789 resultados para The missed encounter
Resumo:
We present a new set of dissipationless N-body simulations to examine the feasibility of creating bright ellipticals (following the Kormendy relation, hereafter KR) by hierarchically merging present-day early-type dwarf galaxies, and to study how the encounter parameters affect the location of the end product in the (mu(e))-R-e plane. We investigate the merging of one-component galaxies of both equal and different masses, the merging of two-component galaxy models to explore the effect of dark haloes on the final galaxy characteristics, and the merging of ultracompact dwarf galaxies. We find that the increase of (mu(e)) with R-e is attributable to an increase in the initial orbital energy. The merger remnants shift down in the (mu(e))-R-e plane and fail to reach the KR. Thus, the KR is not reproducible by mergers of dwarf early-type systems, rendering untenable the theory that present-day dwarfs are responsible for even a small fraction of the present-day ellipticals, unless a considerable amount of dissipation is invoked. However, we do find that present-day dwarfs can be formed by the merger of ultracompact dwarfs.
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In 3 experiments, the authors examined the role of memory for prior instances for making relative judgments in conflict detection. Participants saw pairs of aircraft either repeatedly conflict with each other or pass safely before being tested on new aircraft pairs, which varied in similarity to the training pairs. Performance was influenced by the similarity between aircraft pairs. Detection time was faster when a conflict pair resembled a pair that had repeatedly conflicted. Detection time was slower, and participants missed conflicts, when a conflict pair resembled a pair that had repeatedly passed safely. The findings identify aircraft features that are used as inputs into the memory decision process and provide an indication of the processes involved in the use of memory for prior instances to make relative judgments.
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This article is a review of the recent literature pertaining to the oral sequelae of eating disorders (EDs). Dentists are recognized as being some of the first health care professionals to whom a previously undiagnosed eating disorder patient (EDP) may present. However, despite the prevalence (up to 4 per cent) of such conditions in teenage girls and young adult females, there is relatively little published in the recent literature regarding the oral sequelae of EDs. This compares unfavourably with the attention given recently in the dental literature to conditions such as diabetes mellitus, which have a similar prevalence in the adult population. The incidence of EDs is increasing and it would be expected that dentists who treat patients in the affected age groups would encounter more individuals exhibiting EDs. Most of the reports in the literature concentrate on the obvious clinical features of dental destruction (perimolysis), parotid swelling and biochemical abnormalities particularly related to salivary and pancreatic amylase. However, there is no consistency in explanation of the oral phenomena and epiphenomena seen in EDs. Many EDPs are nutritionally challenged; there is a relative lack of information pertaining to non-dental, oral lesions associated with nutritional deficiencies.
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Background: Despite the availability of expert surgeons and preoperative imaging investigations, some patients require reoperation for persistent or recurrent hyperparathyroidisms. Method: Fifty consecutive patients were reviewed. Results: There were 28 persistent cases (24 primary, 4 secondary) and 22 recurrent cases (15 primary, 7 secondary) and 98% had successful surgical treatment. Multigland disease was present in 24 of 39 (62%) of primary cases, 11 of 24 persistent and 13 of 15 recurrent (P < 0.02). Four patients in the recurrent primary group had multiple endocrine neoplasia type 1, whereas the other 20 primary patients had sporadic multigland disease. Multigland disease was present in all secondary cases and was a very important factor in this entire series of patients (70%). Regrowth of a remnant of a gland biopsied or partially resected at an earlier operation was the cause of recurrence in 12 of 15 primary and 2 of 7 secondary cases (P < 0.05). The site of missed glands in persistent disease was ectopic in 60%. Ectopic glands were found in the following sites: intrathyroidal 10 (8 inferior and 2 superior), intrathymic 9, posterior mediastinum 4, base of skull 2, carotid sheath 1 and supernumerary 5. Investigations to locate missing glands were positive in 28 of 43 sestamibi scans (65%), 14 of 34 ultrasound scans (41%), 10 of 24 computed tomography scans (42%) and 11 of 13 selective venous sampling tests (85%). Conclusion: Some persistent cases are unavoidable because of ectopic locations and some recurrences are inevitable because of multigland disease.
