The mini clinical evaluation exercise (mini-CEX) for assessing clinical performance of international medical graduates

Objective: To evaluate the feasibility, reliability and acceptability of the mini clinical evaluation exercise (mini-CEX) for performance assessment among international medical graduates (IMGs). Design, setting and participants: Observational study of 209 patient encounters involving 28 IMGs and 35 examiners at three metropolitan teaching hospitals in New South Wales, Victoria and Queensland, September-December 2006. Main outcome measures: The reliability of the mini-CEX was estimated using generatisability (G) analysis, and its acceptability was evaluated by a written survey of the examiners and IMGs. Results: The G coefficient for eight encounters was 0.88, suggesting that the reliability of the mini-CEX was 0.90 for 10 encounters. Almost half of the IMGs (7/16) and most examiners (14/18) were satisfied with the mini-CEX as a learning tool. Most of the IMGs and examiners enjoyed the immediate feedback, which is a strong component of the tool. Conclusion: The mini-CEX is a reliable tool for performance assessment of IMGs, and is acceptable to and well received by both learners and supervisors.

Advanced transmission electron microscope triboprobe with automated closed-loop nanopositioning

Here the design and operation of a novel transmission electron microscope (TEM) triboprobe instrument with real-time vision control for advanced in situ electron microscopy is demonstrated. The NanoLAB triboprobe incorporates a new high stiffness coarse slider design for increased stability and positioning performance. This is linked with an advanced software control system which introduces both new and flexible in situ experimental functional testing modes, plus an automated vision control feedback system. This advancement in instrumentation design unlocks new possibilities of performing a range of new dynamical nanoscale materials tests, including novel friction and fatigue experiments inside the electron microscope.

Luotettavaa tietoa ja merkityksellisiä valintoja – Kuluttajien ympäristövastuullista järkeilyä ilmastonmuutoksesta ja ohjausjärjestelmien hyväksyttävyydestä

Tutkielmassa tarkastellaan kuluttajien näkemyksiä ilmastonmuutoksesta ja ilmastovaikutusten seuranta- ja palautejärjestelmän hyväksyttävyydestä kulutuksen ohjauskeinona. 15 kuluttajaa kokeili kuukauden ajan kulutuksen ilmastovaikutusten seuranta- ja palautejärjestelmän demonstraatioversiota ja he osallistuivat kokeilun pohjalta aihepiiriä käsitelleeseen verkkokeskusteluun. Analysoin verkkokeskustelun aineistoa arkisen järkeilyn näkökulmasta tutkien kuluttajien ilmastonmuutokseen ja ympäristövastuullisuuteen liittyvää arkitietoa sekä palvelun hyväksyttävyyteen liittyviä heuristiikkoja. Ilmastonmuutoksen todettiin yleisesti olevan vielä melko abstrakti ja monitulkintainen ilmiö, minkä vuoksi kuluttajilla on vaikeuksia ymmärtää omien valintojensa konkreettista merkitystä ilmastonmuutoksen kannalta. Vaikka tietoa kulutuksen ilmastovaikutuksista on saatavilla paljon, niin erityisesti yritysten tuottama tieto koettiin ristiriitaiseksi ja osin epäluotettavaksi. Kuluttajat myös kritisoivat ilmastonmuutoskeskustelun tarjoamaa kapeaa näkemystä kulutuksen ympäristövaikutuksista. Hiilidioksidipäästöihin keskittymisen sijaan ympäristövaikutuksia tulisi kuluttajien mielestä tarkastella kokonaisuutena, josta ilmastovaikutukset muodostavat vain yhden osan. Tutkimukseen osallistuneiden kuluttajien kulutustottumuksiin ilmastonmuutos vaikutti eriasteisesti. Toisille ilmastonmuutoksesta oli muodostunut keskeinen omaa kulutusta ohjaava normi, kun taas toiset kertoivat pohtivansa ilmastovaikutuksia pääasiassa suurimpien hankintojen kohdalla. Ympäristövastuullisuudessa merkitykselliseksi koettiin tasapainon löytäminen ja henkilökohtainen tunne siitä, että kokee toimivansa oikein. Ilmasto- tai ympäristökysymyksiä punnitaan valinnoissa joustavasti yhdessä muiden tekijöiden kanssa. Vaikka kuluttajilla toisaalta olisi tietoa ja halua ottaa ilmasto- ja ympäristövaikutukset huomioon valinnoissaan, toimintaympäristö rajaa keskeisesti kuluttajien mahdollisuuksia toimia ympäristövastuullisesti. Tutkimus toi esille neljä kuluttajien käyttämää heuristiikkaa heidän pohtiessaan ilmastovaikutusten seuranta- ja palautejärjestelmän hyväksyttävyyden ehtoja ja toimivuutta ohjauskeinona. Ensinnäkin palvelun tulee olla käytettävyydeltään nopea ja vaivaton sekä tarjota tietoa havainnollisessa ja helposti ymmärrettävässä muodossa. Toiseksi palvelun tarjoaman tiedon tulee olla ehdottoman luotettavaa ja kuluttajien valintojen kannalta merkityksellistä siten, että palvelu ottaa huomioon erilaiset kuluttajat ja tiedontarpeet. Kolmanneksi palvelu tulee toteuttaa kokonaisvaltaisesti ja läpinäkyvästi useampien kaupparyhmittymien ja julkisten toimijoiden yhteistyönä. Neljänneksi toteutuksessa tulee huomioda palvelun kannustavuus ja kytkeytyminen muihin ohjauskeinoihin.

