Using modeling as a co-design approach in the planning process of new care environments

Current research shows a relationship between healthcare architecture and patient-related Outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modelling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience. An explorative and qualitative design was used to describe participants’ experiences of participating in the group modelling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analysed by qualitative content analysis. Two themes were formed, representing the experiences in the group modeling process: ‘Partaking in the G-M created knowledge and empowerment’and ‘Partaking in the G-M was different from what was expected and required time and skills’. The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

The Use of Ternary Mixtures in Concrete, TPF-5(117), 2014

This manual is a summary of the findings of a comprehensive study. Its purpose is to provide engineers with the information they need to make educated decisions on the use of ternary mixtures for constructing concrete structures. It discusses the effects of ternary mixtures on fresh and hardened mixture properties and on concrete sustainability; factors that need to be considered for both structural and mixture design; quality control issues; and three example mixtures from constructed projects

A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up.

This study compared the outcome of total knee replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses during the first post-operative year and at five years' follow-up, using gait parameters as a new objective measure. This double-blind randomised controlled clinical trial included 55 patients with mobile-bearing (n = 26) and fixed-bearing (n = 29) prostheses of the same design, evaluated pre-operatively and post-operatively at six weeks, three months, six months, one year and five years. Each participant undertook two walking trials of 30 m and completed the EuroQol questionnaire, Western Ontario and McMaster Universities osteoarthritis index, Knee Society score, and visual analogue scales for pain and stiffness. Gait analysis was performed using five miniature angular rate sensors mounted on the trunk (sacrum), each thigh and calf. The study population was divided into two groups according to age (≤ 70 years versus > 70 years). Improvements in most gait parameters at five years' follow-up were greater for fixed-bearing TKRs in older patients (> 70 years), and greater for mobile-bearing TKRs in younger patients (≤ 70 years). These findings should be confirmed by an extended age controlled study, as the ideal choice of prosthesis might depend on the age of the patient at the time of surgery.

Error probability in synchronous digital circuits due to power supply noise

This paper presents a probabilistic approach to model the problem of power supply voltage fluctuations. Error probability calculations are shown for some 90-nm technology digital circuits.The analysis here considered gives the timing violation error probability as a new design quality factor in front of conventional techniques that assume the full perfection of the circuit. The evaluation of the error bound can be useful for new design paradigms where retry and self-recoveringtechniques are being applied to the design of high performance processors. The method here described allows to evaluate the performance of these techniques by means of calculating the expected error probability in terms of power supply distribution quality.

Tuotealustapohjaisen suunnittelun vaikutukset risteilijän suunnitteluaikatauluihin

Tuotealustapohjaisella suunnittelulla pyritään hyödyntämään jo kertaalleen hyväksi todettuja kokonaisuuksia ja moduuleja, joiden avulla voidaan nopeasti suunnitella uusia tuotteita. Tarkoituksena on suunnitella asiakkaan näkökulmasta monia erilaisia tuotteita jopa sarjatuotannon kustannustehokkuudella. Tutkimuksessa esitetään risteilijän tuotealustapohjainen suunnitteluprosessi. Lisäksi työn tavoitteena on tutkia uuden suunnitteluprosessin vaikutukset risteilijän suunnitteluaikatauluihin. Tutkimuksessa haastateltiin Turun telakan suunnitteluosaston ja kehitysosaston johtajia. Haastatteluilla selvitettiin nykyisen suunnitteluprosessin haasteita, joiden nähtiin erityisesti viivästyttävät suunnitteluaikatauluja. Keskeisiä haasteita ovat suunnitteluresurssien ylikuormitus ja suunnittelulaadun huonontuminen. Lisäksi kartoitettiin tavoitteet risteilijän tuotealustaratkaisulle ja suunnitteluaikataululle. Haastattelukierroksen pohjalta ja teoriaa soveltaen analysoitiin risteilijän modulaariseen tuotealustaan perustuva suunnitteluprosessi. Tätä suunnitteluprosessia tutkittiin edelleen case-tutkimuksessa jääasemien osalta, jossa haastateltiin kyseisten alueiden suunnittelijoita. Lisäksi case-tutkimuksessa verrattiin jääaseman ja baaripentterin perussuunnittelun vaiheita toisiinsa. Näistä saatuja tutkimustuloksia verrattiin hyttialueen vakioidun perussuunnitteluohjeen vaikutuksiin suunnitteluprosessissa. Onnistunut tuotealustapohjainen suunnittelu vaatii sitoutumista jokaisella organisaation tasolla, jotta tuotealustassa olevien vakioituja moduuleja myös käytettäisiin. Modulaarisesta toiminnasta siirtyminen tuotealustapohjaiseen suunnitteluun vaatii vakioituja moduuleja ja vakioituja rajapintoja risteilijässä. Case-tutkimuksessa ja johtopäätöksissä on todettu uuden suunnitteluprosessin lyhentävän ja tuovan kustannussäästöjä tuotteen valmistusprosessissa.

