Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

BACKGROUND: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol. METHODS/DESIGN: MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff. DISCUSSION: This study evaluates factors that are critical to successful implementation of a web-based risk assessment tool into routine clinical care in a variety of healthcare settings. The result will identify resource needs and potential barriers and solutions to implementation in each setting as well as an understanding potential effectiveness. TRIAL REGISTRATION: NCT01956773.

Development of a GEM Electronic Board (GEB) for triple-GEM detectors

Developed for use with triple GEM detectors, the GEM Electronic Board (GEB) forms a crucial part of the electronics readout system being developed as part of the CMS muon upgrade program. The objective of the GEB is threefold; to provide stable powering and ground for the VFAT3 front ends, to enable high-speed communication between 24 VFAT3 front ends and an optohybrid, and to shield the GEM detector from electromagnetic interference. The paper describes the concept and design of a large-size GEB in detail, highlighting the challenges in terms of design and feasibility of this deceptively difficult system component.

Spaces of observation and obscurity: cinematic prisons of light and dark

In The Eye of Power, Foucault delineated the key concerns surrounding hospital architecture in the latter half of the eighteenth century as being the ‘visibility of bodies, individuals and things'. As such, the ‘new form of hospital' that came to be developed ‘was at once the effect and support of a new type of gaze'. This was a gaze that was not simply concerned with ways of minimising overcrowding or cross-contamination. Rather, this was a surveillance intended to produce knowledge about the pathological bodies contained within the hospital walls. This would then allow for their appropriate classification. Foucault went on to describe how these principles came to be applied to the architecture of prisons. This was exemplified for him in the distinct shape of Bentham's panopticon. This circular design, which has subsequently become an often misused synonym for a contemporary culture of surveillance, was premised on a binary of the seen and the not-seen. An individual observer could stand at the central point of the circle and observe the cells (and their occupants) on the perimeter whilst themselves remaining unseen. The panopticon in its purest form was never constructed, yet it conveys the significance of the production of knowledge through observation that became central to institutional design at this time and modern thought more broadly. What is curious though is that whilst the aim of those late eighteenth century buildings was to produce wellventilated spaces suffused with light, this provoked an interest in its opposite. The gothic movement in literature that was developing in parallel conversely took a ‘fantasy world of stone walls, darkness, hideouts and dungeons…' as its landscape (Vidler, 1992: 162). Curiously, despite these modern developments in prison design, the façade took on these characteristics. The gothic imagination came to describe that unseen world that lay behind the outer wall. This is what Evans refers to as an architectural ‘hoax'. The façade was taken to represent the world within the prison walls and it was the façade that came to inform the popular imagination about what occurred behind it. The rational, modern principles ordering the prison became conflated with the meanings projected by and onto the façade. This confusion of meanings have then been repeated and reenforced in the subsequent representations of the prison. This is of paramount importance since it is the cinematic and televisual representation of the prison, as I argue here and elsewhere, that maintain this erroneous set of meanings, this ‘hoax'.

Insolvency: ordering a sale of the family home

Comments on the Chancery Division ruling in Nicholls v Lan on whether the interests of a bankrupt husband's creditors prevailed over those of the wife, despite her circumstances being exceptional within the meaning of the Insolvency Act 1986 s.335A on account of her suffering from chronic schizophrenia, where the wife was the joint owner of another property which could be realised to buy out the trustee in bankruptcy's half share in the equity of the matrimonial home.

Managing the risk of parenting

The aim of parents is to enable their children to become autonomous individuals capable of participating fully in the culture in which they live (Korbin 1997). Furthermore, the quality of parenting is reflected in an adult’s ability to recognize and adequately meet a child’s needs in a developmentally and emotionally appropriate manner (Donald & Jureidini 2004).Within contemporary society however, parents are faced with the tensions of providing boundaries whilst affording children rights. This in itself brings risks and a common thread that runs through approaches to parenting is the attempt to define a threshold of acceptable parenting. Above the threshold and a parent is good enough and below is not good enough. This paper will consider what the minimum requirements are and explore different dimensions of parenting. The concept of good enough parenting will be revisited in relation to risks that parents have to take, within the context of contemporary policy related to improving outcomes for children as enshrined in the Every Child Matters: Change for Children Agendas (Department for Education and skills 2003). The current dominance of a risk management approach to safeguarding children will be addressed within the context of a ‘risk society’ and the importance of the safety and well-being of the child will be examined It will be suggested that we need to achieve a better balance of ensuring the safety of the child, meeting the child's developmental needs, and supporting family functioning if we are to help parents manage the risks.

