Defining barriers in caring for seriously-ill children in a resource-limited setting: An observational study of 2 children's hospitals in Haiti

Background. According to the WHO 2007 country report, Haiti lags behind the Millennium Development Goal of reducing child mortality and maintains the highest under-5 mortality rate in the Western hemisphere. 3 Overall, few studies exist that seek to better grasp barriers in caring for a seriously ill child in a resource-limited setting and only a handful propose sustainable, effective interventions. ^ Objectives. The objectives of this study are to describe the prevalence of serious illnesses among children hospitalized at 2 children's hospitals in Port au Prince, to determine the barriers faced when caring for seriously ill children, and to report hospital outcomes of children admitted with serious illnesses. ^ Methods. Data were gathered from 2 major children's hospitals in Port au Prince, Haiti (Grace Children's Hospital [GCH] and Hopital d l'Universite d'Etat d'Haiti [HUEH]) using a triangulated approach of focus group discussions, physician questionnaires, and retrospective chart review. 23 pediatric physicians participated in focus group discussions and completed a self-administered questionnaire evaluating healthcare provider knowledge, self-efficacy, and perceived barriers relating to the care of seriously ill children in a resource-limited setting. A sample of 240 patient charts meeting eligibility criteria was abstracted for pertinent elements including sociodemographics, documentation, treatment strategies, and outcomes. Factors associated with mortality were analyzed using χ2 test and Fisher exact test [Minitab v.15]. ^ Results. The most common primary diagnoses at admission were gastroenteritis with moderate dehydration (35.5%), severe malnutrition (25.8%), and pneumonia (19.3%) for GCH, and severe malnutrition (32.6%), sepsis (24.7%), and severe respiratory distress (18%) for HUEH. Overall, 12.9% and 27% of seriously ill patients presented with shock to GCH and HUEH, respectively. ^ Shortage of necessary materials and equipment represented the most commonly reported limitation (18/23 respondents). According to chart data, 9.4% of children presenting with shock did not receive a fluid bolus, and only 8% of patients presenting with altered mental status or seizures received a glucose check. 65% of patients with meningitis did not receive a lumbar puncture due to lack of materials. ^ Hospital mortality rates did not differ by gender or by institution. Children who died were more likely to have a history of prematurity (OR 4.97 [95% CI 1.32-18.80]), an incomplete vaccination record (OR 4.05 [95% CI 1.68-9.74]), or a weight for age ≤3rd percentile (OR 6.1 [95% CI 2.49-14.93]. Case-fatality rates were significantly higher among those who presented with signs of shock compared with those who did not (23.1% vs. 10.7%, RR=2.16, p=0.03). Caregivers did not achieve shock reversal in 21% of patients and did not document shock reversal in 50% of patients. ^ Conclusions. Many challenges face those who seek to optimize care for seriously ill children in resource-limited settings. Specifically, in Haiti, qualitative and quantitative data suggest major issues with lack of supplies, pre-hospital factors, including malnutrition as a comorbidity, and early recognition and management of shock. A tailored intervention designed to address these issues is needed in order to prospectively evaluate improvements in child mortality in a high-risk population.^

Seasonal and Rotational Influences on Corn Nitrogen Requirements

This project is designed to study the N fertilization needs in continuous corn (CC) and corn rotated with soybean (SC) as influenced by location and climate. Multiple rates of fertilizer N are spring applied, with the intent to measure yield response to N within each rotation on a yearly basis for multiple years at multiple sites across Iowa. This will allow the determination of N requirements for each rotation, differences that exist between the two rotations, responses to applied N across different soils and climatic conditions, and evaluation of tools used to adjust N application.

Water Table Level as Influenced by Rainfall, Crop Requirements, and Tiling Method during the past Three Years

In 1979, a portion of the research farm was pattern tiled including the large tillage plots. This was used as an opportunity to compare tile installation methods: a conventional trenching machine (used widely prior to late 70s), and a trenchless “tile plow” machine. The tile plow inserted plastic tile using a mole approach, which is the current primary tiling method. This research showed that plow and trenching tiling methods were not significantly different and both provided adequate drainage. It also showed that water table measurements were influenced more by timing of water needs of the crop being grown and intensity of the rainfall event than tiling method. This report focuses on continued research completed on these trial plots from 2009 to 2011 measuring water table level.

Seasonal and Rotational Influences on Corn Nitrogen Requirements

This project was designed to study the N fertilization needs in continuous corn (CC) and corn rotated with soybean (SC) as influenced by location and climate. Multiple rates of fertilizer N were spring applied, with the intent to measure yield response to N within each rotation on a yearly basis for multiple years at multiple sites across Iowa. This will allow the determination of N requirements for each rotation, differences that exist between the two rotations, responses to applied N across different soils and climatic conditions, and evaluation of tools used to adjust N application.