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Movements of wide-ranging top predators can now be studied effectively using satellite and archival telemetry. However, the motivations underlying movements remain difficult to determine because trajectories are seldom related to key biological gradients, such as changing prey distributions. Here, we use a dynamic prey landscape of zooplankton biomass in the north-east Atlantic Ocean to examine active habitat selection in the plankton-feeding basking shark Cetorhinus maximus. The relative success of shark searches across this landscape was examined by comparing prey biomass encountered by sharks with encounters by random-walk simulations of ‘model’ sharks. Movements of transmitter-tagged sharks monitored for 964 days (16754km estimated minimum distance) were concentrated on the European continental shelf in areas characterized by high seasonal productivity and complex prey distributions. We show movements by adult and sub-adult sharks yielded consistently higher prey encounter rates than 90% of random-walk simulations. Behavioural patterns were consistent with basking sharks using search tactics structured across multiple scales to exploit the richest prey areas available in preferred habitats. Simple behavioural rules based on learned responses to previously encountered prey distributions may explain the high performances. This study highlights how dynamic prey landscapes enable active habitat selection in large predators to be investigated from a trophic perspective, an approach that may inform conservation by identifying critical habitat of vulnerable species.
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The enhancement of service quality is an area of optimal managerial relevance that has, to date, received minimal attention in the literature. Because customers' service quality evaluations are based almost entirely upon the behaviours of frontline employees, organisations rely heavily upon these employees to improve overall service quality provision. However, much of the literature looking at service quality enhancement lacks detail when examining the impact of employee service-related behaviours on customers' service quality perceptions. As a result, this paper comprehensively conceptualises those front-line employee behaviours which are the most likely to enhance customers' service quality perceptions. This conceptualisation is grounded in an extensive review of the services marketing literature, pooling together previously disparate research strands. Formal hypotheses are presented. Implications and future research directions are also discussed.
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Service encounter quality is an area of growing interest to researchers and managers alike, yet little is known about the effects of face-to-face service encounter quality within a business-to-business setting. In this paper, a psychometrically sound measure of such service encounter quality is proposed, and consequences of this construct are empirically assessed. Both a literature review and a dyadic in-depth interview approach were used to develop a conceptual framework and a pool of items to capture service encounter quality. A mail survey of customers was undertaken, and a response rate of 36% was obtained. Data analysis was conducted via confirmatory factor analysis and structural equation modeling. Findings reveal a four-factor structure of service encounter quality, encompassing professionalism, civility, friendliness and competence dimensions. Service encounter quality was found to be directly related to customer satisfaction and service quality perceptions, and indirectly to loyalty. The importance of these findings for practitioners and for future research on service encounter quality is discussed.
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There would seem to be no greater field for observing the effects of neo-liberal reforms in higher education than the former Soviet university, where attempts to legitimize neo-liberal philosophy over Soviet ideology plays out in everyday practices of educational reform. However, ethnographic research about higher education in post-Soviet Central Asia suggests that its “liberalization” is both an ideological myth and a complicated reality. This chapter focuses on how and why neo-liberal agendas have “travelled” to the Central Asian republic of Kyrgyzstan, what happens when educators encounter and resist them, and why these spaces of resistance are important starting points for the development of alternative visions of educational possibility in this recently “Third-worlded” society.
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The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.
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Customer satisfaction and service quality are two important concepts in the marketing literature. However, there has been some confusion about the conceptualisation and measurement of these two concepts and the nature of the relationship between them. The primary objective of this research was to develop a more thorough understanding of these concepts, and a model that could help to explain the links between them and their relationships with post-purchase behaviour. A preliminary theoretical model was developed, based on an exhaustive review of the literature. Following exploratory research, the model was revised by incorporating "Perceived Value" and "Perceived Sacrifice" to help explain customer's post-purchase behaviour. A longitudinal survey was conducted in the context of the restaurant industry, and the data were analysed using structural equation modelling. The results provided evidence to support the main research hypotheses. However, the effect of "Normative Expectations" on "Encounter Quality" was insignificant, and "Perceived Value" had a direct effect on "Behavioural Intentions" despite expectations that such an effect would be mediated through "Customer Satisfaction". It was also found that "Normative Expectations" were relatively more stable than "Predictive Expectations". It is argued that the present research significantly contributes to the marketing literature, and in particular the role of perceived value in the formation of customers' post-purchase behaviour. Further research efforts in this area are warranted.
