship with PM tasks. Confirming the findings of the previous study, patients performed significantly more poorly on all two PM tasks than HC. Performance on time-based PM task significantly correlated with age, education level and DFT in HC and with age, DFT, TOL and WCST in patients. Patients' performance on the event-based PM correlated with DFT and one measure of WCST. In patients, TOL and age predicted the performance on time-based PM task; DFT and WCST predicted the event-based task. Involving a large sample of patients with matched controls, this study confirmed that PM is impaired in chronic schizophrenia. Deficient PM functions were related to prefrontal lobe dysfunction in both HC and patients but not to the patients' clinical condition, nor did they significantly affect ADL. ACMs determined certain aspects of PM.

Left ventricular asynergy score as an indicator of previous myocardial infarction

International Nuclear Information System (INIS)

Backman, C.; Jacobsson, K.A.; Linderholm, H.; Osterman, G.

1986-01-01

Sixty-eight patients with coronary heart disease (CHD) i.e. a hisotry of angina of effort and/or previous 'possible infarction' were examined inter alia with ECG and cinecardioangiography. A system of scoring was designed which allowed a semiquantitative estimate of the left ventricular asynergy from cinecardioangiography - the left ventricular motion score (LVMS). The LVMS was associated with the presence of a previous myocardial infarction (MI), as indicated by the history and ECG findings. The ECG changes specific for a previous MI were associated with high LVMS values and unspecific or absent ECG changes with low LVMS values. Decision thresholds for ECG changes and asynergy in diagnosing a previous MI were evaluated by means of a ROC analysis. The accuracy of ECG in detecting a previous MI was slightly higher when asynergy indicated a 'true MI' than when autopsy result did so in a comparable group. Therefore the accuracy of asynergy (LVMS ≥ 1) in detecting a previous MI or myocardial fibrosis in patients with CHD should be at least comparable with that of autopsy (scar > 1 cm). (orig.)

Accountable priority setting for trust in health systems - the need for research into a new approach for strengthening sustainable health action in developing countries

Directory of Open Access Journals (Sweden)

Olsen Øystein E

2009-10-01

Full Text Available Abstract Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i relevance to the local setting, decided by agreed criteria; ii publicizing priority-setting decisions and the reasons behind them; iii the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being

Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries.

Science.gov (United States)

Byskov, Jens; Bloch, Paul; Blystad, Astrid; Hurtig, Anna-Karin; Fylkesnes, Knut; Kamuzora, Peter; Kombe, Yeri; Kvåle, Gunnar; Marchal, Bruno; Martin, Douglas K; Michelo, Charles; Ndawi, Benedict; Ngulube, Thabale J; Nyamongo, Isaac; Olsen, Oystein E; Onyango-Ouma, Washington; Sandøy, Ingvild F; Shayo, Elizabeth H; Silwamba, Gavin; Songstad, Nils Gunnar; Tuba, Mary

2009-10-24

Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met.REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research

Men's health promotion interventions: what have we learned from previous programmes.

Science.gov (United States)

Robertson, Steve; Witty, Karl; Zwolinsky, Steve; Day, Rhiannon

2013-11-01

Concern persists in health-related literature about men's reduced life expectancy and higher premature death rates; this is often linked to difficulties in engaging with men as a client group. However, some innovative projects and programmes, often led by health visitors or other community based nurses, have developed successful health promotion work with men. This article collates existing tacit knowledge (previous learning) about men's health interventions by integrating interview data from nine practitioners who have established such initiatives with data from 35 men's health project reports to consider 'what works'. Five themes stood out as being significant across the data reviewed: using the right setting (often outside statutory services); ensuring the right approach (drawing on male-specific interests and language); actively listening to what local men say; appropriate training (initial and ongoing) for those involved in such work; and partnership working with local community groups, businesses and statutory service providers. While not a panacea for working with any and all men, these themes form a good basis for successful engagement with men and align well with what a recent review of health visitor interventions suggest works in helping bridge service provision-uptake gaps.

