IMPLEMENTING BACK PAIN TREATMENT PATHWAYS IN CLINICAL PRACTICE: QUALITATATIVE ANALYSIS OF STAKEHOLDER PERCEPTIONS

Background
Evidence-based practice advocates utilising best current research evidence, while reflecting patient preference and clinical expertise in decision making. Successfully incorporating this evidence into practice is a complex process. Based on recommendations of existing guidelines and systematic evidence reviews conducted using the GRADE approach, treatment pathways for common spinal pain disorders were developed.

Aims
The aim of this study was to identify important potential facilitators to the integration of these pathways into routine clinical practice.

Methods
A 22 person stakeholder group consisting of patient representatives, clinicians, researchers and members of relevant clinical interest groups took part in a series of moderated focus groups, followed up with individual, semi-structured interviews. Data were analysed using content analysis.

Results
Participants identified a number of issues which were categorized into broad themes. Common facilitators to implementation included continual education and synthesis of research evidence which is reflective of everyday practice; as well as the use of clear, unambiguous messages in recommendations. Meeting additional training needs in new or extended areas of practice was also recognized as an important factor. Different stakeholders identified specific areas which could be associated with successful uptake. Patients frequently defined early involvement in a shared decision making process as important. Clinicians identified case based examples and information on important prognostic indicators as useful tools to aiding decisions.

Conclusion
A number of potential implementation strategies were identified. Further work will examine the impact of these and other important factors on the integration of evidence-based treatment recommendations into clinical practice.

Communication and behavior in high reliability organizations: An Analysis of Communication in Civil Aviation

Communication can be seen as one of the most important features to manage conflicts and the stress of the work teams that operate in environments with strong pressure, complex operations and continuous risk, which are aspects that characterize a high reliability organization. This article aims to highlight the importance of communication in high-reliability organizations, having as object of study the accidents and incidents in civil aviation area. It refers to a qualitative research, outlined by documental analysis based on investigations conducted by the Federal Aviation Administration and the Center of Investigation and Prevention of Aeronautical Accidents. The results point out that human errors account for 60 to 80 percent of accidents and incidents. Most of these occurrences are attributed to miscommunication between the professionals involved with the air and ground operation, such as pilots, crewmembers and maintenance staff, and flight controllers. Inappropriate tone of voice usage, difficulties to understand different accents between the issuer and the receiver or even difficulty to perceive red flags between the lines of verbal and non-verbal communication, are elements that contribute to the fata of understanding between people involved in the operation. As a research limitation this present research pointed out a lack of a special category of "interpersonal communications failures" in the official agency reports. So, the researchers must take the conceptual definition of "social ability", communication implied, to classify behaviors and communication matters accordingly. Other research finding indicates that communication is superficially approached in the contents of air operations courses what could mitigate the lack of communications skills as a social ability. Part of the research findings refers to the contents of communication skills development into the program to train professional involved in air flight and ground operations. So, it is expected that this present article gives an appropriate highlight towards the improvement of flight operations training programs. Developing communication skills among work teams in high reliability organizations can contribute to mitigate stress, accidents and incidents in Civil Aviation Field. The original contribution of this article is the proposal of the main contents that should be developed in a Communication Skills Training Program, specially addressed to Civil Aviation operations.

Analysis of Policies for Safety Improvements on Low-Volume Rural Roadways,1994

In order to determine the adequacy with which safety problems on low-volume rural roadways were addressed by the four states of Federal Region VII (Iowa, Kansas, Missouri, and Nebraska), a review was made of the states' safety policies. After reviewing literature dealing with the identification of hazardous locations, evaluation methodologies, and system-wide safety improvements, a survey of the states' safety policies was conducted. An official from each state was questioned about the various aspects and procedures dealing with safety improvements. After analyzing and comparing the remarkably diverse policies, recommendations were made in the form of a model safety program. This program included special modifications that would help remediate hazards on low-volume rural roadways. Especially encouraged is a system-wide approach to improvement which would cover all parts of the highway system, not just urban and high-volume roadways.

A Valuation Analysis of the Physical Oceanographic Real Time System (PORTS)

This analysis estimates several economic benefits derived from national implementation of the National Oceanic and Atmospheric Administration’s Physical Oceanographic Real-Time System (PORTS®) at the 175 largest ports in the United States. Significant benefits were observed owing to: (1) lower commercial marine accident rates and resultant reductions in morbidity, mortality and property damage; (2) reduced pollution remediation costs; and, (3) increased productivity associated with operation of more fully loaded commercial vessels. Evidence also suggested additional benefits from heightened commercial and recreational fish catch and diminished recreational boating accidents. Annual gross benefits from 58 current PORTS® locations exceeded $217 million with an addition $83 million possible if installed at the largest remaining 117 ports in the United States. Over the ten-year economic life of PORTS® instruments, the present value for installation at all 175 ports could approach $2.5 billion.

