Comparison of ASAS improvement criteria for ankylosing spondylitis with clinically relevant improvement according to an expert panel

Objective: To investigate whether the recently developed (statistically derived) "ASsessment in Ankylosing Spondylitis Working Group" improvement criteria (ASAS-IC) for ankylosing spondylitis (AS) reflect clinically relevant improvement according to the opinion of an expert panel. Methods: The ASAS-IC consist of four domains: physical function, spinal pain, patient global assessment, and inflammation. Scores on these four domains of 55 patients with AS, who had participated in a non-steroidal anti-inflammatory drug efficacy trial, were presented to an international expert panel (consisting of patients with AS and members of the ASAS Working Group) in a three round Delphi exercise. The number of (non-) responders according to the ASAS-IC was compared with the final-consensus of the experts. The most important domains in the opinion of the experts were identified, and also selected with discriminant analysis. A number of provisional criteria sets that best represented the consensus of the experts were defined. Using other datasets, these clinically derived criteria sets as well as the statistically derived ASAS-IC were then tested for discriminative properties and for agreement with the end of trial efficacy by patient and doctor. Results: Forty experts completed the three Delphi rounds. The experts considered twice as many patients to be responders than the ASAS-IC (42 v 21). Overall agreement between experts and ASAS-IC was 62%. Spinal pain was considered the most important domain by most experts and was also selected as such by discriminant analysis. Provisional criteria sets with an agreement of greater than or equal to 80% compared with the consensus of the experts showed high placebo response rates (27-42%), in contrast with the ASAS-IC with a predefined placebo response rate of 25%. All criteria sets and the ASAS-IC discriminated well between active and placebo treatment (chi(2) = 36-45; p < 0.001). Compared with the end of trial efficacy assessment, the provisional criteria sets showed an agreement of 71-82%, sensitivity of 67-83%, and specificity of 81-88%. The ASAS-IC showed an agreement of 70%, sensitivity of 62%, and specificity of 89%. Conclusion: The ASAS-IC are strict in defining response, are highly specific, and consequently show lower sensitivity than the clinically derived criteria sets. However, those patients who are considered as responders by applying the ASAS-IC are acknowledged as such by the expert panel as well as by. patients' and doctors' judgments, and are therefore likely to be true responders.

Integrating group Delphi, fuzzy logic and expert systems for marketing strategy development:the hybridisation and its effectiveness

A hybrid approach for integrating group Delphi, fuzzy logic and expert systems for developing marketing strategies is proposed in this paper. Within this approach, the group Delphi method is employed to help groups of managers undertake SWOT analysis. Fuzzy logic is applied to fuzzify the results of SWOT analysis. Expert systems are utilised to formulate marketing strategies based upon the fuzzified strategic inputs. In addition, guidelines are also provided to help users link the hybrid approach with managerial judgement and intuition. The effectiveness of the hybrid approach has been validated with MBA and MA marketing students. It is concluded that the hybrid approach is more effective in terms of decision confidence, group consensus, helping to understand strategic factors, helping strategic thinking, and coupling analysis with judgement, etc.

Identifying criteria for the assessment of pharmacy students' communication skills with patients

Objectives To identify criteria by which patients can assess the communication skills of pharmacy students. Method Potential assessment criteria were generated from 2 main sources: a literature review and a focus group discussion. A modified two-round Delphi survey was subsequently conducted with 35 professionals who were actively involved in teaching and assessing communication skills of pharmacy students to determine the importance and reliability of each criterion. Results Consensus ratings identified 7 criteria that were important measures of pharmacy students' communication skills and could be reliably assessed by patients. Conclusions A modified two-round Delphi consultation survey successfully identified criteria that can be used by patients to assess the communication skills of pharmacy undergraduates. Future work will examine the feasibility of using patients as assessors of communication skills of pharmacy students, preregistration pharmacists, and qualified pharmacists.

