Empirically-Based Warehouse Design: Can Academics Accept Such an Approach?

It is our opinion that existing research is not sufficient to support the design of a warehouse. As a result, facility designers that work in practice are left to face the design process with their own methods. These methods are in stark contrast to the analytical models developed in academia in that they are highly based on empirical observations. Supported by a collection of empirical observations, facility designers who work in practice employ an ad hoc design process. We present a design process based on empirical observations and then formalize it so that it can be taught and used. We illustrate the process with an example and discuss ways in which analytical methods can be used to supplement the process and improve the design. We conclude by describing additional work that is required if the design process is to be realized

The state of professional practice and policy in the English further education system: a view from below

This paper addresses a recurring theme regarding the UK’s Vocational Education and Training (VET) policy in which Further Education (FE) and training are primarily driven by employer demand. It explores the tensions associated with this process on the everyday working practices of FE practitioners and institutions and its impact on FE’s contribution to the wider processes of social and economic inclusion. At a time when Ofsted and employer-led organisations have cast doubt on the contribution of FE, we explore pedagogies of practice that are often unacknowledged by the current audit demands of officialdom. We argue that such practice provides a more enlightened view of the sector and the challenges it faces in addressing wider issues of social justice, employability and civic regeneration. At the same time, the irony of introducing laissez-faire initiatives designed to remove statutory qualifications for FE teachers ignores the progress made over the past decade in raising the professional profile and status of teachers and trainers in the sector. In addressing such issues, the paper explores the limits and possibilities of constructing professional and vocational knowledge from networks and communities of practice, schools, universities, business, employers and local authorities, in which FE already operates

Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting

High-sensitivity cardiac troponin T (hs-cTnT) and the ESC 0/1h-hs-cTnT-algorithm have worse performance in the early diagnosis of myocardial infarction (MI) in patients with prior coronary artery bypass grafting (CABG). It is unknown, whether this concern applies also to hs-cTnI, the most widely used analyte worldwide.; In an international multicenter diagnostic study, two cardiologists centrally adjudicated the final diagnosis in patients presenting to the emergency department with symptoms suggestive of MI according to the Third Universal Definition of MI. The objective was to compare the diagnostic accuracy of hs-cTnI assays and their performance within the ESC hs-cTnI 0/1h-algorithms in patients with versus without prior CABG. Findings were externally validated in an U.S. multicenter diagnostic study.; A total of 392/5'200 patients (8%) had prior coronary artery bypass grafting (CABG). Diagnostic accuracy of hs-cTnI as quantified by the area under the receiver-operating characteristics-curve (AUC) in these patients was high, but lower versus patients without prior CABG (e.g. hs-cTnI-Architect 0.91 versus 0.95; p = 0.016). Sensitivity/specificity of rule-out/in by the European Society of Cardiology (ESC) 0/1h-hs-cTnI-algorithms remained very high [e.g. hs-cTnI-Architect 100% and 93.5%], but efficacy was lower (52% versus 74%, p < 0.01). External validation (n = 2113) confirmed these findings in 192 patients with prior CABG using hs-cTnI-Atellica, with 52% versus 36% (p < 0.001) remaining in the observe zone.; Diagnostic accuracy of hs-cTnI and efficacy of the ESC 0/1h-hs-cTnI-algorithms are lower in patients with prior CABG, but sensitivity/specificity remain very high.; https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587

Protocol for Improving Care by FAster risk-STratification through use of high sensitivity point-of-care troponin in patients presenting with possible acute coronary syndrome in the EmeRgency department (ICare-FASTER):a stepped-wedge cluster randomised quality improvement initiative

Introduction Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1–2 hours. New generation, high-sensitivity, point-of-care cardiac troponin I (POC-cTnI) assays use whole blood on a bedside (or near bedside) analyser that provides a rapid (8 min) result. This may expedite clinical decision-making and reduce length of stay. Our purpose is to determine if utilisation of a POC-cTnI testing reduces ED length of stay. We also aim to establish an optimised implementation process for the amended clinical pathway.Methods and analysis This quality improvement initiative has a pragmatic multihospital stepped-wedge cross-sectional cluster randomised design. Consecutive patients presenting to the ED with symptoms suggestive of possible AMI and having a cTn test will be included. Clusters (comprising one or two hospitals each) will change from their usual-care pathway to an amended pathway using POC-cTnI—the ‘intervention’. The dates of change will be randomised. Changes occur at 1 month intervals, with a minimum 2 month ‘run-in’ period. The intervention pathway will use a POC-cTnI measurement as an alternate to the laboratory-based cTn measurement. Clinical decision-making steps and logic will otherwise remain unchanged. The POC-cTnI is the Siemens (Erlangen Germany) Atellica VTLi high-sensitivity cTnI assay. The primary outcome is ED length of stay. The safety outcome is cardiac death or AMI within 30 days for patients discharged directly from the ED.Ethics and dissemination Ethics approval has been granted by the New Zealand Southern Health and Disability Ethics Committee, reference 21/STH/9. Results will be published in a peer-reviewed journal. Lay and academic presentations will be made. Māori-specific results will be disseminated to Māori stakeholders.Trial registration number ACTRN12619001189112

Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction

Background: The observed incidence of type 2 myocardial infarction (T2MI) is expected to increase with the implementation of increasingly sensitive cardiac troponin (cTn) assays. However, it remains to be determined how to diagnose, risk stratify and treat patients with T2MI. We aimed to discriminate and risk-stratify T2MI using biomarkers. Methods: Patients presenting to the Emergency Department with chest pain, enrolled in the CHOPIN study, were retrospectively analyzed. Two cardiologists adjudicated type 1 MI (T1MI) and T2MI. The prognostic ability of several biomarkers alone or in combination to discriminate T2MI from T1MI was investigated using receiver operating characteristic (ROC) curve analysis. The biomarkers analyzed were cTnI, copeptin, mid-regional pro-atrial natriuretic peptide (MRproANP), C-terminal pro-endothelin-1 (CT-proET1), mid-regional pro-adrenomedullin (MRproADM) and procalcitonin. Prognostic utility of these biomarkers for all-cause mortality and major adverse cardiovascular event (MACE: a composite of acute MI, unstable angina pectoris, reinfarction, heart failure, and stroke) at 180-day follow-up was also investigated. Results: Among the 2071 patients, T1MI and T2MI were adjudicated in 94 and 176 patients, respectively. Patients with T1MI had higher levels of baseline cTnI, while those with T2MI had higher baseline levels of MR-proANP, CT-proET1, MR-proADM, and procalcitonin. The area under the ROC curve (AUC) for the diagnosis of T2MI was higher for CT-proET1, MRproADM and MR-proANP (0.765, 0.750, and 0.733, respectively) than for cTnI (0.631). Combining all biomarkers resulted in a similar accuracy to a model using clinical variables and cTnI (0.854 versus 0.884, p = 0.294). Addition of biomarkers to the clinical model yielded the highest AUC (0.917). Other biomarkers, but not cTnI, were associated with mortality and MACE at 180-day among all patients, with no interaction between the diagnosis of T1MI or T2MI. Conclusions: Assessment of biomarkers reflecting pathophysiologic processes occurring with T2MI might help differentiate it from T1MI. Additionally, all biomarkers measured, except cTnI, were significant predictors of prognosis, regardless of type of MI

why do romanian universities fail to internalize quality assurance

Despite legal provisions in place since 2005, Romanian universities are considered to perform internal quality assurance only at a formal level, on paper, and usually in anticipation of external evaluations demanded by the government or other official institutions. This paper posits five hypotheses to explain this situation. We analyze 187 interviews with people in universities in order to evaluate these hypotheses. Only two hypotheses are confirmed by the data, allowing us to construct a narrative of policy failure. First, there are top-down failures resulting from unclear and inconsistent legal provisions that focus on multilayered evaluation procedures. Second, there are bottom-up failures related to the lack of ownership over internal quality assurance systems by the actors in the universities. The existing procedures are often seen as control-tools of government, and understood as disconnected from the universities' own goals and problems. Consequently, people on the ground passively try to subvert these tools by carrying them out in a ritualistic manner—which is why quality assurance cannot become internalized

Use of electromyography to detect muscle exhaustion in finishing barrows fed ractopamine HCl

Citation: Noel, J. A., Broxterman, R. M., McCoy, G. M., Craig, J. C., Phelps, K. J., Burnett, D. D., . . . Gonzalez, J. M. (2016). Use of electromyography to detect muscle exhaustion in finishing barrows fed ractopamine HCl. Journal of Animal Science, 94(6), 2344-2356. doi:10.2527/jas2016-0398The objectives of this study were to determine the effects of dietary ractopamine HCl (RAC) on muscle fiber characteristics and electromyography (EMG) measures of finishing barrow exhaustion when barrows were subjected to increased levels of activity. Barrows (n = 34; 92 +/- 2 kg initial BW) were assigned to 1 of 2 treatments: a conventional swine finishing diet containing 0 mg/kg ractopamine HCl (CON) or a diet formulated to meet the requirements of finishing barrows fed 10 mg/kg RAC (RAC+). After 32 d on feed, barrows were individually moved around a track at 0.79 m/s until subjectively exhausted. Wireless EMG sensors were affixed to the deltoideus (DT), triceps brachii lateral head (TLH), tensor fasciae latae (TFL), and semitendinosus (ST) muscles to measure median power frequency (MdPF) and root mean square (RMS) as indicators of action potential conduction velocity and muscle fiber recruitment, respectively. After harvest, samples of each muscle were collected for fiber type, succinate dehydrogenase (SDH), and capillary density analysis. Speed was not different (P = 0.82) between treatments, but RAC+ barrows reached subjective exhaustion earlier and covered less distance than CON barrows (P 0.29). There was a treatment x muscle interaction (P = 0.04) for end-point RMS values. The RAC diet did not change end-point RMS values in the DT or TLH (P > 0.37); however, the diet tended to decrease and increase end-point RMS in the ST and TFL, respectively (P 0.10). Muscles of RAC+ barrows tended to have less type I fibers and more capillaries per fiber (P < 0.07). Type I and IIA fibers of RAC+ barrows were larger (P < 0.07). Compared with all other muscles, the ST had more (P < 0.01) type IIB fibers and larger type I, IIA, and IIX fibers (P < 0.01). Type I, IIA, and IIX fibers of the ST also contained less SDH compared with the other muscles (P < 0.01). Barrows fed a RAC diet had increased time to subjective exhaustion due to loss of active muscle fibers in the ST, possibly due to fibers being larger and less oxidative in metabolism. Size increases in type I and IIA fibers with no change in oxidative capacity could also contribute to early exhaustion of RAC+ barrows. Overall, EMG technology can measure real-time muscle fiber loss to help explain subjective exhaustion in barrows

The uses and abuses of power: teaching school leadership through children's literature

There are relatively few studies of how representations of teachers, schools and educational administrators in popular films and television might be, and are, used in leadership preparation. This paper seeks to add to this small body of work; it reports on an exploratory study of the representation of headteachers in contemporary children's fiction. Thirty-one texts are analysed to ascertain key themes and the major characterisations. The paper draws on children's literature scholars to argue that both the historical school story and its contemporary counterpart focus heavily on the power of the head to control the micro-world of the school. Because these fictional accounts deal with issues of power and justice more openly than many mainstream educational administration texts, this makes them particularly useful in the preparation of potential school leaders