Seasonal and Rotational Influences on Corn Nitrogen Requirements

This project was designed to study the N fertilization needs in continuous corn (CC) and corn rotated with soybean (SC) as influenced by location and climate. Multiple rates of fertilizer N were spring applied, with the intent to measure yield response to N within each rotation on a yearly basis for multiple years at multiple sites across Iowa. This will allow determination of N requirements for each rotation, differences that exist between the two rotations, responses to applied N across different soils and climatic conditions, and evaluation of tools used to adjust N application.

Seasonal and Rotational Influences on Corn Nitrogen Requirements

This project was designed to study the N fertilization needs in continuous corn (CC) and corn rotated with soybean (SC) as influenced by location and climate. Multiple rates of fertilizer N were spring applied, with the intent to measure yield response to N within each rotation on a yearly basis for multiple years at multiple sites across Iowa. This will allow the determination of N requirements for each rotation, differences that exist between the two rotations, responses to applied N across different soils and climatic conditions, and evaluation of tools used to adjust N application.

CO2 and vitamin B12 interactions determine bioactive trace metal requirements of a subarctic Pacific diatom

Phytoplankton growth can be limited by numerous inorganic nutrients and organic growth factors. Using the subarctic diatom Attheya sp. in culture studies, we examined how the availability of vitamin B(12) and carbon dioxide partial pressure (pCO(2)) influences growth rate, primary productivity, cellular iron (Fe), cobalt (Co), zinc (Zn) and cadmium (Cd) quotas, and the net use efficiencies (NUEs) of these bioactive trace metals (mol C fixed per mol cellular trace metal per day). Under B(12)-replete conditions, cells grown at high pCO(2) had lower Fe, Zn and Cd quotas, and used those trace metals more efficiently in comparison with cells grown at low pCO(2). At high pCO(2), B(12)-limited cells had ~50% lower specific growth and carbon fixation rates, and used Fe ~15-fold less efficiently, and Zn and Cd ~3-fold less efficiently, in comparison with B(12)-replete cells. The observed higher Fe, Zn and Cd NUE under high pCO(2)/B(12)-replete conditions are consistent with predicted downregulation of carbon-concentrating mechanisms. Co quotas of B(12)-replete cells were 5- to 14-fold higher in comparison with B(12)-limited cells, suggesting that >80% of cellular Co of B(12)-limited cells was likely from B(12). Our results demonstrate that CO(2) and vitamin B(12) interactively influence growth, carbon fixation, trace metal requirements and trace metal NUE of this diatom. This suggests the need to consider complex feedback interactions between multiple environmental factors for this biogeochemically critical group of phytoplankton in the last glacial maximum as well as the current and future changing ocean.

Impact of product-related environmental regulations / voluntary requirements on Thai firms

The rules governing the trade of goods in global markets have shifted toward non-tariff measures related to environmental and chemical safety. Unlike traditional environmental/safety requirements, the scope of modern regulations covers products’ environmental performance and chemical safety. To comply with these modern regulations, production practices along the entire supply chain must be realigned to manage certain chemical substances incorporated into the final product. This paper examines the implications of product-related environmental and chemical safety regulations on different firms operating in Thailand.

Traditional Building Adaptation to New Requirements: Historic Center of Arequipa, Perú

The traditional buildings in the historic center of the city of Arequipa, Perú, recently declared of human heritage, are of volcanic tuff both in walls and in vaulted roofs on the ground floor. Having been built in the 18th century and up to the beginning of the 20th century, they have suffered many damages from the seismic movements registered in this region. Due to this, many of them have had to be rebuilt. In this presentation, the different changes to adapt the city of Spanish colonial origin to the present tertiary use are analyzed.

Identifying Moderator Variables Through Requirements Elicitation Experiments Limitations

Interviews are the most widely used elicitation technique in Requirements Engineering (RE). Despite its importance, research in interviews is quite limited, in particular from an experimental perspective. We have performed a series of experiments exploring the relative effectiveness of structured and unstructured interviews. This line of research has been active in Information Systems in the past years, so that our experiments can be aggregated together with existing ones to obtain guidelines for practice. Experimental aggregation is a demanding task. It requires not only a large number of experiments, but also considering the influence of the existing moderators. However, in the current state of the practice in RE, those moderators are unknown. We believe that analyzing the threats to validity in interviewing experiments may give insight about how to improve further replications and the corresponding aggregations. It is likely that this strategy may be applied in other Software Engineering areas as well.