NanoLAB Triboprobe: Characterizing Dynamic Wear, Friction and Fatigue at the Nanoscale

In-situ transmission electron microscopy (TEM) has developed rapidly over the last decade. In particular, with the inclusion of scanning probes in TEM holders, allows both mechanical and electrical testing to be performed whilst simultaneously imaging the microstructure at high resolution. In-situ TEM nanoindentation and tensile experiments require only an axial displacement perpendicular to the test surface. However, here, through the development of a novel in-situ TEM triboprobe, other surface characterisation experiments are now possible, with the introduction of a fully programmable 3D positioning system. Programmable lateral displacement control allows scratch tests to be performed at high resolution with simultaneous imaging of the changing microstructure. With the addition of repeated cyclic movements, both nanoscale fatigue and friction experiments can also now be performed. We demonstrate a range of movement profiles for a variety of applications, in particular, lateral sliding wear. The developed NanoLAB TEM triboprobe also includes a new closed loop vision control system for intuitive control during positioning and alignment. It includes an automated online calibration to ensure that the fine piezotube is controlled accurately throughout any type of test. Both the 3D programmability and the closed loop vision feedback system are demonstrated here.

Flight dynamics in Drosophila through a dynamically-scaled robotic approach

Flies are particularly adept at balancing the competing demands of delay tolerance, performance, and robustness during flight, which invites thoughtful examination of their multimodal feedback architecture. This dissertation examines stabilization requirements for inner-loop feedback strategies in the flapping flight of Drosophila, the fruit fly, against the backdrop of sensorimotor transformations present in the animal. Flies have evolved multiple specializations to reduce sensorimotor latency, but sensory delay during flight is still significant on the timescale of body dynamics. I explored the effect of sensor delay on flight stability and performance for yaw turns using a dynamically-scaled robot equipped with a real-time feedback system that performed active turns in response to measured yaw torque. The results show a fundamental tradeoff between sensor delay and permissible feedback gain, and suggest that fast mechanosensory feedback provides a source of active damping that compliments that contributed by passive effects. Presented in the context of these findings, a control architecture whereby a haltere-mediated inner-loop proportional controller provides damping for slower visually-mediated feedback is consistent with tethered-flight measurements, free-flight observations, and engineering design principles. Additionally, I investigated how flies adjust stroke features to regulate and stabilize level forward flight. The results suggest that few changes to hovering kinematics are actually required to meet steady-state lift and thrust requirements at different flight speeds, and the primary driver of equilibrium velocity is the aerodynamic pitch moment. This finding is consistent with prior hypotheses and observations regarding the relationship between body pitch and flight speed in fruit flies. The results also show that the dynamics may be stabilized with additional pitch damping, but the magnitude of required damping increases with flight speed. I posit that differences in stroke deviation between the upstroke and downstroke might play a critical role in this stabilization. Fast mechanosensory feedback of the pitch rate could enable active damping, which would inherently exhibit gain scheduling with flight speed if pitch torque is regulated by adjusting stroke deviation. Such a control scheme would provide an elegant solution for flight stabilization across a wide range of flight speeds.

