Reproducibility of peripheral arterial tonometry measurements in male cardiovascular patients

BACKGROUND Assessment of endothelial function of the microvasculature by peripheral arterial tonometry (EndoPAT(®)) has gained increasing popularity in patients with cardiovascular risk factors. Only limited knowledge about its reproducibility in patients with coronary artery disease (CAD) is available. We therefore aimed to quantify reproducibility of EndoPAT(®) parameters in patients with stable CAD. DESIGN EndoPAT(®) measurements were performed repeatedly in 78 male patients (age 66 ± 8 years) with CAD on stable medication. We calculated overall mean, standard deviation (SD), coefficient of variation (CV) and intraclass correlation coefficient (ICC) of the following parameters: reactive hyperemic index (RHI), PAT ratio of the postocclusion period 90-150 s as used for calculation of the RHI (PAT ratio90-150 s) and 90-120 s (PAT ratio90-120 s) as used for the often employed Framingham RHI (F-RHI), as well as PAT ratio of the peak hyperemic response (PAT ratiopeak response). Additionally, least significant changes (LSC) for individual subjects and minimum sample sizes for parallel and cross-over design studies were calculated. RESULTS Mean RHI was 1·84 (SD 0·36). For RHI, PAT ratio90-150 s , PAT ratio90-120 s , and PAT ratiopeak response the CVs were 17·0%, 25·4%, 26·1%, and 25·0%, respectively. The ICCs were 0·45, 0·49, 0·48 and 0·51, respectively, and LSC for RHI was 47·2%. CONCLUSIONS CV of RHI in our population was moderate; however, we consider this precision insufficient to monitor changes in individual patients, as they would need to exceed 47% to show a significant change. Further, the poor ICCs reflect the difficulty of detecting treatment effects in homogenous populations, such as patients with stable CAD.

Neutronic analysis of the bi-spectral moderator such as that proposed for ESS

This paper reports on design studies concerning a moderator concept which aims to maximize the time averaged flux. The idea is to provide neutron spectra showing two clear maxima, with peaks at View the MathML source and View the MathML source arising from leakage from both cryogenic and thermal moderators. Such a concept known as a bi-spectral moderator (Mezei, 2006 [1]) while proven on a reactor source has only been examined for the ESS 2003 proposal. Filges et al. (2003 [2]), which featured a different design than the current ESS. This paper thus reports on a baseline design for such a moderator concept and shows that it can provide substantial gains in count rates for those applications not requiring high resolution in time-of-flight.

Systematic analysis of direct-drive baseline designs for shock ignition with the Laser MégaJoule

We present direct-drive target design studies for the laser mégajoule using two distinct initial aspect ratios (A = 34 and A = 5). Laser pulse shapes are optimized by a random walk method and drive power variations are used to cover a wide variety of implosion velocities between 260 km/s and 365 km/s. For selected implosion velocities and for each initial aspect ratio, scaled-target families are built in order to find self-ignition threshold. High-gain shock ignition is also investigated in the context of Laser MégaJoule for marginally igniting targets below their own self-ignition threshold.

A INFLUÊNCIA DAS PRÁTICAS PEDAGÓGICAS DOCENTES E DAS BARREIRAS DISCENTES SOBRE O DESENVOLVIMENTO DA CRIATIVIDADE DO FUTURO ADMINISTRADOR

As empresas que almejam garantir e melhorar sua posição dentro de em um mercado cada vez mais competitivo precisam estar sempre atualizadas e em constante evolução. Na busca contínua por essa evolução, investem em projetos de Pesquisa & Desenvolvimento (P&D) e em seu capital humano para promover a criatividade e a inovação organizacional. As pessoas têm papel fundamental no desenvolvimento da inovação, mas para que isso possa florescer de forma constante é preciso comprometimento e criatividade para a geração de ideias. Criatividade é pensar o novo; inovação é fazer acontecer. Porém, encontrar pessoas com essas qualidades nem sempre é tarefa fácil e muitas vezes é preciso estimular essas habilidades e características para que se tornem efetivamente criativas. Os cursos de graduação podem ser uma importante ferramenta para trabalhar esses aspectos, características e habilidades, usando métodos e práticas de ensino que auxiliem no desenvolvimento da criatividade, pois o ambiente ensino-aprendizagem pesa significativamente na formação das pessoas. O objetivo deste estudo é de identificar quais fatores têm maior influência sobre o desenvolvimento da criatividade em um curso de graduação em administração, analisando a influência das práticas pedagógicas dos docentes e as barreiras internas dos discentes. O referencial teórico se baseia principalmente nos trabalhos de Alencar, Fleith, Torrance e Wechsler. A pesquisa transversal de abordagem quantitativa teve como público-alvo os alunos do curso de Administração de uma universidade confessional da Grande São Paulo, que responderam 465 questionários compostos de três escalas. Para as práticas docentes foi adaptada a escala de Práticas Docentes em relação à Criatividade. Para as barreiras internas foi adaptada a escala de Barreiras da Criatividade Pessoal. Para a análise da percepção do desenvolvimento da criatividade foi construída e validada uma escala baseada no referencial de características de uma pessoa criativa. As análises estatísticas descritivas e fatoriais exploratórias foram realizadas no software Statistical Package for the Social Sciences (SPSS), enquanto as análises fatoriais confirmatórias e a mensuração da influência das práticas pedagógicas e das barreiras internas sobre a percepção do desenvolvimento da criatividade foram realizadas por modelagem de equação estrutural utilizando o algoritmo Partial Least Squares (PLS), no software Smart PLS 2.0. Os resultados apontaram que as práticas pedagógicas e as barreiras internas dos discentes explicam 40% da percepção de desenvolvimento da criatividade, sendo as práticas pedagógicas que exercem maior influencia. A pesquisa também apontou que o tipo de temática e o período em que o aluno está cursando não têm influência sobre nenhum dos três construtos, somente o professor influencia as práticas pedagógicas.