Analysis of organisational climate to improve the adequacy of primary health care in the State of Kuwait

This study covers two areas of contribution to the knowledge, firstly it tried to investigate rigourously the relationships of a number of factors believed that they may affect the climate perception, classified into three types to arrive to prove a hypothesis of the important role that qualification and personal factors play in shaping the climate perception, this is in contrast with situational factors. Secondly, the study tries to recluster the items of a wide-range applied scale for the measurement of climate named HAY in order to overcome the cross-cultural differences between the Kuwaiti and the American society, and to achieve a modified dimensions of climate for a civil service organisation in Kuwait. Furthermore, the study attempts to carry out a diagnostic test for the climate of the Ministry of Public Health in Kuwait, aiming to diagnose the perceived characteristics of the MoPH organisation, and suggests a number of areas to be given attention if an improvement is to be introduced. The study used extensively the statistical and the computer facilities to make the analysis more representing the field data, on the other hand this study is characterised by the very highly responsive rate of the main survey which would affect the findings reliability. Three main field studies are included, the first one was to conduct the main questionnaire where the second was to measure the "should be" climate by the experts of MoPH using the DELPHI technique, and the third was to conduct an extensive meeting with the very top management team in MoPH. Results of the first stage were subject to CLUSTER analysis for the reconstruction of the HAY tool, whereas comparative analysis was carried on between the results of the second and third stages on one side, the first from the other.

The influence of marketing factors and substance characteristics on pharmaceutical sales in a state-controlled prescriptions pharmaceuticals market

The present dissertation investigates the influence of brand as well as substance-related marketing attributes on prescription pharmaceutical sales within a state-controlled market. For this purpose, a systematic literature review was conducted in the first instance, during which knowledge about the most relevant research within this field was gathered. Consequently, over 538 publications were reviewed and indicated as being potentially relevant, leading to an eventual count of 98 core publications. However, most of these studies had been conducted in the mainly unrestricted US market. These findings were then summarised and statistically evaluated. In a second step, based on the literature review, a qualitative study, containing focus and Delphi groups, was then performed. The participants in these studies were involved in pharmaceutical marketing within a state-controlled prescriptions pharmaceuticals market. Consequently, the findings were slightly different to those derived by the systematic literature review. Based on this second step, seven hypotheses were proposed. In the third step, these hypotheses were tested, using collected data and a secondary market dataset provided by a market research institute. A statistical analysis was then performed, applying descriptive as well as multiple regression analytical methods. The evaluation of the results resulted in a conceptual model of physician targeting, leading to several theoretical, methodological and managerial implications.

Apollo 13 Risk Assessment Revisited

Fault tree methodology is the most widespread risk assessment tool by which one is able to predict - in principle - the outcome of an event whenever it is reduced to simpler ones by the logic operations conjunction and disjunction according to the basics of Boolean algebra. The object of this work is to present an algorithm by which, using the corresponding computer code, one is able to predict - in practice - the outcome of an event whenever its fault tree is given in the usual form.

Localized surface plasmon fiber device coated with carbon nanotubes for the specific detection of CO2

We explored the potential of a carbon nanotube (CNT) coating working in conjunction with a recently developed localized surface plasmon (LSP) device (based upon a nanostructured thin film consisting of of nano-wires of platinum) with ultra-high sensitivity to changes in the surrounding index. The uncoated LSP sensor’s transmission resonances exhibited a refractive index sensitivity of Δλ/Δn ~ -6200nm/RIU and ΔΙ/Δn ~5900dB/RIU, which is the highest reported spectral sensitivity of a fiber optic sensor to bulk index changes within the gas regime. The complete device provides the first demonstration of the chemically specific gas sensing capabilities of CNTs utilizing their optical characteristics. This is proven by investigating the spectral response of the sensor before and after the adhesion of CNTs to alkane gases along with carbon dioxide. The device shows a distinctive spectral response in the presence of gaseous CO2 over and above what is expected from general changes in the bulk refractive index. This fiber device yielded a limit of detection of 150ppm for CO2 at a pressure of one atmosphere. Additionally the adhered CNTs actually reduce sensitivity of the device to changes in bulk refractive index of the surrounding medium. The polarization properties of the LSP sensor resonances are also investigated and it is shown that there is a reduction in the overall azimuthal polarization after the CNTs are applied. These optical devices offer a way of exploiting optically the chemical selectivity of carbon nanotubes, thus providing the potential for real-world applications in gas sensing in many inflammable and explosive environments. © (2015) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