Tuotekehitysprosessin suorituskyvyn parantaminen pienikokoisessa tuotekehitysorganisaatiossa

Tutkimuksen tavoite on selvittää tuotekehitysprosessin vaiheet ja niihin vaikuttavia tekijöi-tä sekä löytää keinoja, joilla parantaa pienikokoisen tuotekehitysorganisaation tuotekehi-tysprosessia ja tuotekehitystoimintaa. Tutkimuksessa selvitettiin, miten hyvin kohdeor-ganisaation tuotekehitysprosessi vastaa teoriamääritelmiä dokumenttitarkasteluna. Lisäksi kartoitettiin kohdeorganisaation tuotekehitystoiminnan nykytilaa ja haastattelemalla henkilökuntaa. Tutkimusote on toiminta-analyyttinen. Kohdeorganisaatiolla on dokumentoitu tuotekehitysprosessi, josta käy ilmi vaiheet, kriteerit ja vastuut. Prosessi vastaa teoriamääritelmiä sitä paremmin, mitä lähemmäksi prosessin loppua siirrytään. Haastatteluista tuli ilmi, että kohdeorganisaation vahvuudet ovat työntekijöiden osaamisessa ja asenteessa sekä työilmapiirissä. Suurimpia kehityskohtia ovat resurssitilanne ja tuotemäärittelyjen taso. Kohdeorganisaatiossa on liian vähän teki-jöitä tehtävämäärään nähden ja tuotemäärittelyt muuttuvat usein prosessin aikana. Seu-rauksena on mm. aikataulujen venyminen ja suunnittelun laadun heikkeneminen. Tuote-kehitystoiminta nähtiin pääasiassa tuotteiden tuotteistamisessa, ei tuoteideoiden kehittä-misessä. Tuotekehitysprosessin tuntemus vaihtelee ja asiakastarpeet eivät ole tuotekehi-tykselle selvät. Lisäksi henkilökunta ei tunne täysin suorituskyvyn mittareita ja menossa olevia kehityshankkeita. Prosessin kriteerien päivitys ja painotus etupään tehtäviin parantaisi prosessia etenkin prosessin loppupään toiminnoissa. Toiminnan parantamiseksi resursointitilannetta pitää parantaa ja tuotemäärittelyjen analysointiin tulee panostaa enemmän. Lisäksi koulutus prosessista, asiakastarpeista, mittaamisesta ja kehityshankkeista parantaisi kokonaisku-van ymmärtämistä ja näin ollen toiminnan taso parantuisi. Innovaatiotoiminnan ja ideoin-nin lisäämiseksi tulisi tutkia, mitä mahdollisuuksia toiminnan lisäämiseksi on.

Plan Exportador Advantage 6704

Advantage es una empresa de confecciones constituida legalmente en el 2004, la cual se destaca por sus diseños y calidad en sus productos. Gracias a la colaboración obtenida por el gerente de la empresa, el cual facilitó información muy valiosa, se pudo desarrollar el Plan Exportador de la empresa, en el cual después de evaluar una serie de variables se logró identificar el segmento de mercado y tipo de cliente al cual se va a exportar. En este proceso no solo se tuvieron en cuenta, variables relacionadas con la exportación, sino variables que pudieran evaluar cómo se encuentra internamente la empresa. Al obtener los resultados de esta evaluación se sugirieron algunas recomendaciones necesarias para poder comenzar con el Plan Exportador, en el cual se planteará el mercado objetivo con el cual se deberá comenzar, y los pasos a seguir para poder tener una internacionalización exitosa. Hemos desarrollado este trabajo teniendo en cuenta cada factor que pueda afectar de una u otra forma este proceso. La recomendación que consideramos la más importante, es que se concentren en realizar principalmente los cambios internos de la empresa, para que al momento de exportar puedan mostrar no solo ventaja competitiva en diseño y calidad de sus productos, sino que puedan garantizar capacidad productiva y tiempos de entrega adecuados para el mercado objetivo.

