Arsenic exposure and outcomes of antimonial treatment in visceral leishmaniasis patients in Bihar, India : a retrospective cohort study

Funding: This work was supported by a Clinical PhD Fellowship to MRP (090665) and a Principal Research Fellowship to AHF (079838) from the Wellcome Trust (http://www.wellcome.ac.uk). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Prior Antithrombotic Use is Associated with Favorable Mortality and Functional Outcomes in Acute Ischemic Stroke

Sources of Funding The GWTG-Stroke program is currently supported in part by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, manuscript preparation, or approval of this study.

Nvidia, matrox, paper? - Undergraduate game design tools in the humanities and social sciences

Eschewing costly high-tech approaches, this paper looks at the experience of using low-tech approaches to game design assignments as problem based learning and assessment tool over a number of years in undergraduate teaching. General game design concepts are discussed, along with learning outcomes and assessment rubrics in line with Blooms Taxonomy based on evidence from students who had no prior experience of serious game play or design. Approaches to creating game design based assessments are offered.

Coal-fired Power Plants with Flexible Amine-based CCS and Co-located Wind Power: Environmental, Economic and Reliability Outcomes

Carbon Capture and Storage (CCS) technologies provide a means to significantly reduce carbon emissions from the existing fleet of fossil-fired plants, and hence can facilitate a gradual transition from conventional to more sustainable sources of electric power. This is especially relevant for coal plants that have a CO2 emission rate that is roughly two times higher than that of natural gas plants. Of the different kinds of CCS technology available, post-combustion amine based CCS is the best developed and hence more suitable for retrofitting an existing coal plant. The high costs from operating CCS could be reduced by enabling flexible operation through amine storage or allowing partial capture of CO2 during high electricity prices. This flexibility is also found to improve the power plant’s ramp capability, enabling it to offset the intermittency of renewable power sources. This thesis proposes a solution to problems associated with two promising technologies for decarbonizing the electric power system: the high costs of the energy penalty of CCS, and the intermittency and non-dispatchability of wind power. It explores the economic and technical feasibility of a hybrid system consisting of a coal plant retrofitted with a post-combustion-amine based CCS system equipped with the option to perform partial capture or amine storage, and a co-located wind farm. A techno-economic assessment of the performance of the hybrid system is carried out both from the perspective of the stakeholders (utility owners, investors, etc.) as well as that of the power system operator.

In order to perform the assessment from the perspective of the facility owners (e.g., electric power utilities, independent power producers), an optimal design and operating strategy of the hybrid system is determined for both the amine storage and partial capture configurations. A linear optimization model is developed to determine the optimal component sizes for the hybrid system and capture rates while meeting constraints on annual average emission targets of CO2, and variability of the combined power output. Results indicate that there are economic benefits of flexible operation relative to conventional CCS, and demonstrate that the hybrid system could operate as an energy storage system: providing an effective pathway for wind power integration as well as a mechanism to mute the variability of intermittent wind power.

In order to assess the performance of the hybrid system from the perspective of the system operator, a modified Unit Commitment/ Economic Dispatch model is built to consider and represent the techno-economic aspects of operation of the hybrid system within a power grid. The hybrid system is found to be effective in helping the power system meet an average CO2 emissions limit equivalent to the CO2 emission rate of a state-of-the-art natural gas plant, and to reduce power system operation costs and number of instances and magnitude of energy and reserve scarcity.

Creating New Design-Build-Test Experiences as Outputs of Undergraduate Design-Build-Test Projects

This paper describes a methodology of using individual engineering undergraduate student projects as a means of effectively and efficiently developing new Design-Build-Test (DBT) learning experiences and challenges.
A key aspect of the rationale for this approach is that it benefits all parties. The student undertaking the individual project gets an authentic experience of producing a functional artefact, which has been the result of a design process that addresses conception, design, implementation and operation. The supervising faculty member benefits from live prototyping of new curriculum content and resources with a student who is at a similar level of knowledge and experience as the intended end users of the DBT outputs. The multiple students who ultimately undertake the DBT experiences / challenges benefit from the enhanced nature of a learning experience which has been “road tested” and optimised.
To demonstrate the methodology the paper will describe a case study example of an individual project completed in 2015. This resulted in a DBT design challenge with a theme of designing a catapult for throwing table tennis balls, the device being made from components laser cut from medium density fibreboard (MDF). Further three different modes of operation will be described which use the same resource materials but operate over different timescales and with different learning outcomes, from an icebreaker exercise focused on developing team dynamics through to full DBT where students get an opportunity to experience the full impact of their design decisions by competing against other students with a catapult they have designed and built themselves.

The Evolution of 'Design Build Fly' Led Teaching in Aerospace Engineering

This paper describes the evolution of a ‘Design - Build-Fly’ (DBF) approach to the delivery and assessment of a Stage Three Aircraft Design module. It focuses on the primary learning outcomes around the design and manufacturing functions associated with the development of a remotely controlled aircraft. The work covers a six year period from 2011 to present mapping the transformation of the module from report based assessment to a more hands on approach resulting in a fully functioning remotely controlled aircraft. Results show that both the staff and student experience improved across key performance metrics including student feedback, learning and competency development. Challenges still remain in methods of placing students within teams and maintaining technical rigour in reporting as students develop vocational skills and more reflective writing styles.