BaTboT: a biologically inspired flapping and morphing bat robot actuated by SMA-based artificial muscles

Bats are animals that posses high maneuvering capabilities. Their wings contain dozens of articulations that allow the animal to perform aggressive maneuvers by means of controlling the wing shape during flight (morphing-wings). There is no other flying creature in nature with this level of wing dexterity and there is biological evidence that the inertial forces produced by the wings have a key role in the attitude movements of the animal. This can inspire the design of highly articulated morphing-wing micro air vehicles (not necessarily bat-like) with a significant wing-to-body mass ratio. This thesis presents the development of a novel bat-like micro air vehicle (BaTboT) inspired by the morphing-wing mechanism of bats. BaTboT’s morphology is alike in proportion compared to its biological counterpart Cynopterus brachyotis, which provides the biological foundations for developing accurate mathematical models and methods that allow for mimicking bat flight. In nature bats can achieve an amazing level of maneuverability by combining flapping and morphing wingstrokes. Attempting to reproduce the biological wing actuation system that provides that kind of motion using an artificial counterpart requires the analysis of alternative actuation technologies more likely muscle fiber arrays instead of standard servomotor actuators. Thus, NiTinol Shape Memory Alloys (SMAs) acting as artificial biceps and triceps muscles are used for mimicking the morphing wing mechanism of the bat flight apparatus. This antagonistic configuration of SMA-muscles response to an electrical heating power signal to operate. This heating power is regulated by a proper controller that allows for accurate and fast SMA actuation. Morphing-wings will enable to change wings geometry with the unique purpose of enhancing aerodynamics performance. During the downstroke phase of the wingbeat motion both wings are fully extended aimed at increasing the area surface to properly generate lift forces. Contrary during the upstroke phase of the wingbeat motion both wings are retracted to minimize the area and thus reducing drag forces. Morphing-wings do not only improve on aerodynamics but also on the inertial forces that are key to maneuver. Thus, a modeling framework is introduced for analyzing how BaTboT should maneuver by means of changing wing morphology. This allows the definition of requirements for achieving forward and turning flight according to the kinematics of the wing modulation. Motivated by the biological fact about the influence of wing inertia on the production of body accelerations, an attitude controller is proposed. The attitude control law incorporates wing inertia information to produce desired roll (φ) and pitch (θ) acceleration commands. This novel flight control approach is aimed at incrementing net body forces (Fnet) that generate propulsion. Mimicking the way how bats take advantage of inertial and aerodynamical forces produced by the wings in order to both increase lift and maneuver is a promising way to design more efficient flapping/morphing wings MAVs. The novel wing modulation strategy and attitude control methodology proposed in this thesis provide a totally new way of controlling flying robots, that eliminates the need of appendices such as flaps and rudders, and would allow performing more efficient maneuvers, especially useful in confined spaces. As a whole, the BaTboT project consists of five major stages of development: - Study and analysis of biological bat flight data reported in specialized literature aimed at defining design and control criteria. - Formulation of mathematical models for: i) wing kinematics, ii) dynamics, iii) aerodynamics, and iv) SMA muscle-like actuation. It is aimed at modeling the effects of modulating wing inertia into the production of net body forces for maneuvering. - Bio-inspired design and fabrication of: i) skeletal structure of wings and body, ii) SMA muscle-like mechanisms, iii) the wing-membrane, and iv) electronics onboard. It is aimed at developing the bat-like platform (BaTboT) that allows for testing the methods proposed. - The flight controller: i) control of SMA-muscles (morphing-wing modulation) and ii) flight control (attitude regulation). It is aimed at formulating the proper control methods that allow for the proper modulation of BaTboT’s wings. - Experiments: it is aimed at quantifying the effects of properly wing modulation into aerodynamics and inertial production for maneuvering. It is also aimed at demonstrating and validating the hypothesis of improving flight efficiency thanks to the novel control methods presented in this thesis. This thesis introduces the challenges and methods to address these stages. Windtunnel experiments will be oriented to discuss and demonstrate how the wings can considerably affect the dynamics/aerodynamics of flight and how to take advantage of wing inertia modulation that the morphing-wings enable to properly change wings’ geometry during flapping. Resumen: Los murciélagos son mamíferos con una alta capacidad de maniobra. Sus alas están conformadas por docenas de articulaciones que permiten al animal maniobrar gracias al cambio geométrico de las alas durante el vuelo. Esta característica es conocida como (alas mórficas). En la naturaleza, no existe ningún especimen volador con semejante grado de dexteridad de vuelo, y se ha demostrado, que