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This is a study of third sector organisations and organisational change resulting from European Union funding. While there is a growing body of research which shows how governmental funding can contribute to the organisational challenges that third sector organisations encounter, research on how European Union funding affects third sector organisations is limited. This thesis contributes towards closing this gap in knowledge by identifying a number of organisational changes which can be attributed to the use of European Union funding. A qualitative approach was taken to explore organisational change resulting from the use of URBAN II funding in nine third sector organisations which were studied in the context of the URBAN II programmes of Belfast, Berlin and Bristol. The conceptual framework for this study draws on organisation theory and resource dependence theory, together with concepts of co-production and multi-level governance. URBAN II funding was found to have affected organisational structures, processes, services, goals and participants, as well as the interactions of organisations with their external environment. In contrast to earlier research however, the findings from this study suggest that many of these organisational changes improved the capacity of third sector organisations to carry out their work. The cross-national comparison of the findings further showed that organisational impacts resulting from the use of URBAN II funding can vary significantly between different countries. Programme Managers were found to have played a critically important' role in enabling third sector organisations to obtain benefits from URBAN II funding. Many positive organisational changes arose from a close collaboration between Programme Managers and third sector organisations. Conversely, many negative organisational impacts were found to be due, not to the regulations associated with European funding, but primarily to the approach adopted by the Programme Managers and Local Development Partnerships towards engaging third sector organisations in programme delivery.
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Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories. © 2010 Elsevier Inc.
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This aim of this paper, from a study funded by the National Council for Graduate Entrepreneurship (NCGE), is to explore access to finance for ethnic minority graduate entrepreneurs (EMGEs) with a particular focus on comparisons between different ethnic groups, and men and women. The authors interviewed selected individuals based upon a review of literature on finance for ethnic minority enterprise. A number of key results from the survey, in that EMGEs: • use external finance significantly (more so than non graduates) and encounter barriers in accessing finance at start-up, in particular those belonging to poor families. • rely excessively on personal savings and family finance, at the start-up and long after the start-up stage, that has implications for the optimal capital structure. • start up businesses that are, on average, larger than non-graduate enterprises and have the potential to reduce economic inactivity amongst the ethnic population. • have, in contrast to general graduate start-ups, a high level of unemployment, take a longer period of time to enter employment and there is a higher level of dissatisfaction with career progression. These findings raise the question whether the right financial advice is taken and whether this behaviour constrains EMGEs' expansion.
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Purpose: To demonstrate the importance of OCT examination of fellow, normal eyes in unilateral nAMD follow up clinics. Methods: The authors present three cases of unilateral nAMD who were undergoing treatment with ranibizumab, in whom OCT evaluation of the previously unaffected, asymptomatic fellow eye allowed early diagnosis, treatment and preservation of vision. Fundus examination had previously failed to demonstrate abnormality. Results: Intravitreal anti-VEGF treatment for nAMD has caused a sharp increase in the number of subjects attending macular clinics, frequently overburdening the system. It may sometimes be tempting for hospitals to reduce the workload by for example, concentrating only on OCT examination of the affected eye in cases of unilateral nAMD. The three reported cases demonstrate that OCT scanning of the fellow, previously unaffected eye is essential in detecting asymptomatic nAMD, which gives a better chance of preservation of vision. Conclusions: Patients with unilateral neovascular AMD undergoing review in macular clinics should always undergo OCT scanning of normal, fellow eyes, as otherwise asymptomatic, “invisible” choroidal neovascular membranes may be missed.
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BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.