Multimodal Transportation in Northeast Seattle: An Integrated Design

Thesis (Master's)--University of Washington, 2016-06

Prescription drug samples: Does this marketing strategy counteract policies for quality use of medicines?

Prescription drug samples, as used by the pharmaceutical industry to market their products, are of current interest because of their influence on prescribing, and their potential impact on consumer safety. Very little research has been conducted into the use and misuse of prescription drug samples, and the influence of samples on health policies designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate, with increasing costs and increasing concerns about optimizing use of medicines. This manuscript critically evaluates the research that has been conducted to date about prescription drug samples, discusses the issues raised in the context of traditional marketing theory, and suggests possible alternatives for the future.

The treatment of domestic wastewater using small-scale vermicompost filter beds

The aim of this study is to quantity the effect of filter bed depth and solid waste inputs on the performance of small-scale vermicompost filter beds that treat the soluble contaminants within domestic wastewater. The study also aims to identify environmental conditions within the filters by quantifying the oxygen content and pH of wastewater held within it. Vermicompost is being utilised within commercially available on-site domestic waste treatment systems however, there are few reported studies that have examined this medium for the purpose of wastewater treatment. Three replicate small-scale reactors were designed to enable wastewater sampling at five reactor depths in 10-cm intervals. The surface of each reactor received household solid organic waste and 1301 m(-2) per day of raw domestic wastewater. The solid waste at the filter bed surface leached oxygen demand into the wastewater flowing through it. The oxygen demand was subsequently removed in lower reactor sections. Both nitrification and denitrification occurred in the bed. The extent of denitrification was a function of BOD leached from the solid waste. The environmental conditions measured within the bed were found to be suitable for earthworms living within them. The study identified factors that will affect the performance and application of the vermicompost filtration technology. (C) 2004 Elsevier B.V. All rights reserved.

Multisite, quality-improvement collaboration to optimise cardiac care in Queensland public hospitals

Objective: To evaluate changes in quality of in-hospital care of patients with either acute coronary syndromes (ACS) or congestive heart failure (CHF) admitted to hospitals participating in a multisite quality improvement collaboration. Design: Before-and-after study of changes in quality indicators measured on representative patient samples between June 2001 and January 2003. Setting: Nine public hospitals in Queensland. Study populations: Consecutive or randomly selected patients admitted to study hospitals during the baseline period (June 2001 to January 2002; n = 807 for ACS, n = 357 for CHF) and post-intervention period (July 2002 to January 2003; n = 717 for ACS, n = 220 for CHF). Intervention: Provision of comparative baseline feedback at a facilitative workshop combined with hospital-specific quality-improvement interventions supported by on-site quality officers and a central program management group. Main outcome measure: Changes in process-of-care indicators between baseline and post-intervention periods. Results: Compared with baseline, more patients with ACS in the post-intervention period received therapeutic heparin regimens (84% v 72%; P < 0.001), angiotensin-converting enzyme inhibitors (64% v 56%; P = 0.02), lipid-lowering agents (72% v 62%; P < 0.001), early use of coronary angiography (52% v 39%; P < 0.001), in-hospital cardiac counselling (65% v 43%; P < 0.001), and referral to cardiac rehabilitation (15% v 5%; P < 0.001). The numbers of patients with CHF receiving β-blockers also increased (52% v 34%; P < 0.001), with fewer patients receiving deleterious agents (13% v 23%; P = 0.04). Same-cause 30-day readmission rate decreased from 7.2% to 2.4% (P = 0.02) in patients with CHF. Conclusion: Quality-improvement interventions conducted as multisite collaborations may improve in-hospital care of acute cardiac conditions within relatively short time frames.

Psychotherapy at the point of a pistol

Although specific phobias are among the most prevalent and most treatable of the anxiety disorders, successful treatments for firearm phobias are seldom reported. The assessment and treatment of a phobia specific to firing the 9 mm service pistol is described. The case was identified during a Return to Australia Psychological Screening (RTAPS) evolution, following the operational deployment of a Royal Australian Navy warship. The screening package involved group based psychoeducation and standardised self report scales for detecting trauma experiences and sources of psychological distress. These were followed by semi-structured individual interviews. This process revealed a sailor with a phobia linked to a traumatic experience following an unauthorised discharge of a 9 mm pistol. A behavioural treatment regime was planned and conducted at sea under operational conditions. Live firing constituted the main intervention. The positive results suggest live firing is a safe and effective form of single session exposure, conditional on additional safety precautions to supplement regulated weapons handling procedures. (author abstract)

