A New Approach Model in Post Graduate Training of Local Government Officers

In 2013-15 there was a new type of post graduate training elaborated and piloted in Hungary at the Institute of Executive Training and Continuing Education (VTKI) within the National University of Public Service (NKE). Although the pilot financed by the State Administration Reform Operative Program (ÁROP) had not lacked the previously established attempts to include interactivity in the training, it was the first to observe and apply the actual principles of the European Union 2020 expressed in the threefold criteria of economic growth: smartness, sustainability and inclusiveness. All of them are represented by a pillar of the program like e-learning, class training and field training with the inclusion of local society. According to the objectives of the program there were at least 10 thousand attendees from the civil service sphere set as project indicators, so it has been a large scale training program that took place in 2014 in Hungary. The following article shows the innovations included in this new approach model of post graduate training civil servants.

An investigation into equations for estimating water requirements and the development of new equations for predicting total water intake

The primary purpose of this study was to investigate agreement among five equations by which clinicians estimate water requirements (EWR) and to determine how well these equations predict total water intake (TWI). The Institute of Medicine has used TWI as a measure of water requirements. A secondary goal of this study was to develop practical equations to predict TWI. These equations could then be considered accurate predictors of an individual’s water requirement. ^ Regressions were performed to determine agreement between the five equations and between the five equations and TWI using NHANES 1999–2004. The criteria for agreement was (1) strong correlation coefficients between all comparisons and (2) regression line that was not significantly different when compared to the line of equality (x=y) i.e., the 95% CI of the slope and intercept must include one and zero, respectively. Correlations were performed to determine association between fat-free mass (FFM) and TWI. Clinically significant variables were selected to build equations for predicting TWI. All analyses were performed with SAS software and were weighted to account for the complex survey design and for oversampling. ^ Results showed that the five EWR equations were strongly correlated but did not agree with each other. Further, the EWR equations were all weakly associated to TWI and lacked agreement with TWI. The strongest agreement between the NRC equation and TWI explained only 8.1% of the variability of TWI. Fat-free mass was positively correlated to TWI. Two models were created to predict TWI. Both models included the variables, race/ethnicity, kcals, age, and height, but one model also included FFM and gender. The other model included BMI and osmolality. Neither model accounted for more than 28% of the variability of TWI. These results provide evidence that estimates of water requirements would vary depending upon which EWR equation was selected by the clinician. None of the existing EWR equations predicted TWI, nor could a prediction equation be created which explained a satisfactory amount of variance in TWI. A good estimate of water requirements may not be predicted by TWI. Future research should focus on using more valid measures to predict water requirements.^

Campus Design: Locating a new center of international studies

FIU's campus master plan should portray an overall concept of the University's vision. Its design should represent a distinctive sense of institutional purpose. Its architecture should support the campus design in the realization of an ideal academic environment. The present master plan of Florida International University (FIU) offers neither a clear typology of architectural elements nor adequate relationships and connections between buildings. FIU needs to enhance its master plan with an architectural and urban vocabulary that creates a better environment. This thesis will examine FIU's present master plan, explaining the history of its development. Further, it will critically examine the quality of the campus, highlighting the success and failure of its various parts. The unrealized potential of the campus' original vision will be juxtaposed to the built reality. In addition, FlU's planning strategies will be parallel with the planning of several master plans of American universities. Finally, this thesis will propose a set of criteria for the inclusion of a new building in the campus master plan. The Center of International Study will be the catalyst that would bring into focus the university's vision. As a means to prove the validity of these criteria, a new location for the center of international studies will be selected, and a schematic architectural proposal will be made.

The new Jamaican migration : implications for theory and practice

While analysis of the effect which education and migration have on development is neither clear cut, nor obvious, regimes such as those of Jamaica have traditionally placed great emphasis on development through education at all levels. The process of human resource development and the accumulation of human capital is intended to unlock the door to modernization. Nevertheless, our findings indicate a considerable loss of professional and skilled personnel -- the same group that embody a disproportionate amount of educational expenditure relative to the population. Insofar as planning is concerned this migration represents a negative factor. The developing country of Jamaica is unintentionally supplying the developed world with an "annual gift" of human capital which its economy cannot afford. The major issue becomes: to what extent can any government "protect" its investments by restricting movements of capital and people. The general assumption of this paper is that the question of human rights cannot be ignored especially in democracies (which Jamaica decidedly is), where movement is seen as an ingrained human right. During the 1970s and 1980s, Jamaica and the Caribbean as a whole has lost much through intellectual capital migrations. Yet brains may also die in their own environment, if deprived the ability to create their own criteria and goals. Forcing people to stay with their money and know-how may only serve to produce and economic environment overgrown with weeds of lethargy, indolence and mediocrity.

