Coalition Structures and Policy Change in a Consensus Democracy

This paper studies the relation between coalition structures in policy processes and policy change. While different factors such as policy images, learning processes, external events, or venue shopping are important to explain policy change, coalition structures within policy processes are often neglected. However, policy change happens as a result of negotiations and coordination among coalitions within policy processes. The paper analyzes how conflict, collaboration, and power relations among coalitions of actors influence policy change in an institutional context of a consensus democracy. Empirically, I rely on a Qualitative Comparative Analysis to conduct a cross-sector comparison of the 11 most important policy processes in Switzerland between 2001 and 2006. Coalition structures with low conflict and strong collaboration among coalitions as well as structures with dominant coalitions and weak collaboration both facilitate major policy change. Competing coalitions that are separated by strong conflict but still collaborate strongly produce policy outputs that are close to the status quo.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.

Clinical effectiveness of cognitive behavioral therapy for depression in routine care: A propensity score based comparison between randomized controlled trials and clinical practice

Background: The efficacy of cognitive behavioral therapy (CBT) for the treatment of depressive disorders has been demonstrated in many randomized controlled trials (RCTs). This study investigated whether for CBT similar effects can be expected under routine care conditions when the patients are comparable to those examined in RCTs. Method: N=574 CBT patients from an outpatient clinic were stepwise matched to the patients undergoing CBT in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). First, the exclusion criteria of the RCT were applied to the naturalistic sample of the outpatient clinic. Second, propensity score matching (PSM) was used to adjust the remaining naturalistic sample on the basis of baseline covariate distributions. Matched samples were then compared regarding treatment effects using effect sizes, average treatment effect on the treated (ATT) and recovery rates. Results: CBT in the adjusted naturalistic subsample was as effective as in the RCT. However, treatments lasted significantly longer under routine care conditions. Limitations: The samples included only a limited amount of common predictor variables and stemmed from different countries. There might be additional covariates, which could potentially further improve the matching between the samples. Conclusions: CBT for depression in clinical practice might be equally effective as manual-based treatments in RCTs when they are applied to comparable patients. The fact that similar effects under routine conditions were reached with more sessions, however, points to the potential to optimize treatments in clinical practice with respect to their efficiency.

A review of the published literature on interventions to increase compliance with follow-up outpatient medical appointments in primary care practice

Effective strategies for patient follow-up compliance in family practice are essential for the prevention and early detection of disease with the consequences of decreasing morbidity and mortality. With effective appointment reminder systems in place, physicians can better manage the overall health of their patients by providing preventive care as well. This literature review examines intervention strategies used by the authors, the compliance rate of appointment adherence using these techniques, as well as theories relating to study outcomes. The findings of this study may be used as an educational tool by practices to suggest which intervention strategies might be the most effective for their clinic.^

Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Organic matter preservation in sediments of the Peru and Oman continental margin

Detailed petrographical and bulk geochemical investigations of organic matter (OM) have been performed on sediments deposited below or close to upwelling areas offshore Peru (ODP-Leg 112; Sites 679, 681, 688) and Oman (ODP-Leg 117; Sites 720, 723, 724) in order to obtain a quantitative understanding of its accumulation and degradation. Microscopical as well as nanoscopical investigations reveal that the OM in sediments affected by upwelling mechanisms mainly (up to 98%) consists of unstructured (amorphous) organic aggregates without any apparent biological structures. In sediments which are not or to a lesser extent affected by upwelling (Site 720) terrestrial OM predominates. Organic carbon (TOC) contents are highly variable and range between 9.8% in sediments deposited below upwelling cells and 0.2% in sediments outside the upwelling zone. The TOC/sulphur ratios of the sediments scatter widely. The samples from the deep-water locations (Sites 688 and 720), show C/S-ratios of "normal" marine sediments, whereas at the other locations no correlation or even a negative correlation between sulphur and TOC concentration exists. In most of the upwelling-influenced sediments OM contains a significant amount of sulphur. The incorporation of sulphur into the OM followed microbial sulphate reduction and occurred in the upper meters of the sedimentary column. Below, OM is still present in vast amounts and relatively hydrogen-rich, but is nevertheless non-metabolizable and becomes the limiting factor for bacterial sulphate reduction. According to mass balance calculations 90-99% of the OM produced in the photic zone was remineralized and 1-3% was consumed by microbial sulphate reduction. The aerobic and anaerobic processes have greatly affected degradation and conservation of OM.