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.

Anti-VEGF treatment of patients with diabetic macular edema : Studies of visual acuity, macular edema and patient-reported outcomes

The aim of this thesis was to describe and evaluate visual acuity, macular edema and patientreported outcomes (PRO) following anti-VEGF treatment of diabetic macular edema (DME) patients in a real-world setting. Using a longitudinal study design, a cohort of DME patients was followed from baseline to 1 year after treatment start. Data were collected from two eye clinics at two county hospitals. Social background characteristics, medical data and PRO were measured before treatment initiation, at four month and after 1 year. A total of 57 patients completed the study. Mean age was 69 years and the sample was equally distributed regarding sex. At baseline, the patients described their general health as low. One year after treatment initiation, 30 patients had improved visual acuity and 27 patients had no improvement in visual acuity. The patients whose visual acuity improved reported an improvement in several subscales in patient-reported outcome measures (PROM), which was in contrast to the group that experienced a decline in visual acuity, where there was no improvement in PROM. Outcomes from the study can be useful for developing and providing relevant information and support to patients undergoing this treatment.

Are we asking the right questions? Rethinking post-graduate design education towards sustainable visions for the future

Our society is currently facing complex challenges, such us climate change, loss of biodiversity, ageing population, unemployment, to name but a few. This has created growing expectations on designers and engineers to explore, experiment and implement innovative solutions to such issues. At this critical time, if we want design to be part of the solution, we need to wonder whether we are asking designers suitable and sustainable questions. Both in post-graduate design education and in business, the brief still overwhelmingly requires designers to follow a linear problem-solving approach that focuses on product rather than strategies, services and systems. Traditional design briefs result no longer appropriate to face the challenges of our unsustainable world, as they relate to market, growth economy and human needs rather than society, business models and the needs of nature. Instead, we need to be asking questions about, for example, how we create sustainable business opportunities, how we overcome the barriers for change, or how we facilitate the process of innovation through design methodology. If the role of design is to create new visions and outline strategic directions towards a sustainable future world - for policy makers, businesses, communities and individual citizens – we need those stakeholders to create briefs for designers that allow them to do that. This paper will explain how the reframing of questions has been embedded into SustainRCA’s teaching practice in post-graduate design, art and engineering, leading to the development of new tools and methods, as well as some innovative outcomes

Citizen science and natural resource governance: program design for vernal pool policy innovation

Effective natural resource policy depends on knowing what is needed to sustain a resource and building the capacity to identify, develop, and implement flexible policies. This retrospective case study applies resilience concepts to a 16-year citizen science program and vernal pool regulatory development process in Maine, USA. We describe how citizen science improved adaptive capacities for innovative and effective policies to regulate vernal pools. We identified two core program elements that allowed people to act within narrow windows of opportunity for policy transformation, including (1) the simultaneous generation of useful, credible scientific knowledge and construction of networks among diverse institutions, and (2) the formation of diverse leadership that promoted individual and collective abilities to identify problems and propose policy solutions. If citizen science program leaders want to promote social-ecological systems resilience and natural resource policies as outcomes, we recommend they create a system for internal project evaluation, publish scientific studies using citizen science data, pursue resources for program sustainability, and plan for leadership diversity and informal networks to foster adaptive governance.

COACHES, CLIMATES, “FIELD” GOALS, AND EFFICACY: A “DE-CONSTRUCTION” OF THE MASTERY-APPROACH TO COACHING AND EXAMINATION OF RELATIONSHIPS TO PSYCHOSOCIAL OUTCOMES IN A YOUTH FOOTBALL PLAYER DEVELOPMENT PROGRAM.

In support of the achievement goal theory (AGT), empirical research has demonstrated psychosocial benefits of the mastery-oriented learning climate. In this study, we examined the effects of perceived coaching behaviors on various indicators of psychosocial well-being (competitive anxiety, self-esteem, perceived competence, enjoyment, and future intentions for participation), as mediated by perceptions of the coach-initiated motivational climate, achievement goal orientations and perceptions of sport-specific skills efficacy. Using a pre-post test design, 1,464 boys, ages 10-15 (M = 12.84 years, SD = 1.44), who participated in a series of 12 football skills clinics were surveyed from various locations across the United States. Using structural equation modeling (SEM) path analysis and hierarchical regression analysis, the cumulative direct and indirect effects of the perceived coaching behaviors on the psychosocial variables at post-test were parsed out to determine what types of coaching behaviors are more conducive to the positive psychosocial development of youth athletes. The study demonstrated that how coaching behaviors are perceived impacts the athletes’ perceptions of the motivational climate and achievement goal orientations, as well as self-efficacy beliefs. These effects in turn affect the athletes’ self-esteem, general competence, sport-specific competence, competitive anxiety, enjoyment, and intentions to remain involved in the sport. The findings also clarify how young boys internalize and interpret coaches’ messages through modification of achievement goal orientations and sport-specific efficacy beliefs.

