PREPARE Study: Patient satisfaction survey with care provided in the low clearance clinic

Background Formalised predialysis care has been shown to extend the wellness of individuals with advanced chronic kidney disease, slow disease progression and increase the uptake of home dialysis. Predialysis care, incorporating multidisciplinary input is also vital in delaying the onset of end-stage kidney disease and reducing hospital admissions; thereby decreasing financial demands on health budgets. Predialysis care should include comprehensive information provision and predialysis education. This empowers patients to choose self-care strategies and therapies.

“I understand. I am a participant”: Navigating the ‘fuzzy’ boundaries of visual methods in qualitative longitudinal research

In this chapter we discuss how utilising the participatory visual methodology, photovoice, in an aged care context with its unique communal setting raised several ‘fuzzy boundary’ ethical dilemmas. To illustrate these challenges, we draw on immersive field notes from an ongoing qualitative longitudinal research (QLR) exploring the lived experience of aged care from the perspective of older residents, and focus on interactions with one participant, 81 year old Cassie. We explore how the camera, which is integral to the photovoice method, altered the researcher/participant ethical dynamics by becoming a continual ‘connector’ to the researcher. The camera took on a distinct agency, acting as a non-threatening ‘portal’ that lengthened contact, provided informal opportunities to alter the relationship dynamics and enabled unplanned participant revelation.

Fuzzy Logic-Based Approaches in Water Resource System Modelling

Recent research in modelling uncertainty in water resource systems has highlighted the use of fuzzy logic-based approaches. A number of research contributions exist in the literature that deal with uncertainty in water resource systems including fuzziness, subjectivity, imprecision and lack of adequate data. This chapter presents a broad overview of the fuzzy logic-based approaches adopted in addressing uncertainty in water resource systems modelling. Applications of fuzzy rule-based systems and fuzzy optimisation are then discussed. Perspectives on the scope for further research are presented.

A Global Constraint On Relative Rotation To Avoid Lumped Compliant Mechanisms In Topology Optimization

Some of the well known formulations for topology optimization of compliant mechanisms could lead to lumped compliant mechanisms. In lumped compliance, most of the elastic deformation in a mechanism occurs at few points, while rest of the mechanism remains more or less rigid. Such points are referred to as point-flexures. It has been noted in literature that high relative rotation is associated with point-flexures. In literature we also find a formulation of local constraint on relative rotations to avoid lumped compliance. However it is well known that a global constraint is easier to handle than a local constraint, by a numerical optimization algorithm. The current work presents a way of putting global constraint on relative rotations. This constraint is also simpler to implement since it uses linearized rotation at the center of finite-elements, to compute relative rotations. I show the results obtained by using this constraint oil the following benchmark problems - displacement inverter and gripper.

Haemodialysis work environment contributors to job satisfaction and stress: A sequential mixed methods study

Background: Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses. Methods: Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction(IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed. Results: From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful. Conclusions: Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.

A fuzzy multistage evolutionary (FUME) clustering technique

n this paper, a multistage evolutionary scheme is proposed for clustering in a large data base, like speech data. This is achieved by clustering a small subset of the entire sample set in each stage and treating the cluster centroids so obtained as samples, together with another subset of samples not considered previously, as input data to the next stage. This is continued till the whole sample set is exhausted. The clustering is accomplished by constructing a fuzzy similarity matrix and using the fuzzy techniques proposed here. The technique is illustrated by an efficient scheme for voiced-unvoiced-silence classification of speech.

A Fuzzy Approximation Scheme for Sequential Learning in Pattern Recognition

An adaptive learning scheme, based on a fuzzy approximation to the gradient descent method for training a pattern classifier using unlabeled samples, is described. The objective function defined for the fuzzy ISODATA clustering procedure is used as the loss function for computing the gradient. Learning is based on simultaneous fuzzy decisionmaking and estimation. It uses conditional fuzzy measures on unlabeled samples. An exponential membership function is assumed for each class, and the parameters constituting these membership functions are estimated, using the gradient, in a recursive fashion. The induced possibility of occurrence of each class is useful for estimation and is computed using 1) the membership of the new sample in that class and 2) the previously computed average possibility of occurrence of the same class. An inductive entropy measure is defined in terms of induced possibility distribution to measure the extent of learning. The method is illustrated with relevant examples.

The role of engagement on stakeholder's satisfaction with the destination marketing organisation's performance

In the tourism literature there has been a lack of research related to stakeholders' satisfaction with destination marketing organisations (DMO). This study addresses this research gap, in the context of the national tourism office of Oman, by investigating the relationship between stakeholder's perceptions of DMO performance and their overall satisfaction with the DMO. Conceptually the study found DMO engagement with stakeholders to partially mediate satisfaction, a finding of relevance to destination marketers in other parts of the world. From a practical perspective the research was supported by the Oman national tourism office, which has only been in operation for 10 years.

Constraint effects on multiple void interaction in pressure sensitive plastic solids

In this work, effects of pressure sensitive yielding and plastic dilatancy on void growth and void interaction mechanisms in fracture specimens displaying high and low constraint levels are investigated. To this end, large deformation finite element simulations are carried out with discrete voids ahead of the notch. It is observed that multiple void interaction mechanism which is favored by high initial porosity is further accelerated by pressure sensitive yielding, but is retarded by loss of constraint. The resistance curves predicted based on a simple void coalescence criterion show enhancement in fracture resistance when constraint level is low and when pressure sensitivity is suppressed.