Background heat flow values in the region of the Sea of Okhotsk

Particular features of tectonic structure and anomalous distribution of geothermal, geomagnetic, and gravity fields in the region of the Sea of Okhotsk are considered. On the basis of heat flow data, ages of large-scale structures in the Sea of Okhotsk are estimated at 65 Ma for the Central Okhotsk Rise and 36 Ma for the South Okhotsk Basin. Age of the South Okhotsk Basin is confirmed by data on kinematics and corresponds to 50 km thickness of the lithosphere. This is in accordance with thickness value obtained by magnetotelluric soundings. Comparative analysis of model geothermal background and measured heat flow values on the Akademii Nauk Rise is performed. Analysis points to abnormally high (~20%) measured heat flow agrees with high negative gradient of gravity anomalies. Estimates of deep heat flow and basement age of riftogenic basins in the Sea of Okhotsk were carried out in the following areas: Deryugin Basin (18 Ma, Early Miocene), TINRO Basin (12 Ma, Middle Miocene), and West Kamchatka Basin (23 Ma, Late Oligocene). Temperatures at boundaries of the main lithological complexes of the sedimentary cover are calculated and zones of oil and gas generation are defined. On the basis of geothermal, magnetic, structural, and other geological-geophysical data a kinematic model of the region of the Sea of Okhotsk for period of 36 Ma was calculated and constructed.

Geophysical mapping of the sediment architecture in the Orkhon Valley, Mongolia

Ground penetrating radar (GPR) and capacitive coupled resistivity (CCR) measurements were conducted in order to image subsurface structures in the Orkhon Valley, Central Mongolia. The data are extended by information from drill cores to the entire transects distinguishing different sedimentary environments in the valley. The Orkhon Valley is part of the high sensitive Steppe region in Central Mongolia, one of the most important cultural landscapes in Central Asia. There, archaeological, geoarchaeological and sedimentological research aims to reconstruct the landscape evolution and the interaction between man and environment during the last millennia since the first settlement. In May 2009 and 2010 geophysical surveys have been conducted including transects with lengths between 1.5 and 30 km crossing the entire valley and a kilometre-scaled grid in the southern part of the investigation area. The geoelectrical and GPR data revealed the existence of two layers characterized by different resistivity values and radar reflectors. The two layers do not only represent material contrasts, but also reflect the influence of sporadic permafrost which occurs in several areas of Mongolia. The results help to reconstruct the evolution of the braided Orkhon River and therefore give important hints to understand the environmental history of the Orkhon Valley.

Migration to an a on-line laboatory in mechanical engineering. The case of a cam-follower design practice.

The European Higher Education Area (EHEA) has leaded to a change in the way the subjects are taught. One of the more important aspects of the EHEA is to support the autonomous study of the students. Taking into account this new approach, the virtual laboratory of the subject Mechanisms of the Aeronautical studies at the Technical University of Madrid is being migrated to an on-line scheme. This virtual laboratory consist on two practices: the design of cam-follower mechanisms and the design of trains of gears. Both practices are software applications that, in the current situation, need to be installed on each computer and the students carry out the practice at the computer classroom of the school under the supervision of a teacher. During this year the design of cam-follower mechanisms practice has been moved to a web application using Java and the Google Development Toolkit. In this practice the students has to design and study the running of a cam to perform a specific displacement diagram with a selected follower taking into account that the mechanism must be able to work properly at high speed regime. The practice has maintained its objectives in the new platform but to take advantage of the new methodology and try to avoid the inconveniences that the previous version had shown. Once the new practice has been ready, a pilot study has been carried out to compare both approaches: on-line and in-lab. This paper shows the adaptation of the cam and follower practice to an on-line methodology. Both practices are described and the changes that has been done to the initial one are shown. They are compared and the weak and strong points of each one are analyzed. Finally we explain the pilot study carried out, the students impression and the results obtained.