Conceptualisation, design and development of a primary school based child healthy weight intervention

INTRODUCTION: In common with much of the developed world, Scotland has a severe and well established problem with overweight and obesity in childhood with recent figures demonstrating that 31% of Scottish children aged 2-15 years old were overweight including obese in 2014. This problem is more pronounced in socioeconomically disadvantaged groups and in older children across all economic groups (Scottish Health Survey, 2014). Children who are overweight or obese are at increased risk of a number of adverse health outcomes in the short term and throughout their life course (Lobstein and Jackson-Leach, 2006). The Scottish Government tasked all Scottish Health Boards with developing and delivering child healthy weight interventions to clinically overweight or obese children in an attempt to address this health problem. It is therefore imperative to deliver high quality, affordable, appropriately targeted interventions which can make a sustained impact on children’s lifestyles, setting them up for life as healthy weight adults. This research aimed to inform the design, readiness for application and Health Board suitability of an effective primary school-based curricular child healthy weight intervention. METHODS: the process involved in conceptualising a child healthy weight intervention, developing the intervention, planning for implementation and subsequent evaluation was guided by the PRECEDE-PROCEED Model (Green and Kreuter, 2005) and the Intervention Mapping protocol (Lloyd et al. 2011). RESULTS: The outputs from each stage of the development process were used to formulate a child healthy weight intervention conceptual model then develop plans for delivery and evaluation. DISCUSSION: The Fit for School conceptual model developed through this process has the potential to theoretically modify energy balance related behaviours associated with unhealthy weight gain in childhood. It also has the potential to be delivered at a Health Board scale within current organisational restrictions.

Empirical evidence of bias in the design of experimental stroke studies: a metaepidemiologic approach

Background and Purpose: At least part of the failure in the transition from experimental to clinical studies in stroke has been attributed to the imprecision introduced by problems in the design of experimental stroke studies. Using a metaepidemiologic approach, we addressed the effect of randomization, blinding, and use of comorbid animals on the estimate of how effectively therapeutic interventions reduce infarct size. Methods: Electronic and manual searches were performed to identify meta-analyses that described interventions in experimental stroke. For each meta-analysis thus identified, a reanalysis was conducted to estimate the impact of various quality items on the estimate of efficacy, and these estimates were combined in a meta meta-analysis to obtain a summary measure of the impact of the various design characteristics. Results: Thirteen meta-analyses that described outcomes in 15 635 animals were included. Studies that included unblinded induction of ischemia reported effect sizes 13.1% (95% CI, 26.4% to 0.2%) greater than studies that included blinding, and studies that included healthy animals instead of animals with comorbidities overstated the effect size by 11.5% (95% CI, 21.2% to 1.8%). No significant effect was found for randomization, blinded outcome assessment, or high aggregate CAMARADES quality score. Conclusions: We provide empirical evidence of bias in the design of studies, with studies that included unblinded induction of ischemia or healthy animals overestimating the effectiveness of the intervention. This bias could account for the failure in the transition from bench to bedside of stroke therapies.

Investigating the outcomes of a physical activity program offered to older adults in South Florida and understanding the correlates of completion

Despite the well-known benefits of physical activity, in 2012, only 37.5% of older adults aged 60 years or older met recommended aerobic physical activity levels and 16.1% met muscle-strengthening guidelines. Effective exercise programs can help combat the problem of inactivity but 50% of those who start participating in an exercise program drop out within first few weeks, preventing them from gaining any health benefits. Since fall 2008, the Healthy Aging Regional Collaborative of South Florida has offered EnhanceFitness (EF), an evidence-based physical activity program to older adults. This dissertation compared EF effectiveness at 4-, 8-, and 12-months and examined the factors that were associated with program completion. A paired sample t-test identified changes at 4-months and repeated measures design was used to identify changes from baseline to 4-, 8-, and 12- months. Logistic regression was used to identify correlates associated with completion.^ Between October 1, 2008 and December 31, 2012, 4,531 older adults (>=60 years) attended one or more EF sessions. Participants showed significant improvement in the number of chair stands performed in 30-seconds with mean change of 1.7, 1.6, and 2.0 respectively at 4-,8-,and 12- months (p<0.001). Results suggest Black, non-Haitian men were less likely to complete the program when compared to white, non-Hispanic men (OR=0.41, p=0.02). Men who self-reported having at least one risk factor were more likely to complete the program (OR=1.81, p= 0.03). In addition, women who lived in Miami-Dade County (OR=2.13, p<0.001) and were 80 years or older (OR=1.46, p<0.05) were more likely to complete the program. When compared with non-Hispanic whites, Black women were less likely to complete the program (OR=0.613, p<0.01). Women who did not report depression were 1.6 times more likely to complete the program (OR=1.62, p<0.05). Absence of risk factors for chronic conditions increased completion rates among women (OR=1.63, p<0.01).^ Effectiveness results revealed that all participants significantly improved on all outcome measures. However, improvement is more than double for those who completed recommended sessions (p<0.01). Study findings reaffirm the successful translation of EF in community-based settings. Our findings suggest that participants should attend the minimum recommended sessions to attain greater health benefits.^