Characterizing the physical and chemical properties of a vermicompost filter bed

Vermicompost filtration is a new on-site waste treatment system. Consequently, little is known about the filter medium properties. The aim of this preliminary study was to quantify physical and compositional properties of vermicompost filter beds that had been used to treat domestic solid organic waste and wastewater. This paper presents the trials performed on pilot-scale reactors filled with vermicompost from a full-scale vermicompost filtration system. Household solid organic waste and raw wastewater at the rate of 130 L/m(2)/d was applied to the reactor bed surface over a four-month period. It was found that fresh casts laid on the bed surface had a BOD of 1290 mg/g VS while casts buried to a depth of 10 cm had a BOD of 605 mg/g VS. Below this depth there was little further biodegradation of earthworm casts despite cast ages of up to five years. Solid material in the reactor accounted for only 7-10% of the reactor volume. The total voidage comprised of large free-draining pores, which accounted for 15-20% of the reactor volume and 60-70% micropores, able to hold up water against gravity. It was shown that water could flow through the medium micropores and macropores following a wastewater application. The wastewater flow characteristics were modeled by a two-region model based on the Richards Equation, an equation used to describe porous spatially heterogeneous materials.

Viscosupplementation for the treatment of osteoarthritis of the knee (Review)

Background Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Objectives To assess the effects of viscosupplementation in the treatment of OA of the knee. The products were hyaluronan and hylan derivatives (Adant, Arthrum H, Artz (Artzal, Supartz), BioHy (Arthrease, Euflexxa, Nuflexxa), Durolane, Fermathron, Go-On, Hyalgan, Hylan G-F 20 (Synvisc Hylan G-F 20), Hyruan, NRD-101 (Suvenyl), Orthovisc, Ostenil, Replasyn, SLM-10, Suplasyn, Synject and Zeel compositum). Search strategy MEDLINE (up to January (week 1) 2006 for update), EMBASE, PREMEDLINE, Current Contents up to July 2003, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Specialised journals and reference lists of identified randomised controlled trials (RCTs) and pertinent review articles up to December 2005 were handsearched. Selection criteria RCTs of viscosupplementation for the treatment of people with a diagnosis of OA of the knee were eligible. Single and double-blinded studies, placebo-based and comparative studies were eligible. At least one of the four OMERACT III core set outcome measures had to be reported (Bellamy 1997). Data collection and analysis Each trial was assessed independently by two reviewers for its methodological quality using a validated tool. All data were extracted by one reviewer and verified by a second reviewer. Continuous outcome measures were analysed as weighted mean differences (WMD) with 95% confidence intervals (CI). However, where different scales were used to measure the same outcome, standardized mean differences (SMD) were used. Dichotomous outcomes were analyzed by relative risk (RR). Main results Seventy-six trials with a median quality score of 3 (range 1 to 5) were identified. Follow-up periods varied between day of last injection and eighteen months. Forty trials included comparisons of hyaluronan/hylan and placebo (saline or arthrocentesis), ten trials included comparisons of intra-articular (IA) corticosteroids, six trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs), three trials included comparisons of physical therapy, two trials included comparisons of exercise, two trials included comparisons of arthroscopy, two trials included comparisons of conventional treatment, and fifteen trials included comparisons of other hyaluronans/hylan. The pooled analyses of the effects of viscosupplements against 'placebo' controls generally supported the efficacy of this class of intervention. In these same analyses, differential efficacy effects were observed for different products on different variables and at different timepoints. Of note is the 5 to 13 week post injection period which showed a percent improvement from baseline of 28 to 54% for pain and 9 to 32% for function. In general, comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA corticosteroids. In general, few adverse events were reported in the hyaluronan/hylan trials included in these analyses. Authors' conclusions Based on the aforementioned analyses, viscosupplementation is an effective treatment for OA of the knee with beneficial effects: on pain, function and patient global assessment; and at different post injection periods but especially at the 5 to 13 week post injection period. It is of note that the magnitude of the clinical effect, as expressed by the WMD and standardised mean difference (SMD) from the RevMan 4.2 output, is different for different products, comparisons, timepoints, variables and trial designs. However, there are few randomised head-to-head comparisons of different viscosupplements and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products. The clinical effect for some products, against placebo, on some variables at some timepoints is in the moderate to large effect-size range. Readers should refer to relevant tables to review specific detail given the heterogeneity in effects across the product class and some discrepancies observed between the RevMan 4.2 analyses and the original publications. Overall, the analyses performed are positive for the HA class and particularly positive for some products with respect to certain variables and timepoints, such as pain on weight bearing at 5 to 13 weeks postinjection. In general, sample-size restrictions preclude any definitive comment on the safety of the HA class of products; however, within the constraints of the trial designs employed no major safety issues were detected. In some analyses viscosupplements were comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events. In other analyses HA products had more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.