Migration to an a on.line laboratory in mechanical engineering. The case of a cam follower design practice.

The European Higher Education Area (EHEA) has leaded to a change in the way the subjects are taught. One of the more important aspects of the EHEA is to support the autonomous study of the students. Taking into account this new approach, the virtual laboratory of the subject Mechanisms of the Aeronautical studies at the Technical University of Madrid is being migrated to an on-line scheme. This virtual laboratory consist on two practices: the design of cam-follower mechanisms and the design of trains of gears. Both practices are software applications that, in the current situation, need to be installed on each computer and the students carry out the practice at the computer classroom of the school under the supervision of a teacher. During this year the design of cam-follower mechanisms practice has been moved to a web application using Java and the Google Development Toolkit. In this practice the students has to design and study the running of a cam to perform a specific displacement diagram with a selected follower taking into account that the mechanism must be able to work properly at high speed regime. The practice has maintained its objectives in the new platform but to take advantage of the new methodology and try to avoid the inconveniences that the previous version had shown. Once the new practice has been ready, a pilot study has been carried out to compare both approaches: on-line and in-lab. This paper shows the adaptation of the cam and follower practice to an on-line methodology. Both practices are described and the changes that has been done to the initial one are shown. They are compared and the weak and strong points of each one are analyzed. Finally we explain the pilot study carried out, the students impression and the results obtained.

Uncertainties in the modal estimation from output-only data in civil structures

Cualquier estructura vibra según unas frecuencias propias definidas por sus parámetros modales (frecuencias naturales, amortiguamientos y formas modales). A través de las mediciones de la vibración en puntos clave de la estructura, los parámetros modales pueden ser estimados. En estructuras civiles, es difícil excitar una estructura de manera controlada, por lo tanto, las técnicas que implican la estimación de los parámetros modales sólo registrando su respuesta son de vital importancia para este tipo de estructuras. Esta técnica se conoce como Análisis Modal Operacional (OMA). La técnica del OMA no necesita excitar artificialmente la estructura, atendiendo únicamente a su comportamiento en servicio. La motivación para llevar a cabo pruebas de OMA surge en el campo de la Ingeniería Civil, debido a que excitar artificialmente con éxito grandes estructuras no sólo resulta difícil y costoso, sino que puede incluso dañarse la estructura. Su importancia reside en que el comportamiento global de una estructura está directamente relacionado con sus parámetros modales, y cualquier variación de rigidez, masa o condiciones de apoyo, aunque sean locales, quedan reflejadas en los parámetros modales. Por lo tanto, esta identificación puede integrarse en un sistema de vigilancia de la integridad estructural. La principal dificultad para el uso de los parámetros modales estimados mediante OMA son las incertidumbres asociadas a este proceso de estimación. Existen incertidumbres en el valor de los parámetros modales asociadas al proceso de cálculo (internos) y también asociadas a la influencia de los factores ambientales (externas), como es la temperatura. Este Trabajo Fin de Máster analiza estas dos fuentes de incertidumbre. Es decir, en primer lugar, para una estructura de laboratorio, se estudian y cuantifican las incertidumbres asociadas al programa de OMA utilizado. En segundo lugar, para una estructura en servicio (una pasarela de banda tesa), se estudian tanto el efecto del programa OMA como la influencia del factor ambiental en la estimación de los parámetros modales. Más concretamente, se ha propuesto un método para hacer un seguimiento de las frecuencias naturales de un mismo modo. Este método incluye un modelo de regresión lineal múltiple que permite eliminar la influencia de estos agentes externos. A structure vibrates according to some of its vibration modes, defined by their modal parameters (natural frequencies, damping ratios and modal shapes). Through the measurements of the vibration at key points of the structure, the modal parameters can be estimated. In civil engineering structures, it is difficult to excite structures in a controlled manner, thus, techniques involving output-only modal estimation are of vital importance for these structure. This techniques are known as Operational Modal Analysis (OMA). The OMA technique does not need to excite artificially the structure, this considers its behavior in service only. The motivation for carrying out OMA tests arises in the area of Civil Engineering, because successfully artificially excite large structures is difficult and expensive. It also may even damage the structure. The main goal is that the global behavior of a structure is directly related to their modal parameters, and any variation of stiffness, mass or support conditions, although it is local, is also reflected in the modal parameters. Therefore, this identification may be within a Structural Health Monitoring system. The main difficulty for using the modal parameters estimated by an OMA is the uncertainties associated to this estimation process. Thus, there are uncertainties in the value of the modal parameters associated to the computing process (internal) and the influence of environmental factors (external), such as the temperature. This Master’s Thesis analyzes these two sources of uncertainties. That is, firstly, for a lab structure, the uncertainties associated to the OMA program used are studied and quantified. Secondly, for an in-service structure (a stress-ribbon footbridge), both the effect of the OMA program and the influence of environmental factor on the modal parameters estimation are studied. More concretely, a method to track natural frequencies of the same mode has been proposed. This method includes a multiple linear regression model that allows to remove the influence of these external agents.