On the Role of Delays in Biological Systems : Analysis and Design

This work quantifies the nature of delays in genetic regulatory networks and their effect on system dynamics. It is known that a time lag can emerge from a sequence of biochemical reactions. Applying this modeling framework to the protein production processes, delay distributions are derived in a stochastic (probability density function) and deterministic setting (impulse function), whilst being shown to be equivalent under different assumptions. The dependence of the distribution properties on rate constants, gene length, and time-varying temperatures is investigated. Overall, the distribution of the delay in the context of protein production processes is shown to be highly dependent on the size of the genes and mRNA strands as well as the reaction rates. Results suggest longer genes have delay distributions with a smaller relative variance, and hence, less uncertainty in the completion times, however, they lead to larger delays. On the other hand large uncertainties may actually play a positive role, as broader distributions can lead to larger stability regions when this formalization of the protein production delays is incorporated into a feedback system.

Furthermore, evidence suggests that delays may play a role as an explicit design into existing controlling mechanisms. Accordingly, the reccurring dual-feedback motif is also investigated with delays incorporated into the feedback channels. The dual-delayed feedback is shown to have stabilizing effects through a control theoretic approach. Lastly, a distributed delay based controller design method is proposed as a potential design tool. In a preliminary study, the dual-delayed feedback system re-emerges as an effective controller design.

Terapia comportamental no controle da incontinência urinária da mulher idosa: uma ação de enfermagem na promoção do autocuidado

A incontinência urinária gera implicações negativas nos âmbitos emocional, social e econômico tanto para o indivíduo incontinente, como para seus cuidadores. A terapia comportamental é uma das abordagens não-invasivas para a incontinência urinária. A terapia comportamental é realizada durante as consultas de enfermagem e a atuação do enfermeiro consiste na aplicação de um protocolo de orientações sobre hábitos de vida, medidas de controle da micção, treinamento para realização do diário miccional, treinamento de exercícios perineais e avaliação da resposta da paciente à terapia. O estudo tem como base teórica a Teoria do autocuidado de Dorothea Elisabeth Orem, pois a terapia comportamental visa instrumentalizar o indivíduo a realizar práticas de autocuidado a partir do protocolo de atendimento do ambulatório. O objetivo da pesquisa é avaliar a efetividade da terapia comportamental aplicada pelo enfermeiro para o controle miccional e melhora da qualidade de vida da mulher idosa. Trata-se de um ensaio clínico não-controlado.40 Foram incluídas no estudo mulheres acima de 60 anos que participam do Ambulatório do Núcleo de Atenção ao Idoso com a queixa clínica de perda involuntária de urina encaminhadas para o ambulatório de urogeriatria. A população estudada foi composta por 13 participantes. Os dados da pesquisa foram coletados a partir dos instrumentos de avaliação do ambulatório de urogeriatria que foram arquivados nos prontuários das pacientes: o diário miccional, avaliação de enfermagem na terapia comportamental e o questionário sobre qualidade de vida em mulheres com incontinência urinária chamado de Kings Health Questionnaire. Estes instrumentos foram aplicados antes e depois da terapia comportamental. Foram colhidos dados das pacientes acompanhadas no ambulatório durante o período de abril de 2011 a junho de 2012. Os resultados foram que após a terapia comportamental todas as idosas responderam que ingerem líquidos no período diurno, 92,30% das idosas responderam que estabeleceram um ritmo miccional de 2/2 horas ou de 3/3 horas. Sobre o parâmetro miccional perda de urina ao final da terapia comportamental 75% das idosas apresentaram ausência de perda de urina. Além disso, após a terapia comportamental nenhuma das pacientes teve perda de urina durante a realização dos exercícios e 92,30% apresentaram contração eficiente dos músculos perineais. Deste modo, esta pesquisa demonstrou que as idosas que participaram da terapia comportamental obtiveram melhora do controle urinário e da qualidade de vida. A terapia é um sistema que sofre retroalimentação à medida que o paciente adere às práticas de autocuidado e o enfermeiro reforça as orientações a fim de atingir o objetivo maior que é a sensação de bem estar. A teoria de Dorothea Orem se adequou bem ao estudo, pois a terapia comportamental permitiu aos idosos a assumirem responsabilidade com o seu corpo e se empenharem efetivamente para melhorar a sua condição de saúde e qualidade de vida.