Development of Innovative Load Transfer Mechanism to Reduce Hurricane-Induced Failures in New and Existing Residential Construction

Implicit in current design practice of minimum uplift capacity, is the assumption that the connection's capacity is proportional to the number of fasteners per connection joint. This assumption may overestimate the capacity of joints by a factor of two or more and maybe the cause of connection failures in extreme wind events. The current research serves to modify the current practice by proposing a realistic relationship between the number of fasteners and the capacity of the joint. The research is also aimed at further development of non-intrusive continuous load path (CLP) connection system using Glass Fiber Reinforced Polymer (GFRP) and epoxy. Suitable designs were developed for stud to top plate and gable end connections and tests were performed to evaluate the ultimate load, creep and fatigue behavior. The objective was to determine the performance of the connections under simulated sustained hurricane conditions. The performance of the new connections was satisfactory.

Towards a performance based design of shear walls based on damage criteria = Vers un dimensionnement performanciel des murs de refend basé sur des critères d'endommagement

Le dimensionnement basé sur la performance (DBP), dans une approche déterministe, caractérise les objectifs de performance par rapport aux niveaux de performance souhaités. Les objectifs de performance sont alors associés à l'état d'endommagement et au niveau de risque sismique établis. Malgré cette approche rationnelle, son application est encore difficile. De ce fait, des outils fiables pour la capture de l'évolution, de la distribution et de la quantification de l'endommagement sont nécessaires. De plus, tous les phénomènes liés à la non-linéarité (matériaux et déformations) doivent également être pris en considération. Ainsi, cette recherche montre comment la mécanique de l'endommagement pourrait contribuer à résoudre cette problématique avec une adaptation de la théorie du champ de compression modifiée et d'autres théories complémentaires. La formulation proposée adaptée pour des charges monotones, cycliques et de type pushover permet de considérer les effets non linéaires liés au cisaillement couplé avec les mécanismes de flexion et de charge axiale. Cette formulation est spécialement appliquée à l'analyse non linéaire des éléments structuraux en béton soumis aux effets de cisaillement non égligeables. Cette nouvelle approche mise en œuvre dans EfiCoS (programme d'éléments finis basé sur la mécanique de l'endommagement), y compris les critères de modélisation, sont également présentés ici. Des calibrations de cette nouvelle approche en comparant les prédictions avec des données expérimentales ont été réalisées pour les murs de refend en béton armé ainsi que pour des poutres et des piliers de pont où les effets de cisaillement doivent être pris en considération. Cette nouvelle version améliorée du logiciel EFiCoS a démontrée être capable d'évaluer avec précision les paramètres associés à la performance globale tels que les déplacements, la résistance du système, les effets liés à la réponse cyclique et la quantification, l'évolution et la distribution de l'endommagement. Des résultats remarquables ont également été obtenus en référence à la détection appropriée des états limites d'ingénierie tels que la fissuration, les déformations unitaires, l'éclatement de l'enrobage, l'écrasement du noyau, la plastification locale des barres d'armature et la dégradation du système, entre autres. Comme un outil pratique d'application du DBP, des relations entre les indices d'endommagement prédits et les niveaux de performance ont été obtenus et exprimés sous forme de graphiques et de tableaux. Ces graphiques ont été développés en fonction du déplacement relatif et de la ductilité de déplacement. Un tableau particulier a été développé pour relier les états limites d'ingénierie, l'endommagement, le déplacement relatif et les niveaux de performance traditionnels. Les résultats ont démontré une excellente correspondance avec les données expérimentales, faisant de la formulation proposée et de la nouvelle version d'EfiCoS des outils puissants pour l'application de la méthodologie du DBP, dans une approche déterministe.

Effet des charges sur les chaussées en période de restriction des charges - volet terrain