A fuzzy logic based dynamic wave model inversion algorithm for canal regulation

A fuzzy logic based centralized control algorithm for irrigation canals is presented. Purpose of the algorithm is to control downstream discharge and water level of pools in the canal, by adjusting discharge release from the upstream end and gates settings. The algorithm is based on the dynamic wave model (Saint-Venant equations) inversion in space, wherein the momentum equation is replaced by a fuzzy rule based model, while retaining the continuity equation in its complete form. The fuzzy rule based model is developed on fuzzification of a new mathematical model for wave velocity, the derivational details of which are given. The advantages of the fuzzy control algorithm, over other conventional control algorithms, are described. It is transparent and intuitive, and no linearizations of the governing equations are involved. Timing of the algorithm and method of computation are explained. It is shown that the tuning is easy and the computations are straightforward. The algorithm provides stable, realistic and robust outputs. The disadvantage of the algorithm is reduced precision in its outputs due to the approximation inherent in the fuzzy logic. Feed back control logic is adopted to eliminate error caused by the system disturbances as well as error caused by the reduced precision in the outputs. The algorithm is tested by applying it to water level control problem in a fictitious canal with a single pool and also in a real canal with a series of pools. It is found that results obtained from the algorithm are comparable to those obtained from conventional control algorithms.

A fuzzy dynamic flood routing model for natural channels

A fuzzy dynamic flood routing model (FDFRM) for natural channels is presented, wherein the flood wave can be approximated to a monoclinal wave. This study is based on modification of an earlier published work by the same authors, where the nature of the wave was of gravity type. Momentum equation of the dynamic wave model is replaced by a fuzzy rule based model, while retaining the continuity equation in its complete form. Hence, the FDFRM gets rid of the assumptions associated with the momentum equation. Also, it overcomes the necessity of calculating friction slope (S-f) in flood routing and hence the associated uncertainties are eliminated. The fuzzy rule based model is developed on an equation for wave velocity, which is obtained in terms of discontinuities in the gradient of flow parameters. The channel reach is divided into a number of approximately uniform sub-reaches. Training set required for development of the fuzzy rule based model for each sub-reach is obtained from discharge-area relationship at its mean section. For highly heterogeneous sub-reaches, optimized fuzzy rule based models are obtained by means of a neuro-fuzzy algorithm. For demonstration, the FDFRM is applied to flood routing problems in a fictitious channel with single uniform reach, in a fictitious channel with two uniform sub-reaches and also in a natural channel with a number of approximately uniform sub-reaches. It is observed that in cases of the fictitious channels, the FDFRM outputs match well with those of an implicit numerical model (INM), which solves the dynamic wave equations using an implicit numerical scheme. For the natural channel, the FDFRM Outputs are comparable to those of the HEC-RAS model.

Structural Damage Detection Using Modal Curvature and Fuzzy Logic

A fuzzy logic system (FLS) with a new sliding window defuzzifier is proposed for structural damage detection using modal curvatures. Changes in the modal curvatures due to damage are fuzzified using Gaussian fuzzy sets and mapped to damage location and size using the FLS. The first four modal vectors obtained from finite element simulations of a cantilever beam are used for identifying the location and size of damage. Parametric studies show that modal curvatures can be used to accurately locate the damage; however, quantifying the size of damage is difficult. Tests with noisy simulated data show that the method detects damage very accurately at different noise levels and when some modal data are missing.

Pressure sensitive flow and constraint factor in amorphous materials below glass transition

The constraint factor, C (given by the hardness-yield strength ratio H/Y in the fully lastic regime of indentation), in metallic glasses, is greater than three, a reflection of the sensitivity of their plastic flow to pressure. Furthermore, C increases with increasing temperature. In this work, we examine if this is true in amorphous polymers as well, through experiments on amorphous poly(methyl methacrylate) (PMMA). Uniaxial compression as well as spherical indentation tests were conducted in the 248-348 K range to construct H/Y versus indentation strain plots at each temperature and obtain the C-values. Results show that C increases with temperature in PMMA as well. Good correlation between the loss factors, measured using a dynamic mechanical analyzer, and C, suggest that the enhanced sensitivity to pressure is possibly due to beta-relaxation. We offer possible mechanistic reasons for the observed trends in amorphous materials in terms of relaxation processes.

The relationship between the determinants of rental housing satisfaction and considering moving in Finland

Purpose The purpose of this paper is to discuss the relation between dissatisfaction with housing conditions and considering moving among residents of Finnish rental multifamily buildings. The paper examines physical attributes, socioeconomic factors, and subjective opinions related to housing conditions and satisfaction with housing. Design/methodology/approach Logistic regression analysis is used to examine survey data to analyse which factors contribute to dissatisfaction with the housing unit and the apartment building and whether dissatisfaction is related to consideration of moving. Findings The findings indicate that dissatisfaction with the building and individual housing unit are associated with greater probability of considering moving. Satisfaction with kitchen, living room, storage, and building age are the most important indicators of satisfaction with the housing unit, and satisfaction with living room, bathroom, storage, and building age are associated with satisfaction with the apartment building. These are the areas in which landlords could invest in renovations to increase satisfaction in an attempt to reduce turnover. Research limitations/implications The study is conducted with Finnish data only. The sample is not a representative sample of the Finnish population. A longitudinal study would be needed to determine whether dissatisfied residents indending to move actually change residence. Originality/value This study is the first of its kind in the Finnish housing market. It tests a general model that has been suggested to be customized to local conditions. In addition, much of the research on this topic is more than 20 years old. Examination of the model under current housing and socioeconomic conditions is necessary to determine if relationships have changed over time.

A constraint-led approach for PE teachers

The Game Sense coaching approach emphasises the modification of game elements or the development of modified games to achieve learning outcomes. In this article we will introduce the constraints-led approach to learning and demonstrate how the theory can underpin the design of games lessons ensuring that teachers give themselves the best chance of satisfying the skill acquisition and psychological needs of every child in PE.