Patient-Therapeut-Bindung bei Drogenabhängigen: Instrumentenvalidierung und Therapieevaluation

In der vorliegenden Arbeit wird zum einen ein Instrument zur Erfassung der Patient-Therapeut-Bindung validiert (Client Attachment to Therapist Scale, CATS; Mallinckrodt, Coble & Gantt, 1995), zum anderen werden Hypothesen zu den Zusammenhängen zwischen Selbstwirksamkeitserwartung, allgemeinem Bindungsstil, therapeutischer Beziehung (bzw. Therapiezufriedenheit), Patient-Therapeut-Bindung und Therapieerfolg bei Drogen-abhängigen in stationärer Postakutbehandlung überprüft. In die Instrumentenvalidierung (einwöchiger Retest) wurden 119 Patienten aus 2 Kliniken und 13 Experten einbezogen. Die Gütekriterien des Instrumentes fallen sehr zufriedenstellend aus. An der naturalistischen Therapieevaluationsstudie (Prä-, Prozess-, Post-Messung: T0, T1, T2) nahmen 365 Patienten und 27 Therapeuten aus 4 Kliniken teil. Insgesamt beendeten 44,1% der Patienten ihren stationären Aufenthalt planmäßig. Auf Patientenseite erweisen sich Alter und Hauptdiagnose, auf Therapeutenseite die praktizierte Therapierichtung als Therapieerfolgsprädiktoren. Selbstwirksamkeitserwartung, allgemeiner Bindungsstil, Patient-Therapeut-Bindung und Therapiezufriedenheit eignen sich nicht zur Prognose des Therapieerfolgs. Die zu T0 stark unterdurchschnittlich ausgeprägte Selbstwirksamkeits-erwartung steigert sich über den Interventionszeitraum, wobei sich ein Moderatoreffekt der Patient-Therapeut-Bindung beobachten lässt. Es liegt eine hohe Prävalenz unsicherer allgemeiner Bindungsstile vor, welche sich über den Therapiezeitraum nicht verändern. Die patientenseitige Zufriedenheit mit der Therapie steigt von T1 zu T2 an. Die Interrater-Konkordanz (Patient/Therapeut) zur Einschätzung der Patient-Therapeut-Bindung erhöht sich leicht von T1 zu T2. Im Gegensatz dazu wird die Therapiezufriedenheit von Patienten und Therapeuten zu beiden Messzeitpunkten sehr unterschiedlich beurteilt. Die guten Testgütekriterien der CATS sprechen für eine Überlegenheit dieses Instrumentes gegenüber der Skala zur Erfassung der Therapiezufriedenheit. Deshalb sollte die Patient-Therapeut-Bindung anhand dieses Instrumentes in weiteren Forschungsarbeiten an anderen Patientenkollektiven untersucht werden, um generalisierbare Aussagen zur Validität treffen zu können.