A META-COMPOSITE SOFTWARE DEVELOPMENT APPROACH FOR TRANSLATIONAL RESEARCH

Science.gov (United States)

Sadasivam, Rajani S.; Tanik, Murat M.

2013-01-01

Translational researchers conduct research in a highly data-intensive and continuously changing environment and need to use multiple, disparate tools to achieve their goals. These researchers would greatly benefit from meta-composite software development or the ability to continuously compose and recompose tools together in response to their ever-changing needs. However, the available tools are largely disconnected, and current software approaches are inefficient and ineffective in their support for meta-composite software development. Building on the composite services development approach, the de facto standard for developing integrated software systems, we propose a concept-map and agent-based meta-composite software development approach. A crucial step in composite services development is the modeling of users’ needs as processes, which can then be specified in an executable format for system composition. We have two key innovations. First, our approach allows researchers (who understand their needs best) instead of technicians to take a leadership role in the development of process models, reducing inefficiencies and errors. A second innovation is that our approach also allows for modeling of complex user interactions as part of the process, overcoming the technical limitations of current tools. We demonstrate the feasibility of our approach using a real-world translational research use case. We also present results of usability studies evaluating our approach for future refinements. PMID:23504436

A meta-composite software development approach for translational research.

Science.gov (United States)

Sadasivam, Rajani S; Tanik, Murat M

2013-06-01

Translational researchers conduct research in a highly data-intensive and continuously changing environment and need to use multiple, disparate tools to achieve their goals. These researchers would greatly benefit from meta-composite software development or the ability to continuously compose and recompose tools together in response to their ever-changing needs. However, the available tools are largely disconnected, and current software approaches are inefficient and ineffective in their support for meta-composite software development. Building on the composite services development approach, the de facto standard for developing integrated software systems, we propose a concept-map and agent-based meta-composite software development approach. A crucial step in composite services development is the modeling of users' needs as processes, which can then be specified in an executable format for system composition. We have two key innovations. First, our approach allows researchers (who understand their needs best) instead of technicians to take a leadership role in the development of process models, reducing inefficiencies and errors. A second innovation is that our approach also allows for modeling of complex user interactions as part of the process, overcoming the technical limitations of current tools. We demonstrate the feasibility of our approach using a real-world translational research use case. We also present results of usability studies evaluating our approach for future refinements.

Laser in situ keratomileusis enhancements with the Ziemer FEMTO LDV femtosecond laser following previous LASIK treatments.

Science.gov (United States)

Pietilä, Juhani; Huhtala, Anne; Mäkinen, Petri; Uusitalo, Hannu

2013-02-01

The aim of this paper is to present the accuracy, predictability, and safety outcomes of LASIK enhancements performed with the FEMTO LDV femtosecond laser (Ziemer Ophthalmic Systems, Port, Switzerland) and the Allegretto Wave Concerto 500 Hz excimer laser (Wavelight AG, Erlangen, Germany), following previous LASIK treatments. FEMTO LDV was used for flap creation in 85 previously LASIK-treated eyes of 62 patients. The intended flap thickness was 90 μm in 81 eyes and 140 μm in 4 eyes. The size of the suction ring was 9.0 mm in 72 eyes and 9.5 mm in 13 eyes. Flap dimensions were measured and correlated to preoperative characteristics. With the intended flap thickness of 90 μm in previously LASIK-treated eyes, the actual flap thickness was 90.2 ± 6.6 μm (range 80-122), and the flap diameter was 9.2 ± 0.2 mm (range 8.7-9.9). The mean hinge length was 4.0 ± 0.2 mm (range 3.0-4.8). Flap thickness correlated positively with patient age and hinge length. Complications were reported in 12 eyes (14.1 %). Most of the complications were very mild, and none of them prevented further refractive laser treatment. One eye lost two Snellen lines of best spectacle-corrected visual acuity. Femtosecond LASIK enhancement is warranted only in rare cases. Surgical experience is needed and special caution must be practiced. For cases of a primary free cap, femtosecond LASIK is not recommended.