Strategic Human Resources Management Performance Metrics for Unit-Level Managers: An Exploratory Study of U.S Casual Restaurants

Many restaurant organizations have committed a substantial amount of effort to studying the relationship between a firm’s performance and its effort to develop an effective human resources management reward-and-retention system. These studies have produced various metrics for determining the efficacy of restaurant management and human resources management systems. This paper explores the best metrics to use when calculating the overall unit performance of casual restaurant managers. These metrics were identified through an exploratory qualitative case study method that included interviews with executives and a Delphi study. Experts proposed several diverse metrics for measuring management value and performance. These factors seem to represent all stakeholders’interest.

Does U.S counter-drug policy affect nationalism in the Anglophone Caribbean? A comparative study on the impact of counter-drug policy on nationalism in Jamaica and Trinidad and Tobago

This dissertation examined the effect of United States counter-drug policy on nationalism in small states, focusing on Jamaica and Trinidad and Tobago. The states were selected for their roles and geostrategic importance in the illegal drug trade; Jamaica being the largest drug producing country in the Anglophone Caribbean and having strong links to the trade of Colombian cocaine, and Trinidad being a mere seven miles from the South American coast. Since U.S. counterdrug policies have frequently been viewed in the region as imperialistic, this dovetails into ideas on the perceptions of smallness and powerlessness of Caribbean nations. Hence, U.S. drug policies affect every vulnerability faced by the Caribbean, individually and collectively. Thus, U.S. drug policy was deemed the most appropriate independent variable, with nationalism as the dependent variable. In both countries four Focus Groups and one Delphi Study were conducted resulting in a total of 60 participants. Focus Group participants, recruited from the general population, were asked about their perception of the illegal drug trade in the country and the policies their government had created. They were also asked their perception on how deeply involved the U.S. was in the creation of these policies and their opinions on whether this involvement was positive or negative. The Delphi Study participants were experts in the field of local drug policies and also gave their interpretations of the role the U.S. played in local policy creation. Coupled with this data, content analysis was conducted on various newspaper articles, press releases, and speeches made regarding the topic. In comparing both countries, it was found that there is a disconnect between government actions and the knowledge and perceptions of the general public. In Trinidad and Tobago this disconnect was more apparent given the lack of awareness of local drug policies and the utter lack of faith in government solutions. The emerging conclusion was that the impact of U.S. drug policy on nationalism was more visible in Trinidad and Tobago where there was a weaker civil society-government relationship, while the impact on nationalism was more obscure in Jamaica, which had a stronger civil-society government relationship.

The Christology of Jesus' Disciples

The question of whether Jesus claimed to be the Messiah, and if so in what sense, is one of the most important in historical Jesus research. Although many factors play a role in answering this question, one has been neglected for far too long: the Christology of Jesus’ disciples. This thesis provides a much needed analysis of the disciples’ view of Jesus. Numerous Gospel passages are evaluated using criteria, such as the criterion of multiple independent attestation and the criterion of embarrassment, to determine their historicity. These passages are then studied against the background of Second Temple Judaism to determine how the disciples viewed Jesus. The analysis demonstrates that from the time Jesus’ disciples first began following him they believed he was the Messiah. Ultimately, this conclusion strongly reinforces the view that Jesus made a messianic claim for himself.