Temperature Variation Aware Energy Optimization in Heterogeneous MPSoCs

Thermal effects are rapidly gaining importance in nanometer heterogeneous integrated systems. Increased power density, coupled with spatio-temporal variability of chip workload, cause lateral and vertical temperature non-uniformities (variations) in the chip structure. The assumption of an uniform temperature for a large circuit leads to inaccurate determination of key design parameters. To improve design quality, we need precise estimation of temperature at detailed spatial resolution which is very computationally intensive. Consequently, thermal analysis of the designs needs to be done at multiple levels of granularity. To further investigate the flow of chip/package thermal analysis we exploit the Intel Single Chip Cloud Computer (SCC) and propose a methodology for calibration of SCC on-die temperature sensors. We also develop an infrastructure for online monitoring of SCC temperature sensor readings and SCC power consumption. Having the thermal simulation tool in hand, we propose MiMAPT, an approach for analyzing delay, power and temperature in digital integrated circuits. MiMAPT integrates seamlessly into industrial Front-end and Back-end chip design flows. It accounts for temperature non-uniformities and self-heating while performing analysis. Furthermore, we extend the temperature variation aware analysis of designs to 3D MPSoCs with Wide-I/O DRAM. We improve the DRAM refresh power by considering the lateral and vertical temperature variations in the 3D structure and adapting the per-DRAM-bank refresh period accordingly. We develop an advanced virtual platform which models the performance, power, and thermal behavior of a 3D-integrated MPSoC with Wide-I/O DRAMs in detail. Moving towards real-world multi-core heterogeneous SoC designs, a reconfigurable heterogeneous platform (ZYNQ) is exploited to further study the performance and energy efficiency of various CPU-accelerator data sharing methods in heterogeneous hardware architectures. A complete hardware accelerator featuring clusters of OpenRISC CPUs, with dynamic address remapping capability is built and verified on a real hardware.

A Measurement System Experiment to Evaluate the Nosing-to-nosing Method for Measuring Dimensions of Steps

Non-uniformity of steps within a flight is a major risk factor for falls. Guidelines and requirements for uniformity of step risers and tread depths assume the measurement system provides precise dimensional values. The state-of-the-art measurement system is a relatively new method, known as the nosing-to-nosing method. It involves measuring the distance between the noses of adjacent steps and the angle formed with the horizontal. From these measurements, the effective riser height and tread depth are calculated. This study was undertaken for the purpose of evaluating the measurement system to determine how much of total measurement variability comes from the step variations versus that due to repeatability and reproducibility (R&R) associated with the measurers. Using an experimental design quality control professionals call a measurement system experiment, two measurers measured all steps in six randomly selected flights, and repeated the process on a subsequent day. After marking each step in a flight in three lateral places (left, center, and right), the measurers took their measurement. This process yielded 774 values of riser height and 672 values of tread depth. Results of applying the Gage R&R ANOVA procedure in Minitab software indicated that the R&R contribution to riser height variability was 1.42%; and to tread depth was 0.50%. All remaining variability was attributed to actual step-to-step differences. These results may be compared with guidelines used in the automobile industry for measurement systems that consider R&R less than 1% as an acceptable measurement system; and R&R between 1% and 9% as acceptable depending on the application, the cost of the measuring device, cost of repair, or other factors.