Improvements in Hudson River Water Quality Create the Need for a new Approach to Monitoring and Management

Science.gov (United States)

O'Mullan, G. D.; Juhl, A.; Sambrotto, R.; Lipscomb, J.; Brown, T.

2008-12-01

localized events, demonstrate that a new approach is needed to monitor and manage the lower Hudson River Estuary. One important component of this new approach is consideration of local and extreme conditions, rather than just spatial and temporal means. Another aspect is increased public dissemination of available water quality data. A new Hudson River water quality web site has been launched as an example of this type of public outreach.

Determinants of childhood obesity: need for a trans-sectoral convergent approach.

Science.gov (United States)

Kiranmala, Naorem; Das, Manoja K; Arora, Narendra K

2013-03-01

The emerging burden of non communicable diseases is likely to erode the "Demographic-Dividend" of India and compromise the national growth and development. Increasing rates of childhood obesity globally and in India is a cause for serious public health concern. It is becoming increasingly apparent that obesity is result of complex interplay between multiple genes, environmental factors and human behavior. Clear comprehension of this interaction and pathway is still not clear, making the prevention and management of obesity especially challenging. Globalization and rapid economic growth has led to dramatic changes in the life style of the population including food intake, physical activity, market, environmental factors and social structures. A growing economy, urbanization and motorized transport have increased physical inactivity. A systematic multi-sectoral approach with population health as the center of discourse and attention is the only key to tackle this problem.

The enabling approach for housing supply

Directory of Open Access Journals (Sweden)

Ghada Farouk Hassan

2011-12-01

The paper attempts to highlight prerequisites needed to improve the success of the enabling approach in achieving adequate housing provision. Then the paper revisits the Egyptian experiences in the application of the enabling approach from 2005 till 2010. Finally, the paper highlights the main drops and lessons must be considered as promising approach after the revolution.

The crisis is homemade. Why we need a playful approach in teaching and practising strategic preparedness

Directory of Open Access Journals (Sweden)

Reinhard Ematinger

2012-01-01

Full Text Available Although the research on how to develop strategic preparedness, or resilience, has generated a great deal of interest among organizational theorists, many of the empirical studies conducted share important methodological limitations. When investigating how educational experiences boosting the participants’ capacities to learn, adapt, and apply can create sustainable value for organizations – be it non-profit-organizations or international enterprises – it becomes obvious that applied systematic creativity like playful construction, improvisation, and imagination, as well as making use of design thinking approaches, will benefit the organizations’ strategic preparedness for future scenarios.The first chapter will be on a relevant framework and the theories which fuel the value of playful and design-led approaches when it comes to corporate strategy, service development, and team identity. The framework will be illustrated in the second chapter with a proven approach designed for this very purpose. The third chapter will reflect on how to utilize this approach for teaching purposes and will elaborate on a draft for educators who want to move in this direction.

Pediatric acute gastroenteritis: understanding caregivers' experiences and information needs.

Science.gov (United States)

Albrecht, Lauren; Hartling, Lisa; Scott, Shannon D

2017-05-01

Pediatric acute gastroenteritis (AGE) is a common condition with high health care utilization, persistent practice variation, and substantial family burden. An initial approach to resolve these issues is to understand the patient/caregiver experience of this illness. The objective of this study was to describe caregivers' experiences of pediatric AGE and identify their information needs, preferences, and priorities. A qualitative, descriptive study was conducted. Caregivers of a child with AGE were recruited for this study in the pediatric emergency department (ED) at a tertiary hospital in a major urban centre. Individual interviews were conducted (n=15), and a thematic analysis of interview transcripts was completed using a hybrid inductive/deductive approach. Five major themes were identified and described: 1) caregiver management strategies; 2) reasons for going to the ED; 3) treatment and management of AGE in the ED; 4) caregivers' information needs; and 5) additional factors influencing caregivers' experiences and decision-making. A number of subthemes within each major theme were identified and described. This qualitative descriptive study has identified caregiver information needs, preferences, and priorities regarding pediatric AGE. This study also identified inconsistencies in the treatment and management of pediatric AGE at home and in the ED that influence health care utilization and patient outcomes related to pediatric AGE.