Evaluation of particle degradation due to high-speed impacts in a pneumatic handling system

Particle degradation can be a significant issue in particulate solids handling and processing, particularly in pneumatic conveying systems, in which high-speed impact is usually the main contributory factor leading to changes in particle size distribution (comparing the material to its virgin state). However, other factors may strongly influence particles breakage as well, such as particle concentrations, bend geometry,and hardness of pipe material. Because of such complex influences, it is often very difficult to predict particle degradation accurately and rapidly for industrial processes. In this article, a general method for evaluating particle degradation due to high-speed impacts is described, in which the breakage properties of particles are quantified using what are known as "breakage matrices". Rather than a pilot-size test facility, a bench-scale degradation tester has been used. Some advantages of using the bench-scale tester are briefly explored. Experimental determination of adipic acid has been carried out for a range of impact velocities in four particle size categories. Subsequently, particle breakage matrices of adipic acid have been established for these impact velocities. The experimental results show that the "breakage matrices" of particles is an effective and easy method for evaluation of particle degradation due to high-speed impacts. The possibility of the "breakage matrices" approach being applied to a pneumatic conveying system is also explored by a simulation example.

"The Black Imprint of Sandals in White Mosaic Floors": H.D.'s Mythomystical Poetics

My dissertation examines the traces of inverse (mytho)mysticism, more synchronous with mythical alchemy than transcendent mystery, in H.D.’s mature work (1946-1961). Whereas H.D.’s earliest works respond to a fin de siècle occultism and a collective psyche troubled by the eschatological distress that, as Susan Acheson writes, “was widespread amongst modernist writers grappling with …world events and with the implications of Nietzsche’s inaugural annunciation of modernity in terms of the death of God” (187), her later oeuvre is dedicated to the same work of soul undertaken by the “secret cult of Night” in Vale Ave. Here, her thematic scope faces two ways: backward to ancient Greek mystery cults and their palingenesic rites and forward to depth psychologists searching for the Soul of the World. Vale Ave plays a pronounced role in my study as symbolic guide; in its seventy-four sequences the layering of time in the “trilogy” of past, present, and future that H.D. had explored during the years of the Second World War in order to get behind the fallen walls of cause and effect collapses into two distinct phases of human origin���“meeting” (evolution) and “parting” (involution)—and the poem invites Lilith and Lucifer to be its archetypal guides. My method for the study is imaginal, entering such disciplines as history, philosophy, and theology and bringing psychological understanding to them. John Walsh’s introduction to Vale Ave notes H.D.’s theme “that the human psyche exists in a dimension outside of time and space as well as within them. In Vale Ave, H.D. presents the extremity of this dual-dimensionality: metempsychosis” (vii). However, the concept that H.D. investigates is more than a literary processus of characters who adopt different masks and appear at various junctures in a chronological unwinding of history. I explore H.D.'s works as part of a Modernist tradition of writing “books of the dead” designed not to guide the soul after death, but to draw the gaze upon “a nearer thing,” as H.D. writes in Erige Cor Tuum Ad Me In Caelum, the wisdom intrinsic in the spirit of life itself.

So what if time is of the essence?

This article is concerned with the remedies available for delay in the performance of contractual obligations, and in particular with the proper analysis of the question whether time is of the essence. The law in this area is both difficult and complex, not only with regard to whether time is of the essence in any given case, but also with regard to what this entails. It is argued that many of the difficulties arise from the ambiguous and inconsistent way in which the courts have approached the question whether time is of the essence, the concept being used in several distinct, albeit related, senses. The article seeks to demonstrate that the law relating to the topic is unnecessarily complicated, and to suggest ways in which it might be simplified.

Emotional speech: towards a new generation of databases

Research on speech and emotion is moving from a period of exploratory research into one where there is a prospect of substantial applications, notably in human-computer interaction. Progress in the area relies heavily on the development of appropriate databases. This paper addresses the issues that need to be considered in developing databases of emotional speech, and shows how the challenge of developing apropriate databases is being addressed in three major recent projects - the Belfast project, the Reading-Leeds project and the CREST-ESP project. From these and other studies the paper draws together the tools and methods that have been developed, addresses the problems that arise and indicates the future directions for the development of emotional speech databases.

Bimetallic effects in the liquid phase hydrogenation of 2-butanone

A series of bimetallic Ru-containing monometallic and bimetallic catalysts were prepared and tested for their activity for the hydrogenation of 2-butanone to 2-butanol at 30 °C and 3 bar H2. RuPt bimetallic catalysts were the most active for the reaction, with a ratio of 5 wt% Ru:1 wt% Pt on activated carbon (AC) found to be optimum. The activity of this bimetallic catalyst was more than double that of the sum of the activities of the monometallic Ru and Pt catalysts, providing evidence of a “bimetallic” effect. Structural analysis of the bimetallic catalysts revealed that they consisted of clusters of particles of the order of 1–2 nm. Extended X-ray absorption fine structure analysis showed that there were two types of particle on the surface of the bimetallic RuPt catalyst, specifically monometallic Ru and bimetallic RuPt particles. For the bimetallic particles, it was possible to fit the data with a model in which a Ru core of 1.1 nm is enclosed by two Pt-rich layers, the outer layer containing only 13 at% Ru. Pretreatment of the monometallic and bimetallic catalysts in hydrogen had a significant effect on the activity. Both the bimetallic and monometallic Ru-based catalysts showed a trend of decreasing activity with increasing temperature of prereduction in hydrogen. This loss of activity was almost fully reversible by exposure of the catalysts to air after reduction. The changing activity with exposure to different gas phase environments could not be attributed to changes in particle size or surface composition. It is proposed that the introduction of hydrogen results in a gradual smoothing of the surface and loss of defect sites; this process being reversible on introduction of air. These defect sites are particularly important for the dissociative adsorption of hydrogen, potentially the rate-determining step in this reaction.

