Internet-based stress management for women with preterm labour: a case-based experience report

Pregnant women with preterm labour (PTL) in pregnancy often experience increased distress and anxieties regarding both the pregnancy and the child's health. The pathogenesis of PTL is, among other causes, related to the stress-associated activation of the maternal-foetal stress system. In spite of these psychobiological associations, only a few research studies have investigated the potential of psychological stress-reducing interventions. The following paper will present an online anxiety and stress management self-help program for pregnant women with PTL. Structure and content of the program will be illustrated by a case-based experience report. L.B., 32 years (G3, P1), was recruited at gestational week 27 while hospitalized for PTL for 3 weeks. She worked independently through the program for 6 weeks and had regular written contact with a therapist. Processing the program had a positive impact on L.B.'s anxiety and stress levels, as well as on her experienced depressive symptoms and bonding to the foetus. As PTL and the risk of PTB are associated with distress, psychological stress-reducing interventions might be beneficial. This study examines the applicability of an online intervention for pregnant women with PTL. The case report illustrates how adequate low-threshold psychological support could be provided to these women.

Computer-based summative assessment of clinical reasoning in clerkships: A mixed-method comparison of key feature problems with case-based multiple choice questions

Background: It is yet unclear if there are differences between using electronic key feature problems (KFPs) or electronic case-based multiple choice questions (cbMCQ) for the assessment of clinical decision making. Summary of Work: Fifth year medical students were exposed to clerkships which ended with a summative exam. Assessment of knowledge per exam was done by 6-9 KFPs, 9-20 cbMCQ and 9-28 MC questions. Each KFP consisted of a case vignette and three key features (KF) using “long menu” as question format. We sought students’ perceptions of the KFPs and cbMCQs in focus groups (n of students=39). Furthermore statistical data of 11 exams (n of students=377) concerning the KFPs and (cb)MCQs were compared. Summary of Results: The analysis of the focus groups resulted in four themes reflecting students’ perceptions of KFPs and their comparison with (cb)MCQ: KFPs were perceived as (i) more realistic, (ii) more difficult, (iii) more motivating for the intense study of clinical reasoning than (cb)MCQ and (iv) showed an overall good acceptance when some preconditions are taken into account. The statistical analysis revealed that there was no difference in difficulty; however KFP showed a higher discrimination and reliability (G-coefficient) even when corrected for testing times. Correlation of the different exam parts was intermediate. Conclusions: Students perceived the KFPs as more motivating for the study of clinical reasoning. Statistically KFPs showed a higher discrimination and higher reliability than cbMCQs. Take-home messages: Including KFPs with long menu questions into summative clerkship exams seems to offer positive educational effects.

Pounding force assessment in performance-based design of bridges

Bridges with deck supported on either sliding or elastomeric bearings are very common in mid-seismicity regions. Their main seismic vulnerabilities are related to the pounding of the deck against abutments or between the different deck elements. A simplified model of the longitudinal behavior of those bridges will allow to characterize the reaction forces developed during pounding using the Pacific Earthquake Engineering Research Center framework formula. In order to ensure the general applicability of the results obtained, a large number of system parameter combinations will be considered. The heart of the formula is the identification of suitable intermediate variables. First, the pseudo acceleration spectral value for the fundamental period of the system (Sa(Ts)) will be used as an intensity measure (IM). This IM will result in a very large non-explained variability of the engineering demand parameter. A portion of this variability will be proved to be related to the relative content of high-frequency energy in the input motion. Two vector-valued IMs including a second parameter taking this energy content into account will then be considered. For both of them, a suitable form for the conditional intensity dependence of the response will be obtained. The question of which one to choose will also be analyzed. Finally, additional issues related to the IM will be studied: its applicability to pulse-type records, the validity of scaling records and the sufficiency of the IM.