Financing to meet community needs: a guide for small hospitals.

Science.gov (United States)

Wilson, Bill

2009-03-01

To succeed in the current financial markets, small hospitals need flexible project and financing plans. Many small local banks today can offer small hospitals financing solutions on par with what was previously offered only by the country's strongest investment-grade rated banks. Federal assistance through programs such as HUD's Section 242 mortgage insurance program is also a viable option for small hospitals.

Energy needs

International Nuclear Information System (INIS)

Chateau, Bertrand

2014-05-01

The author first discusses the various concepts and definitions associated with energy needs, and then the difference between actual needs and energy needs by distinguishing personal needs, needs of the productive sector, energetic needs and services. In the next part, he discusses how energy needs are assessed. He discusses the relationship between energy needs and energy consumption, how energy consumptions can be analysed and interpreted. He comments how energy needs can be assessed and analysed in time and in space. He notices and explains why economy and climate are the main causes of spatial differences for energy needs per habitant, and comments the evolution of energy consumption over long periods

Indicators of development: the search for a basic-needs yardstick

Energy Technology Data Exchange (ETDEWEB)

Hicks, N; Streeten, P

1979-06-01

The measurement of development efforts in developing countries has generally focused on the growth of GNP per head and related concepts. Increasingly, development economists have become aware that growth of output or income by themselves are not adequate indicators of development, and that the reduction of poverty and the satisfaction of basic human needs are goals that should show up in a measure of development. There has been growing interest in designing better measures of development, including modifications of GNP, social indicators and associated systems of social accounts, and composite indices of development. A review of these approaches and concepts points to the conclusion that the use of social and human indicators is the most promising supplement to GNP, particularly if work on social indicators is done in areas central to the basic-needs approach. 48 references, 5 notes.

On the Tengiz petroleum deposit previous study

International Nuclear Information System (INIS)

Nysangaliev, A.N.; Kuspangaliev, T.K.

1997-01-01

Tengiz petroleum deposit previous study is described. Some consideration about structure of productive formation, specific characteristic properties of petroleum-bearing collectors are presented. Recommendation on their detail study and using of experience on exploration and development of petroleum deposit which have analogy on most important geological and industrial parameters are given. (author)

An Approach to Interface Synthesis

DEFF Research Database (Denmark)

Madsen, Jan; Hald, Bjarne

1995-01-01

Presents a novel interface synthesis approach based on a one-sided interface description. Whereas most other approaches consider interface synthesis as optimizing a channel to existing client/server modules, we consider the interface synthesis as part of the client/server module synthesis (which...... may contain the re-use of existing modules). The interface synthesis approach describes the basic transformations needed to transform the server interface description into an interface description on the client side of the communication medium. The synthesis approach is illustrated through a point...

Approach and plan for cleanup actions in the 100-FR-2 operable unit of the Hanford Site, Revision 0

International Nuclear Information System (INIS)