Quantitative and Qualitative Trade-Off Analysis of Drowsy Driver Detection Methods: Single Electrode Wearable EEG Device, Multi-Electrode Wearable EEG Device, and Head-Mounted Gyroscope

Drowsy driving impairs motorists’ ability to operate vehicles safely, endangering both the drivers and other people on the road. The purpose of the project is to find the most effective wearable device to detect drowsiness. Existing research has demonstrated several options for drowsiness detection, such as electroencephalogram (EEG) brain wave measurement, eye tracking, head motions, and lane deviations. However, there are no detailed trade-off analyses for the cost, accuracy, detection time, and ergonomics of these methods. We chose to use two different EEG headsets: NeuroSky Mindwave Mobile (single-electrode) and Emotiv EPOC (14- electrode). We also tested a camera and gyroscope-accelerometer device. We can successfully determine drowsiness after five minutes of training using both single and multi-electrode EEGs. Devices were evaluated using the following criteria: time needed to achieve accurate reading, accuracy of prediction, rate of false positives vs. false negatives, and ergonomics and portability. This research will help improve detection devices, and reduce the number of future accidents due to drowsy driving.

From policy development to effectiveness and alignment: An analysis of the UK’s Higher Education Open Access policy landscape

The number of Open Access (OA) policies that have been adopted by universities, research institutes and research funders has been increasing at a fast pace. The Registry of Open Access Repository Mandates and Policies (ROARMAP) records the existence of 724 OA policies across the world, of which 512 have been adopted by universities and research institutions. The UK is one of the leading countries in terms of OA policy development and implementation with a total of 85 institutional1 and an estimated 35 funder2 OA policies. In order to understand and contextualise how OA policies are developed and how they can be effectively implemented and aligned, this brief looks at two areas. The first section provides an overview on the processes evolving around policy making, policy effectiveness and policy alignment. In particular, it summarises the criteria and elements generally specified in OA policies, it points out some of the relevant steps informing the development, monitoring and revision of OA policies, it outlines what OA policy elements contribute to policy effectiveness, and highlights the benefits in aligning OA policies. The second section revisits the issues previously discussed within the context of the UK institutional (universities) OA policy landscape.

Resistance to phosphine in Sitophilus oryzae in Australia: A national analysis of trends and frequencies over time and geographical spread

In Australia, along with many other parts of the world, fumigation with phosphine is a vital component in controlling stored grain insect pests. However, resistance is a factor that may limit the continued efficacy of this fumigant. While strong resistance to phosphine has been identified and characterised, very little information is available on the causes of its development and spread. Data obtained from a unique national resistance monitoring and management program were analysed, using Bayesian hurdle modelling, to determine which factors may be responsible. Fumigation in unsealed storages, combined with a high frequency of weak resistance, were found to be the main criteria that led to the development of strong resistance in Sitophilus oryzae. Independent development, rather than gene flow via migration, appears to be primarily responsible for the geographic incidence of strong resistance to phosphine in S. oryzae. This information can now be utilised to direct resources and education into those areas at high risk and to refine phosphine resistance management strategies.

Assessment and Life-Cycle Analysis of Recycled Materials for Sustainable Highway

Recycled materials replacing part of virgin materials in highway applications has shown great benefits to the society and environment. Beneficial use of recycled materials can save landfill places, sparse natural resources, and energy consumed in milling and hauling virgin materials. Low price of recycled materials is favorable to cost-saving in pavement projects. Considering the availability of recycled materials in the State of Maryland (MD), four abundant recycled materials, recycled concrete aggregate (RCA), recycled asphalt pavement (RAP), foundry sand (FS), and dredged materials (DM), were studied. A survey was conducted to collect the information of current usage of the four recycled materials in States’ Department of Transportation (DOTs). Based on literature review, mechanical and environmental properties, recommendations, and suggested test standards were investigated separately for the four recycled materials in different applications. Constrains in using these materials were further studied in order to provide recommendations for the development of related MD specifications. To measure social and environmental benefits from using recycled materials, life-cycle assessment was carried out with life-cycle analysis (LCA) program, PaLATE, and green highway rating system, BEST-in-Highway. The survey results indicated the wide use of RAP and RCA in hot mix asphalt (HMA) and graded aggregate base (GAB) respectively, while FS and DM are less used in field. Environmental concerns are less, but the possibly low quality and some adverse mechanical characteristics may hinder the widely use of these recycled materials. Technical documents and current specifications provided by State DOTs are good references to the usage of these materials in MD. Literature review showed consistent results with the survey. Studies from experimental research or site tests showed satisfactory performance of these materials in highway applications, when the substitution rate, gradation, temperature, moisture, or usage of additives, etc. meet some requirements. The results from LCA revealed significant cost savings in using recycled materials. Energy and water consumption, gas emission, and hazardous waste generation generally showed reductions to some degree. Use of new recycled technologies will contribute to more sustainable highways.