Process, performance, and pollution potential: A review of septic tank-soil absorption systems

On-site wastewater treatment and dispersal systems (OWTS) are used in non-sewered populated areas in Australia to treat and dispose of household wastewater. The most common OWTS in Australia is the septic tank-soil absorption system (SAS) - which relies on the soil to treat and disperse effluent. The mechanisms governing purification and hydraulic performance of a SAS are complex and have been shown to be highly influenced by the biological zone (biomat) which develops on the soil surface within the trench or bed. Studies suggest that removal mechanisms in the biomat zone, primarily adsorption and filtering, are important processes in the overall purification abilities of a SAS. There is growing concern that poorly functioning OWTS are impacting upon the environment, although to date, only a few investigations have been able to demonstrate pollution of waterways by on-site systems. In this paper we review some key hydrological and biogeochemical mechanisms in SAS, and the processes leading to hydraulic failure. The nutrient and pathogen removal efficiencies in soil absorption systems are also reviewed, and a critical discussion of the evidence of failure and environmental and public health impacts arising from SAS operation is presented. Future research areas identified from the review include the interactions between hydraulic and treatment mechanisms, and the biomat and sub-biomat zone gas composition and its role in effluent treatment.

Minimal disease activity for rheumatoid arthritis: A preliminary definition

Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA. True remission is still rare in RA; in addition, the American College of Rheumatology definition is difficult to apply in the context of trials. Participants at OMERACT 6 in 2002 agreed on a conceptual definition of minimal disease activity (MDA): "that state of disease activity deemed a useful target of treatment by both the patient and the physician, given current treatment possibilities and limitations." To prepare for a preliminary operational definition of MDA for use in clinical trials, we asked rheumatologists to assess 60 patient profiles describing real RA patients seen in routine clinical practice. Based on their responses, several candidate definitions for MDA were designed and discussed at the OMERACT 7 in 2004. Feedback from participants and additional on-site analyses in a cross-sectional database allowed the formulation of 2 preliminary, equivalent definitions of MDA: one based on the Disease Activity Score 28 (DAS28) index, and one based on meeting cutpoints in 5 out the 7 WHO/ILAR core set measures. Researchers applying these definitions first need to choose whether to use the DAS28 or the core set definition, because although each selects a similar proportion in a population, these are not always the same patients. In both MDA definitions, an initial decision node places all patients in MDA who have a tender joint count of 0 and a swollen joint count of 0, and an erythrocyte sedimentation rate (ESR) no greater than 10 mm. If this condition is not met: center dot The DAS28 definition places patients in MDA when DAS28

Effectiveness of topical skin care provided in aged care facilities

Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in long-term aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases: PubMed (NLM) (1966–4/2003), Embase (1966–4/2003), CINAHL (1966–4/2003), Current Contents (1993–4/2003), Cochrane Library (1966–2/2003), Web of Science (1995–12/2002), Science Citation Index Expanded and ProceedingsFirst (1993–12/2002). Health Technology Assessment websites were also searched. No language restrictions were applied. Selection criteria Systematic reviews of randomised controlled trials, randomised and non-randomised controlled trials evaluating any non-medical intervention or program that aimed to maintain or improve the integrity of skin in older adults were considered for inclusion. Participants were 65 years of age or over and residing in an aged care facility, hospital or long-term care in the community. Studies were excluded if they evaluated pressure-relieving techniques for the prevention of skin breakdown. Data collection and analysis Two independent reviewers assessed study eligibility for inclusion. Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data. Results The resulting evidence of the effectiveness of topical skin care interventions was variable and dependent upon the skin condition outcome being assessed. The strongest evidence for maintenance of skin condition in incontinent patients found that disposable bodyworn incontinence protection reduced the odds of deterioration of skin condition compared with non-disposable bodyworns. The best evidence for non-pressure relieving topical skin care interventions on pressure sore formation found the no-rinse cleanser Clinisan to be more effective than soap and water at maintaining healthy skin (no ulcers) in elderly incontinent patients in long-term care. The quality of studies examining the effectiveness of topical skin care interventions on the incidence of skin tears was very poor and inconclusive. Topical skin care for prevention of dermatitis found that Sudocrem could reduce the redness of skin compared with zinc cream if applied regularly after each pad change, but not the number of lesions. Topical skin care on dry skin found the Bag Bath/Travel Bath no-rinse skin care cleanser to be more effective at preventing overall skin dryness and most specifically flaking and scaling when compared with the traditional soap and water washing method in residents of a long-term care facility. Information on the safety of topical skin care interventions is lacking. Therefore, because of the lack of evidence, no recommendation on the safety on any intervention included in this review can be made.