Selenium for preventing cancer

BACKGROUND This review is an update of the first Cochrane publication on selenium for preventing cancer (Dennert 2011).Selenium is a metalloid with both nutritional and toxicological properties. Higher selenium exposure and selenium supplements have been suggested to protect against several types of cancers. OBJECTIVES Two research questions were addressed in this review: What is the evidence for:1. an aetiological relation between selenium exposure and cancer risk in humans? and2. the efficacy of selenium supplementation for cancer prevention in humans? SEARCH METHODS We conducted electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2013, Issue 1), MEDLINE (Ovid, 1966 to February 2013 week 1), EMBASE (1980 to 2013 week 6), CancerLit (February 2004) and CCMed (February 2011). As MEDLINE now includes the journals indexed in CancerLit, no further searches were conducted in this database after 2004. SELECTION CRITERIA We included prospective observational studies (cohort studies including sub-cohort controlled studies and nested case-control studies) and randomised controlled trials (RCTs) with healthy adult participants (18 years of age and older). DATA COLLECTION AND ANALYSIS For observational studies, we conducted random effects meta-analyses when five or more studies were retrieved for a specific outcome. For RCTs, we performed random effects meta-analyses when two or more studies were available. The risk of bias in observational studies was assessed using forms adapted from the Newcastle-Ottawa Quality Assessment Scale for cohort and case-control studies; the criteria specified in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the risk of bias in RCTs. MAIN RESULTS We included 55 prospective observational studies (including more than 1,100,000 participants) and eight RCTs (with a total of 44,743 participants). For the observational studies, we found lower cancer incidence (summary odds ratio (OR) 0.69, 95% confidence interval (CI) 0.53 to 0.91, N = 8) and cancer mortality (OR 0.60, 95% CI 0.39 to 0.93, N = 6) associated with higher selenium exposure. Gender-specific subgroup analysis provided no clear evidence of different effects in men and women (P value 0.47), although cancer incidence was lower in men (OR 0.66, 95% CI 0.42 to 1.05, N = 6) than in women (OR 0.90, 95% CI 0.45 to 1.77, N = 2). The most pronounced decreases in risk of site-specific cancers were seen for stomach, bladder and prostate cancers. However, these findings have limitations due to study design, quality and heterogeneity that complicate interpretation of the summary statistics. Some studies suggested that genetic factors may modify the relation between selenium and cancer risk-a hypothesis that deserves further investigation.In RCTs, we found no clear evidence that selenium supplementation reduced the risk of any cancer (risk ratio (RR) 0.90, 95% CI 0.70 to 1.17, two studies, N = 4765) or cancer-related mortality (RR 0.81, 95% CI 0.49 to 1.32, two studies, N = 18,698), and this finding was confirmed when the analysis was restricted to studies with low risk of bias. The effect on prostate cancer was imprecise (RR 0.90, 95% CI 0.71 to 1.14, four studies, N = 19,110), and when the analysis was limited to trials with low risk of bias, the interventions showed no effect (RR 1.02, 95% CI 0.90 to 1.14, three studies, N = 18,183). The risk of non-melanoma skin cancer was increased (RR 1.44, 95% CI 0.95 to 1.17, three studies, N = 1900). Results of two trials-the Nutritional Prevention of Cancer Trial (NPCT) and the Selenium and Vitamin E Cancer Trial (SELECT)-also raised concerns about possible increased risk of type 2 diabetes, alopecia and dermatitis due to selenium supplements. An early hypothesis generated by NPCT that individuals with the lowest blood selenium levels at baseline could reduce their risk of cancer, particularly of prostate cancer, by increasing selenium intake has not been confirmed by subsequent trials. As the RCT participants were overwhelmingly male (94%), gender differences could not be systematically assessed. AUTHORS' CONCLUSIONS Although an inverse association between selenium exposure and the risk of some types of cancer was found in some observational studies, this cannot be taken as evidence of a causal relation, and these results should be interpreted with caution. These studies have many limitations, including issues with assessment of exposure to selenium and to its various chemical forms, heterogeneity, confounding and other biases. Conflicting results including inverse, null and direct associations have been reported for some cancer types.RCTs assessing the effects of selenium supplementation on cancer risk have yielded inconsistent results, although the most recent studies, characterised by a low risk of bias, found no beneficial effect on cancer risk, more specifically on risk of prostate cancer, as well as little evidence of any influence of baseline selenium status. Rather, some trials suggest harmful effects of selenium exposure. To date, no convincing evidence suggests that selenium supplements can prevent cancer in humans.

Community-based programmes to prevent pedestrian injuries in children 0-14 years: A systematic review

Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing pedestrian injury in children 0-14 years of age. A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children under 14 years; outcome measure is either pedestrian injury rates or observed child pedestrian or vehicle driver behaviour; and use of a community control or an historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.

Community-based programmes to prevent falls in children: A systematic review

Objective: We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years. Methods: We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Results: Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult. Conclusion: There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Community-based programs to promote care seat restraints in children 0-16 years - A systematic review

Study Objective: Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0-16 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study: target population was children aged 0-16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33-55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1-5 year aged children by up to 11%; child booster seat use in 4-8 year aged children by up to 13%; rear restraint use in children aged 0-15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5-11 years. Conclusion: While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base. (C) 2004 Elsevier Ltd. All rights reserved.

Whole life performance bid evaluation in the Korean public sector

Korea has increasingly adopted design-build for public construction projects in the last few years. There is a much greater awareness of the need to change a system based on ‘Value for Money’ which is high on the government's agenda. A whole life performance bid evaluation model is proposed to aid decision makers in the selection of a design-builder. This is based on the integration of a framework using an analytic hierarchy process as the bid awarding system is being changed from one based on lowest price, to one based on best value over the life-cycle. Key criteria like whole life cost, service life planning and design quality are important through the key stages of evaluation process. The model uses a systematic and holistic approach which enables a public sector to make better decisions in design-builder selection, which will deliver whole life benefits, based on long term cost-effectiveness and whole life.