Legal consideration on Convention for the Prevention of Dumping of Wastes and Other Matter (at sea) and assessment of its implementation in Iran (The London [dumping] Convention)

Making use of sea, as a place for dumping of wastes and other materials from human activities wasn’t forbidden before creation of the convention on the prevention of marine pollution by dumping of wastes and other matters (London Convention). Therefore, industrial countries, without any specific consideration, were dumping their wastes into the world’s seas. Many years and before the beginning of rapid development of industry, the great self- purification of seas were preventing some of discharging problems. But gradually, the increase of industrial development activities, exceeded the production of wastes and other matters, and this led to the misuse of world’s seas and oceans as a dump site. One of the most important consequences of 1972 Stockholm World Conference was to focusing world attention on threats have jeopardized marine environment balance. World countries` leaders committed in Stockholm to begin protecting the environment. Finally, this movement at marine environment section led to the creation of London Convention in the same year. London Convention was concluded for cooperating between countries at December 29, 1972 to promote effective control of all marine environment polluting resources and to prevent marine pollution by dumping wastes and other matters. Then it was opened for signature to other countries. At last, after 15 states signature, this convention was entered in to force at August 30.1975. Ratification and execution of London Convention resulted in coordinated performance of countries in marine waste management. Common actions with supports and cooperation of different international, regional, governmental and non-governmental organizations and agencies prevent marine pollution by dumping of wastes and other matters. Due to the importance of wastes in our marine and coastal areas, investigation of the performance of London Convention can identify the lack of regulations and lack of regulation supports about marine pollution prevention by dumping of wastes and other matters in Iran. Considering this issue, proper protection of seas will be achieved. London Convention has been studied here to achieve intended purposes. In first chapter, generalities about marine environment, including the importance and necessity of marine environment protection, with the focus on some internal and international resources of environmental law accompanying with marine pollution and its recourses, and finally, due to the study theme, dumping of wastes and other matters at seas with its impacts have been investigated .In the section of international measures, a brief history of marine pollution and marine environment international law with international law framework, exclusively for controlling of wastes and other material discharge at seas and oceans has been reviewed. In second chapter, obligations, amendments, and annexes of London Convention have been investigated and classified. The obligations have been categorized in to legal obligations and technical and organizational obligations. In former section, subject ,purpose, territory, exceptions, rights and duties of parties, convention amendments,… and in latter, special requirements for wastes assessment, determination of pollutants` permissible limit, site selection and type of discharge selection, design principles for marine environment quality monitoring program, and discharge license issuance mechanism have been studied. In third chapter, due to the examination of convention performance in Iran, the internal law system for marine environment conservation and its pollution has been mentioned in detail. Considering this, two issues have been compared .firstly, convention obligations with regional treaties that Iran as a party to them and secondly, Iranian internal law there of .Finally, common and different aspects of these issues have been determined. At last, recommendations and strategies for convention enforcement and conformity of its obligations with internal regulations have been presented. Furthermore, translation of convention English text has been reviewed and its protocol has been translated.

Dual layer solid phase extraction based on molecular imprinting technology: Seeking a route to enhance selectivity for trace analysis of pesticide residues in olive oil.

Aiming to introduce a multiresidue analysis for the trace detection of pesticide residues belonging to organophosphorus and triazine classes from olive oil samples, a new sample preparation methodology comprising the use of a dual layer of “tailor-made” molecularly imprinted polymers (MIPs) SPE for the simultaneous extraction of both pesticides in a single procedure has been attempted. This work has focused on the implementation of a dual MIP-layer SPE procedure (DL-MISPE) encompassing the use of two MIP layers as specific sorbents. In order to achieve higher recovery rates, the amount of MIP layers has been optimized as well as the influence of MIP packaging order. The optimized DL-MISPE approach has been used in the preconcentration of spiked organic olive oil samples with concentrations of dimethoate and terbuthylazine similar to the maximum residue limits and further quantification by HPLC. High recovery rates for dimethoate (95%) and terbuthylazine (94%) have been achieved with good accuracy and precision. Overall, this work constitutes the first attempt on the development of a dual pesticide residue methodology for the trace analysis of pesticide residues based on molecular imprinting technology. Thus, DL-MISPE constitutes a reliable, robust, and sensitive sample preparation methodology that enables preconcentration of the target pesticides in complex olive oil samples, even at levels similar to the maximum residue limits enforced by the legislation.