Two-dimensional isostatic meshes in the finite element method

In a Finite Element (FE) analysis of elastic solids several items are usually considered, namely, type and shape of the elements, number of nodes per element, node positions, FE mesh, total number of degrees of freedom (dot) among others. In this paper a method to improve a given FE mesh used for a particular analysis is described. For the improvement criterion different objective functions have been chosen (Total potential energy and Average quadratic error) and the number of nodes and dof's of the new mesh remain constant and equal to the initial FE mesh. In order to find the mesh producing the minimum of the selected objective function the steepest descent gradient technique has been applied as optimization algorithm. However this efficient technique has the drawback that demands a large computation power. Extensive application of this methodology to different 2-D elasticity problems leads to the conclusion that isometric isostatic meshes (ii-meshes) produce better results than the standard reasonably initial regular meshes used in practice. This conclusion seems to be independent on the objective function used for comparison. These ii-meshes are obtained by placing FE nodes along the isostatic lines, i.e. curves tangent at each point to the principal direction lines of the elastic problem to be solved and they should be regularly spaced in order to build regular elements. That means ii-meshes are usually obtained by iteration, i.e. with the initial FE mesh the elastic analysis is carried out. By using the obtained results of this analysis the net of isostatic lines can be drawn and in a first trial an ii-mesh can be built. This first ii-mesh can be improved, if it necessary, by analyzing again the problem and generate after the FE analysis the new and improved ii-mesh. Typically, after two first tentative ii-meshes it is sufficient to produce good FE results from the elastic analysis. Several example of this procedure are presented.

Differences in frontal cortical activation by a working memory task after substitution of risperidone for typical antipsychotic drugs in patients with schizophrenia

Antipsychotic drug treatment of schizophrenia may be complicated by side effects of widespread dopaminergic antagonism, including exacerbation of negative and cognitive symptoms due to frontal cortical hypodopaminergia. Atypical antipsychotics have been shown to enhance frontal dopaminergic activity in animal models. We predicted that substitution of risperidone for typical antipsychotic drugs in the treatment of schizophrenia would be associated with enhanced functional activation of frontal cortex. We measured cerebral blood oxygenation changes during periodic performance of a verbal working memory task, using functional MRI, on two occasions (baseline and 6 weeks later) in two cohorts of schizophrenic patients. One cohort (n = 10) was treated with typical antipsychotic drugs throughout the study. Risperidone was substituted for typical antipsychotics after baseline assessment in the second cohort (n = 10). A matched group of healthy volunteers (n = 10) was also studied on a single occasion. A network comprising bilateral dorsolateral prefrontal and lateral premotor cortex, the supplementary motor area, and posterior parietal cortex was activated by working memory task performance in both the patients and comparison subjects. A two-way analysis of covariance was used to estimate the effect of substituting risperidone for typical antipsychotics on power of functional response in the patient group. Substitution of risperidone increased functional activation in right prefrontal cortex, supplementary motor area, and posterior parietal cortex at both voxel and regional levels of analysis. This study provides direct evidence for significantly enhanced frontal function in schizophrenic patients after substitution of risperidone for typical antipsychotic drugs, and it indicates the potential value of functional MRI as a tool for longitudinal assessment of psychopharmacological effects on cerebral physiology.