Investigation of feasibility of utilizing available heat resistant materials for hypersonic leading edge applications.

"Volumes I through VIII are unclassified while volume IX is classified secret."

A INFLUÊNCIA DAS PRÁTICAS PEDAGÓGICAS DOCENTES E DAS BARREIRAS DISCENTES SOBRE O DESENVOLVIMENTO DA CRIATIVIDADE DO FUTURO ADMINISTRADOR

As empresas que almejam garantir e melhorar sua posição dentro de em um mercado cada vez mais competitivo precisam estar sempre atualizadas e em constante evolução. Na busca contínua por essa evolução, investem em projetos de Pesquisa & Desenvolvimento (P&D) e em seu capital humano para promover a criatividade e a inovação organizacional. As pessoas têm papel fundamental no desenvolvimento da inovação, mas para que isso possa florescer de forma constante é preciso comprometimento e criatividade para a geração de ideias. Criatividade é pensar o novo; inovação é fazer acontecer. Porém, encontrar pessoas com essas qualidades nem sempre é tarefa fácil e muitas vezes é preciso estimular essas habilidades e características para que se tornem efetivamente criativas. Os cursos de graduação podem ser uma importante ferramenta para trabalhar esses aspectos, características e habilidades, usando métodos e práticas de ensino que auxiliem no desenvolvimento da criatividade, pois o ambiente ensino-aprendizagem pesa significativamente na formação das pessoas. O objetivo deste estudo é de identificar quais fatores têm maior influência sobre o desenvolvimento da criatividade em um curso de graduação em administração, analisando a influência das práticas pedagógicas dos docentes e as barreiras internas dos discentes. O referencial teórico se baseia principalmente nos trabalhos de Alencar, Fleith, Torrance e Wechsler. A pesquisa transversal de abordagem quantitativa teve como público-alvo os alunos do curso de Administração de uma universidade confessional da Grande São Paulo, que responderam 465 questionários compostos de três escalas. Para as práticas docentes foi adaptada a escala de Práticas Docentes em relação à Criatividade. Para as barreiras internas foi adaptada a escala de Barreiras da Criatividade Pessoal. Para a análise da percepção do desenvolvimento da criatividade foi construída e validada uma escala baseada no referencial de características de uma pessoa criativa. As análises estatísticas descritivas e fatoriais exploratórias foram realizadas no software Statistical Package for the Social Sciences (SPSS), enquanto as análises fatoriais confirmatórias e a mensuração da influência das práticas pedagógicas e das barreiras internas sobre a percepção do desenvolvimento da criatividade foram realizadas por modelagem de equação estrutural utilizando o algoritmo Partial Least Squares (PLS), no software Smart PLS 2.0. Os resultados apontaram que as práticas pedagógicas e as barreiras internas dos discentes explicam 40% da percepção de desenvolvimento da criatividade, sendo as práticas pedagógicas que exercem maior influencia. A pesquisa também apontou que o tipo de temática e o período em que o aluno está cursando não têm influência sobre nenhum dos três construtos, somente o professor influencia as práticas pedagógicas.