An analysis of workforce efficiency using organization expenses indicators

The objective of this paper is to carry out an evaluation of employee efficiency in the United States using a professional data base, namely the ECS Survey on Workforce Efficiency (2000/2001) conducted by Watson Wyatt, which includes the responses of 453 organizations covering 1,685,336 employees. To that end, we measure workforce efficiency of US organizations, differentiated by profit status, industry sector and employee size, using expenses indicators. Our findings reveal that new employee strengths will depend upon developing and using the kinds of information and analyzes that can keep workers, educators, employers and employee program administrators abreast or ahead of changing conditions.

Performance Analysis of IP based WSNs in real time systems

Wireless sensor networks (WSNs) are the key enablers of the internet of things (IoT) paradigm. Traditionally, sensor network research has been to be unlike the internet, motivated by power and device constraints. The IETF 6LoWPAN draft standard changes this, defining how IPv6 packets can be efficiently transmitted over IEEE 802.15.4 radio links. Due to this 6LoWPAN technology, low power, low cost micro- controllers can be connected to the internet forming what is known as the wireless embedded internet. Another IETF recommendation, CoAP allows these devices to communicate interactively over the internet. The integration of such tiny, ubiquitous electronic devices to the internet enables interesting real-time applications. This thesis work attempts to evaluate the performance of a stack consisting of CoAP and 6LoWPAN over the IEEE 802.15.4 radio link using the Contiki OS and Cooja simulator, along with the CoAP framework Californium (Cf). Ultimately, the implementation of this stack on real hardware is carried out using a raspberry pi as a border router with T-mote sky sensors as slip radios and CoAP servers relaying temperature and humidity data. The reliability of the stack was also demonstrated during scalability analysis conducted on the physical deployment. The interoperability is ensured by connecting the WSN to the global internet using different hardware platforms supported by Contiki and without the use of specialized gateways commonly found in non IP based networks. This work therefore developed and demonstrated a heterogeneous wireless sensor network stack, which is IP based and conducted performance analysis of the stack, both in terms of simulations and real hardware.

Numerical analysis of wooden slabs with perforations under fire conditions

Wood is considered an ideal solution for floors and roofs building construction, due the mechanical and thermal properties, associated with acoustic conditions. These constructions have good sound absorption, heat insulation and relevant architectonic characteristics. They are used in many civil applications: concert and conference halls, auditoriums, ceilings, walls… However, the high vulnerability of wooden elements submitted to fire conditions requires the evaluation of its structural behaviour with accuracy. The main objective of this work is to present a numerical model to assess the fire resistance of wooden cellular slabs with different perforations. Also the thermal behaviour of the wooden slabs will be compared considering different material insulation, with different sizes, inside the cavities. A transient thermal analysis with nonlinear material behaviour will be solved using ANSYS© program. This study allows to verify the fire resistance, the temperature evolution and the char-layer, throughout a wooden cellular slab with perforations and considering the insulation effect inside the cavities.

Fire analysis of car park building structures

The thermal loading of an open car park building structure is going to be analysed, based on different fire scenarios that depend on the type of vehicle (different heat release rate). The compartment is going to be fixed and the thermal effect on beams is going to be analysed, depending on the vehicle position. The result of simple calculation method will be used to determine several temperature-time curves. The simple calculation method (Hasemi method) is also to be compared with the calculations of the Elefir-EN calculation program to analyse the thermal effect of the localized fire on beams.

REFUGEES AND RESETTLEMENT: A QUALITATIVE ANALYSIS OF REFUGEE INTEGRATION THROUGH SOCIAL & SUPPORT SERVICES

This dissertation studies refugee resettlement in the United States utilizing the Integration Indicator’s framework developed by Ager and Strang for the U.S. context. The study highlights the U.S. refugee admissions program and the policies in the states of Maryland and Massachusetts while analyzing the service delivery models and its effects on refugee integration in these locations. Though immigration policy and funding for refugee services are primarily the domain of the federal government, funds are allocated through and services are delivered at the state level. The Office of Refugee Resettlement (ORR), which operates under the Department of Health and Human Services, was established after the Refugee Act of 1980 to deliver assistance to displaced persons. The ORR provides funds to individual states primarily through The Refugee Social Service and Targeted Assistance Formula Grant programs. Since the inauguration of the ORR three primary models of refugee integration through service delivery have emerged. Two of the models include the publicly/privately administered programs, where resources are allocated to the state in conjunction with private voluntary agencies; and the Wilson/Fish Alternative programs, where states sub-contract all elements of the resettlement program to voluntary agencies and private organizations —in which they can cease all state level participation and voluntary agencies or private organizations contract directly from the ORR in order for all states to deliver refugee services where the live. The specific goals of this program are early employment and economic self-sufficiency. This project utilizes US Census, state, and ORR data in conjunction with interviews of refugee resettlement practitioners involved in the service delivery and refugees. The findings show that delivery models emphasizing job training, English instruction courses, institutional collaboration, and monetary assistance, increases refugee acclimation and adaptation, providing insight into their potential for integration into the United States.