Dans un contexte climatique rigoureux comme celui du Québec, l’interaction entre la charge et le climat a une grande influence sur la performance des structures de chaussées flexibles (Doré et Zubeck, 2009). Pendant le dégel printanier, avec la fonte de la glace, la chaussée s’affaiblit et cet affaiblissement la rend vulnérable à la sollicitation par le trafic lourd ce qui accélère divers phénomènes de dégradation, notamment l’endommagement par fatigue et l’orniérage structural (Farcette, 2010). Afin de minimiser les effets des charges lourdes sur une chaussée affaiblie lors du printemps, les administrations routières choisissent souvent de limiter les charges par essieu ou par véhicule lors du dégel. L’objectif de ce projet est de développer un outil d’aide pour la gestion des restrictions de charge en période de dégel en fonction des données recueillies par les stations de météo routière. Deux sections expérimentales composées des mêmes matériaux mais avec des épaisseurs d’enrobés bitumineux différentes situées au Site Expérimental Routier de l’Université Laval (SERUL) ont été utilisées pour ce projet. Pour bien interpréter le comportement des structures, des jauges de déformations verticales et horizontales, des jauges de contraintes, des jauges de teneur en eau et des thermistances ont été installées dans chaque couche. Pour solliciter mécaniquement la chaussée, un déflectomètre à masse tombante (FWD) a été utilisé. Les résultats obtenus ont permis de de bien comprendre les mécanismes d’affaiblissement de la chaussée durant la période de dégel. Ils ont aussi montré que l’application d’une période de restriction de charge pendant la période de dégel permettait d’avoir un gain sur la durée de vie de la chaussée, cette période de restriction est donc justifiée et efficace. Néanmoins, pour une meilleure gestion du réseau routier, de nouveaux critères pour mieux déterminer la période de restriction de charges sont proposés.

Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present: (1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia; (2) Chronic or recurrent blepharitis and/or chalazia/ hordeola; (3) Eyelid telangiectasia documented by an ophthalmologist; (4) Primary periorificial dermatitis and/ or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.

Clinical trial designs of new medicinal products for treating schizophrenia: discussion of EMA's Guideline and a Better Long Term Trial Design

Background and Objectives: Schizophrenia is a severe chronic disease. Endpoint variables lack objectivity and the diagnostic criteria have evolved with time. In order to guide the development of new drugs, European Medicines Agency (EMA) issued a guideline on the clinical investigation of medicinal products for the treatment of schizophrenia. Methods: Authors reviewed and discussed the efficacy trial part of the Guideline. Results: The Guideline divides clinical efficacy trials into short-term trials and long-term trials. The short-term three-arm trial is recommended to replace the short-term two-arm active-controlled non-inferiority trial because the latter has sensitivity issues. The Guideline ultimately makes that three-arm trial a superiority trial. The Guideline discusses four types of long-term trial designs. The randomized withdrawal trial design has some disadvantages. Long-term two-arm active-controlled non-inferiority trial is not recommended due to the sensitivity issue. Extension of the short-term trial is only suitable for extension of the short-term two-arm active-controlled superiority trial. The Guideline suggests that a hybrid design of a randomized withdrawal trial incorporated into a long-term parallel trial might be optimal. However, such a design has some disadvantages and might be too complex to be carried out. Authors suggest instead a three-group long-term trial design, which could provide comparison between test drug and active comparator along with comparison between the test drug and placebo. This alternative could arguably be much easier to carry out compared with the hybrid design. Conclusions: The three-group long-term design merits further discussion and evaluation.

A prática baseada na evidência : a amamentação como fator preventivo da depressão pós-parto

Enquadramento: É expectável que o pós-parto seja um período de alegria. Todavia, nem sempre é assim, já que pode ser um período marcado por momentos de tristeza, cansaço e desânimo. Reconhecendo as vantagens da amamentação para a saúde e bem-estar do recémnascido e da mãe, acreditamos que esta possa ser preventiva da depressão pós-parto. Objetivos: Obter a melhor evidência científica para compreender se a amamentação tem efeito preventivo na depressão pós-parto. Método: Foi efetuada uma revisão integrativa da literatura sobre a relação entre a amamentação e a depressão pós-parto através das bases de dados: EBSCO host, LILACS, PubMed, SciELO, Repositórios institucionais e Google Académico. Selecionaram-se quinze artigos que obedeceram aos critérios de inclusão deste estudo. Resultados: A maioria dos estudos identifica a amamentação como sendo preventiva da depressão pós-parto, destacando a importância da amamentação para a saúde mental da puérpera e consequentemente para a diminuição das hipóteses de desenvolver depressão pósparto. Cinco artigos identificam-na também como sendo um fator de risco e um estudo não encontrou uma associação clara entre a amamentação e a depressão pós-parto. Conclusões: São descritos vários benefícios da amamentação, os quais terão um efeito preventivo contra a depressão pós-parto. Uma mulher informada e apoiada acerca da amamentação será capaz de se sentir confiante no seu novo papel. É essencial um investimento constante por parte da equipa de saúde, iniciado durante o processo do planeamento do casal para a gravidez, e mantendo-se ao longo da gravidez, parto e pós-parto. Palavras-chave: “Amamentação”, “depressão pós-parto”, “prevenção”.