ROBOT DYNAMIC CONTROL INSTABILITIES.

The authors demonstrate that a widely proposed method of robot dynamic control can be inherently unstable, due to an algebraic feedback loop condition causing an ill-posed feedback system. By focussing on the concept of ill-posedness a necessary and sufficient condition is derived for instability in robot manipulator systems which incorporate online acceleration cross-coupling control. Also demonstrated is a quasilinear multivariable control framework useful for assessing the robustness of this type of control when the instability condition is not obeyed.

Estradiol stimulates growth hormone production in female goldfish

The effects of estradiol (E(2)) on growth hormone (GH) production was investigated in gonad-intact female goldfish. It was first necessary to generate a specific antibody for use in immunocytochemistry, Western, and dot-blot analyses of GH production. To accomplish this, grass carp GH (gcGH) cDNA was cloned by the reverse transcription polymerase chain reaction (RT-PCR) and expressed in Echerichia coli and a specific polyclonal antibody to recombinant gcGH was generated in the rabbit. In Western blot, the anti-gcGH antibody specifically immunoreacted with recombinant gcGH, purified natural common carp GH, and with a single 21.5-kDa GH form from pituitary extracts of grass carp, common carp, goldfish, and zebrafish but not salmon, trout, or tilapia. Intraperitoneal injection of the recombinant gcGH enhanced the growth rates of juvenile common carp demonstrating biological activity of this GH preparation. Electron microscopic studies showed that the anti-gcGH-I antibody specifically reacted with GH localized in the secretory granules of the goldfish somatotroph. Using anti-gcGH-I in a dot-blot assay, it was found that in vivo implantation of solid silastic pellets containing E(2) (100 mu g/g body weight for 5 days) increased pituitary GH content by 150% in female goldfish. In a second, independent study employing a previously characterized anticommon carp GH antibody for radioimmunoassay, it was found that E(2) increased pituitary GH content by 170% and serum GH levels by approximately 350%. The E(2)-induced hypersecretion of GH and increase in pituitary GH levels was not associated with changes in steady-state pituitary GH mRNA levels, suggesting that this sex steroid may enhance GH synthesis at the posttranscriptional or translational level. Previous observations indicate that GH can stimulate ovarian E(2) production. The present results show that E(2) can in turn stimulate GH production, indicating the existence of a novel pituitary GH-ovarian feedback system in goldfish. (C) 1997 Academic Press.

基于Internet的力反馈技术研究

论述了基于Internet的力反馈技术及其相关技术的发展和研究意义 ,综合机器人遥操作控制领域的理论方法 ,结合多媒体技术的最新发展 ,构建了一种基于事件的系统结构及其设计方法 .基于该方法 ,分析了系统的可靠性、稳定性及力媒体传输的透明性 ,并设计了一个基于Internet的力反馈技术的系统实例

An Investigation towards colossal success of Larsen and Toubro Limited: Human resource management perspective

Larsen and Toubro (L&T) Limited is India’s largest construction conglomerate. L&T’s expertise is harnessed to execute high value projects that demand adherence to stringent timelines in a scenario where disparate disciplines of engineering are required to be coordinated on a critical path. However, no company can acquire such a feat without systematic management of its human resource. An investigation on the human resource management practices in orienting L&T’s success can help to identify some of the ethical human resource practices, especially in the context of Indian market. Accordingly, a well-designed employee satisfaction survey was conducted for assessment of the HRM practices being followed in L&T. Unlike other companies, L&T aims to meet the long-term needs of its employees rather than short-term needs. There were however few areas of concerns, such as yearly appraisal system and equality to treat the employees. It is postulated that the inequality to treat the male and female employees is primarily a typical stereotype due to the fact that construction is conventionally believed to be a male dominant activity. A periodic survey intended to provide 360° feedback system can help to avoid such irregularities. This study is thus expected to provide healthy practices of HRM to nurture the young talents of India. This may help them to evaluate their decisions by analyzing the complex relationship between HRM practices and output of an organization.