1995-06-01

A new administrative approach is being used to reach a cleanup decision for the 100-FR-2 Operable Unit. The unit, located at the 100-F Area, contains solid waste sites and is one of the remaining operable units scheduled for characterization and cleanup in the 100 Area. This Focus Package (1) describes the new approach and activities needed to reach a decision on cleanup actions for the 100-FR-2 Operable Unit and (2) invites public participation into the planning process. The previous approach included the production of a Work Plan, a Limited Field Investigation Report, a Qualitative Risk Assessment, a Focused Feasibility Study, and a Proposed Plan, all culminating in an interim action Record of Decision. Information gathered to date on other operable units allows the analgous site approach to be used on the 100-FR-2 Operable Unit, and therefore, a reduction in documentation preparation. The U.S. Environmental Protection Agency, Washington State Department of Ecology, and the U.S. Department of Energy (Tri-Party Agreement) believe that the new approach will save time and funding. In the new approach, the Work Plan has been condensed into this 12 page Focus Package. The Focus Package includes a summary of 100-F Area information, a list of waste sites in the 100-FR-2 Operable Unit, a summary of proposed work, and a schedule. The new approach will also combine the Limited Field Investigation and Qualitative Risk Assessment reports into the Focused Feasibility Study. The Focused Feasibility Study will analyze methods and costs to clean up waste sites. Consolidating the documents should reduce the time to complete the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) process by 16 months, compared to the previous approach

What You Need to Know about Project Management

CERN Document Server

O'Connell, Fergus

2012-01-01

What You Need to Know About Project Management Project Management is all about getting things done without spending too much or taking too long. But when you start hearing things like man-days, PSOs and stakeholders, it just makes it difficult to understand. So what do you really need to know about project management? Find out:Why setting clear goals mattersHow to estimate absolutely everything.How to get things back on track after they've gone wrongHow to track big projectsWhy work/life balance matters when you're running a big project This clear and simple approach will mean you'll never pan

Identification of future engineering-development needs of alternative concepts for magnetic-fusion energy

International Nuclear Information System (INIS)

Krakowski, R.A.

1982-01-01

A qualitative identification of future engineering needs of alternative fusion concepts (AFCs) is presented. These needs are assessed relative to the similar needs of the tokamak in order to emphasize differences in required technology with respect to the well documented mainline approach. Although nearly thirty AFCs can be identified as being associated with some level of reactor projection, redirection, refocusing, and general similarities can be used to generate a reduced AFC list that includes only the bumpy tori, stellarators, reversed-field pinches, and compact toroids. Furthermore, each AFC has the potential of operating as a conventional (low power density, superconducting magnets) or a compact, high-power-density (HPD) system. Hence, in order to make tractable an otherwise difficult task, the future engineering needs for the AFCs are addressed here for conventional versus compact approaches, with the latter being treated as a generic class and the former being composed of bumpy tori, stellarators, reversed-field pinches, and compact toroids

Planning flexible learning to match the needs of consumers: a national survey.

Science.gov (United States)

Ayer, S; Smith, C

1998-05-01

The injection of market forces into the National Health Service (NHS) has led to nurse education being viewed as a commodity which educational institutions supply and NHS employers purchase. Conscious of the costs of paying for courses within this new consumer culture, NHS trusts and other health service employers are increasingly looking for cost-effective flexible training to educate their workforce quickly and efficiently. Parallel to this is the accelerated demand for continuing professional development (CPD) brought about by the inception of the UKCC's Post-Registration Education and Practice Project (PREPP). Both registered and enrolled nurses are finding they need professional updating and skills and thus increased access to courses. The increased demand for education and training brought about by these changes cannot be met through traditional methods alone, requiring educational institutions to re-appraise their methods of delivery and introduce more flexible approaches to learning. There is every evidence that this is now the case with open learning, distance learning and flexible approaches to learning ever growing in popularity as providers of nurse education recognize the benefits such approaches offer. The emphasis is on meeting the diverse needs of the health care employers and individuals by providing education that is flexible, learner-centred and customer focused. This paper presents the findings of a national survey to ascertain how providers of flexible education plan educational programmes to meet the needs of their customers. Based on data collected from 120 educational institutions within the higher education, health and social care and private sectors, it highlights: the ways in which flexible learning programmes and courses are delivered; what aspects of flexibility are considered important when designing programmes to meet the needs of prospective customers; and what approaches are used to assess demand for flexible education. The study

Transforming User Needs into Functional Requirements for an Antibiotic Clinical Decision Support System

Science.gov (United States)

Bright, T.J.