ANALISANDO A RELAÇÃO DOS VOLUMES DE EXPORTAÇÃO E DE IMPORTAÇÃO, PIB, TAXAS DE CÂMBIO E INFLAÇÃO NO PERÍODO DE 2004 A 2014. SÃO BERNARDO DO CAMPO 2015

As empresas que almejam garantir e melhorar sua posição dentro de em um mercado cada vez mais competitivo precisam estar sempre atualizadas e em constante evolução. Na busca contínua por essa evolução, investem em projetos de Pesquisa & Desenvolvimento (P&D) e em seu capital humano para promover a criatividade e a inovação organizacional. As pessoas têm papel fundamental no desenvolvimento da inovação, mas para que isso possa florescer de forma constante é preciso comprometimento e criatividade para a geração de ideias. Criatividade é pensar o novo; inovação é fazer acontecer. Porém, encontrar pessoas com essas qualidades nem sempre é tarefa fácil e muitas vezes é preciso estimular essas habilidades e características para que se tornem efetivamente criativas. Os cursos de graduação podem ser uma importante ferramenta para trabalhar esses aspectos, características e habilidades, usando métodos e práticas de ensino que auxiliem no desenvolvimento da criatividade, pois o ambiente ensino-aprendizagem pesa significativamente na formação das pessoas. O objetivo deste estudo é de identificar quais fatores têm maior influência sobre o desenvolvimento da criatividade em um curso de graduação em administração, analisando a influência das práticas pedagógicas dos docentes e as barreiras internas dos discentes. O referencial teórico se baseia principalmente nos trabalhos de Alencar, Fleith, Torrance e Wechsler. A pesquisa transversal de abordagem quantitativa teve como público-alvo os alunos do curso de Administração de uma universidade confessional da Grande São Paulo, que responderam 465 questionários compostos de três escalas. Para as práticas docentes foi adaptada a escala de Práticas Docentes em relação à Criatividade. Para as barreiras internas foi adaptada a escala de Barreiras da Criatividade Pessoal. Para a análise da percepção do desenvolvimento da criatividade foi construída e validada uma escala baseada no referencial de características de uma pessoa criativa. As análises estatísticas descritivas e fatoriais exploratórias foram realizadas no software Statistical Package for the Social Sciences (SPSS), enquanto as análises fatoriais confirmatórias e a mensuração da influência das práticas pedagógicas e das barreiras internas sobre a percepção do desenvolvimento da criatividade foram realizadas por modelagem de equação estrutural utilizando o algoritmo Partial Least Squares (PLS), no software Smart PLS 2.0. Os resultados apontaram que as práticas pedagógicas e as barreiras internas dos discentes explicam 40% da percepção de desenvolvimento da criatividade, sendo as práticas pedagógicas que exercem maior influencia. A pesquisa também apontou que o tipo de temática e o período em que o aluno está cursando não têm influência sobre nenhum dos três construtos, somente o professor influencia as práticas pedagógicas.

Novel formulation strategies for the fabrication of lyophilised orally disintegrating tablets

Orally disintegrating Tablets (ODTs), also known as fast-disintegrating, fast-melt or fast-dissolving tablets, are a relatively novel dosage technology that involves the rapid disintegration or dissolution of the dosage form into a solution or suspension in the mouth without the need for water. The solution containing the active ingredients is swallowed, and the active ingredients are then absorbed through the gastrointestinal epithelium to reach the target and produce the desired effect. Formulation of ODTs was originally developed to address swallowing difficulties of conventional solid oral dosage forms (tablets and capsules) experienced by wide range of patient population, especially children and elderly. The current work investigates the formulation and development of ODTs prepared by freeze drying. Initial studies focused on formulation parameters that influence the manufacturing process and performance of lyophilised tablets based on excipients used in commercial products (gelatin and saccharides). The second phase of the work was followed up by comprehensive studies to address the essential need to create saccharide free ODTs using naturally accruing amino acids individually or in combinations. Furthermore, a factorial design study was carried out to investigate the feasibility of delivering multiparticulate systems of challenging drugs using a novel formulation that exploited the electrostatic associative interaction between gelatin and carrageenan. Finally, studies aimed to replace gelatin with ethically and morally accepted components to the end users were performed and the selected binder was used in factorial design studies to investigate and optimise ODT formulations that incorporated drugs with varies physicochemical properties. Our results show that formulation of elegant lyophilised ODTs with instant disintegration and adequate mechanical strength requires carful optimisation of gelatin concentration and bloom strength in addition to saccharide type and concentration. Successful formulation of saccharides free lyophilised ODTs requires amino acids that crystallise in the frozen state or display relatively high Tg', interact and integrate completely with the binder and, also, display short wetting time with the disintegrating medium. The use of an optimised mixture of gelatin, carrageenan and alanine was able to create viscous solutions to suspend multiparticulate systems and at the same time provide tablets with short disintegration times and adequate mechanical properties. On the other hand, gum arabic showed an outstanding potential for use as a binder in the formulation of lyophilised ODTs. Compared to gelatin formulations, the use of gum arabic simplified the formulation stages, shortened the freeze drying cycles and produced tablets with superior performance in terms of the disintegration time and mechanical strength. Furthermore, formulation of lyophilised ODTs based on gum arabic showed capability to deliver diverse range of drugs with advantages over commercial products.