The global atmospheric water cycle

Water vapour plays a key role in the Earth's energy balance. Almost 50% of the absorbed solar radiation at the surface is used to cool the surface, through evaporation, and warm the atmosphere, through release of latent heat. Latent heat is the single largest factor in warming the atmosphere and in transporting heat from low to high latitudes. Water vapour is also the dominant greenhouse gas and contributes to a warming of the climate system by some 24°C (Kondratev 1972). However, water vapour is a passive component in the troposphere as it is uniquely determined by temperature and should therefore be seen as a part of the climate feedback system. In this short overview, we will first describe the water on planet Earth and the role of the hydrological cycle: the way water vapour is transported between oceans and continents and the return of water via rivers to the oceans. Generally water vapour is well observed and analysed; however, there are considerable obstacles to observing precipitation, in particular over the oceans. The response of the hydrological cycle to global warming is far reaching. Because different physical processes control the change in water vapour and evaporation/precipitation, this leads to a more extreme distribution of precipitation making, in general, wet areas wetter and dry areas dryer. Another consequence is a transition towards more intense precipitation. It is to be expected that the changes in the hydrological cycle as a consequence of climate warming may be more severe that the temperature changes.

Design of SPR systems with dynamic compensators and output variable structure control

This paper presents necessary and sufficient conditions for the following problem: given a linear time invariant plant G(s) = N(s)D(s)-1 = C(sI - A]-1B, with m inputs, p outputs, p > m, rank(C) = p, rank(B) = rank(CB) = m, £nd a tandem dynamic controller Gc(s) = D c(s)-1Nc(s) = Cc(sI - A c)-1Bc + Dc, with p inputs and m outputs and a constant output feedback matrix Ko ε ℝm×p such that the feedback system is Strictly Positive Real (SPR). It is shown that this problem has solution if and only if all transmission zeros of the plant have negative real parts. When there exists solution, the proposed method firstly obtains Gc(s) in order to all transmission zeros of Gc(s)G(s) present negative real parts and then Ko is found as the solution of some Linear Matrix Inequalities (LMIs). Then, taking into account this result, a new LMI based design for output Variable Structure Control (VSC) of uncertain dynamic plants is presented. The method can consider the following design specifications: matched disturbances or nonlinearities of the plant, output constraints, decay rate and matched and nonmatched plant uncertainties. © 2006 IEEE.

Síntese de sistemas estritamente reais positivos através do critério de routh-hurwitz

Given a linear time-invariant plant Gol(s) with one input and q outputs, where q > 1, a method based on the Routh-Hurwitz Stability Criterion is proposed to obtain a constant tandem matrix F ∈ ℝq, such that FGOl(s) is a minimumphase system. From this solution, the system FGol(s) is represented in state space by {A, B, FC} and a constant output feedback matrix K0 ∈ ℝ is obtained such that the feedback system {A - BK0C, B, FC} is Strictly Positive Real (SPR). The proposed procedure offers necessary and sufficient conditions for both problems. Initially, the general case, with a generic q, is analyzed. Following, the particular cases q = 2 and q = 3 are studied.

Constipação intestinal

It was reviewed the definition, mechanisms and classification of functional constipation. The diagnostic resources available were showed and it was underlined the importance to investigate and exclude the multiple causes of secondary constipation. The therapy was divided in general measures, like diet and specialized, involving laxatives and others alternatives. It was commented the different categories of laxatives, their actions and adverse effects. It was concluded that the best approach to functional defecatory disorder is biofeedback. Otherwise, for defecatory disturbance caused by mechanical obstruction and refractory constipation due to slow transit the therapeutical option is surgery.