Understandings of citizenship education in Northern Ireland and the Republic of Ireland: Public discourses among stakeholders in the public and private sectors

Internationally, citizenship education has come to the fore in the past decade. It may be particularly importantwithin the context of societies with a legacy of political conflict, such as Northern Ireland and the Republic of Ireland, where it is being implemented as part of the statutory curriculum. This article explores understandingsof citizenship education among stakeholders in the private and public sectors in Northern Ireland and the Republic of Ireland with the aim to compare these with curricular conceptualizations of citizenship inboth contexts. Semi-structured interviews were conducted in both societies involving non-governmentalorganizations, political parties, trade unions and the police. Results indicated that levels of awareness aboutcitizenship education varied substantially and understandings mainly reflected current theory and curriculumpractice in citizenship. Commonalities emerged as in both societies similar key concepts were identified whiledifferences transpired over issues relating to national identity and political conflict, which may raise questionsfor history and citizenship education in both societies.

Application of EXAFS to molten salts and ionic liquid technology

This paper describes the use of extended X-ray absorption fine structure spectroscopy (EXAFS) to examine the structure of molten salts and ionic liquids and species dissolved in them. The EXAFS theory is briefly described as are the methods by which EXAFS of these systems can be studied. A range of applications have used EXAFS to investigate the structure of metallic species in ionic liquids from extraction studies to catalysts. The area of structural investigations of ionic liquids is still being developed, although growing rapidly, whereas the structure of molten salts has been studied using EXAFS in more detail.

A novel application of ratio spectra derivative spectroscopy for the determination of amphotericin in highly icteric plasma.

Derivative spectroscopy has been utilised for the determination of amphotericin in various biological matrices including plasma, serum, urine and brain tissue. Whilst these methods have all been shown to be suitable for the determination of the drug in these matrices it has been reported that the application fails in the case of highly icteric plasma, this being due to the presence of high concentrations (>50 mu M) of bilirubin. This paper details the application of ratio spectra derivative spectroscopy to overcome the interference of bilirubin with amphotericin in such situations.

Angelina Muñiz: construcción de un “yo” fragmentado

En su condición de hija de exiliados españoles, Angelina Muñiz Huberman emprenderá un largo y doloroso periplo desde su nacimiento hasta la edad adulta para consumar el proceso de construcción de sí misma. Una lectura cruzada de Castillos en la tierra. Seudomemorias (1995) y Molinos sin viento (2001) nos muestra que, a través de la memoria, propia o colectiva, Muñiz intenta unir los pedazos para forjarse una identidad hecha de fragmentos.

Co-regulation of Gremlin and Notch signalling in diabetic nephropathy

Diabetic nephropathy is currently the leading cause of end-stage renal disease worldwide, and occurs in approximately one third of all diabetic patients. The molecular pathogenesis of diabetic nephropathy has not been fully characterized and novel mediators and drivers of the disease are still being described. Previous data from our laboratory has identified the developmentally regulated gene Gremlin as a novel target implicated in diabetic nephropathy in vitro and in vivo. We used bioinformatic analysis to examine whether Gremlin gene sequence and structure could be used to identify other genes implicated in diabetic nephropathy. The Notch ligand Jagged1 and its downstream effector, hairy enhancer of split-1 (Hes1), were identified as genes with significant similarity to Gremlin in terms of promoter structure and predicted microRNA binding elements. This led us to discover that transforming growth factor-beta (TGFß1), a primary driver of cellular changes in the kidney during nephropathy, increased Gremlin, Jagged1 and Hes1 expression in human kidney epithelial cells. Elevated levels of Gremlin, Jagged1 and Hes1 were also detected in extracts from renal biopsies from diabetic nephropathy patients, but not in control living donors. In situ hybridization identified specific upregulation and co-expression of Gremlin, Jagged1 and Hes1 in the same tubuli of kidneys from diabetic nephropathy patients, but not controls. Finally, Notch pathway gene clustering showed that samples from diabetic nephropathy patients grouped together, distinct from both control living donors and patients with minimal change disease. Together, these data suggest that Notch pathway gene expression is elevated in diabetic nephropathy, co-incident with Gremlin, and may contribute to the pathogenesis of this disease.