Temple Beth Elohim

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Plato's Cretan Colony: Theology and Religion in the Political Philosophy of the Laws

The Laws is generally regarded as Plato’s attempt to engage with the practical realities of political life, as opposed to the more idealistic, or utopian, vision of the Republic. Yet modern scholars have often felt disquieted at the central role of religion in the Laws’ second-best city and regime. There are essentially the two dominant interpretations on offer today: either religion supports a repressive theocracy, which controls every aspect of the citizens’ lives to such an extent that even philosophy itself is discouraged, or religion is an example of the kind of noble lie, which the philosopher must deceive the citizens into believing—viz., that a god, not a man, is the author of the regime’s laws. I argue that neither of these interpretations do justice to the dialogue’s intricately dramatic structure, and therefore to Plato’s treatment of civil religion. What I propose is a third position in which Plato both takes seriously the social and political utility of religion, and views theology as a legitimate, and even necessary, subject of philosophical inquiry without going so far as to advocate theocracy as the second best form of regime.

I conclude that a proper focus on the dialogue form, combined with a careful historical analysis of Plato’s use of social and political institutions, reveals an innovative yet traditional form of civil religion, purified of the harmful influence of the poets, based on the authority of the oracle at Delphi, and grounded on a philosophical conception of god as the eternal source of order, wisdom, and all that is good. Through a union of traditional Delphic theology and Platonic natural theology, Plato gives the city of the Laws a common cult acceptable to philosopher and non-philosopher alike, and thus, not only bridges the gap between religion and philosophy, but also creates a sense of community, political identity, and social harmony—the prerequisites for political order and stability. The political theology of the Laws, therefore, provides a rational defense of the rule of law (νόμος) re-conceived as the application of divine Reason (νοῦς) to human affairs.

Beyond the Convent Walls: The Local and Japan-wide Activities of Daihongan’s Nuns in the Early Modern Period (c. 1550–1868)

This dissertation examines the social and financial activities of Buddhist nuns to demonstrate how and why they deployed Buddhist doctrines, rituals, legends, and material culture to interact with society outside the convent. By examining the activities of the nuns of the Daihongan convent (one of the two administrative heads of the popular pilgrimage temple, Zenkōji) in Japan’s early modern period (roughly 1550 to 1868) as documented in the convent’s rich archival sources, I shed further light on the oft-overlooked political and financial activities of nuns, illustrate how Buddhist institutions interacted with the laity, provide further nuance to the discussion of how Buddhist women navigated patriarchal sectarian and secular hierarchies, and, within the field of Japanese history, give voice to women who were active outside of the household unit around which early modern Japanese society was organized.

Zenkōji temple, surrounded by the mountains of Nagano, has been one of Japan’s most popular pilgrimage sites since the medieval period. The abbesses of Daihongan, one Zenkōji’s main sub-temples, traveled widely to maintain connections with elite and common laypeople, participated in frequent country-wide displays of Zenkōji’s icon, and oversaw the creation of branch temples in Edo (now Tokyo), Osaka, Echigo (now Niigata), and Shinano (now Nagano). The abbesses of Daihongan were one of only a few women to hold the imperially sanctioned title of eminent person (shōnin 上人) and to wear purple robes. While this means that this Pure Land convent was in some ways not representative of all convents in early modern Japan, Daihongan’s position is particularly instructive because the existence of nuns and monks in a single temple complex allows us to see in detail how monastics of both genders interacted in close quarters.

This work draws heavily from the convent’s archival materials, which I used as a guide in framing my dissertation chapters. In the Introduction I discuss previous works on women in Buddhism. In Chapter 1, I briefly discuss the convent’s history and its place within the Zenkōji temple complex. In Chapter 2, I examine the convent’s regular economic bases and its expenditures. In Chapter 3, I highlight Daihongan’s branch temples and discuss the ways that they acted as nodes in a network connecting people in various areas to Daihongan and Zenkōji, thus demonstrating how a rural religious center extended its sphere of influence in urban settings. In Chapter 4, I discuss the nuns’ travels throughout the country to generate new and maintain old connections with the imperial court in Kyoto, confraternities in Osaka, influential women in the shogun’s castle, and commoners in Edo. In Chapter 5, I examine the convent’s reliance upon irregular means of income such as patronage, temple lotteries, loans, and displays of treasures, and how these were needed to balance irregular expenditures such as travel and the maintenance or reconstruction of temple buildings. Throughout the dissertation I describe Daihongan’s inner social structure comprised of abbesses, nuns, and administrators, and its local emplacement within Zenkōji and Zenkōji’s temple lands.