2013-01-01

Summary Background Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. Objective To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). Methods The approach consisted of five steps: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. Results The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. Conclusion This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an

Previous experiences and emotional baggage as barriers to lifestyle change - a qualitative study of Norwegian Healthy Life Centre participants.

Science.gov (United States)

Følling, Ingrid S; Solbjør, Marit; Helvik, Anne-S

2015-06-23

Changing lifestyle is challenging and difficult. The Norwegian Directorate of Health recommends that all municipalities establish Healthy Life Centres targeted to people with lifestyle issues. Little is known about the background, experiences and reflections of participants. More information is needed about participants to shape effective lifestyle interventions with lasting effect. This study explores how participants in a lifestyle intervention programme describe previous life experiences in relation to changing lifestyle. Semi-structured qualitative in-depth interviews were performed with 23 participants (16 women and 7 men) aged 18 - 70 years. The data were analysed using systematic text condensation searching for issues describing participants' responses, and looking for the essence, aiming to share the basis of life-world experiences as valid knowledge. Participants identified two main themes: being stuck in old habits, and being burdened with emotional baggage from their previous negative experiences. Participants expressed a wish to change their lifestyles, but were unable to act in accordance with the health knowledge they possessed. Previous experiences with lifestyle change kept them from initiating attempts without professional assistance. Participants also described being burdened by an emotional baggage with problems from childhood and/or with family, work and social life issues. Respondents said that they felt that emotional baggage was an important explanation for why they were stuck in old habits and that conversely, being stuck in old habits added load to their already emotional baggage and made it heavier. Behavioural change can be hard to perform as psychological distress from life baggage can influence the ability to change. The study participants' experience of being stuck in old habits and having substantial emotional baggage raises questions as to whether or not Healthy Life Centres are able to help participants who need to make a lifestyle

Technical Note: A novel leaf sequencing optimization algorithm which considers previous underdose and overdose events for MLC tracking radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Wisotzky, Eric, E-mail: eric.wisotzky@charite.de, E-mail: eric.wisotzky@ipk.fraunhofer.de; O’Brien, Ricky; Keall, Paul J., E-mail: paul.keall@sydney.edu.au [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, NSW 2006 (Australia)

2016-01-15

Purpose: Multileaf collimator (MLC) tracking radiotherapy is complex as the beam pattern needs to be modified due to the planned intensity modulation as well as the real-time target motion. The target motion cannot be planned; therefore, the modified beam pattern differs from the original plan and the MLC sequence needs to be recomputed online. Current MLC tracking algorithms use a greedy heuristic in that they optimize for a given time, but ignore past errors. To overcome this problem, the authors have developed and improved an algorithm that minimizes large underdose and overdose regions. Additionally, previous underdose and overdose events are taken into account to avoid regions with high quantity of dose events. Methods: The authors improved the existing MLC motion control algorithm by introducing a cumulative underdose/overdose map. This map represents the actual projection of the planned tumor shape and logs occurring dose events at each specific regions. These events have an impact on the dose cost calculation and reduce recurrence of dose events at each region. The authors studied the improvement of the new temporal optimization algorithm in terms of the L1-norm minimization of the sum of overdose and underdose compared to not accounting for previous dose events. For evaluation, the authors simulated the delivery of 5 conformal and 14 intensity-modulated radiotherapy (IMRT)-plans with 7 3D patient measured tumor motion traces. Results: Simulations with conformal shapes showed an improvement of L1-norm up to 8.5% after 100 MLC modification steps. Experiments showed comparable improvements with the same type of treatment plans. Conclusions: A novel leaf sequencing optimization algorithm which considers previous dose events for MLC tracking radiotherapy has been developed and investigated. Reductions in underdose/overdose are observed for conformal and IMRT delivery.

Learning from a Special Care Dentistry Needs Assessment.