Muscle fatigue resistance: comparison of Martin vigorimeter and Jamar dynamometer in community-dwelling people

Background: For the diagnosis of frailty exhaustion is a criteria currently measured by self-reported questionnaires, which are subjective and dependent on individual perception. The FR test has been developed as a bed side objective evaluation of muscle fatigue. The test was validated for the VM. However, the JD is frequently used to measure the grip strength. So the comparison of these devices is required to understand if FR is similar when measured with both devices. Methods: Fifty-four (29 female and 25 male; mean age: 39.98 ± 18.09) community-dwelling people were tested for muscle function. The Fatigue resistance (FR), which is the time during that grip strength drops to 50% of its maximum, was recorded with each device and simultaneous sEMG of the forearm muscles was obtained. The (co-)activation of agonist and antagonist muscles was calculated and compared with the differences between the performances with each device (controlling for gender and age). Results: FR was significantly better when measured with VM compared to JD. At all phases of the FR-test the antagonist muscle co-activation was significantly higher for VM compared to JD. In contrast, the agonist muscle activation level was significantly higher in JD compared to VM. When performing the FR-test with VM, both the agonist muscle activation and antagonist muscle co-activation decreased significantly (p<0.05). Whereas when using the JD, only a significant decrease in the antagonist muscle co-activation was observed. The difference in antagonist muscle activation between VM and JD was significantly related to the difference in FR between both devices. Conclusion: The results suggest that the FR-test when using the VM induces a more prominent muscle exhaustion than when using the JD, which makes the VM more suitable for measuring muscle fatigue resistance. However, these findings must be confirmed in a larger study population.

The impact of geometric non-linearities on the fatigue analysis of trailing edge bond lines in wind turbine rotor blades

The accurate prediction of stress histories for the fatigue analysis is of utmost importance for the design process of wind turbine rotor blades. As detailed, transient, and geometrically non-linear three-dimensional finite element analyses are computationally weigh too expensive, it is commonly regarded sufficient to calculate the stresses with a geometrically linear analysis and superimpose different stress states in order to obtain the complete stress histories. In order to quantify the error from geometrically linear simulations for the calculation of stress histories and to verify the practical applicability of the superposition principal in fatigue analyses, this paper studies the influence of geometric non-linearity in the example of a trailing edge bond line, as this subcomponent suffers from high strains in span-wise direction. The blade under consideration is that of the IWES IWT-7.5-164 reference wind turbine. From turbine simulations the highest edgewise loading scenario from the fatigue load cases is used as the reference. A 3D finite element model of the blade is created and the bond line fatigue assessment is performed according to the GL certification guidelines in its 2010 edition, and in comparison to the latest DNV GL standard from end of 2015. The results show a significant difference between the geometrically linear and non-linear stress analyses when the bending moments are approximated via a corresponding external loading, especially in case of the 2010 GL certification guidelines. This finding emphasizes the demand to reconsider the application of the superposition principal in fatigue analyses of modern flexible rotor blades, where geometrical nonlinearities become significant. In addition, a new load application methodology is introduced that reduces the geometrically non-linear behaviour of the blade in the finite element analysis.

Multicenter prospective validation of the Baveno IV and Baveno II/III criteria in cirrhosis patients with variceal bleeding

International audience

Use of flucinolone acetonide for patients with diabetic macular oedema:patient selection criteria and early outcomes in real world setting

Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.

Fatigue and Damage Tolerance in Primary Composite Aeronautical Structures

The challenging requirements set on new full composite aeronautical structures are mostly related to the demonstration of damage tolerance capability of their primary structures, required by the airworthiness bodies. And while composite-made structures inherently demonstrate exceptional fatigue properties, when put in real life working conditions, a number of external factors can lead to impact damages thus reducing drastically their fatigue resistance due to fiber delamination, disbonding or breaking. This PhD aims towards contributing to the better understanding of the behavior of the primary composite aeronautical structure after near-edge impacts which are inevitable during the service life of an aircraft. The behavior of CFRP structures after impacts in only one small piece of the big picture which is the certification of CFRP built aircraft, where several other parameters need to be evaluated in order to fulfill the airworthiness requirements. These parameters are also discussed in this PhD thesis in order to give a better understanding of the complex task of CFRP structure certification, in which behavior of the impacted structure plays an important role. An experimental and numerical campaign was carried out in order to determine the level of delamination damage in CFRP specimens after near-edge impacts. By calibrating the numerical model with experimental data, it was possible, for different configurations and energy levels, to predict the extension of a delamination in a CFRP structure and to estimate its residual static strength using a very simple but robust technique. The original contribution of this work to the analysis of CFRP structures is the creation of a model which could be applicable to wide range of thicknesses and stacking sequences of CFRP structures, thus potentially being suitable for industrial application, as well.