Intermolecular and Intramolecular Charge Transfer in Functional Molecular Materials

This thesis is devoted to the investigation of inter and intramolecular charge transfer (CT) in molecular functional materials and specifically organic dyes and CT crystals. An integrated approach encompassing quantum-chemical calculations, semiempirical tools, theoretical models and spectroscopic measurements is applied to understand structure-property relationships governing the low-energy physics of these materials. Four main topics were addressed: 1) Spectral properties of organic dyes. Charge-transfer dyes are constituted by electron donor (D) and electron acceptor (A) units linked through bridge(s) to form molecules with different symmetry and dimensionality. Their low-energy physics is governed by the charge resonance between D and A groups and is effectively described by a family of parametric Hamiltonians known as essential-state models. These models account for few electronic states, corresponding to the main resonance structures of the relevant dye, leading to a simple picture that is completed introducing the coupling of the electronic system to molecular vibrations, treated in a non-adiabatic way, and an effective classical coordinate, describing polar solvation. In this work a specific essential-state model was proposed and parametrized for the dye Brilliant Green. The central issue in this work has been the definition of the diabatic states, a not trivial task for a multi-branched chromophore. In a second effort, we have used essential-state models for the description of the early-stage dynamics of excited states after ultrafast excitation. Crucial to this work is the fully non-adiabatic treatment of the coupled electronic and vibrational motion, allowing for a reliable description of the dynamics of systems showing a multistable, broken-symmetry excited state. 2) Mixed-stack CT salts. Mixed-stack (MS) CT crystals are an interesting class of multifunctional molecular materials, where D and A molecules arrange themselves to form stacks, leading to delocalized electrons in one dimension. The interplay between the intermolecular CT, electrostatic interactions, lattice phonons and molecular vibrations leads to intriguing physical properties that include (photoinduced) phase transitions, multistability, antiferromagnetism, ferroelectricity and potential multiferroicity. The standard microscopic model to describe this family of materials is the Modified Hubbard model accounting for electron-phonon coupling (Peierls coupling), electron-molecular vibrations coupling (Holstein coupling) and electrostatic interactions. We adopt and validate a method, based on DFT calculations on dimeric DA structures, to extract relevant model parameters. The approach offers a powerful tool to shed light on the complex physics of MS-CT salts. 3) Charge transfer in organic radical dipolar dyes. In collaboration with the group of Prof. Jaume Veciana (ICMAB- Barcellona), we have studied spectral properties of a special class of CT dyes with D-bridge-A structure where the acceptor group is a stable radical (of the perchlorotriphenylmethyl, PTM, family), leading to an open-shell CT dyes. These materials are of interest since they associate the electronic and optical properties of CT dyes with magnetic properties from the unpaired electron. The first effort was devoted to the parametrization of the relevant essential-state model. Two strategies were adopted, one based on the calculation of the low-energy spectral properties, the other based on the variation of ground state properties with an applied electric field. 4) The spectral properties of organic nanoparticles based on radical species are investigated in collaboration with Dr. I. Ratera (ICMAB- Barcellona). Intriguing spectroscopic behavior was observed pointing to the presence of excimer states. In an attempt to rationalize these findings, extensive calculations (TD-DFT and ZINDO) were performed. The results for the isolated dyes are validated against experimental spectra in solution. To address intermolecular interactions we studied dimeric structures in the gas phase, but the preliminary results obtained do not support excimer formation.