Science.gov (United States)

Johnson, Ilona

2015-05-01

The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales. The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD. A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping. Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services. General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.

Successive Research: A Strategy for Building on Previous Research.

Science.gov (United States)

Noble, Mary Anne

1979-01-01

Describes an approach to clinical research used by the author in teaching graduate nursing students, involving replication and expansion of a primary study of hospital intensive care units. This approach provided valuable experience as well as validated data about clinical practice. Discusses advantages and disadvantages in the approach. (MF)

Aeroelastic modelling without the need for excessive computing power

Energy Technology Data Exchange (ETDEWEB)

Infield, D. [Loughborough Univ., Centre for Renewable Energy Systems Technology, Dept. of Electronic and Electrical Engineering, Loughborough (United Kingdom)

1996-09-01

The aeroelastic model presented here was developed specifically to represent a wind turbine manufactured by Northern Power Systems which features a passive pitch control mechanism. It was considered that this particular turbine, which also has low solidity flexible blades, and is free yawing, would provide a stringent test of modelling approaches. It was believed that blade element aerodynamic modelling would not be adequate to properly describe the combination of yawed flow, dynamic inflow and unsteady aerodynamics; consequently a wake modelling approach was adopted. In order to keep computation time limited, a highly simplified, semi-free wake approach (developed in previous work) was used. a similarly simple structural model was adopted with up to only six degrees of freedom in total. In order to take account of blade (flapwise) flexibility a simple finite element sub-model is used. Good quality data from the turbine has recently been collected and it is hoped to undertake model validation in the near future. (au)

Are experiences of sexual violence related to special needs in patients with substance use disorders? A study in opioid-dependent patients.

Science.gov (United States)

Schäfer, Ingo; Gromus, Lil; Atabaki, Armita; Pawils, Silke; Verthein, Uwe; Reimer, Jens; Schulte, Bernd; Martens, Marcus

2014-12-01

A history of sexual violence has been related to more complex treatment needs in patients with substance use disorders (SUD). Most of the existing studies, however, included patients with various types of SUD, did not examine gender differences and focused on a small range of clinical domains. Our sample consisted of opioid-dependent outpatients treated during a three-year period in a German metropolitan region. The analysis was based on a local case register and included all patients for whom information on lifetime sexual violence was available (N=3531; 68.3% males). In a case-control design, patients with a history of sexual violence were compared to patients without these experiences regarding a wide range of clinical and social factors indicative of potential needs. Almost two thirds (65.6%) of the female patients and 10.9% of the males reported experiences of sexual violence. Victims differed from non-victims across a variety of domains, including more psychiatric symptoms and suicide attempts, more legal problems, financial and family problems, as well as a higher use of services. In contrast to a previous study among alcohol-dependent patients, no gender differences became apparent. Our findings suggest that experiences of sexual violence are an indicator for more complex needs in opioid-dependent patients of both genders. In addition to integrated trauma-informed approaches, an effort needs to be made to link addiction facilities to further institutions to meet these complex needs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Defining the Needs of Patients with Intellectual Disabilities in the High Security Psychiatric Hospitals in England

Science.gov (United States)

Thomas, S. D.; Dolan, M.; Johnston, S.; Middleton, H.; Harty, M. A.; Carlisle, J.; Thornicroft, G.; Appleby, L.; Jones, P.

2004-01-01

Previous studies have suggested that a substantial proportion of the patients with intellectual disabilities (ID) in the high security psychiatric hospitals (HSPHs) should be transferred to more appropriate services to cater for their specific needs in the longer term. The individual and placement needs of high secure psychiatric patients detained…

Trajectories and Expectations in China. A Decentered Approach to Spanish International Mobility

Directory of Open Access Journals (Sweden)

Amelia Sáiz López

2017-12-01

Full Text Available The decade of 2010 has awakened the research interest in emerging flows of qualified young people towards Europe and Latin America. Spanish international migration is not exhausted in these destinations. A decentralized approach allows studying the Spanish residents in Shanghai, elaborating a typology from the perspective of mobilities where processes analyzed separately in previous migration studies converge. The complexity of mobility is not only explained by the geographical or labor dimensions. Based on in-depth interviews, the proposed qualitative analysis shows the need to cross-link all dimensions involved in individual and collective decision-making and the different strategies, within a given gender system, and according to objectives, social and family positions, resources and capital, in the context of globalization.