Efffluent flux prediction in variably saturated soil zones within a septic tank-soil absorption trench

The treatment and hydraulic mechanisms in a septic tank-soil absorption system ( SAS) are highly influenced by the clogging layer or biomat zone which develops on bottom and lower sidewall surfaces within the trench. Flow rates through the biomat and sub-biomat zones are governed largely by the biomat hydraulic properties (resistance and hydraulic conductivity) and the unsaturated hydraulic conductivity of the underlying soil. One- and 2-dimensional models were used to investigate the relative importance of sidewall and vertical flow rates and pathways in SAS. Results of 1-dimensional modelling show that several orders of magnitude variation in saturated hydraulic conductivity (Ks) reduce to a 1 order of magnitude variation in long-term flow rates. To increase the reliability of prediction of septic trench hydrology, HYDRUS-2D was used to model 2-dimensional flow. In the permeable soils, under high trench loading, effluent preferentially flowed in the upper region of the trench where no resistant biomat was present (the exfiltration zone). By comparison, flow was more evenly partitioned between the biomat zones and the exfiltration zones of the low permeability soil. An increase in effluent infiltration corresponded with a greater availability of exfiltration zone, rather than a lower resistance of biomat. Results of modelling simulations demonstrated the important role that a permeable A horizon may play in limiting surface surcharge of effluent under high trench hydraulic loading.

Pattern-based reuse of successful designs: usability ofsafety-critical systems

Users of safety-critical systems are expected to effectively control or monitor complex systems, with errors potentially leading to catastrophe. For such systems, safety is of paramount importance and must be designed into the human-machine interface. While many case studies show how inadequate design practice led to poor safety and usability, concrete guidance on good design practices is scarce. The paper argues that the pattern language paradigm, widely used in the software design community, is a suitable means of documenting appropriate design strategies. We discuss how typical usability-related properties (e.g., flexibility) need some adjustment to be used for assessing safety-critical systems, and document a pattern language, based on corresponding "safety-usability" principles

Fostering professional development through integrating work and formal learning

The Undergraduate Site Learning Program (USLP) is an innovative work-based learning program that addresses the call to develop a broader set ofattributes in engineering graduates. Unlike cooperative education programs, site learning can give students full academic credit for their placement without extending the duration of the degree through the use of an innovative learning alignment model. A cenrralpart ofthis program is a unique course entitled Professional Development in which students articulate and reflect upon the lessons they leom while on placement in industry. Students spend the bulk ofa semester on-site often in remote locations, which requires a flexible approach to course operation and fosters independent learning. Thus the USLP challenges both staff and students and produces outcomes that bofh the alumni and industry value.

Practical assessment of neural network applications

This paper reports the initial results of a joint research project carried out by Aston University and Lloyd's Register to develop a practical method of assessing neural network applications. A set of assessment guidelines for neural network applications were developed and tested on two applications. These case studies showed that it is practical to assess neural networks in a statistical pattern recognition framework. However there is need for more standardisation in neural network technology and a wider takeup of good development practice amongst the neural network community.

Re-engineering construction communication in distance management framework

In an exploding and fluctuating construction market, managers are facing a challenge, which is how to manage business on a wider scale and to utilize modern developments in information technology to promote productivity. The extraordinary development of telecommunications and computer technology makes it possible for people to plan, lead, control, organize and manage projects from a distance without the need to be on site on a daily basis. A modern management known as distance management (DM) or remote management is emerging. Physical distance no longer determines the boundary of management since managers can now operate projects through virtual teams that organize manpower, material and production without face-to-face communication. What organization prototype could overcome psychological and physical barriers to reengineer a successful project through information technology? What criteria distinguishes the adapted way of communication of individual activities in a teamwork and assist the integration of an efficient and effective communication between face-to-face and a physical distance? The entire methodology has been explained through a case application on refuse incineration plant projects in Taiwan.