Case-based reasoning to support decision making for managing drinking water quality events in distribution systems

Peer reviewed

Structure-based design of selective and potent G quadruplex-mediated telomerase inhibitors

The telomerase enzyme is a potential therapeutic target in many human cancers. A series of potent inhibitors has been designed by computer modeling, which exploit the unique structural features of quadruplex DNA. These 3,6,9-trisubstituted acridine inhibitors are predicted to interact selectively with the human DNA quadruplex structure, as a means of specifically inhibiting the action of human telomerase in extending the length of single-stranded telomeric DNA. The anilino substituent at the 9-position of the acridine chromophore is predicted to lie in a third groove of the quadruplex. Calculated relative binding energies predict enhanced selectivity compared with earlier 3,6-disubstituted compounds, as a result of this substituent. The ranking order of energies is in accord with equilibrium binding constants for quadruplex measured by surface plasmon resonance techniques, which also show reduced duplex binding compared with the disubstituted compounds. The 3,6,9-trisubstututed acridines have potent in vitro inhibitory activity against human telomerase, with EC50 values of up to 60 nM.

Analysis of homeodomain function by structure-based design of a transcription factor.

The homeodomain is a 60-amino acid module which mediates critical protein-DNA and protein-protein interactions for a large family of regulatory proteins. We have used structure-based design to analyze the ability of the Oct-1 homeodomain to nucleate an enhancer complex. The Oct-1 protein regulates herpes simplex virus (HSV) gene expression by participating in the formation of a multiprotein complex (C1 complex) which regulates alpha (immediate early) genes. We recently described the design of ZFHD1, a chimeric transcription factor containing zinc fingers 1 and 2 of Zif268, a four-residue linker, and the Oct-1 homeodomain. In the presence of alpha-transinduction factor and C1 factor, ZFHD1 efficiently nucleates formation of the C1 complex in vitro and specifically activates gene expression in vivo. The sequence specificity of ZFHD1 recruits C1 complex formation to an enhancer element which is not efficiently recognized by Oct-1. ZFHD1 function depends on the recognition of the Oct-1 homeodomain surface. These results prove that the Oct-1 homeodomain mediates all the protein-protein interactions that are required to efficiently recruit alpha-transinduction factor and C1 factor into a C1 complex. The structure-based design of transcription factors should provide valuable tools for dissecting the interactions of DNA-bound domains in other regulatory circuits.

Protein structure-based design of potent orally bioavailable, nonpeptide inhibitors of human immunodeficiency virus protease.

A class of potent nonpeptidic inhibitors of human immunodeficiency virus protease has been designed by using the three-dimensional structure of the enzyme as a guide. By employing iterative protein cocrystal structure analysis, design, and synthesis the binding affinity of the lead compound was incrementally improved by over four orders of magnitude. An inversion in inhibitor binding mode was observed crystallographically, providing information critical for subsequent design and highlighting the utility of structural feedback in inhibitor optimization. These inhibitors are selective for the viral protease enzyme, possess good antiviral activity, and are orally available in three species.

Organizational, DS, GS, and depot maintenance manual (including repair parts list) : light target, surveying, u/w range pole, self illuminating, w/carrying case (military design), FSN 6675-612-1187.

"March 1966."

Organizational, DS, GS, and depot maintenance manual including repair parts : light, signal, surveying, 5 in. dia. reflector, grille housing, in carrying case (military design) FSN 6675-641-3537.

"June 1965."

A rigorous foundation for pattern based design models

This paper presents a way to describe design patterns rigorously based on role concepts. Rigorous pattern descriptions are a key aspect for patterns to be used as rules for model evolution in the MDA context, for example. We formalize the role concepts commonly used in defining design patterns as a role metamodel using Object-Z. Given this role metamodel, individual design patterns are specified generically as a formal pattern role model using Object-Z. We also formalize the properties that must be captured in a class model when a design pattern is deployed. These properties are defined generically in terms of role bindings from a pattern role model to a class model. Our work provides a precise but abstract approach for pattern definition and also provides a precise basis for checking the validity of pattern usage in designs.

Towards pattern-based design recovery

A method and a corresponding tool is described which assist design recovery and program understanding by recognising instances of design patterns semi-automatically. The approach taken is specifically designed to overcome the existing scalability problems caused by many design and implementation variants of design pattern instances. Our approach is based on a new recognition algorithm which works incrementally rather than trying to analyse a possibly large software system in one pass without any human intervention. The new algorithm exploits domain and context knowledge given by a reverse engineer and by a special underlying data structure, namely a special form of an annotated abstract syntax graph. A comparative and quantitative evaluation of applying the approach to the Java AWT and JGL libraries is also given.