Staging the Axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer

International Nuclear Information System (INIS)

Ruano, R.; Garcia-Talavera, J.R.; Arriba, A. de; Ramos, M.; Gonzalez-Orus, J.; Iglesias, M.; Serrano, E.; Macias, M.C.

2008-01-01

To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ( 99m Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located. Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla. The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue. (orig.)

Tanks Focus Area Site Needs Assessment - FY 2001

Energy Technology Data Exchange (ETDEWEB)

Allen, Robert W.; Josephson, Gary B.; Westsik, Joseph H.; Nickola, Cheryl L.

2001-04-30

The TFA uses a systematic process for developing its annual program that draws from the tanks science and technology development needs expressed by the five DOE tank waste sites. TFA's annual program development process is iterative and involves the following steps: Collection of site needs; Needs analysis; Development of technical responses and initial prioritization; Refinement of the program for the next fiscal year; Formulation of the Corporate Review Budget (CRB); Preparation of Program Execution Guidance (PEG) for the next FY Revision of the Multiyear Program Plan (MYPP). This document describes the outcomes of the first phase of this process, from collection of site needs to the initial prioritization of technical activities. The TFA received site needs in October - December 2000. A total of 170 site needs were received, an increase of 30 over the previous year. The needs were analyzed and integrated, where appropriate. Sixty-six distinct technical responses were drafted and prioritized. In addition, seven strategic tasks were approved to compete for available funding in FY 2002 and FY 2003. Draft technical responses were prepared and provided to the TFA Site Representatives and the TFA User Steering Group (USG) for their review and comment. These responses were discussed at a March 15, 2001, meeting where the TFA Management Team established the priority listing in preparation for input to the DOE Office of Science and Technology (OST) budget process. At the time of publication of this document, the TFA continues to finalize technical responses as directed by the TFA Management Team and clarify the intended work scopes for FY 2002 and FY 2003.

Complementarities of two existing intermediate conservation approaches

Directory of Open Access Journals (Sweden)

Sergei Volis

2017-12-01

Full Text Available The need for integration of ex situ and in situ approaches in conservation of plants has long been recognized. However, ex situ collections have numerous limitations that reduce their utility for conservation, necessitating the introduction of new, more appropriate, flexible and less costly approaches. Two new approaches that can be called “intermediate” between in situ and ex situ, and bridging them in some way have been proposed over the last two decades. In these approaches material collected in natural populations is planted and maintained outside the original location, but with a different purpose. While the purpose of the inter situs approach is reintroduction, the concern of the quasi in situ approach is long-term storage of species genetic diversity. I view these two approaches as complementary and necessary components of conservation-oriented restoration. In restoration of a degraded habitat using threatened species (i.e. inter situs, quasi in situ collections can serve an important role in providing long-term preservation of these species’ genetic diversity and production of seeds needed for restoration.

A New Approach for Assessing the Needs of Service Members and Their Families

Science.gov (United States)

2011-01-01

their families. Nothing that I do as the Secretary of the Army is more important than this [emphasis added] ( Harvey , 2009). According to the Army...to address the physical, material, mental and spiritual needs of each member of the Total Army Family [emphasis added] ( Harvey and Schoomaker, 2006...Laurie Weinstein and Christie C. White, eds., Wives and Warriors: Women and the Military in the United States and Canada, Westport, Conn.: Greenwood

Who's empowered to protect? How are they empowered? What do they need to know?