las fuerzas inerciales producidas por el batir de las alas juega un papel fundamental en los movimientos que orientan al animal en vuelo. Estas características pueden inspirar el diseño de un micro vehículo aéreo compuesto por alas mórficas con redundantes grados de libertad, y cuya proporción entre la masa de sus alas y el cuerpo del robot sea significativa. Esta tesis doctoral presenta el desarrollo de un novedoso robot aéreo inspirado en el mecanismo de ala mórfica de los murciélagos. El robot, llamado BaTboT, ha sido diseñado con parámetros morfológicos muy similares a los descritos por su símil biológico Cynopterus brachyotis. El estudio biológico de este especimen ha permitido la definición de criterios de diseño y modelos matemáticos que representan el comportamiento del robot, con el objetivo de imitar lo mejor posible la biomecánica de vuelo de los murciélagos. La biomecánica de vuelo está definida por dos tipos de movimiento de las alas: aleteo y cambio de forma. Intentar imitar como los murciélagos cambian la forma de sus alas con un prototipo artificial, requiere el análisis de métodos alternativos de actuación que se asemejen a la biomecánica de los músculos que actúan las alas, y evitar el uso de sistemas convencionales de actuación como servomotores ó motores DC. En este sentido, las aleaciones con memoria de forma, ó por sus siglas en inglés (SMA), las cuales son fibras de NiTinol que se contraen y expanden ante estímulos térmicos, han sido usados en este proyecto como músculos artificiales que actúan como bíceps y tríceps de las alas, proporcionando la funcionalidad de ala mórfica previamente descrita. De esta manera, los músculos de SMA son mecánicamente posicionados en una configuración antagonista que permite la rotación de las articulaciones del robot. Los actuadores son accionados mediante una señal de potencia la cual es regulada por un sistema de control encargado que los músculos de SMA respondan con la precisión y velocidad deseada. Este sistema de control mórfico de las alas permitirá al robot cambiar la forma de las mismas con el único propósito de mejorar el desempeño aerodinámico. Durante la fase de bajada del aleteo, las alas deben estar extendidas para incrementar la producción de fuerzas de sustentación. Al contrario, durante el ciclo de subida del aleteo, las alas deben contraerse para minimizar el área y reducir las fuerzas de fricción aerodinámica. El control de alas mórficas no solo mejora el desempeño aerodinámico, también impacta la generación de fuerzas inerciales las cuales son esenciales para maniobrar durante el vuelo. Con el objetivo de analizar como el cambio de geometría de las alas influye en la definición de maniobras y su efecto en la producción de fuerzas netas, simulaciones y experimentos han sido llevados a cabo para medir cómo distintos patrones de modulación de las alas influyen en la producción de aceleraciones lineales y angulares. Gracias a estas mediciones, se propone un control de vuelo, ó control de actitud, el cual incorpora información inercial de las alas para la definición de referencias de aceleración angular. El objetivo de esta novedosa estrategia de control radica en el incremento de fuerzas netas para la adecuada generación de movimiento (Fnet). Imitar como los murciélagos ajustan sus alas con el propósito de incrementar las fuerzas de sustentación y mejorar la maniobra en vuelo es definitivamente un tópico de mucho interés para el diseño de robots aéros mas eficientes. La propuesta de control de vuelo definida en este trabajo de investigación podría dar paso a una nueva forma de control de vuelo de robots aéreos que no necesitan del uso de partes mecánicas tales como alerones, etc. Este control también permitiría el desarrollo de vehículos con mayor capacidad de maniobra. El desarrollo de esta investigación se centra en cinco etapas: - Estudiar y analizar el vuelo de los murciélagos con el propósito de definir criterios de diseño y control. - Formular modelos matemáticos que describan la: i) cinemática de las alas, ii) dinámica, iii) aerodinámica, y iv) actuación usando SMA. Estos modelos permiten estimar la influencia de modular las alas en la producción de fuerzas netas. - Diseño y fabricación de BaTboT: i) estructura de las alas y el cuerpo, ii) mecanismo de actuación mórfico basado en SMA, iii) membrana de las alas, y iv) electrónica abordo. - Contro de vuelo compuesto por: i) control de la SMA (modulación de las alas) y ii) regulación de maniobra (actitud). - Experimentos: están enfocados en poder cuantificar cuales son los efectos que ejercen distintos perfiles de modulación del ala en el comportamiento aerodinámico e inercial. El objetivo es demostrar y validar la hipótesis planteada al inicio de esta investigación: mejorar eficiencia de vuelo gracias al novedoso control de orientación (actitud) propuesto en este trabajo. A lo largo del desarrollo de cada una de las cinco etapas, se irán presentando los retos, problemáticas y soluciones a abordar. Los experimentos son realizados utilizando un túnel de viento con la instrumentación necesaria para llevar a cabo las mediciones de desempeño respectivas. En los resultados se discutirá y demostrará que la inercia producida por las alas juega un papel considerable en el comportamiento dinámico y aerodinámico del sistema y como poder tomar ventaja de dicha característica para regular patrones de modulación de las alas que conduzcan a mejorar la eficiencia del robot en futuros vuelos.