Exploring these themes sheds light on the lives of Japanese Buddhist nuns in this period. While the tensions between freedom and agency on the one hand and obligations to patrons, subordination to monks, or gender- and status-based restrictions on the other are important, and I discuss them in my work, my primary focus is on the nuns’ activities and lives. Doing so demonstrates that nuns were central figures in ever-changing economic and social networks as they made and maintained connections with the outside world through Buddhist practices and through precedents set centuries before. This research contributes to our understanding of nuns in Japan’s early modern period and will participate in and shape debates on the roles of women in patriarchal religious hierarchies.

Dedication and Display of Portrait Statues in Hellenistic Greece: Spatial Practices and Identity Politics

This dissertation models a new approach to the study of ancient portrait statues—one that situates them in their historical, political, and spatial contexts. By bringing into conversation bodies of evidence that have traditionally been studied in discrete categories, I investigate how statue landscapes articulated and reinforced a complex set of political and social identities, how space was utilized and manipulated on a local and a regional level, and how patrons responded to the spatial pressures and visual politics of statue dedication within a constantly changing landscape.

Instead of treating sites independently, I have found it to be more productive—and, indeed, necessary—to examine broader patterns of statue dedication. I demonstrate that a regional perspective, that is, one that takes into account the role of choice and spatial preference in setting up a statue within a regional network of available display locations, can illuminate how space shaped the ancient practice of portrait dedication. This level of analysis is a new approach to the study of portrait statues and it has proved to be a productive way of thinking about how statues and context were used together to articulate identity. Understanding how individual monuments worked within these broader landscapes of portrait dedications, how statue monuments functioned within federal systems, and how monuments set up by individuals and social groups operated along side those set up by political bodies clarifies the important place of honorific statues as an expression of power and identity within the history of the site, the region, and Hellenistic Greece.

ThreeDimensional Epigraphic Recording at Stobi (Former Yugoslav Republic of Macedonia): Creating a Virtual Lapidarium

There is an increased need for 3D recording of archaeological sites and digital preservation of their artifacts. Digital photogrammetry with prosumer DSLR cameras is a suitable tool for recording epigraphy in particular, as it allows for the recording of inscribed surfaces with very high accuracy, often better than 2 mm and with only a short time spent in the field. When photogrammetry is fused with other computational photography techniques like panoramic tours and Reflectance Transformation Imaging, a workflow exists to rival traditional LiDAR­based methods. The difficulty however, arises in the presentation of 3D data. It requires an enormous amount of storage and end­user sophistication. The proposed solution is to use game­engine technology and high definition virtual tours to provide not only scholars, but also the general public with an uncomplicated interface to interact with the detailed 3D epigraphic data. The site of Stobi, located near Gradsko, in the Former Yugoslav Republic of Macedonia (FYROM) was used as a case study to demonstrate the effectiveness of RTI, photogrammetry and virtual tour imaging working in combination. A selection of nine sets of inscriptions from the archaeological site were chosen to demonstrate the range of application for the techniques. The chosen marble, sandstone and breccia inscriptions are representative of the varying levels of deterioration and degradation of the epigraphy at Stobi, in which both their rates of decay and resulting legibility is varied. This selection includes those which are treated and untreated stones as well as those in situ and those in storage. The selection consists of both Latin and Greek inscriptions with content ranging from temple dedication inscriptions to statue dedications. This combination of 3D modeling techniques presents a cost and time efficient solution to both increase the legibility of severely damaged stones and to digitally preserve the current state of the inscriptions.