Developing a process to create and validate an instrument assessing student attainment of competencies at an intercultural university in Mexico

This study took place at one of the intercultural universities (IUs) of Mexico that serve primarily indigenous students. The IUs are pioneers in higher education despite their numerous challenges (Bertely, 1998; Dietz, 2008; Pineda & Landorf, 2010; Schmelkes, 2009). To overcome educational inequalities among their students (Ahuja, Berumen, Casillas, Crispín, Delgado et al., 2004; Schmelkes, 2009), the IUs have embraced performance-based assessment (PBA; Casillas & Santini, 2006). PBA allows a shared model of power and control related to learning and evaluation (Anderson, 1998). While conducting a review on PBA strategies of the IUs, the researcher did not find a PBA instrument with valid and reliable estimates. The purpose of this study was to develop a process to create a PBA instrument, an analytic general rubric, with acceptable validity and reliability estimates to assess students' attainment of competencies in one of the IU's majors, Intercultural Development Management. The Human Capabilities Approach (HCA) was the theoretical framework and a sequential mixed method (Creswell, 2003; Teddlie & Tashakkori, 2009) was the research design. IU participants created a rubric during two focus groups, and seven Spanish-speaking professors in Mexico and the US piloted using students' research projects. The evidence that demonstrates the attainment of competencies at the IU is a complex set of actual, potential and/or desired performances or achievements, also conceptualized as "functional capabilities" (FCs; Walker, 2008), that can be used to develop a rubric. Results indicate that the rubric's validity and reliability estimates reached acceptable estimates of 80% agreement, surpassing minimum requirements (Newman, Newman, & Newman, 2011). Implications for practice involve the use of PBA within a formative assessment framework, and dynamic inclusion of constituencies. Recommendations for further research include introducing this study's instrument-development process to other IUs, conducting parallel mixed design studies exploring the intersection between HCA and assessment, and conducting a case study exploring assessment in intercultural settings. Education articulated through the HCA empowers students (Unterhalter & Brighouse, 2007; Walker, 2008). This study aimed to contribute to the quality of student learning assessment at the IUs by providing a participatory process to develop a PBA instrument.

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

Obstetric mode of delivery and child psychological development

Background/aims: Objective of the current thesis is to investigate the potential impact of birth by Caesarean section (CS) on child psychological development, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), behavioural difficulties and school performance. Structure/methods: Published literature to date on birth by CS, ASD and ADHD was reviewed (Chapter 2). Data from the UK Millennium Cohort Study (MCS) were analysed to determine the association between CS and ASD, ADHD and parent-reported behavioural difficulties (Chapter 3). The Swedish National Registers were used to further assess the association with ASD, ADHD and school performance (Chapters 4-6). Results: In the review, children born by CS were 23% more likely to be diagnosed with ASD after controlling for potential confounders. Only two studies reported adjusted estimates on the association between birth by CS and ADHD, results were conflicting and limited. CS was not associated with ASD, ADHD or behavioural difficulties in the UK MCS. In the Swedish National Registers, children born by CS were more likely to be diagnosed with ASD or ADHD. The association with elective CS did not persist when compared amongst siblings. There was little evidence of an association between birth by elective CS and poor school performance. Children born by elective CS had slight reduction in school performance. Conclusions: The lack of association with the elective CS in the sibling design studies indicates that the association in the population is most probably due to confounding. A small but significant association was found between birth by CS and school performance. However, the effect may have been due to residual confounding or confounding by indication and should be interpreted with caution. The overall conclusion is that birth by CS does not appear to have a causal relationship with the aspects of child psychological development investigated.

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

Designing Out Medical Error, WCDH Boston 2011

This talk is about using research and design to reduce medical errors. It doesn’t matter whether you deliver healthcare in the old-fashioned pathogenic way, or salutogenically, it all falls apart if systems and protocols let the patient down, and harm them.

The Ingenuity of Ageing

What can a remarkable community of 6,000 retired academics living on the campus of Tsinghua University, Beijing, tell us about strategies for ‘ageing well’ in societies around the world? The Ingenuity of Ageing tells the story of an experimental piece of design research carried out by Dr Yanki Lee, a research fellow in the Helen Hamlyn Centre for Design at the Royal College of Art, who spent a year in China investigating new approaches to design for ageing. Supported by a UK-China Fellowship of Excellence funded by the Department of Business, Innovation and Skills (BIS), Dr Yanki Lee’s post-Doctoral study combines the techniques of reflexive ethnography and action research in order to challenge conventional thinking about the designer as expert and propose an alternative, participatory model of social interaction and innovation through which the ingenuity of older people can be revealed.